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With Robert King

Driving The Day

‘IN EVERY STATE IN WHICH WE POLLED’ — The Supreme Court last year stripped federal protections for abortion, saying that the half-century debate should be settled not by judges but by the voters and their representatives.

Over the last 17 months, in contest after contest, Americans have done so — voting overwhelmingly to preserve or restore Roe-like protections.

Margins matter: Abortion protections win in red states that voted for President Donald Trump. They win in counties President Joe Biden lost by more than 20 points. They win when popular Republicans campaign for it and when Republicans ignore it. They win even when the outcome has no immediate effect on abortion access.

Support for abortion cuts across party lines, performing significantly better at the ballot box than Biden and other Democrats. In fact, abortion outruns Biden most in the most Republican areas, according to a POLITICO analysis of election results from the five states that have had direct votes on abortion rights. In those five states — California, Kansas, Kentucky, Michigan, and Ohio — every county that voted for Biden also voted for abortion, POLITICO’s Alice Miranda Ollstein, Megan Messerly and Jessica Piper report.

The pattern of cross-partisan support for abortion is so strong, the analysis found, that it suggests only a small handful of states, such as Wyoming or Alabama, might be uniformly conservative enough to vote against abortion if given the opportunity.

“Abortions being ‘always’ or ‘mostly’ legal won in Texas. It won in every state in which we polled the question,” said Don Levy, director of the Siena College Research Institute. “That’s where America is.”

Why it matters: The issue is expected to fuel ballot initiatives in several more states in 2024 and become a leading argument in Democratic campaigns for the White House and Congress.

WELCOME TO THURSDAY PULSE. Bike enthusiast Rep. Earl Blumenauer (D-Ore.) told us Wednesday on the Hill that electric bikes “turn any cyclist into a bike commuter.” Ben is our cyclist/co-author — Chelsea is happy on her own two feet — so direct your thoughts to him and, of course, send your tips, scoops and feedback to [email protected] and [email protected] and follow along @ChelseaCirruzzo and @_BenLeonard_.

TODAY ON OUR PULSE CHECK PODCAST, host Alice Miranda Ollstein talks with Politico health care reporter Daniel Payne, who breaks down key takeaways from the 2023 Milken Future of Health Summit, including experts’ prediction that artificial intelligence will revolutionize health care and warnings from lawmakers and regulators about the risks around misinformation and data privacy.

In Congress

BECERRA DEFENDS CHILD CARE FUNDING — Senate Republicans questioned HHS Secretary Xavier Becerra on Wednesday about the sustainability of a supplemental funding request for the child care industry, Chelsea reports.

Background: In October, President Joe Biden requested $16 billion in supplemental funding to cover an additional year of money to support the child care industry after funding from the American Rescue Act ended.

Becerra told the Senate Appropriations Committee that without additional funding, child care providers will be forced to close their doors, and thousands of families will be left without care.

But some lawmakers on the committee, including ranking member Susan Collins (R-Maine), pushed back, calling instead for support for the Child Care and Development Block Grant program, which provides lower-income families with financial aid toward child care.

“I’ve long been a strong supporter of improving access to quality affordable child care, and I don’t think extending pandemic subsidies is the way to do that,” Collins said. “Wouldn’t it be better to invest additional child care funds in a program that directly helps subsidize child care costs for low-income families?”

Nebraska Republican Deb Fischer questioned Becerra on why the administration asked for only $9 billion for the grant funding during the regular fiscal 2024 budget process and is now asking for $16 billion in supplemental funding.

“As a government, we cannot continue to bolster certain priorities through unsustainable and really unreliable emergency supplementals instead of addressing priorities through regular order and budgeting,” Fischer said.

Becerra told the committee he supported long-term solutions like block grant funding but noted it goes to only certain qualifying families and not providers.

“The stabilization money was meant to actually help providers, not necessarily directly the families, because providers were going under,” he said.

Medicare

THE LEFT SCRUTINIZES CMS ON MA — Progressive House Democrats are ramping up their calls for CMS to penalize Medicare Advantage plans that deny care and have poor doctor networks, Robert reports.

