The Federal Government’s Spookiest Sites

Washington, DC is a historic city, and one of the ways that history manifests itself is though tales of ghosts and other unexplained phenomena.  With Halloween just around a corner, what better time to check in on all the federally owned buildings and well-known landmarks in the District of Columbia that have their own spooky histories?

The White House

One of the most well-known buildings in Washington, DC is also perhaps the most haunted.  Abraham Lincoln reportedly received visits from his son Willie, who passed away in the White House at age 11, while the former first lady Mary Todd Lincoln may have heard Thomas Jefferson playing the violin and Andrew Jackson swearing.  Following his assassination, President Lincoln himself purportedly became a ghost and allegedly appeared before British Prime Minister Winston Churchill and Queen Wilhelmina of the Netherlands.

Smithsonian Castle

The Smithsonian’s namesake is English chemist and mineralogist James Smithson, and his remains were reinterred in the Castle in 1904.  Despite Smithson never setting foot in the Smithsonian Castle when alive, his ghost has appeared in the building many times. The ghost of Spencer Baird, the Smithsonian’s first curator, has also been spotted.

US Capitol Building

The Capitol building served as a makeshift infirmary during the Civil War, which would explain why staffers have spotted the ghost of an unknown Union Army soldier in the Hall of Statues.  Other ghosts purportedly include Congressman William Preston Taulbee (D-KY), who was shot in the Capitol building by a journalist who was the subject of Taulbee’s bullying, and John Lenthall, a construction superintendent who died in an accident during the building’s construction.  However, the Capitol’s most famous supernatural specter may be a so-called “demon cat” who has appeared just days before tragic events such as the assassinations of Abraham Lincoln and John F. Kennedy. 

Federal Aviation Administration (FAA) Headquarters

The location of the FAA headquarters is at 600 Independence Avenue SW, which was once the site of a slave market on the property of Robey’s Tavern.  The property consisted of a large wall where slaves were auctioned as well as a two-story home that housed slaves in the basement.  Some people have allegedly heard the clinking of chains at night near the headquarters.

Lafayette Square Park

Located just across from the White House, Lafayette Square is the site where Philip Barton Key II, the son of Francis Scott Key, was shot to death after having an affair with a married woman.  Key’s ghost has since been spotted in the park.

Library of Congress

Shortly after the end of World War I, visitors to the Library of Congress began noticing a ghost in the library’s main reading room.  The ghost was suspected to be Cecil Barda, a young man who visited the room almost daily for several years before enlisting in the Army in 1917.  Barda later died in a training accident before he could be deployed to Europe.  Since the Library of Congress was modernized shortly after World War II, there has been no sighting of Barda’s ghost in the main reading room. 

What Will Congress Do about Pending PAYGO Cuts?

The debt ceiling, appropriations, infrastructure, reconciliation – Congress has a lot on its plate right now.  On top of that, Congress has another item to address that health care stakeholders have been watching closely: an automatic 4% cut to Medicare starting on January 1, 2022.

What’s going on?  In March, the $1.9 trillion American Rescue Plan Act passed and raised the deficit. This triggered automatic PAYGO cuts to Medicare and other programs because of a law signed in 2010, the Pay-As-You-Go (PAYGO) Act, which prohibited new legislation from increasing the federal budget deficit. 

What’s Congress doing?  Congress has always acted to waive PAYGO cuts, but not in March of 2021 when lawmakers failed to reach an agreement. At the time, the House overwhelmingly voted to waive PAYGO, but a similar proposal in the Senate failed to garner enough votes to override a filibuster.  So far, there has been little word from lawmakers about the plans to address PAYGO as the end of the year approaches.

Why does it matter?  The American Hospital Association (AHA) estimates that a 4% reduction in Medicare spending, or about $36 billion, would result in $9.4 billion in cuts to hospitals provider for fee-for-service (FFS) Medicare reimbursement in calendar year 2022.  These losses would come at a time when hospitals and other providers are still grappling with revenue losses related to the COVID-19 pandemic.

It’s not just PAYGO: Health care providers are facing other cuts at the year’s end that, combined with PAYGO, could prove devastating.  These include:

  • Medicare sequestration.  Congress passed legislation back in April to extend the moratorium on 2% cuts to Medicare payments, known as sequestration, through the end of 2021.  The 2% cuts were initially postponed by Congress as a part of the CARES Act in 2020 to help providers struggling with the financial burden of the pandemic.
  • 2021 Physician Fee Schedule.  Finalized in July, the 2021 Physician Fee Schedule will cut payments to physicians next year by 3.75%.  The cut was initially set to go into effect in 2021, but Congress provided an extra $3 billion in funding in late 2020 to hold on the cuts until the beginning of 2022.

