Good Monday evening! House Democrats returned to the Capitol today looking to mend intraparty rifts and resolve a standoff that threatens to derail their economic agenda and scuttle President Biden’s proposed expansion of the social safety net. At the moment, it’s not clear they’ll succeed. Here’s what you need to know.
Pelosi Dares Moderate Dems to Blow Up Biden Agenda
With President Biden’s economic agenda hanging in the balance, House Speaker Nancy Pelosi and a band of moderate Democrats are still engaged in a standoff over the party’s $3.5 trillion budget blueprint.
Here's where things stand:
As moderates and progressives continue to jockey for leverage, Pelosi (D-CA) on Monday called for a 5:30 p.m. meeting of her caucus ahead of a planned procedural vote to begin debate on the budget resolution later in the evening. She reportedly also held talks with Rep. Josh Gottheimer (D-NJ), the leader of a group of nine moderates who have insisted that they won’t vote for the budget framework unless the House first holds a stand-alone vote on the $1 trillion bipartisan infrastructure deal passed by the Senate earlier this month.
Pelosi reportedly offered the moderates a deal that would fold the rules for debate and passage of the budget resolution into one vote. That wouldn’t address moderates’ demands that the infrastructure bill be passed first, but it would allow Democrats who are uneasy about the $3.5 trillion spending package a way to avoid a direct vote on it. Pelosi reportedly also suggested setting a firm deadline for passing the infrastructure bill of October 1, when current surface transportation programs expire.
Members of the moderate holdout group reportedly were less than enthusiastic about the offer.
The whip count on the budget bill was further complicated when Rep. Stephanie Murphy (D-FL) announced late Monday that she would not vote to start the reconciliation process unless the infrastructure bill is finished first. Democrats can’t afford to lose more than three of their members given that Republicans are expected to uniformly oppose the budget framework.
Both sides warn against delay: Pelosi’s latest proposal came after both sides ramped up the pressure by signaling that they would stick by their strategies. Pelosi has insisted that she will only bring the infrastructure bill up for consideration in the House after the Senate has passed a budget reconciliation bill. Dozens of progressives have said they won’t vote for the infrastructure bill until they see that the reconciliation package addresses their priorities and isn’t stripped down or killed by moderates.
In a “Dear Colleague” letter on Monday, Pelosi urged her members to pass both the budget plan and the infrastructure bill. “We must not squander our Congressional Democratic Majorities and jeopardize the once-in-a-generation opportunity to create historic change to meet the needs of working families,” she wrote, adding, “The success of each bill contributes to the success of the other.”
But in an op-ed published at The Washington Post on Sunday night, the moderates insisted that the infrastructure bill should not take a back seat, and that delay could threaten its passage. “Time kills deals,” they wrote. “This is an old business saying and the essence of why we are pushing to get the bipartisan infrastructure bill through Congress and immediately to President Biden’s desk — as the president himself requested the day after it passed the Senate.”
The bottom line: Given the chaotic withdrawal from Afghanistan, Biden could use a win — and a messy intraparty battle is probably the last thing the White House wants at this point. As of now, though, any deal on the budget and infrastructure remains very much in question. Gottheimer and several other moderates in his group have indicated a willingness to negotiate, meaning that Democratic leaders may still be able to find a path forward.
At this point, though, it looks like House leaders will hold a vote tonight on a rule that will also pass the budget resolution, daring the moderates holdouts to oppose it.
FDA Approves Pfizer’s COVID-19 Vaccine
The Food and Drug Administration on Monday gave full approval to the Covid-19 vaccine manufactured by Pfizer and BioNTech, which until now had been used under emergency authorization. The vaccine has also been given a new name: Comirnaty.
The first Covid-19 vaccine to receive full approval, Comirnaty can be given to everyone aged 16 and older. The green light from the FDA opens the door to wider use of vaccine mandates at a variety of private and public institutions, and could help reduce resistance to the shots among those who have expressed concerns about the hurried conditions under which they were first approved for use.
