Manchin throws a wrench in reconciliation timeline

From: POLITICO Pulse - Tuesday Nov 02,2021 02:03 pm
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Quick Fix

— A House vote on the social spending package is hazy as Democrats spar over legislation to prioritize.

— The Supreme Court heard arguments on the Texas abortion ban Monday, with justices questioning the ramifications of the law.

— The Biden administration is readying millions of Covid shots for young kids, all of them Pfizer vaccines as others are delayed.

WELCOME TO TUESDAY PULSEThis is vaccine messaging that millennials can get behind. Send tips and your favorite early aughts movies to sowermohle@politico.com and acancryn@politico.com.

 

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From out-of-pocket costs, to deductibles, to hospital bills – the most vulnerable patients face challenges. 3 in 10 Americans who have insurance still face a financial barrier to care. We need to make the cost of medicine more predictable and affordable. Learn more.

 
Driving the Day

RECONCILIATION TIMELINE DERAILED ... AGAIN — Don’t expect a vote on the social spending package today — and maybe not this week. While that goal was always aspirational for the Democratic leaders who worked to finalize details through the weekend, Sen. Joe Manchin (D-W.V.) on Monday all but assured it’s out the window.

The moderate senator, who has become a linchpin in congressional efforts to lock down both the social spending and the infrastructure packages, in a Monday news conference refused to endorse the White House-blessed $1.75 trillion social spending bill, Burgess Everett and Sarah Ferris report.

Manchin told reporters that he would not be pressured into supporting his party's more progressive social spending package and decried the “shell games, budget gimmicks” used in writing it.

Basically, he wants the House to immediately pass the bipartisan infrastructure bill. And his move could embolden other moderate Democrats who are increasingly frustrated that the measure keeps stalling before House votes, Burgess and Sarah write.

What now: In a uniquely fast statement released after Manchin spoke, White House press secretary Jen Psaki said Biden aides "remain confident that the plan will gain Senator Manchin’s support."

But besides Manchin, between four and eight centrists have raised concerns to leadership about either process or policy on the $1.75 trillion bill, according to one source close to the talks. Their issues range from opposition to immigration reform or a proposed methane emissions fee to a demand that the bill is fully scored by independent budget analysts. Senior Democrats still believe they can resolve several of those concerns this week.

Where’s drug pricing reform? According to Senate Finance Committee Chair Ron Wyden (D-Ore.), it’s right around the corner.

Reading the parameters of the tentative agreement off his cell phone, Wyden said the deal being worked on would allow the government to negotiate with pharmaceutical companies over certain drugs in Medicare Part B and Part D, with special provisions for insulin products.

“Every insulin product in Part D would be available at a low cost, and insulin prices would be negotiated by the government,” he said. “We're trying to make sure that these prescription drugs aren't a financial ball and chain that seniors and others are carrying around.”

 

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TAKEAWAYS ON DAY ONE OF THE SCOTUS ABORTION ARGUMENTSJustices Brett Kavanaugh and Amy Coney Barrett surprised Supreme Court watchers on Monday by sounding receptive to the arguments that opponents have leveled against Texas’ abortion ban, Alice Miranda Ollstein and Josh Gerstein reported after three hours of arguments. Some highlights:

— Any decision ripples. Both sides argued that a ruling in either direction could trigger an avalanche of legal consequences that range far beyond abortion.

Clinic defenders said allowing Texas’ law to stand would enable states across the country to pass laws empowering regular citizens to file suits interfering with gun rights or religious liberty or free speech. Texas’ representatives said allowing the federal government to intervene in this case would lead to the trampling of states’ rights more broadly.

— Congress gets called on the carpet. Justices turned to the role of federal lawmakers on several occasions. Defenders of the Texas statute said Congress could have passed a law to give the federal courts or the Justice Department the right to step in over such a law, but had not done so.

But Justice Elena Kagan shot back that “Go ask Congress” was an inadequate answer for citizens whose rights are being infringed on. “Isn't the point of a right that you don't have to ask Congress?” she asked.

— Justices battle over hypotheticals vs. reality. Justice Samuel Alito, for instance, asked multiple times about the possibility of a person who has had an abortion suing their own doctor for emotional damages.

Kagan, meanwhile, argued that abortion providers are so afraid of a potential wave of lawsuits that the number of abortions has fallen by about half, according to health researchers at the University of Texas.

ADMIN PREPS FOR KID VACCINESThe White House Covid-19 Task Force said Monday 15 million pediatric Pfizer doses, which are one-third the amount of an adult dose, are being sent to distribution centers in preparation for the CDC’s recommendation, David Lim writes.

“Over the next couple of days, several million doses will start arriving at local pediatricians and family doctors offices, pharmacies, children's hospitals, community health centers, rural health clinics and other locations,” White House Covid-19 Coordinator Jeff Zients told reporters during a briefing.

