| Vaccine policy remains top of mind for the Senate health panel evaluating two of President Donald Trump’s nominees to lead the nation’s public health and emergency preparedness agencies. Erica Schwartz, Trump’s third pick to lead the Centers for Disease Control and Prevention, repeatedly demurred when asked by multiple lawmakers whether she would push back on Health Secretary Robert F. Kennedy Jr.’s vaccine agenda that’s prompted resistance from lawmakers in both parties. They invoked former CDC director Susan Monarez, who was ousted almost a year ago after clashing with Kennedy about actions on vaccines. Would Schwartz oppose Kennedy if he asked her to approve vaccine recommendations not backed up by science?, lawmakers posited. “The secretary would never ask me to do that,” Schwartz replied, at other times calling it a theoretical and hypothetical question. “If I’m confirmed as a CDC director, the nation’s health and well-being will take premacy, and I will never compromise on that,” Schwartz said at one point. → When choosing Schwartz, Trump administration officials had weighed finding someone acceptable to Kennedy and his allies — many of whom are deeply skeptical of vaccines — while choosing someone who could win Senate confirmation and stabilize a CDC workforce beset by low morale, staffing cuts and other challenges. “While I think you are immensely qualified,” Sen. Lisa Blunt Rochester (D-Deleware) told Schwartz, “I’m very, very concerned that even qualified people have either had to change their positions or quit.” It’s unclear whether Schwartz cleared the latter bar, as Sen. Bill Cassidy (R-Louisiana), who leads the Senate Health, Education, Labor and Pensions Committee, closed the hearing with a fiery set of questions for nominees. “I felt like you were always trying not to answer my questions, which was disappointing,” Cassidy told Schwartz. He asked several times about her views on vaccines and whether she’d be willing to object to any request to set aside longstanding CDC processes. “I’m here personally liking you, but feeling as if I’m having to represent the public health of the United States of America so that it’s not taken over by people who are ideologically inclined and looking to file a lawsuit — not looking to prevent disease,” Cassidy said. Lawmakers also peppered Sean Kaufman, tapped to be Assistant Secretary for Preparedness and Response (ASPR), with questions about posts he made about vaccines and autism and the CDC, as first reported by STAT. Kaufman said many of his positions had been mischaracterized, and some of his posts had been deleted because they were divisive. “We’re talking about restoring trust,” Cassidy said, questioning Kaufman about a post that appeared to link the Hepatitis B shot with autism in children. “Why would you repeat the damn lies? Because that destroys trust.” Kaufman said that, contrary to the tone of some of his social media posts, he believed in vaccines as safe and effective. He also defended the cuts to mRNA vaccine research, implemented by the Trump administration, to a credulous Cassidy. ASPR, the office within the Department of Health and Human Services that Kaufman would lead, is in charge of spearheading pandemic and infectious disease countermeasures — including vaccine development. Other tidbits: - Kaufman told lawmakers that he wanted to “strengthen” legislation that reauthorizes federal pandemic and biosecurity programs, which had expired last year amid outcry from House Republicans who argued it needed reforms after the covid-19 pandemic.
- Sen. Josh Hawley (R-Missouri) asked whether the CDC is studying any potential health impacts of living near data centers used to power artificial intelligence. Schwartz said that, if confirmed, she would speak with staff at the agency to see whether they are evaluating the safety.
