KHN’s ‘What the Health?’: Manchin makes a deal

Reviewed by Emily Henderson, B.Sc.Jul 28 2022

The Democrats' on-again, off-again budget bill is apparently on again, and it's bigger than expected. In a surprise move, Senate Majority Leader Chuck Schumer announced an agreement with Sen. Joe Manchin (D-W.Va.) to expand the scope of the limited health bill that was headed to the Senate floor to also include climate change and some tax increases for corporations and certain wealthy Americans.

But the measure is still a fraction of what President Joe Biden and Democratic leaders had hoped for and does not include such high-profile health priorities as new Medicare benefits or expanded eligibility for insurance for people in states that did not opt to expand the Medicaid program.

Meanwhile, the Biden administration restored anti-discrimination protections in health care for LGBTQ+ individuals that the Trump administration had rolled back, while the Affordable Care Act returned to court in Texas, this time to hear a case challenging the health law's requirement for preventive benefits.

This week's panelists are Julie Rovner of KHN, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Sarah Karlin-Smith of the Pink Sheet, and Alice Miranda Ollstein of Politico.

Among the takeaways from this week's episode:

• The blockbuster announcement late Wednesday that Manchin had changed his mind and was willing to support a broader party-line bill to fund some of the president's key priorities did not unveil any major changes to the health provisions agreed to earlier. Manchin previously said he'd sign on to Senate Democrats' plan to allow Medicare to negotiate drug prices and keep the enhancements to premium subsidies for health policies purchased on the Affordable Health Care marketplaces.

• The outline of the new Senate legislation, however, would extend those premium enhancements for three years, a year longer than what Manchin and Senate Majority Leader Chuck Schumer had previously agreed on. That means a renewal of those subsidies will not become a 2024 campaign issue.
• Several big-ticket health items that progressives had sought in this legislation were left off, including new funding for home health care and a popular provision to lower consumers' out-of-pocket costs for insulin. A separate bill would do that, but it has hit roadblocks in the Senate.
• Passage of the bill is not assured. First, the Senate parliamentarian must confirm that its provisions are allowed under complicated rules that allow the Senate to pass spending and tax measures without the threat of a filibuster. Under that process, all 50 of the senators in the Democratic caucus must support the bill and the vice president would have to cast the tie-breaking vote. It's not yet clear whether all senators are on board or if they can all be present for a vote in the next week. Several, including Manchin and Sen. Dick Durbin (D-Ill.), have announced they have covid and are in isolation.
• Biden has recovered from his covid infection, according to the White House physician. While recuperating, he was careful to show that he continued to work and was doing quite well. And he made a point of noting that federal efforts he helped spearhead to make more vaccine and treatment options easily available would help others beat back an infection, too.
• Some critics, however, suggested that Biden's message about working while recuperating sent a bad signal because patients should be encouraged to rest and recuperate.
• A new survey by KFF found that 4 in 10 parents of children under age 5 say they will not get their kids vaccinated against covid. This appears to be a byproduct of parents assuming the disease is not as threatening to little ones, their confusion about the studies of the vaccine, and their long wait for a vaccine.
• In a surprising twist, it appears that Congress may pass a bill enshrining the right to gay marriage but not be able to pass a bill guaranteeing a woman's right to contraception. The contraception bill has passed the House but has hit a roadblock in the Senate. Conservatives are concerned about complaints from anti-abortion groups who think some forms of contraception cause abortion.
• A federal judge in Texas who has ruled against portions of the ACA before is presiding over a challenge to the law's provision that guarantees insured people have no out-of-pocket costs for preventive care. The case could make its way to the Supreme Court, which has turned aside other efforts to undermine the ACA. But the power center has shifted in the court, so it's not clear how the justices might look at this case.

Also this week, Rovner interviews Dr. Céline Gounder, an infectious disease doctor, a KFF senior fellow, and KHN's editor-at-large for public health, about the ongoing monkeypox outbreak in the U.S. and around the world.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: NPR's "Because of Texas Abortion Law, Her Wanted Pregnancy Became a Medical Nightmare," by Carrie Feibel

Alice Miranda Ollstein: The Hill's "Top FDA Tobacco Official Leaving for Philip Morris Job," by Nathaniel Weixel

Joanne Kenen: Science's "Blots on a Field? A Neuroscience Image Sleuth Finds Signs of Fabrication in Scores of Alzheimer's Articles, Threatening a Reigning Theory of the Disease," by Charles Piller

Sarah Karlin-Smith: NPR's "Drugmakers Are Slow to Prove Medicines That Got a Fast Track to Market Really Work," by Sydney Lupkin