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Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy. | | | | | |  | | By Sarah Owermohle and Adam Cancryn | | | 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. | | | — Democratic leaders’ hopes are pinned on pivotal votes this week but the social spending package is far from safe. — Booster confusion begins with questions about which people perform high-risk jobs and what happens for people who don’t have the Pfizer shot. — CDC is plagued by burnout and fatigue at a critical moment in pandemic strategy, vaccine decisions and the fight against Delta variant. WELCOME TO MONDAY PULSE. The pandemic isn’t over but at least certain cultural norms, like screaming matches at the Capitol, are back. Send tips and Hill gossip to sowermohle@politico.com and acancryn@politico.com. | | | | A message from PhRMA: Right now, Medicare Part D includes a provision that protects access to medicines. But some politicians want to take that away. That would mean that no matter what your doctor prescribes - you could be stuck with whatever medicines the government says you can have. Ask Congress if your medicine will be at risk in Medicare. | | | | | | THE $3.5 TRILLION VOTE — House Speaker Nancy Pelosi says that her chamber will pass a multibillion-dollar infrastructure package on Thursday. But today is also the self-imposed deadline to advance the $3.5 trillion social spending package — don’t hold your breath. How we got here: The infrastructure bill and the massive reconciliation measure are keystone measures in President Joe Biden’s agenda. They also are inextricably linked: Pelosi and other leaders want both votes this week in part to keep progressives — champions of the social spending legislation — on board with the infrastructure vote. Congressional Progressive Caucus leader Rep. Pramilia Jayapal (D-Wash.) said last week that at least 50 CPC members will vote against the infrastructure bill without agreement on the massive package that includes drug pricing reform, Medicare expansion and long term care support. But that package is in jeopardy with some moderate Democrats’ opposition to drug price negotiation and others’ concern about the massive price tag. To pass both bills, "it's going to take work," Jayapal said on CNN’s “State of the Union” Sunday. "And it's going to take the Senate, Joe Manchin and others, sitting down to actually negotiate. And I am ready, willing and able to talk to anyone about anything at any time to get that done.” Raise the stakes: On top of the reconciliation bill and infrastructure package, Congress needs to fund the government this month. Pelosi projected confidence on ABC's "This Week” Sunday even as she acknowledged that progressives’ ambitious social-spending goals may need to be pared down. It "seems self-evident" that the $3.5 trillion price tag will shrink, she told George Stephanopoulos. "Obviously, with negotiation, there will have to be some changes … the sooner the better so that we can build our consensus to go forward," she said. Read more: Republicans in the roughly 50-member centrist group the Problem Solvers Caucus took some credit this summer for helping craft the infrastructure plan. But that doesn’t mean they’ll vote for it, write POLITICO’s Sarah Ferris and Nicholas Wu. | | | | Registration is OPEN for Breakthrough Summit 2021, the most important rare disease conference of the year! On Oct. 18 and 19, the National Organization for Rare Disorders will host the virtual Rare Disease and Orphan Products Breakthrough Summit. The Summit brings together the rare disease community from across the globe, including experts from patient advocacy, government, industry, media and academia, to discuss the current and critical topics in rare diseases. For access to two days of networking and dynamic programming on topics including drug pricing, genetic testing, Covid-19, equity and inclusivity, REGISTER NOW. | | | | | ICYMI: BOOSTER CONFUSION IS HERE — Biden and his advisers defended their decision to authorize boosters of a third dose of the Pfizer-BioNTech vaccine for some Americans on Friday, saying they let science lead the way. FDA and CDC last week recommended boosters for people 65 and older, medically vulnerable or in high-exposure jobs. The latter category was a source of contention, with CDC advisers voting against the group and Director Rochelle Walensky overruling them in a late-Thursday night verdict. So, in addition to the elderly and those with workplace exposure to Covid-19, the Pfizer-BioNTech booster will now be available to nursing home residents and people 18 and older with underlying health conditions that increase their chances of severe illness, Erin Banco writes with us and Lauren Gardner. But the policy does not allow boosters for people initially vaccinated with the Moderna or Johnson & Johnson shots. Questions abound about the data FDA and CDC used, boosters, including whether there is enough to show the extent to which and the length that boosters can protect against hospitalization, and whether the U.S. should worry about breakthrough infections in the coming months. It is also unclear when individuals working in high-risk settings or with underlying health conditions will be able to receive their third shots. Walensky told reporters Friday that the U.S. has “very little” data on whether a booster shot would