Insights

Sanders, AHA Disagree over Charity Care Standards

According to a new report by Senate Health, Education, Labor, and Pensions (HELP) Committee Chair Bernie Sanders, most non-profit hospitals don’t provide enough charity care to justify their tax-exempt status.  To rectify this, Sanders’ report recommends tying tax exemption to a certain level of charity care, setting better standards for financial assistance, and defining the community engagement that non-profit hospitals are required to partake in.  In a separate report released this week, the American Hospital Association (AHA) disputed Sanders’ findings by pointing out that non-profit hospitals provided more than $129 billion in total benefits to their communities in 2020.  According to AHA CEO Rick Pollack, these benefits include housing assistance, financial aid, and patient education.

Walgreens’ Pharmacy Staff Go On 3-Day Strike

Several hundred pharmacists and pharmacy staff employed by Walgreens went on strike for 3 days this week to protest poor working conditions.  The strike follows recent walkouts at fellow pharmacy CVS and health care provider Kaiser Permanente.   According to staff, the strike is a response to increasing pressure from management to hit quotas for vaccinations, prescriptions filled, and testing, as well as bullying and harassment from customers.  To improve working conditions, staff are asking for dedicated training time for new staff, changes to the quota system, and more transparency in hour staff hours are set.  1 day after the strike ended, Walgreens announced plans to close 60 clinics and exit 5 markets as part of a $1 billion cost-cutting program.

CDC: Long COVID Rare in Children

Long COVID is rare among children, according to new survey data from the Centers for Disease Control and Prevention (CDC).  The survey found 1.3% of children had long COVID in 2022 and 0.5% currently have it in 2023.  The survey defined long COVID as post-viral symptoms lasting more than 3 months.  While long COVID can include a multitude of conditions, the most common are fatigue, shortness of breath, and chronic pain.  The survey data comes as public health experts and educators continue to debate whether school closures and other non-pharmaceutical interventions intended to limit children’s exposure to COVID-19 were justified.

FDA Launches New Committee on Digital Health, AI

The Food and Drug Administration (FDA) launched a new Digital Health Advisory Committee that will be tasked with advising the agency’s leaders on the risk, benefits, and possible outcomes of emerging technologies.  Possible subjects of exploration for the committee include artificial intelligence (AI) virtual reality, digital therapeutics, wearables, and remote patient monitoring.  The committee’s announcement comes as FDA’s regulatory activities have grown to include AI-enabled medical devices, clinical decision support software, and genomic data.  The committee, which is slated to have 9 members, is expected to be operational sometime next year.

ICYMI: Tours Aim to Show to the Scary Side of Washington

A pair of tours hope to give patrons a sense of the paranormal side of Congress and Capitol Hill.  National Nightmares’ Hill of Haunts walking tours on Fridays and Saturdays in October will immerse participants in the ghost stories and hauntings of the Capitol, the Library of Congress, and congressional office buildings.  Just a few miles away at the Congressional Cemetery, Soul Strolls provides visitors with a haunting recap of the cemetery’s more famous residents, complete with portrayals from local actors.

Moderna Requests Authorization for COVID-19 Vaccine in Children under 6

Moderna announced on Thursday that it has begun the application process for emergency use authorization (EUA) for its COVID-19 vaccine in children six months to six years of age.  Moderna also released revised clinical trial data on Thursday that showed its two-shot regimen is 51% effective at preventing symptoms in children ages 6 months to under 2 years.  However, Moderna’s application process is ongoing, and the company is not expected to submit all of its clinical trial data to the FDA until the first week of May.  According to a tentative schedule by the Food and Drug Administration (FDA), kids under age six maybe be able to receive their COVID-19 vaccine from Moderna as soon as this June.

Administration Finalizes the 2023 Notice of Benefit and Payment Parameters

On Thursday, the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) issued a final rule on the 2023 Notice of Benefit and Payment Parameters, which includes updates to the nondiscrimination policy for Affordable Care Act essential health benefits, standardized health plan options, and other changes.  The rule also refined prospective network adequacy reviews to focus on time and distance as well as appointment waiting times starting in plan year 2024.

