The ‘fed up’ phase of Biden’s vaccination campaign

From: POLITICO Pulse - Friday Sep 10,2021 02:05 pm

Sep 10, 2021

Presented by

With Alice Miranda Ollstein and Daniel Lippman

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Quick Fix

— President Joe Biden is embracing a series of tough vaccination mandates to suppress Covid-19, in a striking shift from his first months helming the pandemic response.

— House Democrats unveiled plans to close the Medicaid coverage gap by temporarily using the Obamacare markets.

— The FDA is ordering 5 million e-cigarette products off the market, but anti-tobacco advocates still aren't happy.

WELCOME TO FRIDAY PULSE — where today's Elizabeth Holmes trial curiosity is the $2,000 jewelry at the center of a fight over whether her luxurious lifestyle as Theranos CEO is relevant to the case. Tips to acancryn@politico.com and sowermohle@politico.com.

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Driving the Day

BIDEN WILL TURN THIS CAR AROUND — He tried encouraging. He tried cajoling. He tried dangling gifts and all manner of incentives. But eight months into a vaccination campaign hampered by widespread misinformation and hardening resistance, Joe Biden is fed up.

Biden signaled the start Thursday of the most aggressive phase yet of his vaccination effort, rolling out a series of vaccine mandates covering two-thirds of the nation’s workforce. He plans to force federal workers to get the shot or risk their jobs, and require that most private-sector employees face vaccination-or-regular testing decisions at their jobs.

Tens of thousands of health facilities will soon also face the stark choice of vaccinating all of their workers, or potentially losing crucial federal funding.

And over roughly 30 minutes of remarks, Biden delivered sharp admonishments of the unvaccinated — offering an implicit warning that the majority of the country has already chosen a side, and is more than ready to move on.

“This is not about freedom and personal choice,” he said in a speech. “The bottom line, we’re going to protect vaccinated workers from unvaccinated coworkers.”

That’s a far cry from earlier this year, when the White House refused at times to even utter the word “mandate” — let alone embrace the concept. But Covid-19’s resurgence over the last two months, combined with rising stubbornness through pockets of the U.S. and at highest levels of the GOP, have prompted a shift in thinking, administration allies said.

“For the first part of the Biden presidency, mandates were a political third rail,” said Lawrence Gostin, a Georgetown health law professor in touch with the White House. Now, he added, “I’ve never ever seen a president mandate adult vaccination as widely as this president has.”

Still, he could have gone further. Biden’s plan stops short of mandating vaccination for interstate travel such as flying, a move that health experts have urged the administration to adopt for weeks. It also does little to incentivize states to require vaccinations for school staff.

The federal vaccination mandate also excludes the Postal Service (though it will be subject to the broader vaccination-or-test requirement), which an administration official said is “traditionally independent of federal personnel actions” given its independent agency status.

Yet overall, the Biden administration is assuming a noticeably more combative attitude. And the backlash is already beginning…

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GOP GOVS BLAST BIDEN’s VAX PLAN — The administration’s chief antagonists wasted little time attacking the new directives as a federal overreach , with Florida Gov. Ron DeSantis vowing to oppose “mandates of any kind,” POLITICO’s Gary Fineout reports.

The Republican — who has tried to limit local officials’ ability to impose Covid-19 restrictions — warned that mandates risked backfiring and alienating people. Other governors, including South Dakota’s Kristie Noem and Georgia’s Brian Kemp, are already vowing to sue to stop employers from being required to vaccinate or regularly test their workers.

But in another departure from his early months as president, Biden indicated Thursday that there’s little appetite to negotiate with Republican state leaders. “If these governors won’t help us beat the pandemic, then I’ll use my power to get them out of the way,” he said.

HOW HOUSE DEMS WANT TO EXPAND MEDICAID — A new proposal from the House Energy and Commerce Committee would implement a “hybrid” Medicaid model, allowing people in the 12 GOP-led states that have yet to expand coverage enroll in subsidized Obamacare plans for the next three years.

The Biden administration in the meantime would construct a new federal program to cover them through Medicaid starting in 2025, POLITICO’s Alice Miranda Ollstein reports.

The plan, outlined as part of Democrats’ $3.5 trillion reconciliation package, also tries to incentivize states that have already expanded coverage not to suddenly roll it back by threatening a 10 percent penalty of the state’s monthly per-capita Medicaid costs.

The proposal aims to close a gap that has left roughly 2 million low-income people without coverage — fulfilling a longstanding goal that Democrats also believe will boost them in key states ahead of the midterms.

But not everyone is sold: Rep. Lloyd Doggett on Thursday raised concerns that some people would end up falling through the cracks anyway, saying he worries about “moving poor people back and forth” by temporarily relying on the Obamacare markets.

Among the other elements in the E&C plan:

— The major provision of the drug price negotiation bill that Democrats passed in 2019, and that the Congressional Budget Office has estimated would save $456 billion over the next decade.

That language most notably permits Medicare to negotiate the cost of certain medicines — an approach that the Biden administration officially endorsed on Thursday. It would also cap out-of-pocket costs in Medicare Part D and penalize companies that hike prices too fast.

