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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 Chelsea Cirruzzo and Ben Leonard | | | With Carmen Paun
| | |  President Joe Biden delivers remarks on July 25 about making it easier for Americans to get mental health care — and is now threatening to penalize insurers if they fail to treat mental and physical health equally. | MandelNgan/AFP via Getty Images | MENTAL HEALTH PARITY PUSH — The Biden administration is prepared to go after health insurers it says don’t follow the law mandating them to treat mental health care in the same way they do physical health care, Ben reports. And the White House is talking tough. The administration has proposed new rules it says will make insurers comply and threatens hefty fines if they don’t. Insurers are pleading innocent and, backed by some of America’s biggest companies, claiming the Biden plan could make an intractable problem worse. “We hope insurers will change their behavior going forward without the sticks, but we will continue to fully enforce the parity law,” Neera Tanden, head of President Joe Biden’s domestic policy council, told POLITICO. The administration says those ploys include requirements that doctors seek insurers’ approval before delivering mental health care, lower reimbursement rates for providers who treat mental illness and deliberate efforts to limit the number of in-network physicians available to patients. The history: The U.S. health care system historically treated mental and physical health care differently. Insurers didn’t typically cover mental health care until after World War II. John F. Kennedy was the first president to try to address parity in 1961, and both Presidents Bill Clinton and George W. Bush signed legislation with the aim of requiring insurers to treat mental and physical health equally. What’s different: The Biden administration’s proposal substantially expands the law Bush signed. It would mandate that insurers analyze the outcomes of their coverage to ensure there’s equivalent access to mental health care and take action to comply if they’re falling short. Insurers respond: AHIP, the lobbying group for insurers, says the situation is more complicated than Biden makes out and workforce shortages are behind barriers to access. “For years, health insurance providers have implemented programs and strategies to expand networks and increase access,” AHIP spokesperson Kristine Grow said in a statement. The administration has set a deadline for comments on its proposed rules for early October; insurers and their allies are asking for more time to respond. The ERISA Industry Committee, which represents large employers’ benefit interests, joined AHIP, among other associations, employers and health plans, in writing to administration officials to ask that the comment period on the proposed rules be extended. They warned that the rules could create “unnecessary burdens” for providers, insurers and patients and “unintentionally” impede access to care. WELCOME TO MONDAY PULSE. Capital Weather Gang declared summer over in D.C., and we’re thrilled to be done with the worst of the humidity. Fingers crossed. Reach us with tips, feedback and scoops at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo.
| | | | A message from PhRMA: Here’s another way insurance companies and their pharmacy benefit managers (PBMs) put their profits before your health. | | | | | POLITICO is hosting a health care event, Site-Neutral Payments & Billing Transparency, on Wednesday, September 20, starting at 8:30 a.m. ET. Join POLITICO to explore how site-neutral payments could reduce health care spending and whether bipartisan legislation that would align costs for services across hospitals and doctors' offices will survive a polarized Congress. | | TODAY ON OUR PULSE CHECK PODCAST, host Kelly Hooper speaks with Ben, who expands on his reporting about the Biden administration’s proposed rules aimed at making health insurers comply with a 2008 law requiring them to offer mental health care on the same terms as physical health.
| | | |  Dr. Mandy Cohen, the CDC's new director, is traveling the nation to regain Americans' trust in the agency. | Mike Stewart/AP Photo | COHEN ON ‘TRUST TOUR’ — New CDC director Mandy Cohen is continuing her predecessor’s work: restoring America’s trust, Chelsea reports. Cohen spent her first two months on the job telling audiences in New York, Wisconsin and Washington state that the agency has made mistakes, a mea culpa of sorts meant to show that she understands past shortcomings. “Trust is easily broken and, as folks know, trust takes time to rebuild,” Cohen told POLITICO. “It isn’t something you can fix overnight. I know that this is a long-term way of thinking about it.” The tour, which has several more stops ahead, comes as the Biden administration launches its Covid-19 vaccination drive and the CDC faces questions over its pandemic decision-making and messaging. She’s contending with growing vaccine skepticism fueled by some presidential candidates and public health officials and a public that has, for the most part, moved beyond Covid. Will it work? There’s reason to believe people are receptive to the administration’s message. More than half of voters are likely to seek out the newest Covid shot, according to new polling conducted by Morning Consult and POLITICO, including about 4 in 10 Republicans. On the horizon: Cohen will make the bid for Americans to get vaccinated in the weeks to come and has been meeting with lawmakers in Congress, including Republicans who’ve been critical of the CDC.
