By Chelsea Cirruzzo and Ben Leonard

Despite protests in Washington last month to raise awareness of the fentanyl crisis, Congress hasn't been able to move foward the SUPPORT Act to help fight and treat addiction. | Manuel Balce Ceneta/AP Photo

SNUBBING THE SUPPORT ACT — Congress is showing little urgency about reupping the SUPPORT Act, the landmark opioid-fighting law that expired Sept. 30.

That’s not because of partisan division but a realization that there are no quick fixes a new law could bring to bear, POLITICO’s Carmen Paun reports.

The lack of urgency contrasts sharply with Congress’ attitude in 2018 when Republicans, Democrats and then-President Donald Trump united around legislation that threw $20 billion into treatment, prevention and recovery.

Trump promised the law would end the scourge of drug addiction in America or at least make a big dent in it.

But five years later, the number of Americans dying from overdoses has grown more than 60 percent, driven by illicit fentanyl.

Last year, the grim tally was 105,000 lives.

Why the delay? The House Energy and Commerce Committee unanimously approved a new SUPPORT Act in July, and the Judiciary Committee advanced it last month. Its most significant new provision would lift a 1965 rule prohibiting addiction treatment in large mental health institutions.

But the measure’s limited ambition suggests a reason for the lack of urgency to pass it. No floor vote is scheduled, and the House is at a standstill as Republicans try to select a new speaker.

Still, the House is further along than the Senate. Asked why the Senate committee responsible for the law hasn’t even begun to consider it, Chair Bernie Sanders (I-Vt.) said other priorities had precedence. “We’re working on a myriad of problems,” he said after listing his efforts to shore up the primary care system and lower drug prices.

The fallout: Congress can continue to fund opioid-fighting efforts without passing a new version of the SUPPORT Act.

But failing to pass another law forfeits the opportunity to try new approaches. That has advocates discouraged.

“We are in the middle of a crisis of proportions we couldn't have imagined even five years ago when the original SUPPORT Act was passed,” said Libby Jones, program director of the Overdose Prevention Initiative at the Global Health Advocacy Incubator. “If they can’t pass this, it’s really sad.”

WELCOME TO MONDAY PULSE. I spent part of my weekend taking a twilight tour of the Congressional Cemetery, walking among the graves of FBI Director J. Edgar Hoover, composer John Philip Sousa and former D.C. Mayor Marion Barry.

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

TODAY ON OUR PULSE CHECK PODCAST, Katherine Ellen Foley interviews Carmen Paun about her report on the out-of-control U.S. drug overdose crisis and why Congress' efforts to stop it have stalled.

A message from PhRMA:

Middlemen game the system at your expense. Pharmacy benefit managers (PBMs) charge fees tied to the price of medicines, which experts warn can lead to higher costs for patients and the health care system. A new survey finds 72% of voters believe PBMs should receive a fixed fee for their services instead. See the data.

Demand for Sanofi's RSV vaccine for infants, Beyfortus, has exceeded supply. | AstraZeneca via AP Photo

RSV SHOT SHORTAGE — The federal government recommends a recently approved vaccine that protects against respiratory syncytial virus in infants, but doctors and parents say they can’t get their hands on it, Chelsea reports.

Sanofi, the shot’s manufacturer, told POLITICO it underestimated the demand and is working with the Centers for Disease Control and Prevention to fix the problem.

Why it matters: The supply shortage comes just ahead of what’s usually the height of RSV season, which typically sends between 58,000 and 80,000 children under age 5 to the hospital every year.

The CDC informed state vaccine managers that the federal Vaccines for Children Program, which helps cover the cost of shots for low-income, uninsured and underinsured kids, has temporarily stopped ordering the new RSV injection. It said it would ration supply when it resumes. The CDC also said the 100-milligram dose, recommended for babies 11 pounds and over until they’re 8 months old, isn’t available.

Sanofi confirmed a pause in orders for the 100-mg dose to POLITICO, citing “higher than anticipated” demand, but didn’t say when ordering would resume. The 50-milligram dose, for babies under 11 pounds, is also in high demand, Sanofi said, but supply has so far kept up.

At the same time, pediatricians are concerned that insurers won’t cover the injection because of its price, according to the American Academy of Pediatrics. The shot costs $495 a dose.

While CDC-recommended shots must be covered by insurers under the Affordable Care Act, insurers are given one year to set up that coverage.

