Sparring over high-risk health coverage

By Chelsea Cirruzzo and Ben Leonard

With Carmen Paun

Republican Rep. Brad Wenstrup (R-Ohio) (pictured) has teamed up with Rep. Earl Blumenauer (D-Ore.) on a bill to update high-deductible health savings accounts. | Amanda Andrade-Rhoades/AP Photo

DIVISION OVER HIGH-DEDUCTIBLE PLANS — Lawmakers want to update high-deductible health plans coupled with health savings accounts — now 20 years old — to make it easier for patients to access care, Ben reports.

The plans, which already enroll more than 60 million people, offer low premiums and tax breaks but require patients to pay more toward their care before benefits kick in. The plans have taken off even more than some of their designers had expected.

“We knew that the market could be electric. We just didn’t know how much current would be flowing through those wires,” said Joel White, a health care lobbyist at the Health Innovation Alliance who helped draft the language creating high-deductible health plans in the 2003 Medicare Modernization Act when he was a Republican Ways and Means Committee aide.

The House Ways and Means Committee advanced proposals to allow pre-deductible coverage of telehealth and chronic conditions with strong bipartisan votes. The push to allow the plans to cover more expenses has drawn support from some Democrats, who think the changes can make care more affordable.

“The government should be focusing on enhancing care, rather than burdensome requirements for the providers who care for patients,” said Rep. Brad Wenstrup (R-Ohio), who’s teamed with progressive Oregon Democrat Earl Blumenauer on a bill to expand benefits.

But some Democrats, like Ways and Means Health Subcommittee ranking member Lloyd Doggett (D-Texas), worry the plans would still pose financial and medical risks for low-income employees who can’t afford to pay their deductibles and would skip care as a result. Doggett believes the legislation would mainly benefit the wealthy and undermine the Affordable Care Act by offering inadequate coverage.

“The idea is to provide larger and larger tax shelters,” Doggett told POLITICO.

The bigger picture: The proposed changes reflect the new state of play on health care for Republicans, who have turned away from efforts to repeal Obamacare but see high-deductible plans as a way to boost market forces in the system.

The proposed changes moving through the House would retain another benefit Republicans favor: High-deductible plans aim to discourage people from seeking unneeded care, reducing health care costs, which lowers inflation.

The division over the plans is a familiar argument on Capitol Hill that’s playing out again.

What’s next: The full House is expected to vote on the bills after Congress returns from its August recess.

WELCOME TO FRIDAY PULSE. Last year, a turbulent respiratory illness season swept the nation. This time around, we have shots for Covid-19, RSV and the flu. Yes, Covid is still out there and hospitalizations are spiking. Do you have thoughts or questions about how officials are preparing for and handling respiratory illnesses this fall/winter? Email us!

Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard and @ChelseaCirruzzo.

TODAY ON OUR PULSE CHECK PODCAST, host Megan Messerly talks with POLITICO global health reporter Carmen Paun about her Q&A with John Bell, the former U.K. testing czar, who says that governments should increase disease surveillance, develop routine adult vaccination programs and build clinical trial networks in Africa to better prepare for the next pandemic.

While Americans have shown interest in weight-loss drugs, their costs will likely be prohibitive for many. | M. Spencer Green/AP Phioto

HIGH COST OF OBESITY DRUGS — Popular weight-loss drugs are much more expensive in the U.S. than in other parts of the world, according to a new analysis by KFF.

More and more people are seeking buzzy drugs like Ozempic and Wegovy, but most will have to pay out of pocket to buy them — and the price is steep.

In the U.S., the cost of Ozempic could run a patient $938 a month, the highest cost in the world. The second highest list price is in Japan at $169 monthly.

As for Wegovy, U.S. patients pay $1,349 a month compared with just $328 in Germany.

What to watch: About half the adults in the U.S. would be interested in prescriptions for weight-loss drugs, another recent KFF poll found, but that interest drops to 16 percent if a person’s insurance company won’t cover it.

While a set of bills in Congress would direct Medicare to cover weight-loss drugs, private insurers aren’t going for it just yet, POLITICO’s Daniel Payne previously reported.

