The thinking behind the Biden administration's new covid playbook

The thinking behind the Biden administration’s new covid playbook


Good morning, and happy Wednesday. The top of today’s newsletter is excerpted from a story out this morning from The Post’s Dan Diamond.

Today’s edition: Our top takeaways from Pennsylvania’s Senate debate, a key state that could determine which party controls the chamber. Medicaid enrollment growth is expected to decline next year. But first…

Officials say they’ve exhausted their ideas for reaching the vaccine-hesitant

President Biden‘s health officials rolled out their “fall playbook” to combat the coronavirus yesterday.

The impetus? Projections that tens of thousands of Americans could die if they don’t get free coronavirus shots or treatments.

White House Chief of Staff Ron Klein summoned federal health officials to a meeting last week to hash out what they could do to stop such preventable deaths, The Post’s Dan Diamond reports. The strategy that emerged included steps like renewing efforts to target seniors for shots to enlisting Walgreens, DoorDash and Uber to provide free delivery of covid-fighting pills.

The episode underscores health officials’ private worries over limited funding to combat the virus, worn-down front-line health workers and many Americans’ hostility to covid precautions ahead of a potential winter surge. Several health officials told Dan that they’re bracing for 30,000 to 70,000 deaths over the course of the winter, many of which could be avoided with vaccines and treatments.

  • “This year, nearly every death is preventable. Let me say it again: Nearly every death is preventable,” Biden said in remarks shortly before he got his updated booster shot.

It’s been nearly three years since the coronavirus started tearing through the country. And local and national officials told Dan that they’ve effectively exhausted all their ideas for reaching those resistant to the vaccine and are instead focused on protecting vulnerable Americans who want to get the shots.

The administration is again attempting to increase awareness of tools like Pfizer’s Paxlovid and the reformulated booster shot targeting more recent omicron subvariants. This includes fanning out to events in person and online; launching new ads targeting rural, Black and Latino populations; and urgent health providers to reach out to their patients about getting vaccinated.

But some outside experts have said officials should have done more earlier, and pointed to missteps in messaging. Most recently, it was when Biden declared “the pandemic is over,” a comment that his deputies rushed to clarify. Four covid experts who advised Biden’s transition team wrote in a New York Times op-ed that they are “deeply dismayed by what has been left undone.”

  • “There were many opportunities that would have permanently improved American health and the public health system. They have not yet been pursued,” Ezekiel J. Emanuel, David Michaels, Rick Bright and Michael T. Osterholm wrote last week. They faulted Congress for failing to authorize more dollars for the pandemic response, as well as the federal government for not prioritizing indoor air quality earlier on.

David Michaels, epidemiologist and professor at the George Washington University’s public health school:

Earlier this year, White House officials’ frustration with Health and Human Services Secretary Xavier Becerra had prompted internal conversations about potentially replacing the secretary, Dan, Yasmeen Abutaleb and Tyler Pager reported. Some administration officials also blamed Becerra’s team for some stumbles over monkeypox this summer, and there’s been growing speculation that the nation’s top health official would leave after the midterms to pursue political opportunities in California, a state he represented in Congress for years.

But Becerra’s spokesperson, Sarah Lovenheimsaid he has no plans to go anywhere, and is looking forward to implementing the Inflation Reduction Act and seeing out his agenda.

Meanwhile, some officials had also discussed whether Rochelle Walensky, the head of the Centers for Disease Control and Prevention, would leave after the midterms, three officials, who spoke on the condition of anonymity to discuss sensitive conversations, told Dan.

A spokesperson for Walensky referred The Post to an interview the CDC director did on CNN earlier this month. She was touting her plan to reform the agency and vowed to stay to oversee it.

Officials have been wary about signaling their unhappiness with the two officials, Dan told The Health 202, noting that prior reports about White House frustrations with Becerra inadvertently strengthened support for the health secretary and made it more difficult to fire him. Biden also has been loath to fire senior officials, preferring that they leave of their own accord.

Read the full story here.

Top takeaways from the Fetterman-Oz showdown

Democrat John Fetterman and Republican Mehmet Oz clashed last night over abortion and other key issues in the only debate scheduled in the Pennsylvania Senate race, Colby Itkowitz and Amanda Morris report.

The event featured closed captioning at the request of Fetterman, whose doctors have said he is dealing with symptoms of an auditory processing disorder since suffering a stroke in May. Fetterman’s health has increasingly become a focal point of both campaigns in the final stretch before the midterm elections in a state that could decide which party controls the Senate.

Here are three key moments from the debate:

1. Republicans immediately jumped on Fetterman’s performance, highlighting clips where the candidate misspoke or did not answer clearly, The Post’s Dylan Wells reports. During the debate, Fetterman at times stumbled over his words and struggled with some of the rapid-fire format — and he sought to stave off criticism from the get-go by appealing to voters’ empathy.

