| | | | _tstmp_1734698880-80-0.png) | | With research by McKenzie Beard | The newsletter once known as “The Health 202” was launched 2,782 days ago, as President Donald Trump and his congressional allies attempted to repeal the Affordable Care Act. (It didn’t go well.) Today, the rechristened Health Brief newsletter goes on hiatus as President-elect Donald Trump and his congressional allies attempt to fund the government. (It’s not going well.) Some things change. Other things don’t. It’s been a privilege to guest author a few editions of this newsletter. You can find me at dan.diamond@washpost.com. And thanks to McKenzie Beard for her hard work, for years, to bring this newsletter to you every day. The Health Brief newsletter will be on hiatus after the Dec. 20 edition. The Washington Post’s latest health policy and medical news and analysis can be found at washingtonpost.com/health. We appreciate your loyal readership and would be happy to hear what you’ve found most valuable about the Health Brief. You can share your thoughts with our reporters and editors by emailing ideas@washpost.com. While the Health Brief is on hiatus, readers can follow the latest health-care policy and politics news at Morning Briefing, published by our friends at KFF Health News. Sign up for free here. Today’s edition: The federal government is careening toward a shutdown. The Food and Drug Administration has a new definition of what foods count as “healthy.” But first … The rise of Paragon Health Institute |  | | Paragon Heath Institute President Brian Blase interviews former health secretaries Kathleen Sebelius and Alex Azar at an event on Medicare policy in July 2024. (Dan Diamond/The Washington Post) | | Brian Blase sat onstage, flanked by former Trump Health and Human Services Secretary Alex Azar and former Obama HHS Secretary Kathleen Sebelius, nodding as the three discussed the need to overhaul Medicare payments. It was July 2024 and a rare moment of odd bedfellows agreeing on the same health policy. Experts from the American Enterprise Institute, Brookings Institution and the Center for American Progress would soon take the stage, too — all calling for Medicare to adopt site-neutral payments, a bid to level reimbursement for hospitals and physician groups that performed the same procedure. But it was also a moment that marked the ascendance of Paragon Health Institute, the small policy shop founded by Blase in November 2021, which had organized the day’s event. Now Paragon is at the center of Washington health policy conversations — and potentially for the next four years, as well. Blase is helping shape the incoming Trump administration’s priorities, overseeing HHS policy planning for the transition team, according to people who spoke on the condition of anonymity to discuss confidential plans; Theo Merkel, another senior Paragon official, is also working on the transition. While Blase is expected to remain at Paragon, other Paragon staffers and allies are likely to go into the Trump administration, the people said. Blase, who declined comment on the transition, allowed that it was an “exciting time” for his 11-person policy group. “We don’t just write white papers,” Blase said in an interview Thursday. “We focus on trying to make change.” Paragon’s priorities. The group has raised questions about Affordable Care Act enrollment, identifying what Blase and others have concluded is significant fraud. (GOP lawmakers are exploring the issue.) Paragon also has targeted ACA subsidies that are set to expire next year, with Democrats pushing to renew them and Republicans growing wary — in part because of Paragon’s analysis. “A lot of folks on the left don’t want to critique how the ACA is actually working relative to expectations,” Blase said. Paragon also has drawn in a circle of people poised to shape the policy landscape. The group held a book event this year with Marty Makary — a Paragon adviser who is now President-elect Donald Trump’s pick to run the Food and Drug Administration. Meanwhile, Drew Keyes, a Paragon alumnus, is serving as health policy adviser to House Speaker Mike Johnson (R-Louisiana). Filling a void Paragon, which was initially endorsed by a slew of conservative health officials and experts, has benefited from a policy reality: There aren’t that many health-policy shops focused on conservative issues. “In many ways, Paragon feels like an outgrowth of the Paul Ryan wing of the Republican Party, with its focus on markets and smaller government,” said Loren Adler of Brookings, who has collaborated with the group. “That focus on markets means there are areas like site-neutral payments where we tend to agree, even as our views on health care coverage and access are very different.” “Free-market advocates in health policy are vastly outgunned,” said Michael Cannon of the Cato Institute, hailing Paragon as an ally, and calling Blase a friend. “I have such respect for his principles, mind and his work.” | |  | On the Hill | Shutdown on the horizon after House GOP funding bill fails | | House Speaker Mike Johnson speaks with members of the press inside the Capitol in Washington on Thursday. (Marvin Joseph/The Washington Post) | | A federal shutdown is looming after the House rejected Speaker Mike Johnson’s new plan to extend the deadline, despite support from Trump and his billionaire adviser Elon Musk, The Post’s Jacob Bogage and Marianna Sotomayor report. The slimmed-down stopgap measure was defeated 174-to-235, with hard-right Republicans and nearly all Democrats rejecting it. The legislation would have extended federal funding for three months and suspended the debt limit for two years, a key demand from Trump. It also included extensions for some public health programs and Medicare telehealth flexibilities but omitted pharmacy benefit manager reforms and other policies negotiated with Democrats. As of Friday morning, next steps remain unclear. If no agreement is reached by 12:01 a.m. Saturday, the government could temporarily shut down, though Congress could still pass funding over the weekend to