Sep 14, 2021

Axios Vitals

Good morning. Don't worry, Tina will be back tomorrow.

Today's word count is 1,144, or a 4-minute read.

1 big thing: 60% of voters back Biden vaccine mandates
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Data: Axios/Ipsos Poll; Note: Margin of error +/-3.2%; Chart: Kavya Beheraj/Axios

A majority of Americans — including suburban voters — support vaccine mandates for federal workers as well as private companies, according to the latest installment of the Axios/Ipsos Coronavirus Index.

Why it matters: The findings, on the heels of President Biden's mandates announcement last week, suggest that while his move was divisive, it may be politically safer than his opponents hope, Axios' Margaret Talev writes.

What they're saying: "From a political perspective, he especially reinforces himself with independents," said Cliff Young, president of Ipsos U.S. Public Affairs.

The big picture: Respondents were asked two separate questions: Do you support the federal government requiring all federal employees to be vaccinated against COVID-19? And do you support a federal government rule that requires all business with 100 or more employees to make all staff be vaccinated or undergo regular COVID testing?

  • Their overall responses were virtually identical: 42% strongly supported both; 18% somewhat supported both; 13%–14% somewhat opposed both; and 25%–26% strongly opposed both.
  • In other words, respondents didn't draw major distinctions between mandates for public or private employees.

Between the lines: The high concentrations of strong support and strong opposition reinforce the depth of polarization.

By the numbers: About seven in 10 urban respondents supported the mandates or testing requirements, compared with nearly six in 10 suburban voters — and a little less than half of rural voters.

  • About two-thirds of respondents 65 and older, or under 30, support the mandates — compared with a little more than half of those in between.
2. Hospitals wary of Dems' drug pricing bill

Illustration: Lazaro Gamio/Axios

Hospitals are worried that the Democrats' plans to curb prescription drug costs could be the beginning of a slippery slope that ultimately cuts into their bottom lines, too.

Why it matters: Hospitals and drug companies aren't always allies, and hospitals aren't likely to lobby very hard solely on pharma's behalf. But the industry could become another powerful opponent for Democrats if its own profits are on the line.

State of play: House Democrats' signature drug pricing bill would only allow Medicare to negotiate the price of some drugs, but would also extend those prices into the private market.

Between the lines: Medicare already has broad power to decide how much it will pay hospitals, and hospitals aren't voicing concern about the same standard being applied to the drug industry.

  • But hospital prices are much higher for private insurance — and the industry is adamantly opposed to any policy that could threaten these rates.

What they're saying: Allowing government-negotiated drug prices to extend to the commercial market "sets a very bad precedent when you have real negotiation on the private sector side, whether it's in drugs or for other providers," Chip Kahn, president and CEO of the Federation of American Hospitals, told Axios.

  • "This sets a precedent that could lead to other public policy that might undermine private sector negotiation," he added.
3. Surgeries are getting delayed again

The COVID-19 vaccination rollout led to influxes of patients returning to doctors this summer, but many surgeries are getting postponed again as the Delta variant spreads throughout unvaccinated areas, Axios' Bob Herman reports.

The big picture: Medical providers are postponing orthopedic and less-severe outpatient procedures, and device companies are forecasting lower sales in the short term.

What they're saying: "We are experiencing negative effects from the Delta variant on elective procedures, most specifically for us in our joint replacement, being hip and knee as well as spine," Stryker CEO Kevin Lobo told investors Monday at the Morgan Stanley health care conference. "The effects have been more negative than we imagined."

  • Hospitals are postponing procedures most in areas like Texas and Florida, where vaccination rates are lower and staff are stretched thin, Intuitive Surgical CFO Marshall Mohr said at the Wells Fargo health care conference.
  • "There is a direct correlation between hospital resource availability and how strained it is, and deferrable procedures and da Vinci procedures," Mohr said, noting that things like hernias, gall bladder removals and bariatric procedures are among procedures being delayed.

Yes, but: Surgical volumes likely will bounce back, just like they did earlier this year, because people can only put off a procedure for so long.

  • "There is a significant backlog of procedures that will drive a strong recovery," said Joaquin Duato, the incoming CEO of Johnson & Johnson, which makes orthopedic implants.
4. The Modi shot campaign

Illustration: Shoshana Gordon/Axios

The Biden administration is quietly pressuring India to restart vaccine exports with plans to offer a higher-profile role for Prime Minister Narendra Modi at an upcoming COVID-19 global summit in New York if he agrees to release vaccines soon, Axios' Jonathan Swan and Hans Nichols report.

Why it matters: India is the world's biggest vaccine maker. In March, Modi halted exports of the AstraZeneca vaccine — one of the cheapest on the market — because the virus was ravaging his own population.

  • Convincing Modi to renew his vaccine supply to the world — through the global vaccination organization COVAX — is an important part of the Biden administration's strategy to mitigate the international spread of the virus.
  • Vaccinating as much of the developing world, as quickly as possible, is in America's vital interest, because the uncontrolled spread of the virus inevitably produces more dangerous variants.

An administration official acknowledged discussing vaccine exports but denied they're tied to Modi's upcoming participation.

  • The U.S. itself effectively banned its own vaccine exports for months until it had enough supply for all Americans. It's also reserved hundreds of millions of doses for boosters, complicating its position as a proponent of dose-sharing.

My thought bubble: This isn't likely to let the U.S. off the hook for planning to give Americans a third vaccine dose before much of the world has received any, a decision that many public health experts have criticized.

5. Medicare to repeal medical device rule

The Centers for Medicare & Medicaid Services is proposing to kill a regulation the agency finalized earlier this year under the Trump administration that would have required Medicare to pay for any medical device deemed as a "breakthrough" by the FDA, Bob writes.

Driving the news: After receiving public feedback, CMS determined the rule was "not in the best interest of Medicare beneficiaries because the rule may provide coverage without adequate evidence that the breakthrough device would be a reasonable and necessary treatment."

Between the lines: The rule would have been a gift to the medical device industry, which supported the rule.

  • It would have guaranteed four years of Medicare coverage for all devices designated as "breakthroughs" — i.e., new technologies that attempt to improve care for people with life-threatening conditions.
  • However, these kinds of devices often do not prove any clinical benefit and have safety risks.

What to watch: This is still a proposal with another 30 days of public comment. Medical device lobbyists will be in full force.