House lawmakers hope for the same success that Sen. Ron Wyden (D-Ore.) had when he called for the agency to boost oversight of Medicare Advantage third-party marketers. The progressives are scheduled to hold a press conference today after sending three letters to the agency.

The letters, led by Rep. Mark Pocan (D-Wis.), focused on CMS’ enforcement actions on plans that improperly deny medical care and don’t have enough doctors in their network. The lawmakers also want CMS to do more on tackling overpayments to plans.

House progressives have long been skeptical of the Medicare Advantage program, which has grown to represent more than 30 million older Americans. However, the program has robust bipartisan support in Congress, leaving little opportunity for legislative action.

Progressives hope instead to prod CMS to crack down more on such plans and take a similar move Wyden employed last month on third-party marketing organizations that mislead older Americans to sign up for plans they don’t understand.

Less than two weeks later, CMS released a proposed rule to halt bonuses to agents and brokers that can incentivize misleading tactics.

DOCTOR PAY PASSES FINANCE — The Senate Finance Committee unanimously advanced a bipartisan health care package Wednesday, POLITICO’s David Lim and Robert report.

The legislation — the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act — partially mitigates a Medicare payment cut for doctors, extends certain expiring Medicare and Medicaid provisions, aims to increase access to mental health care and targets pharmacy benefit manager practices.

The bipartisan package is the second major swing at health care legislation by the committee this legislative session.

Inside the bill: The bill contains a one-year 1.25 percent increase to Medicare reimbursement rates for doctors, who face a 3.4 percent cut next year. The nonpartisan Congressional Budget Office estimates the 1.25 percent increase in reimbursement rates will cost $670 million.

The bill also includes:

— Provisions to reduce costs for some Medicare enrollees for certain drugs starting in 2028 by tying cost-sharing after the plans’ deductible phase to net price instead of list price. That means cost-sharing would take effect after rebates and discounts.

— An extension to the incentive bonus doctors receive when they enter an alternative Medicare payment model, which pays them based on the value of care delivered instead of flat fees for services rendered.

What’s next: Wyden, the committee’s chair, told POLITICO he’s discussed the package with Senate Majority Leader Chuck Schumer but said it’s up to him to decide the next procedural steps.

At the Agencies

CMS HIRING FREEZE — Congress’ failure to pass a budget has forced CMS to implement a partial hiring freeze, the agency confirmed to POLITICO.

CMS Administrator Chiquita Brooks-LaSure warned Wednesday at a Milken Institute event in Washington that if the impasse on Capitol Hill persists, it could threaten agency operations, Robert reports.

Why it matters: Congress is hurtling toward another pressing deadline to fund the federal government. The continuing resolution that funds operations at fiscal 2023 levels expires on Nov. 17, and lawmakers are debating another patch.

CMS confirmed that the hiring freeze was first imposed in July and only affects parts of the agency funded via the annual appropriations process.

The agency is concerned that Congress will pass either another, longer-term continuing resolution that keeps funding flat or a fiscal 2024 spending bill that does the same.

A lack of funds and the freeze could impact several key positions for the agency.

Jon Blum, principal deputy administrator for CMS, told POLITICO in a statement that if CMS gets flat funding again, state survey agencies “would likely not be able to complete all statutorily required nursing home surveys” as the agency seeks to improve oversight of the facilities.

The freeze isn’t likely to impact hiring for the agency’s Medicare drug price negotiation program. The agency hopes to hire roughly 100 positions thanks to funding included in the Inflation Reduction Act, which directed CMS to bargain with drugmakers over prices.

Names in the News

Sara Lonardo joined HHS as a deputy assistant secretary for public affairs, covering the health care portfolio. She previously worked for CMS, FamiliesUSA, the Service Employees International Union and Rep. Rosa DeLauro (D-Conn.).

WHAT WE’RE READING

STAT reports on a study that may explain why some CAR-T patients experience severe complications.

POLITICO’s Lauren Gardner reports on FDA approval of a new weight loss drug.

Devex reports on the major failings of a $9.5 billion USAID program meant to transform how drugs and other health supplies reach developing countries.