We are in the final weeks of the FY21 fiscal year, and Congress is focused on avoiding a government shutdown while simultaneously negotiating the Build Back Better budget reconciliation bill.
Congress faces down deadlines on appropriations, reconciliation, and the debt limit
Congress is continuing to debate a pathway forward with government funding ending on September 30th and the upcoming debt limit deadline. Expectations are that Congress will pass a Continuing Resolution (CR) that will fund the government until the start of December to give time for negotiators to finalize FY22 appropriations. The debt limit is expected to run out in October, at which point Congress must either raise it or breach it and trigger long-lasting and deep economic damage. Congressional Republicans are currently demanding that Democrats raise it on a party-line vote through reconciliation while Democrats are insisting that raising the debt limit must be bipartisan because both parties voted for the creation of the debt. At this point, the Senate has not publicly released their FY22 appropriations bills while the House passed 9 of their 12.
Congress is additionally debating the structure and pathway to passage for the 3.5 trillion reconciliation package, which Democrats can pass without Republican support. Numerous negotiations are happening simultaneously and there are significant restrictions on what can be in the reconciliation bill. It can only be used to pass legislation related to spending and revenue, and it can’t add to the national deficit after the first decade. It will remain to be seen how many of the planned Democratic policies, such as creating universal pre-K, expanding Medicare, or creating a pathway to citizenship for Dreamers will pass that test.
With narrow majorities, Democrats are trying to juggle the needs of both its centrist and progressive wings in the legislation. On September 15, conservative Democrats in the House Energy and Commerce Committee voted to kill proposed drug price negotiation legislation that was to be included in the reconciliation bill. It remains to be seen whether the House Rules Committee will add it in anyway or if there will be new legislation. Senators are separately considering a proposal that would allow Medicare to pay the same prices that other government programs, like the Veterans Affairs Department, pays.
Cures 2.0 and ARPA-H language to be released
Representatives DeGette (D-CO) and Upton (R-MI) have announced that they will release new legislative text for the Cures 2.0 bill to include proposals for the Advanced Research Projects Agency for Health (ARPA-H). ARPA-H is intended to speed biomedical breakthroughs by offering a nimble and flexible funding structure. AcademyHealth has consistently advocated for the inclusion of robust implementation and delivery funding to go alongside biomedical innovations to reduce health disparities.
Millions of people are missing from CDC COVID-19 data as states fail to report cases
The Centers for Disease Control and Prevention has tallied over 39 million cases of COVID-19 in the U.S, but more specific information about where patients live, whether patients were hospitalized or died, and demographic details like race, gender and age are all collected separately. In that more detailed CDC data set, about 1 in 5 known cases — or 7 million people — are completely missing, and many more data points are incorrectly submitted. Most states have voluntarily sent whatever records they have, but a handful have not. Texas, Missouri, Louisiana, West Virginia and Wyoming have each submitted less than one-tenth of their total cases. Another handful of states, including Florida, Michigan and Kentucky, have smaller but still significant gaps in their data, each completely missing over 30 percent of their known cases. Over 3 million Texans have had COVID-19, but just 81,000 are in the data set. That's not even 3 percent.
Updates on COVID-19 boosters and vaccines authorized for young children
The FDA’s 18-member Vaccines and Related Biological Products Advisory Committee met and voted on authorizing Pfizer vaccine booster shots. They overwhelmingly rejected approving the booster for all individuals over 16, but did approve it for individuals 65 years and older and for individuals of any age at high risk of severe COVID-19.
Clashes between the White House, CDC, and FDA on potential COVID-19 booster shots are becoming more public as the contentious policy proposal is crafted. It is reported that senior officials from the White House Covid-19 task force and the Food and Drug Administration have repeatedly accused CDC of withholding critical data needed to develop the booster shot plan. In the leadup to the meeting of the FDA’s vaccine advisory committee on a potential Pfizer booster, top FDA vaccine officials were publicly dissenting and debating the outcome in leading journals.
