| | | | By Chelsea Cirruzzo and Ben Leonard | Presented by the Coalition to Strengthen America’s Healthcare | | | | Stanford University physician Jay Bhattacharya — President-elect Donald Trump's choice to lead the NIH — has criticized Covid-19 lockdowns and health agency leadership. | Francis Chung/POLITICO | THEN AND NOW — Covid contrarians top the roster for President-elect Donald Trump’s health agency nominees, Chelsea, Ben and POLITICO’s Erin Schumaker and Juan Perez Jr. report. That includes his choice for NIH director, Jay Bhattacharya, a Stanford University physician and economist who criticized lockdowns, school closures and health agency leadership during the pandemic, and Marty Makary, a Johns Hopkins surgeon critical of the Biden administration’s Covid-19 response and is Trump’s pick to lead the FDA. Why it matters: Trump’s selections speak to a growing sentiment among many Americans that health officials got some of the pandemic response wrong — particularly on school closures and lockdowns. Here’s how experts view some of the claims Bhattacharya and Makary made during the pandemic, given what is known today: — Makary, February 2021: Natural immunity from prior infection could end the pandemic A drop in new Covid cases of 77 percent over six weeks was evidence, Makary said, that herd immunity was imminent, at which point vaccination and prior infection would cause a dramatic decline in disease spread. Makary acknowledged that new variants would mean that Covid-19 would “persist for decades.” He also said reinfections were generally mild. What the evidence shows: Many virologists expected mutation was inevitable. Covid spread did slow significantly as vaccinations expanded in the spring of 2021. But, then came the Delta variant and then Omicron, which led to high case counts. Studies suggest Covid reinfections likely have similar levels of severity.
| Marty Makary, a Johns Hopkins surgeon who has been critical of the Biden administration’s Covid-19 response, is President-elect Donald Trump’s pick to lead the FDA. | Noam Galai/Getty Images for HBO | — Makary, June 2021, and Bhattacharya, November 2021: Vaccine mandates and guidance for young, healthy people were unscientific At the time, federal and state officials ordered workers to get vaccinated before returning to work. Because the vaccines did not prevent infection, Bhattacharya argued that mandating the Covid shots was unethical. Makary also argued that vaccine guidance — two doses of the shots for everyone — was overbroad. What the evidence shows: There’s near-universal agreement among public health officials that most people are well served by getting the initial two shots. “It is true that as the pandemic went on, we knew the risk to kids was less than we originally thought,” Georges Benjamin, executive director of the American Public Health Association, told POLITICO. In recent years, the CDC has shifted public health messaging around updated Covid vaccination to target vulnerable groups, including older Americans and people who are immunocompromised, to acknowledge their higher risk of severe complications. Benjamin noted that the benefits of vaccinating young, healthy people is also about protecting vulnerable populations. — Bhattacharya, October 2020: Lockdown costs outweighed their benefits Most states issued stay-at-home orders in the spring of 2020 as Covid spread. Bhattacharya laid out an alternative strategy in his Great Barrington Declaration, an open letter published in October 2020 and signed by thousands of public health experts. It argued against lockdowns and favored letting low-risk people build herd immunity. What the evidence shows: Some infectious disease experts think Bhattacharya had a point about the costs and benefits of at least some of the restrictions. “Children suffered from decreased education, decreased socialization … We probably didn’t need to close businesses as long as we closed them, either,” Paul Offit, a vaccine inventor and pediatric infectious disease specialist at The Children’s Hospital of Philadelphia, said. Others think the jury may still be out on the impact of social distancing. “We know now that the intent of social distancing was to stop the spread of infection before we had the vaccine,” Benjamin said. “We had to bend the curve to decompress our health systems.” Read more here. WELCOME TO MONDAY PULSE. Welcome back! I’m still thinking about the sweet potatoes my aunt made over Thanksgiving dinner. Send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.
| | A message from the Coalition to Strengthen America’s Healthcare: NEW REPORT: More than 60% of all Emergency Department visits occur after regular business hours or on weekends when other providers and care facilities are typically closed. Hospitals and health systems are indispensable, crucial access points for critical care 24 hours a day, 7 days a week, 365 days a year. ACCESS THE REPORT. | | | | UNWINDING SURPRISE — Government officials have seemingly navigated the largest shift in the nation’s health care landscape since the Affordable Care Act’s passage without the disasters that many predicted, Kelly and Robert report. In fact, policy experts, state officials and health care advocacy groups say the so-called unwinding of Medicaid coverage that began last year has been beneficial in many ways. “We have hit bumps in the road, but overall, we’ve been fairly successful,” said Melisa Byrd, Medicaid director for the District of Columbia. “Definitely, a lot of great things have come from unwinding.” Though more than 25 million have been kicked off Medicaid since March 2023, overall enrollment declined by about 13 million, suggesting many people who mistakenly lost coverage were able to re-enroll after. The national uninsured rate stands at 7.6 percent, down from 8.6 percent in 2020, according to the most recent data from the National Center for Health Statistics. More than 100 million people are now enrolled in the government insurance programs for low-income people, roughly 10 million more than when the Covid-19 pandemic began, according to KFF, a health care think tank. Background: CMS cracked down on states early on that had disproportionate numbers of people losing coverage due to missing or unreturned paperwork or other procedural reasons. The agency also worked with states to boost automatic renewal rates. Key context: States also stepped up to mitigate fallout from the unwinding. States including Indiana, West Virginia and Nevada took the opportunity to fix long-standing problems in Medicaid programs that the unwinding process exposed, including updating their communications with enrollees and increasing engagement with their managed care partners.
