The Health 202: Joe Biden is likely to draw on Obama health experts if he wins the White House


The Health 202: Joe Biden is likely to draw on Obama health experts if he wins the White House

THE PROGNOSIS

Polling indicates the coronavirus pandemic could make it harder for former vice president Joe Biden to beat President Trump.

But Biden’s team is arguing the opposite: That the virus and subsequent economic landslide highlight precisely why Americans should elect the former vice president in November.

“He’s battle-tested,” a Biden campaign policy adviser told me in an interview yesterday, noting that Biden became vice president amid the 2008 financial crisis and was there as the U.S. responded to the H1N1 swine flu in 2009 and the Ebola outbreak in Africa in 2014.

“He has gone through taking over an administration in the middle of an economic decline, so he stands ready to set up the infrastructure and the talent you need at that moment in time,” the adviser said.

This much is true: a president Biden would have many health policy veterans to draw from in setting up his administration.

Many of his appointees likely would be from Team Obama, a group of people who turned into policy veterans as they shaped the 2010 Affordable Care Act, oversaw its massive rollout and crafted the U.S. response to global disease outbreaks. Some of them – former Centers for Medicare and Medicaid Services administrator Andy Slavitt and former Ebola czar Ron Klain, to name two – are outspoken voices as the Trump administration responds to the rapid spread of covid-19, the disease caused by the novel coronavirus, around the country.

“I think it’s going to be a blend of people from the Obama administration and fresh faces,” the Biden campaign policy advisor told me. “I think certainly one of the benefits of getting vice president Biden as the president is he knows how to set up a government.”

Were Biden to win the Democratic nomination and then the November election, it would be the shortest time frame in half a century – just four years – between two Democratic presidents. Biden would have a natural pipeline of Obama health-care appointees who have since scattered to industry, university and think-tank gigs. 

“Some people I’m sure will be from the Obama administration years…that’s a pretty natural evolution or natural flow of talent,” Mack McLarty, who served as President Bill Clinton’s first White House chief of staff, told me.

The Democratic health-policy establishment has largely lined up behind Biden’s campaign, some of whom first cut their teeth in the 1990s during the Clinton administration. They include people like Chris Jennings and Nancy-Ann DeParle, who advised the White House on the ACA. 

Other top Obama administration officials include former Health and Human Services secretary Sylvia Burwell, now president of American University; Cindy Mann and later Vikki Wachino, who directed Medicaid at CMS; Mandy Cohen, chief operating officer at CMS; Tom Frieden, who led the Centers for Disease Control and Prevention during both Obama terms; and Obama’s Food and Drug Administrator chiefs Margaret Hamburg and Robert Califf.

Democratic staffers on the congressional health-care committees would also have a natural pipeline to a  Biden administration. So might Democrats from state government – someone, for example, like Robert Gordon, who served as acting deputy director of the Office of Management and Budget under Obama and now directs the Michigan Department of Health and Human Services.

“There will be an idea of a restoration of Obama’s third term – I’m sure that will be a big flavor, but I think [Biden] will also be looking for people who worked with senators or governors or mayors who express the same basic governing philosophy,” a former CMS staffer under Obama told me.

Of course, there are also staffers and advisers to Biden’s campaign. They include his policy director Stef Feldman, who advised him on health care, energy and the environment during his vice presidency, and adviser Sarah Bianchi, who worked in the Clinton and Obama White Houses.

Of course, a Biden victory is by no means assured. He isn’t even the Democratic nominee, with Sen. Bernie Sanders (I-Vt.) still in the race.

And after more than a year of nonstop campaign travel, the 77-year-old is now limited to speaking to Americans from his basement. The deeply unusual circumstance has left Biden struggling to maintain his public presence as President Trump and his advisers hold daily coronavirus press briefings and their response to the pandemic consumes the news cycle.

And a poll released over the weekend indicated Biden could have a tougher time in a matchup against Trump than before coronavirus. 

Trump has moved from what was a seven-point deficit in February to a near tie with Biden today, according to the fresh Washington Post-ABC News poll. More voters say they trust Trump to handle the outbreak and the economy, and Trump supporters expressed more enthusiasm for their candidate than Biden supporters.

Yet Biden is trying to showcase leadership chops on pandemic response. On March 11, just as cities and states were starting to enforce social distancing measures, his campaign announced a six-person public health advisory committee. 

The group, which includes physicians and former government officials, is intended to advise Biden on how to reduce the virus’s threat. Members include Zeke Emanuel, a vice provost at the University of Pennsylvania’s medical school and brother to former Obama chief of staff Rahm Emanuel; and David Kessler, who served as FDA commissioner under Clinton and George H.W. Bush. 

Some of the task force members are scathing in their criticism of how Trump has handled the crisis. Irwin Redlener, director of the National Center for Disease Preparedness at Columbia University, said Trump “cannot be believed” on virtually anything he says about the pandemic.

“He is a source of misinformation, creating havoc by the unreliability of what he says in general,” Redlener told me recently.

