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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 Adam Cancryn and Sarah Owermohle | | | With Megan R. Wilson and Carmen Paun 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.
| | | — Democrats are weighing Medicare Advantage cuts to help pay for their social spending bill — a move that's already prompting industry pushback. — Medicare expansion and drug pricing are among the final issues holding up an agreement on President Joe Biden's spending plan. — The CDC recommended Moderna and Johnson & Johnson Covid-19 booster shots. WELCOME TO FRIDAY PULSE — and for the sake of your health and the CDC's peace of mind, back away from the onions. Send tips to acancryn@politico.com and sowermohle@politico.com. | | | | A message from PhRMA: Some in Congress are considering a plan that would tie medicine prices in Medicare to those in the U.S. Department of Veterans Affairs. This misguided approach is just the latest in a series of government price-setting proposals that threaten patients’ access to medicines and future innovation. Read the five reasons tying Medicare Part D prices to the VA misses the mark. | | | | | | DEMS TARGET MEDICARE ADVANTAGE IN SAVING SEARCH — Democratic leaders seeking ways to pay for their domestic agenda are putting a new option on the table: Big cuts to the private Medicare market. The move to rein in Medicare Advantage would generate hundreds of billions of dollars in savings, bringing the party closer to fulfilling its vow to offset its planned $2 trillion spending package. Yet it risks sparking a war with the deep-pocketed insurance industry in the process, POLITICO’s Alice Miranda Ollstein and Megan R. Wilson report. The battle lines: Democrats landed on Medicare Advantage cuts after earlier proposals to slash drug prices and raise taxes on the wealthy stalled out in face of opposition from a handful of centrists. The market has also long been a target of progressives, who object to the government paying insurers generous rates to administer Medicare benefits. Medicare Advantage has more than doubled in size over the past decade, with the private market now serving more than 40 percent of beneficiaries. But the industry is already ramping up its defense. Groups allied with private insurers have already spent $2.6 million on advertising opposing cuts to Medicare Advantage since the spring, and are dialing up their lobbying and ad spending to warn Democrats that squeezing the market would alienate older Americans and backfire politically. What’s at stake: Roughly $100 billion to $150 billion in cuts over a decade, according to estimates from Raymond James analyst Chris Meekins. Momentum for a crackdown on Medicare Advantage has also picked up on the left amid indications that insurers in the market have overcharged taxpayers, including through questionable medical reviews and risk assessments.
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HEALTH CARE HOLDS UP DEMS’ SPENDING DEAL — Proposals to expand Medicare benefits and crack down on pharmaceutical costs are among the final items dividing Democrats as they race to assemble a $2 trillion spending package, POLITICO’s Sarah Ferris, Marianne LeVine and Nicholas Wu report.
The disputes could prevent Democratic leaders from reaching an agreement by the end of the week, as lawmakers across the House and Senate try to bridge gaps between the party’s centrist and progressive wings. In addition to Medicare benefits and drug pricing, Democrats are negotiating over paid leave and major climate provisions – with the fate of each threatening to cost critical votes. Already, Democrats are skeptical they’ll find a deal on prescription drugs after Sen. Kyrsten Sinema registered her opposition, sending leadership scrambling for alternatives to help pay for the broader package. And during a CNN town hall Thursday night, President Joe Biden downplayed the potential for a major Medicare benefits expansion, calling it a "reach" due to Sen. Joe Manchin's opposition. Should they resolve those issues soon, Democratic leaders are planning to push for a vote on both the social spending plan and bipartisan infrastructure package by Oct. 31 – in time to head off the expiration of key transportation programs. Yet they’re developing a contingency plan as well: An extension of just the Highway Trust Fund through Dec. 3, giving lawmakers several more weeks to nail down the final details. CDC GREENLIGHTS MODERNA, J&J BOOSTERS — The CDC has formally endorsed the use of Moderna and Johnson & Johnson boosters for some adults, POLITICO's Lauren Gardner reports. The decision comes after the agency's outside advisory committee unanimously recommended the additional Covid-19 shots, and a day after the FDA authorized them as well. The CDC's outside panel also signed off on a mix-and-match option, which would allow people who are eligible for boosters to choose any vaccine they want – no matter what they received for their initial series. Under the CDC guidelines, millions more Americans would be instantly eligible for booster shots aimed at reinforcing their protection against Covid-19. That includes Moderna recipients who are 65 and over, or all adults who have underlying conditions or work in settings that expose them to the virus. The guidance for J&J recipients is even more permissive: All adults can get a booster if they’re at least two months past their initial immunization. Meanwhile: Pfizer and BioNTech, whose booster was authorized last month, disclosed new data that