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Presented by the Healthcare Distribution Alliance: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy. | | | | | |  | | By Adam Cancryn and Sarah Owermohle | | | PROGRAMMING NOTE: Morning Pulse will not publish Monday, Aug. 30, to Monday, Sept. 6. We'll return to our normal schedule on Tuesday, Sept. 7. Editor’s Note: POLITICO Pulse is a free version of POLITICO Pro Health Care's morning newsletter, which is delivered to our s each morning at 6 a.m. The POLITICO Pro platform combines the news you need with tools you can use to take action on the day’s biggest stories. Act on the news with POLITICO Pro.
| | | — Outdated and unreliable data are hampering the Biden administration's efforts to track breakthrough Covid-19 cases. — President Joe Biden said he'll pull funding from nursing homes that don't vaccinate their staff. But following through on that vow is a bit more complicated. — House Democrats struck a compromise that will allow their $3.5 trillion spending plan to move forward. WELCOME TO WEDNESDAY PULSE. This is a cat newsletter with some health care news. Send both to acancryn@politico.com and sowermohle@politico.com. | | A message from the Healthcare Distribution Alliance: America’s healthcare distributors connect 1,400 pharmaceutical manufacturers to more than 180,000 healthcare providers — delivering more than 10 million medicines, vaccines and healthcare products safely, efficiently and reliably every day. Distributors are the logistics experts of healthcare, continuously innovating to increase efficiencies, provide value to the healthcare system, and ultimately support patient health. That’s Health Delivered. | | | | | | CDC STRUGGLES TO TRACK BREAKTHROUGH CASES — For the last several weeks, Biden officials and the public alike have puzzled over a key question: Just how many fully vaccinated Americans are getting infected with Covid-19? It’s a question with no precise answer, thanks to a piecemeal public health system that’s left the CDC to sift through reams of outdated and unreliable data — even as the agency is confronted with decisions that could determine the pandemic’s course, POLITICO’s Erin Banco reports. The CDC long ago ruled out tracking all breakthrough infections, in favor of focusing only on closely monitoring the most severe cases. But even with that limited scope, the information the Biden administration collects from 49 states has often proved inaccurate or absent key details. Those errors routinely include patients listed with the wrong gender or age, or missing data on whether someone is fully vaccinated or which shot they received. On top of that, there’s a significant reporting lag — sometimes as long as two weeks. The data issues have exposed the CDC to criticism inside and outside the administration, especially after health officials endorsed a plan for booster shots beginning in September. Outside critics say they’re unconvinced the existing data shows extra vaccines are needed, while those in the White House are frustrated at how long it takes the CDC to share its new information. “We don’t have a clear understanding of what the data actually says about the Delta variant, transmission and boosters,” one senior Biden official said. Here’s what we do know: Breakthrough infections are on the rise. But so far, the vast majority of those infections aren’t resulting in severe illness. That’s the readout from the data that CDC does have — including one study of frontline health workers that showed the vaccines’ effectiveness declining nearly 30 percentage points since Delta became the nation’s dominant strain. A second report examining 43,000 Los Angeles residents found that a quarter of new infections from May to July came in fully vaccinated people. Yet despite the uptick in total breakthroughs, cases in vaccinated people are still rare — with the infection rate among unvaccinated people 29 times the rate of the vaccinated. And, critically, the vaccines have remained highly effective at keeping Americans out of the hospital. While breakthrough infections accounted for 25.3 percent of cases in the Los Angeles study, they made up just 3.2 percent of those hospitalized and 0.5 percent of patients with Covid admitted to intensive care. | | | | STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today. | | | | | WHAT BIDEN’S VAX ORDER REALLY MEANS FOR NURSING HOMES — When Biden vowed last week to yank federal funding from nursing homes with unvaccinated staff , public health experts hailed it as a straightforward way to juice the vaccination rate — and protect the nation’s most vulnerable. But inside the agency responsible for delivering on his promise, officials are still working on how to translate it into viable policy, people with knowledge of the discussions told PULSE. The simplest — and most likely — path is to add a staff vaccination requirement to the list of conditions nursing homes must meet to participate in Medicare and Medicaid. That could be put in place quickly, and would open facilities up to a range of traditional enforcement mechanisms if they failed to comply with the mandate. Under the conditions-of-participation approach, nursing homes wouldn’t automatically lose funding if they refuse to vaccinate their staff. The facilities that violate conditions of participation have historically been given time to comply with several interim steps, including civil money penalties and other sanctions available, before they’re tossed from Medicare and Medicaid altogether. The upshot is that Biden won’t immediately be cutting off noncompliant nursing homes across the country come late September, no matter how tough the rhetoric around the issue gets. And it could take a while for even the most stubborn facility to be penalized. Instead, officials are quietly hoping the mere threat of losing funding