By Ben Leonard and Chelsea Cirruzzo

DeSantis’ stance has worried public health officials, who say he’s mainstreaming fringe positions | Scott Olson/Getty Images

DESANTIS LEANS INTO VAX MESSAGE — Ron DeSantis made a name for himself in large part due to his response to Covid as governor of Florida, echoing the frustration some had about pandemic restrictions, facemasks and vaccine mandates.

But as cases rise and DeSantis continues to tout a similar message on the virus, Republicans don’t seem as energized on the issue, POLITICO’s Sally Goldenberg reports in the third story of a five-part series diving into the rise of the anti-vaccine political movement.

“Covid restrictions have gone from a dominant issue that got talked about all the time in the focus groups to one that never comes up. People just don’t talk about it anymore,” said Sarah Longwell, an anti-Trump Republican strategist who routinely conducts focus groups. “Covid cost [DeSantis] one of his calling cards.”

Among major GOP presidential candidates, few, if any, have so closely tied themselves to vaccine skepticism as DeSantis. He's minimized vaccine development project Operation Warp Speed, which was spearheaded by his chief rival, former President Donald Trump, suggested placing Robert F. Kennedy Jr. in a top public health role and said he never got a Covid booster.

DeSantis and his aides have insisted that they are not inherently anti-vaccine; rather they are opposed to vaccine mandates. But his operation has also pushed messages tying the Covid vaccine to injury and death. The governor asked the state's Supreme Court to empanel a grand jury to investigate "any and all wrongdoing in Florida with respect to Covid-19 vaccines."

Contrast: DeSantis' messaging on Covid is in part to take advantage of what he sees as a weakness for Trump, arguing he pushed against Trump administration guidance. His state surgeon general also recently discouraged the newest Covid vaccine shot.

“COVID revealed to the American people the depths of government overreach and abuse,” campaign spokesperson Bryan Griffin said in a statement.

Public health response: DeSantis’ stance has worried public health officials, who say he's mainstreaming fringe positions and priming GOP voters to distrust vaccines generally.

Looking back: During DeSantis’ time in Congress and early on as governor, there was little indication distrust of public health officials would come to define his time in office.

When the Covid shots came online, he embraced them, even as he publicly broke with the federal guidance about which groups should receive them first. That changed as the pandemic persisted.

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TODAY ON OUR PULSE CHECK PODCAST , host Alice Miranda Ollstein talks with POLITICO reporter Sally Goldenberg about how former President Donald Trump’s zigzagging on abortion policy is causing turmoil in the anti-abortion movement and shaking up the GOP presidential primary.

A message from PhRMA:

Here’s another way insurance companies and their pharmacy benefit managers (PBMs) put their profits before your health.

Sen. Roger Marshall (R-Kan.) and Sanders partnered on the package. | Francis Chung/POLITICO

PRIMARY CARE BILL MOVES THROUGH HELP — The Senate HELP Committee on Thursday advanced a package aimed at bolstering primary care access in a 14-7 vote, despite conflict between committee leaders, POLITICO’s Megan R. Wilson reports.

The $26 billion package, introduced by Chair Bernie Sanders (I-Vt.) and Sen. Roger Marshall (R-Kan.), budgets billions in funding for community health centers and to bolster the doctor, nursing and dentist workforces. Three Republicans — Marshall and Sens. Mike Braun (Ind.) and Lisa Murkowski (Alaska) — voted with every Democrat to approve the bill.

Push and pull: Sanders argued that health worker shortages have hurt access to care. Ranking member Bill Cassidy (R-La.) pushed back against the legislation, saying it lacked provisions to offset costs.

“We're working on a new proposal six legislative days before the program expires. We have no time to align with our House counterparts, guaranteeing that we'll have to do a short term, flat-funded patch,” he said.

Hospitals have expressed opposition to the bill. Following the markup, the Federation of American Hospitals said that some of the provisions would threaten patients' access to care.

“Funding for community health centers and workforce programs is desperately needed, but it is a travesty to fund them at the expense of essential patient care. Robbing Peter to pay Paul is no way to ensure health care for America’s most vulnerable," said Chip Kahn, the group's CEO.

Bottomline: The package isn’t likely to pass the Republican-controlled House, but it is significant because it marks the Senate’s negotiating position in reauthorizing several programs that expire on Sept. 30.

