Health Policy Report (10/5)

October 6, 2020

Over the weekend, Senate Majority Leader Mitch McConnell (R-KY) announced that votes for this week would be cancelled and the Senate adjourned after three Republican Senators — Sens. Mike Lee (R-UT), Thom Tillis (R-NC), and Ron Johnson (R-WI) — tested positive for COVID-19. Leader McConnell originally sought a consent agreement to meet in pro forma sessions until October 26, but Minority Leader Chuck Schumer (D-NY) objected, likely with an eye toward keeping vulnerable Senate Republicans in Washington and off the campaign trail. Due the new positive COVID-19 cases in the Senate, however, Leader McConnell will now try to reach that agreement again, though this time seeking pro forma sessions until October 19. While the difference between a pro forma session and adjournment is minimal, the latter does offer the minority protection against recess appointments by the President.

Meanwhile,Speaker Nancy Pelosi (D-CA) and Treasury Secretary Steven Mnuchin have ramped up their efforts to clinch a bipartisan COVID-19 relief agreement despite the uncertainty in the upper chamber’s schedule. Secretary Mnuchin has reportedly had conversations with Federal Reserve Chairman Jerome Powell on state and local aid as the Secretary and Speaker look to iron out their differences on one of the key sticking points in the relief negotiations. In a tweet earlier over the weekend, President Donald Trump — who was moved to Walter Reed National Military Medical Center last Friday following his positive COVID-19 case — urged lawmakers to “work together and get [relief aid] done.” While this fresh sense of urgency may produce a deal (given the increasing number of cases among officials in Washington), the two sides still have significant space between them on the overall size and scope of the package before an agreement can be clinched.

Prior to the end of last week, Transportation and Infrastructure Committee Chairman Peter DeFazio (D-OR) attempted to pass a bill by unanimous consent that would have renewed the airline Payroll Support Program (PSP) through next March, but the effort was blocked by House Republicans. The move to expedite this legislation signaled a shift in Speaker Pelosi’s opposition to moving standalone relief bills, possibly opening the door to a more targeted approach on the most pressing issues pertaining to the pandemic. Going forward, House lawmakers will receive 24 hours’ notice of any scheduled votes in the upper chamber over the course of this month and could convene as soon as this week if there is a deal.

Trump and Biden Clash Over Health Care, COVID-19 in First Presidential Debate

Last Tuesday night, President Trump and former Vice President Joe Biden clashed over how best to handle COVID-19 and health care reform in the first of three scheduled presidential debates. The presidential candidates focused the majority of time on criticizing the other’s actions and ideas, allowing few talking points on their own health care platforms to surface. Moderator Chris Wallace pressed the president on his plan for an alternative to the Affordable Care Act, to which President Trump responded that he had abolished the individual mandate and “guaranteed preexisting conditions.” The president went on to accuse Biden of supporting Medicare for All, stating he would extinguish “180 million people with private health care.” Additionally, the president pointed to his recent efforts to lower drug prices, stating he was “getting insulin so cheap it’s like water.” Biden countered that Trump had not lowered drug prices for anyone.

Additionally, the presidential candidates sparred over how best to handle the coronavirus pandemic. The president pledged that the administration’s Operation Warp Speed was “weeks away from a vaccine,” although Biden questioned how the American people could trust the president after “all the lies he’s told you about, the whole issue relating to COVID.” Biden stated that the president had “no plan” for pandemic response, and asked that the president listen to his own health officials and instate a mask mandate. President Trump countered that Dr. Fauci had, at some point, indicated masks weren’t important in reducing the spread of COVID-19, and said Biden was trying to “shut down the country.” It is currently unclear how President Trump’s recent positive COVID-19 diagnosis will impact future debates currently scheduled for October 15 and October 22.