lower transmissibility, especially in the context of the Delta variant. She said the CDC is working on studies to determine what other portions of the population would be eligible to receive the booster shot next. But, she said: “I want to be clear, we are not going to boost our way out of this pandemic.” | | | |   | | | LOW MORALE HOBBLING CDC — Staff at the Centers for Disease Control and Prevention are increasingly reluctant to join the agency’s pandemic response team, citing debilitating burnout and fatigue after 19 months of fighting Covid-19, Erin reports. She spoke with five CDC officials, all of whom requested anonymity to discuss internal agency matters more freely. They describe an intense summer marked by demands to digest complex data in record time as the government raced to update policies on vaccines, masks and travel in the face of Delta — all on top of a grueling prior year. Bad timing: CDC is struggling to maintain productivity and morale at one of the most pivotal and confusing moments of the pandemic. The burnout also raises questions about the agency’s ability to recruit qualified scientists and leaders to help handle the increased Covid-19 workload that health experts say will come when Americans begin to gather indoors for the holidays, driving up new infections, and the looming challenges over children’s’ vaccines. Walensky in the spring consolidated several Covid-19 task forces under Henry Walke’s leadership, including most of the groups working on vaccines. Walensky moved other officials off the pandemic response team, including former top CDC respiratory official Nancy Messonnier, to streamline the pandemic task force’s work. During the same period, Anne Schuchat, the CDC’s former principal deputy director, announced she was retiring. “I think it is going to take a while to find people who want to help and who have the ability to help right now,” another CDC official said. “We have to gear up for what is probably coming this winter.” PFIZER CEO: BOOSTERS WON’T SLOW FIRST SHOTS — First doses of the Pfizer and BioNTech vaccine can be distributed simultaneously with boosters and neither effort should slow down, Albert Bourla told ABC’s “This Week” on Sunday. "I think it is also not the right thing to try to resolve it with an 'or' when you can resolve it with an 'and,'" Bourla said. "It's not, 'Shall we give boosters or give primary doses to other people?' I think the answer should be, 'Let's give both boosters and doses for other people.'" Why it matters: The World Health Organization has said that rather than implementing widespread rollouts of boosters, wealthier nations should work to get more first shots to countries with lower vaccination rates, POLITICO’s Maya Parthasarathy writes. Bourla said that out of the 2 billion vaccine doses Pfizer will produce by the end of September, 500 million of them will have gone to middle- or lower-income countries. | | | | TELL US WHAT YOU THINK: Do you listen to POLITICO podcasts? We want to hear from you! Tell us what you like, what you could do without, and what you want to see in the future from the POLITICO Audio team! Your responses will help us improve our offerings and tailor our podcast content to better fit your needs. Find the survey here. | | | | | | | | FEDERAL CONTRACTORS HAVE DECEMBER VAX DEADLINE — The White House approved new guidance Friday that would require federal contractors and subcontractors to have their workforce fully vaccinated by Dec. 8, POLITICO’s Rebecca Rainey reports. Millions of workers will be affected. The guidance from the Safer Federal Workforce Task Force requires those contracting with the federal government to ensure their workers have received the Covid-19 vaccination except “in limited circumstances” when an employee needs a religious or disability accommodation. They must also ensure workers and staff are following masking and physical-distancing rules, among other safety precautions. “These safeguards will decrease the spread of SARS-CoV-2,” the document said, “which will decrease worker absence, reduce labor costs, and improve the efficiency of contractors and subcontractors performing work for the Federal Government.“ | | | Andrew Schwab is Vice President and Head of Government Affairs at Oak Street Health, a provider network for Medicare enrollees. He was most recently Director of Policy, Federal Affairs and Partnerships for United States of Care. | | | | A message from PhRMA: Right now, Medicare Part D includes a provision that protects access to medicines for seniors and people with disabilities.
But some politicians want to take that away.
That would mean that no matter what your doctor prescribes - you could be stuck with whatever medicines the government says you can have.
Learn more. | | | | | | Idaho morgues are running out of space to store bodies as Covid-19 deaths mount and the state struggles to curb new cases, The Washington Post’s Derek Hawkins reports. New York may use the National Guard and out-of-state health care workers to replace unvaccinated hospital staff as staff shortages loom, NPR’s Rachel Treisman writes. Hospitals are struggling to address the backlog of non-Covid cases, with some delayed care dragging on for months as the pandemic continues and health workers are spread thin, Reed Abelson writes in The New York Times. | | | | Follow us on Twitter | | | | Follow us | | | | |  |
