But House Democrats on the Appropriations Committee recently unveiled a plan to restore earmarks, and their counterparts in the Senate are discussing whether to follow suit.
The return of earmarks could be a boon for certain individual hospitals, especially during the coronavirus pandemic. Before Congress put a moratorium on earmarks in 2011, health-care institutions received hundreds of millions in earmark money, according to data from Taxpayers for Common Sense.
“Hospitals are the largest employer in most congressional districts, so I think it’s safe to say that we’ll see a large portion of these earmarks going toward health-care providers,” said Zack Cooper, a professor of health policy and economics at Yale University.
The coronavirus response has burnished hospitals’ reputation on Capitol Hill, and earmarks could give legislators a way to signal their support for their local health-care institutions. Any earmarks are likely to be a drop in the bucket compared to the billions the federal government has poured into shoring up hospitals amid the pandemic, but for certain institutions the extra money could represent a small windfall after a year of depressed health-care spending.
Earmarks became a dirty word in Washington, but they can be useful for getting bills passed.
Many conservatives are still opposed to earmarks even though they champion locally directed funding, leaving Republicans divided on whether to join Democrats in reviving the practice, our colleague Paul Kane reports.
But defenders say they are crucial to restoring Congress’s power of the purse. Earmarks, they argue, don’t increase government spending, but instead shift it from the hands of bureaucrats to elected officials who know the needs of their communities. Not to mention, earmarks can help entice reluctant legislators to back major spending bills — a feature that might be particularly appealing to Democrats now given their slim congressional majorities.
“I think Democrats are looking for mechanisms and leverage to be able to push for specific policies,” said Lisa Gilbert, the executive vice president of Public Citizen, a consumer advocacy and government accountability organization.
Democrats have vowed to introduce safeguards to prevent abuse this time around.
Rep. Rosa L. DeLauro (D-Conn.), chair of the House Appropriations Committee, released a plan that would limit each lawmaker to 10 earmarks, cap the total amount spent on earmarks to 1 percent of discretionary spending, and restrict funding to public or nonprofit entities.
That last provision could make nonprofit hospitals and university medical centers a compelling target for lawmakers who want to spend money in their districts.
Still, some experts are skeptical that earmarks will be divvied up fairly.
“The devil is in the details,” said Steve Ellis, the president of Taxpayers for Common Sense, a government watchdog organization. “Is 10 earmarks to a rank-and-file freshman or second-term Republican the same thing as 10 earmarks to chair DeLauro?”
Earmarks can make a big difference in individual communities.
But they represent a small portion of overall grants to hospitals from the federal government.
When earmarks were active, they made up just 3 to 5 percent of grants to hospitals and health-care systems each year, according to JP Leider, a professor of health policy at the University of Minnesota who co-authored a study on earmarks targeted at health-care facilities.
That’s enough to add up to a few billion dollars over several years, and it’s a big deal to facilities who receive them, but most grants stem from provisions not aimed at an individual hospital or institution. In those cases, officials at the Department of Health and Human Services determine which facilities meet the criteria to receive a government grant.
Previous earmarks, for instance, pale in comparison to the $100 billion included for hospitals in the Cares Act, the coronavirus relief bill passed in March 2020.
The American Hospital Association told The Health 202 that it does not have any position on the return of earmarks.
Earmarks have not traditionally been the most equitable way to divvy up health-care money.
When it comes to earmarks for health-care institutions, it pays (quite literally) to be located in jurisdictions represented by a lawmaker on the House or Senate Appropriations Committee, according to Leider’s research.
That may be why former senator GOP Thad Cochrane was able to secure $85 million to improve public health services in his home state of Mississippi while serving as the ranking Republican on the Senate Appropriations Committee, or why former West Virginia Sen. Robert Byrd (D), another former powerful member on the committee, boasts at least four health-care institutions that bear his name.
Leider and his colleagues analyzed 10 years of earmarks before the moratorium went into effect and found that congressionally directed spending generally went to areas with higher poverty but did not track closely with health-care needs.
“That makes me worry about whether the dollars under the new ‘Community Project Funding’ initiative are going to end up where they are needed most,” Leider said. “Then again, money doesn’t end up where it is needed most if bills don’t pass in the first place.”
Ahh, oof and ouch
AHH: The CDC identified public-health guidance from the Trump administration that downplayed the severity of the pandemic.
A review ordered by the agency’s Director Rochelle Walensky concluded that several controversial pandemic recommendations released during the Trump administration were “not primarily authored” by staff and do not reflect the best scientific evidence, The Post’s Lena H. Sun reports.
