The Health 202: Biden’s pick to lead Medicare and Medicaid knows the policy weeds

“What is interesting about Chiquita’s career is she’s been at the most ground level of policy, helping to craft regulations that are very esoteric and fine-tuned — very technical aspects of Medicare and Medicaid policy,” said Nancy-Ann DeParle, who led CMS under former president Bill Clinton.

Republicans had virtually no criticisms of Brooks-LaSure at a Senate Finance Committee confirmation hearing yesterday.

A few hot-button topics, including Medicaid work requirements and abortion coverage in ACA marketplace plans, were alluded to. But no one questioned whether she was qualified to do the job.

  • During the Clinton administration, Brooks-LaSure analyzed Medicare and Medicaid spending at the White House Office of Management and Budget.
  • She worked on the House Ways and Means Committee from 2007 to 2010 as Democrats wrote the ACA.
  • Then she helped to implement the law, first at the Department of Health and Human Services and then at CMS.
That’s considerably more agency and legislative experience than previous CMS administrators had.
  • Seema Verma, who led the agency under former president Donald Trump, had never worked there before, instead spending the bulk of her career as a Medicaid consultant to states.
  • Of  former president Barack Obama’s administrators, Marilyn Tavenner was a nurse, hospital executive and then served as Virginia’s health secretary, while Don Berwick was a pediatrician and founder of a nonprofit institute aimed at improving health care.
  • George W. Bush’s CMS administrators included Mark McClellan, who had previously led the Food and Drug Administration and worked at the Treasury Department, and Tom Scully, who had worked at the Office of Management and Budget before leading the Federation of American Hospitals.
Those who know Brooks-LaSure emphasize her diplomatic style.

Melanie Nathanson, now a health-care lobbyist, first met Brooks-LaSure on Capitol Hill while working for then-Sen. Bob Graham (D-Fla.). Brooks-LaSure was more eager than most to hear diverse perspectives and find areas for common ground, Nathanson said.

“I think that is her natural place — to drive to consensus,” Nathanson told me.

DeParle described Brooks-LaSure as a problem-solver who is both collegial but firm when she feels strongly about something.

“It’s an iron fist and a silk glove,” DeParle said. “When she thinks the policy is wrong, she’s not going to hesitate to let you know it.”

During the hearing yesterday, Brooks-LaSure seemed to show that style when GOP senators expressed concerns over the Biden administration’s approach to the Medicaid program.

“I’m deeply concerned by the administration’s approach to Medicaid,” Sen. Mike Crapo (Idaho), the committee’s ranking Republican, said, referring to the new administration’s recent reversal of the Trump administration’s permission for states to impose work requirements.

“I will work to make sure states understand decisions and, as you said, are part of the decision-making,” Brooks-LaSure responded.

CMS will be a critical agency as Democrats seek to expand health coverage.

The White House and top congressional Democrats are currently considering which policy pathways to pursue to get coverage to around 29 million Americans who still lack it.

Lowering the Medicare eligbility age is one possibility; another is making permanent more generous subsidies in the individual marketplaces. In either case, it would be up to CMS to oversee such changes.

The Senate Finance Committee may vote to advance Brooks-LaSure next week.

The panel is also considering the nomination of former Wisconsin health secretary Andrea Palm to serve as deputy HHS secretary.

A spokeswoman for Crapo responded “TBD” when asked whether the senator would vote to confirm Brooks-LaSure. Spokespeople for Sens. Bill Cassidy of Louisiana and Chuck Grassley of Iowa, two influential Republicans heavily involved in health policy, also declined to comment on how their bosses would vote.

Ahh, oof and ouch

AHH: People might need a coronavirus booster shot.

That’s according to White House scientific advisor David Kessler, who spoke at a House subcommittee hearing yesterday. Kessler said the U.S. should plan for booster shots in the future, Erin Cunningham reports.

In separate remarks released yesterday, Pfizer CEO Albert Bourla said a “likely scenario” included the need for a third vaccine dose six to 12 months after inoculation, after which “there will be an annual revaccination.”

“A growing consensus among scientists and public health experts over the need for additional injections could have serious implications for the equitable distribution of vaccine doses worldwide,” Erin writes.

OOF: The Biden administration will roll back Trump-era restrictions on fetal tissue research.

