| | | | |  | | By Ben Leonard and Chelsea Cirruzzo | | | With Carmen Paun and Megan R. Wilson
| | |  Blood is tested in South Africa's AIDS Care Training and Support Initiative, a facility partly funded by PEPFAR. | Denis Farrell/AP Photo | PEPFAR REAUTHORIZATION AT RISK — The Senate returns to Washington today facing an imminent lapse in the law governing the United States’ global HIV/AIDS relief work as the widely praised program has become mired in the fight over abortion, Carmen and POLITICO’s Alice Miranda Ollstein report. The five-year reauthorization of the President’s Emergency Plan for AIDS Relief, or PEPFAR, as it’s commonly known, is almost certain to blow past a Sept. 30 deadline. And while that’s happened in the past, this is the first time in the program’s 20-yeas history that its reauthorization by the end of the year is uncertain. State of confusion: A spokesperson for Sen. Jim Risch (R-Idaho), the top Republican on the Foreign Relations Committee, which oversees the program, said that “ongoing confusion” among lawmakers about PEPFAR’s intersection with abortion makes it “unlikely” Congress will renew it before Sept. 30. The spokesperson pointed to several provisions that could expire as a result, such as a requirement that at least 10 percent of the program’s funds go to children orphaned by AIDS. While the program would limp on, the impasse threatens to turn an initiative credited with saving 25 million lives into an annual political battle, making it far more difficult for groups fighting HIV and AIDS to hire staff or launch long-term projects. How we got here: GOP House members and conservative advocates allege that some of PEPFAR’s nearly $7 billion annual budget flows to abortion providers — a charge the Biden administration, the program’s leaders and outside experts vehemently deny. Rep. Chris Smith (R-N.J.), who leads the House’s global health subcommittee that controls PEPFAR, is leading the charge against renewing the program until anti-abortion restrictions the Biden administration lifted in 2021 are reinstated. Those restrictions would block groups that receive PEPFAR funds from using other sources of money to provide abortions or even discuss them as an option. Rep. Barbara Lee (D-Calif.), a co-author of the law that created PEPFAR during the George W. Bush administration and the top Democrat on the Appropriations panel that controls the program’s budget, plans a lobbying blitz when the House returns next week, targeting members elected since the program launched in 2003. WELCOME TO TUESDAY PULSE. We hope you enjoyed recess. Anything you’re working on that you’d like us to know about? Reach us at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo. TODAY ON OUR PULSE CHECK PODCAST, host Kelly Hooper talks with Chelsea about the threat of a government shutdown due to a funding standoff between Congress and the White House — and what that would mean for health care agencies.
| | | | | | | A message from PhRMA: Middlemen can profit from where patients fill their prescriptions. Because insurance companies and PBMs own pharmacies, too. | | | | | | | 
The Biden administration seeks to require minimum staffing levels in nursing homes. | Getty Images | THE RULE THEY LOVE TO HATE — The Biden administration has set a proposed federal standard for nursing home staffing levels after the Covid-19 pandemic left the industry reeling — and almost no one is happy with it, POLITICO’s Daniel Payne reports. HHS is walking a tightrope: The rule must be stringent enough to increase staffing at the facilities but not so demanding that it could lead to closures or wider care shortages. And though administration officials defend the proposed regulation, announced Friday, as both strong and realistic, patient advocates maintain it doesn’t go far enough. “Frankly, we didn’t imagine it would be this low,” Sam Brooks, director of public policy for long-term care resident advocacy group Consumer Voice, said of the staffing level requirement. “We’re kind of reeling from it.” Lawmakers on both sides are pushing back. “All of us are concerned about the failure of these proposed staffing standards to meet the needs of seniors and individuals with disabilities,” Rep. Lloyd Doggett (D-Texas) said in a statement to Pulse. Others in Congress have sided with the industry, arguing the proposal would reduce access to patient care. House Energy and Commerce Chair Cathy McMorris Rodgers (R-Wash.) said in a statement that the rule “will put nursing homes — particularly in rural areas — in an impossible dilemma as they grapple with how to manage current occupancy levels with the insufficient workforce available to meet the requirements.” House Ways and Means Chair Jason Smith (R-Mo.) slammed the proposal, saying it would only worsen staffing shortages. The nursing home industry also decried the proposal for being too stringent in its requirements. “It requires nursing homes to hire tens of thousands of nurses that are simply not there,” Mark Parkinson, American Health Care Association president and CEO, said. “It then penalizes us and threatens to displace hundreds of thousands of residents when we can’t achieve the impossible.” Katie Smith Sloan, president of LeadingAge, the trade association for nonprofit aging providers, said mandates that can’t be met are “meaningless.” One contingent, however, was pleased with the announcement: labor groups. The AFL-CIO’s president, Liz Shuler, said the rule would help improve the system, adding the administration had listened to the group. Mary Kay Henry, president of the Service Employers International Union, said it would work to ensure the proposal is “strengthened, finalized, and implemented with rigor.”
