Democrats eye rebate rule repeal for savings — Biden officials debate pressing for renewed mask mandates — Vaccine requirements grow by the day

From: POLITICO Pulse - Tuesday Jul 27,2021 02:03 pm

Jul 27, 2021

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Quick Fix

— Repealing the rebate rule looks increasingly appealing to Democrats scrambling to find pay-fors for sweeping infrastructure packages.

— The White House is weighing new messaging on masks and vaccines amid the Delta threat, but concerns persist about politicized attacks.

— State governments and the VA are requiring vaccines for employees while medical groups are pushing hospitals to do the same.

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Driving the Day

DEMOCRATS EYE REBATE RULE REPEAL FOR SAVINGS — Party leaders are considering a repeal of Trump’s Medicare rebate rule in their upcoming $3.5 trillion reconciliation package, a move that could save as much as $180 billion in future federal spending as lawmakers scramble to fill funding gaps in the multitrillion-dollar legislation, four people familiar with the talks told Sarah and Rachel Roubein.

Lawmakers on both sides already backed delaying the rule — by as much as three years — in the bipartisan infrastructure package struggling through negotiations. But Democrats believe they could repeal the rebate rule entirely in their reconciliation package to pay for the party’s health care priorities, like expanding Medicare and extending Medicaid to roughly 2.2 million or low-income adults.

A senior Democratic aide confirmed the plans, calling the rebate rule a “massive giveaway to PhRMA at taxpayer expense.”

Looking under the couch cushions. Lawmakers are still scrambling to find savings for both the bipartisan bill and reconciliation, putting some other health care measures on the chopping block. As much as $43 billion allotted to a Provider Relief Fund created with the CARES Act could be channeled to bipartisan bill savings, earning the ire of provider groups, including the American Hospital Association.

Also on the table is a measure that would bar pharmacy benefit managers from charging a set drug price to Medicaid plans even if the drug’s cost falls. PBMs argue the practice, known as spread pricing, is used to project spending regardless of drug companies’ price changes. Previous congressional budget projections estimate the change would save roughly $1 billion.

BIDEN OFFICIALS WEIGH RENEWED CALLS FOR MASK-WEARING — Top Biden administration officials are debating whether to recommend that states and communities with low vaccination rates reimpose mask mandates, particularly indoors, as part of discussions on how the administration can do more to slow the spread of the Delta variant, Erin Banco, Adam and Anita Kumar report.

White House and health agency officials debated the option at a Sunday meeting that took place amid a surge of Covid-19 cases and hospitalizations in the South and Midwest, four individuals with knowledge said.

Officials have similarly debated in recent days whether they should encourage businesses and health care facilities to require proof of vaccination—something some businesses, state governments and one federal agency are forging ahead on anyway.

But officials are split on the merits of issuing new federal guidelines , with some fearing they’ll be politicized and embolden new Republican attacks. This camp believes recommending proof of vaccination would raise the specter of “vaccine passports” — an increasingly potent conservative talking point — and alienate and stigmatize portions of the country where individuals have chosen not to get the shot. And they fear calls to reimpose mask mandates will be futile.

“It's political,” one of the people said. “They think people like [Florida Gov. Ron] DeSantis and company are just waiting for the White House to announce some kind of vaccine mandate, and then they're going to jump on it for political reasons.” (More on DeSantis below…)

The White House declined to comment about the Sunday meeting. But White House press secretary Jen Psaki in a Monday briefing seemed to open the door for more measures. “It is certainly prudent for the federal government to be looking at any steps,” she said shortly before the VA rolled out its new vaccine mandate.

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GOVERNMENTS AND HOSPITALS: GET VACCINATED OR GET TESTED — California, New York City and the Department of Veterans Affairs all said Monday their employees must get vaccinated or tested regularly for coronavirus, marking some of the first steps by state and federal officials to institute vaccine requirements as new cases tick upwards.

