| |  | | | | |  | By Megan R. Wilson | Not a subscriber? Sign up here to get this newsletter in your inbox. - Shutdown showdown: President Donald Trump said he could be open to a deal on health care, but the continued partisan bickering on Capitol Hill signals there’s a long way to go to get there.
- Funding lapse: A multi-billion-dollar program to help fund community health centers lapsed on Sept. 30. Although some facilities are holding on, financial challenges could create longer-lasting ripple effects.
- Splitting the MMR vaccine: The Trump administration has called for separating the measles, mumps and rubella combination vaccine into three separate shots. But experts say that would be expensive, arduous and without scientific backing.
Good afternoon, and welcome to the Health Brief newsletter. I’m Megan Wilson, and I’m your host. I’m watching a number of things in the context of the shutdown — and not all of them are health-related: Burbank’s airport was without air traffic controllers for hours yesterday. Other airports, already short staffed, report a higher-than-usual number of people in these roles calling out sick. Although the staffing issue isn’t new, these folks aren’t being paid during the shutdown — and I can’t help but think that few things can motivate Congress to act quite like disruptions in air travel. → Breaking: The Supreme Court heard arguments this morning about whether a Colorado state ban on conversion therapy is unconstitutional. Read Justin Jouvenal’s report for The Post about the court appearing skeptical of the ban and the impacts overturning it could have on other states. Do you have any tips, scoops or intel? Let’s chat. You can reach me at megan.wilson@washpost.com or on Signal at megan.434. This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from the Washington Post newsroom. Learn more about WP Intelligence. | | | |  | The Lead Brief | There is not yet a clear path forward on a deal to reopen the government as the shutdown enters its second week, making the prospects of a resolution in the near term appear pretty bleak. The Washington Post’s Dan Diamond and Riley Beggin have a new story that talks about a potential bright spot — President Donald Trump hinting he’s open to a funding deal — while acknowledging the political hurdles that still remain. The money quote: “I’d like to see a deal made for great health care,” Trump told reporters in the Oval Office. Here’s a timeline featuring the key players and most recent statements: MONDAY → Sen. Angus King (I-Maine), who has been siding with Republicans on the House-passed stopgap funding bill, said he might be switching his vote — a signal that things are headed in the wrong direction: “So far, the Republicans aren’t being forthcoming with significant assurances about dealing with this ACA issue, which is really urgent,” he said, according to Dan and Riley. “The best they’ve been able to tell us so far is that they’re open to conversations about solving the ACA problem,” King said. “That doesn’t cut it.” → Rep. Marjorie Taylor Greene (R-Georgia) posted on social media that, while she opposes the Affordable Care Act, she wants lawmakers to act on the tax credits. “Let’s just say as nicely as possible, I’m not a fan,” she wrote in a post on X. “But I’m going to go against everyone on this issue because when the tax credits expire this year my own adult children’s insurance premiums for 2026 are going to DOUBLE, along with all the wonderful families and hardworking people in my district.” While moderate Republicans have been leading the charge on a potential compromise to extend the tax credits with some reforms — including imposing income limits — Greene’s shift could mark a turning point for some more conservative House members of the caucus. TUESDAY → Sen. Susan Collins (R-Maine) told reporters on Monday evening she is circulating a bipartisan plan to address the Affordable Care Act subsidies once the government has reopened — calling it a path out of the shutdown. On Tuesday, Collins said she wanted to offer Democrats a “commitment” to working on the Affordable Care Act tax credits if they vote to reopen the government. Dan and Riley report that the offer would try to set a deadline for a discussion on ACA tax credits, in addition to an agreement to move other appropriations bills. → But, Sen. John Barrasso (Wyoming), the No. 2 Republican in the Senate, threw cold water on the idea: “Let’s open the government, and we can have lots of discussions and lots of negotiations,” he said. → Flashback: Democrats could be having a déjà vu moment from Trump’s first term: During the 2018 shutdown over border wall funding, Republicans promised to vote on a compromise immigration bill once the government reopened. Trump then went back and forth on his support for measures in the House and Senate in the months that followed, and both ultimately failed. → House Minority Leader Hakeem Jeffries (D-New York) called a one-year extension of the Affordable Care Act tax credits a “non-starter,” complicating efforts. → Senate Minority Leader Charles E. Schumer (D-New York) read Greene’s post about extending the Affordable Care Act subsidies on the Senate floor as an endorsement of the need to make a deal. On Monday, Schumer said: “After five failed votes, it should be clear to Republicans that we cannot go forward unless they sit down and seriously negotiate with Democrats to address the health care prices.” | | | | | | Industry Rx | As the government shutdown enters its second week, I wanted to take a look at the impacts facing the health care industry. While health industry lawyers and lobbyists tell me that some providers and many insurers are largely insulated from the impacts of a shorter-term shutdown, there are some providers particularly vulnerable to a funding shortfall. → The Community Health Center Program’s funding lapsed at the end of the fiscal year on Sept. 30. Extending funding at current levels would cost roughly $4.3 billion on an annualized basis. Community health centers serve 34 million patients across the country, often lower-income people. Community health centers operate on such thin profit margins, said Amanda Pears Kelly, the chief executive of Advocates for Community Health, adding: “Anytime there’s a situation where a lever gets pulled or a string gets pulled, something else is going to fall. They’re just not in a position where they can continue to bear the strain and the tension of the unpredictability.” → Although she said that some of the group’s members have been able to draw on existing program funds, the uncertainty of when — and at what level — the program will be replenished is already having an impact: - Banks have declined to provide funds to facilities to expand services they’d already lined up “because they're looking at the environment and saying, ‘I don't know that that's a sound investment,’” she said. “I've already talked to multiple organizations where lenders are saying, ‘No, we're not going to go ahead with [funding] whatever the proposal or the plan was.’”
