Trump, Biden and a hot mess of a health care debate Presented by

With Brianna Ehley

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Quick Fix


— The chaotic and disastrous first debate between President Donald Trump and Joe Biden hit on a range of major health issues, but offered few new insights.

— The administration's controversial ad campaign to "defeat despair" about coronavirus is sputtering as celebrities drop out and production falls behind.

— Congressional Democrats are taking one more shot at striking an agreement with the White House on another coronavirus aid package.

WELCOME TO WEDNESDAY PULSE — where it wasn’t just you; the incomprehensibility of that debate at times could indeed only be described as Gorpman and Bleemer-esque.

Help us decode what comes next: send tips to [email protected] and [email protected].

A message from PhRMA: Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. More.

Driving the Day

TRUMP, BIDEN AND A HOT MESS OF A HEALTH CARE DEBATE — For the first 20 minutes of Tuesday’s presidential debate, the nominees argued, obfuscated and hurled accusations over a range of health issues, including but not limited to: coronavirus, Obamacare, abortion, drug prices, vaccines, trust in science, stay-at-home orders, private health insurance, the public option, and the Trump administration’s ongoing lack of a health care plan.

As for what the voting public got out of all that? Not a whole lot. Here’s what we do know:

— Trump offered no new defense of his pandemic response. He instead spent much of the debate interrupting and talking over Biden, turning much of the night into an unintelligible back-and-forth.

When Trump did address the pandemic, he fell back on old talking points like playing up the January decision restricting travel from China, repeated assertions that he’d done a “great job” managing the public health threat and urged states to reopen.

— Trump contradicted his top health officials — and overpromised on a vaccine. The president publicly disagreed again with the views of his CDC director and top vaccine science adviser that a viable vaccine could take until the end of the year, claiming without evidence that it would happen “a lot sooner.”

— Biden tried to block out the noise, and keep the focus on Covid-19. The Democratic nominee on several occasions refused to engage with Trump, making his case directly to the camera that Trump’s pandemic response has failed. “The president has no plan,” he said at one point, and throughout the debate sought to pivot the discussion back to the pandemic.

— Only one side sees the SCOTUS fight as synonymous with health care. Echoing Democrats’ broader strategy, Biden immediately tried to tie the debate over the Supreme Court to the fate of Obamacare. But his points landed only briefly before they were buried by Trump’s interruptions and attacks.

The president, meanwhile, framed the high court debate more simply: He won the 2016 election, and therefore he should get his nominee.

— Don’t expect any policy nuance on drug pricing and health coverage. Trump weaved a series of falsehoods and half-truths when it came to drug prices and Obamacare, including one notable whopper: That insulin is so cheap it’s “like water” (insulin often retails at hundreds of dollars per vial). And most of that came in service of trying to falsely link Biden to left-wing health plans — rather than defending his own record or offering a second-term vision.

Biden, meanwhile, focused on hammering home the various progressive ideas that he would not support as president, like eliminating private health insurance.

INSIDE THE ADMINISTRATION's SUDDENLY SHAKY AD BLITZ — HHS officials made a list of more than 30 celebrities including Justin Timberlake, Taylor Swift and Billy Joel to appear in their ad campaign to "inspire hope" about coronavirus, but they ended up with only Dennis Quaid, CeCe Winans and Hasidic singer Shulem Lemmer, POLITICO's Dan Diamond scooped.

— The $300 million-plus campaign had been conceived by Michael Caputo, the HHS spokesperson who's now on medical leave. One stated goal was to help raise Americans' morale amid the outbreak, and HHS has maintained that the public service announcement effort is focused on public health, not politics. Democrats have alleged that the rushed campaign is an effort to boost Trump's prospects before the election.

But the effort was already flagging before POLITICO last week reported on Caputo's business ties to the subcontractor selected to produce the PSAs. Tasked to come up with 20 public service announcements before the election, the production team had only succeeded in booking three — Quaid, Winans and Lemmer — and Quaid this week quit the campaign, saying that his participation was not political and he wasn't paid for it.

