The court decision that could defang federal health agencies

From: POLITICO Pulse - Friday Jun 10,2022 02:01 pm
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By Sarah Owermohle and Krista Mahr

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QUICK FIX

A looming Supreme Court decision could have massive health care ramifications, and it’s not the Roe v. Wade one.

But speaking of Roe: The president’s options for executive action are limited.

The intellectual property waiver is on awkward ground as supporters go quiet ahead of a key World Trade Organization meeting.

WELCOME TO FRIDAY PULSEICYMI: The Jan. 6 hearings began last night. Send news and tips to sowermohle@politico.com and kmahr@politico.com.

 

A message from PhRMA:

New data show that 35% of insured Americans spent more on out-of-pocket costs than they could afford in the past month. Read more about how insurance is leaving patients exposed to deepening inequities.

 
Driving the Day

The Supreme Court is pictured.

A looming Supreme Court decision on environmental policies could reverberate across health agencies. | AP Photo

HOW SCOTUS COULD UNRAVEL AGENCY AUTHORITIES — The Supreme Court is expected to issue a ruling this month hobbling the Biden administration’s efforts to rein in greenhouse gases — but its impact could weaken Washington’s power to oversee wide swaths of American life well beyond climate change.

The upcoming decision on the Environmental Protection Agency’s climate oversight could reverberate across federal agencies as the court assesses what the bureaucracy can do without explicit congressional directions — impacting everything from Obamacare protections to health-equity efforts.

“A narrow reading of what the federal agencies can do is going to literally handcuff the federal government from taking action to protect Americans’ health safety and the environment,” said Lawrence Gostin, a public health law professor at Georgetown University.

What could happen: Legal experts on both sides of the issue widely expect the court to side with conservatives by saying the Obama-era EPA had gone too far. But the big mystery is whether the court’s majority is prepared to go big — and open the door to a judicial crackdown on the executive branch.

The courts have never precisely defined where the line between legislative and executive power lies. But they’ve repeatedly cited a “major questions” principle to knock down executive branch actions they think went too far. That includes prior decisions on tobacco regulation and, more recently, pandemic-era vaccine-or-test mandates and eviction moratoriums.

What it could mean: The Health and Human Services Department is already defending decisions related to payments through the 340B program and Affordable Care Act–mandated contraceptive coverage requirements, both of which could be harder cases to win without deference to agency interpretations. But if the Supreme Court goes big and curtails executive branch authority, a wave of new legal challenges to Obamacare, health justice initiatives and even drug approvals could crash.

POLITICO’s Alex Guillén and Sarah break down just some of the battles that could happen .

WHAT CAN BIDEN REALLY DO ON ABORTION? President Joe Biden says he’s looking at ways to shore up abortion rights if the Supreme Court overturns Roe v. Wade in the coming weeks. The problems: Legal experts say he can do little to stop states that want to outlaw the procedure.

The president is looking at executive orders, he said on Jimmy Kimmel Live! Wednesday night, though he avoided specifics on what those would entail. Echoing Democratic congressional leaders, Biden largely focused his remarks on electing more abortion-rights supporters to Congress in the November midterms.

Yet, many Democratic officials and abortion-rights activists fear the party is unlikely to pick up enough seats in the midterms to pass comprehensive abortion-rights legislation. And even if it can, many fear that waiting until a new Congress is seated in January will be too late to prevent the harm they expect if tens of millions of people lose access to abortion.

What he can do: The administration could make it easier to obtain abortion medication, protect patient privacy and ensure affordable and accessible contraception options, according to lawmakers and abortion-rights groups.

White House spokesperson Alexandra LaManna told POLITICO in a statement that the administration is looking at “every possible option” and “believes we should defend the right of all Americans to make their own decisions.”

The White House has repeatedly said it’s waiting for a Supreme Court ruling, which could happen as early as next week, before the administration rolls out any response — angering Democrats at both the state and federal levels who want to see Biden take a stronger and more proactive stand.

“We knew this was coming and, nationally, didn't have a plan,” fumed Rep. Elissa Slotkin (D-Mich.) in an interview with POLITICO. “Part of my frustration is with, frankly, some of my own colleagues and peers. The other side for 50 years has had a legal strategy — where is our 50-year strategy?”