Yet Biden stayed away yesterday from harshly criticizing his potential opponent. Biden declined on “Meet the Press” to suggest the president “has blood on his hands,” per a question from NBC’s Chuck Todd. Later in the day, Trump announced the federal government would extend social distancing guidelines through at least April 30 as the pandemic is expected to peak in two weeks.

When asked about Trump’s boosted approval ratings, Biden noted that’s how the public typically responds to U.S. presidents during a crisis.

“In every single crisis we’ve had that I’ve been around, going back to Jimmy Carter and the hostages all the way through to this moment, presidents ratings have always gone up in a crisis,” Biden said. “And — but you know the old expression, the proof, you know, is going to be in the pudding. You know, what’s it going to look like?”

AHH, OOF and OUCH

AHH: Trump is extending the federal guidance on social distancing until the end of April, officially abandoning his prior goal of opening the nation by April 12, Easter Sunday.

“It was just an aspiration,” Trump said of the Easter timeline, adding that day now “could be the peak number of deaths before it starts coming down” in the United States. 

“Nothing would be worse than declaring victory before the victory is won,” the president said. “That would be the greatest loss of all.”

Public health experts widely scoffed at Trump’s idea of packed churches and bustling businesses by Easter. “The nation has reached more than 136,000 confirmed cases of covid-19…and more than 2,400 related deaths — with numbers continuing to climb across the country,” our colleagues Ian Duncan and Felicia Sonmez write. ”New York continues to be hit particularly bad, eclipsing 1,000 confirmed deaths related to the coronavirus on Sunday.

Former FDA commissioner Scott Gottlieb:

— Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, predicts the U.S. could see 100,000 deaths minimum and millions of cases. But he said those predictions could change as the pandemic unfolds nationwide – and warned that worst-case-scenario projections rarely come to fruition.

“Whenever the models come in, they give a worst-case scenario and a best-case scenario,” Fauci said in an interview on CNN’s “State of the Union.” “Generally, the reality is somewhere in the middle. I’ve never seen a model of the diseases that I’ve dealt with where the worst case actually came out. They always overshoot.”

“I mean, looking at what we’re seeing now, you know, I would say between 100 and 200,000. But I don’t want to be held to that,” he added. 

Fauci describing his interactions with Trump, via CNN reporter Brian Stelter:

— This much is clear to virtually everyone: The country’s economy can’t stay shut down forever. But when and how to open things back up is a subject of fierce debate among public health and economics officials and experts.

The administration is considering a plan where counties would be classified as high-risk, medium-risk or low-risk. State and local officials could use the information to make decisions about when and to what extent to lift distancing restrictions.

“This is what we envision,” Trump wrote in a letter to state governors last week. “Our expanded testing capabilities will quickly enable us to publish criteria, developed in close coordination with the Nation’s public health officials and scientists, to help classify counties with respect to continued risks posed by the virus. This will incorporate robust surveillance testing, which allows us to monitor the spread of the virus throughout the country. Under these data-driven criteria, we will suggest guidelines categorizing counties as high-risk, medium-risk, or low-risk.”

Epidemiologists and infectious disease specialists, as well as former top agency officials, “have put out their own ideas — in preprint papers online, by Twitter and in op-eds,” our colleagues Laurie McGinley and William Wan report. 

“In a recent flurry of proposals, a consensus of sorts has begun to coalesce around several key ingredients for an American strategy to move forward while minimizing human and economic casualties. They include mounting a large-scale contact tracing effort, widespread testing, building up health care capacity before easing restrictions, making future quarantines more targeted, and allowing those who have recovered and have some immunity to go back to work.”

One 19-page plan from Scott Gottlieb, former Food and Drug Administration commissioner in the Trump administration, offers a step-by-step timeline, with clear benchmarks states and regions would need to meet to safely move forward to the next step. 

Gottlieb “has been acting as an informal adviser to the White House and has shared the paper with administration officials,” Laurie and William report. “His collaborators include Mark McClellan, a former FDA commissioner from the George W. Bush Administration; Caitlin Rivers, an epidemiologist at Johns Hopkins Center for Health Security, and other leading policy experts and infectious disease specialists.”

— More than a third of U.S. counties – counties that are largely rural, poor and have generally less daily contact between people – have not yet reported any positive coronavirus infections, the Associated Press’s Morgan Lee and Nicky Forster report. 

 “Of the counties without positive tests, 85% are in rural areas — from predominantly white communities in Appalachia and the Great Plains to majority Hispanic and Native American stretches of the American Southwest,” they report.

But these areas, should they suddenly see an influx of cases, are full of particularly vulnerable populations. The counties have a higher median age and higher proportion of people older than 60, as well as “far fewer intensive care beds should they fall sick. Median household income is lower, too, potentially limiting health care options.”

OOF: Will there be an in-home test for covid-19? The FDA has previously warned against home tests, saying they weren’t approved. But the agency recently took a major step that could help clear the way for home testing, our colleagues Laurie, Steven Mufson and Elizabeth Dwoskin report.

