A ‘fire Fauci’ senator might soon lead a top health committee

Get ready for some colorful covid hearings if Sen. Rand Paul takes HELP committee reins

Sen. Rand Paul (R-Ky.) vowed to “Fire Fauci” on his campaign website and clashed with Biden health officials throughout the pandemic. Now he could soon lead probes into the nation’s covid-19 response. 

Administration officials are dreading the very real possibility of Paul becoming chair of a key Senate committee if Republicans retake the chamber next week. GOP control comes with immense power: Paul could lead investigations and help set legislative priorities next year, either as the head of the Senate’s sweeping health panel or its oversight committee.

Some health-care leaders and trade groups worry the libertarian doctor would follow through on his criticism of “Big Pharma, the medical establishment and public health officials” for their stances on covid. The American Public Health Association (APHA), which represents public health professionals, recently gave Paul the lowest-possible grade on its report card: 0 percent.

But the idea of Paul helming a key committee has thrilled his GOP allies, who contend he’d uncover issues with the Biden administration’s covid response that the Democratic-controlled Congress has overlooked.  

Paul is set to be the senior-most GOP lawmaker on the Health, Education, Labor and Pensions Committee with Sen. Richard Burr (R-N.C.) retiring. The practice among Republicans is generally to allow the committee veteran to assume the top slot if they want it.

But Paul and Senate leaders could also opt for another path: serving as the top Republican on the Homeland Security and Governmental Affairs Committee, the chamber’s chief panel conducting oversight. 

The Kentucky Republican — who’s heavily favored to win his own reelection race — has indicated he’ll wait until after the midterms to make a decision about which committee spot he wants. His office didn’t respond to interview requests.

But Paul isn’t being quiet about what he would do: “If you help me win, I promise to subpoena every last document of Dr. Fauci’s unprecedented coverup,” said a Paul fundraising email sent on Oct. 20, referring to Paul’s allegations that Anthony Fauci — the nation’s top infectious disease expert — contributed to the virus’ creation by funding research in Wuhan, China. Fauci has categorically denied those allegations.

• “I’m always open and happy to cooperate with any committee,” Fauci told Dan, noting he had testified before Congress hundreds of times over the past four decades. Fauci plans to step down in December after more than a half-century in government.
• But inside the administration, some senior officials are less sanguine about the prospect of Chairman Paul, who has sent letters demanding information about covid guidance and sought to unwind masking requirements on public transit.

Some administration officials and congressional staff questioned whether Paul — who has a reputation for an independent streak that’s at times frustrated other lawmakers — could build consensus among his colleagues. But others are cheering the fact that Paul could be charged with investigations into the virus. Senate Minority Leader Mitch McConnell (R-Ky.) touted the prospect at a Kentucky GOP rally for Paul, the Associated Press reported in May.

• “I’m not sure there is a single Senator who has more dogmatically pursued the truth regarding federal public health policy than Dr. Paul,” Josh Holmes, a co-host of the conservative “Ruthless” podcast and an outside adviser to McConnell, wrote in an email.

Several health groups have cited concerns about Paul as a chairman (some of whom declined to go on the record due to fears that criticizing him could backfire). 

• “He has not been an exemplar of prevention or wellness,” said Georges C. Benjamin, executive director of the APHA, referring to Paul’s reticence about whether he got a coronavirus vaccine and reports that he used the Senate gym while waiting for a coronavirus test result in March 2020 that showed he was infected. “That is a real problem when you’re a physician. … You should know better.”

On the Democratic side, some lobbyists and Hill staff expect Sen. Patty Murray (D-Wash.) — the current health chair — to leave the panel’s top slot for the Senate Appropriations Committee if she wins reelection next week. An aide to the senator said that she is “focused on her reelection” and legislative work.

Doing so could open up a leadership spot for Sen. Bernie Sanders (I-Vt.), a self-described democratic socialist. That would set up an unusual pairing of two lawmakers who have been known to buck the party they caucus with.

“It goes from one of the most productive committees in the Senate to one of the least productive committees of the Senate,” said one Senate GOP aide, who spoke on the condition of anonymity to be candid.

But Sanders and Paul have occasionally found common ground with each other. Such a notion was on public display in June, when Paul supported a sweeping amendment from Sanders to allow drug importation from Canada, the United Kingdom and other countries. 

“Well, I’ve always wanted to go to a Bernie rally — now I feel like I’ve been there,” Paul said after Sanders finished castigating Congress and pharmaceutical companies.

Read the rest of our deep dive here.

