With Daniel Lippman
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— The Covid-19 booster effort is driving a wedge between the CDC and top health officials at other agencies and the White House.
— Sen. Joe Manchin signalled he’d back a smaller spending bill as party leaders race to finish their multitrillion-dollar social spending package.
— Businesses are already concerned about vaccine requirements and potential costs, or lawsuits, in store.
WHY ARE PEOPLE MAD AT THE CDC? — Disputes over when to start widely offering booster shots — and how to sell the public on third doses — are pitting some health agencies against each other, Erin Banco, Sarah and Adam write.
In meetings and conversations over the past month, senior officials from the White House Covid-19 task force and the Food and Drug Administration have repeatedly accused CDC of withholding critical data needed to develop the booster shot plan that top officials and President Joe Biden already said would be in motion by Sept. 20.
Tensions hit a high last month when the agency appeared to publicly reject the White House plan for broad booster access within weeks, according to two officials. CDC officials during an advisory meeting instead made the case for prioritizing high-risk nursing home patients and frontline health care workers before expanding access to the broader population.
But that was just the latest episode in building White House frustrations with the CDC’s pace and messaging, according to 10 senior officials and people familiar with the matter.
CDC officials are left exasperated. “Science takes time,” one said. “I don’t know how many times we have to say this.”
The agency has for years struggled with obtaining accurate disease data from state health departments, and the pandemic further strained the country’s public health infrastructure, causing massive delays in reporting and case investigation. That has made it difficult for CDC to gather information on breakthrough infections to inform the administration’s policies around boosters, officials argue.
But in a sign that even CDC Director Rochelle Walensky recognizes the agency has repeatedly fallen short on messaging, multiple people with knowledge of the matter said she has recently weighed bringing on new communications staff. She also tried to streamline CDC’s pandemic response team earlier this year in a move that some argued sidelined agency veterans like Nancy Messonnier, but that at least three former health officials said was an overdue restructuring.
MANCHIN: I’LL BACK A PARED-DOWN SPENDING AGENDA — The West Virginia Democrat who has become a linchpin Senate vote said Sunday that he’d support a $1 trillion to $1.5 trillion reconciliation bill but still stands firm against a $3.5 trillion price tag.
“It’s not going to be at $3.5 [trillion], I can assure you,” he told CNN’s Dana Bush after being pressed multiple times for the number he’d back.
His statement was quickly slammed by another guest on the CNN show, Sen. Bernie Sanders (I-Vt.), who said “No, it is absolutely not acceptable to me,” and argued progressives had already compromised enough.
Manchin’s continued opposition comes as Senate Democrats are pushing full speed ahead on the bill, aiming to hammer out its details this week and get it to the House for a vote by Sept. 27 — which Manchin on Sunday said would not be possible.
On deck: The House Energy and Commerce Committee begins marking up the spending bill this morning, with health provisions front-and-center today. Lawmakers will discuss provisions aimed at cutting prescription drug prices, boosting home care and expanding Medicare coverage to dental, vision and hearing care.
SLOW SPEED: FISCAL CLIFF AROUND THE CORNER — While Democrats duke it out over the massive social spending plan, the debate will soon be eclipsed by much more urgent problems: avoiding an economic collapse and a government shutdown, Burgess Everett and Heather Caygle write.
There is growing worry among some rank-and-file Democrats that their tunnel-vision mentality on the reconciliation bill could provoke economic blowback if Republicans hold the line and tank efforts to lift the debt ceiling.
Top Democrats insist they have a plan — they just don’t want to talk about it yet. And they are urging calm before a calamitous month of legislating.
House Democrats are planning a vote next week to likely extend government funding until Dec. 10 and have discussed rolling the debt ceiling, disaster aid and assistance for the Afghanistan withdrawal into it, according to aides. They hope pairing the debt limit with a bill to avoid a government shutdown, as well as disaster relief, makes it impossible for Republicans from hard-hit areas like Louisiana and Mississippi to vote no, Burgess and Heather write.
INDUSTRY OPPOSITION TO VAX MANDATES ROLLS IN — Biden’s surprise Covid-19 vaccine order for large companies is already facing headwinds, even from some of his union allies, Rebecca Rainey writes.
