| Hellooo, happy Thursday! If this photo of Pelosi and Biden doesn't encapsulate a congressional baseball game where Democrats face multiple deadlines the next day, we don't know what does. Today, Congress rushes to avert a government shutdown, and Democrats struggle to craft drug pricing legislation. But first: | Democrats debate health care cuts in $3.5 trillion bill |  Georgia Sens. Raphael Warnock and Jon Ossoff are pushing for Democrats to extend Medicaid to roughly 2.2 million low-income adults. (Photo by Chip Somodevilla/Getty Images) | | | Democrats are wrestling with how long to provide health insurance to some of the poorest Americans living in states that have refused Obamacare's Medicaid expansion for nearly a decade. Top lawmakers view extending the safety net program to roughly 2.2 million adults as key to fulfilling the Affordable Care Act. But the length of the new coverage program is increasingly caught in the crossfire of how to allocate limited dollars. The issue is a prime example of the intraparty rift over whether to spend heavily on shoring up Obamacare or expanding Medicare benefits. The fight over cuts is growing as Democrats scale down the size of their overall package and struggle to craft a drug plan to pay for their health priorities. The state of play: | - There's broad recognition that Democrats want to use the social spending bill to bypass Republican officials in the dozen states that haven't expanded Medicaid.
- Key House committees advanced a permanent solution to close the Medicaid coverage gap, though the chamber's overall package will likely change once an agreement is reached on its top-line spending figure.
- Key Senate leaders haven't released a proposal for a federal fix. Several people familiar with the negotiations, who requested anonymity to describe the talks, say the chamber has discussed a temporary fix as short as three years. However, negotiations are extremely fluid since the dollar amount of the package hasn't been hammered out.
| | Three Democratic senators hail from states that haven't embraced expansion: Georgia Sens. Raphael Warnock and Jon Ossoff, as well as Wisconsin Sen. Tammy Baldwin. By nature, that makes their task of building support for a permanent fix — which may cost roughly $250 billion to $300 billion — harder. | | "We all prioritize the needs of our own states," Sen. Chris Murphy (D-Conn.) said. "But the states that haven't accepted Medicaid dollars, they're costing the taxpayers in my state." Still, there are concerns. | - Sen. Mark Warner (D-Va.): "I understand the moral arguments. It's very expensive. What I don't want to do is set incentives so that states that were late to expand, like Virginia, suddenly reverse themselves" so the government picks up the full cost of expansion.
- Sen. Tim Kaine (D-Va.): "The concern is, will the states feel like, 'wow, we should have held out, and the feds would have done this for us?' … That's not a dealbreaker for me, but I know that's the concern that's being raised by states that have already done this."
| | Some aides have privately fretted about the limited political benefits of helping states that traditionally elect Republicans. Meanwhile, other advocates say they're worried some Democrats harbor concerns the policy would be seen as rewarding red state lawmakers who have repeatedly declined to broaden coverage. Warnock — the Senate's leading champion for a permanent fix — said he has not heard that concern directly from any senator in the caucus. "The people who sent me to the United States Senate from the state of Georgia, and therefore put the Democrats in the majority, did so for us to expand Medicaid," said Warnock, who's up for reelection next year. | | Sen. Raphael Warnock (D-Ga.): |  | | | | | House Majority Whip Jim Clyburn (D-S.C.) is a powerful advocate for plugging the Medicaid coverage gap. At an event with liberal activists last week, Clyburn suggested he was willing to expand Medicaid for just a few years, believing the coverage will be harder to strip away once implemented, The Post's Paul Kane reports. In brief comments to The Health 202, he said he was still advocating for a permanent fix. | | On Tuesday, Clyburn urged his caucus to prioritize expanding the safety net program, describing expanding more benefits to wealthy seniors rather than extending benefits to low-income Americans as a racial issue, Politico's Sarah Ferris and Heather Caygle report. "Social Security did not apply to domestic workers, didn't apply to farmworkers. That's where the Black people were," Clyburn told The Health 202. "That's why I'm not a Roosevelt Democrat. Because we got left out, and we still get left out." | | |  | On the Hill | | Congress plans vote on averting a shutdown today | | In the nick of time: Both chambers are racing to pass a stopgap spending bill to fund the government into early December, attempting to overcome any last minute hurdles that could risk the potential for a shutdown, my colleague Tony Romm reports. | - The Senate is set to take its first step this morning. "The tight timeline leaves lawmakers with just hours to spare before funding lapses for key federal agencies and operations, an outcome that Democrats and Republicans have pledged to avoid given the potential for dire consequences during the coronavirus pandemic."