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LAG IN FREE VACCINES FOR UNINSURED — The Biden administration’s efforts to provide free Covid-19 vaccines to the uninsured won’t start at retail pharmacies until mid-October, weeks after an updated version of the shot is expected to be available to the broader public, POLITICO’s Adam Cancryn and David Lim report.

What it means: Millions of uninsured Americans won’t immediately be able to get a no-cost vaccine at popular pharmacies like CVS and Walgreens, while the shot will be widely available for people with insurance.

Instead, they will need to go to federal health centers or individual providers for free vaccines during the first stage of the fall vaccination campaign. That adds a layer of complexity, public health officials warn, that could discourage people from getting the shot — despite rising cases and hospitalizations in recent weeks.

Background: The Department of Health and Human Services announced in April a $1.1 billion “bridge” program to offer the uninsured continued access to free Covid vaccines and treatments at least through the end of 2024.

But with roughly a month to go before the vaccine rollout, the CDC has yet to finalize contracts with companies like CVS and Walgreens, which would allow them to distribute the free vaccines.

The agency expects the updated vaccine’s initial rollout to begin the third or fourth week of September, a spokesperson said, but the contracts with pharmacies will likely not be finished until mid-October.

USING TECH TO REVERSE ‘UNACCEPTABLE’ HEALTH OUTCOMES — The White House’s Office of Science and Technology Policy and the Office of Management and Budget are asking agencies to prioritize certain public health priorities related to cancer, antibiotics and infectious diseases in funding requests.

A memo sent Thursday from OMB Director Shalanda Young and White House science adviser Arati Prabhakar to agency heads outlines federal research and development priorities for the fiscal 2025 budget requests to OMB.

Among priorities, agencies are directed to use research activities to “achieve better health outcomes.”

“Current U.S. health outcomes are unacceptable. Science, technology, and innovation must open pathways to reverse the course,” the memo says.

The memo lists broad guidance for research and development activities that agencies might propose, including:

— Funding activities to assist President Joe Biden’s cancer moonshot initiative, with a focus on early detection, novel therapies and prevention

— Addressing antibiotic resistance as well as identifying and eliminating infectious outbreaks

— Preventing exposure to harmful chemicals, including lead and per- and polyfluoroalkyl substances

— Mitigating health efforts on climate change, particularly for communities that are disproportionately impacted

FORMER GAVI CEO JOINS BROWN’S PANDEMIC CENTER — Seth Berkley, who led Gavi, the vaccine alliance, for 12 years, will join Brown University Pandemic Center as a senior adviser starting Sept 1. Berkley will also serve as adjunct faculty in the Department of Epidemiology at the Brown University School of Public Health, Carmen reports.

Berkley stepped down as CEO of Gavi in early August, following the end of two terms at the helm of the organization, which negotiates vaccine prices for the poorest countries. Berkley was heavily involved in getting Covid-19 vaccines to low-income countries as part of the global vaccine equity effort COVAX.

The search for his successor continues, as Muhammad Ali Pate, who was chosen to lead the organization after Berkley, ultimately turned down the job to become Nigeria’s health minister.

NEW YORK WATER PROBED FOR BACTERIA — A Long Island resident has died after contracting the bacterial infection vibriosis, New York Governor Kathy Hochul said Wednesday. The infection most commonly results from eating raw or undercooked shellfish or exposing a wound to seawater, according to the CDC.

State health officials are investigating the death to determine whether the bacteria came from New York waters or elsewhere. Two Connecticut residents died in July after being infected with the bacteria, the Connecticut’s health department said Tuesday.

Elizabeth Holcomb has been promoted to director of the office of health strategy and coordination. She was previously its deputy director.

Jorge Zurita-Coronado is now adviser for strategic planning in HHS’ Office of Public Affairs. He most recently was special assistant and briefing book coordinator to the secretary at HHS.

KFF Health News reports on how Florida hospitals are reacting to a state law requiring them to ask about their patients’ immigration status.

The Washington Post reports on the challenge of finding free Covid tests in the U.S.

NBC News reports that hospitals are spending exponentially more on cancer drugs amid drug shortages.

Bloomberg reports that the Pentagon has created a team to assess emerging biothreats.

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