Unions have been treading a fine line over the new policy, arguing that workers and labor should have a say in any vaccine mandate policy — required by the federal government or not — while also strongly urging their members to get the shot.
“I think this redefines ‘ideas are simple, execution is hard,’” said attorney Michael Lotito, who represents businesses for law firm Littler Mendelson.
The emergency temporary standard will require companies with more than 100 workers to verify that their workforce is vaccinated or get tested weekly for Covid-19. Employers who break the rules could face fines of $14,000 per violation. But there are many questions about what the scope of the rule will be. For instance, does the 100-employee threshold apply to one worksite, or an entire company? Does the company have to pay for testing or does the employee? Plus, implementing a rapid testing program is logistically difficult and costly.
The Department of Labor has been working on the standard for at least a week, according to two people familiar with the matter.
MURTHY: VACCINE POLICIES HAVE PRECEDENT — Surgeon General Vivek Murthy on Sunday defended the administration’s new vaccine mandate, calling it “an appropriate legal measure” that fits with traditional safety requirements in schools and workplaces.
Murthy also said he believed the administration’s new policy would withstand legal challenges. “Certainly this wouldn’t have been put forward if the president and the administration didn’t believe that it was an appropriate legal measure to take,” he said.
See more: Our POLITICO DataPoint colleague Taylor Miller Thomas sketches out the workforce impact of Biden’s mandate in a series of graphics:
CMS PROPOSES NEW INSURER TRANSPARENCY REGS — Insurers selling Obamacare plans or short-term health coverage would have to disclose any financial ties with insurance agents or brokers under a new rule proposed by the Biden administration.
The companies would also need to report how much they’ve paid the agent or broker, in an effort to boost transparency of the arrangements underpinning plans sold on the individual market.
The proposal is part of CMS’ implementation of a surprise billing law that Congress passed last year. A separate provision would require insurers, providers and air ambulance services to report more data about air ambulance claims, which have historically been a source of hefty surprise bills.
Regulators have already banned out-of-network air ambulance providers from balance-billing people with private health coverage. And in this latest proposal, CMS floats penalties of up to $10,000 per violation for insurers, providers and air ambulance companies that improperly hit patients with surprise bills.
FEDERAL OFFICIALS PROBE FLORIDA MASK MANDATE BAN — The administration on Friday opened a probe into Florida’s efforts to block school mask mandates, hours after Gov. Ron DeSantis won a temporary legal victory from an appeals court that reinstated his mandate ban, Andrew Atterbury writes.
The investigation in Florida hinges on a pandemic-era use of federal civil rights law. In a letter to the Florida Department of Education, federal officials expressed concern that restrictions on mask use could keep schools from complying with federal laws that protect disabled students from discrimination.
The appeals court decision in the meantime allows Florida’s education department to penalize 13 school districts that require students to wear masks without allowing parents to opt out of face coverings.
Child Covid-19 deaths are racking up at worrisome levels in the state: Since August, the number of Covid-related child deaths in Florida has more than doubled, Arek Sarkissian writes.
Polly Webster is the new vice president of federal affairs for the Association for Accessible Medicines, while Scott Kuzner joins as senior director of sciences and regulatory affairs. Webster was most recently principal policy adviser for government relations at Kaiser Permanente, and is a Diana DeGette (D-Colo.) alum. Kuzner was most recently director of the board and convention operations at the United States Pharmacopeial Convention.
Digital Therapeutics Alliance named Andy Molnar chief executive officer. He most recently served as the vice president of market access and government affairs for Cognoa.
The PhRMA Foundation selected Amy Miller as its next president, replacing the retiring Eileen Cannon. Miller was most recently the president and chief executive officer of the Society for Women’s Health Research.
At least 21 percent of nursing home residents are on antipsychotic drugs even though many don’t need the treatments, which carry serious side effects for vulnerable patients, Katie Thomas, Robert Gebeloff and Jessica Silver-Greenberg report in a New York Times investigation.
Sen. Sanders struck a major deal this summer while hashing out social and health priorities with Democratic leaders — that he would agree to a smaller package if Medicare expansion for vision, dental and hearing care was secured, The Washington Post’s Sean Sullivan, Marianna Sotomayor, Tyler Pager and Jeff Stein report.