Fetterman defended his fitness for office in response to a question about why he wouldn’t release his full medical records, saying his doctor believes he’s able to serve.

2. Oz declined to support a federal 15-week ban on abortion introduced by Sen. Lindsey Graham (RS.C.). But Democrats immediately hit the Republican nominee for a statement mentioning the involvement of local leaders in making decisions on abortion.

“I don’t want the federal government involved with that at all,” Oz said. “I want women, doctors, local political leaders leading the democracy that’s always allowed our nation to thrive to put the best ideas forward so states can decide for themselves.”

3. Oz defended his years as the host of the “Dr. Oz” medical show where critics say he promoted dubious, miracle cures for weight loss and other illnesses. “I never sold weight loss products as described in those commercials,” Oz said, referring to ads that allege he made a profit off the supplements he promoted.

Pennsylvania Senate candidates Lt. Gov. John Fetterman (D) and Mehmet Oz (R) squared off in their first and only debate in Harrisburg, Pa., on Oct. 25. (Video: JM Rieger/The Washington Post)

KFF: Medicaid enrollment expected to slow down next year

Growth in Medicaid enrollment slowed in fiscal year 2022 compared to the year before and is expected to continue its decline into next year, when state Medicaid agencies anticipate that the covid-19 public health emergency (PHE) will expire, according to a new survey from tea Kaiser Family Foundation.

The projections follow steep gains in enrollment since 2020which were largely driven by a federal pandemic policy that increased the federal matching rate for Medicaid payments to states so long as they agreed not to remove anyone from the safety net program for the duration of the PHE.

By-the-numbers: Medicaid enrollment rose sharply in fiscal 2021, increasing by 11.2 percent that year. State Medicaid agencies report that growth slowed in fiscal 2022 to 8.4 percent and forecast a 0.4 percent enrollment decline in fiscal 2023 based on the assumption that the PHE and continuous enrollment requirement will end by the middle of next year.

  • Along with the rise in enrollment, total Medicaid spending, which includes state and federal funds, is expected to reach a peak growth rate of 12.5 percent in fiscal 2022 and slow to 4.2 percent in fiscal 2023 — but states expect a sharp growth in their share of the pie. State Medicaid agencies identified an increase in enrollment as the most significant factor driving spending hikes.

The ACA’s preventive care requirement could be at risk

Plaintiffs in an Affordable Care Act lawsuit are expanding the scope of their case, asking a federal judge to toss out all parts of the law requiring employers to provide their workers with coverage of preventive health services at no cost to patients, Axios reports.

What’s happening: In a motion filed late Monday, plaintiffs in the closely watched case asked US District Court Judge Reed O’Connor to rule that the entire ACA requirement is unconstitutional because it mandates that most commercial plans cover services recommended by the U.S. Preventive Services Task Force. The group of Texans argues that, because the task force was never appointed by Congress, it lacks the authority to decide which services employers have to cover under the Constitution’s Appointments Clause.

Key context: O’Connor ruled in favor of the plaintiffs last month, agreeing that the government cannot require employers to cover HIV preventive drugs because it violates their religious rights. He noted at the time that the task force members are “unconstitutionally appointed,” calling into question whether their recommendations can be considered requirements under law, Axios’s Oriana González writes.

The impact: “If that ruling stands and the plaintiffs get what they want here, more than 150 million Americans could lose access to guaranteed coverage of those preventive services without cost sharing,” Katie Keithhealth law expert at Georgetown Universitywrote in an email to The Health 202.

But remember… O’Connor ruled the entire ACA unconstitutional back in 2018, a decision the Supreme Court reversed 7 to 2 last year.

Larry Levitt, executive vice president for health policy at KFF:

  • Democrats on the House Oversight and Reform Committee released a staff report yesterday that found some of the nation’s largest insurers and pharmacy benefit managers require patients to pay for birth control, despite the ACA requirement that health plans cover FDA-approved contraceptives without cost sharing.
  • Enrollment in the federal government’s health insurance marketplace grew for all racial and ethnic groups from 2020 to 2022with Black and Latino enrollees reporting the largest increases at 49 percent and 53 percent respectively, according to an HHS report released yesterday.
  • Men were more likely to die of coronavirus complications than women in both rural and urban parts of the country in 2020, according to new data from the CDC’s National Center for Health Statistics.

High prices, low speeds and fraud plague US help to keep people online (By Tony Romm | The Washington Post)

GOP debt ceiling threats set to revive brinkmanship with White House (By Jeff Stein and Marianna Sotomayor | The Washington Post)

$38,398 for a Single Shot of a Very Old Cancer Drug (By Arthur Allen | Kaiser Health News)

Thanks for reading! See y’all tomorrow.

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