“More doses will be packed and shipped and delivered each and every day over the next week or so,” said Zients, who added that the federal government has enough Pfizer vaccines to inoculate every child 5 to 11 years old.

“We're in great shape on supply, and the whole plan is based on Pfizer vaccines,” Zients said.

DOJ, RITE AID WORK OUT VAX PORTAL AGREEMENT — The Justice Department on Monday announced a settlement with Rite Aid aimed at helping people with disabilities book their Covid-19 vaccination appointments online.

The case, involving the U.S. Attorney’s Office for the Middle District of Pennsylvania, sprung from Rite Aid’s original vaccine registration portal, which attorneys argued was not accessible to people with disabilities including those who use screen reader software or can’t use a mouse.

Rite Aid through the settlement has agreed to make its Covid-19 information and scheduling forms accessible per the Web Content Accessibility Guidelines.

 

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In Congress

PROVIDERS LAUNCH KIDS’ MENTAL HEALTH CAMPAIGN — Children’s health groups this week launched Sound the Alarm for Kids , a $250,000 campaign to get lawmakers to pass legislation that improves mental health care access for children. Mental health emergencies among children have soared during the pandemic, the groups say.

Sound the Alarm for Kids — backed by the Children’s Hospital Association, American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatrists — includes digital ads in POLITICO and The Washington Post plus local radio spots.

LAWMAKERS INTRO BILL TARGETING COPAY CHANGE Reps. Donald McEachin (D-Va.) and Rodney Davis (R-Ill.) on Monday introduced a bill that aims to stop insurers from excluding cost-sharing assistance from counting toward a patient’s out-of-pocket maximum via copay accumulator adjustment programs.

The bill comes in response to a policy change during the Trump administration in the 2021 Notice of Benefit and Payment Parameters allowing insurers and pharmacy benefit managers to use such programs, David writes.

Around the Nation

NYC PUTS 9K ON UNPAID LEAVE AFTER VAX MANDATENew York City placed 9,000 city workers on leave without pay Monday as its coronavirus vaccine mandate for the public workforce kicked in.

In context: The overall vaccination rate for NYC workers surged to 91 percent after the Mayor Bill de Blasio signed the order, one of the most aggressive in the nation, POLITICO NY’s Erin Durkin writes.

But at least 21,000 city workers covered by the mandate remain unvaccinated: 9,000 who have now been barred from working, and another 12,000 who have applied for religious or medical exemptions. The latter group is being allowed to work until decisions on those exemptions are made in the coming days.

There are ongoing issues. First responder and uniformed agencies have some of the lowest vaccination rates, though they have climbed in recent days: 77 percent of firefighters have received at least one shot, 83 percent of Sanitation workers, 85 percent of the NYPD and 88 percent of emergency medical services.

The mandate has led thousands of firefighters to call in sick, heated protests by city workers, unsuccessful lawsuits and garbage piling up in a slowdown by sanitation workers.

But de Blasio said agencies are filling in the gaps with overtime and extra shifts. “We’re not seeing disruptions to any city services,” he said Monday. “People are picking up the slack.”

An exception: New York City Board of Elections employees and their contractors are exempt from full vaccination requirements until Nov. 30, when most of the heavy lifting for the Nov. 2 election will likely be completed the Board of Health ruled Monday.

Names in the News

Jason Ginenthal is now VP of healthcare media at FleishmanHillard. He most recently was a freelance PR consultant.

 

BECOME A GLOBAL INSIDER: The world is more connected than ever. It has never been more essential to identify, unpack and analyze important news, trends and decisions shaping our future — and we’ve got you covered! Every Monday, Wednesday and Friday, Global Insider author Ryan Heath navigates the global news maze and connects you to power players and events changing our world. Don’t miss out on this influential global community. Subscribe now.

 
 


What We're Reading

Afghan hospitals are struggling with staff shortages and lack of pay for overworked staff under Taliban rule, Samya Kullab and Bram Janssen report in The Associated Press.

A small group of doctors, some with undisclosed financial ties to Biogen , became vocal defenders of the company’s controversial new Alzheimer’s medicine Aduhelm in the press, Stat News’ Nicholas Florko reports.

Gilead is eyeing outpatient approval for Covid-19 treatment Veklury, an infusion currently administered only in the hospital — but that could be used earlier if cleared by the FDA, Ron Leuty writes in the San Francisco Business Times.

 

A message from PhRMA:

The most vulnerable patients face challenges.

3 in 10 Americans who have insurance still face a financial barrier to care.

We need to make the cost of medicine more predictable and affordable. That means covering more medicines from day one, making out-of-pocket costs more predictable, and sharing negotiated savings with patients at the pharmacy counter.

Learn more.

 
 

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