Separately, the Biden Administration is donating hundreds of millions of more doses of the Pfizer vaccine to global vaccination efforts. President Biden has called on global leaders to fully vaccinate 70 percent of the world’s population by September 2022.
The FDA has announced that when a COVID-19 vaccine is submitted for emergency authorization for children under 12 that they will move to vet and approve it as rapidly as possible – likely “in a matter of weeks rather than months”, depending on the quality and timeliness of the manufacturers submissions. To date, none of the three companies whose vaccines have been cleared in the U.S. have sought authorization for their use in children under 12.
The Biden Administration released $25 billion to health care providers for the pandemic
The Biden Administration released $25 billion in the latest tranche of a total $187 billion fund that Congress funded to help health care providers in the pandemic. Health care providers and lawmakers from both parties had in recent weeks ratcheted up pressure on the Department of Health and Human Services to release billions in unused funds. Providers can apply for a share of $17 billion in grants if they can prove they had losses or expenses due to Covid-19 between July 2020 and the end of March — a time frame that leaves out hospitals struggling due to the ongoing surge, largely fueled by the Delta variant, that’s currently filling emergency rooms and delaying elective procedures. Smaller providers will be reimbursed at a higher rate than larger ones, the department said.
What I’m reading
The United Nations has warned us that global plans to reduce greenhouse gas emissions are woefully short of what is needed, and that we are on track for 2.8 C increase in global temperatures over the next century. As we have seen more damaging storms, cataclysmic fires, devastating droughts, spreading diseases, and environmental health crises, it is clear the current climate crisis is adding strain to health systems and societies. It is no surprise that so many young people feel an existential anxiety to be growing up in an era of massive climate disasters. For that reason, I am glad to see more than 200 medical and health journals worldwide declaring even a 1.5 degree rise in global temperatures to be the “greatest threat to global public health.” We must demand more be done and done immediately.
The explosion of the delta variant has jolted health systems into a crisis mode, and cracks in our foundations are widening. For example, some rural hospitals are facing the devastating questions of how to ration life saving health interventions. When doctors, like at the Providence Alaska Medical Center in Anchorage, have more patients needing dialysis than they or anyone in the region of access to, how does one choose who receives treatment? Tragically, one in every 500 Americans have now died of COVID-19 in this pandemic as the death toll exceeds 660,000. This number, which does not count individuals who were unable to access other medical care or put off needed interventions, is devastating.
America’s life span has continued to fall behind those in Europe. A new working paper released by the National Bureau of Economic Research found that Americans are more likely to die earlier than Europeans regardless of age – American babies are more likely to die before they turn 5, teens more likely to die before they turn 20, and adults more likely to die before 65. There are many reasons behind this gap, but social determinants of health and how we deliver health care may have a larger role than previously thought. The authors found that across Europe, the life expectancy between the richest and poorest is very similar, where as in America household wealth and geography are key determinants.
An article by Ni et al in Science looked at the gendered nature of scientific authorship. Using an international survey, they examined gendered practices in authorship communication, disagreement, and fairness. They found that women were more likely to experience authorship disagreements and experience them more often. Their contributions to research papers were more often devalued by both men and women. Women were more likely to discuss authorship with coauthors at the beginning of the project, whereas men were more likely to determine authorship unilaterally at the end. Women perceived that they received less credit than deserved, while men reported the opposite. This devaluation of women’s work in science creates cumulative disadvantages in scientific careers.
Similarly, Nature discusses the problem that women still lag in receiving international prizes for rewarding research excellence. There is a narrowing, but still persistent gap in the awarding of the highest tiers, which is greatest in life sciences, computer science and mathematics. Women have comparable publication and citation rates to men, but tend to have shorter careers and publish fewer papers as first or last author.
And finally, if you are in need of a smile during this forever pandemic, enjoy this brief video about the potential anxiety linked to finally returning to the office.