With Rachel Roubein
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— President-elect Joe Biden’s health agenda is about to get more ambitious, with Democrats on the verge of winning a pair of Georgia Senate races and control of the chamber.
— The nation’s Covid-19 vaccination effort is off to a dreadful start, as stretched health officials scramble to figure out what exactly is going wrong.
— The Trump administration will speed plans to distribute the Covid-19 vaccines in pharmacies, after badly missing its initial inoculation projections.
WELCOME TO WEDNESDAY PULSE — where you can forget about Georgia: the real divide in America is Team Baby vs. Team Baybi. Send tips and your favorite internet feuds to [email protected] and [email protected].
BIDEN’s HEALTH AMBITIONS JUST GOT BIGGER — If Democrats’ lead in a Georgia runoff holds, it would give Biden 50 votes in the Senate – and breathe a whole lot of life into his administration’s health care plans.
— The immediate impact: Biden gets his Cabinet. Adding Raphael Warnock and Jon Ossoff to the Senate means that suddenly Republicans’ threats to block HHS nominee Xavier Becerra from confirmation over his abortion rights record don’t mean much of anything. And that would go doubly for Neera Tanden, the Office of Management and Budget pick whose nomination many Republicans (and quietly, several Democrats) deemed dead on arrival just a few weeks ago.
Instead, they’d only need to convince 50 Democrats to back them, a process that a newly Democratic-controlled Senate will be eager to speed along.
— Dems would also get the gavels. Sen. Patty Murray – who has spent months advocating for a stronger federal Covid response – is in line to lead the HELP Committee if Democrats take power. And Sen. Ron Wyden is poised to run the powerful Finance Committee, where he’s been central to the push for sweeping drug pricing legislation.
— It would ratchet up expectations for Biden’s legislative agenda too. The president-elect would be able to pursue major legislation through reconciliation – the same process Republicans used in trying (and failing) to repeal Obamacare, and that Biden could conceivably lean on to further expand the health law.
A BUTTERFLY FLAPS ITS WINGS… When President-elect Donald Trump tapped then-Rep. Tom Price to be his HHS secretary, that opened the longtime GOP congressman’s seat in Georgia-06, a staunchly Republican district.
A year later, Price was out of politics, and a young Democrat named Jon Ossoff had become a national name, building a fundraising machine and polishing his political skills in a closely watched upset bid.
Now, the 30-year-old who lost the race to replace Price in 2017 is poised to be a 33-year-old Senator in 2021 — and the clinching vote if the chamber flips. Ossoff held a narrow lead over Sen. David Perdue at PULSE filing time.
Meanwhile, Warnock ousted Sen. Kelly Loeffler in a tight race, setting him up to be Georgia’s first Black senator. (And speaking of Price’s old seat, that’s now in the hands of Democrats too.)
VACCINATIONS — NOT VACCINES — ARE WHAT ENDS THE PANDEMIC, is the refrain that we’ve heard from public health experts for months. But judging by the last couple weeks, the United States totally missed the memo.
After researchers developed a pair of Covid-19 vaccines in record time, the nationwide deployment of those shots to date has been nothing short of chaotic.
States are scrambling to rework their distribution plans on the fly. Pharmacists are racing to use up all of their doses before they spoil, resorting at times to simply handling them out to passersby. And Americans are struggling to figure out when they can get the vaccine and from where, with some seeking help from their local newspapers.
Of the 17 million doses that the Trump administration has shipped out, just 4.8 million have made it into arms — a calamitous start that’s left health officials frustrated and searching for answers, POLITICO’s Rachel Roubein, Brianna Ehley and Sarah Owermohle report.
IT’S A ROLLOUT SHORT ON LEADERSHIP — not supply, say state officials who complained of a vacuum of federal support and mounting responsibilities heaped on overworked local health staff already dealing with record numbers of new cases.
Indeed, Trump officials insist it’s not their responsibility to manage a vaccination process that must occur at the ground level. That’s left America to rely on patchwork procedures guided by underfunded state health departments—and little clarity on how the most ambitious inoculation campaign in U.S. history gets back on track.
“What we need from the federal government is for them to have started vaccine distribution planning much earlier in the year last year,” said Casey Katims, a federal liaison for Washington state.
BUT THERE’S STILL TIME FOR A RECOVERY, and a senior HHS official late Tuesday signaled a new urgency on the federal level, telling Rachel the administration is accelerating plans to offer shots in pharmacies.
As many as 6,000 pharmacies could start administering vaccines in the next two weeks under the strategy, which relies on partnerships with private pharmacy chains. Federal officials will also start to encourage states to move beyond health care workers and vaccinate other priority groups.