The bottom line: The combination of PAYGO, Medicare sequestration, and the Physician Fee Schedule could mean a 9% reduction in Medicare physician payments next year.

What’s being done?  Leading stakeholder organizations including the AHA and the American Medical Association (AMA) have sent letters to congressional leadership urging action to waive pending PAYGO cuts, as well as the coming Medicare sequester and Physician Fee Schedule cut.  Furthermore, on October 14, 245 bipartisan House members sent a letter to congressional leaders on the aforementioned Medicare cuts.  Congress has provided much assistance to health care providers over the course of the pandemic, and providers are urging Congress to take action once again to help the industry make it through what is hopefully the final stage of the pandemic.   

What Happened, What You Missed: October 18-22

FDA Authorizes Moderna, J&J Boosters, Approves Mixed Booster Regimens

On October 20, the Food and Drug Administration (FDA) authorized “booster” shots for people who initially received vaccines from Moderna and Johnson & Johnson (J&J).  Moderna recipients will be eligible for a third dose six months after their second shot if they’re age 65 or older, between ages 18-64 and are at risk of severe complications from COVID-19, or have frequent “occupational exposure” to the virus.  However, all J&J vaccine recipients will be eligible for a booster at least two months after their initial shot, likely due to the J&J vaccine’s lower efficacy.  Of note, the FDA also authorized a “mix-and-match” approach that allows people to receive a vaccine as a booster dose that’s different from the vaccine used in their initial vaccination regimen.  On October 21, a Centers for Disease Control and Prevention (CDC) advisory panel issued booster shot recommendations that were aligned with the FDA’s authorization.  

Two Longtime House Dems Announce Retirement

Earlier this week, Reps. David Price (D-NC) and Mike Doyle (D-PA), both of whom have served in Congress for over 20 years, announced they will not seek an additional term in the 118th Congress.  Their announcements came just a week after House Budget Committee Chairman John Yarmuth (D-KY) announced that he will not be running for reelection.  While all three Democrats represent safe Democratic districts, their retirements are stoking fears that the party is facing an increasingly uphill battle to maintain its majority in the House in the next Congress.  Already, five Democrats who represent competitive districts have announced their retirement plans.

House Dems Inch Toward $2T Reconciliation Framework, but Questions Remain

Leading House Democrats left a closed-door meeting on Wednesday saying they’re optimistic that they could reach an agreement on a $2 trillion reconciliation package as soon as the end of the week.  Scaling down the package from its originally proposed $3.5 trillion level would require significant changes, and President Biden, suggested on Tuesday in meetings with House Democrats, that two years of free community college and lifting the cap on the state and local tax (SALT) deduction could be dropped from the final measure.  However, Democrats representing high cost-of-living districts in the Northeast have said they won’t support a broader reconciliation package without restoration of the SALT deduction. Also, centrist Sen. Joe Manchin (D-WV), whose vote is essential for ensure passage in the Senate, is staying firm on his demand for no more than $1.5 trillion in new spending.

Senate, House Dems Differ on ARPA-H Funding Levels, Placement

The Biden administration’s proposal to create an Advanced Research Projects Agency for Health (ARPA-H) to drive innovation in biomedical research is advancing in Congress, albeit under two different approaches.  On October 18, the Senate Appropriations Committee released a bill that would provide $2.4 billion to the new agency for Fiscal Year (FY) 2022.  However, there are two bills in the House that offer a different FY 2022 funding level for ARPA-H.  House Energy and Commerce Health Subcommittee Chairwoman Anna Eshoo (D-CA) just recently introduced a bill that would provide the new agency $3 billion for FY 2022, the same amount that the House included in its FY 2022 appropriations minibus it passed in July.  Additionally, both chambers differ on the placement of ARPA-H.  The Senate appropriations bill would house the new agency under the National Institutes of Health (NIH), while Eshoo’s bill would make ARPA-H an independent agency within the Department of Health and Human Services (HHS).

ICYMI: Paris Hilton Meets with Lawmakers on Capitol Hill

On Wednesday, actress and socialite Paris Hilton hosted a press conference on Capitol Hill, where she called on President Biden and Congress to take action against congregate care facilities that abuse children.  Hilton, who endured abuse as a teen in a psychiatric youth treatment center in Utah, appeared with other survivors in Washington to advocate for the Accountability for Congregate Care Act.  During her visit, Hilton met with Sen. Mitt Romney (R-UT), Sen. Jeff Merkley (D-OR), and Rep. Ro Khanna (D-CA).

Where Members of Congress Live These Days

A group of West Virginians had something to say to Sen. Joe Manchin (D-WV) about the $3.5 trillion budget reconciliation bill, so they took their message directly to the Senator’s Washington, DC residence – by kayaking up to his houseboat on the Potomac River.  When legislators are conducting their business in our nation’s capital, just like anyone else, they need a place to stay.  And where members of Congress choose to stay has changed over the years, with potential consequences for how lawmakers do their job.