“The FDA’s approval of this vaccine is a milestone as we continue to battle the COVID-19 pandemic,” said Acting FDA Commissioner Janet Woodcock in a statement. “While this and other vaccines have met the FDA’s rigorous, scientific standards for emergency use authorization, as the first FDA-approved COVID-19 vaccine, the public can be very confident that this vaccine meets the high standards for safety, effectiveness, and manufacturing quality the FDA requires of an approved product.”
White House pushes mandates: Following the announcement of the approval, President Joe Biden called on leaders in business and government to implement vaccine mandates.
“I'm calling on more companies in the private sector to step up with vaccine requirements that will reach millions more people,” Biden said. “If you're a business leader, a nonprofit leader, a state or local leader, who has been waiting for full FDA approval to require vaccinations, I call on you now to do that — require it.”
The Department of Defense announced Monday that it would require the vaccine for all active members of the military. White House Press Secretary Jen Psaki said that the administration expects to see more departments within the federal government start rolling out mandates. “I think you’re looking more at agency-to-agency or different factions of the government at this point. But I expect there will be more on that front,” she told reporters.
Some university systems will also start enforcing mandates. All students at the State University of New York and City University of New York schools will now have 45 days to get vaccinated, and the University of Minnesota System and Louisiana State University have announced they will also start enforcing a mandate as well.
Some Surprising Findings From Once-Secret Hospital Prices
The federal government this year began requiring hospitals to publicly post a full list of the prices they negotiate with private insurers. Many hospitals are not complying with the rule, which was enacted by the Trump administration and is also supported by the Biden administration. But Sarah Kliff, Josh Katz and Rumsey Taylor of The New York Times report that the information already available shows why hospitals and insurers fought hard against the new rule:
“It shows hospitals are charging patients wildly different amounts for the same basic services: procedures as simple as an X-ray or a pregnancy test.
“And it provides numerous examples of major health insurers — some of the world’s largest companies, with billions in annual profits — negotiating surprisingly unfavorable rates for their customers. In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all.”
The Times worked with researchers from the University of Maryland-Baltimore County to study data from 60 major hospitals. They found many cases in which insurers are paying more than the cash price for people without insurance. “The worrying thing is that the third party you’re paying to negotiate on your behalf isn’t doing as well as you would on your own,” Zack Cooper, a Yale economist who studies health care pricing, told the Times.
At the University of Mississippi Medical Center, for example, a colonoscopy costs $1,463 for patients covered by Cigna, $2,144 for those on Aetna plans and $782 for those with no insurance. At Memorial Regional Hospital in Florida, an MRI costs $1,827 for Cigna patients, $2,455 for those with Blue Cross plans and $262 for Medicare patients.
Those previously hidden differences could spoil even the most careful calculations of someone shopping for an insurance plan. “People carefully weighing two plans — choosing a higher monthly cost or a larger deductible — have no idea that they may also be picking a much worse price when they later need care,” the Times notes. “Even for simple procedures, the difference can be thousands of dollars, enough to erase any potential savings.”
What hospitals and insurers say: Industry representatives told the Times that looking at just some services fails to provide a complete picture of their negotiated prices and doesn’t account for key elements of their contracts, such as bonuses for high-quality care. “Insurers want to make sure they are negotiating the best deals they can for their members, to make sure their products have competitive premiums,” said Matt Eyles, CEO of America’s Health Insurance Plans, a trade group for insurers.
Why it matters: The rationale behind the new rule was that price transparency would lead to greater competition and ultimately lower costs. The Times report hints at how lifting the veil of secrecy around prices could still help that happen — but it also illustrates the many obstacles and financial incentives that stand in the way of such efforts to empower patients or employers trying to navigate the complicated maze of health care pricing.
Read the full piece at The New York Times.
Consultants Raking In Millions From Government Covid Contracts: Report
Private consultants have been running key parts of the governmental response to the Covid-19 pandemic, and that isn’t always producing the best results, according to an analysis by The Washington Post’s Isaac Stanley-Becker.
The service contracts for consulting services signed by federal, state and local governments can be quite costly, Stanley-Becker says, and tend to leave states without the internal resources and capacities they need to respond to this and other crises over the long term.