| | | | DOWNLOAD THE POLITICO APP: Stay in the know with the POLITICO mobile app, featuring timely political news, insights and analysis from the best journalists in the business. The sleek and navigable design offers a convenient way to access POLITICO's scoops and groundbreaking reporting. Don’t miss out on the app you can rely on for the news you need. DOWNLOAD FOR iOS – DOWNLOAD FOR ANDROID. | | | | | | | | UNWINDING’S IMPACT — More than 5.5 million Medicaid beneficiaries have been disenrolled, according to a KFF analysis of the latest data from nearly all states and Washington, D.C. The rate of people being booted from the safety-net program is greatly disparate between states, going as high as 72 percent in Texas and as low as 8 percent in Wyoming. Among states reporting data on the subject, close to three-quarters of people disenrolled lost coverage because of procedural issues like not completing paperwork. In the 15 states reporting age data, 43 percent of those disenrolled have been children. The share of children among those disenrolled ranges from 81 percent in Texas to 18 percent in Massachusetts.
|  | What may be at play: Children in several states might be mistakenly losing their health insurance, CMS said last week. States might be mistakenly reviewing a family’s eligibility for Medicaid instead of an individual’s eligibility, causing an unknown number of people who should have had their insurance renewed without needing to submit any additional paperwork to lose coverage. CMS, in letters to state Medicaid directors, warned that any state terminating people for that reason violates federal requirements, and the agency threatened to strip funding from states that don’t immediately act to pause terminations, reinstate coverage and fix the problem.
| | | | A message from PhRMA:   | | | | | ADVOCACY GROUP JUMPS INTO SITE-NEUTRAL FIGHT — Families USA is launching a campaign called “Same Service, Same Price,” an effort that examines the fees hospital-owned physician offices and clinics charge for services. The ads target consumers and local markets that aim to reach key members of Congress — including House Speaker Kevin McCarthy, Senate Majority Leader Chuck Schumer, Senate Finance Chair Ron Wyden (D-Ore.) and Sen. Joe Manchin (D-W.Va.), among 27 others. It comes as Congress contemplates including so-called site-neutral payment policies, which would require hospitals to charge the same for a service regardless of where it's performed, in health care packages moving on Capitol Hill. Advocacy groups — including Families USA — hope the policies could end up in a year-end package.
| | | | FDA MISSES MENTHOL TARGET — The FDA missed its August target of finalizing its menthol cigarette ban, drawing disappointment from health care groups, including the American Medical Association. It’s not uncommon for agencies to miss their targets for finalizing rules, but some groups have threatened legal action if the FDA didn't finalize the rule by its target date. FDA spokesperson Jim McKinney told Pulse that the agency will issue the final rule “in the coming months” and is ensuring the more than 250,000 comments it received have been properly addressed.
| | | | DON’T MISS POLITICO’S TECH & AI SUMMIT: America’s ability to lead and champion emerging innovations in technology like generative AI will shape our industries, manufacturing base and future economy. Do we have the right policies in place to secure that future? How will the U.S. retain its status as the global tech leader? Join POLITICO on Sept. 27 for our Tech & AI Summit to hear what the public and private sectors need to do to sharpen our competitive edge amidst rising global competitors and rapidly evolving disruptive technologies. REGISTER HERE. | | | | | | | | | Andi Lipstein Fristedt is leaving the FDA to become deputy director for policy, communications and legislative affairs at the CDC. Paloma Izquierdo-Hernandez is now the chair of the board of directors at the National Association of Community Health Centers. She’s the CEO of Urban Health Plan Inc. Rosalind Brewer, the CEO of Walgreens, is stepping down. Jen Schultz, Vaishu Jawahar and Jackson Thein are joining Waxman Strategies’ health practice. Schultz was previously in the Minnesota legislature, Jawahar was domestic policy coordinator for Vice President Kamala Harris and Thein was a policy adviser to Sen. Jeff Merkley (D-Ore.).
| | TechCrunch reports on the fall of a behemoth telehealth startup, Babylon Health. POLITICO’s Robert King reports on Humana suing CMS over a Medicare Advantage audit rule.
| | | | A message from PhRMA: Insurance companies and pharmacy benefit managers (PBMs) are putting their profits before your health. That’s because the largest PBMs own or are owned by the largest insurance companies, and they own pharmacies, too. First the PBM can deny coverage for your medicine in favor of one that makes them more money. Then, they steer you to the pharmacy they own. Without you ever knowing why it all happens this way. See what else they do. | | | | | | | Follow us on Twitter | | | | Follow us | | | | |