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WHAT TO WATCH ON THE HILL — House Republicans appear to be headed back to the drawing board after ditching Rep. Jim Jordan’s (R-Ohio) bid for speaker.

This comes as Congress faces no shortage of pressing business that it can’t conduct while the House stays shut. At the top of that list: a government shutdown deadline that’s less than a month away and a $100 million-plus emergency funding request from the Biden administration.

Here’s what else we’re watching on the Hill this week:

— The Senate Health, Education, Labor and Pensions Committee holds a markup Tuesday to vote on the nominee for NIH director, Dr. Monica Bertagnolli.

— The House select coronavirus subcommittee holds a hearing Tuesday on reforming the World Health Organization with witnesses from HHS, the State Department and the U.S. Agency for International Development.

— The House Veterans’ Affairs Committee marks up several pieces of legislation, including one on caregiving for veterans and disability benefits, on Tuesday.

— The House Energy and Commerce health subcommittee holds a hearing Wednesday on proposed long-term care regulations.

— The Senate Aging Committee holds a hearing on access to therapies for progressive diseases like Alzheimer’s on Wednesday.

— The Senate HELP Committee heads to New Jersey on Friday to hold a hearing on the nurse staffing shortage — a hearing that ranking Republican Sen. Bill Cassidy (R-La.) has raised concerns about because it coincides with a labor strike in the area.

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NEARLY 2 MILLION LOSSES — The number of children who have lost Medicaid since unwinding began in the spring is nearly at 2 million, according to researchers at Georgetown University’s Center for Children and Families, although they say the numbers might be higher.

The analysis, published Friday, notes that the 1.9 million children who’ve lost coverage doesn’t include data from Michigan, New York or Oregon. Additionally, the data from Texas, which has seen some of the steepest coverage losses, was available only through July.

Why it matters: While most children deemed ineligible for Medicaid are likely eligible to move to the Children’s Health Insurance Program, Georgetown researchers say early data isn’t promising.

Researchers say net enrollment in 30 states where CHIP is run separately from Medicaid has increased by only 104,000, and, in five of those states, CHIP enrollment continues to decline.

SERVING UNDERSERVED AREAS — Female, LGBTQ and medical students of color were more likely than white and male students to say they plan to practice in an underserved area, according to a new research letter published in JAMA.

The research, which broke out the demographic data from surveys administered by the Association of American Medical Colleges from 2019-2021, found that more than 27 percent of medical students surveyed said they want to practice in an underserved area.

What to watch: The authors say future studies should examine whether diversifying the medical student body will improve access to health care for patients in underserved areas.

CONGRESS AGAINST NURSING HOME RULE — More than a hundred members of Congress have spoken out against a proposed rule to set a minimum federal staffing standard in nursing homes.

A bipartisan letter sent Friday from nearly a hundred members, led by Rep. Greg Pence (R-Ind.), urges HHS Secretary Xavier Becerra to reconsider the proposal, which the lawmakers say would limit care for older adults, drive up state Medicaid costs and lead to nursing home closures. The nursing home industry has decried the rule as too stringent.

It comes the same week that Sens. Kevin Cramer (R-N.D.) and Angus King (I-Maine) wrote to CMS, urging the agency to rescind the rule.

But it also comes just after major care advocates, labor groups and nursing home workers published a full-page ad in The Washington Post urging Congress to support the proposed rule.

KFF has estimated that only 1 in 5 nursing homes would currently be able to meet the new requirements. The proposed rule has already received more than 9,000 comments ahead of the Nov. 6 comment deadline.

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Michelle Liz Tabajonda is joining Rep. Nanette Diaz Barragán’s (D-Calif.) office as legislative assistant covering the Energy and Commerce Health Subcommittee. She previously was an APAICS fellow specializing in health care with Rep. Judy Chu (D-Calif.).

Robert Samonte Tagalicod has been promoted to chief of staff to the HHS Assistant Secretary for Administration. He previously was an HHS senior adviser.

The Associated Press reports on Gaza hospitals' struggles to operate without anesthesia, beds or electricity.

The Wall Street Journal reports on the scientists fighting to remove over-the-counter decongestants with phenylephrine from the shelves.

A message from PhRMA:

Middlemen can make you pay more. Newly released data show 74% of voters think health insurers and their PBMs should pass the rebates and discounts they receive to patients, so no patient pays more for their medicines than their insurer. Read the new poll.

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