“At least 25 states, along with federal agencies and many cities and counties, hired consulting firms,” Stanley-Becker writes. “The American vaccination drive came to rely on global behemoths such as McKinsey and Boston Consulting Group (BCG), with downsized state and local health departments and even federal health agencies relying on the private sector to make vaccines available to their citizens.”
While the consultants say they are providing essential services and specialized expertise, critics charge that the contracts, which are often awarded on a no-bid basis, are difficult to monitor, with little oversight of the goals and work product. In one example cited by Stanley-Becker, an official said that California paid Blue Shield and other consultants millions of dollars to do work that was already being done by state employees.
In a more critical example at the national level, Stanley-Becker reports that Boston Consulting Group has been paid more than $9 million to develop a plan to distribute Covid vaccines across the country, with the contract calling for the delivery of “robust central infrastructure” to coordinate the effort at all levels of government. But coordination of the vaccine effort has been notably lacking, especially in the beginning of the year, and neither the consultants nor officials at the Center for Disease Control and Prevention can identify any “robust central infrastructure” that has been created by the consultants.
“It’s another example of the government farming things out, and often to the wrong folks,” Jeffrey P. Koplan, a former CDC director, told Stanley-Becker.
Even when the consulting firms do provide obviously necessary services, their know-how disappears as soon as their contracts end. “The contractors leave and we’re not retaining that expertise,” Robin Taylor Wilson, former chair of the American Public Health Association’s epidemiology section, said. “So the next time an emergency hits, we’re going to have another delayed reaction.”
Early Cutoff of Unemployment Benefits Pushed Few Back Into Jobs: Analysis
Twenty-six states ended federal unemployment programs early in an effort to force reluctant workers to take jobs, but the cutoff appears to have produced few job takers while leaving those who remain unemployed worse off.
The latest evidence comes from a report released by the Labor Department late last week showing that states that cut the benefits early had roughly the same rates of job growth as those that did not.
Arindrajit Dube, an economist at the University of Massachusetts, told The New York Times that the basic idea underlying the early cutoff was just plain wrong. “The idea was that there were lots of jobs — it was just that people weren’t looking. That was the narrative,” he said. “I don’t think that story holds up.”
In a separate study, Dube found that few workers in cutoff states found jobs, while aggregate spending showed a significant drop, hurting overall demand – possibly weighing on job growth. Here’s his quick summary of the findings from the study, which Dube co-wrote:
* For every eight workers who lost benefits early, one found a job by August.
* Cutoff states lost $4 billion in income due to loss of benefit payments.
* Aggregate spending in cutoff states fell by $2 billion.
* Aggregate earnings in cutoff states rose by $270 million.
* At the individual level, the unemployed saw a loss of $218 on average per week in benefits in cutoff states.
* Earnings rose by $14 on average per week in cutoff states.
The take-away from the analysis, says Dube, is “of the ~1.1 mil additional people losing benefits, ~145k found jobs by early Aug. But ~900k did not. Added jobs were moved up by few months, but at substantial cost to recipients.”
- Let’s Take the Win. Let’s Do Infrastructure First – Democratic Reps. Carolyn Bourdeaux, Ed Case, Jim Costa, Henry Cuellar, Jared Golden, Vicente Gonzalez, Josh Gottheimer, Kurt Schrader and Filemon Vela – Washington Post
- How Pelosi Can Give the Rebels a Way Out of the Hostage Crisis They Created – Paul Waldman and Greg Sargent, Washington Post
- Failing on Infrastructure Would Be Bad for the Nation and a Self-Own for Democrats – Washington Post Editorial Board
- The Reconciliation Bill Is Really About Health Care. And 2022 – Jennifer Rubin, Washington Post
- Biden and the Fed Wanted a Hot Economy. There’s Risk of Getting Burned – Neil Irwin, New York Times
- Scoring Biden’s ‘Care Economy’ Plan – Peter Coy, New York Times
- Why the FDA’s Full Approval of the Pfizer-Biontech Vaccine Could Be a Turning Point – Leana S. Wen, Washington Post
- The GOP Fought Mandates by Emphasizing the Vaccines’ Emergency Status. Now What? – Aaron Blake, Washington Post