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| Presented By PhRMA |
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| Axios Vitals |
| By Tina Reed · May 12, 2023 |
| It's finally Friday, Vitals readers! Today's newsletter is 1,143 words or a 4½-minute read. Situational awareness: The Biden administration's "Project NextGen" — which will operate similarly to Operation Warp Speed — will funnel $4.7 billion to BARDA for new vaccines and treatments, with another $300 million going to NIH, officials told Axios' Oriana González. |
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| 1 big thing: The fight over nursing home staffing mandates |
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| Illustration: Brendan Lynch/Axios |
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| A fight over nursing home staffing mandates is pitting an industry that was at the epicenter of the pandemic against organized labor and some senior lawmakers in Congress, Axios' Arielle Dreher writes. The big picture: The Biden administration this spring wants to make every facility have enough adequately trained staff to provide high-quality care. But operators say they can't hire people out of thin air after COVID-19 hollowed out the long-term care workforce. Driving the news: The industry's opposition to staffing mandates is rankling lawmakers like Democratic Reps. Jan Schakowsky and Lloyd Doggett, who accuse nursing home operators of diverting federal funds away from patient care to lobbying, per McKnight's Long-Term Care News. - The Service Employees International Union is also mounting rallies around the country and pressing the administration to finalize the reform effort.
Where things stand: Nursing homes have been understaffed for decades: HHS in 2003 found the vast majority of facilities were not meeting state staffing ratios where they existed. - The pandemic experience made things worse. More than 1 in 5 of all COVID-19 deaths in the U.S. took place in long-term care settings. And an estimated 200,000 care workers have left and there are 37,000 fewer beds available in facilities since 2020.
- The CMS is conducting a staffing study and meeting with advocates, nursing home staff and residents to inform whatever standards it devises, per the Washington Post.
But the industry argues any changes will require more spending. - "How do they increase that workforce without increasing costs?" said Rodney Whitlock, vice president at McDermott+Consulting, which has nursing home clients.
Go deeper. |
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| 2. Speaking of workforce shortages... |
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| Illustration: Annelise Capossela/Axios |
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| Thousands of foreign nurses are stuck in limbo after the State Department stopped processing some visa applications this month, leaving nursing homes and assisted living facilities without a workforce they've already hired, Arielle writes. Why it matters: The situation shows how immigration policies are intertwined with health care workforce issues amid a pandemic-driven nursing shortage. - "1 in 6 registered nurses practicing medicine today in the United States is an immigrant," said Patty Jeffrey, president of the American Association of International Healthcare Recruitment.
The intrigue: The freeze affects employment-based priority visas. After applications exceeded the allowed limit for the year, the government restricted interviews to only those individuals who applied for green cards up to last June. By the numbers: The State Department is facing unprecedented backlogs in visa applications due to the COVID-19 pandemic, and as of March more than 370,000 applicants still have a scheduled interview pending. - "As a result of increased demand for visas in this numerically limited category, it became necessary to establish final action dates," per a statement from a department spokesperson.
What to watch: Providers are calling on Congress to raise the cap for health care worker visas. |
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| 3. Senate panel advances PBM, generic drug bills |
| The Senate health committee on Thursday advanced several bills aimed at increasing competition from generic drugs, as well as a measure looking to reform pharmacy benefit manager practices, Axios' Peter Sullivan writes. The details: The PBM bill was voted out 18-3, but not before Sens. Mitt Romney (R-Utah) and Rand Paul (R-Ky.) objected to a ban on spread pricing, in which PBMs charge a health plan more than they pay a pharmacy for a drug. - They argued that some smaller employers actually prefer spread pricing as a cheaper option.
Things moved more smoothly after last week's markup was postponed following an array of process complaints. - An amendment from Sen. Maggie Hassan (D-N.H.) which would ease the way for competition from generic drugs by cracking down on a "guessing game" with branded manufacturers over inactive ingredients, was adopted after a deal was reached with Ranking Republican Bill Cassidy of Louisiana.
