By Chelsea Cirruzzo and Ben Leonard

Presented by PCMA // Pharmaceutical Care Management Association

With Robert King and Kelly Hooper 

Sen. Joe Manchin could be standing in the way of advancing the nomination of the VA's general counsel. | Francis Chung/POLITICO

THE MANCHIN FACTOR — Sen. Joe Manchin’s opposition has stalled President Joe Biden’s nominee to be the VA’s general counsel over the agency’s abortion policies, according to two people familiar with the matter, Ben reports.

Manchin (D-W.Va.) has joined Republicans on the Veterans’ Affairs Committee in blocking Anjali Chaturvedi, a top Department of Justice lawyer, over agency policy to provide abortion counseling and, in certain situations, abortions. Democrats hold a one-seat majority on the committee and can’t advance her nomination without Manchin’s vote if Republicans remain united.

A Manchin spokesperson declined multiple requests to say whether he opposes her nomination but said he opposes the policy, which the senator says is a “blatant violation of federal law.”

The policy: The VA policy, finalized last month, enables it to provide the procedure when the life or health of a veteran or a beneficiary is in peril or in cases of rape or incest. Manchin and GOP lawmakers point to federal laws preventing the government from providing abortion care for veterans.

The VA has argued it can update the scope of “needed” medical care to include abortions. VA Secretary Denis McDonough has called the move a “patient-safety decision.” A VA watchdog report released Thursday found that few patients have sought abortion services at VA facilities.

Chaturvedi received a Senate Veterans’ Affairs Committee hearing last July, but the panel hasn’t voted on her nomination. Ranking member Jerry Moran (R-Kan.) and other committee Republicans pushed her on the abortion policy. She said she hadn’t thoroughly studied the situation but would work with experts in the legal department and study the issue “very closely” if confirmed.

The impact: The lack of a confirmed general counsel could hamper the VA’s oversight and impact its ability to execute its plans and meet statutory obligations.

If confirmed, her portfolio would include implementing the PACT Act, legislation signed last year that expanded access to benefits for veterans exposed to burn pits and toxins and overseeing the agency’s troubled electronic health records modernization.

The push: McDonough recently said he was concerned about her nomination not moving. Dozens of current and former government officials have written to lawmakers urging her confirmation in a letter first obtained by Pulse.

WELCOME TO FRIDAY PULSE. Congress has until tomorrow night at midnight to come to a funding deal before the government shuts down. It’s not looking good.

How might a shutdown impact your work? Let us know at [email protected] and [email protected] and follow along @_BenLeonard_ and @ChelseaCirruzzo.

TODAY ON OUR PULSE CHECK PODCAST, host Katherine Ellen Foley talks with POLITICO health care reporter Daniel Payne about key takeaways from POLITICO’s “Mission Update: Inside the Cancer Moonshot” live event.

A message from PCMA // Pharmaceutical Care Management Association:

Big Pharma is the link between patients and high drug prices. Don’t fall for Big Pharma’s “delinking” blame game. Weakening tools pharmacy benefit companies use to lower drug costs gives Big Pharma more power to keep drug prices high. The Big Pharma bills to end so-called “delinking” hand billions of dollars annually to drug companies, while costing patients and payers billions. “Delinking” means employers lose out on savings and employees pay more for prescriptions.

HHS Secretary Xavier Becerra says about 42 percent of the agency's staff would be furloughed. | Evan Vucci/AP Photo

HHS PREPARES FOR SHUTDOWN — HHS is telling employees to get ready for a government shutdown — which could delay routine FDA inspections, stall NIH research and diminish emergency preparedness, Chelsea writes.

Congress has until Saturday at midnight to come up with a funding deal. But with no consensus among House Republicans, a shutdown is looking more and more likely.

In an email obtained by POLITICO, HHS Secretary Xavier Becerra and Deputy Secretary Andrea Palm warned staffers that some of the workforce would be reduced. HHS’ contingency plan in the event of a shutdown would furlough about 42 percent of its workforce, while some staffers would be retained to keep essential services running, including Medicare and Medicaid.

The email outlined some impacts on specific agencies:

— The FDA would continue drug and medical reviews and monitor medical-product and infant-formula supply disruptions. But routine inspections of potentially unsafe products could be postponed.

— The NIH’s clinical center would admit new patients, but research on diseases like cancer and Alzheimer’s could be stalled.

— The Administration for Strategic Preparedness and Response will continue some disaster response operations, but preparedness and response capabilities would be diminished.

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FINANCE WEIGHS MEDICARE TRUST FUND NOMS — The Senate Finance Committee on Thursday weighed two nominations to serve on the board of the Federal Supplementary Medical Insurance Trust Fund, Ben reports.

Those nominees are Tricia Neuman of KFF and Demetrios Kouzoukas, former CMS Medicare director under the Trump administration.

