A full House

With Rep. Jim Jordan's third failure to grab the House Speaker title late last week, nine potential contenders entered the race. One frontrunner is GOP Whip Tom Emmer, who is endorsed by former Speaker Kevin McCarthy and promises to stitch together the splintered caucus. But it's unclear whether that's enough: Former President Donald Trump, who had endorsed Jordan, held back on supporting Emmer when asked Monday about the race.

Others vying for the speakership include Pennsylvania's Dan Meuser, a member of the bipartisan Problem Solvers Caucus; Florida's Byron Donalds, a member on the Freedom Caucus that triggered the current leadership chaos; Georgia's Austin Scott, a McCarthy ally; and Alabama's Gary Palmer, chairman of the Republican Policy Committee.

Republicans met Monday night in a closed-door session to hammer out a strategy and avoid another floor vote embarrassment (with a vote scheduled this morning). But they're still staring down the same old problem: deciding between consensus builders and vocal far-right opponents to the status quo.

Emmer, a former Minnesota state lawmaker and gubernatorial candidate, has been a vocal proponent of expanded mental health care coverage, including for incarcerated people. But other than that, his health care portfolio is not extensive. Still, Republicans seemed cautiously optimistic after last night's meeting that he could garner the most support. Is it 217 votes of support? Remains to be seen.

industry lobbying

What the latest lobbying tell us

Drug companies and their major lobbies aren't spending as much on congressional lawmakers as they did during last year's IRA frenzy, but pharmacy benefit managers — under the spotlight with legislation this session — are picking up the slack.

PhRMA's spending dropped from $7.3 million in last year's third quarter to $6.4 million in the same period this year. Similarly, BIO's lobbying went from roughly $3.2 million to $2.2 million. Individual drug companies also pulled back, though that was expected after several exited PhRMA (and with that, its dues) in the past year. One of the most dramatic drops came from AbbVIe, which spent $2.4 million in third-quarter 2022 and just $750,000 in the same window this year.

Meanwhile PBMs, feeling the heat from congressional hearings and proposed reforms, significantly ramped up spending. Their lobby, PCMA, doled out $4 million in the past three months compared to $1.9 million in the same period in 2022.

Also of note: Despite Juul's recent setbacks, including significant layoffs, the company seemingly hasn't surrendered entirely to FDA policy: The popular e-cigarette brand hired a new lobby on "issues related to the regulation of electronic nicotine delivery system products, and the enforcement of illicit tobacco products" including counterfeit and illegally marketed disposable products.

senate probes

Bernie targets Bertagnolli

Senate health committee Chair Bernie Sanders (I-Vt.) is asking for an investigation into the NIH for granting an exclusive patient for a cervical cancer treatment to an obscure company run by a former NIH employee who worked on the drug.

President Biden's director to lead the NIH, Monica Bertagnolli, isn't named in the letter, but the accusation is implicit. She led the National Cancer Institute when the patent was issued in September. Sanders dragged his feet on holding a hearing on Bertagnolli's confirmation hearing for months, and now is publicly questioning her leadership just days before the panel is supposed to vote on her confirmation.

Sanders is asking the HHS Inspector General to investigate whether the patent grant violated ethics rules, and how the agency decides whether to grant exclusive licenses for drugs. He argues "hundreds of millions, if not billions of dollars" could be on the line.

drug shortages

Could pharmacists fix the drug shortages?

Pharmacists increasingly are being asked to make drugs, even chemotherapies, in bulk for hospitals that are in short supply. The practice, known as compounding, has become more frequent during a slew of drug shortages, John Wilkerson writes.

But industry experts are worried that the rise in pharmacist reliance could expose new gaps in the system and fix a temporary problem without addressing a core, persistent issue in shortages — costs.

Also, bulk compounders typically use less rigorous and far cheaper sterilization processes than generic drugmakers do, experts told John. That's why under FDA rules, compounded drugs usually have a shorter shelf-life than their counterparts, further complicating shortage gambles. Read more from John on the complexity of relying on compounders.

around america

Checking in with the Medicaid expansion holdouts

There are just 10 states that have not adopted ACA-funded Medicaid expansion. But if they did, roughly 2.3 million more people would be insured, according to the latest analysis by the Urban Institute, out Monday.

Most of the holdouts are in the South and the Midwest. More than half a million Floridians would be eligible for the government program, dropping the state's uninsured rate by a quarter. Alabama and Mississippi would see uninsured rates decline by close to 40% if they adopted the Obama-era expansion that lowers eligibility for the low-income insurance program.

But what is most notable is who could be covered under an expanded program. Uninsured rates among Black women of reproductive age could be halved, and 20% more young adults would be eligible. That said, state spending would increase by roughly $1.5 billion, and federal spending by more than $20 billion. Read the breakdown by the Urban Institute.

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