A Brief History

For much of the 19th century, members of Congress lived in boarding homes in the Capitol Hill neighborhood.  Senators and Representatives usually chose which house they lived in based on their political affiliation or state.  Known as “messes,” these groupings often included one or two members from a different state or party, allowing lawmakers the chance to build relationships across state or party lines.

As the US entered the 20th century, a growing federal government required members of Congress to be present more regularly in Washington.  Soon, it became the norm for legislators to have their homes and their families in the Washington, DC area.  By living in the same metropolitan area for most of the year, Representatives and Senators hailing from different political affiliations naturally found ways to form connections outside of legislative business through activities and institutions like schools, playgrounds, sporting events, and places of worship. 

1995 marked a major turning point, when then-Speaker Newt Gingrich (R-GA) reduced the workweek in the House from five to three days in order to allow more days for members of his caucus to engage in fundraising.  As Congress entered the new millennium, it became increasingly rare for members to spend their time outside of the halls of Congress in DC.   Instead, many lawmakers now head right to the airport or hit the road once the workweek ends or recess begins to make the journey back to their home states or districts, where they meet with constituents and fend off potential challengers.

With so many legislators going back and forth, what kind of places do they call home when they’re in Washington?

  • Congressional offices.  In recent years, dozens of members including former Speaker Paul Ryan (R-WI) and former House Majority Leader Dick Armey (R-TX) have opted to live rent-free in their offices, opting to sleep on sofas or foldable mattresses.  While supporters say office living allows them to focus on their work and ignore the distractions of Washington, DC, detractors say the practice unfairly uses taxpayer-funded housekeeping services.  Members who live in their offices are most likely to travel frequently between Washington and their state/district.
  • Group homes or apartments.  Renting a room in a DC rowhouse or apartment isn’t only popular with staffers – members of Congress do it, too.  Similar to congressional offices, apartments are popular with members who travel routinely to and from Washington.  Echoing back to the days where lawmakers lived in boarding homes, some members opt for a group-home style set-up.  A notable example of this is Senate Majority Leader Chuck Schumer (D-NY), Sen. Dick Durbin (D-IL), and former Rep. George Miller (D-CA), who shared a Capitol Hill rowhome until 2014.
  • Property ownership in the DC area.  A smaller portion of Senators and Representatives reside on property they own in the Washington, DC area.  This can range from condominiums or rowhomes in the District to single family homes in the suburban communities of Maryland and northern Virginia.  Members in this category generally do not travel as frequently to their home district or state as their fellow legislators, and some even raise their families in the DC area.  Examples of current lawmakers who relocated their families to the DC area following their election to Congress include Sen. Josh Hawley (R-MO) and Rep. Jodey Arrington (R-TX).  A notable exception within this group is lawmakers from Maryland, Virginia, and other jurisdictions in the Mid-Atlantic who already reside withing commuting distance of Washington.

There are several factors that determine where members of Congress choose to live – and how often they travel to and from Washington.

  • Cost of living.  Real estate costs have soared in the Washington, DC area over the past decade, with the median price of a rowhouse in the District climbing from $420,000 in 2009 to $760,000 in 2020
  • Competitiveness of seat.  Members who expect to face serious primary or general challenges from an opponent  are incentivized  to return more frequently to their home district or state to campaign or fundraise.  Due to frequent travel, they are more likely to keep their housing footprint in the District limited.  In contrast, members who hold a “safe” seat might opt to spend more time and put down roots in the District.
  • Personal preference.  Some members, regardless of their geographic proximity to Washington, choose to bring their families to the Washington, DC area to “keep them grounded” and maintain relationships with children and spouses.  These members more likely own property and spend more time in the National Capitol Region.

Why does a member’s housing situation matter?  The growing polarization in Congress over the last 20-plus years has coincided with the trend of members not putting down roots in the Washington, DC area.  When Representatives and Senators are constantly jetting out of DC, it limits the chances for them to bond, socialize, and see one another as peers.  If more members spent more time living in the DC area, could this shift the current political climate and contribute more to bipartisanship?

What’s Going on with Booster Shots?

There’s been a lot of discussion about COVID-19 booster shots lately – so much so, that it’s hard to keep track of who can get booster shots and what kind of booster shots are available.  Here, we provide a lay of the land on booster shots.

Why are booster shots necessary?  Booster shots provide an extra “boost” to immunity through an additional dose that cues the immune system to produce a stronger antibody response.  While all three currently approved vaccines from Pfizer, Moderna, and Johnson & Johnson are highly effective in protecting against hospitalization and death, a growing number of studies show that vaccine efficacy gradually wanes over time. 

