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Health provisions in peril without bipartisan bill

With Alice Miranda Ollstein

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— Democrats are vowing they’ll protect health priorities if a bipartisan infrastructure package fails and they have to rely on a party line vote.

— President Joe Biden’s global vaccine strategy is in jeopardy over a cash crunch at the agency leading the rollout.

— Republicans questioned Biden officials on a booster plan in a contentious Senate hearing.

WELCOME TO WEDNESDAY PULSEIt’s a new but familiar world on Capitol Hill as the Delta variant and breakthrough infections put people on edge, our colleagues report. Send tips to [email protected] and [email protected].

HEALTH PROVISIONS IN PERIL WITHOUT BIPARTISAN BILL — The possible defeat of the bipartisan infrastructure package in a test vote on Wednesday has Democrats weighing options if they must rely on a party line bill brought through the reconciliation process, Alice Miranda Ollstein reports.

House Democrats already want their Senate counterparts to abandon efforts to win over 10 Republicans for the bipartisan bill and to move on, pointing to the months-long effort to court GOP votes for the Affordable Care Act as a cautionary tale.

“The play is always delay, delay, delay and wait until you get to August recess,” Progressive Caucus Chair Pramila Jayapal said Tuesday. “Anybody who believes that Republicans are going to come along at this point is losing credibility.”

But moderate Democrats may balk at the price tag required to cover the full cost of the physical infrastructure and “human infrastructure” packages in one massive reconciliation bill, and some on the Hill fear that costly health provisions, like expanding Medicare’s benefits, could be on the chopping block.

“There could be a number of areas of policy related to seniors, people with disabilities and kids that we have to fight very hard to defend, because, frankly, they don’t have the lobbying power that some other issues do,” Sen. Bob Casey (D-Penn.) told Alice.

Jayapal says progressives will block any bill lacking the provisions boosting Medicare, Medicaid, and long-term care. “It’s not going to get slimmed down. It won’t pass if it doesn’t have our priorities,” she said. “And there are quite a few people with me on this.”

Grain of salt: Senate aides noted the fate of the reconciliation package rests with Joe Manchin and other moderate Senate Democrats, who previously indicated that they will only support it if the bipartisan bill also moves forward. Additionally, staffers see the bill’s climate provisions likelier to drop out than the health provisions to address cost concerns.

Rebate rule play draws drug industry fire: News this weekend (and in yesterday’s PULSE) that senators could delay the Trump-era Medicare rebate rule for Part D drugs to generate projected savings for either the bipartisan package or reconciliation bill has pharmaceutical companies on guard.

“Despite railing against high drug costs on the campaign trail, lawmakers are threatening to gut a rule that would provide patients meaningful relief at the pharmacy,” PhRMA EVP for Public Affairs Debra DeShong said.

CASH SHORTAGE HAMPERS BIDEN’s GLOBAL VACCINE CAMPAIGN — The U.S. bid to play a leading role in distributing vaccines to the world is in jeopardy over a $1.5 billion shortfall at the agency charged with handing out the shots, POLITICO’s Erin Banco reports.

The financial issues at the U.S. Agency for International Development emerged after the White House siphoned money from the agency to pay for additional doses of Pfizer’s Covid-19 vaccine — leaving USAID scrambling to find new funding meant to help foreign countries distribute shots and buy Covid drugs and personal protective gear.

USAID is now negotiating with Congress for more money, and may ask for supplemental funding that would close the $1.5 billion gap. But it’s unclear how quickly that could happen, leading to delays in getting aid to countries the U.S. pledged to help.

The internal shuffling has frustrated officials within USAID, which has been tasked with much of the leg work in responding to requests from other countries battling outbreaks. The number of nations seeking assistance has overwhelmed the agency, senior administration officials said. And in the meantime, the 500 million Pfizer shots that the White House purchased with USAID’s money aren’t due to arrive for months.

GOP SENATORS PRESS BIDEN OFFICIALS ON BOOSTER PLAN — Several Senate Republicans used a sometimes-contentious HELP Committee hearing Tuesday to point out the Biden administration still hasn’t come up with a coronavirus booster plan, even as other countries forge ahead with frameworks for medically vulnerable people.

Sen. Richard Burr kicked off his remarks by asking when boosters would be available and questioning why U.S. authorities weren’t acting on data from Israel showing breakthrough infections that suggest the need for additional coronavirus vaccines.

“We don’t want people to believe that when you’re talking about boosters that means that the vaccines are not effective,” Biden’s chief medical advisor Anthony Fauci told the panel. “They are highly effective. We’re talking about the durability of that and we’re doing studies now to determine that.”

But GOP senators didn’t let up, questioning why U.S. officials would stay mum while other countries release plans — providing an interesting contrast to others in the party who argue the Biden administration has been too aggressive about vaccine outreach. “There are a number of us that would get in line to get a booster,” Sen. Mitt Romney (R-Utah) said. “Can we not use the data that’s come from those places to allow people in this country to get a third shot if they want to?”

