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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 Krista Mahr and Sarah Owermohle | | | With help from Alice Miranda Ollstein, Daniel Lippman and Rachael Levy 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.
| | | — The Supreme Court has voted to overturn landmark Roe v. Wade, according to a draft majority opinion obtained by POLITICO. WELCOME TO TUESDAY PULSE — People had already started to gather outside the Supreme Court late Monday night after POLITICO's story published. As always, send news and tips to kmahr@politico.com and sowermohle@politico.com.
| | | | A message from PhRMA: Nearly half of insured Americans who take prescription medicines encounter barriers that delay or limit their access to medicines. In a new report, learn more about the abusive insurance practices that can stand between patients and the care they need. | | | | | | | 
People had already started to gather outside the Supreme Court late Monday night after POLITICO's story published. | Anna Johnson/AP Photo | DOCUMENT: SCOTUS VOTED TO STRIKE DOWN ROE V. WADE — The Supreme Court has voted to strike down Roe v. Wade, according to an initial draft majority opinion written by Justice Samuel Alito circulated inside the court and obtained by POLITICO,scoop Josh Gerstein and Alexander Ward. “Roe was egregiously wrong from the start,” Alito writes in the document in a rejection of the landmark 1973 decision that guaranteed federal constitutional protections of abortion rights and a subsequent 1992 decision that largely maintained the right. “We hold that Roe and Casey must be overruled,” he writes. “It is time to heed the Constitution and return the issue of abortion to the people’s elected representatives.” Four of the other Republican-appointed justices — Clarence Thomas, Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett — voted with Alito in the conference held among the justices after hearing oral arguments in December, according to a person familiar with the court’s deliberations. That line-up remains unchanged as of this week. If the Alito draft is adopted, it would rule in favor of Mississippi in the closely watched case over that state’s attempt to ban most abortions after 15 weeks of pregnancy. It would overturn a decision by the New Orleans–based 5th Circuit Court of Appeals that found the state’s law ran afoul of Supreme Court precedent by seeking to effectively ban abortions before viability. The overturning of Roe would almost immediately lead to stricter limits on abortion access in the South and Midwest. Several states are set to immediately impose broad abortion bans. Democratic governors weighed in following the POLITICO report on Monday night, saying they would uphold the right to abortion in their state or fight the pending decision. “There will never be an abortion ban under my watch,” Minnesota governor Tim Walz wrote on Twitter. “The right to an abortion will be respected in Minnesota as long as I am in office.” The court’s holding will not be final until it is published. Justices can and sometimes do change their votes as draft opinions circulate. The exceedingly rare disclosure of a draft decision while a case is still pending is bound to intensify the debate over one of the most consequential cases before the court in the last five decades. Some of the key passages from Alito’s draft opinion:
- “We hold that Roe and Casey must be overruled. The Constitution makes no reference to abortion, and no such right is implicitly protected by any constitutional provision …”
- “The inescapable conclusion is that a right to abortion is not deeply rooted in the Nation’s history and traditions. On the contrary, an unbroken tradition of prohibiting abortion on pain of criminal punishment persisted from the earliest days of the common law until 1973.”
- “Roe was egregiously wrong from the start. Its reasoning was exceptionally weak, and the decision has had damaging consequences. And far from bringing about a national settlement of the abortion issue, Roe and Casey have enflamed debate and deepened division. It is time to heed the Constitution and return the issue of abortion to the people’s elected representatives.”
| | | | A message from PhRMA:   | | | | | | DEMS TORN ON COVID FUNDS AS REPUBLICANS SAY NO TO UKRAINE PAIRING — Democrats are uncertain how to get a long-stalled tranche of Covid funding through Congress amid Republican opposition to attaching the roughly $10 billion for new therapeutics and testing to a package of military aid for Ukraine that’s seen as a must-pass bill, Alice reports. The Ukraine package is widely viewed as Democrats’ best and possibly last chance to approve more funding to fight Covid-19 as cases rise again and the midterm elections draw closer. The White House and Democratic leaders on the Hill pleaded Monday for the two efforts to remain linked. “If Republicans continue to obstruct more funding now, then a few months from now, we could be in the terrible situation of not having vaccines to save lives, testing to monitor the disease and therapeutics to treat the disease,” warned Senate Majority Leader Chuck Schumer in a floor speech. Republicans were unmoved. Appropriations ranking member Richard Shelby (R-Ala.) told Alice Monday night that the GOP would “absolutely” oppose any effort to attach Covid funding to the Ukraine bill, and Sen. Jim Inhofe (R-Okla.) argued the Covid money would “dilute” the package and endanger its passage. Some moderate Democrats are siding with the GOP. In a letter to Hill leaders, Reps. Jared Golden (D-Maine), Jimmy Panetta (D-Cal.) and Kaiali'i Kahele (D-Hawaii) argue that the “unrelated” Covid funding “adds uncertainty and precious time to the process of passing this crucial aid” to Ukraine. Returning from her Ukraine trip on Monday night, House Speaker Nancy Pelosi declined to say whether Ukraine aid and Covid relief should be linked and instead emphasized the urgency of getting the military aid passed, according to POLITICO’s Andrew Desiderio. Democrats are expected to discuss how to move forward during today’s policy lunch.