HALF MILLION MISTAKENLY LOSE MEDICAID — Half a million people — many of them children — were wrongly booted from Medicaid due to state errors, CMS said Thursday.

POLITICO’s Megan Messerly reports that 29 states and Washington, D.C. were incorrectly reviewing Medicaid eligibility at the family level instead of on an individual basis. That meant that many, including kids, were determined to be ineligible for the safety net program when they should have been automatically reenrolled.

CMS warned states last month that they needed to reinstate the coverage for those losing it and stop disenrollments for others potentially affected as they fix the issue or lose federal funding.

Nice of you to say so: Several Medicaid directors from affected states said they were unaware they were out of compliance with federal rules until CMS informed them in August. They wished the federal agency had told them back in January, when they were developing renewal plans.

The backdrop: About 7.2 million people have been removed from Medicaid since the post-pandemic unwinding process began in April, per KFF’s latest analysis.

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MA CRACKDOWN? — A leading CMS official pledged "tougher" oversight on Medicare Advantage plans amid concern about care denials and access, POLITICO's Robert King reports.

CMS Deputy Administrator Jon Blum discussed what he considers flaws in the growing program during a session Thursday at the fall conference of the National Association of Accountable Care Organizations in Washington, D.C. Blum’s remarks could belie CMS’ thinking on how to handle a program, which enrolls more than 30 million people.

“We see a plethora of new benefits offered … but then hear a lot of friction of beneficiaries not getting access to core services they are entitled to,” said Blum.

That squares with a 2022 report from HHS’ Office of the Inspector General that found some Medicare Advantage plans denied prior authorization requests for services that must be covered by traditional Medicare.

A message from PhRMA:

BIDEN TO SIGN ORGAN TRANSPLANT BILL — President Joe Biden is expected to sign legislation on Friday that would overhaul the nation’s organ donation system.

The context: For decades, the federal government has contracted with a single organization, the nonprofit United Network for Organ Sharing, to match patients with donated organs.

But a Senate Finance Committee investigation into UNOS found that the network put Americans' lives at risk by failing to ensure organs weren’t lost or destroyed in transit. The committee recommended breaking up the existing contract. UNOS has said that it welcomed a competitive bidding process and did not oppose the legislation, which would allow the federal government to award contracts to multiple bidders.

Reps. Robin Kelly (D-Ill.) and Larry Bucshon (R-Ind.) and Sens. Ron Wyden (D-Ore.) and Chuck Grassley (R-Iowa) led the push.

“This legislation promises a more efficient system to serve patients and save thousands of lives,” Kelly said in a statement.

PUSH TO BAN MEDICAL DEBT FROM CREDIT REPORTS — The Consumer Financial Protection Bureau is developing a rule to prevent credit reporting companies from including medical debt in consumer reports, the White House announced Thursday.

POLITICO’s Katy O’Donnell reports that the agency released an outline of proposals it's weighing and is also seeking to prohibit lenders from using medical collections information when evaluating a borrower’s application.

The three companies dominating the credit reporting industry — Equifax, Experian and TransUnion — said in April they would no longer include medical debt under $500 or paid medical debts on credit reports. Democrats have pressed executives of those companies to remove unpaid medical bills entirely.

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NEW TOP LOBBYIST AT PHRMA — Drugmakers’ most powerful industry group, PhRMA, has a new top lobbyist — Steve Tilton.

Tilton, the lead lobbyist for Takeda Pharmaceuticals, will begin Oct. 17, Megan reports. It’s a significant hire for the Pharmaceutical Research and Manufacturers of America, which is fighting to regain its footing following the industry’s biggest legislative loss in decades with the passage of the Inflation Reduction Act.

"The biopharmaceutical industry is at a unique and pivotal moment,” Tilton said in a statement. “The science has never been more promising, but the policy environment poses new challenges every day."

The Associated Press reports that the recently departed DEA No. 2 has returned to a pharmaceutical consulting firm after reporting on potential conflicts.

An NIH-backed study found a potential biomarker in the brain for monitoring depression recovery.

A message from PhRMA:

Your prescription might have different out-of-pocket costs at different pharmacies. Why? Because insurance companies and their pharmacy benefit mangers (PBMs) can make more money if you use the pharmacies they own. So they’ll try to steer you to what’s best for them, instead of what’s best for you. It’s another way that insurance companies and their PBMs put their profits before your health. See what else Middlemen are up to.

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