- The committee also adopted an amendment from Sens. Tammy Baldwin (D-Wis.) and Mike Braun (R-Ind.) to require drug companies to submit justifications for price hikes.
A version of this story was published first on Axios Pro. Get news like this by subscribing. Use code POLICY100 which gives you $100 off. |
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| A message from PhRMA |
| Middlemen say they want lower prices |
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| Yet they often deny or limit coverage of lower-cost generics and biosimilars while giving preferential coverage to medicines with higher prices. This might be good for PBMs' bottom line, but it can lead to higher costs for patients. What else are they hiding? |
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| 4. DeSantis signs "medical freedom" law |
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| Illustration: Shoshana Gordon/Axios |
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| Florida Gov. Ron DeSantis on Thursday sought to draw a contrast with the expiring COVID-19 public health emergency, signing a set of "medical freedom" measures into law, including bans on mask and vaccine mandates, and new conscience protections for health providers. Why it matters: The potential 2024 presidential contender, has made medical freedom a key issue, casting aspersions on tools aimed at stopping COVID, such as dubbing the vaccines "mRNA jabs." Between the lines: The moves are part of a COVID-inspired appeal to libertarian sensibilities and personal choice that casts public health mandates as failed attempts that trampled on individual rights. - That rallying cry has proved particularly potent among many conservatives in the wake of the COVID pandemic, even as public health experts warn of the ongoing danger of misinformation it sows.
Details: The legislation blocks businesses or government entities from requiring vaccines or proof of post-infection recovery from COVID-19, as well as testing or mask-wearing, to gain entry or access services. - It also creates protections for prescribing alternative treatments and for those who opt out of providing health services on religious or moral grounds, as well as blocks "gain-of-function" research.
What they're saying: Sowing mistrust in public health measures like vaccines goes far beyond rhetoric. It actually harmed people, said Peter Hotez, co-director of the Center for Vaccine Development at Texas Children's Hospital, who led the development of a COVID vaccine for developing nations and received death threats as a key antagonist among the anti-vaccine crowd. - "It's not some abstract concept or theoretical discussion. 200,000 Americans died because of this," Hotez told Axios.
The other side: "The public health establishment botched the COVID response and any distrust of them by the public is self-generated," DeSantis spokesman Bryan Griffin said last month in a response to an email from Axios. Read the rest. |
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| 5. Mental health crisis costs local governments |
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| Illustration: Sarah Grillo/Axios |
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| The shortage of behavioral health workers is increasingly making courts and jails de facto providers of mental health services, straining local budgets nationwide, Axios' Sabrina Moreno writes from a new report from the National Association of Counties. The big picture: The justice and public safety system was never designed for the task, and while the majority of incarcerated people in state prisons report a history of mental health problems, more than 70% have not received treatment since being jailed. - Americans suffering from mental illness are 10 times more likely to be put in jail than hospitalized, per a National Judicial Task Force report on state courts' response to mental health.
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| 6. Dog of the week |
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| Chica. Photo: Melinda Colaizzi |
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| Meet Chica, a Yorkshire Terrier who hails from Pittsburgh. - Chica is sporting her "Women Who Rock" onesie to support her human, Melinda Colaizzi, who founded the company to champion women in music and women's health awareness. What a little rockstar! 🎸
Do you have a dog in your life you'd like to nominate? Reply to this email with a photo and some details and we might feature them in an upcoming edition of Vitals! |
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| A message from PhRMA |
| PBMs control your health care |
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| They decide if medicines get covered and what you pay. They often deny or limit coverage of lower-cost generics and biosimilars, instead covering medicines with higher prices. This business model allows PBM profits to soar and can lead to higher costs for everyone. What else are they hiding? |
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| Thanks for reading, and thanks to senior health care editor Adriel Bettelheim and senior copy editor Bryan McBournie for the edits.21 |
 | | Dive deeper into the future of health care | | |
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