showed a third dose of their vaccine bumps its efficacy up to 96.5 percent. But the median time between the initial series and the booster was 11 months, well beyond the six-month mark set by the FDA and CDC. | | | |   | | | | | | HEALTH CARE LOBBYING: SO HOT RIGHT NOW — Lobbying spending by the health care industry’s largest players surged in the third quarter , compared to the same period last year, as Covid-19 and Democrats’ bid to pass major health policies as part of their spending package dominated the agenda. There were 64 health-related trade groups, corporations and nonprofits that spent at least $500,000 on advocacy between July 1 and Sept. 30. That collectively totaled $95.73 million, or 17 percent more than the third quarter last year, according to public disclosures, Megan reports. Those big spenders were led by PhRMA, which shelled out $7.44 million (vs. $5.96 million last year) amid a period dominated by Covid-19 vaccine debates and a push on Capitol Hill to crack down on drug pricing. The American Hospital Association spent $4.47 million, and American Medical Association tallied $3.49 million. Several drug makers also made the top 10, including Horizon Therapeutics, Genentech, Amgen, Gilead Sciences and the trade group BIO. | | | WHO DETAILS RESPONSE TO SEXUAL EXPLOITATION SCANDAL — The World Health Organization will spend $7.6 million to improve its capacity to prevent, detect and respond to sexual abuse allegations in 10 countries at risk, as part of its response to the sexual exploitation and abuse by its staffers during an Ebola outbreak response in the Democratic Republic of the Congo, POLITICO’s Carmen Paun reports. Afghanistan, the Central African Republic, the DRC, Venezuela and Yemen are among the 10 countries. Dozens of women were promised and given local WHO jobs in exchange for sex during the 2018-2020 outbreak in the provinces of North Kivu and Ituri, according to a report released in September by an independent commission. In the plan published Thursday, the WHO said it will help women who were sexually exploited or abused to support themselves. Children born as a result of the exploitation or abuse will get support for education, medical needs and DNA testing to help them access rights regarding the nationality of their father, it said. An external organization will review accusations of managerial misconduct at WHO, after the independent commission found that top WHO managers were informed of the cases in the DRC and did not respond appropriately. | | | STUDY: UNFAIR TREATMENT MORE LIKELY FOR BLACK ADULTS SEEKING PUBLIC BENEFITS — Black and Hispanics adults are three times more likely to report unfair treatment or judgement when applying for public benefits as white adults, according to a new survey from the Urban Institute and Robert Wood Johnson Foundation. The poll found that one in six Black adults – or 15.8 percent – felt unfairly treated when seeking public benefits, versus just 6 percent of white adults. Among those who did feel inappropriately judged, nearly 70 percent said it negatively affected them — most commonly by resulting in them delaying or going without needed benefits. | | | Julie Morita, executive vice president of the Robert Wood Johnson Foundation and a former member of the Biden transition’s Covid-19 advisory board, was one of 14 people appointed to the newly re-established CDC Advisory Committee to the Director. Hogg Foundation for Mental Health Executive Director Octavio Martinez is also among those joining the committee. He is a member of the White House’s Covid-19 Health Equity Task Force. Former acting HHS Secretary Eric Hargan is joining Vanderbilt University as an adjunct professor and a fellow of the Center for Healthcare Market Innovation in its Owen Graduate School of Management.
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| | | Dania Palanker and JoAnn Volk of Georgetown’s Center on Health Insurance Reform spoke with 20 health insurance sales representatives – and only five directed them to Affordable Care Act plans, they detail in a report on misleading marketing. Johnson & Johnson is using a controversial bankruptcy maneuver to dodge lawsuits linked to claims its baby powder was contaminated with cancer-causing asbestos, NPR’s Brian Mann reports. For the Texas Tribune, Karen Brooks Harper explores why a Covid-19 vaccine developed by Texans hasn’t been distributed in the United States. CORRECTION: Wednesday’s edition of PULSE misidentified the public policy director for the National Association of Social Workers. Her name is Sarah Christa Butts. | | | | A message from PhRMA: Some in Congress are considering a plan that would tie medicine prices in Medicare to those in the U.S. Department of Veterans Affairs. This misguided approach is just the latest in a series of government price-setting proposals that threaten patients’ access to medicines and future innovation.
Here are five reasons why the VA is a wrong model for Medicare:
1. Unlike Medicare Part D, the VA uses a one-size-fits-all system that restricts access to medicines.
2. The majority of VA beneficiaries rely on other sources to help supplement their drug coverage, including Medicare Part D.
3. The VA relies on quality-adjusted life year (QALY)-based assessments to set prices for medicines.
4. Imposing the VA system on Medicare is wildly unpopular with seniors.
5. Comparisons between Medicare Part D and the VA fail to acknowledge inherent structural distinctions between the two programs.
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