Meet the new leaders of the Senate health panel: Bernie and Cassidy


Good morning, and TGIF, everybody.

Today’s edition: The World Health Organization is negotiating a draft pandemic treaty, which our colleague Adam Taylor obtained. Epilepsy drugs are on the rise in nursing homes. But first … 

The Senate health committee is probably getting new leadership: the Medicare-for-all man and a conservative wonk

The Senate’s top health panel is entering a new era of leadership.

Sens. Bernie Sanders (I-Vt.) and Bill Cassidy (R-La.) are likely to take the reins, with both lawmakers announcing yesterday their intentions to pursue top spots on the Senate HELP Committee next year. Though not yet official, it’s expected that both will assume the posts on the panel with jurisdiction over the nation’s public health agencies, the Food and Drug Administration and other aspects of federal health policy. 

The pairing avoids the unpredictability and potentially explosive clashes of a committee led by Sanders and Sen. Rand Paul (R-Ky.), which was a distinct possibility earlier this week. Paul, a fierce critic of the Biden administration’s pandemic response, announced yesterday that he was opting to be the top Republican on the Senate’s chief oversight panel instead.

The committee will have a more moderate ranking member in Cassidy, a gastroenterologist who voted to impeach Trump after Jan. 6 and is known for being a health policy wonk. With Sanders, the committee will be led by a firebrand whose rise — particularly with the 2016 presidential election — has led to the party’s embrace of more liberal health policies. 

Sanders and Cassidy don’t have a lengthy history of working together, making it difficult to pinpoint where they will wind up finding common ground. But doing so will be imperative to getting anything done in a split Congress and a razor-thin Democratic majority in the Senate.

Sanders has long championed a far-reaching proposal to transform Medicare into a single-payer system, granting the federal government sweeping power to negotiate the cost of drug prices. If he helms the health committee, universal coverage and lowering the cost of medicines would be top priorities for him, according to spokesman Mike Casca.

Medicare-for-all and drug negotiation are both technically under the purview of the Senate Finance Committee, but leading the health committee would still give Sanders a high-profile platform to promote both policies. 

He would also have the power to pursue legislation broadly authorizing the importation of drugs from other countries — a policy he attempted to push through the HELP Committee earlier this year to no avail. Sanders is known for his penchant for railing against pharmaceutical companies, whether during committee hearings or on the Senate floor. 

  • “He’ll go after [the drug companies] at every turn, and they only have a couple friends left in the caucus any more so it’s going to be tough,” said one Democratic pharmaceutical lobbyist, who spoke on the condition of anonymity in order to be candid.

Some people on and off the Hill privately wondered whether Sanders would be able to build consensus among Republicans and within the Democratic caucus. But his defenders contend he’s a savvy politician who knows when to try and push the bounds, and when to come to the table, noting that he voted for Democrats’ economic package over the summer even though it was far smaller in scope than he wanted. 

  • “I think there’s a caricature out there of Bernie Sanders that doesn’t take note of the fact that the guy is a politician who has been doing this for a really long time,” said Alex Lawson, the executive director of left-leaning advocacy group Social Security Works. “He knows how to work with his colleagues.”

The Kaiser Family Foundation’s Larry Levitt:

Cassidy as the top Republican on the health committee will likely be much different than Paul in the post. One Senate GOP aide said they believed the Louisiana senator — who has also said he’ll decide this week whether he’ll run for governor — would be more focused on legislating rather than probing the pandemic. 

But Cassidy would still be interested in scrutinizing aspects of the Biden administration’s health policies, even though his powers to do so will be limited in the minority. 

Specifically, Cassidy told The Health 202 that he wants to conduct oversight into how the federal government is implementing a law to stop surprise medical bills. He was instrumental in pushing a more doctor-friendly version of the legislation and argued the administration hasn’t carried out the law as Congress intended. 

Meanwhile, Cassidy has been open to nontraditional ways of paying for drugs. The senator was supportive of Louisiana’s efforts under a Democratic governor to chart a new way of paying for expensive hepatitis C treatments, where the state would pay a flat fee and get unlimited supply of the drug. 

But not all Cassidy’s efforts have been bipartisan. In 2017, he mounted a last-ditch campaign to salvage the GOP’s failed bid to repeal and replace Obamacare. But the legislation didn’t have the votes, prompting Sanders to declare a “major victory” for the American people in stopping “another disastrous Republican proposal.”

WHO members to consider a pandemic pact

Members of the World Health Organization will begin negotiating the terms of a pandemic treaty in Geneva next month in a bid to prepare global states for future health emergencies. 

