By Chelsea Cirruzzo and Ben Leonard

Former President George W. Bush is working behind the scenes to convince GOP lawmakers to reauthorize PEPFAR. | AFP via Getty Images

NO ‘SHAME’ IN BUSH’S GAME — Prominent Republicans inside and outside of Congress are defying anti-abortion groups and pushing for a reauthorization of the President’s Emergency Plan for AIDS Relief before it lapses at the end of the month, POLITICO’s Alice Miranda Ollstein and Carmen Paun report.

Former President George W. Bush, who oversaw the program’s creation in 2003, has waded into the fight, reaching out to GOP lawmakers and publishing an op-ed urging Congress to reauthorize PEPFAR for five more years “without delay,” saying that failing to do so would be “a source of national shame.”

Former Senate Majority Leader Bill Frist of Tennessee — an architect of PEPFAR two decades ago — and former Pennsylvania Sen. Rick Santorum are also working the phones to push for reauthorization.

The GOP-on-GOP effort might be working. 

Rep. Michael McCaul (R-Texas) in the House and Sen. Lindsey Graham (R-S.C.) are quietly working on multiyear reauthorization bills even as anti-abortion groups and hardline conservatives vow to oppose them over claims the program money is flowing to abortion providers — a charge the Biden administration, program leaders and outside experts deny.

The lawmakers told POLITICO that the reauthorization bills might fall short of the usual five years and include new language to mollify anti-abortion groups but insisted it would provide PEPFAR more stability than the one-year funding patch House Republicans have put forward.

Still, passage won’t be easy. Susan B. Anthony and other influential anti-abortion groups have vowed to penalize any member who votes for a “clean” PEPFAR reauthorization, and Rep. Chris Smith (R-N.J.) is among the hardline GOP members lobbying his colleagues against the effort.

“If we were to support a three- or five-year reauthorization, we would be rubber-stamping and endorsing all of the radical changes that have been made by President Biden,” he said. “We’re ready to fight this.”

WELCOME TO THURSDAY PULSE. Nintendo is announcing its winter lineup today, but I’m still not sure how they can follow up “The Legend of Zelda: Tears of the Kingdom.”

Send me your tips, scoops and feedback to [email protected] and my colleague [email protected]. Follow along @_BenLeonard_ and @ChelseaCirruzzo.

TODAY ON OUR PULSE CHECK PODCAST, host Katherine Ellen Foley talks with POLITICO cannabis editor Paul Demko about the three remaining Obamacare health insurance co-ops and how their example might help improve health care access.

A message from PhRMA:

Middlemen can profit from where patients fill their prescriptions. Because insurance companies and PBMs own pharmacies, too.

The Biden administration is looking for ways to curb Medical Debt. | Wilfredo Lee/AP Photo

MEDICAL DEBT SOLUTIONS WANTED — Representatives from HHS, the Internal Revenue Service and the Consumer Financial Protection Bureau met Wednesday with patient advocates to discuss the burden of medical debt as the administration solicits comments about solutions, Chelsea reports.

Why it matters: The Biden administration has been putting a special focus on medical debt, which affects roughly 100 million Americans. This summer, the Treasury, HHS and the CFPB jointly issued a request for information that asked for feedback from the public and health care stakeholders on medical credit cards, loans and other products used to pay for medical services, noting those products might lead to higher costs for patients who don’t understand the risks.

But without concrete federal action so far, state lawmakers have been left to push their own measures to tackle medical debt, POLITICO’s Dan Goldberg reports.

Mona Shah, senior director of policy and strategy for Community Catalyst, a patient advocacy group, who attended Wednesday’s meeting, tells Pulse that the Biden administration is taking medical debt seriously, but the RFI is just a first step.

“We would love to see proposed regulations actually be issued now that they have comments on the RFI,” she said.

The group is among 70 patient advocacy groups asking HHS to:

— Publish a financial assistance application model for hospitals to use and require, through Conditions of Participation issued by CMS, that hospitals screen patients for eligibility for the financial assistance programs

— Bolster oversight of insurance claims denials in private plans and require states to more thoroughly oversee claims denial in Medicaid managed care organizations

The group also wants the Treasury to strengthen and enforce regulations for nonprofit hospitals to better provide patients with financial assistance and once again require nonprofit hospitals to provide charity care.

A message from PhRMA:

HEALTH CARE ON THE FLOOR — A major health care package focusing on transparency could get a full House vote next week, Ben reports.

House leadership is eyeing a potential vote under suspension of the rules, the Congressional Budget Office said Wednesday, meaning it would need a two-thirds vote to pass.