New CDC Data Shows Most Americans Have Had COVID-19

New data from the Centers for Disease Control and Prevention (CDC) revealed that at least 60% of adults and 75% percent of children have been infected with COVID-19.  The latest figures show a considerable jump from December 2021 data which estimated that 35% of adults at the time had contracted the virus at some point.  According to a CDC report, the higher percentage of Americans having COVID-19 over the past several months can be contributed to the more transmissible Omicron variant.  The CDC gathered the data by analyzing blood specimens.

Former Sen. Orrin Hatch (R-UT) dies at 88

On April 23, former Sen. Orrin Hatch (R-UT), the longest-serving Republican senator, died in his home in Salt Lake City at age 88.  First elected to the Senate in 1977, Hatch was an ardent conservative who helped advance the Tax Cuts and Jobs Act of 2017 while serving as chairman of the Senate Finance Committee.  Hatch also made a bid for the Republican presidential nomination in 2000 but lost to George W. Bush.  In contrast to other members of Congress who recently passed away – including Sen. Harry Reid (D-NV) and Rep. Don Young (R-AK) – Hatch will not lie in state at the US Capitol.  Instead, Hatch will lie in state at the Utah State Capitol due to the late senator’s strong connections to the state.

ICYMI: Wild Turkey Attacks People in DC Parks

If you’re visiting Washington, DC anytime soon, you may want to take extra caution when visiting Anacostia Park and Kenilworth Aquatic Gardens.  That’s where a wild male turkey has been aggressively attacking cyclists, runners, pedestrians, and nature enthusiasts for at least the past five months.  The National Park Service says they’re aware of the turkey and have been attempting to catch it for weeks.  Until the turkey is captured, park rangers are advising people to “appear bigger and louder” if they come across the animal.

The 2022 primary season kicks off in Texas on March 1, and with the start of primary season comes some big questions about which direction either party will go.  Democrats will be duking out over what direction the party will take after its agenda has largely stalled in Congress, while Republican candidates face tough questions about former President Donald Trump’s role in the party and whether they acknowledge the results of the 2020 presidential election.

On top of this, the 2022 primary season includes numerous races for offices like governor and attorney general, who will play an important role in certifying election results for 2024 and beyond, adding extra weight to the questions some candidates will face over democracy and the legitimacy of the 2020 election.

Wait, what is a primary?  Political parties hold primary elections to select their nominees for candidates who will run on behalf of the party in the general election.  In a primary, Republicans run against Republicans, while Democrats run against other Democrats.  In contrast, the general election determines which candidates will occupy offices that are up for election.

Additionally, different states have different rules on how they conduct their primaries.  These are the four types of basic primary elections:

• Open primaries, where anyone of any political party affiliation may vote.
• Closed primaries, where only those voters who registered with that particular political party may vote.
• Hybrid primaries, also called semi-open and semi-closed primaries, where anyone of any political party affiliation can vote, but can only vote in one primary.
• Runoff primaries, where a few states hold a second primary between two candidates with the most votes.  Of note, both Louisiana and Georgia will have runoff races for their general elections scheduled after Election Day on November 8 for the top-two candidates if one candidate fails to win at least 50% of the vote in their most recent primary.

Below is a list of all key primary dates for congressional races with their respective state and runoff status.

*Indicates runoff election date.

Administration Working on New Masking Guidelines

On Wednesday, White House Coronavirus Response Coordinator Jeff Zients told reporters that the administration is working with public health experts and business leaders to updates its pandemic guidance. The guidance will focus on hospitalizations rather than case numbers as metrics for determining when Americans should wear masks indoors.  The announcement comes as many blue states and cities have announced plans to roll back indoor mask requirements without input from the federal government.  In recent weeks, both case numbers and hospitalizations have declined across the nation.  Reports suggest new mask guidance from the Center for Disease Control and Prevention (CDC) could come as early as next week.

Senate Narrowly Confirms Robert Califf to Lead FDA

On Tuesday, the Senate voted 50-46 to confirm Robert Califf as the new Food and Drug Administration (FDA) Commissioner, clearing the way for the FDA to have a permanent leader in over a year.  The narrow vote comes after senators from both parties raised concerns about Califf’s handling of the opioid epidemic when he led the FDA from 2016 to 2017 as well as his ties to the pharmaceutical industry.  Califf will replace Janet Woodcock, who has served as the FDA’s temporary chief since January 2021 and will remain at FDA as principal deputy commissioner. It is not clear when Califf will officially begin his new role.