The review took issue with three documents that have already been removed from the agency’s website: Guidelines for reopening released in April by the White House that were less detailed than what had been drafted by the CDC and the Federal Emergency Management Agency; a strong argument for school reopenings released in July that downplayed health risks; and guidelines released in August that discouraged testing of people without covid-19 symptoms.
Walensky said the intent of the review was to restore public trust in the CDC. While the report made little mention of politics, it provides official confirmation of press reports that political appointees had interfered with CDC guidance.
OOF: Trump voters wary of coronavirus vaccines insist they want to be “educated not indoctrinated.”
A recent focus group of 19 vaccine-hesitant Trump voters had some advice for pollsters and politicians: “Be honest that scientists don’t have all the answers. Tout the number of people who got the vaccines in trials. And don’t show pro-vaccine ads with politicians — not even ones with Donald Trump,” The Post’s Dan Diamond reports.
The focus group participants, convened over Zoom by longtime GOP pollster Frank Luntz, said that they all believed the coronavirus was real and didn’t want to be condemned as anti-vaccine. But they worried about the long-term effects of new vaccines and felt that politicians were using the virus as a political weapon.
“We want to be educated, not indoctrinated,” said a man identified as Adam from New York, who praised the vaccines as a “miracle, albeit suspicious.”
The nation’s ability to stop the spread of the coronavirus may hinge on whether it can make a convincing case to the tens of millions of Republicans who say they don’t want a shot. A CBS News-YouGov poll released Sunday found that 33 percent of Republicans said that they would not get a shot and another 20 percent were undecided. Among Democrats, just 10 percent said they were opposed to getting vaccinated and another 19 percent were undecided.
The focus group comes as the White House prepares to launch a sweeping campaign to combat vaccine hesitancy. STAT reports that the Biden administration will soon unveil a television, radio and digital advertising blitz designed to combat vaccine apathy and skepticism among young people, people of color and conservatives.
OUCH: Doctors snapped photographs of patients’ organs for a ‘Price is Right’ guessing game.
The residents asked the public to guess the weight of an unidentified organ, comparing the challenge to the television game show ‘Price is Right,’ according to the NBC affiliate WOOD-TV.
“The other game we play in the OR is guess that weight,” read the Instagram post that showed the organ. “It applies to much more than just babies. As always, ‘Price is Right’ rules apply so if you go over then you’re out!”
One photograph showed a doctor posing with a large human tissue while a patient law on the operating table. Some Instagram users were outraged by the posts, which they said invaded patient privacy.
Spectrum Health has said that it is taking “corrective action” but did not provide additional details.
The federal government has sweetened the deal for states to expand Medicaid.
The $1.9 trillion American Rescue Plan signed into law last week offers billions of dollars to a dozen holdout states if they expand Medicaid, The Washington Post’s Amy Goldstein reports. The new law provides 5 percent in extra federal aid for each person in a state’s Medicaid program — an amount that would more than offset the state’s 10 percent share in covering the costs of expanding.
The legislation will “pose an early test of Biden’s powers of persuasion as he tries to make good on his pledge to close the nation’s considerable gaps in insurance and health care,” Amy writes.
It will also test how much the Republican opposition to expanding Medicaid is rooted in financial concerns over state budgets — and how much is ideology and politics over health care.
“The opposition has persisted despite hundreds of studies measuring expansion’s effects that have found benefits. They include improving people’s health, narrowing racial disparities in insurance coverage and helping state economies,” Amy writes.
More in coronavirus news
Medicare’s nursing home rating system failed to predict which facilities were prepared for the coronavirus.
A New York Times investigation found the people at nursing homes with a five-star quality rating from the federal government were roughly as likely to die of coronavirus as people at nursing homes receiving a one-star rating.
The Times investigation found the ratings program, run by the U.S. Centers for Medicare & Medicaid Services, obscured serious problems in many nursing homes.
“At homes whose five stars masked serious problems, residents developed bed sores so severe that their bones were exposed. Others lost the ability to move,” The Times’s Jessica Silver-Greenberg and Robert Gebeloff report. The Times documented one nursing home where a resident’s foot became infected with maggots after bandages were left on for days and another home in which a resident was raped by an employee. Both received five-star ratings.
Reports of abuse, neglect or even violence were frequently not enough to downgrade a nursing home’s rating. The Times also found deficiencies with nursing homes’ self-reported data, which is rarely audited by the government. Homes that received five-star ratings were almost as likely to fail an in-person inspection as to ace them. And surprise inspections may not always be that surprising. Data suggests that nursing increased their staffing levels on days that they were to be inspected, a sign they may have known in advance.