Who can get booster shots now?  Pfizer’s COVID-19 vaccine is the only vaccine that is currently authorized by the Food and Drug Administration (FDA) to be used as a booster dose.  The FDA formally amended the emergency authorization use (EUA) for the Pfizer vaccine on September 22.  According to the amended EUA, the following people are eligible for booster shots at least six months after their initial series of shots:

  • People over age 65.
  • People ages 18 to 64 at high risk of severe COVID-19 due to chronic medical conditions or compromised immune systems.
  • People with greater risk of workplace exposure, such as frontline medical workers, teachers, and emergency responders.

More booster shots are on the way.  The FDA Vaccines and Related Biological Products Advisory Committee (VRBPAC) voted during an October 14-15 public meeting to recommend booster doses from Moderna and Johnson & Johnson. The panel recommended the Moderna booster be administered under the same criteria as Pfizer’s – six months after the second dose for people over 65, individuals at risk for serious complication from COVID-19, and essential workers.  However, the panel recommended broader criteria for the Johnson & Johnson booster – it said anyone who received the single dose Johnson & Johnson vaccine should be eligible to receive a second booster dose at least two months later

  • Why? Several studies have shown the Johnson & Johnson vaccine is less effective that other currently approved shots, particularly against new variants like Delta.

What happens next: The CDC Advisory Committee on Immunization Practices (ACIP) will meet on October 20-21 to offer its recommendations on who should get the Moderna and Johnson & Johnson booster shots.  Its recommendations are subject to a final decision from the CDC director.  Afterwards, the FDA could officially authorize booster shots from both companies in the following days. 

The conversation on booster shots hasn’t been without controversy.  Over the past few months, scientists, researchers, and public health officials within the federal government haven’t seen eye-to-eye on when booster shots should become available, and who should get them. 

  • For example, CDC Director Rochelle Walensky partially overruled ACIP last month when the panel initially declined to offer booster shots for essential workers under 65 who do not have chronic medical conditions.  Some ACIP members said that without additional data, they weren’t comfortable automatically allowing younger people to get boosters just because of their jobs.  While Walensky acknowledged the panel’s uncertainty, she said in a statement that CDC must use “imperfect data” to “take actions that we anticipate will do the greatest good.”
  • There are also ethical considerations as billions worldwide remain unvaccinated.  While many public health experts believe people with chronic health conditions should get additional shots, they feel extra doses should be allocated to countries with low vaccination rates first in order to prevent more dangerous variants from developing. 

The administration’s internal disputes have been quite apparent to the public.  Back in August, President Biden announced a plan to start distributing booster shots to all eligible Americans as soon as September 20.  However, the health care agencies tasked with rolling out boosters have taken a more conservative approach, and one month later after Biden’s original deadline, only certain segments of the population have access to one vaccine booster.   

With limited information and uncertainty about the future of the virus, administration officials are between a rock and a hard place.  On one hand, federal officials don’t have enough data to make definitive decisions on who needs a booster and how much a booster would improve efficacyOn the other hand, the administration knows it can’t wait for definitive findings to become available, especially if case number surge once again in the next few months as colder temperatures drive more Americans indoors.

At the end of the day, COVID-19 is still a novel virus, and there are many unanswered questions on how long protection from vaccines last and how much that protection varies between different groups of people.  While new data on vaccines will continue to gradually become available, federal health officials will have to continue discussing and weighing the risks and benefits of authorizing vaccines in the US.   

What Happened, What You Missed: October 11-15

Biden Likely to Nominate Califf to Lead FDA

On October 14, The Washington Post first reported that former Food and Drug Administration (FDA) Commissioner Robert Califf is the Biden administration’s top pick to lead the FDA.  Califf previously served as FDA Commissioner for nearly a year during the second term of the Obama administration.   Despite the agency’s important role in addressing the COVID-19 pandemic, the FDA has been without a permanent leader since the current administration took office in January.  If confirmed, Califf will play a pivotal role in leading the FDA through what is hopefully the final stage of the pandemic and overseeing the review of vaccines and treatments.  However, the White House has said a final decision has yet to be made, and sources close to the vetting process have acknowledged that the situation could still change.

FDA Advisory Panel Approves Moderna “Booster” for Seniors, At-Risk People

The FDA Vaccines and Related Biological Products Advisory Committee (VRBPAC) unanimously voted on Thursday to recommend that the agency authorize a “booster” dose of Moderna’s COVID-19 vaccine for all individuals over 65 and younger people who have chronic medical conditions and/or are essential workers.  The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) is expected to vote on the Moderna booster doses on October 21, and a final FDA decision could follow within days. Recap: three weeks ago, the FDA amended the emergency use authorization (EUA) of Pfizer’s COVID-19 vaccine to make it the first vaccine available as a booster dose. 