— Inside the health department, officials say they have concerns about how the campaign has been executed and funded, with Caputo's team tightly steering the campaign's development after abruptly taking $300 million from the CDC.

"There are ways to inform the American people about the risks of coronavirus," said one HHS official. "This wasn't the way to do it."

On the Hill

PELOSI, MNUCHIN SEEK LAST-DITCH COVID DEAL — House Speaker Nancy Pelosi will speak with Treasury Secretary Steven Mnuchin one last time today in hopes of striking a longshot deal on more coronavirus aid, POLITICO’s Heather Caygle, Melanie Zanona and Sarah Ferris report.

— Democrats are anticipating a GOP offer by noon. That Republican proposal is expected to contain roughly $1.5 trillion in aid — more than the White House initially wanted to spend, but still far less than Democrats’ $2.2 trillion minimum. That persistent gap on a top-line number has prevented the two sides from reaching an agreement for more than a month.

— A fallback option could move fast. If the talks fall apart again, Democrats are likely to push ahead with passing their own $2.2 trillion aid bill. Under that scenario, a vote could happen as soon as this week.

SCHUMER TRIES TO CENTER SCOTUS FIGHT ON OBAMACARE — Senate Minority Leader Chuck Schumer on Tuesday set up a vote blocking the Justice Department from supporting litigation to overturn the Affordable Care Act, POLITICO’s Marianne LeVine and Susannah Luthi report.

The unusual procedural move escalates Democrats’ campaign to make Judge Amy Coney Barrett’s Supreme Court confirmation a referendum on the future of Obamacare. The party has warned that she could provide the deciding vote in favor of a GOP-led lawsuit to eliminate the ACA that the high court is scheduled to hear in November.

— It also forces GOP senators on the record. The Senate will likely take a roll call vote on Thursday, forcing several vulnerable Republican lawmakers to weigh in on whether the Trump administration should support the anti-Obamacare lawsuit.

— Meanwhile: Barrett met with a range of Republicans on Tuesday. She trekked to the Hill for several hours of meetings with GOP senators, kicking off Republicans’ sprint to confirm her before Election Day.

And in written responses to a Senate Judiciary questionnaire obtained by POLITICO’s Andrew Desiderio and Mariane LeVine, Barrett did not commit to recusing herself from possible cases related to the outcome of the 2020 election.

Opioids

HOW THE US SPENT $7.6 BILLION IN OPIOID CRISIS FUNDING — Roughly three-quarters of the $7.6 billion in federal aid set aside to combat the opioid crisis went to treatment, recovery and prevention efforts in fiscal 2019, according to a new Bipartisan Policy Center report out today.

The rest went toward research, interdiction, law enforcement and other criminal justice initiatives.

— But BPC researchers raised a series of concerns about that overall spending, including difficulties tracking whether the money is effectively meeting the needs of people at the highest risk of overdose.

The report also found that incarcerated individuals in many places still lack access to medication assisted treatment — and that states have had difficulty offering community-based care and wraparound services when those people re-enter society.

— What could help: The BPC researchers recommended that Congress boost funding for the Substance Abuse and Mental Health Services Administration’s substance abuse prevention and treatment block grant.

They also advocated removing federal restrictions on funding for syringes as part of a broader harm reduction strategy, targeting grant funding to address treatment gaps among minority populations, and making permanent the administration’s pandemic-prompted expansion of telehealth services.

A message from PhRMA: America’s biopharmaceutical companies are making great progress against a common enemy – COVID-19. They’re learning from successful vaccines for other diseases, developing new treatments and collaborating like never before. Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. America’s biopharmaceutical companies are working day and night until they defeat COVID-19. Because science is how we get back to normal.

What We're Reading

In the Washington Post, seven former FDA commissioners warn the Trump administration that it is damaging the agency’s credibility in its pursuit of a Covid-19 vaccine.

Early-stage trial results suggest a new antibody cocktail may help treat nonhospitalized Covid-19 patients, Bloomberg’s Robert Langreth reports.

The Trump administration’s push for a vaccine before the election also risks stoking the anti-vaxx conspiracy theories, BuzzFeed News’ Stephanie Lee reports.