| | REGISTER NOW: As the 118th Congress ends, major decisions loom, including healthcare appropriations. Key focus: site neutrality. Can aligning hospital and clinic costs cut federal spending, reflect physician costs, and lower patient expenses? Join policymakers and providers to discuss. | | | | | | President-elect Donald Trump has chosen Chad Chronister, sheriff of Hillsborough County, Florida, to head the Drug Enforcement Administration. | Chris O'Meara/AP | TAPPED FOR DEA — President-elect Donald Trump has chosen Chad Chronister, a Florida sheriff representing the county that includes Tampa, to lead the Drug Enforcement Administration, Chelsea and Ben report. Why it matters: If confirmed, Chronister would lead the DEA as it considers whether to permanently extend eased Covid-era telehealth rules for certain drugs and as it works to curb the fentanyl seeping into the U.S. from the Southern border. What to know about him: Chronister has been part of Hillsborough County sheriff’s office for more than three decades. As sheriff, he backed programs that offer substance use care and mental health treatment to incarcerated individuals, including veterans. He is a member of Florida’s drug policy advisory council, which issued a report last year heralding expanded access to medication-assisted treatment for people with substance use disorders in the state. Chronister could face some opposition from congressional Republicans for his actions during the Covid-19 pandemic. In 2020, his office arrested a Tampa pastor for violating quarantine orders to hold services. Charges against the pastor were ultimately dropped. “Trump’s nominee for head of DEA should be disqualified for ordering the arrest [sic] a pastor who defied COVID lockdowns,” Rep. Thomas Massie (R-Ky.) posted Sunday on X.
| | A message from the Coalition to Strengthen America’s Healthcare: | | | | FIRST IN PULSE: AI ASSURANCE LAB SCRUTINY — Leading House Republicans want HHS to back away from assurance labs intended to vet artificial intelligence tools, signaling there might be a different approach to AI in health care with GOP control of Washington, Ben reports. The details: Reps. Dan Crenshaw (R-Texas); Brett Guthrie (R-Ky.), who is running to chair the Energy and Commerce Committee; Jay Obernolte (R-Calif.); and Mariannette Miller-Meeks (R-Iowa) say the agency must stop any plans to create “government-administered assurance labs” and “walk back support” for a model for such labs from the Coalition for Health AI. Micky Tripathi, HHS’ assistant secretary for technology policy, was an adviser to CHAI and has signaled support for the group’s plan, which includes efforts to evaluate models based on “consensus-driven standards.” CHAI — whose founding partners included Google, Microsoft, Stanford Medicine and the Mayo Clinic — has said the labs would not be a part of the government regulatory processes. “We recognize that you were a board observer for CHAI and ask that you help us understand how putting the organization directly in control of market entry for innovative technologies does not represent a significant conflict of interest,” the lawmakers wrote in a letter to HHS. “These types of blurred lines are exactly what foster distrust in government and big tech.” Under CHAI’s plan, labs would adhere to standards for testing laboratories as defined by the International Organization for Standardization, a Switzerland-based nongovernmental group that promotes tech platforms working across borders. CHAI also unveiled standards for AI transparency in line with HHS’ requirements for firms seeking government certification. HHS has eyed a network of assurance labs and an AI safety program as part of its broader strategy. HHS and CHAI didn’t respond to requests for comment. The bigger picture: Deregulation is a top priority for the incoming Trump administration and House GOP leaders have been skeptical of new legislation that would further regulate AI. Trump is expected to rescind President Joe Biden’s executive order promising a coordinated approach to AI.
| | Want to know what's really happening with Congress's make-or-break spending fights? Get daily insider analysis of Hill negotiations, funding deadlines, and breaking developments—free in your inbox with Inside Congress. Subscribe now. | | | | | STAT reports that Scott Gottlieb, former Trump FDA chief, is speaking out against Robert F. Kennedy Jr. for HHS secretary. The Washington Post reports that SCOTUS today will consider regulation of vapes.
| | A message from the Coalition to Strengthen America’s Healthcare: NEW REPORT: In 2021 alone, Americans visited Emergency Departments more than 83 million times after hours or on weekends when other providers and care facilities are typically closed. With more than 60% of ED visits occurring on weekends or after regular business hours, when many other providers are closed, hospitals play an essential role in their communities, providing crucial access points for care 24 hours a day, 7 days a week, 365 days a year to all patients.
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