A Q&A with Pelosi’s right-hand man on health policy

We talk to Wendell Primus about his career with Pelosi, Medicare for All and the tensions during the ACA debate

As a top Democratic adviser on Capitol Hill, Wendell Primus has been at the center of high-stakes health policy battles for nearly two decades.

Primus quit Congress earlier this year after serving as senior health and budget policy adviser to the former president Nancy Pelosi (D-California). He has been an influential figure in debates on the Affordable Care Act and the Democratic Party Inflation Reduction Act which granted Medicare the power to negotiate prescription drug prices for the first time. He’s so well known in health policy that some people just call him “Wendell.”

Earlier in his career he quit his job as deputy assistant secretary in the federal health department due to objections to the former president bill clintonThe decision to sign the Welfare Bill, which some aides had backed, was too harsh. In recent years he has come under fire from the party’s progressive flank for being criticism of medicare for all.

We caught up with Primus on Zoom last week. This interview has been edited and condensed for length and clarity.

Health 202: What do you think are some of the biggest health policy issues Congress needs to address right now?

Primus: I still think the most important thing to do is the 10 states that are left now to do Medicaid expansion. North Carolina, I understand the governor signed the bill last week. So North Carolina is now a Medicaid expansion state. … We’re always going to face cost and quality issues trying to contain costs one way or another. Mental health is a problem, our deaths of despair, the problem of gun violence, I think it’s a public health problem.

Health 202: Do you think any of these lists are realistic in a divided Congress?

Primus: I would like to think like that. … I think there could be bipartisan labor work because I think both parties recognize that the health workforce is a major problem.

Health 202: What was the highlight of your career?

Primus: I would obviously say the passage of the Affordable Care Act and drug pricing (bill last year). A lot of my friends thought we could never touch the drug companies, and I went through three rounds of negotiations with the Senate.

Health 202: You brought up the ACA, was there a time when you thought the ACA wouldn’t go through? And was it true that you and Rahm Emanuel couldn’t be in the same room together sometimes ?

Primus: This story started with a welfare reform bill, which I thought was a mistake, and he was working for Clinton and was plead for its adoptionAnd I quit for that. He was arguing — and I think Nancy Pelosi gets a lot of credit — that he wanted to do a smaller version of the Affordable Care Act, and she wouldn’t. It was really his ability to get votes that I think helped move the bill forward.

I mean, obviously, when we lost the 60th vote in the Senate because we did not retain At Senator Kennedy’s headquarters in Massachusetts, there were a lot of people who thought we couldn’t do it. But we did and it was kind of a convoluted legislative process.

Health 202: What was the biggest disappointment you had on the Hill?

Primus: I find it amazing that so many states haven’t expanded Medicaid. … I thought with 100% Federal Funding for three years, then from 95 (percent to) 5 (percent), then finally dropping to 90 (percent to) 10 (percent) that states would expand Medicaid. I remember saying to Pelosi right after the trial, “Don’t worry, the states aren’t going to give up all that money,” but they did.

Health 202: What do you think of this Medicare debate in Congress? Should there be any changes to try to put Medicare on a better financial path? And if so, what are some of the proposals you see?

Primus: Well, some of them were in the president’s budget. Probably the thing I’m most proud of in my congressional career was the package of drug pricing proposals that made it into the Cut Inflation Act, and the president went all out. Since we did the ACA, I thought the net tax on the investment should have gone into the hospital insurance fund. … I think Medicare Advantage plans have a lot to say about themselves, but they are really overpaid. But it is politically very sensitive.

Health 202: You have already criticized Medicare for All, do you still think this is a policy the Democratic Party should not adopt?

Primus: Yes, it’s just too expensive. You look at the cost of Medicare for All, and we can’t afford it. Once we complete the expansion of Medicaid to the remaining 10 states, we can honestly say that every American, putting the undocumented issue aside for a moment, has access to affordable health care. And Medicare for All could never pass, and we have solvency issues in Social Security, and I think a complete rewrite of our health care system is just not in the cards, it doesn’t make sense .