- Some facilities are having to scale back services, which can vary depending on the organization. Maternal health services is one area that’s having to be dialed back in some cases because it is a “loss leader,” reimbursed at lower rates than it costs to provide. That’s particularly troubling “because a lot of our organizations are serving maternal health deserts.”
→ While some organizations may be threatened with closure, the overall issue of staff morale and the potential inability for some facilities to keep staff amid the financial uncertainty may have longer-lasting ripple effects on care, Pears Kelly said. |  | | A MMR vaccine at Lubbock Public Health in Lubbock, Texas, in February. (Ramsay de Give/For The Washington Post) | | | | | | Regulatory Sweep | Deputy Health Secretary Jim O’Neill called for vaccine makers to separate the combination measles, mumps and rubella vaccine into three separate shots — a move that startled the scientific community and would go much further than the administration’s official actions on vaccines. O’Neill, who is also serving as the acting director of the Centers for Disease Control and Prevention, made the call in a social media post on Tuesday. The Department of Health and Human Services didn’t answer questions about whether drugmakers should view this as a directive from the agency or whether it would be making any more formal rulemaking moves on the shots. There are two companies, Merck and GSK, that make combination measles, mumps and rubella vaccines for the U.S. market. Both companies emailed me statements emphasizing the scientific backing underscoring their vaccines — and the lack of evidence to support separating them out. The two companies stopped short of rejecting the administration’s call to make new vaccines. → The idea to separate the shots originates from a paper published in 1998 that looked at a dozen children and claimed the combination vaccine could be linked to autism, which was ultimately redacted following allegations of fraud. Many large-scale studies have shown there is no connection between the combination vaccines and autism. The combination measles, mumps and rubella vaccine has been around since 1971, and serves to reduce the number of shots children receive. Separating them out — in addition to being untested — would also likely decrease adherence to the entire schedule, scientists say, and therefore increase disease. “It's a huge investment of effort to separate them out, and I don't think it's ethical, because you know what it means — it means you're going to give kids extra injections, and it also means that the likelihood is this will decrease access,” Peter Hotez, a pediatrician and vaccine scientist, told me in a call yesterday. “It has no scientific basis.” Autism is one of the birth defects that can result from congenital rubella, he said: “It'll actually be that this act of separating the three components will actually increase autism rates.” The CDC website touts that rubella has been eradicated in the U.S. since 2004 and encourages getting the MMR vaccine to “maintain rubella elimination.” | | | | | | Questions With… | But, I wondered: What would it mean if companies actually had to execute this request? → Jesse Goodman — a physician and former head of the Center for Biologics Evaluation and Research, the agency that oversees the approval of vaccines — walked me through it: - Merck and GSK would each need to agree to conduct clinical trials of the three individual vaccines, because they haven’t been available separately for decades so they can’t “simply be resurrected as previously approved,” he said.
→ But what does that mean? Put simply: Lots of money, years of uncertainty and several hundred parents willing to subject their children to testing, including control groups that receive the current combination vaccine against which to measure each of the separate shots. - There would need to be trials for each individual vaccine in both age groups that normally receive the shots — the initial doses tested on 12 to 15 month olds and the 4 to 6 year olds that receive the boosters.
- In total, that’s 12 separate clinical trials between the two companies, including the control groups. Goodman said each would need “several hundred subjects … to show that the immune response to the individual component is not inferior to the combination vaccine.”
- He added: “This doesn't even consider the issue of what order and at what intervals would the three separate vaccines be given” to ensure they would work as well, he said.
- After that, the drug companies would have to comply with other regulatory requirements and the continued evaluation of the individual vaccines’ effectiveness — if they achieved that result.
→ What would it cost?: Bringing a new vaccine to market in the U.S. costs more than $886 million on average, according to HHS estimates. The development process can take roughly 10 years. → O’Neill’s post on social media echoes comments made by Trump, who has argued to separate the MMR combination vaccine into individual doses: “It seems to be that when you mix them, there could be a problem.” Andrew Nixon, a spokesperson for HHS, said in an email that O’Neill “agrees with President Trump that immunizations for measles, mumps, and rubella would be best administered as three separate vaccines.” | | | | | | Jobs Report | Nick Magallanes has joined top health lobbying firm Todd Strategy Group after serving more than two years at genomics company Illumina. His résumé also includes working at Iovance Biotherapeutics and industry trade groups PhRMA and the Biotechnology Innovation Organization. Todd Strategy Group earned more than $6 million in lobbying revenue in the first half of this year, according to the Center for Responsive Politics. The firm’s clients include the American Medical Association, the Puerto Rico Department of Health, Siemens Healthineers, McKesson Corporation, and myriad top drugmakers such as Bristol-Myers Squibb, Eli Lilly, Gilead, Merck and Takeda Pharmaceuticals. | | | | | | | | |
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