Senate Approves Bill to Fund Government through March 11

The Senate voted 65-27 to approve a continuing resolution (CR) on Thursday night to move the government funding deadline to March 11, giving lawmakers three more weeks to hammer out an agreement on a Fiscal Year (FY) 2022 appropriations omnibus.  Earlier in the week, the status of the three-week CR was in doubt after several GOP senators called for votes on controversial amendments to be added to the CR.  Some of the amendments, which only required a simple majority vote, would have prevented the Biden administration from enforcing vaccine mandates and make it harder to raise the debt ceiling.  Any changes to the CR would have forced the measure to go back to the House, which is in the middle of a two-week recess and where Democrats are unlikely to support a bill with any controversial amendments attached.  However, with several Republican senators absent from Washington to attend a security conference in Munich, the amendments failed to garner a majority vote.  President Biden is expected to sign the CR in law later today.

FTC Rejects Probe into Pharmacy Benefit Managers

On Thursday, the Federal Trade Commission (FTC) voted 2-2 to defeat a proposed investigation into whether pharmacy benefit managers (PBMs) are violating federal anti-competitive regulations.  Three PBMs currently control 80% of the market, and pharmacists and patient advocates have voiced concern for years that PBMs engage in anticompetitive practices that lead to higher drug prices and disadvantage independent or specialty pharmacies.  While the two commissioners who voted against the probe say they aren’t opposed to looking into the role of PBMs, they ultimately voted against the proposed investigation because it wasn’t comprehensive enough and they weren’t provided with sufficient notice of the vote.

ICYMI: The Obamas’ Portraits Go On Tour

In May 2021, the National Portrait Gallery’s portraits of former President Barack Obama and former First Lady Michelle Obama embarked on a five-city tour that includes an audio-visual element, educational workshops, presentations, and an illustrated book. The portraits were initially supposed to return to Washington this summer, but the Smithsonian has since announced new stops in San Francisco and Boston that will keep the portraits away from Washington until the fall.  Anyone who wants to see the portraits now can view them at Atlanta’s High Art Museum until March 20.

Earmarks returned to the appropriations process last year for the first time since Congress banned the practice over a decade ago.  However, as lawmakers keep kicking the can down the road on Fiscal Year (FY) 2022 appropriations with continuing resolution after continuing resolution (also known as a CR), the likelihood that these earmarks will make it into an appropriations omnibus for FY 2022 is looking less likely.

The Demise and Rise of Earmarks

Earmarks, or provisions inserted in appropriations bills directed for a specific project or recipient, exploded in practice throughout the 1990s and 2000s.  Earmarks gradually gained a bad reputation over time for their perceived role in adding to corruption or fueling “pork barrel spending,” which caused lawmakers to place a moratorium on the practice in 2011.

In the years since the ban on earmarks took hold, the appropriations process only got worse, with government shutdowns becoming more common.  To incentivize lawmakers to work together on spending bills – and ultimately reduce dysfunction in the appropriations process – the Select Committee on the Modernization of Congress issued a recommendation that earmarks should return, albeit with some changes to make the process more transparent.

In February 2021, House Democrats brought earmarks back to the appropriations process as Community Project Funding.  Unlike the earmarks of the past, House members are limited to 10 earmark requests and must declare that they have no financial connections to the projects they request.   Additionally, earmark requests are limited to schools, hospital, municipal authorities, and other non-profit organizations.

And in the Senate, earmarks returned in April 2021 under the moniker of Congressionally Directed Spending.  Senators must follow the same earmarks rules as their counterparts in the House, with the exception that they can make an unlimited number of requests.

Earmarks and FY 2022 Appropriations

Members of both parties have made earmark requests since the start of the FY 2022 appropriations process, although activity is much higher among Democrats than Republicans.  In the House, over 220 Democrats requested funding for more than 2,000 projects, while 108 Republicans issued requests for over 700 projects.  In the Senate, a total of 60 Senators, 44 Democrats and 16 Republicans, have submitted earmarks to be included in an omnibus package.

