Biden’s health care legacy: A 'BFD’?

Aug 20, 2024

With Alice Miranda Ollstein and Megan Messerly

Driving The Day

President Joe Biden speaks during the Democratic National Convention.

President Joe Biden gave a rundown of his administration's health care accomplishments at the DNC on Monday. | Francis Chung/POLITICO

BIDEN’S HEALTH CARE FOOTPRINT — President Joe Biden used his address at the Democratic National Convention on Monday (and a bit of Tuesday) to make the case for Vice President Kamala Harris as his party’s future while cementing his health care legacy.

Biden’s speech — which could be the most consequential of his remaining political career — gave a nod to his administration’s accomplishments, saying it has had “one of the most extraordinary four years of progress ever.”

“Covid no longer controls our lives,” Biden said. “More Americans have health insurance today than ever before in American history … and we finally beat Big Pharma,” noting Harris cast the tie-breaking vote for the Inflation Reduction Act, allowing Medicare to negotiate drug prices.

Of course, those two big achievements are fragile: The former could be upended if Congress doesn’t re-up the Affordable Care Act subsidies that expire next year, and the latter could still be undone by the courts.

But Biden’s health care legacy goes beyond what he mentioned from the stage.

In his roughly three and a half years in office, Biden has taken several actions to boost cancer research, including relaunching the cancer moonshot and signing legislation to authorize the Advanced Research Projects Agency for Health to accelerate biomedical research. He oversaw the rollout of Covid-19 vaccines, and his administration took a number of actions to expand access to reproductive health care in the wake of the Dobbs decision, including allowing birth control pills to be sold over the counter for the first time.

Debbie Curtis, vice president at McDermott+, who was a key Democratic staffer in crafting the ACA, told Pulse that Biden achieved more than “anyone ever could have imagined in one term.”

Leslie Dach, director of left-leaning health care group Protect Our Care, called his health care legacy a “BFD” in a nod to Biden’s 2010 quote on Obamacare, saying the Inflation Reduction Act wouldn’t have happened without him.

Republicans, however, see it differently. Joel White, president of the Council for Affordable Health Coverage, whose members include health plans, providers, patients and employers, said Biden’s legacy will be “big government health care activism.”

“President Biden sees the so-called ‘Inflation Reduction Act’ … as the crown jewel of his time in the White House,” said White, a former top House Ways and Means GOP staffer. “Hollow promises on reducing inflation [aren’t] fooling voters, as Medicare seniors are paying more now for their Part D premiums and their prescription drugs than in the history of the Part D program.”

Pharmaceutical companies and their allies also see Biden’s drug price negotiations as a threat to innovation.

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Abortion

Kentucky Gov. Andy Beshear speaks during the Democratic National Convention.

Three women shared their stories on Monday night to demonstrate the far-reaching consequences of state abortion bans in the post-Roe era. | Francis Chung/POLITICO

DNC SPOTLIGHTS ABORTION DIVIDE — Democratic delegates adopted a party platform Monday night that pledges to “make Roe the law of the land again.” The document also promises “reproductive freedom for every woman in every state.”

For many of the activists marching outside the DNC, and even those inside working closely with the Democratic Party, those two goals conflict, Alice and Megan report.

Roe protected abortion only up to fetal viability — around 22 to 24 weeks — and allowed states to impose mandatory waiting periods and regulations that forced many clinics to close.

That’s why some groups protesting at the DNC, and even some groups pouring money into boosting Harris, are critical of her Roe-focused approach.

“Starting at Roe is the wrong framework,” said Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund and Planned Parenthood Federation of America. “It was never grounded in justice.”

Abortion rights have energized voters since the Dobbs decision in 2022 — helping Democrats win gubernatorial, congressional and state legislative races. Democrats, hoping the trend will continue, are making the issue a core part of their 2024 message.

On Monday night, the convention featured speeches by three women from red states who suffered medical complications or sexual abuse to highlight the need for abortion protections. It’s the first time such personal stories have made it to the convention stage in a rebuke to former President Donald Trump’s stance that leaving it to the states resolves the issue.