Authorization of COVID-19 Antiviral Pill Anticipated in December

In their October 14 public meeting, the FDA VRBPAC announced that it will meet on November 30 to review data on Merck’s experimental oral antiviral COVID-19 treatment, which potentially means that FDA could issue an EUA for the antiviral drug sometime in December.  On Monday, Merck submitted an EUA for the drug, known as molnupiravir, which contained data showing that the antiviral treatment reduced hospitalization and death by 50%.  While the FDA does have the option to bypass review by VRBPAC, the agency communicated in a press release that it believes a “public discussion” will help “ensure clear understanding of the scientific data” necessary to decide whether it’s worth approving the antiviral for emergency use.

House Dems Clear Short-Term Debt Ceiling Bill, but Divisions on Reconciliation Bill Remain

On October 12, the House voted 219-206 to increase the debt ceiling by $480 billion, staving off default through at least early December. But despite unanimous support among House Democrats to address the debt ceiling, which they will have to address again in two short months, members of the caucus have yet to come to an agreement on a $3.5 trillion budget reconciliation package. Democrats can only afford to lose three votes in the House and no votes in the Senate. Therefore, achieving unanimous or near-unanimous support in both chambers has been an enormous challenge for the White House and Democratic leadership, who are eager to pass a measure in the upcoming weeks.  On Tuesday, Speaker Nancy Pelosi (D-CA) acknowledged that the bill’s final price tag is likely to be lower than $3.5 trillion as lawmakers within the party continue to negotiate on the  final package. 

ICYMI: Zebras Are on the Loose outside Washington, DC

Three zebras who escaped from a farm in Upper Marlboro, MD in August have been spotted roaming the wooded areas and green spaces of the Maryland suburbs of Washington, DC for the past several weeks.  While wildlife experts say the zebras appear to be safe due to a lack of predators like lions and hyenas, one of the zebras unfortunately died last month after it was caught in an illegal snare trap in Prince George’s County, MD.  Although local animal control officials are on the case, experts say catching the zebras will be difficult due to their intelligence and strong fight-or-flight response. 

Collins Leaves Big Shoes to Fill at NIH

Francis Collins announced plans to retire from his role as Director of the National Institutes of Health (NIH) on October 5.  This is a big deal for the Biden administration, as this leaves another crucial leadership position vacant, as the administration still has not nominated a Commissioner for the Food and Drug Administration (FDA).

Brief background: The Staunton, Virginia native first came to NIH in 1993 to serve as Director of the National Human Genome Research Institute, a role he held for 15 years.  Under his leadership, the institute made landmark discoveries of disease genes and contributed to the international Human Genome Project, which for the first time fully mapped all genes of the human genome.  Collins was later nominated to lead NIH under then-President Barack Obama and was confirmed by the Senate in 2009.

Why is he retiring?  Even though a public health emergency is still ongoing, Collins told reporters that his “hour-to-hour oversight” is no longer as necessary now that three vaccines are out and case numbers are declining nationwide.  According to reports from Politico, Collins initially wanted to quit last winter, but National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci convinced him to stay on a little while longer.

It wasn’t a spur of the moment decision.  Collins said he had been thinking about retirement for the past 3-4 months.  By making the decision now, Collins hopes to facilitate a smooth transition for the next NIH director.

Who’s taking over?  Principal Deputy Director Lawrence Tabak, number two at NIH, is most likely to serve as acting director in the interim.  But it’s unclear if he’s in the running for the top job – Collins said in an October 5 interview that he wants a woman to succeed him.  The only certainty is that Fauci won’t be the next NIH director – he’s already said no to the role.

Whoever takes over will have big shoes to fill.  During his decade-plus at the helm of NIH, Collins:

And whoever becomes the next NIH director has plenty of challenges to look forward to, including:

  • Leading the agency though the next (and hopefully final) phase of the pandemic.
  • Shaping the development of the Advanced Research Projects Agency, or ARPA-H.
  • Overseeing clinical trials for COVID-19 treatments.
  • Defending the administration’s public health policies and handling of the  pandemic on Capitol Hill. 

It’s also worth noting that Francis Collins is a bit of a Renaissance man.  Here are some of his other accomplishments outside of leading the world’s largest medical agency.

Collins won’t be the NIH director anymore, but he isn’t leaving NIH.  In fact, he’s planning to return to his laboratory at the National Human Genome Research Institute. 

Why Feelings Are Mixed on the New Surprise Billing Rule

The administration’s latest interim final rule to implement the No Surprises Act dropped on September 30.  Here’s a look at the various reactions from stakeholders and why they are mixed.

What does it say?  The rule outlines a baseball-style, independent dispute resolution (IDR) process for settling payment disputes between out-of-network providers and commercial insurance plans.  Before the IDR process can begin, both parties involved must enter into a 30-day negotiation period to determine a payment rate.  If these negotiations fail, either party can initiate the IDR process. 