Acting FDA Commissioner Janet Woodcock pushed back, saying there are multiple factors to consider. “When does immunity wane to the point that you need to give a boost? We can’t just boost them all the time, right, we need to boost them when it’s appropriate.”

Besides manufacturer-led research on booster shots, studies are underway at NIH to evaluate additional doses of different vaccines. Meanwhile CDC Director Rochelle Walensky offered a sobering new figure during the hearing: Roughly 83 percent of new U.S. coronavirus cases are with the more transmissible Delta variant.

Fauci-Paul battle continues. Sen. Rand Paul also got in a tense back-and-forth with Fauci over the origins of the virus, reviving unproven theories that its origins were connected to NIH funded gain-of-function research that increases the transmissibility of viruses. “You do not know what you are talking about,” Fauci told the Kentucky Republican as they accused each other of lying.

WHERE THE WHITE HOUSE ISN’T GOING: FOX NEWS — While President Biden scrambles to convince hesitant American to get the Covid-19 vaccines, his administration has largely steered clear of the major cable news outlet spreading unsubstantiated fears about vaccinations, Christopher Cadelago and Sam Stein report.

Biden officials said they recognize the need to reach Fox’s substantial audience and insist that they are making efforts to do so. All told, members of Biden’s Covid-19 team have made roughly a dozen appearances on Fox since late January, albeit on a select few shows. Meanwhile officials have been reluctant to call out the network for misinformation.

Outside Democrats say Biden’s team should go much further. They want them to place officials on Fox more frequently, particularly in prime time, when disinformation and even fear-mongering around the vaccines has been most rampant.

“The nighttime shows present challenges,” said Lis Smith, a Democratic strategist who popularized a go-anywhere approach while helping helm Pete Buttigieg’s 2020 Democratic presidential campaign. “But what’s the goal here? We’re not trying to win a political argument. Our goal here is to give people critical public health information and facts and save lives.”

FIRST IN PULSE: TRUMP HHS OFFICIAL PENNING WARP SPEED TELL-ALLTrump-era health official Paul Mango will be out with a book in early 2022 about Operation Warp Speed, in what he told PULSE will be an in-the-room look at the administration’s sprint to develop Covid-19 vaccines.

Mango — a former deputy chief of staff and close ally of then-HHS Secretary Alex Azar — has been at work on the book for months, combining his recollections with interviews of more than a dozen top officials involved in Warp Speed.

The result is likely to be a celebration of the Trump team’s effort, and a more flattering portrait of certain key players like Azar, compared with the several already-published books on the shortcomings of the broader pandemic response.

“There’s a lot of misunderstanding about how this came about and who did it,” Mango said, adding that the book will also serve as an implicit rebuke to Biden’s early declarations that his administration had been left with no vaccine rollout plan. “There was so much done in such a short period of time.”

But it won’t be all sunshine and rainbows. Mango said the book will recount various clashes and disagreements within a famously fractious Covid-19 team that fought throughout much of the Trump era — and has since jockeyed for credit for the few bright spots in its pandemic response. “There were a number of personalities … and tension-filled meetings and differences of opinion about what should be done,” he said.

The book — which is being handled by conservative publisher Republic Book Publishers — is one of several due out from former Trump officials, as they race to shape the legacy of the administration and their place in it. That includes Jared Kushner’s book, which is also expected out in early 2022, and accounts from Kellyanne Conway and former Vice President Mike Pence – both of whom worked closely on the pandemic response.

COMMUNITY HEALTH CENTERS FORM NEW COALITIONMore than a dozen community health centers have established a coalition that will advocate for policies aimed expanding health equity and health care availability to underserved populations.

The group, Advocates for Community Health, is chaired by California-based Family HealthCare Network CEO Kerry Hydash and made up of community health center members across six states and Puerto Rico.

A PATCHWORK OF VACCINE PASSPORT BANSMore than 100 bills have been introduced nationwide barring employers or schools from requiring Covid-19 vaccination or documentation of a person’s status, according to an analysis by the National Academy for State Health Policy.

Governors in Arkansas, Montana, North Dakota and Utah have signed five of those bills into law but many others couldn’t find support in both chambers of state legislatures. Dozens more bills are still in play, foreshadowing battles across the country as schools prepare to reopen.

Rep. Steve Scalise, the No. 2 House Republican, only received his first Covid-19 vaccination on Sunday, NOLA.com’s Tyler Bridges reports.

A new study suggests that the Johnson & Johnson vaccine could be much less effective against Covid-19’s Delta and Lambda variants, The New York Times’ Apoorva Mandavilli writes.

The drug lobby flooded a House Democrat’s campaign with donations a day after he sought to derail legislation allowing Medicare to negotiate the price of medicines, STAT’s Rachel Cohrs reports.

CORRECTION: An earlier version of this report misstated the publisher of the book by Trump-era health official Paul Mango. The publisher is Republic Book Publishers.

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