A newsletter briefing on the health-care policy debate in Washington.

with research by McKenzie Beard

A newsletter briefing on the health-care policy debate in Washington.

Good morning, everybody. On this day five years ago, Sen. John McCain (R-Ariz.) gave a dramatic thumbs down to Republicans’ years-long quest to repeal and replace Obamacare. Send tips and trivia to rachel.roubein@washpost.com. 

Today’s edition: The Biden administration may soon declare a public health emergency for monkeypox. Sen. Mitt Romney (R-Utah) is unveiling a proposal for a new agency to better collect spotty public health data. But first … 

There’s a new version of Democrats’ economic package. And this time, the measure sidesteps what would have been a major headache for them during the 2024 presidential election.

Instead of allowing extra Obamacare subsidies to expire at the end of that election year – which would hike health insurance premiums for some voters – the package would extend the subsidies for an additional year, through 2025.

It came as a surprise yesterday when Senate Majority Leader Chuck Schumer (D-N.Y.) and Sen. Joe Manchin III (D-W.Va.) unveiled a deal yesterday on a new spending package that aims to lower health care costs, combat climate change and reduce the federal deficit. 

Earlier this month, Manchin appeared set on a two-year extension of key financial aid — set to run out at the end of the year — for Americans with health coverage through Obamacare’s insurance marketplaces. That would have meant roughly 13 million people would learn of hikes to their health insurance premiums just weeks before the presidential election. 

But Manchin ultimately agreed to extend the enhanced financial help for three years through 2025. It’s a big sigh of relief for Democratic lawmakers who have long pledged to make health care more affordable and who feared campaigning amid price hikes.

Now, Senate Democrats are rushing to pass the latest iteration of the economic package — one that has Manchin’s seal of approval for the first time. Lawmakers shipped revised text to the arbiter of the Senate rules last night, and party leaders are aiming to try to advance the measure next week, Tony Romm, Jeff Stein, Maxine Joselow and I report.

Bill text here: https://t.co/QctbW0Llst https://t.co/0TKGkP2oey

For months, the negotiations between Schumer and Manchin have been clouded in secrecy, so much so that the deal was a shock to many Democratic lawmakers. 

Just two weeks ago, the package was set to become a health-care-only bill, after Manchin said he wouldn’t support new climate or tax hikes on the wealthy. But now, the climate and tax hikes are back in, emblematic of the whiplash over the past year-plus. 

When it comes to health care, the legislation revolves around two main policies.

In recent weeks, some rank-and-file Democrats and advocates were pushing hard for the inclusion of policies meant to help poor adults and low-income women. Here’s what the legislation excludes.

Kaiser Family Foundation's Larry Levitt:

$64 billion for the ACA would pay for a 3-year extension of enhanced premium assistance but not fill in the Medicaid gap in the dozen states that have not expanded coverage. https://t.co/6JsSNCKmZh

After the agreement was released yesterday, Schumer set about briefing members of his party on the legislation now called the Inflation Reduction Act of 2022 (we see what the Senate did here with that title).

Schumer said the goal is to vote on the legislation next week, though it’s not clear yet if the full Democratic caucus is on board. In a narrowly divided Senate, the party needs the support of all its members to pass the legislation without any Republican votes.

Meanwhile, the Senate parliamentarian must review whether all the policies are allowed under the budget maneuver that Democrats are using to circumvent GOP votes. The new text was sent for review last night. 

On the other side of the Capitol … House Speaker Nancy Pelosi (D-Calif.) has her own razor-thin majority to contend with. The chamber is expected to leave for August recess at the end of the week, but return to Washington to vote if Senate Democrats pass their long-sought package.

For months, progressives have advocated for a reconciliation bill on policies with consensus across the Democratic Caucus: climate, health care, and tax fairness. We'll need to evaluate the details, but it's promising a deal to deliver on those issues might finally be in reach.

The Biden administration is expected to declare monkeypox a public health emergency in the coming days as confirmed cases continue to climb across the country, Politico reports. 

Such a declaration by the nation’s federal health department could potentially unlock a slew of new authorities to confront the rapidly spreading virus, including access to new money and appointing new personnel to oversee the country’s response, Politico's Erin Banco and Adam Cancryn write.

Talks about whether such a declaration is warranted for monkeypox have been ongoing within the administration for days. Some officials have raised questions about the declaration given that the virus hasn’t been linked to a single confirmed U.S. death. Yet, cases are surging among gay and bisexual men, and some health officials say it’s necessary to help the government cut through red tape and better collect information about monkeypox’s spread, our colleague Dan Diamond reported earlier this week. 

Yet, the decision isn’t final. Officials insisted to Dan last night that no decision has been made, though discussions are still active on the topic. An HHS spokesperson told Politico the agency “is continuing to explore options.” Xavier Becerra, head of the nation's federal health department, is scheduled to hold a news conference on the virus this morning. 

Also: Officials tonight continue to insist no decision has been made on declaring a public health emergency for monkeypox, per four Biden administration sources. (Though discussions remain v active.) Some background from Monday on the debate inside admin. https://t.co/auriw6Xuzx

WHO Director General Tedros Adhanom Ghebreyesus:

The #monkeypox outbreak can be stopped if countries, communities and individuals inform themselves, take the risks seriously, and take the steps needed to stop transmission and protect vulnerable groups.pic.twitter.com/7CumPFyPhc

Sen. Mitt Romney (R-Utah) this morning will unveil a proposal for the creation of a public health data agency aimed at providing real-time information to improve the country’s ability to respond to infectious diseases. 

Romney’s proposal comes amid long-standing criticisms that federal health data is messy, incomplete and outdated, forcing public health authorities to rely on the United States’ decentralized and underfunded reporting system when shaping the country’s response to crises like the covid-19 pandemic.

“We have again seen the shortcomings as monkeypox has started to spread around the country,” Romney said in a statement. “These failures show the need for reliable, real-time data during days of blue-skies so we can better prepare for and potentially prevent major outbreaks.”

The Center for Public Health Data would be an independent sub-agency inside the Department of Health and Human Services. It would focus on efforts like streamlining and aggregating existing data across HHS and reporting daily data that would be accessible to all levels of government, hospitals, researchers and the public. It wouldn’t collect personally identifiable information or make public policy recommendations.

The response from Sen. Jon Tester (D-Mont.):

Senate Republicans just blocked the PACT Act – critical veterans’ healthcare legislation that they supported just weeks ago. You need to watch @SenatorTester’s response. pic.twitter.com/Z1GNDHF7jO

Because of my Administration's investment in free booster shots, at-home tests, and effective treatments, today, we can protect ourselves from serious illness and prevent most COVID deaths. COVID is still with us, but our fight against it is stronger than ever. pic.twitter.com/24toy7NiGR

School mask mandates return as latest coronavirus variants surge (By Donna St. George | The Washington Post)

Health Insurance Price Data: It’s Out There, but It’s Not for the Faint of Heart (By Julie Appleby | Kaiser Health News)

After Roe, Democrats say they, not the GOP, are the party of freedom (By Colby Itkowitz | The Washington Post)

Thanks for reading! See y'all tomorrow.