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With Ruth Reader and Carmen Paun

PPE PRODUCTION QUESTIONS — Lawmakers who sit on committees overseeing Veteran Affairs worry the U.S. is too reliant on China for personal protective equipment and want to know what the administration is doing about it before the next pandemic. Their concern comes as President Joe Biden met with Chinese President Xi Jinping in San Francisco on Wednesday.

Those lawmakers fear little has been done in recent years to boost the domestic supply chain, and members wanted answers Wednesday from the VA and HHS.

“The Covid-19 pandemic highlighted how fragile the supply chain is,” chair of the Senate Veterans’ Affairs Committee Jon Tester (D-Mont.) said Wednesday. “Essential medications were in short supply and materials to make PPE dwindled.”

But officials for the VA and HHS tried to alleviate that concern, telling the committee its agencies are working to fortify the U.S. supply chain before the next public health crisis.

“Procurement officers interact with industry frequently to educate and inform them that the federal government, the VA, must comply with the [Buy America Act] … and we are very interested in products that are made in America,” Bobby Small, acting executive director of the VA’s office of emergency management and resiliency, said.

Why it matters: A year into the pandemic, as the nation struggled to rapidly increase PPE manufacturing, the Biden administration ordered the VA, HHS and other agencies to identify vulnerabilities in the nation’s PPE supply chain and develop a strategy to remedy it. The order came as both Chinese exports of PPE to the U.S. and prices skyrocketed.

According to International Trade Commission data, as of mid-2023, 40 percent of the U.S.’ nitrile glove supply comes from China, while U.S. manufacturers make around 2 percent of what’s needed annually.

VA spokesperson Terrence Hayes told Pulse the agency is working on responses to a letter sent this month by Reps. Mike Bost (R-Ill.), who chairs the House Veterans’ Affairs Committee, and Mike Gallagher (R-Wis.) on the issue.

Meanwhile, some domestic manufacturers of PPE told Pulse they received contracts from HHS in 2021 to increase domestic production of supplies needed to produce PPE, but they can’t get manufacturing off the ground without additional investments.

Such is the case with Blue Star NBR, which received more than $123 million from HHS to increase production of the nitrile butadiene rubber used in medical gloves. CEO Scott Maier told Pulse the company wasn’t awarded additional contracts to finish the factory and produce the gloves.

HHS did not respond to a request for comment about ongoing and prior contracts with domestic PPE manufacturers.

WELCOME TO THURSDAY PULSE. We’re intrigued by the Thanksgiving meal being offered today in the Senate Carryout. Let us know if it’s good and send your tips, scoops and feedback to [email protected] and [email protected] and follow along @ChelseaCirruzzo and @_BenLeonard_.

TODAY ON OUR PULSE CHECK PODCAST, host Alice Miranda Ollstein talks with POLITICO health care reporter Robert King, who explains why the lack of a year-end omnibus spending bill creates uncertainty for health industry groups seeking 11th-hour fixes on Medicare physician payment cuts and also explores the possibility of fixes added to other year-end spending bills.

VA EHR STABILITY CONCERNS — Lawmakers’ patience with the VA’s troubled electronic health records system transition is wearing thin more than three years after it first went live, Ben reports.

Rep. Matt Rosendale (R-Mont.), chair of the House Veterans’ Affairs subcommittee on technology modernization, argued in a hearing Wednesday that VA data on system performance isn’t showing the extent of the issues, pointing to information from health IT research firm KLAS showing user dissatisfaction with the system. He said employees have stopped reporting glitches, echoing a POLITICO report last month.

Kurt DelBene, the VA’s chief information officer, said contractor Oracle Cerner has met incident-free time requirements in only four of the 10 past months as of September.

In written testimony, top Oracle executive Mike Sicilia said that in 12 of the past 13 months, there have been no system outages, meaning the system is unavailable. He said Oracle gave the VA a “credit” under the terms of a newly negotiated contract after not meeting incident-free requirements.