HHS Secretary Xavier Becerra told lawmakers on Thursday the administration was poised to make an announcement as soon as today about what he characterized as a fetal tissue research ban, The Post’s Amy Goldstein reports.

Becerra did not provide details, but he made it clear he opposes rules implemented by Trump in 2019 cutting off National Institutes of Health funding for fetal tissue research by scientists who work for the government.

The rule didn’t prohibit scientists at universities and outside laboratories from pursuing research, but their grant proposals must receive an additional layer of scrutiny from an ethics board. That ethics advisory board recommended rejecting all but one of 14 proposals when it convened last summer.

“The immediacy of an announcement — three weeks after Becerra was sworn in — caught by surprise leading fetal-tissue researchers, scientific organizations and congressional Democrats, all of whom have been leaning on the Biden administration to undo the funding restrictions,” Amy writes.

Fetal tissue has played a role in biomedical since the 1950s, when Swedish researchers used fetal cells to develop a polio vaccine. But many on the religious right oppose research that relies on cells from elective abortions.

OUCH: The world is not prepared for antibiotic superbugs.

Nearly all of the new antibiotics brought to market are variations on classes of drugs discovered decades ago, according to the newly released WHO report.

The overuse of antibiotics and antimicrobials has pushed bacteria to evolve in ways that allow it to evade commonly used medicines. Already in poorer countries, an estimated 30 percent of the newborns with sepsis die of bacterial infections that are resistant to first-line antibiotics.

Some scientists estimate that these “superbugs” will kill 10 million people a year after 2050.

More in coronavirus news

Coronavirus long-haulers are navigating the disability system.

Scientists still don’t know how many people are suffering from “long covid” — a range of health problems that last for months after a coronavirus infection. But many people struggling with symptoms such as brain fog, fatigue, shortness of breath and muscle pains are finding it difficult to return to work, leading them to pursue disability benefits, including workers’ compensation or Social Security disability payments.

Some people experience “long covid” months after their battle with covid-19. While cures remain unknown, there are some practical steps you can take. (Allie Caren/The Washington Post)

To receive Social Security disability payments, a person must have a medical impairment expected to last at least a year preventing them from substantial gainful activity. Lawmakers have pressed the Social Security Administration to evaluate the long-term impact of covid-19 on people’s ability to work. Meanwhile, workers’ compensation is paid to people injured by a job, but it can be harder to prove that an infection occurred on a job than it is to prove a slip or fall.

“There are already some signs of how long COVID may change the disability services landscape. For instance, Stop The Wait — a coalition of disability, health and aging organizations — is reupping a fight to eliminate a two-year waiting period for Medicare coverage and five-month waiting period for Social Security Disability Insurance for many people with disabilities,” Chelsea writes.

Anthony Fauci and Rep. Jim Jordan clashed in a heated exchange about reopening.

Jordan (R-Ohio) asked Fauci, the director of the National Institute of Allergy and Infectious Diseases, when the country could begin relaxing physical distancing and mask-wearing restrictions, framing it as a matter of regaining personal liberty.

“We had 15 days of ‘slow the spread’ turn into one year of lost liberty,” Jordan said during a hearing of the House Coronavirus Crisis Subcommittee. “What metrics, what measures, what has to happen before Americans get more freedoms back?”

“You’re indicating liberty and freedom. I look at it as a public health measure to prevent people from dying and going to the hospital,” Fauci responded.

Fauci accused Jordan of “making this a personal thing.”

On April 15, Anthony S. Fauci, the nation’s top infectious-disease expert, claimed Rep. Jim Jordan (R-Ohio) was using coronavirus pandemic as a personal attack. (The Washington Post)

Elsewhere in health care

The FDA is looking for ways to ensure the safety of old drugs without triggering price hikes.

In November, the Trump administration ended the FDA’s Unapproved Drugs Initiative. The program was created to ensure that older drugs went through FDA approval to determine their safety and efficacy, but critics say it had unintended consequences, as drugmakers at times implemented massive price hikes for medicines that had been around for decades.

“Now the FDA is considering whether and how to replace it, while advancing the Biden administration’s goal of reducing prescription drug prices overall. An announcement is expected soon,” Kaiser Health News’s Harris Meyer reports. “But health care policy analysts and executives fear drugmakers still will find ways to maintain high prices for drugs already approved through the program, and to jack up prices for remaining unapproved drugs on the market, estimated to number at least 1,500.”

Sugar rush

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