However, none of these earmarks will fund their intended projects until Congress finalizes appropriations for FY 2022.  The current CR to fund the government expires in less than two weeks, and there are still major disagreements between both parties that include policy riders over controversial issues like the Hyde Amendment, disagreements over parity between defense and non-defense spending increases, and finalizing topline spending levels.   In anticipation of continued gridlock, congressional leaders introduced on February 7 a new CR that would extend the government funding deadline from February 18 to March 11.

However, the longer it takes lawmakers to agree on an appropriations omnibus for FY 2022, the less likely earmarks will be included.  Many Republicans are still concerned about the optics of earmarks, and many top Republicans in the House and Senate opted not to make earmark requests last summer when the FY 2022 appropriations process began in earnest.  As discussions on major sticking points continue, congressional leaders may simply decide to strike community funding or congressionally directed projects from an omnibus, especially if they make it harder to reach a final compromise.

A Year-Long Continuing Resolution?

Additionally, concerns are growing that Congress could ultimately settle for a year-long CR – which means earmark might not have another shot at getting funded until the FY 2023 appropriations process is underway.

Of course, lawmakers could still reach a deal, and earmarks could ultimately make their grand return in a 2022 appropriations omnibus.  Members of Congress who submitted earmark requests know their projects will remain unfunded until a deal is reached regarding FY 22 funding, and therefore they could be incentivized to break the gridlock in the near-term.

Additionally, with the Democrats hitting pause on passing some version of the Build Back Better Act  could mean Republicans aren’t  as sensitive to a compromise appropriations bill that calls for big spending increases.  But as Republicans don’t have as much skin in the game on earmarks as Democrats, there is no reason to believe Congress will hang its hat on earmarks being the saving grace on passing an omnibus package, which means the possibility of a year-long CR looms larger by the day.

However, even if FY 2021 spending levels are sustained through September 30, 2022, the practice of including earmarks in future appropriation cycles aren’t out for the count.  There’s no reason to suspect the House and Senate won’t include Community Project Funding or Congressionally Directed Spending in the FY 2023 appropriations process, meaning advocates have plenty of time to prepare to lobby for projects in the next appropriations cycle.

Bipartisan Senators Release Draft of Pandemic Preparedness Bill

On Tuesday, Senate Health, Education, Labor, and Pensions (HELP) Committee Chairwoman Patty Murray (D-WA) and Ranking Member Richard Burr (R-NC) released the discussion draft of legislation aimed at improving the nation’s response to pandemics.  Some of the draft’s key components include creating a 9/11 Commission-style task force to examine the response the pandemic, making the Director of the Centers for Disease Control and Prevention (CDC) a Senate-confirmed position, and authorizing new grants for genomic sequencing to detect new pathogens or variants.  The Senators requested feedback by February 4 to hopefully markup the legislation in the next few weeks.

NIH: It’s OK to Mix-and-Match COVID-19 Vaccine Doses

According to research published by the National Institutes of Health (NIH) on Wednesday, any combination of primary and booster vaccines against COVID-19 yields strong antibody levels.  The findings support a “mix-and-match” approach to COVID-19 booster that means people who received an initial vaccination regiment from one of the three COVID-19 vaccines granted Emergency Use Authorization (EUA) or approval from the Food and Drug Administration (FDA) can expect enhanced protection from an additional booster dose from any of the vaccines.  However, the study did not look into which mix-and-match approach might be the most effective. According to the CDC, only about 40% of Americans fully vaccinated against COVID-19 have received booster shots.

FDA Limits Use of 2 COVID-19 Antibody Treatments

On Monday, the FDA announced that it will curb the use of COVID-19 antibody treatments from Regeneron and Eli Lilly because they aren’t effective against the Omicron variant, which accounts for nearly 99% of COVID-19 cases in the US.  Now, only patients infected with other variants such as Delta will be able to use the antibody treatments from either company.  A third antibody treatment from GlaxoSmithKline and Vir Biotechnology remains effective against Omicron and continues to have full authorization from the FDA.  While the Department of Health and Human Services (HHS) has said that it will no longer distribute antibody treatments from Regeneron and Eli Lilly, the drugs could be fully authorized once again if proven effective against any future variants.

