Trump set to ask for more coronavirus cash Presented by

With Susannah Luthi

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Quick Fix

— President Donald Trump is set to ask Congress for more money to fight the widening coronavirus outbreak, an about-face after weeks of hesitation.

— HHS Secretary Alex Azar will defend the coronavirus response and his department’s fiscal 2021 budget request in a series of congressional hearings this week.

— A controversial Trump administration immigration rule takes effect today, with public health advocates warning that it will limit Medicaid enrollment.

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WELCOME BACK TO MONDAY PULSE — Where PULSE this weekend read the memoir of 91-year-old Martin Tolchin, the founder of The Hill and a member of POLITICO's founding editorial team — and a New York Times health reporter, decades ago. Tolchin argues that the world has changed, but PULSE isn't so sure; here's Tolchin's 1968 New York Times story about anxieties that Medicaid was too liberal — and too expensive.

Help make PULSE worth reading, 50 years from now. Tips to [email protected] and [email protected].

Driving the Day

TRUMP PREPARES TO ASK FOR MORE MONEY TO FIGHT CORONAVIRUS — The administration is set to ask Congress for an emergency-funding infusion, and the request could come as soon as Monday, POLITICO scooped on Saturday night.

Congressional Democrats have been pressing the administration to request emergency coronavirus funds since the beginning of February. The outbreak, which began about three months ago and has spread to 28 countries, has sickened more than 77,000 people in China and killed more than 2,400 there.

While there are about three dozen confirmed cases of coronavirus in the U.S., almost two-thirds are citizens who were flown home after contracting the virus abroad.

— Azar versus the budget wonks: The HHS secretary has been pushing for a more robust emergency-funding package, arguing that it's necessary as the likelihood rises of a U.S. outbreak. But White House officials have been resistant, pointing to existing funds that they say the Trump administration can tap, and also arguing that the outbreak could burn itself out by the summer. Azar notified Congress on Feb. 2 that he was prepared to shift up to $136 million in already approved funds to fight the virus.

Two individuals also told POLITICO that the amount could be significantly lower than some public health officials have argued is necessary — potentially as little as $1 billion, which could be rapidly exhausted by development of potential vaccines, widespread lab tests and numerous other investments.

— One expert's recommendation for emergency funding: $15 billion. That's what Raymond James analyst Chris Meekins, a former Trump administration HHS emergency-preparedness official, concludes in a new report. For instance, Meekins argues that $3 billion alone would be needed for vaccine development, and that $4 billion is necessary for stockpiling diagnostics, therapeutics and other products.

MEANWHILE: WHITE HOUSE GRAPPLES WITH CORONAVIRUS EFFECT ON 2020 — The Trump administration is bracing for a possible coronavirus outbreak in the United States that could sicken thousands — straining the government's public health response and threatening an economic slowdown in the heat of President Donald Trump’s reelection campaign.

That stark realization has taken hold in high-level White House meetings, during which some administration officials have voiced concerns the coronavirus is already spreading undetected within U.S. borders, two officials told POLITICO.

— Trump's privately voiced his own anxieties, rebuking public health leaders over the decision to fly home 14 Americans who tested positive for the virus while aboard a cruise ship off Japan, POLITICO was first to report. Trump was worried that transporting the Americans to the United States without adequate precautions could create new risks. The president wasn't told about the flights, fueling his anger, WaPo's Yasmeen Abutaleb and Josh Dawsey report.

AZAR’s BUSY WEEK — The HHS secretary will face Congress at four separate hearings to defend the administration’s budget request, with additional questions set to come about the Azar-led coronavirus response effort and other priorities.

On tap:

— Tuesday morning: A Senate Appropriations subcommittee hearing, which could be the least contentious of the four panels next week, given the GOP’s leadership. But it also gives subcommittee Chairman Roy Blunt (R-Mo.) a chance to whack at Azar over HHS’ new liver transplant allocation policy, which Blunt has repeatedly called flawed and harmful.

