Biden Warns of ‘Dark Winter’ as Covid Cases Top 10 Million

Plus, Biden's health care agenda  [The Fisc](   By Yuval Rosenberg and Michael Rainey Biden Warns of ‘Dark Winter’ as Covid Cases Top 10 Million President-elect Joe Biden made clear Monday what he sees as Job. 1: addressing the coronavirus pandemic that just reached a new milestone, topping [10 million]( confirmed cases. After a victory speech Saturday in which he urged a polarized nation to come together and renewed his promise to try to be a president for all Americans, Biden began his transition to office on Monday by signaling just how different his approach to the virus would be. He warned that the United States faces “a dark winter” ahead, pleaded with Americans to wear face masks, emphasized that his response would be informed by science and announced a new advisory board of public health experts to help guide his efforts. Biden lauded drugmaker Pfizer’s announcement that its Covid-19 vaccine was more than 90% effective in a trial, but noted that even if the vaccine is approved, it won’t be widely available for months. Pfizer said Monday that it aims to deliver 100 million doses of the vaccine, enough for 50 million people, by March. Biden, who has mapped out a [coordinated national strategy]( to combat the virus, warned Monday that hundreds of thousands more could die if the public grows complacent before the vaccine arrives. “We could save tens of thousands of lives if everyone would just wear a mask for the next few months. Not Democratic or Republican lives, American lives,” Biden said. “Please, I implore you, wear a mask.” A new advisory board: In a 5 a.m. news release, Biden formally announced that the new Transition COVID-19 Advisory Board will be co-chaired by: - Dr. David Kessler, who served as commissioner of the Food and Drug Administration under Presidents George H.W. Bush and Bill Clinton; - Dr. Vivek Murthy, who was Surgeon General under President Obama from 2014 to 2017; - Dr. Marcella Nunez-Smith, associate dean for health equity research at the Yale School of Medicine. Others on the 13-member task force include: - Dr. Luciana Borio, who was director for medical and biodefense preparedness on President Trump’s National Security Council until 2019; - Dr. Rick Bright, the former head of the Biomedical Advanced Research and Development Authority, who filed a whistleblower complaint against the Trump administration’s approach to the pandemic; - Dr. Ezekiel Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania; - Dr. Atul Gawande, a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School who is also a noted author and former head of health care venture Haven; - Dr. Celine Gounder of New York University’s Grossman School of Medicine; - Dr. Eric Goosby, global AIDS coordinator under President Barack Obama and professor of medicine at the University of California at San Francisco School of Medicine; - Dr. Julie Morita, executive vice president of the Robert Wood Johnson Foundation and former Chicago health commissioner; - Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota; - Loyce Pace, president and executive director of the Global Health Council, a nonprofit dedicated to global health issues; - Dr. Robert Rodriguez, a professor of emergency medicine at the UCSF School of Medicine. Multiple challenges ahead: We only have one president at a time, so even as Biden looks to take an assertive role in the nation’s pandemic response, time and the Trump administration may complicate his plans. With more than two months until Biden is set to take office, the surge in virus cases is expected to continue, given that Trump is unlikely to enact more aggressive efforts to curb it. “The reality is that by the time the president-elect takes office, we’ll probably be at the sort of apex, if you will, of what we’re going through right now,” Dr. Scott Gottlieb, former commissioner of the Food and Drug Administration, told CBS’s [“Face the Nation”]( on Sunday. “You know, this is going to play out over the next couple of months. And I think as the president takes office, we'll be coming down the other side of the epidemic curve, hopefully. And the only question is going to be how many people have died in the course of this and how many people have been infected.” And as President Trump contests the election results, cooperation between the current administration and the incoming one remains a question. The head of the General Services Administration — Emily Murphy, a Trump political appointee — still needs to “ascertain” that Biden won the election, and without that ruling, the Biden team won’t be able to access nearly $10 million in transition funds “and resources such as briefing books prepared by career federal employees,” Government Executive [reports](. Biden has called for ramping up the country’s testing and contact-tracing efforts, and he is reportedly looking to take a role in the congressional negotiations over a new coronavirus stimulus package. But securing the funding necessary to enact his initiatives could also be a challenge. Planning executive orders: As he prepares to take office and strategizes how best to advance his agenda in the face of likely Republican control of the Senate, Biden reportedly is also readying a series of executive orders that he can sign quickly after taking office. From [The Washington Post]( “He will rejoin the Paris climate accords, according to those close to his campaign and commitments he has made in recent months, and he will reverse President Trump’s withdrawal from the World Health Organization. He will repeal the ban on almost all travel from some Muslim-majority countries, and he will reinstate the program