“He calls it a beautiful thing,” said Hadley Duvall, who was raped and impregnated by her stepfather when she was 12 years old. “What is so beautiful about a child having to carry her parent’s child?”

HEALTH CARE

UNPACKING THE DNC PLATFORM — The 2024 DNC platform has several familiar proposals like codifying Roe v. Wade in federal legislation and maintaining Obamacare premium tax credits, but it also has less familiar health care proposals.

Surprise billing: Democrats say they’ll expand protections against surprise bills — when insured patients unintentionally get care from out-of-network providers — to include ground ambulances.

Drug pricing negotiations: Harris previously said she would “accelerate” Medicare drug price negotiations, but now the DNC platform says the party will push to add “at least” 50 drugs annually to be eligible for negotiation for a total of 500 “this decade.” As it stands, 60 drugs would be eligible by 2029.

Generics: The platform says Democrats will make a model limiting Medicare cost-sharing for some generic drugs to $2 mandatory for all beneficiaries.

PBMs: The DNC pledges to mandate more transparency from pharmacy benefit managers, which negotiate rebates with pharmaceutical companies on behalf of health insurers, in what could be a boon for House-passed legislation Congress will weigh post-election.

Medical debt: The platform says Democrats would push to exclude medical debt from credit reporting after previous proposals to limit reporting.

INDUSTRY REACTS TO HARRIS’ PROPOSALS — Lobbying groups for pharmaceutical manufacturers and PBMs aren’t thrilled with Harris’ plans to rein in PBMs and expand Medicare drug price negotiations but pledged to keep working with policymakers.

“Doubling down on the flawed [Inflation Reduction Act] would only exacerbate the coverage disruptions Medicare beneficiaries are experiencing, including fewer choices, higher costs and more frustrating insurance denials,” PhRMA spokesperson Catherine Hill told Pulse, endorsing PBM reform.

Greg Lopes, a spokesperson for the Pharmaceutical Care Management Association, a PBM lobbying group, said PBMs have a “proven track record” of lower drug costs and that targeting “patent abuse” by drug companies is “the best way” to reduce drug costs.

The platform is just the latest venue for the clash between PBMs and the pharmaceutical industry, which will continue ahead of an end-of-year legislative battle.

CAMPAIGN 2024

HEALTH CARE ON THE AIRWAVES — Health care is becoming a flashpoint in television advertising for a number of tight races for Congress, POLITICO’s Madison Fernandez reports.

Democrats — who generally have public opinion on their side on health care issues — have leaned into the issue more throughout the campaign, while Republicans have used ads to fight back against Democratic attacks on abortion. Here are two highlights:

Montana: Sen. Jon Tester (D-Mont.) accused GOP opponent Tim Sheehy of wanting to privatize health care.

New York: Rep. Marc Molinaro (R-N.Y.) said he “was the first Republican to back federal protection for [in vitro fertilization] and support federal access to birth control” and opposes a national abortion ban.

WORKFORCE

VA NURSES PROTEST — Registered nurses at VA hospitals are pushing the agency to end what they say is “in effect a hiring freeze” that has led to significant vacancies.

Nursing unions announced a slew of protests Monday aimed at VA medical centers, including in Durham, North Carolina, and Miami. The VA Inspector General said in a report this month that 82 percent of VA facilities had severe nursing shortages.

VA Secretary Denis McDonough has said the agency is taking a more “strategic” approach to hiring. Government Executive reported that a May memo from a top VA official said the VA should “consider allowing attrition” in areas that can handle it.

VA spokesperson Terrence Hayes denied there is a hiring freeze nationwide and said the agency has the largest health care workforce in its history. He also pointed to data showing the agency had thousands more nurses this year than last year.

Names in the News

Peter Olsen-Phillips has joined the Association for Community Affiliated Pharmacies as Medicaid policy manager. He was previously a policy analyst for Sen. Ron Wyden’s (D-Ore.) Finance Committee staff.

WHAT WE'RE READING

In a Lancet viewpoint piece, Dr. Zeke Emanuel and others compare how popular GLP-1 weight-loss drugs are covered in other countries, and few provide national coverage.

Fierce Healthcare reports on how “food is medicine” programs “rarely weigh in on ultra-processed food.”

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