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Many progressive groups and lawmakers are frustrated over the lack of progress on drug pricing reform. | FIRST IN PULSE: ADVOCACY GROUPS MAKE FRESH PUSH FOR DRUG PRICE REFORM — The group Patients for Affordable Drugs is launching a new, six-figure ad campaign to push the Senate to restart efforts on Medicare negotiation of drug prices, inflation caps and other cost controls the House passed last year and advance a bill by Memorial Day. The two 30-second digitalads, first shared with Alice, will run in the D.C. area over the next month. Many progressive groups and lawmakers are voicing frustration at the lack of progress made on health policy since Democrats’ sweeping “Build Back Better” package went off the rails last December. Patients for Affordable Drugs is among the groups arguing that drug price reform would be a political winner for Democrats in what’s expected to be a difficult election. FIRST IN PULSE: PROVIDERS, INSURERS SEEK PERMANENT ACA TAX CREDITS — Several major groups and insurers are asking Congress to make expanded tax credits under the American Rescue Plan Act of 2021 permanent so millions of Americans don’t lose affordable insurance once they expire at year’s end. Last year, ARPA expanded access to the Affordable Care Act’s advanced premium tax credits, ensuring no American would spend more than 8.5 percent of their income on health insurance premiums. It also made the credits more generous for low-income families. More than 14.5 million Americans took advantage of the new policy, enrolling in ACA marketplace coverage in 2022. The tax credits are due to expire on Dec. 31. In a letter to lawmakers on Tuesday , the Federation of American Hospitals, America’s Health Insurance Plans, the American Medical Association and others warned that “if Congress allows this deadline to pass, the lowest income enrollees could see their premiums increase from less than $1 per month to $26 per month.”
| | | | SUBSCRIBE TO NATIONAL SECURITY DAILY : Keep up with the latest critical developments from Ukraine and across Europe in our daily newsletter, National Security Daily. The Russian invasion of Ukraine could disrupt the established world order and result in a refugee crisis, increased cyberattacks, rising energy costs and additional disruption to global supply chains. Go inside the top national security and foreign-policymaking shops for insight on the global threats faced by the U.S. and its allies and what actions world leaders are taking to address them. Subscribe today. | | | | | | | | THIS IS THE DAY THE TRAVEL MASK MANDATE WAS SUPPOSED TO END — Today, May 3, is when the CDC said it would come back to Americans with an update on whether masks on public transportation were still needed, given the rising number of cases across the country. Instead, a Florida judge placed an injunction on the order and ended the mandate for everyone. The DOJ has appealed the decision, and now we wait to see whether it fights the case or tries to have the ruling vacated now that the injunction is moot. Watch this space.
| | | MIXED REVIEWS FOR CMS’ PLAN D EXTENSION — The Centers for Medicare and Medicaid Services is giving Part D plans an extra year to comply with a new rule the agency says will reduce drug costs, delivering a win to pharmacy benefit managers and some health insurers, Rachael writes. Part D plans will have until Jan. 1, 2024, to comply with a price concession provision at pharmacies, CMS said Friday, a year after the initial date the regulator originally proposed. Trade groups for pharmacists and health insurers applauded CMS’ decision to delay the rule. The Pharmaceutical Care Management Association, which represents pharmacy benefit managers, said the tweak would give plans “time to adjust.” AHIP said it appreciated the delay but was “disappointed” that CMS hadn’t withdrawn a larger proposal “to require all possible pharmacy price concessions to be included in a Part D plan’s point-of-sale negotiated price.”
| | | John Myers has joined the Hospital and Healthsystem Association of Pennsylvania as vice president of federal advocacy. He was previously director of federal government affairs at AstraZeneca. Mia Palmieri Heck is now director for federal health policy at Change Healthcare. She most recently was VP of external affairs and healthcare policy fellow at the Joseph Rainey Center for Public Policy and a Trump HHS and CMS alum. Maral Farsi is deputy director of legislative and governmental affairs at the California Department of Public Health. She most recently was deputy director for legislative and intergovernmental affairs at the California Governor's Office of Business and Economic Development. Kristi Henderson is now chair of the board of the American Telemedicine Association. Henderson is the CEO of Optum Everycare Now and has served on the ATA board of directors since December 2020.
| | | | 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. | | | | | | | | America’s dependence on Russia for uranium is prompting talks about building up that industry in the West and sparking fears of its toxic legacy, writes The New York Times’ Simon Romero. As federal and local Covid-19 mitigation measures end, Black and Latino Americans remain more cautious than their white counterparts, according to The Los Angeles Times.
| | | | A message from PhRMA: According to data just released, insurance isn't working for too many patients. Despite paying premiums each month, Americans continue to face insurmountable affordability and access issues:
- Roughly half (49%) of insured patients who take prescription medicines report facing insurance barriers like prior authorization and “fail first” when trying to access their medicines.
- More than a third (35%) of insured Americans report spending more in out-of-pocket costs in the last 30 days than they could afford.
Americans need better coverage that puts patients first. Read more in PhRMA’s latest Patient Experience Survey. | | | | | | | Follow us on Twitter | | | | Follow us | | | | |  |