It’s an abrupt policy shift for government entities that initially tried simply to encourage vaccination. The changes will directly affect hundreds of thousands of people, from health care and state government employees in California to frontline VA health employees in every state, Victoria Colliver reports. Veterans Affairs is the first federal agency to embrace such a policy, even as White House officials are hesitant to suggest vaccine requirements.

But officials point to alarming Covid-19 surges amid the Delta variant’s spread and stagnating vaccination rates. “We have reached the limits of a purely voluntary system,” New York City Mayor Bill de Blasio said Monday. “It’s time for more mandates, different kinds, different places.”

Medical groups are also on board. More than 50 health care organizations released a statement the same day endorsing mandatory Covid-19 vaccinations for health workers. Groups including the American Medical Association, the American Nurses Association, the American College of Physicians and the American College of Surgeons — representing millions of doctors, nurses and pharmacists — wrote that “we hope all other employers across the country will follow our lead and implement effective policies to encourage vaccination.” The Federation of American Hospitals later endorsed requirements in a separate statement.

Some businesses, particularly bars and restaurants, have also implemented vaccine requirements — especially in California, Victoria writes. And the NFL said last week that teams experiencing an outbreak among unvaccinated players could be forced to forfeit games, placing a multimillion dollar financial incentive on teams and their players to get vaccinated.

But blowback is already brewing. Conservative firebrand Rep. Marjorie Taylor Greene (R-Ga.) tweeted Sunday that businesses’ decision to turn away unvaccinated patrons was tantamount to “segregation.” Greene has previously compared Biden’s door-to-door strategy and mask mandates to Nazi Germany. She and California Gov. Gavin Newsom exchanged barbs on Twitter late Monday about vaccine messaging, with Newsom calling Greene’s rhetoric “murderous.”

BIDEN STILL SEARCHING FOR HIS FDA FAVORITE — The president hasn’t found his nominee for FDA commissioner yet, Psaki said Monday, suggesting that acting commissioner and longtime drug chief Janet Woodcock is not the pick.

“He's certainly eager to nominate someone,” she said in a White House press briefing. “He wants to make sure we have the right person to nominate, and he's not going to do it at a pace faster than having the right person to put forward.”

While the FDA search has dragged on for months, the clock is ticking on Woodcock’s tenure as acting commissioner. She can stay in the role through mid-August, though the position can remain vacant through November.

Around the Nation

CONSERVATIVES RAIL AGAINST DESANTIS’ VACCINE PUSH — The Republican Florida governor has come under attack from the medical community and Democrats as the Delta strain of Covid-19 sweeps through Florida, turning it into a national coronavirus hotspot. But as Ron DeSantis encourages vaccinations, he is also facing backlash from the anti-vaccination wing of his political base, POLITICO Florida’s Matt Dixon writes.

The state recorded more than 73,000 infections last week — four times as many as during the start of July — leading to overcrowded hospitals and more than 300 deaths in the most recent seven-day period.

But one conservative radio host, Stew Peters, last week called DeSantis a “sellout” and suggested the governor was taking bribes, though he didn’t specify from whom. Meanwhile, former Trump National Security Adviser Michael Flynn said on another program that DeSantis shouldn’t “let political correctness get in the way of health choices.”

Pressure on the governor could only grow: Officials in Palm Beach on Monday announced that they would require people to wear masks inside city buildings or on town property regardless of vaccination status, underscoring another heated debate. Health officials, meanwhile, are also pressing the governor to provide more assistance to frontline health care workers.

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What We're Reading

CNN’s Morgan Stephens writes about the debilitating effects of long Covid and how few doctors and medical experts are equipped to deal with its challenges, even as millions struggle with elusive physical and mental health issues months after being infected.

Calls for vaccinations among health care workers have reached “ a tipping point,” California’s health secretary tells The Washington Post’s Dan Diamond as a host of vaccine requirements are announced.

The new wave of coronavirus cases in the U.S. is already outpacing 2020 spring and summer waves according to an analysis by Stat News’ Emory Parker.

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