Supreme Court Justice Breyer Announces Retirement

On Thursday, US Supreme Court Justice Stephen Breyer announced that he would step down from the high court following the end of the 2021-2022 term in late June-early July.  For the past year, some Democratic members of Congress and liberal activists have been calling on the 83-year-old justice to retire so that President Joe Biden could nominate a younger, liberal justice to replace him.  Nominated to the Supreme Court by former President Bill Clinton in 1994, Breyer served as a clerk to Supreme Court Associate Justice Arthur Goldberg and taught at Harvard Law School before being nominated to the US Court of Appeals in 1980 under former President Jimmy Carter.  President Biden has since announced that he will nominate a Black woman to fill Breyer’s seat.

ICYMI: Bidens Welcome New Cat to White House

This week, the First Family welcomed a new White House resident: a two-year-old gray tabby cat named Willow.  First Lady Dr. Jill Biden first met Willow in 2020 during a campaign stop in her hometown of Willow Grove, PA, where the young kitten jumped on stage as Dr. Biden was speaking.  Willow will become the first cat to live in the White House since India, President George W. Bush’s cat, in 2009.  The new cat won’t be the only White House pet – last month, the Bidens adopted Commander, a German shepherd puppy.

Pfizer Asks FDA to Authorize Its COVID-19 Booster Shot for All Adults

On November 9, Pfizer announced it’s asking the Food and Drug Administration (FDA) to amend its emergency use authorization (EUA) to allow all individuals ages 18 and older to get a third “booster” dose of its COVID-19 vaccine.  Currently, only individuals over age 65, people with chronic medical conditions, and at-risk workers are eligible to receive booster doses.  Pfizer also submitted data to the FDA from a Phase 3 clinical trial that found its booster shot is 95% effective against symptomatic COVID-19.  The request comes as more and more data suggests efficacy of currently approved vaccines wanes over time.

Federal Court Blocks Administration’s Vaccination Mandate for Employers

On November 6, a federal court in Louisiana block an emergency temporary standard (ETS) from the Occupational Safety and Health Administration (OSHA) that requires employers with 100 or more employees to develop a mandatory COVID-19 vaccination policy, with an exception for testing.  The 26 states are behind the lawsuit are making the argument that the Department of Labor lacks the authority to issue the rule and did not follow the correct procedure to issue the ETS.  The Department of Justice has vowed to fight the ruling in court.

CBO Says Congress Will Have to Wait for a Full Score on BBB Act

On Tuesday, the Congressional Budget Office (CBO) announced that lawmakers will have to wait some time for a final score on the Build Back Better (BBB) Act, Democrats’ social and climate spending bill.  In a blog post, CBO say it will provide a cost estimate for the full bill “as soon as practicable” and will provide advance notice once a release date can be determined.  CBO has taken a piecemeal approach to issuing cost estimates, and so far, only the titles for Science, Space, and Technology, Homeland Security, Small Business, and Veterans Affairs have been scored.  Several centrist Democrats in both chambers including Sen. Joe Manchin (D-WV) and Rep. Josh Gottheimer (D-NJ) have said they will hold off on supporting the BBB Act until the CBO fully scores the bill.

Former New Hampshire Governor Nixes Senate Run

On November 9, former New Hampshire Governor Chris Sununu, a Republican, declared that he will not be running to represent the Granite State in the US Senate.  Many Republicans considered Sununu to be a top recruit against Sen. Maggie Hassan (D-NH).  Hassan, who won her seat in 2016 by a margin of only 1,017 votes, is considered to be one of the most vulnerable Senators.  Sununu’s decision is a setback for the Republicans’ plans to retake the Senate majority, as the party was already facing a difficult Senate map heading into 2022.

ICYMI: For the First Time, Tomb of the Unknown Soldier Opens to Public

This week, the Tomb of the Unknown Solider in Arlington National Cemetery allowed the public to walk on to the plaza and lay flowers for the first time ever to commemorate 100 years since an unknown soldier, who died in World War I, was interred at the tomb.  Visitors waited in line for hours this week for this opportunity to pay their respects, which has been under the watch of the US Army’s Old Guard for a century. This was a once-in-a-lifetime opportunity as the Arlington National Cemetery does not “anticipate holding another event in our lifetimes in which the public will be able to approach the Tomb in this manner.”