Meeting that threshold became more likely when the ranking member of the House Energy and Commerce Committee, Sen. Frank Pallone (D-N.J.), signed onto the legislation Friday alongside Energy and Commerce Chair Cathy McMorris Rodgers (R-Wash.), Ways and Means Chair Jason Smith (R-Mo.), and Education and the Workforce Chair Virginia Foxx (R-N.C.). Pallone had asked for changes related to hospital price transparency and secured them in the package.

However, ranking members of the Ways and Means and Education and the Workforce committees, Reps. Richard Neal (D-Mass.) and Bobby Scott (D-Va.), didn’t sign on.

What’s in the bill: The legislation draws substantially from the PATIENT ACT, a bipartisan bill from Rodgers and Pallone that their committee approved unanimously in May.

Many provisions would codify and expand price transparency rules for hospitals established during the Trump administration. The bill also focuses on transparency requirements for insurers and pharmacy benefit managers, which manage prescription drugs for health insurers.

The package would boost funding for community health centers and graduate medical education programs and contains provisions on site-neutral payments, generic drugs and industry consolidation.

DEA PROPOSAL SLAMMED — Top senators, including Mark Warner (D-Va.), who chairs the Intelligence Committee, and GOP whip John Thune (R-S.D.), wrote to the Drug Enforcement Administration Wednesday urging the agency to ease access to care in its telemedicine prescribing proposal.

They’re also calling for the agency to extend pandemic rules allowing prescribing controlled substances virtually for new patients beyond Nov. 2023, as it currently stands.

The lawmakers, alongside Sens. Catherine Cortez Masto (D-Nev.), Shelley Moore Capito (R-W.Va.), Sheldon Whitehouse (D-R.I.) and Dan Sullivan (R-Alaska), called for the DEA to extend the 30-day supply permitted for prescribing many controlled substances before patients must see a doctor in person. The drugs include buprenorphine for opioid use disorder and testosterone for gender-affirming care under a DEA-proposed rule.

“We have concerns about our constituents’ ability to obtain in-person appointments within 30 days of starting a new medication, and the potential consequences to their health of starting a new medication and abruptly ending it should they not be able to obtain such an appointment,” the lawmakers wrote.

They also called for the DEA to establish a special registration process to allow providers to prescribe such substances without an in-person visit, as Congress deemed in a 2008 law.

The background: In February, the agency proposed rolling back those eased rules ahead of the emergency expiration in May. But it reversed course after a record 38,000 comments — many negative — and extended pandemic rules through Nov. 11 for new patients and a year further for established ones.

The DEA held listening sessions Tuesday and Wednesday on a potential special registration process and said it will hold an additional written-comment period, signaling another extension may be needed.

JOIN US ON 9/20 FOR A TALK ON TRANSFORMING HEALTHCARE BILLING: Bipartisan legislation in the House and Senate would align costs for services across hospitals and doctors’ offices and reduce out-of-pocket spending that could potentially save the federal government billions of dollars. Can this legislation survive a polarized Congress? Join POLITICO on Sept. 20 to explore this and whether site-neutral payments and billing transparency policies could help ease health care costs. REGISTER HERE.

Duncan Reece is the new president of Oxeon, a health care firm. Reece previously co-founded Cohere Health and was an executive of Iora Health, which was acquired by OneMedical.

A message from PhRMA:

Insurance companies and pharmacy benefit managers (PBMs) are putting their profits before your health. That’s because the largest PBMs own or are owned by the largest insurance companies, and they own pharmacies, too. First the PBM can deny coverage for your medicine in favor of one that makes them more money. Then, they steer you to the pharmacy they own. Without you ever knowing why it all happens this way. See what else they do.

NBC reports that Kentucky’s AG, a gubernatorial candidate, said he wouldn't undo the state’s Medicaid expansion, but earlier this year he wrote that he supported repealing the ACA as he publicly supports Medicaid work requirements.

The Associated Press reports that specially bred mosquitoes are being released in Honduras to fight dengue.

POLITICO Pro’s Arek Sarkissian reports on Florida’s surgeon general, who’s urging people under 65 not to get an updated Covid shot.

JOIN 9/19 FOR A TALK ON BUILDING THE NEW AMERICAN ECONOMY: The United States is undergoing a generational economic transformation, with a renewed bipartisan emphasis on manufacturing. Join POLITICO on Sept. 19th for high-level conversations that examine the progress and chart the next steps in preserving America’s economic preeminence, driving innovation and protecting jobs. REGISTER HERE.

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