Next, both parties submit their proposed payment rate with supporting documentation to a certified IDR entity, who then issues a binding determination by selecting one of the party’s proposed rates.  When making a determination on which rate to select, the IDR entity must “begin with the presumption” that the most appropriate rate is the median of contracted rates for a specific service in the same geographic region.

  • Why? According to the rule, emphasizing the median in-network rate will help ensure that IDR outcomes are predictable and that stakeholders are not incentivized to overuse the IDR process.

In addition to the median-in network rate, other factors IDR entities may consider include the level of training, experience, and quality and outcomes measurements of the provider or facility that is furnished.

Insurers’ reactions have been favorable overallAmerica’s Health Insurance Plans said the focus on the median in-network rate “is the right approach” to encourage all stakeholders to work together and negotiate in good faith.  And the ERISA Industry Committee said the IDR process will reinforce the intention of the No Surprises Act.” 

But hospitals aren’t so happy.  The Federation of American Hospitals said the rule “misreads Congressional intent” on establishing a “fair and balanced” IDR process, while the American Hospital Association said the rule “unfairly favors insurers to the detriment of hospitals” and other providers. 

Reactions from lawmakers are mixed, too.  Like hospital stakeholders, comments from members of Congress have focused on the rule’s prioritization of median in-network rates in the IDR process.  Ways and Means Committee Chair Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) said in an October 5 letter to the administration that the rule’s bias towards a median rate is not consistent with the law passed by Congress, which requires IDR entities to consider a range of factors when determining the appropriate rate. 

However, House Education and Labor Committee Ranking Member Virginia Foxx (R-NC) commented that the rule is “consistent with congressional intent.” Both the Ways and Means Committee and the Education and Labor Committee played key roles in drafting the No Surprises Act. 

When the No Surprises Act passed late last year, it was considered a win for hospitals, who favored settling out-of-network payment disputes with an IDR process.  In contrast, private health plans were advocating benchmark rates based on the median in-network rate as a solution.  By prioritizing median in-network rates in the IDR process, could the administration be attempting to balance the concerns of all health care stakeholders? 

What’s next: The administration will issue a rule later this year to implement the pharmacy and prescription drug reporting requirements of the No Surprises Act.  Despite a 60-day public comment period, the rule is final, and stakeholders will be required to comply with all of its provisions beginning January 1, 2022.  In the meantime, Reps. Neal and Brady have requested additional written justification from key administration officials on how the latest rule complies with the No Surprises Act, and stakeholders will continue to engage with the administration on upcoming rules.   

What Happened, What You Missed: October 4-8

Pfizer Asks FDA to Authorize Vaccine for Kids

On October 7, Pfizer formally asked the Food and Drug Administration (FDA) to authorize its COVID-19 vaccine for emergency use in children aged 5-11.  When approved, an estimated 28 million children in the US will be eligible for vaccines.  The FDA Vaccines and Related Biological Products Advisory Committee is scheduled to meet on October 26 to discuss use of the Pfizer vaccine in kids, and federal health officials have said emergency use authorization (EUA) could come between late October and late November. 

Senate Clears Short-Term Debt Ceiling Increase

Late Thursday, the Senate voted 50-48, a party line vote, to increase the debt ceiling by $480 billion, which the Treasury Department estimates will enable the federal government to continue to borrow money through December 3.  The current debt limit expired on August 1, and the Treasury Department has been using extraordinary measures to ensure the federal government can meet its debt obligations since then.  However, Thursday’s vote doesn’t change the underlying standoff that caused gridlock over the debt ceiling in the first place.  Since extraordinary measures have been mostly exhausted, the Treasury Department will have little wiggle room to ensure the government can continue to pay its bills if Congress once again fails to address the debt ceiling by December 3.

White House Announces New $1B Investment in At-Home COVID-19 Tests

On October 6, the Biden administration announced plans to invest an additional $1 billion to boost the manufacturing capabilities for rapid, at-home COVID-19 tests.  According to the White House COVID-19 Response Coordinator Jeff Zients, the administration’s $1 billion investment along with the FDA’s recent approval of a rapid antigen test from ACON Laboratories could increase the number of at-home tests by 200 million per month by the year’s end.  As more Americans return to work and school, many public health experts have said more at-home tests could stop asymptomatic spread and control outbreaks.

Experimental Antiviral Shows Promise in Reducing Hospitalization, Death from COVID-19

On October 1, Merck reported that a phase 3 trial of its oral antibody treatment molnupravir reduced the risk of hospitalization or death by about 50% in COVID-19 patients.  The company also mentioned that it plans to seek an emergency use authorization from the FDA “as soon as possible.”  Public health experts see the arrival of an antiviral pill along with the availability of vaccines for children as a major step in transitioning out of the current public health emergency.

