KHN’s ‘What the Health?’: Manchin Blows Up Biden’s ‘Build Back Better’

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Sen. Joe Manchin (D-W.Va.) dashed the hopes of President Joe Biden and congressional Democrats for passage of the giant “Build Back Better” bill before the end of the year, when he announced his opposition to the measure in an interview on “Fox News Sunday.” Democrats still hope to salvage at least some pieces of the bill, but the effort will drag into the 2022 midterm election year.

Meanwhile, the omicron variant is spreading exponentially around the U.S., potentially threatening the ability of the nation’s health care system to tend to patients with ailments other than covid.

This week’s panelists are Julie Rovner of KHN, Joanne Kenen of Politico and the Johns Hopkins School of Public Health, Rachel Cohrs of Stat and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s episode:

• Despite the surprise implosion of Senate Democrats’ negotiations on the Build Back Better Act, which would fund Biden’s climate and social spending plans, many people think Democrats will be able to push out a less ambitious plan in 2022. Manchin has said he would accept a proposal that keeps the federal enhancements to premium subsidies for Affordable Care Act marketplace plans, which otherwise would run out after 2022.
• Still, paring back many of the other programs that have been promised could lead to a bitter debate between progressives and moderates in the party.
• Manchin has also suggested that he would like the package to include strategies to fight high drug prices.
• Some Democrats are urging Biden to try to use his executive power to hold down drug prices in Medicare. But that could prove difficult. Current law does not allow Medicare to negotiate drug prices — a new law would be required to change that. The administration might, however, try smaller, pilot projects to influence Medicare drug pricing.
• As the covid variant omicron spreads quickly through the nation, already-overwhelmed hospitals and officials say they may not be able to handle new surges. Plus, there are concerns that because omicron is so much more transmissible, essential hospital workers — already in short supply — may be at risk for more infections.
• The characterization of omicron as more mild than the delta variant is problematic. The data is not yet clear that it is less of a threat to people — it might be mild, but that doesn’t mean it doesn’t cause illness or make people sick. Those who are vaccinated may avoid hospitalizations, but they still may face days of being sick at home and missing work.
• The maker of Aduhelm, a drug approved this year for the treatment of some Alzheimer’s cases, announced that it is cutting the cost of the drug in half to about $28,000 a year. Yet big questions remain about the effectiveness and safety of the drug, and Medicare has not yet decided whether it will cover it. That decision is expected next month.
• 2021 was a big year in health policy, aside from covid. The panelists select their choices for the most under-covered stories of the year, and the most notable unsung heroes, among others.

Also this week, Rovner interviews Ceci Connolly, president and CEO of the Alliance of Community Health Plans, about the perilous state of the nation’s health care system.

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

Julie Rovner: KHN’s “Crash Course: Injured Patients Who Sign ‘Letters of Protection’ May Face Huge Medical Bills and Risks,” by Fred Schulte

Rachel Cohrs: NBC’s “’Get That Money!’ Dermatologist Says Patient Care Suffered After Private Equity-Backed Firm Bought Her Practice,” by Gretchen Morgenson

Joanne Kenen: ProPublica’s “This Scientist Created a Rapid Test Just Weeks Into the Pandemic. Here’s Why You Still Can’t Get It,” by Lydia DePillis

Sarah Karlin-Smith: The Atlantic’s “I Canceled My Birthday Party Because of Omicron,” by Ed Yong

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