The Trump administration released its proposed updates to the way that doctors are paid in Medicare, a mammoth regulation that’s among the most heavily lobbied by providers every year. It’s dense, it’s complicated — and every dollar matters. There’s still a lot to go through, but here are three initial takeaways from the proposal: 1. Docs could get a pay cut Under the plan, most physicians would receive about 1.7 percent less from Medicare next year than they currently do, while doctors who participate in certain alternative payment models would see a smaller cut of roughly 1.2 percent. Alternative payment models reward providers for the quality and efficiency of care, rather than paying for each service they provide. As providers worry about payments not keeping up with inflation, further cuts are likely to hit resistance. Still, the cuts are smaller than they otherwise would have been because the Centers for Medicare and Medicaid Services is proposing to increase payments for some services, partially offsetting the expiration of a temporary Medicare payment increase approved by Congress that expires next year — unless lawmakers act again. “Medicare physician payments have declined 33 percent from 2001 to 2025 when adjusted for inflation, even as practice expenses have increased,” the American Academy of Family Physicians said following the release of the proposed rule. “Reforming Medicare payment is critical for serving all patients across the health care system, because Medicare payment policies influence Medicaid, Tricare and commercial insurance.” What to watch: A bipartisan group of physicians in the House unveiled legislation Wednesday that would give doctors a compensation boost, which has become an annual ritual on Capitol Hill, and implement other payment reforms. 2. Shift toward primary care The agency says in the proposal that it is “increasingly concerned” that primary care is being undervalued and is signaling that it may rethink how Medicare reimburses primary care doctors. The agency says the current system, which largely pays physicians for each office visit or service they provide, may no longer reflect how primary care is delivered as technology and AI become more common. Although the agency isn’t making any proposed changes yet, it’s requesting feedback about whether doctors should be paid more for managing patients’ overall health, and whether practices that rely on technology should be paid out differently. Regulators also want to know whether Medicare should move away from paying for each visit and toward models that reward better patient outcomes or provide a fixed monthly payment to care for patients. → In addition, there are some tweaks designed to bolster primary care being proposed, such as expanding physician training flexibility and expanding payments for some primary care services, including advance care planning. 3. Potential billing code changes The Trump administration is also taking aim at one of the most influential forces in physician payment: It’s questioning whether the American Medical Association should continue to wield so much influence over the billing codes and payment recommendations that underpin Medicare’s physician payment system. In the proposal, CMS echoes longstanding criticism — including from Kennedy and progressive Sen. Elizabeth Warren (D-Massachusetts) — that the current system favors specialists and procedures over primary care and prevention, while giving physician groups with financial interests an outsize role in setting payment values. The agency asking for public input about whether Medicare should rely less on the AMA’s coding process, explore alternative approaches or develop a more independent way to determine what doctors get paid. But the ask mirrors a probe launched by Cassidy, the leader of the Senate’s health committee, that sought more information about the royalty fees that the association earns from the so-called CPT codes relied upon by providers, insurers and government agencies — and whether it contributes to a conflict of interest. The AMA didn’t respond to an inquiry about the request for information within the CMS proposal. Dan Diamond and Christopher Rowland in The Washington Post newsroom have more details on the nascent CMS effort. → There are other significant proposals, including ones impacting accountable care organizations (ACOs) and the 340B discount drug program, I’ll be covering soon — so stay tuned. There’s been a lot of chatter around some of the changes the Trump administration made to a food surveillance program and whether it’s played a role in an outbreak of cyclospora, the illness caused by a parasite that has sickened thousands of Americans. The Post’s Lena H. Sun sheds some light on this theory. While the CDC last year reduced its surveillance for cyclospora and several other pathogens in a program that tracks longer-term disease trends, experts tell Lena that it likely had little impact on what’s currently happening. The program, known as FoodNet, was scaled back because funding for food safety has not been maintained over the last several years. Lena notes that this was occurring even before Kennedy became the nation’s top health official or cuts launched by billionaire Elon Musk’s U.S. DOGE Service began. To get the intel, Lena talked with Daniel Jernigan, former director of the CDC’s Center for Emerging and Zoonotic Infectious Diseases, which plays a role in investigating and preventing foodborne illnesses. Jernigan is one of three top CDC officials who quit last year over Kennedy’s policy priorities and his approach to leading the department. Jernigan said the FoodNet program is not designed for real-time outbreak detection or response. Meanwhile, federal and state officials have said the cyclosporiasis investigation has not been affected because the parasite remains nationally reportable to a separate database. Read more from Lena on why the source of the outbreak has been so hard to trace. | 
