The Health 202: It’s like the Obamacare repeal-and-replace fight all over again

She and her small staff will act as referees on which parts of President Biden’s $1.9 trillion coronavirus relief plan – passed by the House over the weekend — are kosher under arcane rules governing budget reconciliation bills.

(I wrote this piece back in 2017 about MacDonough and her role as parliamentarian.)

Democrats are using budget reconciliation to pass a relief bill for precisely the same reasons Republicans used the vehicle four years ago to try repealing the ACA: because it can’t be filibustered by the minority party. Reconciliation allows Democrats to move their bill forward without any GOP votes — but it also means certain provisions could be stripped out if the parliamentarian rules they don’t affect federal spending directly enough.

Democrats could run up against obstacles with a broad array of provisions within the massive relief bill, including a minimum-wage increase that MacDonough scuttled late last week, prompting Rep. Ilhan Omar (D-Minn.) to go so far as to call for firing her.

The relief bill includes several health insurance expansions. Amid bigger policy fights, these provisions have received relatively little attention. Yet they represent the first attempt by the Biden administration to start delivering on the president’s promise to expand the 2010 health-care law and make insurance more affordable for more Americans.

The relief bill would temporarily expand Obamacare subsidies in three key ways. It would erase a cap on getting subsidies for individual marketplace plans for households at and above 400 percent of the federal poverty level. It would let those earning up to 150 percent of the poverty level have their monthly premiums fully subsidized. And it would extend full-premium subsidies to those receiving unemployment benefits.

The bill also contains an incentive for the dozen states that still haven’t expanded Medicaid to do so. The federal government would cover an extra 5 percent of costs for all of their Medicaid enrollees if states agreed to expand. 

The expansion of Obamacare subsidies and Medicaid payments, which would last two years, is directly related to federal spending. That means it likely meets the criterion of what can go inside budget reconciliation legislation.

The relief bill provides substantial federal support for people who lose their jobs but stay on their employer-sponsored plan through the COBRA program. Individuals must typically pay the full cost of their premiums, but under the relief bill the government would kick in 85 percent of the costs.

Yet the provision includes more than just spending increases — potentially raising red flags for MacDonough and her crew.

Employers would have to send their terminated employee a notice explaining they might be eligible to receive the new COBRA subsidies. There’s also a complicated technical glitch, pointed out by some insurance experts, that would be interpreted as creating a new eligibility rule under COBRA. 

If either of these elements are viewed by the parliamentarian as creating new rules or regulations, they could be deemed outside the scope of what can be done in a budget reconciliation bill. That could pose problems for the entire COBRA provision.

House Democrats passed the bill shortly after 2 a.m. Saturday after a long day of debate, with Republicans slamming the far-reaching legislation. Even bigger fights await in the Senate, where Democratic unity will face greater tests, Erica Werner and Jeff Stein report. Democrats hope to get the measure signed into law by March 14, when enhanced unemployment benefits are set to expire. 

“While House passage of the legislation had been all but assured, the outlook is trickier in the Senate, where moderate Democrats have raised questions about a number of provisions, including the structure of the state and local aid,” Erica and Jeff write.

“The Senate is split 50-50 between Democrats and Republicans, so if Republicans remain opposed, Democrats can pass the legislation only if they stay united and Vice President Harris breaks the tie,” they note.

Raising the minimum wage to $15 an hour was the top priority for some liberals, and some called on Senate Majority Leader Charles E. Schumer (D-N.Y.) to try to overturn MacDonough’s decision or eliminate the filibuster. As an alternative, Schumer is exploring a tax hike on large corporations that don’t pay a $15-an-hour minimum wage.

“The new vaccine, which is for adults 18 and older, has clear practical and logistical advantages over the first two vaccines — it does not have to be kept frozen, and there is no need for a second round of appointments,” Laurie McGinley and Carolyn Y. Johnson report. “But the Johnson & Johnson shot also has a lower efficacy rate, leading some public health experts and government officials to worry that it will be viewed as substandard compared with the other vaccines.”

Johnson & Johnson’s efficacy rate is 66 percent overall and 72 percent in the United States in preventing moderate to severe cases of the coronavirus — falling short of the 95 percent efficacy achieved by the two-shot Pfizer and Moderna regimens. In fact, the single shot of the Johnson & Johnson vaccine may have similar efficacy to the first shot of Pfizer or Moderna, according to emerging evidence from the U.K.

But the Johnson & Johnson vaccine was also tested after new variants of the coronavirus emerged, which may mean that its efficacy rate cannot be directly compared to that of the other vaccines. So far, all three authorized vaccines have been shown to be effective in preventing hospitalizations and deaths, and experts have said people should not hold off on getting whatever vaccine is offered.