ICYMI: Filming Underway in DC for New HBO Series on Watergate

Over the past two weeks, Washington, DC residents have spotted Woody Harrelson and Justin Theroux, who are in town to film an upcoming HBO docuseries on the Watergate scandal called The White House Plumbers.  Filming of the five-part series has so far brought 1970s-era cars and a recreation of the Nixon campaign headquarters into downtown DC.  Fun fact, Justin Theroux is a Washington, DC native.

Video Games: A New Frontier for Politics?

227 million Americans play video games.  That includes a grow number of US lawmakers, who are not only embracing video games as a hobby but incorporating them into their campaigns.  

Video games come to Washington.  A Politico Magazine article published in 2018 profiled a few members of Congress and their interest in video games.  Reps. Scott Peters (D-CA) and Darrell Issa (R-CA) indicated video games provide a way for lawmakers of different parties to bond, while Rep. Jared Polis (D-CO), now Governor of Colorado, said video games improve critical thinking skills.

Politicians haven’t always liked video games, to say the least.  In 1993, then-Sen. Joe Lieberman (D-CT) first suggested banning violent video games, while then-Sen. Hillary Clinton (D-NY) introduced legislation to add more restrictions to violent and sexually explicit games in 2005.  Over the past 20-plus years, many politicians have at least partially blamed video games on mass shootings, including then-President Donald Trump with the 2018 Parkland High School shooting, and House Minority Leader Kevin McCarthy (D-CA) with the 2019 shooting in El Paso.

Video Games on the Campaign Trail

However, lawmakers’ changing attitudes on video games has coincided with political campaigns’ increased use of video games.  In September 2020, the Biden-Harris campaign made available virtual yard signs that players of the game Animal Crossing could download and place in their virtual front yards.  The COVID-19 pandemic may have also inspired the Biden-Harris campaign to dive into the world of virtual organizing, as many Democratic campaigns had suspended in-person events and shifted online due to the virus. But, the Biden-Harris campaign wasn’t the first political campaign to use  video games – in 2008, the Obama-Biden campaign placed ads on virtual billboards in Madden NFL 09 and NBA Live 08.  

Given the large number of Americans that play video games, it’s hard to deny the potential video games offer politically.  Campaigns can use video games to target specific demographics such as men aged 18-49, who are disproportionately more likely to participate in gaming.  And unlike print, radio, and television ads, video games offer an interactive format that can be potentially more persuasive than traditional forms of media.

That doesn’t mean video games are the new frontier for campaigns.  Instances of campaigns ads in video games appear to be the exception, not the rule, and it’s unclear to what extent politics will encroach on the world of gaming.  Most video game developers prefer to keep their products apolitical, largely to avoid pushback from their (mostly male) customers.  Additionally, many people turn to video games as a way to take a break from aspects of the real world – like politics.  While politicians may see video games as fertile ground for outreach, fear of backlash from developers and gamers could slow down the adoption of virtually campaigning as a major way to reach potential voters.

Travel Nurses Come to the Rescue, but at What Cost?

When it’s a global pandemic and you’re facing a shortage of health care workers, who you gonna call? Travel nurses.  This has been the answer for many health care providers, as travel nurses temporarily fill in gaps where there is a shortage of staff nurses. As the pandemic has changed how businesses operate, how will this impact the future for travel nurses and providers?

Why be a travel nurse?  Compared to staff nurses, travel nurses receive better compensation and attractive benefits like housing and per diem.  Many nurses are attracted to this lifestyle for the ability to travel and the opportunity to help pay off the cost of their nursing education.  Staffing agencies, not health care facilities, employ travel nurses and place them with providers.

Supply and Demand

The market for travel nurses was hot even before the COVID-19 pandemic due to an aging US population and other public health crisis like the opioid epidemic.  And now the pandemic has driven the demand for travel nurses even higher.  A recent poll of hospital executives by Avant Healthcare Professionals found 90% of respondents used travel nurses in 2020, compared to less than 60% in 2019.  Increasing demand has caused compensation for travel nurses to rise in tandem, with contracts for some front-line workers reaching $10,000 per week.

Travel nurses still face plenty of challenges.  Throughout the pandemic, both travel nurses and staff nurses have struggled to make do with a shortage of personal protective equipment, experienced burnout, and encountered emotional trauma from treating seriously ill COVID patients.  Problems have gotten so bad that many nurses are considering leaving the professional altogether.  Plus, since a great deal of travel nurses are geographically separated from family and friends, they lack the emotional support networks that are more readily available to their staff nurse counterparts. 

There are downsides for providers, too.  Sure, travel nurses can alleviate staffing shortages at hospitals and nursing homes, but they can create headaches of their own.

