Happy Wednesday, Vitals gang. Today's newsletter is 951 words or a 3.5-minute read.

1 big thing: One way this election's different

Illustration: Sarah Grillo/Axios

The 2024 presidential election is shaping up to be the first in a long time that won't feature sweeping plans to overhaul American health care, Maya writes.

Why it matters: President Biden's campaign is emphasizing pocketbook health care issues after already securing major health care victories and amid overriding voter concerns about the economy, while former President Trump has offered little about his health care plans.

The big picture: The Affordable Care Act — and efforts to tear it down or build on it — has been at the center of presidential elections since 2008, but there's declining appetite for politically challenging health care reforms.

  • Inflation and rising health care costs have voters looking for immediate pocketbook relief rather than a time-consuming reordering of the health care system, experts said.
  • "The country is unusually pessimistic when you ask them about state of the country and the future. They're also very short-term," said Harvard professor emeritus Robert Blendon, an expert on public opinion and health care.

State of play: Following this month's State of the Union address that served as an unofficial kickoff to the general election, President Biden signaled a campaign health care message that will focus heavily on supporting abortion rights — a major motivator for Democratic voters — and reducing costs.

  • Biden and allies are also focused on building on key health care accomplishments like Medicare drug negotiations and expanded ACA subsidies — and building awareness of those efforts.
  • Although Trump has signaled his interest in pursuing ACA repeal, he hasn't offered a formal plan. Republican lawmakers are wary of taking another crack at a law — though they haven't ruled it out.

The bottom line: A sharply divided Washington doesn't allow much space for sweeping health reforms, which are heavily partisan, cost huge political capital and often come at the expense of other priorities.

  • "There's fatigue amongst policymakers," said Anand Parekh, chief medical adviser at the Bipartisan Policy Center. "There are many other competing challenges. They're not sure if they want to take on some big health care package."

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2. Temporary PEPFAR truce

Illustration: Sarah Grillo/Axios

A successful global AIDS program that was in limbo for months got a temporary reprieve this week when congressional negotiators agreed to a one-year renewal in the next government funding package.

Why it matters: It marked a temporary truce over the President's Emergency Plan for AIDS Relief, or PEPFAR, which is credited with saving 25 million lives since its inception in 2003 but recently became mired in abortion politics, Victoria Knight and Peter Sullivan reported on Axios Pro.

  • Conservative groups last summer charged the Biden administration was using it to promote abortion overseas, a claim the administration and program allies denied.
  • Key program functions expired after the 2023 fiscal year ended in September, although money for the AIDS fight kept flowing through the annual appropriations process.

State of play: The latest agreement, first reported by Semafor, calls for PEPFAR to be reauthorized through March 2025.

  • Punting another reauthorization to next spring will help to get the program out of the fray of election-year politics, said Jen Kates, director of global health and HIV policy at KFF.
  • But doing so also accommodates Republicans, who want to defer action in the hope a potential GOP administration can make bigger changes to the program.

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3. Military flags drug supply chain risks

Illustration: Sarah Grillo/Axios

The military found more than 1 in 4 essential medicines are at "very high risk" because of their reliance on Chinese ingredients or their unknown origins.

Why it matters: Senators who released a new Defense Department report said it underscored the need to shore up the military's pharmaceutical supply chain as U.S. drug shortages hit the highest level in nearly a decade.

What they found: The military has a "high dependence" on foreign manufacturing and trade agreements for drugs on the FDA's list of 200-plus essential medicines, according to the new review.

  • 5% of essential drugs were made with active pharmaceutical ingredients from Chinese manufacturers using Chinese ingredients, while 22% came from a country that couldn't be identified.
  • 25% of the drugs were sourced in the United States, and 3% are from Canada or Mexico and are considered "moderately secure."

Flashback: The Pentagon last summer tapped Valisure to assess the quality and safety of commonly used generics following concerns about drugs the military purchases for service members and families, per Bloomberg.

What's next: Senators asked the Defense Department for a full accounting of disruptions to the military's pharmaceutical supply chain and whether they resulted in shortages.

4. UnitedHealth's new legal headaches

Illustration: Sarah Grillo/Axios

UnitedHealth Group is facing class-action lawsuits from health care providers over financial losses they say they've suffered from a massive cyberattack that's crippled payments across the industry for weeks.

Why it matters: It adds to the potential legal fallout for UnitedHealth over the attack at subsidiary Change Healthcare, as it also faces a federal investigation and patient lawsuits over breached data and trouble filling prescriptions, Tina writes.

The latest: A class-action lawsuit on behalf of a California therapy group filed this week alleges the companies failed "to maintain appropriate and reasonable cybersecurity measures."

  • A Mississippi OB-GYN practice and a Tennessee therapist have also filed suits, according to reports.

The other side: Asked about the lawsuits, a UnitedHealth spokesperson said: "Our focus remains on the investigation and restoring operations at Change Healthcare."

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5. Catch up quick

💊 Bayer will seek approval for a nonhormonal drug treating menopause hot flashes, one year after Astellas brought a potential rival treatment to market. (Reuters)

💉 California state government is fighting local bans on needle exchange programs. (L.A. Times)

📈 Medication abortion accounted for 63% of abortions performed in the U.S. in 2023, up from 53% in 2020. (Axios)

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