| | | | JOIN US ON 9/20 FOR A TALK ON TRANSFORMING HEALTHCARE BILLING: Bipartisan legislation in the House and Senate would align costs for services across hospitals and doctors’ offices and reduce out-of-pocket spending that could potentially save the federal government billions of dollars. Can this legislation survive a polarized Congress? Join POLITICO on Sept. 20 to explore this and whether site-neutral payments and billing transparency policies could help ease health care costs. REGISTER HERE. | | | | | | | | HEALTH PACKAGE HITS THE FLOOR — The House’s sweeping health care package focused on transparency will get a full House vote Monday night. The bill, dubbed the Lower Costs, More Transparency Act, also focuses on transparency requirements for hospitals, insurers and pharmacy benefit managers, which manage prescription drugs for health insurers. It would also boost community health center and graduate medical education funding and contains provisions on site-neutral payments, generic drugs and industry consolidation. A higher bar: The bill would need two-thirds of the House to pass since it’s being considered by the House under suspension of the rules. Republicans got substantial momentum for the bill in securing the support of House Energy and Commerce Committee ranking member Frank Pallone (D-N.J.) and a Congressional Budget Office estimate that the legislation would save more than $800 million over a decade. However, it didn’t get backing from the ranking members of the Ways and Means and Education and the Workforce committees, Reps. Richard Neal (D-Mass.) and Bobby Scott (D-Va.), respectively. Neal told Pulse he didn’t have a prediction on whether the legislation would reach the two-thirds threshold and lamented that it didn’t contain transparency provisions for private equity ownership in health care or “apply transparency equally to Medicare Advantage.” Timing: The vote series is scheduled to begin at 6:30 p.m., and the package is listed last among eight bills. It could be a late night for health policy watchers.
| | RESPIRATORY ILLNESS SEASON CHECKUP — The CDC expects this year’s respiratory illness season will be similar in severity to last year — which led to an estimated 300,000 to 650,000 hospitalizations — though some uncertainties remain, Chelsea writes. The agency released its forecast for the fall and winter last week, noting that, also like last year, hospitalizations are expected to be higher than before the pandemic — driven by the flu and respiratory syncytial virus. Last year, respiratory infections strained hospitals and led to calls from state leaders for people to vaccinate ahead of the holidays. And the agency warns that hospitalizations this season could potentially be higher than last year if a new Covid-19 variant that evades existing immunity emerges or if the flu season is more severe than expected. The flu and updated Covid vaccines are available through pharmacies and providers. Young children, older adults and pregnant people are also eligible to receive an RSV vaccine.
| | | | A message from PhRMA:   | | | | | ANOTHER MARK AGAINST CHINA — On Friday, the Biden administration updated the list of countries the U.S. designates as major drug transit routes and major producers of illicit drugs, Carmen writes. China joined the list for its role in supplying raw materials that end up in fentanyl mostly produced in Mexico. The addition is due to the 2023 National Defense Authorization Act changing the definition of major drug countries to include sources of precursor chemicals used to produce illicit drugs. “The PRC has been identified as a major source country due to this change in legislation, and the United States strongly urges the PRC and other chemical source countries to tighten chemical supply chains and prevent diversion,” the White House said in a memorandum. The Chinese embassy in the U.S. did not immediately respond to a request for comment. Afghanistan, which remains on the list, has made progress over the past year in reducing the cultivation of opium poppy and the production of illicit narcotics, the White House said. That’s due to the Taliban implementing a ban on the cultivation of opium poppy, which some analysts warn could have a negative impact on Afghans and lead them to seek refuge abroad.
| | Thomas P. Glynn has been appointed to Commonwealth Care Alliance’s board of directors. He’s an adjunct lecturer at the Harvard Kennedy School.
| | | | GO INSIDE THE CAPITOL DOME: From the outset, POLITICO has been your eyes and ears on Capitol Hill, providing the most thorough Congress coverage — from political characters and emerging leaders to leadership squabbles and policy nuggets during committee markups and hearings. We're stepping up our game to ensure you’re fully informed on every key detail inside the Capitol Dome, all day, every day. Start your day with Playbook AM, refuel at midday with our Playbook PM halftime report and enrich your evening discussions with Huddle. Plus, stay updated with real-time buzz all day through our brand new Inside Congress Live feature. Learn more and subscribe here. | | | | | | | | | AL.com reports that a major home health provider in Alabama is closing because the state hasn’t expanded Medicaid. KFF Health News reports that Social Security is demanding back millions in overpayments to beneficiaries. POLITICO Pro’s Lara Seligman and Joe Gould report on the Republican senator blocking hundreds of military promotions over an abortion policy few use.
| | | | A message from PhRMA: Your prescription might have different out-of-pocket costs at different pharmacies. Why? Because insurance companies and their pharmacy benefit mangers (PBMs) can make more money if you use the pharmacies they own. So they’ll try to steer you to what’s best for them, instead of what’s best for you. It’s another way that insurance companies and their PBMs put their profits before your health. See what else Middlemen are up to. | | | | | | | Follow us on Twitter | | | | Follow us | | | | |  |