CMS finalizes behavioral health rules

The Centers for Medicare and Medicaid Services finalized policies yesterday aimed at expanding access to behavioral health and substance use disorder treatment services for Medicare beneficiaries in rural areas.

Here’s a snapshot of what the annual Medicare physician payment rule and Medicare hospital outpatient and ambulatory surgical centers rule will do starting Jan. 1:

• Make it easier for addiction counselors, family therapists and others to offer services, particularly in rural areas.
• Make a pandemic-era flexibility permanent that allows hospital outpatient departments to bill for in-home telebehavioral health services.
• Extend Medicare coverage to include opioid treatment programs that initiate the prescribing of buprenorphine — a medication-assisted treatment — via telehealth. Medicare will also cover such services provided through mobile units.
• Other provisions include new monthly payments for comprehensive treatment and management services for patients with chronic pain, as well expanded access to certain cancer-screening coverage and dental care.

Also … CMS will offer enhanced Medicare payments to incentivize hospitals to purchase N95 respirators manufactured in the United States, in an effort to sustain domestic production of the masks for future public health emergencies. 

Requests for abortion pills soar after Roe reversal as travel times for the procedure mount

Online requests for abortion pills surged in the months after the Supreme Court overturned Roe v. Wade, according to a study published yesterday in the Journal of the American Medical Association (JAMA).

The study, led by researchers at the University of Texas at Austin, analyzed requests made through Aid Access, a nonprofit organization based in Austria that mails abortion pills directly to women in the United States. After reviewing data from September 2021 through August 2022, researchers identified two notable surges. The first was after the Supreme Court decision was leaked, and again after the final verdict was passed down.

By the numbers: Before the decision, the service received an average of about 83 requests per day. When the opinion draft was leaked, daily requests increased to roughly 137. Once the formal decision was released and some states enacted abortion bans, requests jumped to nearly 214 each day.

Louisiana, Mississippi, Arkansas, Alabama and Oklahoma saw the largest increases in requests for the mail-order pills. However, every state, regardless of abortion policy, saw a notable rise during the periods after the leak and following the formal decision announcement.

The rise in interest for self-managed abortions comes on the heels of another study out yesterday in JAMA which found that the average travel time to an abortion facility post-Roe has increased substantially nationwide, from less than a half-hour to more than an hour and a half.

Those times are even longer in the South, where many states have restricted or banned the procedure. For instance, women in Louisiana and Texas saw an increase of more than seven hours to the nearest abortion appointment following the verdict.

Few Medicare beneficiaries are shopping for new health plans

Medicare’s annual open enrollment period kicked off last month, but two new analyses from the Kaiser Family Foundation (KFF) suggest that a relatively small share of the nation’s 65 million beneficiaries will explore their coverage options or switch plans.

Key context: Traditional Medicare and Medicare Advantage can make changes from one year to the next that impact enrollees’ premiums, out-of-pocket costs and provider networks, so CMS recommends that consumers reevaluate what coverage options best suit their needs annually.

But oftentimes that’s not the case. Just 3 in 10 beneficiaries said they compared plans during the open enrollment period for 2020, according to KFF. That number is notably lower among Hispanic beneficiaries, adults 85 and over, and those with lower incomes.

An even smaller sliver of beneficiaries opt to switch plans during open enrollment, regardless of whether they’re enrolled in Medicare Advantage or traditional Medicare. For instance: Among people in Medicare Advantage plans with prescription drug coverage, only 1 in 10 beneficiaries enrolled in such plans voluntarily switched options for 2020.

• CMS approved Arkansas’ application to use Medicaid dollars to finance medically necessary nutrition and housing support services, the agency announced yesterday.
• Democratic Ohio Senate candidate Rep. Tim Ryan said at a town hall hosted by Fox News yesterday that he doesn’t support late-term abortions except in the case of a medical emergency, per our colleague Dylan Wells.
• The federal government has launched its first confirmed investigation of an alleged denial of an abortion to a pregnant woman experiencing a medical emergency at a hospital in Missouri, Kaiser Health News reports.
• The D.C. Council voted yesterday to delay its coronavirus vaccine mandate for students ages 12 and older until next school year amid lagging uptake of the shots, our colleague Lauren Lumpkin writes.

They had secret abortions pre-Roe. Now they feel compelled to speak out. (By Gillian Brockell and Joyce Koh | The Washington Post)

Woman who accused Herschel Walker of pressuring her into having abortion says ‘honesty matters’ (Interview with Juju Chang | ABC News)

Thanks for reading! See y’all tomorrow.