Also in veterans’ news: Sen. Jerry Moran (R-Kan.), ranking member of the Veterans’ Affairs Committee, said Wednesday he’d requested a Government Accountability Office audit of the VA’s Veterans Crisis Line.

The background: A VA watchdog report released in September found that a crisis line staffer failed to take sufficient action to help a veteran who died by suicide the same night they contacted the line.

Moran said he received a “credible allegation” that staff are sending veterans requiring “complex needs” to a special division that’s understaffed and undertrained. He’s requesting a GAO investigation of the crisis line’s operations and oversight.

In a letter to Moran Wednesday, VA Secretary Denis McDonough wrote that the “complex needs” program is for callers showing “inappropriately abusive behavior,” who are often not veterans or calling on their behalf. Those callers can use resources that would benefit veterans in “immediate crisis,” McDonough wrote.

21 BILLS ADVANCE — The House Energy and Commerce Health Subcommittee advanced 21 bills to the full committee Wednesday despite divergent views among top Democrats over a proposal that would grant four years of Medicare coverage for breakthrough medical devices, POLITICO’s David Lim reports.

Fireworks: E&C health subcommittee ranking member Anna Eshoo (D-Calif.) and full committee ranking member Frank Pallone (D-N.J.) disagreed over the Ensuring Patient Access to Critical Breakthrough Products Act of 2023, which passed out of committee.

Pallone worries the bill will undermine CMS’ mission to provide reasonable and necessary coverage of medical products for older adults. But Eshoo said the bill is needed to speed Medicare coverage of new medical technologies — a process she said takes too long.

Durable medical equipment payment: Democrats, including Pallone and Eshoo, opposed the DMEPOS Relief Act of 2023, which also covers prosthetics and boosted Medicare reimbursement rates for durable medical equipment during the Covid-19 pandemic, saying it shouldn’t be extended.

What’s next: Energy and Commerce Chair Cathy McMorris Rodgers (R-Wash.) plans to find offsets and work with federal agencies before the full committee marks up legislation.

US AND CHINA TO RESTART DRUG COOPERATION — The United States and China will work together to “significantly reduce” the flow of chemicals and pill presses used to manufacture illicit fentanyl from China to the Western hemisphere, President Joe Biden said after meeting with Chinese President Xi Jinping on Wednesday, Carmen reports.

U.S. authorities say China supplies both and hope effective action from the Chinese government to control the supply would decrease the amount of fentanyl coming to America, where it’s driven a record number of drug overdose deaths in recent years.

“It’s going to save lives, and I appreciate President Xi’s commitment on this issue,” Biden told reporters.

However, he didn’t give details about how the plan would work or what China asked from the U.S. in return.

“President Xi and I tasked our teams to maintain a policy and law enforcement coordination going forward to make sure it works,” Biden said.

FEDS TARGET INFLUENCERS — The FTC is cracking down on a dozen health influencers paid to hock health advice on sweeteners while obscuring their relationship to sugar companies, Ruth reports.

The agency sent letters to 12 health influencers on TikTok and Instagram, including some with millions of followers, warning them of their failure to disclose a financial connection to the American Beverage Association and the Canadian Sugar Institute.

Many posts the FTC flagged involved dietitians telling their followers that aspartame, a calorie-free sweetener, doesn’t pose a health risk. The posts were paid for by the ABA and Canadian Sugar.

The International Agency for Research on Cancer has said the additive is possibly carcinogenic to humans, and the FDA recommends that Americans limit intake to 50 milligrams per 2.2 pounds of weight a day.

Influencers could face civil penalties of $50,000 for each violation.

POLITICO’s Daniel Lippman reports that House Speaker Mike Johnson serves on the board of a Christian publishing house that called mpox a penalty for being gay.

POLITICO’s Alice Miranda Ollstein reports on how Republican infighting has stalled the Labor-HHS bill.

NPR reports that 20 women have joined a Texas lawsuit challenging its abortion laws.