“In a normal world, people would be jumping up and down for a vaccine that is more than 70 percent effective,” Jeanne Marrazzo, an infectious-disease doctor at the University of Alabama at Birmingham, told The Post. Instead, she said, “Some people are saying, ‘I am going to wait until I get the good vaccine.’ ”

Former president Donald Trump told people to get a vaccine during his first big post-presidential address on Sunday.

“Trump, as he is wont to do, couched it in an attack on his successor, President Biden. Trump claimed that Biden hadn’t actually won the election, and he used the vaccine to cast Biden as weak and indebted to Trump for the vaccines being developed on his watch — but not, notably, for actually getting it, which Trump encouraged people to do,” The Post’s Aaron Blake reports.

“We took care of a lot of people — including, I guess, on Dec. 21, we took care of Joe Biden, because he got his shot, he got his vaccine …,” Trump told CPAC, before suggesting Biden’s vaccination shows how few side effects come with the vaccine: “It shows you how unpainful that vaccine shot is.”

“So everybody, go get your shot,” Trump added.

While vaccines were developed rapidly with funding assistance from Trump’s administration, he did little to encourage people to take them. His comments come amid a wide partisan divide in attitude about vaccines: A recent poll from Monmouth University showed that 72 percent of Democrats either planned to get the vaccine as soon as possible or had already gotten it, compared to just 39 percent of Republicans.

Five weeks ago, Los Angeles County was conducting more than 350,000 weekly coronavirus tests. Now, county officials say that demand has collapsed, leaving 180 government-supported sites operating at one-third of their capacity.

The number of U.S. daily tests has fallen by more than 28 percent since its peak on Jan. 15. Officials say this mirrors a decline in new cases, hospitalizations and deaths. It may also reflect the end of holiday travel, pandemic fatigue and a redistribution of attention and resources toward vaccination instead of testing. 

Still, Biden has promised to invest billions in expanding the country’s testing infrastructure, and manufacturers continue to ramp up production of tests, with 110 million rapid and home-based tests expected to hit the market next month. Some experts say that expanded testing will be crucial to tracking and containing new coronavirus variants.

By this time in 2020, covid-19 had claimed six lives in the United States and patients were being treated in at least 15 states. The epicenter was King County, Wash., where dozens of staff and residents of the Life Care Center nursing home had reported covid-19-like symptoms.

“Eating inside a restaurant or a friend’s house may no longer be controversial. Cookouts and summer vacations may return,” William writes.

By July 1, more than half of the U.S. population could be vaccinated with at least their first dose of a vaccine, according to projections by data scientist Youyang Gu, whose past models have been cited by the Centers for Disease Control and Prevention. That may not be enough to reach herd immunity — if it is ever reached — but it will decrease cases and make them easier to manage, and with the most vulnerable protected, deaths will decline dramatically. Meanwhile, warmer weather could make it easier to congregate outside. 

But experts caution that the “glorious summer” requires continued vigilance now, William writes. A sharp decline in cases and hospitalizations since mid-January has started to plateau, and new, concerning variants of the coronavirus are spreading. These concerns are compounded as officials ease restrictions: Iowa and Montana have lifted mask mandates, New York is reopening stadiums for concerts and New York and Washington are allowing indoor dining.

“Reopening just as these variants are spreading is not smart,” Tom Frieden, a former CDC director, told The Post. “We’re like a punch-drunk boxer, getting up just as our opponent is preparing to deliver an even faster punch. … By reopening, we’re leaning into that left hook. Why can’t we ever learn?”

• A Government Accountability Office report probe finds that health agencies’ coronavirus data remains inconsistent and confusing to track, Politico’s Erin Banco reports. The report, which will be released in March, is expected to recommend that agencies centralize their vaccine data. But it’s already receiving pushback from officials at the Centers for Disease Control and Prevention who are worried about changing course in the middle of the pandemic.
   
• States and cities are rushing to open mass vaccination sites that can give thousands of shots a day, the New York Times’s Abby Goodnough reports. The Federal Emergency Management Agency has also joined in, helping to open seven mega-sites in California, New York and Texas staffed by active-duty troops.
   
• Mexico’s President Andrés Manuel López Obrador is expected to ask President Biden to share some vaccine supply with Mexico during a virtual summit that will be held today, Reuters’s Matt Spetalnick, David Graham and Frank Jack Daniel report.

Shingle Mountain was dumped into a section of Dallas settled by formerly enslaved people, The Post’s Darryl Fears reports. Residents have said that the debris, which contains tiny glass fibers and formaldehyde, has caused health problems.

Quincy Roberts, whose bid won a city contract to clear away the shingles, happens to be a trained operatic tenor. He is teaming up with the Dallas Symphony Orchestra to present a tiny concert to a group of neighbors who lived next to the 100,000-ton pile of waste.