It’s a shift that comes amid increasingly harsh scrutiny of the sluggish vaccine distribution process and, more importantly, a mounting human toll: Covid-19 deaths approached 3,500 on Tuesday, and “the next few days are likely to be worse,” the COVID Tracking Project tweeted.
HOSPITALS DRAG THEIR FEET OVER TRUMP’s TRANSPARENCY ORDER — The Trump administration’s new mandate that hospitals publish the secret rates they negotiate with insurers kicked in on Jan. 1. But many hospitals still aren’t posting their prices – and of those that are, the information is often vague or hard to decipher, POLITICO’s Susannah Luthi reports.
The slow compliance is frustrating data analysts’ efforts to make sense of the new trove of data, and raising new questions about how the industry will approach one of the administration’s few signature health care accomplishments.
— Hospitals already spent months fighting the transparency requirement in court, warning it could disrupt their delicate negotiations with insurers. But they lost late last year, clearing the way for rules that say hospitals must publish prices for 300 common services – and make that data easy for patients to understand.
The policy has received bipartisan praise, with policy experts hopeful it will help drive down health costs and expose the industry’s most egregious pricing practices.
— But the penalty for noncompliance is relatively small—just $300 a day, which is unlikely to concern the nation’s largest hospitals. Just one-third of the top 20 hospitals so far have posted visible lists, and it’s unclear how quickly the industry will move with the Trump administration on its way out and little clear signal how the incoming Biden administration will view the mandate.
HHS ‘CLARIFIES’ STANCE ON DISTILLERIES — The department on Tuesday posted a notice that further shields distilleries that made hand sanitizer during the pandemic from FDA fees.
The department moved quickly on New Year’s Eve to reverse those fees, saying that they punished do-gooders and that FDA levied the fees without securing approval from the secretary. FDA allies have complained that the move undermines the agency’s ability to collect user fees and fund its public health agenda.
— How analysts see the new move: “The legal logic here is amazing,” Alec Gaffney of AgencyIQ wrote in a series of tweets, analyzing the notice. “Basically, HHS wants to argue that despite the fact that distillers are making an OTC drug in accordance with an FDA monograph, they aren’t *really* drugmakers because that’s not how the public sees them.”
Gaffney predicted that despite the “factually tortured” notice, the distilleries would end up avoiding user fees.
— How HHS views it: “There was a burning issue on Dec. 31, take care of the bills,” a senior HHS official told PULSE, noting that distilleries were still on the hook for additional fees into 2021. “We knew we’d have to come back and address these lingering issues to ensure the protections continue as the pandemic did.”
The resulting notice, drawn from conversations with advocates for the distillery industry, is also intended to protect businesses if they want to keep making sanitizer. “If a [public health emergency] for Covid exists, you’re going to be protected,” the official added.
MEANWHILE: JOE KENNEDY’s NEXT STEPS? — The Massachusetts Democrat spoke with PULSE on Tuesday as he begins his new life post-Congress, after unsuccessfully challenging Sen. Ed Markey last year.
— Kennedy signaled he’s likely to take some role in mental health advocacy and reform, saying there are “enormous opportunities” to focus on systemic change, particularly given the pressures of the pandemic.
“I’m excited to wrap my arms around this in ways that I couldn’t do as a member of Congress, where you’re pulled in so many directions,” Kennedy said. “This is an area of our health care system that, to this day, is woefully overlooked.”
— But Kennedy demurred about the timing of his new portfolio, saying he’s only now starting to consider a range of options, hours after leaving the House. “My priority is doing it right, not quick,” he told PULSE.
— Reflecting on his time in Congress, Kennedy pointed to standout moments like grilling HHS officials over their claims that Medicaid work requirements improved health — evidence that the Trump administration never produced, Kennedy notes.
“It was an extraordinary opportunity once you learned how to use it,” Kennedy says. “If you could structure the questions right, you could expose them.”
He also reflected on the 2017 ACA repeal fight that catapulted him to national attention, including a clash over GOP efforts to repeal mental health protections — crediting then-E&C aide Rachel Pryor for the tip — and a much-viewed statement where he bashed then-Speaker Paul Ryan’s assertion that ACA repeal was an “act of mercy.”
“There is no mercy in a system that makes health care a luxury,” Kennedy said that day. “There is no mercy in a cold shoulder to the mentally ill.”
New York’s largest health system sued more than 2,500 patients over medical debt during the pandemic, in defiance of a statewide order to stop the practice, The New York Times’ Brian Rosenthal reports.
For Stat, Erin Brodwin and Casey Ross detail the backstory of how Haven suffered “one of the most stunning collapses in modern health care history.”
In her newsletter Sick Note, Libby Watson interviews a hospice worker about death, dying and the intricacies of Medicaid.