— Wednesday morning: A House Appropriations subcommittee hearing, in front of subcommittee Chairwoman Rosa DeLauro (D-Conn.), who has spent weeks pressing Azar to ask for more funding to fight coronavirus and also plans to raise questions on the health department's care for unaccompanied children, an aide said.

— Wednesday afternoon: A House Energy and Commerce subcommittee hearing on the budget, followed by a second panel on the coronavirus response, where Azar will be joined by public health experts.

— Thursday morning: A House Ways and Means hearing, in front of members like Chairman Richard Neal (D-Mass.), who recently warned Azar that administration efforts to overhaul Medicaid spending represent a “direct attack” on the program.

THE ‘PUBLIC CHARGE’ RULE ROLLS OUT TODAY — The Supreme Court on Friday lifted the final statewide freeze on Trump's new crackdown on legal immigrants' use of programs like Medicaid, weeks after the high court halted the last nationwide injunction, POLITICO's Susannah Luthi reports.

Friday's controversial 5-4 ruling included a blistering dissent from Associate Justice Sonia Sotomayor, who criticized her conservative colleagues’ willingness to interrupt lower court proceedings — where district and appellate judges are still debating the legality of the rule — to benefit the Trump administration.

— Health and legal advocates have warned the rule could severely curb access to health services. Under the public charge rule, immigration officials can deny green cards to legal immigrants if they use Medicaid and other safety-net programs. See Kaiser Family Foundation's brief.

They're also worried it will cause unnecessary fear among the broader immigrant population, and Jonathan Petts, co-founder of the Immigrants Like Us nonprofit at Harvard’s Immigration Lab, told Susannah that local groups should run public outreach and education campaigns so immigrants can understand their rights.

“Even for adults, accessing Medicaid should have no effect on immigration status in the vast majority of cases,” Petts added.

Around the Nation

CALIFORNIA HITS BACK AT HHS OVER DEFUNDING THREAT — Gov. Gavin Newsom and Attorney General Xavier Becerra on Friday accused the administration of improperly threatening state health funding over a years-old California abortion law, making the charge in a letter to Roger Severino, the HHS civil rights chief.

"This is extreme presidential overreach and would, if carried out, jeopardize lives of Californians," Newsom said in an accompanying statement. "We will not allow it."

— The HHS civil-rights office in January threatened to cut some of the state's funds unless California drops a state requirement that private health insurers cover abortion, arguing that it violates federal law.

But Newsom and Becerra noted the civil rights office previously upheld that requirement in 2016. Meanwhile, five other states have similar laws, but only California has faced the funding cut.

Severino said HHS is assessing Newsom and Becerra's letter "and all appropriate remedies in light of California’s continued refusal to comply with federal law.”

IS GERRYMANDERING HINDERING MEDICAID EXPANSION? — That's the argument of a new analysis from the left-leaning Center for American Progress, which was shared first with PULSE. "Ten years after the passage of the ACA, hundreds of thousands of people remain uninsured because of gerrymandering," contend authors Alex Tausanovitch and Emily Gee, linking expansion delays in states like Wisconsin and Georgia to GOP-led redistricting.

What We're Reading

The recent drop in cancer deaths is actually a societal failure, oncologist Peter Bach argues in the Boston Globe, because it's driven by the rise of deaths linked to poverty, obesity, addiction, and depression.

As more Americans sign up for Medicare Advantage, detractors worry that it’s helping private insurers more than patients, Mark Miller writes in the New York Times.

In the Sunday NYT, Motoko Rich detailed the chaos and confusion aboard the Diamond Princess cruise ship as it was stuck in its coronavirus-linked quarantine for days.

Insurers are increasingly steering patients toward their own clinics and away from other hospitals and doctors, WSJ's Anna Wilde Mathews writes.

Firefighters play a key role in emergency care, and Ben Oreskes of the Los Angeles Times spent 24 hours embedded at one of the nation's busiest fire stations — the team at the heart of LA's Skid Row — as they responded to overdoses, accidents and other health traumas.

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