— New funding for home- and community-based care for the elderly and people with disabilities, though not nearly as much as Biden and Senate Democrats wanted. The plan would allocate just $190 billion, or less than half of the $400 billion originally sought.

— Pandemic preparedness would get $15 billion — in line with what Biden has said would be a down payment on the $65 million that’ll eventually be needed. But money needed to stand up a proposed health research accelerator would total just $3.5 billion, not the $6.5 billion the administration requested.

— A permanent repeal of the Trump-era rebate rule. The regulation has already been the subject of multiple delays, but the E&C plan would prohibit its implementation starting in 2026.

A message from PhRMA:

Vaping

FDA BANS 5 MILLION E-CIG PRODUCTS — The agency is ordering 5 million e-cigarette products off the market after determining they posed a greater risk to children than benefits to adult smokers, POLITICO’s Katherine Ellen Foley reports.

The move was timed to a court-ordered deadline that will determine the future of the vaping industry. But the FDA opted against weighing in for now on the industry’s larger players, despite saying earlier that its review process would prioritize companies by market share.

The FDA received roughly 6.5 million applications from e-cig makers under regulations requiring them to demonstrate that their products were “appropriate for the protection of public health” and would be safe for current smokers — while at the same time unappealing to non-smokers.

It weighed in on 93 percent of them — including those with flavors such as “Apple Crumble” and “Cinnamon Toast Cereal.”

But that wasn’t enough to please anti-tobacco groups that were hoping the FDA would axe products from vaping giants Juul, Reynolds American’s Vuse and NJoy. The agency’s decision to punt for now was “deeply disappointing,” American Heart Association CEO Nancy Brown said.

The agency indicated it will eventually rule, but that the companies’ applications are still pending and in the final stages of review.

Vaping advocates are angry too. Groups that represent smaller e-cig makers railed against the decision to prohibit millions of products while not touching the industry’s biggest manufacturers. The FDA also banned some e-cigs with flavors like tobacco and menthol, but has not weighed in on all of them — a process that industry organizations criticized as inconsistent.

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Abortion

TEXAS BAN HIGHLIGHTS DEMS’ ANGST ON ABORTION AND TRANS RIGHTS — Texas’ recent move, with the Supreme Court’s blessing, to ban abortions early in pregnancy for the first time since Roe v. Wade has magnified an uncomfortable generational divide on the left over how to talk about abortion rights, our Alice Miranda Ollstein, Josh Gerstein and Alex Thompson report.

Biden, top Democrats in Congress, the attorney general and the liberal members of the Supreme Court, who all expressed outrage over Texas’ abortion ban and vowed to take action, are using gender-specific language, calling the law “an unprecedented assault on a woman’s constitutional rights” and “a disrespect of all women.”

But the activists fighting the law and those like it around the country are taking pains to avoid gender-specific words like “woman” and “women” — instead warning that “patients,” “Texans” and “people who need abortions” are being harmed — and they’re pushing people in power to make the shift as well.

Describing abortion rights solely as a women’s issue, they argue, marginalizes the trans and non-binary people who want to terminate a pregnancy. Still, many older elected officials and advocates are pushing back, warning the gender-neutral language alienates potential supporters and provokes an even bigger backlash from the right.

As the Supreme Court prepares to hear more arguments on abortion rights and the fate of Roe , the diverging language is complicating the left’s efforts to remain united and take on Republicans intent on banning the procedure, while shining a spotlight on a fight that has long played out in private.

Names in the News

Former FDA Commissioner Stephen Hahn will be the interim chief medical officer for blood collection device-maker YourBio Health. Hahn, who is also chief medical officer at venture capital firm Flagship Pioneering, ran the FDA from late 2019 through Jan. 20.

Ashley O’Sullivan is now the director of government affairs at AmerisourceBergen. She was previously the company's senior manager for legislation and policy.

What We're Reading

Vaccine mandates are an American tradition — and so is the backlash to them, The New York Times’ Maggie Astor writes.

Ahead of the anniversary of Sept. 11, Crain’s New York Business’ Maya Kaufman reports on the World Trade Center Health Program that’s providing crucial aid for newly sickened 9/11 survivors.

For The Atlantic, Joshua Prager interviews the woman who, as a child, was at the center of the Roe v. Wade abortion case.

A message from PhRMA:

Proponents of government price setting often misrepresent voter opinion on support for allowing the federal government to “negotiate” drug prices. While nine out of 10 Americans said in a recent Kaiser Family Foundation poll that they support drug price negotiation, opposition to the approach soared to 65% when respondents were told negotiation could limit people’s access to medicines or result in fewer new treatments and cures.

Non-partisan, independent public polls have repeatedly demonstrated that once Americans understand what government negotiation is, and what the tradeoffs are, support drops dramatically.

76% of Americans oppose H.R.3-style “negotiation” if it causes delays in access to new prescription drugs, and 72% oppose it if it results in fewer new medicines developed in the future.

62% agree we should keep the current law that prohibits government interference in Medicare plan negotiations because it protects seniors and people with disabilities from losing access to their medicines.