allowing “dreamers,” who were brought to the United States illegally as children, to remain in the country, according to people familiar with his plans.” The bottom line: He’s not president yet, so all Biden can really do for now is lay the groundwork for his plans and use the bully pulpit he now has to encourage a new approach to the virus. Quotes of the Day “This is a historical moment. This was a devastating situation, a pandemic, and we have embarked on a path and a goal that nobody ever has achieved — to come up with a vaccine within a year.” – Kathrin Jansen, head of vaccine research and development at Pfizer, discussing positive preliminary results for a vaccine candidate in an interview with [The New York Times](. “Going into Thanksgiving people are going to start to see family and get together indoors. Then the cases will spread from that and then five weeks later we have another set of holidays and people will gather then and by January, we will be exploding with cases.” – David Eisenman, director of the UCLA Center for Public Health and Disasters, quoted in [Politico](. “If you want to have a better 2021, then maybe the rest of 2020 needs to be an investment in driving the virus down. Otherwise we’re looking at thousands and thousands of deaths this winter.” – Cyrus Shahpar, a former emergency response leader at the CDC who now leads the outbreak tracker Covid Exit Strategy, also in [Politico](. On Health Care, Biden May Focus on Reversing Trump’s Changes Biden has major plans to enhance health care in the U.S., but his options may be limited if, as expected, Republicans maintain their hold on the Senate in the next Congress. Given the likelihood of what amounts to a GOP veto over major changes in policy, the Biden administration is expected to focus more on undoing much of what Donald Trump has done over the last four years, [says]( Paige Winfield Cunningham of The Washington Post, while leaving more substantial changes such as the creation of a public option for health insurance to a future date, if or when Democrats gain control of both houses of Congress. Larry Levitt of the Kaiser Family Foundation [said]( Monday that Biden “can and probably will reverse much of what President Trump has done in health care administratively.” In addition to changing the federal approach to the coronavirus pandemic so that it includes “facts, science, and empathy,” Levitt said that Biden could make meaningful changes to health care policy without congressional approval in multiple areas, including: - restoring funds for Obamacare outreach; - requiring short-term health care plans to cover pre-existing conditions; - rolling back work requirements in Medicaid; - eliminating restrictions on the use of health care for immigrants; - reversing Trump rules on abortion and birth control. “Beyond using administrative authority to undo much of what President Trump has done,” Levitt added, “I’d look for President-Elect Biden to use executive powers creatively to expand coverage, increase consumer protections, and make health care more affordable.” Backing up the ACA: Winfield Cunningham says Biden is expected to rely on many former Obama administration officials to staff the Department of Health and Human Services and to provide advice to the White House. This will mark a significant change in the administration of the Affordable Care Act, which was targeted for elimination during the Trump years – a multi-pronged Republican effort that will reach the Supreme Court Tuesday, when the justices will hear arguments about the constitutional validity of the ACA in a suit backed by the White House. The high court isn’t expected to render a verdict in the case until next spring, but the Biden administration could take steps to defend the ACA before then. “There are a couple of things Congress could do to make it so there's actually nothing to litigate — so the Supreme Court wouldn't have to decide this case, it would just go away,” Sabrina Corlette of the Center on Health Insurance Reforms at Georgetown University, [told]( NPR. “I don't think the litigation is a win for Republicans politically, and so they may just be perfectly happy to work out a deal,” she added. If Biden is unable to make a deal and the Supreme Court decides against the ACA, lawmakers would have to scramble next year to address the expected fallout, which could include the loss of health insurance for roughly 20 million people and the elimination of protections for patients with pre-existing conditions. Number of the Day: $2,458,764,169 Private health insurers owe nearly $2.5 billion in rebates to consumers under the Affordable Care Act’s “medical loss ratio” rules requiring the companies to spend a minimum percentage of their income from premiums on health care claims and quality improvement, according to Centers for Medicare and Medicaid Services [data](. That’s nearly double the previous record, according to the Kaiser Family Foundation’s [Cynthia Cox](. “Next year's rebates will be even larger as insures are profiting with the pandemic,” Cox said on Twitter. “Before the ACA, if insurers had extremely profitable years, they kept the $. Now, insurers return the excess to individuals and businesses.” More than 11.2 million consumers will be eligible for rebates across the individual, small group and large group markets. The average rebate is $219 per person, with Obamacare enrollees set to get $332 on average — though the numbers vary widely from state to state. Send your tips and feedback to yrosenberg@thefiscaltimes.com. And please tell your friends they can [sign up here]( for their own copy of this newsletter. 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