Vulnerable GOP Senators Vote to Protect ACA from Trump Administration Lawsuit

Six Republican Senators last Thursday sided with Democrats in a procedural vote to block the Trump administration from supporting a lawsuit to dismantle the Affordable Care Act. Although the motion failed on a vote of 51-43 — a threshold of 60 votes was needed — the action was expected to fail and was seen as a ploy by Minority Leader Chuck Schumer (D-NY) to force Republicans to go on record with their support for the lawsuit. The Minority Leader stated that the vote, only three weeks before the election, highlights “the GOP’s hypocrisy in both trying to repeal the health law while also protecting coverage of preexisting conditions.” Sens. Susan Collins, (R-ME), Joni Ernst (R-IA), Cory Gardner (R-CO), Martha McSally (R-AZ), Dan Sullivan (R-AK), and Lisa Murkowski (R-AK) voted in support of the motion to bar the Department of Justice from supporting the lawsuit. All six of the Senators voted for the 2017 tax bill that set the latest Supreme Court challenge to the ACA in motion, and all but Sen. Murkowski are up for reelection this November. Minority Leader Schumer noted after the vote that other Republicans facing reelection had the “golden opportunity to prove they support protections for preexisting conditions, but they missed it.” Last Wednesday, Senate Republicans brought a bill by Sen. Thom Tillis (R-NC) to the floor that would require plans to cover people with preexisting conditions and would ban underwriting based on health status, but did not include other consumers protections like prohibitions on yearly and lifetime limits or requirements that plans cover the ACA’s 10 essential health benefits. The GOP bill stalled 47-47, with Sens. Ted Cruz (R-TX) and Rand Paul (R-KY) joining the Democrats in opposition.

National Academies Releases COVID-19 Vaccine Distribution Proposal

The National Academies of Sciences, Engineering, & Medicine released their final recommendations (report) last Friday on who should receive a successful COVID-19 vaccine first. The National Academies recommended that health care workers, emergency medical technicians, firefighters, and police officers should receive initial doses of a COVID-19 vaccine, to be followed by nursing home residents and vulnerable individuals with two or more serious health conditions. The report defines these serious health conditions as: cancer, kidney disease, chronic obstructive pulmonary disease, immunocompromised state due to organ transplant, obesity, serious heart conditions, sickle cell disease, and Type 2 diabetes. The report states that 100 million doses will be required for the first phase, which the Trump administration has reported they are capable of producing by the end of the year pending vaccine approval or emergency use authorization. Under that plan, 15 percent of the U.S. population would be able to be inoculated with a two-dose vaccine.

Under the second stage, covering about one third of the country, the following populations would be targeted: K-12 teachers; child care workers; essential workers at high risk of exposure; people with one serious health condition; the residents and staff of homeless shelters; the residents and staff of group housing for people with disabilities; people in jails and prisons; and all older adults. The report clarifies that each group should receive equal priority under this phase and will require 400 million doses for a two-dose vaccine. The third phase would target young adults under 30 years old, children, and other essential workers, and the fourth and final phase would target all other populations. Within each phase, the experts recommend prioritizing neighborhoods vulnerable to severe outbreaks because of race or poverty and recommend identifying these areas with the Center for Disease Control and Prevention’s “Social Vulnerability Index” or the “COVID-19 Community Vulnerability Index.”

The recommendations are not binding, and the CDC and National Institutes of Health (NIH) tasked an ad hoc committee with recommending a plan. Next, the CDC’s Advisory Committee on Immunization Practices will weigh the recommendations to make a final determination on guidance for how states and localities should distribute a successful vaccine. The recommendations make clear that many of the important questions surrounding distribution will fall to states and localities as issues arise.

BPC Report Tracks Federal Opioid Funding 

Last Wednesday, the Bipartisan Policy Center (BPC) released a report entitled “Tracking FY2019 Federal Funding to Combat the Opioid Crisis,” following federal funding aimed at combating the opioid epidemic. The report highlights how funding is being used at the state and local levels, and provides a deep dive in case-studies for Arizona, Louisiana, New Hampshire, Ohio, Tennessee, and Washington. The BPC found that the distribution of funding has remained steady, with money going to counties with the highest number of overdose deaths, however, they were unable to determine if the funds are being used efficiently and effectively within counties.

The report found that just a small percentage of the incarcerated population receives the standard of care for opioid use disorder, despite overdose deaths being the leading cause of deaths upon release from jails and prisons. States reported a lack of adequate long-term funding sources, access to community-based care upon reentry, and shortage of supportive housing. States also cited workforce shortages as a significant barrier to expanding treatment and noted a lack of data waiver physicians where vulnerable populations reside. Lastly, the report found that all states fund naloxone training and distribution, however, harm reduction programs, such as syringe services programs, tend to receive limited federal funding. While several states have passed laws allowing syringe services programs, the report found limited coordination between behavioral health and public health agencies