| | But if Congress fails to reach a deal, the Biden administration has taken steps to insulate the federal pandemic response, The Post reports. The Centers for Disease Control and Prevention will continue to track coronavirus cases, hospitalizations and deaths. CDC staff will also continue analyzing vaccine effectiveness and prepare recommendations for the Moderna and Johnson & Johnson booster shots. Meanwhile, the National Institutes of Health will continue covid-19 research and development. However, federal workers, already exhausted by the pandemic workload, would forfeit paychecks while the government is closed. "Come on, government leaders, can you guys work just as hard [as] we're working so the government can keep functioning?" a CDC official, speaking on condition of anonymity to share a frank assessment, told my colleagues. "We're trying to get our s--- together, couldn't you get your expletive together, too?" | Democratic infighting threatens drug price promise | | House Democrats and President Biden ran on curbing prescription drug prices and pledging to let the government negotiate drug prices in Medicare. But now that promise is in jeopardy, our Mike DeBonis reports. Earlier this month, a trio of moderates blocked drug pricing legislation from advancing in a key House committee. In the Senate, party leaders are still struggling to turn a skeleton framework into legislative text. | - Case in point: "Sen. Robert Menendez (D-N.J.), a senior Finance Committee member who represents the industry's epicenter and is considered a key player in the talks, said Wednesday that negotiators were 'not anywhere near' a deal," Mike writes.
| | The pressure campaign: Americans for Prosperity — the main political arm of the influential Koch network — is launching a six-figure tv and digital ad campaign today arguing drug price negotiations stifle innovation. The group is targeting a dozen lawmakers, including Reps. Scott Peters (D-Calif.) and Kathleen Rice (D-N.Y.), who both voted against advancing the drug pricing bill. | | |  | Agency alert | | CDC steps up vaccine messaging for pregnant people |  A pregnant woman receives a vaccine for the coronavirus disease (COVID-19) at Skippack Pharmacy in Schwenksville, Pennsylvania. (REUTERS/Hannah Beier/File Photo) | | | People who are pregnant, recently pregnant, trying to get pregnant or might become pregnant in the future should get vaccinated against the coronavirus to prevent serious illness, death and adverse pregnancy outcomes, according to a health advisory from the CDC. More than 150 pregnant people with covid-19 have died since the onset of the pandemic. Pregnant people with covid-19 have a twofold risk of ICU admission and a 70 percent increased risk of death, according to CDC data. Pregnant people with covid-19 also have an increased risk of preterm birth. | | |  | Coronavirus | | | Here's what else you should know: | - Friends and families of coronavirus victims are traveling to the Washington Monument to see a public art installation and memorial honoring the victims of the pandemic, The Post's Vanessa G. Sánchez reports.
- Nearly 4 in 10 people who contracted covid-19 had at least one lingering symptom three to six months later, such as anxiety, trouble breathing or fatigue, The Post's Marisa Iati reports.
- Health-care workers at large hospital chains are complying with workplace vaccine mandates. The vaccination rates at large hospital groups — including Novant Health, UNC Health in North Carolina and Trinity Health in Michigan — exceed 90 percent, The New York Times's Reed Abelson reports.
- YouTube has banned prominent anti-vaccine activists from its platform, including Joseph Mercola and Robert F. Kennedy Jr. The company has also blocked all anti-vaccine videos that suggest that vaccines approved by health authorities are ineffective or dangerous, The Post's Gerrit De Vynck reports.
- Covid-19 misinformation has led to growing hostility toward health-care workers in Idaho. Some doctors and nurses have been accused of killing patients from families who don't believe the coronavirus is real, The Associated Press's Rebecca Boone reports.
- The NBA announced this week that unvaccinated players will not be paid for missed games and face a slew of restrictions, including separate dining and locker room arrangements. Roughly 90 percent of the league is fully vaccinated, The Hill's Mychael Schnell reports.
| | |  | Industry Rx | | Premiums for federal employees set to rise next year | | Health-care premiums for federal employees will increase an average of 3.8 percent in 2022, despite the ongoing coronavirus pandemic, The Post's Eric Yoder reports. The Federal Employees Health Benefits Program is the nation's largest employer-sponsored health insurance program, with over 4 million enrollees. Pandemic-related costs, prescription drug costs, expenses to cover chronic illnesses and general medical inflation drove the increase. Here's a breakdown of the average biweekly increase: | - Enrollees with self-only coverage will pay $3.17 more.
- Enrollees with plus-one coverage will pay $7.61 more.
- Enrollees with family coverage will pay $10.09 more.
| | |  | Sugar rush | | | Thanks for reading! See y'all tomorrow. | |
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