The draft treaty, shared with The Health 202 by our colleague Adam Taylor, is being championed by WHO Director General Tedros Adhanom Ghebreyesus, who said such a deal would be a “game changer” for ensuring scientific and political cooperation across borders both before and during an outbreak. 

The fine print: The draft accord includes measures to increase transparency around public funding for the development of vaccines and treatments, as well as provisions to ensure that resulting products are distributed equitably. It would also encourage countries to develop mechanisms to transfer relevant “technology and know-how” to potential manufacturers across the globe, with a focus on developing nations. 

If agreed to by WHO members, the treaty could have big implications for the pharmaceutical industry. The draft proposes recommendations to make it compulsory for companies that produce pandemic products like vaccines to disclose prices and terms of any public procurements contracts in times of global health emergencies. 

It remains to be seen what would happen if countries that sign the treaty neglect to follow its rules and if companies fail to comply. The agreement is not expected to be adopted before 2024, Politico notes.

FDA approves first Type 1 diabetes prevention drug

The Food and Drug Administration approved the nation’s first drug that can delay the onset of Type 1 diabetes.

Federal regulators greenlit an injection called TZield for adults and in children aged 8 years and older who currently have stage 2 type 1 diabetes. In clinical trials, the treatment delayed the progression of type 1 diabetes in patients by an average of about two years.

JDRF, a nonprofit funder of Type 1 diabetes research:

Epilepsy drugs are on the rise in nursing homes

Government policies aimed at curbing excessive use of powerful psychiatric drugs for dementia patients in nursing homes are probably having an unintended side effect: greater use of anti-seizure medications, our colleague Christopher Rowland writes. 

A report out yesterday from the Office of Inspector General for the Department of Health and Human Services found that, despite increased federal oversight, the overall use of psychotropic drugs in nursing homes hasn’t decreased. Yet, physicians have shifted toward using anticonvulsant medications to sedate dementia patients instead of antipsychotics. 

It also found that nursing homes with fewer hours worked by a registered nurse, and those with more low-income residents, used measurably greater proportions of all categories of drugs that work in the brain, including antidepressants.

The nursing home industry, represented by the American Health Care Association/National Center for Assisted Living, contends that the medications are often prescribed by health-care providers not affiliated with the facilities. 

Some state abortion bans dont’ include exemptions for mental health

Mental health advocates are decrying abortion bans in several states that allow exemptions for life-threatening physical conditions but not for mental health crises, the Associated Press reports.

The details: At least eight states that have banned abortions include exemptions to save the life of the pregnant woman but not for mental health. Laws in Georgia, Nebraska and West Virginia specify that medical emergencies don’t include suicide threats. Meanwhile, Florida’s exemption includes life-threatening illnesses “other than a psychological condition.” Some antiabortion advocates argue that the laws are intended to keep patients from feigning mental illness to end their pregnancies. 

Postpartum depression is well-recognized, yet evidence suggests depression during pregnancy may be even more common. Mental health conditions including suicide and substance use became the leading underlying cause of pregnancy-related deaths from 2017 to 2019, per the Centers for Disease Control and Prevention

The National Right to Life Committee, an antiabortion group that has lobbied for such measures, defended the restrictions. “A mother facing serious mental health issues should receive counseling and mental health care,” said spokeswoman Laura Echevarria. “Having an abortion will not mitigate mental health issues.” 

Meanwhile, in Oklahoma …

The Justice Department announced yesterday that it opened a civil rights investigation into Oklahoma’s mental health system.

The probe will examine whether the state discriminates against people with mental illness by failing to provide community-based mental health services to those in Oklahoma County, which may lead to unnecessary admissions to psychiatric facilities and police contact.

  • A federal judge will decide today whether Elizabeth Holmes, founder of the disgraced blood-testing start-up Theranos Inc., should serve prison time for duping investors about her company’s technology and financial health, the Wall Street Journal reports.
  • The FDA sent warning letters to seven companies for allegedly illegally selling dietary supplements that claim to cure, treat or prevent cardiovascular disease, the agency announced yesterday.
  • New York City, once a hotspot in the nation’s record monkeypox outbreak, will end its mobile vaccination program as new infections continue to decline. The local government has also shuttered mass vaccination sites and quietly ended the city’s monkeypox state of emergency, New York Times reports.

In rural America, the crisis of disappearing reproductive care steals lives (By Akilah Johnson l The Washington Post)

Covid almost broke this hospital. It also might be what saves it. (By Joseph Goldstein | The New York Times)

How banks and private equity cash in when patients can’t pay their medical bills (By Noam N. Levey and Aneri Pattani | Kaiser Health News)

Thanks for reading! See y’all tomorrow.

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