Health 202: In a 2019 Intercept history, Rep. Mark Pocan (D-Wis.) said he was “not worried about what Wendell thinks. When he gets elected to Congress, it will matter. What do you think of this review as a member/staff?

Primus: I’m a staff member, I’ve always been a staff member. I think the members were jealous to some degree of the role I played… The staff gets blamed, and especially when the members can’t directly criticize the speaker, I mean, what can I say? It’s like that.

Liberals to control Wisconsin Supreme Court ahead of abortion case

Liberals took control of Wisconsin’s high court in an election yesterday, giving them a majority of one vote on a body that is likely to consider 19th-century state abortion bans in years to come, The Post’s patrick marley reports.

Milwaukee County Judge Janet Protasiewicz beat the old judge Daniel Kelly in the most expensive legal contest in history – and which will end the court’s conservative control for the first time in 15 years. Abortion was a dominant issue in the race, with national groups on both sides of the debate jumping into the fray. It was also one of main topics in advertisements supporting Protasiewicz.

During the campaign, Protasiewicz has been open about her personal beliefs in favor of abortion rights. She was able to express her views on the matter so freely thanks to a 2002 U.S. Supreme Court ruling that determined that judicial nominees have the right to express their views on political issues as long as ‘they don’t promise to rule in a specific area. path. But after explaining her perspective, Protasiewicz might face challenges about whether she can be impartial, Patrick writes.

DOJ will allow some inmates to stay home after covid emergency expires

Thousands of federal inmates who were allowed to serve their sentences at home during the coronavirus pandemic could stay there – even after the Biden administration cleared national emergency expires next month.

Under a final rule issued by the justice department yesterday it will be Bureau of Prisons at the Warden’s discretion as to whether inmates can remain on house arrest or will have to finish serving their sentence in a federal prison.

• Regulations should provide some relief to inmateswho feared to be taken back to jail after the emergency order expires on May 11, Sarah N. Lynch reports for Reuters.

Key Context: Since March 2020, more than 12,000 low-level, non-violent federal inmates have been placed on home confinement to limit the spread of the coronavirus in prisons. Among these, the justice department say less than 1 percent were returned to prison due to new criminal behavior.

Senator Richard J. Durbin (D-Ill.), Chairman of the Senate Judiciary Committee:

Whitmer will sign a bill today repealing Michigan’s 1931 abortion ban

On the agenda today: governor of michigan Gretchen Whitmer (D) will sign a bill repealing the state’s near-total ban on abortion, which has been on the books since 1931 and includes no exceptions for rape or incest, his office confirmed to The Health 202. The signing comes after voters approved a ballot measure in November, enshrining the right to abortion in the state constitution and preventing the ban from taking effect.

In Kansas: The Republican-controlled state legislature gave final approval to a bill yesterday that would require doctors to provide care to infants who survive an attempted abortion, a situation that is rare. Both houses passed the measure with more than two-thirds majority, meaning lawmakers have the votes to override a potential Democratic government veto. Laura Kelly, Katherine Bernard reports for the kansas city star.

In Washington : Govt. Jay Inslee (D) announced yesterday that the State has stored a four-year supply of mifepristone, an abortion pill, in anticipation of a court decision which could eliminate access to medicines throughout the country, Claire Withycombe And Nina Shapiro report for the Seattle Times.

Two Alabama districts show a stark divide in the pandemic’s toll on schools (By Laura Meckler l The Washington Post)

DC vending machines to dispense Narcan, fentanyl test strips (By Jenna Portnoy | The Washington Post)

Democrats want to restore Roe. They are divided on whether to go even further. (By Alice Miranda Ollstein and Megan Messerly | Politics)

Indiana’s trans healthcare ban is ‘clear as mud,’ says governor (By Arleigh Rodgers and Tom Davies | The Associated Press)

Thanks for reading! See you tomorrow.