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Big Picture: The Broader Health Agenda in Congress

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Big Picture: The Broader Health Agenda in Congress

Monday, April 26, 2021
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We share this summary of a Politico Pro briefing to inform our members’ advocacy, so they can see how it fits within the broader policy and political climate in the nation’s capital.

1) There's an agenda beyond the pandemic.

Even as the pandemic response has consumed much of the administration’s first months, health officials have begun laying the groundwork for a broader health agenda focused on building out health coverage and making it more affordable.

The federal health department has already extended Obamacare’s enrollment period and poured new funding into outreach efforts, and Biden’s first major legislative package included provisions expanding and beefing up the Obamacare’s subsidies — the first major change to the health law since its passage in 2010.

Further boosting health coverage is likely to be a central focus over the next several months, alongside making insurance more affordable for most Americans. Biden officials in the administration’s early months have also placed a heavy emphasis on equity issues, in particular the need to tackle social determinants of health and boost access to health care for underserved communities.

But [Politico Pro reporter] Adam Cancryn noted the Biden administration has been slow to staff up, complicating efforts to build out a broader agenda beyond Covid. In key agencies like CMS and FDA, there are just a handful of political appointees and no confirmed agency heads.

2) Some of the administration's key goals require buy-in from Republicans.

The administration and its allies are trying to entice a dozen, mostly conservative-led states to expand their Medicaid programs. Biden’s coronavirus relief bill included new incentives, but so far, none of the holdout states appear to be budging.

[Politico Pro reporter] Rachel Roubien noted there's new friction over the Biden administration's decision revoke an extension of a Texas Medicaid program that funds health care for poor residents and was approved in the final days of the Trump administration. Congressional Republicans are harshly criticizing the decision and in the Senate, are slowing the nomination of Biden's pick to run the federal Medicare and Medicaid agency, Chiquita Brooks-LaSure.

3) But the Democrats could opt to go it alone on the infrastructure package.

What investments ultimately get included in the infrastructure package will depend heavily on whether Democratic leaders pick the bipartisan path to enacting Biden’s vision or resort again to the expedited budget reconciliation to sideline the GOP. And the prospects for bipartisanship are looking particularly dim now that Senate Republicans have unveiled a counteroffer that's far less than the more than $2 trillion proposal the president has proposed.

If Democrats decide to work toward a compromise with Republicans, [Politico Pro editor] Jen Scholtes expects the package to fund more traditional infrastructure like airports, roads, bridges, water ports and rail, as well as broadband and water projects. If they go it alone, she said that list is sure to be longer. Several of the president’s Cabinet secretaries have been challenging Congress to think beyond the traditional definition of infrastructure, advocating for the package to include investments in things like home health care and libraries.

Using the budget process to get a partisan package through the Senate still has its own limitations. Jen noted strict budget rules frequently quash major policy language, and it’s hard to predict what provisions the Senate parliamentarian might kill.

4) Democrats want drug price reforms in the infrastructure package.

Democrats still appear willing to take on the powerful drug lobby on the cost of medicines, despite the industry's prominent role developing vaccines and treatments to fight coronavirus.

House Democrats have revived Speaker Nancy Pelosi 's drug price control bill that the House passed in the last Congress to serve as a starting point for negotiations on the health portion of an infrastructure package. It would call for Medicare to negotiate costs of up to 250 of the most expensive drugs with pharmaceutical companies and impose big penalties for not reaching a deal on the price.

That proposal surely won’t fly in the 50-50 Senate, and the ultimate outcome might be something like a bipartisan drug pricing bill that was introduced last year in the Senate Finance Committee and is seen as more palatable to the drug industry.

5) Ending the pandemic and boosting the economy may be enough for Democrats heading into the midterms.

Within Democratic circles, Adam noted there’s a growing hope that ending the pandemic and successfully reviving the economy will provide Biden and Democrats in Congress with more than enough to run on for next year's midterm elections.

That’s eased the pressure to deliver on the some of the president’s more ambitious campaign vows, including passing a public option and expanding Medicare coverage. The administration instead has taken a more modest approach so far, expanding Obamacare’s subsidies and seeking ways to convince the remaining GOP-led states to expand their Medicaid program.”