reopen by Monday. The stakes for health policy: Major programs like Medicare, Medicaid and Obamacare’s insurance marketplace wouldn’t be affected by a short shutdown. The Centers for Disease Control and Prevention would continue responding to outbreaks and emergencies, and the Food and Drug Administration would maintain its oversight of drugs, medical devices and tobacco products. But a funding lapse would disrupt a wide range of health programs and affect thousands of federal workers. At HHS, about 45 percent of staff would be furloughed as of the second day of a shutdown, according to the agency’s contingency plan. In other news from Capitol Hill … Senate “MAHA Caucus” takes shape Sen. Roger Marshall (R-Kansas) on Thursday announced the formation of a new Senate caucus to help ensure Robert F. Kennedy Jr.’s “Make America Healthy Again” agenda is executed in Congress. “The MAHA caucus is committed to improving health outcomes by prioritizing nutrition, providing access to affordable, nutrient-dense foods, and focusing on primary care availability to tackle the root causes of chronic diseases,” Marshall, who met with Kennedy this week and pledged to support him, said in a statement. Other members of the caucus include Sens. Tommy Tuberville (R-Alabama), Rick Scott (R-Florida), Cynthia Lummis (R-Wyoming) and Ron Johnson (R-Wisconsin). | |  | Agency alert | FDA updates definition of ‘healthy’ food | | The FDA released an updated definition of the word “healthy,” which food companies can voluntarily put on their products' packages. (Eunice Straight Head for The Washington Post) | | The FDA has a new definition of what foods count as “healthy,” a claim companies are allowed to put on products that meet the criteria, our colleague Rachel Roubein writes. It’s been three decades since the agency updated the requirements foods and drinks must meet to be labeled “healthy” — and consumer advocacy groups praised the change as a significant improvement. Under the new criteria, products must contain a certain amount of food from at least one of the food groups, such as fruit, vegetables, grains, dairy or protein-rich foods. The items also must meet specific limits for added sugars, saturated fat and sodium. The new definition means foods such as avocados, salmon and nuts will now qualify as healthy. Products that previously qualified as healthy — such as white bread, highly sweetened yogurt and sugary cereal — will no longer qualify. Food companies have the option to put a “healthy” claim on their food packages. The agency is developing a standardized symbol manufacturers can use in an effort to help consumers more easily identify nutritious foods. Meanwhile … The FDA on Thursday reaffirmed its assessment that there is no longer a shortage of Eli Lilly’s blockbuster weight-loss and diabetes drugs, dealing a blow to compounding pharmacies selling cheaper, off-brand versions and the patients who rely on them, The Post’s Daniel Gilbert reports. The details: Lilly convinced the FDA it can meet demand for tirzepatide — the active ingredient in Mounjaro and Zepbound — by ramping up production, maintaining reserves and providing detailed supply data. Compounding pharmacies, which have been allowed to make tirzepatide copies during the shortage, have between 60 and 90 days to phase out production before the FDA takes enforcement action. Key context: The FDA upheld its decision after agreeing to reevaluate tirzepatide’s availability following a lawsuit from compounding pharmacies challenging its decision in October to remove the drug from its shortage list. The industry argued Thursday that patients continue to face challenges accessing Lilly’s drugs. - “The agency’s decision to declare the shortage over based on the manufacturer’s say-so ignores the facts, violates the law and puts patient access at risk,” the Outsourcing Facilities Association, which represents federally licensed compounding pharmacies, said in a statement.
Lilly, which has been waging an aggressive legal campaign against compounded medications, responded: “Anyone marketing or selling unapproved tirzepatide knockoffs must stop.” | |  | From our notebook | Trump threat to immigrant health care tempered by economic hopes | | Immigrants living illegally in Southern California told KFF Health News they believed the economy would improve and their incomes rise in a Trump presidency, with some prioritizing that over concerns about health care. (Jabin Botsford/The Washington Post) | | Our partners at KFF Health News sent this update: Trump’s promise of mass deportations and tougher immigration restrictions is already reigniting mistrust and reducing participation in the health-care system among immigrant communities in California. Still, KFF Health News’ Vanessa G. Sánchez found some immigrants see a silver lining in Trump’s economic promises that outweighs their health-care concerns. Selvin, 39, who asked to be identified by only his first name because he’s living in Southern California without legal permission, said that even though he believes Trump dislikes people like him, he thinks the new administration could help boost his hours at the food processing facility where he works. “I do see how he could improve the economy,” Selvin said in Spanish. “From that perspective, I think it’s good that he won.” Many health-care providers fear Trump will make major cuts to Medicaid, the federal program that provides over 60 percent of the funding for Medi-Cal, California’s Medicaid program, which has been expanded to all otherwise eligible immigrants regardless of residency status over the past several years. Trump could also reinstate changes to the public charge policy, which can deny green cards or visas based on the use of government benefits, and make changes to the Affordable Care Act, which was opened in November to immigrants who were brought to the United States as children and are protected by the Deferred Action for Childhood Arrivals program. Read the full story here. | |  | Quote of the week | | | | |  | Sugar rush | Thanks for reading! | | | | | |