The board — which consists of the secretaries of Health and Human Services, Labor and Treasury; the commissioner of Social Security; and two public trustees — has been without those trustees for eight years. The board’s duties include reporting on Medicare’s solvency each year.

The nominees didn’t receive a vote, and it’s unclear when they will.

Sen. Elizabeth Warren (D-Mass.) expressed concern that Medicare Advantage threatens the program’s solvency. She repeatedly pressed Kouzoukas over whether he’d resign from the board of Clover Health, which offers Medicare Advantage plans, because of the potential conflict of interest. Kouzoukas didn’t say whether he would.

“If you won’t step down from the Clover board, then you should withdraw your nomination. If you do not withdraw, given the clear conflicts … I will strongly oppose your nomination and will encourage every other senator in this body to do so,” Warren said.

WAYS AND MEANS TACKLES HSAs — The House Ways and Means Committee advanced two bills Thursday to bolster high-deductible health plans and associated health savings accounts mostly along party lines, Ben reports.  

The bills, part of a broader push from the House GOP to boost the plans, are:

— Legislation from Reps. Lloyd Smucker (R-Pa.) and Earl Blumenauer (D-Ore.) would allow the plans to include the direct primary care payment model and pay for such care with HSA funds and plans to offer on-site health clinics. The bill passed in a 28-14 vote, with Democratic Reps. Brad Schneider of Illinois, Terri Sewell of Alabama and Jimmy Panetta of California joining Blumenauer.

— Legislation from Rep. Beth Van Duyne (R-Texas) that would substantially raise HSA contribution limits. The bill passed in a 24-18 vote.

The bills are backed by the ERISA Industry Committee, which represents large employers’ benefits interests.

Democrats panned the legislation, citing costs and arguing that boosting high-deductible health plans could result in delayed or missed care. The Joint Committee on Taxation estimated that the bills would cost a combined $71 billion over a decade by decreasing tax revenue.

A message from PCMA // Pharmaceutical Care Management Association:

DEMOCRATS LAUNCH MANAGED CARE PROBE — Senate and House Democrats launched an investigation into the largest Medicaid managed care plans over high rates of care denials, Robert reports.

Rep. Frank Pallone (D-N.J.), chair of the House Energy and Commerce Committee, and Sen. Ron Wyden (D-Ore.), chair of the Senate Finance Committee, sent letters to the managed care plans Thursday seeking information from seven major insurers such as Aetna, AmeriHealth Caritas, Elevance and United Healthcare. Private managed care plans are contracted with a state to administer the Medicaid benefit.

AmeriHealth Caritas told Pulse in a statement its Medicaid plans “have a process for appropriately evaluating requests for health care services that require Prior Authorization.” The other insurers didn’t respond to a request for comment.

The letters seek more information about the insurers’ use of prior authorization, a cost containment tool that requires doctors to get permission from an insurer before delivering a service or a drug. However, a July report from HHS’ Inspector General found that 1 in 8 of prior authorization requests for a service were denied, double the rate in Medicare Advantage.

“While plans may use prior authorization as a means to manage care, this report raises serious questions about whether plans are improperly using prior authorization to deny care,” Wyden and Pallone said in a statement.

The lawmakers called on each insurer to describe their prior authorization practices, including the algorithms and artificial intelligence used in prior authorization decisions.

The probe comes as lawmakers take a closer eye at prior authorization in Medicare Advantage as well. Sens. Richard Blumenthal (D-Conn.) and Ron Johnson (R-Wis.) launched a probe into the use of AI to deny care earlier this year.

Michelle Kirkman is leaving her role as communications director for Rep. Anna Eshoo (D-Calif.) She’s been with Eshoo’s office since March.

John Nkengasong has been nominated by President Joe Biden to be ambassador-at-large for Global Health Security and Diplomacy at the State Department. Nkengasong currently leads the President’s Emergency Plan for AIDS Relief.

A message from PCMA // Pharmaceutical Care Management Association:

Why would Congress let drug companies boost their own profits at the expense of patients and taxpayers? Big Pharma is the link between patients and high drug prices.

Big Pharma is pushing for so-called “delinking” bills that would give them a profit windfall of $10 BILLION in Medicare alone, forcing patients, taxpayers and employers to pay as much as $18 billion more annually for prescription drugs.

What problem is Congress trying to solve? If the goal is to lower drug costs for patients, taxpayers, and employers, the Big Pharma “delinking” plan is the wrong approach.

“Delinking” means employers lose out on savings and their employees pay more for prescriptions they need.

Get the Facts.

POLITICO’s Josh Gerstein reports that a federal appeals court has lifted a lower court ruling that prevented Idaho from enforcing aspects of its near-total ban on abortion.

The Washington Post reports that few people disenrolled from Medicaid are taking advantage of ACA plans.

POLITICO’s Arek Sarkissian writes about mounting fears that children kicked off Medicaid leaves them fully uninsured.

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