The House Appropriations Committee has marked up and passed all 12 of their appropriations bills and will begin Floor consideration this week a bundle of seven of the bills, including the appropriation for Labor, Health and Human Services (Labor-HHS). Republicans have objected to the topline funding levels, arguing that increasing nondefense discretionary spending by 16.5 percent was too high and defense discretionary spending by 1.6 percent was too low, setting the stage for negotiations before any bill can be signed into law.
Senate Appropriators plan on releasing and marking up three-to-four of their 12 appropriations bills before leaving for August recess, with plans to continue with others being pushed to September. The rumored bills that they will be marking up in the next few weeks include Agriculture-FDA, Energy and Water, and Military Construction-VA. More controversial bills like Labor-HHS are likely to wait until after the recess. The federal fiscal year ends on September 30, and Congress will need to pass and the President sign either all 12 appropriations bills or a continuing resolution (CR) by then to avoid a government shutdown. The most likely situation is a CR that keeps the government’s doors open until December, at which point Congress could pass a large omnibus that combines the bills into one. The last time Congress passed all 12 bills on time was 1996.
Senate Democrats are considering Medicare expansions in the infrastructure reconciliation bill
Progressive Senate Democrats, including Senate Budget Committee Chairman Bernie Sanders, are advocating for lowering the Medicare eligibility age to 60 as part of the $3.5 trillion “human” infrastructure package. Centrist Democrats and the Biden Administration have opposed this inclusion on the basis of costs. The reconciliation bill already includes a significant expansion of Medicare by including dental, vision, and hearing costs for beneficiaries. The reconciliation bill also currently includes:
- Expanding long-term care benefits to help people getting home- and community-based services.
- Extending the ACA expansion under the already-passed $1.9 trillion covid-19 relief bill, the American Rescue Plan.
- Closing the Medicaid “coverage gap” in the states that refused to expand coverage under the ACA.
- Reducing the cost of prescription drugs.
The contents of the final bill will depend on negotiations between House and Senate Democrats and the White House.
Veterans Affairs mandates COVID-19 vaccines for most health workers
The Department of Veterans Affairs will require 115,000 of its frontline health care workers to be vaccinated against COVID-19 in the next two months, making it the first federal agency to mandate that employees be inoculated. The mandate will apply to workers who are the most patient-facing, including doctors, dentists, registered nurses, physician assistants and some specialists. Additionally, local and state governments are mandating vaccinations among those who can receive them. For example, all municipal employees in New York City, including police officers and teachers, and all state employees and on-site public and private health care workers in California will have to be vaccinated or face at least weekly testing.
Separately, the American Medical Association, American Nursing Association and dozens of other medical groups issued a joint statement in support of a COVID-19 vaccine mandate for all healthcare workers.
OMB directs federal agencies to make more evidence-based decisions
In early July, the Office of Management and Budget (OMB) gave agencies initial guidance on the Administration’s plans to implement the Evidence-Based Policymaking Act. OMB directed all agencies to complete a four-year strategic plan and learning agenda for creating a culture of evidence-building and statistical analysis, as well as making stakeholder engagement a critical function of federal chief data officers, chief evaluation officers, and statistical officials. The memo also directs agencies without evaluation policies to submit a draft version no later than by Sept. 30, and to publicly post the policies no later than February 2022.
Biden issued an executive order on drug pricing
In an executive order issued on July 9, President Biden ordered the federal government to undertake several programs for lowering consumer drug prices. The order directs his Administration to work with states to devise a plan to import medicines safely from Canada, where they are sold at lower prices. He also directed the Federal Trade Commission to ban pharmaceutical manufacturers from paying generic manufacturers to delay entry of lower-priced medication. The Justice Department and FTC were directed to review and revise merger guidelines to reduce hospital systems mergers.
Capitol Hill physicians reconsider mask mandates
Echoing debates happening nationwide, Capitol's chief physician is considering reimposing a mask recommendation in the Capitol after two months of mostly face-covering-free business in the House and Senate. Attending Physician Brian Monahan warned that the Delta variant is “much more contagious” and poses “a dire health risk to unvaccinated individuals.”
What I’m reading…
CDC Director Rochelle Walensky has called the current surge of COVID-19 a “pandemic of the unvaccinated” as nearly 99% of deaths are now among those who have not received a vaccine. As we work to reach every eligible person to receive a vaccine, we must also be looking inwards at the decisions some healthcare workers are making. Among nursing home workers, a horrifying 40% have not received a single vaccine dose yet, despite COVID-19 killing 133,000 nursing home residents and 2,000 staffers in the last 14 months alone. We must do better.
The Office of the Assistant Secretary for Planning and Evaluation (ASPE) published a description of their work on supporting evidence-based health policy in the Biden Administration in JAMA Health Forum. In it, they argue that creating, sharing, and supporting high-quality data is a necessary first step in conducting evidence-based analysis.
In a macabre and glaring metaphor for the threat of climate change, emergency doctors in Washington State have responded to a rise in heat stroke by putting patients in body bags packed with ice and water to cool down their core temperatures. As we continue to fail to meaningfully address climate change, low-cost emergency interventions like this will become more common.
There is ample evidence that structural racism within the health care system creates worse health care outcomes for Black than for white patients. Another new data point showing that was published by Morden et al in NEJM, where they found that there is a strong racial bias in medication prescription. Their research showed that within the same health system, white patients received both more pills and stronger doses of pain medication than Black patients for comparable needs.
Researchers from the Johns Hopkins School of Medicine and Tufts Medical Center used artificial intelligence to study the electronic health records of nearly two million COVID-19 patients. The study identified patterns in severity of illness, and established expected trajectories for patients based on vital signs and laboratory severities, which could be used for practitioner decision making.
While health care providers focus on their technical and analytical abilities, we must also be aware of the importance of empathy and acknowledging mistakes when they happen in order to support patients. Dr. Krakower wrote in JAMA about how hard it is for physicians and medical providers to own their failures and apologize when they err. As she notes, mistakes will happen, and “when we find ourselves in these terrifying moments, physicians must summon the compassion for ourselves and our patients to apologize honestly and sincerely for the harms caused. Much can be learned from the example of clinical leaders presenting their own morbidity and mortality cases, sharing their errors for colleagues and students to see that mistakes do not need to be shrouded in anonymity. We all falter, but if we are brave enough to admit our humanity, including our flaws, we may become secure enough to preserve trust and provide healing when it matters most.”