“It started allowing individuals to use short swabs to collect samples from the front of their nostrils — but only at drive-through testing sites, hospital parking lots and clinics where they are handed the swab by a health-care worker, then hand it back,” our colleagues write.

FDA has given emergency authorization to a new test developed by Abbott Labs that can give a positive result in as little as five minutes and a negative result in as little as 13 minutes. 

During his Rose Garden address yesterday, Trump said the tests are a “whole new ball game.” “Normally this approval process from the FDA would take 10 months and even longer but we did it in four weeks,” he said, adding the company is set to deliver 50,000 tests per day “starting this week.”

Trump also riffed on the virus, per Atlantic editor Jeffrey Goldberg:

— FDA has also issued an emergency use authorization for hydroxychloroquine and chloroquine, decades-old malaria drugs championed by Trump and used by some physicians, Politico’s Dan Diamond reports.

The agency allowed for the drugs to be “donated to the Strategic National Stockpile to be distributed and prescribed by doctors to hospitalized teen and adult patients with COVID-19, as appropriate, when a clinical trial is not available or feasible,” HHS said in a statement, announcing that Sandoz donated 30 million doses of hydroxychloroquine to the stockpile and Bayer donated 1 million doses of chloroquine.

“Career scientists have been skeptical of the effort, noting the lack of data on the drugs’ efficacy for coronavirus care and worried that it would siphon medication away from patients who need it for other conditions, calling instead for the agency to pursue its usual clinical trials,” Dan writes.

HHS Secretary Alex Azar:

— Health insurers Cigna and Humana will now waive patients’ out-of-pocket costs on coronavirus treatments. Humana – which previously said it would cover patient cost-sharing, said it will now also cover subsequent treatment for inpatient hospitalizations. 

“Leaders of both companies called it the right thing to do to help alleviate financial stress for their members and to remove barriers that could keep people from getting needed medical care,” Bloomberg’s John Tozzi reports. 

 “Our customers with COVID-19 should focus on fighting this virus and preventing its spread…while our customers focus on regaining their health, we have their backs,” said David Cordani, Cigna president and CEO in a statement.

Trump said this: “For anybody who understands insurance, they don’t waive co-pays easily, but we’ve asked them to do it, and they’ve done it.” 

OUCH: In early February, HHS Secretary Alex Azar and an OMB official got into a shouting match over a request from Azar for $2 billion to buy respirator masks and other supplies for a depleted federal stockpile of emergency medical equipment, our colleagues Amy Goldstein, Lena H. Sun and Beth Reinhard report. 

The ask was cut to $500 million in the White House supplemental budget request to Congress, though White House budget officials now say the latest relief package includes $16 billion for the stockpile. 

“The dispute over funding highlights tensions over a repository straining under demands from state officials,” our colleagues write. “States desperate for materials from the stockpile are encountering a beleaguered system beset by years of underfunding, changing lines of authority, confusion over the allocation of supplies and a lack of transparency from the administration.” 

— As the U.S. grapples with the current dearth of medical equipment, the New York Times’s Nicholas Kulish, Sarah Kliff and Jessica Silver-Greenberg report that more than a dozen years ago, U.S. public health officials came up with a plan to address a ventilator shortage. 

The plan “was to build a large fleet of inexpensive portable devices to deploy in a flu pandemic or another crisis. Money was budgeted. A federal contract was signed. Work got underway,” they write. “And then things suddenly veered off course…. The project ultimately produced zero ventilators.”

— And the $2.2 trillion coronavirus response bill won’t address a lot of the shortages facing health-care workers. 

“The problem isn’t a lack of money, experts say. It’s that there’s not enough of those supplies available to buy,” the Associated Press’s Martha Mendoza and Juliet Linderman report. “What’s more, the crisis has revealed a fragmented procurement system now descending into chaos just as demand soars.”

— Other news to know: 

On the front lines: 

  • Instacart’s workers are planning an emergency strike starting today to protest the lack of protection for their workers during the coronavirus crisis, our colleague Nitasha Tiku reports.
  • A linen business – lacking steady business because of canceled cruises and empty hotels – is now making medical masks, The Post’s Arelis R. Hernandez reports.
  • Hospitals across the country are banning visitors to limit the risk of spreading infections, devastating families who may not be able to be with loved ones as they die, the New York Times’s Katie Hafner reports.

The response from Washington: 

  • Lawmakers, economists, think tanks and lobbying groups are already starting to plan for a fourth emergency-spending package, the Wall Street Journal’s Jacob M. Schlesinger and Joshua Jamerson report. This one could even be larger than the previous phase.
  • Trump backed off his suggestion that he may order a quarantine for the New York area. Instead, he tweeted Saturday night that he has asked the Centers for Disease Control and Prevention to issue a “strong Travel Advisory” for New York, New Jersey and Connecticut but that a quarantine on the region “will not be necessary.”

Good to know: 

  • Officials in Washington State say they are seeing evidence that efforts to social distance and contain the spread are working for now, the New York Times’s Mike Baker reports.

SUGAR RUSH




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