  • Cost.  Higher compensation for travel nurses means higher labor costs for providers, which includes an extra cost of paying a commission to the staffing agency.  And don’t forget, many providers have already been facing financial pressures of their own during the pandemic.
  • Competition.  Some nurses employed with hospitals and long-term care facilities are leaving their jobs to pursue more lucrative opportunities as travel nurses, exacerbating the industry’s workforce shortage.   Staff nurses who train travel nurses new to a health care provider may also find themselves frustrated with the fact that they are making less money than their trainees, causing morale to fall and potentially providing another reason for staff nurses to seek greener pastures.
  • The rural factor.  Larger hospitals near metropolitan areas are better able to weather staff shortages due to their more robust financial position, which allows them to afford travel nurses.  Plus, the higher staff sizes of hospitals in urban and suburban areas means they’re not as severely affected by a couple of unfilled nursing positions.  However, it’s a different story for rural health care providers, where just a shortage of just a few nurses can make a big difference on providing care.Additionally, smaller rural hospitals cannot afford to pay nurses as competitive of a salary as their larger, urban counterparts, meaning they’re at greater risk of losing nurses to better-paying travel roles. 

Still, travel nurses aren’t going away anytime soon.  Even when the pandemic ends, an aging population will continue to drive up demand,  while a growing number of nurses retiring, made worse by the public health emergency, will leave many positions unfilled.  Although projections vary widely across the country, many states face a projected shortfall of thousands of nurses by 2030, impacting the amount and quality of care a provider can provide.  While travel nurses may be an imperfect solution, health care providers will have no choice but to fill staffing shortages with temporary workers for the years to come.

What Happened, What You Missed: September 27-October 1

Pfizer Submits Initial Data on COVID-19 Vaccine in Kids

On September 28, Pfizer submitted initial data to the Food and Drug Administration (FDA) that shows its COVID-19 vaccine generates “robust” protection in children aged 5-11.  The announcement came just a week after Pfizer announced positive topline results in its clinical trials for children.  Pfizer says it will formally apply for Emergency Use Authorization for children in that age range “in the coming weeks,” teeing up FDA authorization potentially by the end of October.  Pfizer also announced that it is expected to have topline results for children under 5 in the fourth quarter of this year. 

CDC: Side Effects from Booster Shots Are Mild

A third “booster” shot from Pfizer’s mRNA COVID-19 vaccine produces side effects consistent with the side effects individuals experienced after their second shot, according to a report posted Tuesday by the Centers for Disease Control and Prevention (CDC).  The report found side effects usually appeared the day after the injection, with the most common side effects being mild-to-moderate arm pain, fatigue, and headache.  According to the White House, over 400,000 Americans have received a third Pfizer shot over the past week, including President Joe Biden, who was administered his booster shot during a live event on Monday.  Both the FDA and the CDC approved booster shots for senior citizens, high-risk workers, and people with chronic medical conditions last week.

Gallup: Delta Variant Likely Prompted More Americans to Get Vaccinated

According to a Gallup poll released on September 29, the percentage of US adults who reported being vaccinated for COVID-19 grew to 75%, largely due to growing concerns of being infected with the virus as the Delta variant continues to take its toll.  The poll also found that a rise in vaccine mandates from employers and the FDA fully approving the Pfizer vaccine may have also contributed to higher vaccination rates.  Additionally, for the first time, Gallup found that a majority of adults who identify as Republican say they have been administered at least one vaccine dose. 

Congress Averts Shutdown, but Leaves Debt Limit Unresolved

President Biden signed a continuing resolution (CR) late Thursday to fund the government through December 3, averting a government shutdown that otherwise would have begun on October 1.  The standalone CR was fast-tracked through Congress after Senate Republicans initially blocked a measure that paired government funding with a debt ceiling increase on Tuesday.  Earlier this week, Treasury Secretary Janet Yellen sent a letter to congressional leadership saying that without any action to raise or suspend the debt ceiling, the government could default on its debt obligations as soon as October 18.  Senate Republicans want Democrats to address the debt ceiling through the budget reconciliation process, but Senate Majority Leader Chuck Schumer (D-NY) has so far refused to do so, setting up a standoff between the two parties for the next few weeks. 

ICYMI: DC’s “Cat Census” Estimates 200,000 Felines in the District

There are about 200,000 cats residing in Washington, DC according to the DC Cat Count, the first-ever project to conduct a census on felines in a major US city.  The project estimates that the overwhelming majority of the District’s cats are owned or cared for while about 3,000 are feral.  Of the cats who receive at least some care from humans, half are indoor-only, while the other half have some access to the outdoors.  To conduct the cat census, the Human Research Alliance collaborated with the Smithsonian to place over 1,500 motion-sensor cameras in locations across the District, resulting in about 1.2 million cat photos.