 

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Ngozi Okonjo-Iweala walks outside of the International Monetary Fund building.

World Trade Organization Director-General Ngozi Okonjo-Iweala is championing a vaccine patent waiver. | Jose Luis Magana/AP Photo

THE VACCINE DIPLOMACY BALANCE — A year after President Joe Biden won applause from fellow Democrats for supporting a waiver of patent protections on Covid-19 vaccines … not much has changed.

The proposal brokered by World Trade Organization Director-General Ngozi Okonjo-Iweala is getting little love from advocacy groups that once championed the idea, POLITICO trade reporter Doug Palmer writes. On the other side, the pharmaceutical industry continues to oppose an agreement, calling it harmful to drug innovation and unnecessary at this point to beat back the pandemic.

The path to a final deal is extremely uncertain just days ahead of the WTO’s Ministerial Conference next week in Geneva. Both sides fear political pressures are forcing negotiators into an agreement that neither sees as beneficial. But failure to reach any deal would also underscore the WTO's reputation for being unable to overcome its dysfunctions to respond to global challenges.

Congressional proponents of a broad waiver of intellectual property protections for vaccines — including House Speaker Nancy Pelosi, Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) and Reps. Jan Schakowsky (D-Ill.), Earl Blumenauer (D-Ore.) and Rosa DeLauro (D-Conn.) — have been mostly silent about the deal that’s shaping up.

A solution without a problem: One big question is whether a deal is needed, given the rapid expansion of patented vaccine production over the past year.

“There are enough vaccines being produced to give one to every single person that wants one,” said Clete Willems, a former Trump White House official now at the Akin Gump law firm. “The problem is not enough people want them. And the problem is that distribution channels are not as good as they could be for people who do want them but can't get them.”

 

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eHealth

NATIONAL HEALTH RECORD DATABASE? — Oracle chair Larry Ellison pledged to solve health care’s data fragmentation problems by developing a national electronic health records database, POLITICO’s Ben Leonard and Ruth report.

“We’re building a system where all American citizens’ health records not only exist at the hospital level, but they also are in a unified national health records database,” Ellison said at an event following the company’s closing of a $28.3 billion deal to acquire electronic health record giant Cerner. “That national database solves the electronic health record fragmentation problem.”

The database would allow providers to more easily track down patient data across systems by constantly updating health records in the database, Ellison said.

Needless to say, the proposal is very ambitious. Efforts to boost data-sharing with the aim of bolstering patient outcomes have been tried for decades. Plus, it’s unclear how or whether the database will go beyond the company’s own clients. It also poses questions about how the company will navigate the legalities of inter-health system data sharing.

The U.S. also doesn’t have a national patient identifier, rendering it hard to match patients’ records from different systems with each other or tell the difference between two people with the same name.

Names in the News

Hilary Marston has left the White House after a yearlong detail as senior policy adviser for the global Covid response, a White House official confirmed. Marston is expected to return to a senior role within the health department.

The Senate on Thursday confirmed Samuel Bagenstos to be general counsel of the Health and Human Services Department. Bagenstos will move to HHS from the White House Office of Management and Budget, where he also served as general counsel. He is a former law professor and longtime civil rights lawyer.

Ro Health General Counsel Adam Greenberg is departing for Blank Street, a venture capital–backed coffee-shop startup popular with the tech set. While at Ro, Greenberg was particularly interested in shaping public policy to support asynchronous telemedicine visits. In his wake, Amy Westergren and Lisa Eisenberg will be promoted to associate general counsel.

 

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.

 
 
What We're Reading

People in jail with serious mental illnesses are waiting months to years to receive the psychiatric care that could help them stand trial, delaying treatment but also due process, Kaiser Health News’ Andy Miller and Rebecca Grapevine report.

CMS on Wednesday fined two Georgia hospitals for failing to disclose their prices, the first time it’s enforced a price transparency rule launched last year, The Wall Street Journal’s Anna Wilde Mathews, Melanie Evans and Tom McGinty report.

Public support for stricter gun laws remains high even though Republican support has slightly faded, according toa new Morning Consult and POLITICO survey.

 

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.

 
 

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