will nudge nursing homes into preemptive action and result in a wave of private-sector mandates well ahead of when it makes the new regulations official. DEMS’ SPENDING PLAN MOVES AHEAD — It took several days of high drama and some late-night negotiating, but House Democrats finally have their $3.5 trillion budget back on track. The budget framework’s party-line passage on Tuesday will clear the way for Democrats to assemble their massive social spending bill — a package that’s likely to include a series of provisions central to President Joe Biden’s health agenda. Top Democrats have signaled plans for a major expansion of Medicare benefits and a crackdown on pharmaceutical costs, with progressives pushing to go as far as freeing the government to directly negotiate drug prices. But just getting there took some effort. After Speaker Nancy Pelosi vowed not to pass a bipartisan infrastructure package until the $3.5 trillion plan was hammered out, a group of centrist Democrats revolted. That spurred hours of negotiations to prevent the plan from falling apart and upending Biden’s entire domestic policy vision. The end result: A promise to vote on infrastructure by Sept. 27, no matter where the House is in putting together its reconciliation package. House Democratic leaders also committed to discussing the social spending bill with Senate moderates before finalizing it, amid concerns over the potential bill’s size. That was a sufficient enough compromise to hold the Democratic conference together for now. But it also highlights just how delicately party leaders will have to work to shepherd such a massive package into law. Centrist Democrats have now flexed their muscles somewhat successfully, upping the odds they’ll be emboldened enough to try again. Progressives have had no qualms about openly criticizing their more moderate colleagues. And the clock is now ticking more urgently than before — with Democrats only just now kicking off sure-to-be contentious debates in earnest over what will make it into the finished product. | | | | Be a Policy Pro. POLITICO Pro has a free policy resource center filled with our best practices on building relationships with state and federal representatives, demonstrating ROI, and influencing policy through digital storytelling. Read our free guides today . | | | | | OREGON GOV REQUIRES OUTDOOR MASKING, WITH CAVEATS — Democratic Gov. Kate Brown announced Tuesday that a statewide outdoor mask mandate will go into effect at the end of the week, but with a range of exemptions attached. “The Delta variant is spreading fast and wide, throwing our state into a level of crisis we have not yet seen in the pandemic. Cases and hospitalizations are at a record high,” Brown said in a statement. On Monday, the state reported 4,701 new confirmed and presumptive COVID-19 cases and 24 new deaths in the most recent three days. Seven percent of ICU beds are available statewide. But the mandate itself seems mostly aimed at big sporting and musical events where social distancing is difficult. It doesn’t apply to walking down the street and passing someone, holding outdoor events on private property or individuals playing sports. PATIENT GROUPS PRESS BIDEN ON SURPRISE BILLING DETAILS — Nearly 60 consumer and employer organizations penned a letter to HHS Sec. Xavier Becerra, Treasury Sec. Janet Yellen and Labor Sec. Marty Walsh, looking for reassurances that surprising billing loopholes would be closed in the administration’s looming rule. The top concern laid out by the AFL-CIO, American Benefits Council, National Retail Federation and others is that arbitration — used to resolve billing disputes — could be a lucrative hustle for private businesses and hospitals but won’t benefit consumers. They aren’t alone: Two dozen House Democrats voiced similar concerns to the secretaries in a letter early this month, days after a new regulation that could tackle these issues landed at the White House budget office for review. | | | |   | | | | | | Senate Finance Committee Chair Ron Wyden (D-Ore.) named Peter Fise as the Committees’ new health counsel, focusing on Medicare Part B, telehealth, mental health coverage and other provider issues. Fise most recently worked as health counsel for Sen. Jeanne Shaheen (D-N.H.) and previously at the Bipartisan Policy Center and Alston & Bird. | | | The spectacular implosion of Elizabeth Holmes’ Theranos has made it more difficult for female entrepreneurs in health and science fields to gain traction with investors, The New York Times’ Erin Griffith reports. A Jacksonville, Fla., mother lost two sons to Covid-19 this month after they refused vaccinations. Lisa Brandon, who received the Moderna shots, also became sick with the virus but survived, Vic Micolucci reports for NewsJax4. A North Carolina hospital used its medical records to identify patients who may have been missed by broader Covid-19 vaccine communications — and set out to call them one by one, Katie Palmer writes for Stat News. | | A message from the Healthcare Distribution Alliance: As the backbone of the healthcare ecosystem, HDA members are engaged in COVID-19 response efforts, partnering with the federal, state and local governments to distribute treatments, medical supplies and PPE.
We are the people behind the nation’s largest-ever vaccine rollout, working to make sure vaccines get where they are needed and supporting our pharmacy and provider partners, so they can put shots in arms.
Day in and day out, HDA members are leveraging strong relationships at both ends of the supply chain to direct lifesaving medicines to the frontlines, while continuing to meet the daily healthcare needs of all Americans. Distributors are committed to using their logistics expertise and supply chain relationships in the fight against this global pandemic.
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