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With help from Kelly Hooper

THE VISA-NURSING SHORTAGE— A backlog of green card petitions at the State Department could leave the nursing workforce without thousands of international nurses that would have filled staffing gaps this year, Kelly reports.

Health groups say the department’s pause on processing visa applications could devastate a nursing workforce plagued by staffing shortages in the aftermath of the Covid-19 pandemic, as international nurses have proven to be a useful tool for combating those shortages.

“If that pipeline stops, it ain’t gonna be good — and I’m talking significant holes in the nursing field, which is already on such a razor-thin edge right now,” Luke LeBas, an emergency medicine physician in Louisiana, told POLITICO.

What’s happening: The State Department moved the cut-off date for visa eligibility to June 1, 2022, because of soaring demand for employment-based visas. That means only those who filed petitions before that date can continue with their applications this fiscal year. The move could impact thousands of nurses who filed petitions in the past year.

Beyond the hospital walls: The reduction in foreign visas will affect nursing homes, assisted living facilities and hospice care, which have heavily relied on a pipeline of international nurses since the pandemic.

One nonprofit that works with the American Health Care Association and National Center for Assisted Living had recruited about 300 international nurses. But with the freeze, about 45 percent of those nurses likely won’t be able to enter the U.S. until 2024.

“Particularly in senior services, the demand for our services is exploding, in-home care and institutional care and acute care, and we don’t have enough people,” said Clif Porter, the senior vice president of government relations for AHCA/NCAL. “And if we don’t do something about it soon, we’re going to be in a real, real bad situation.”

All eyes on Congress: Health groups are pushing for the reintroduction of the Health Care Workforce Resilience Act, a bipartisan bill that would recapture visas issued but unused from the previous year for the express use of nurses and doctors.

WELCOME TO MONDAY PULSE. Have you heard of other policies in the works that could affect the health care workforce? We want to hear from you. Drop me a line at [email protected].

TODAY ON OUR PULSE CHECK PODCAST, host Katherine Ellen Foley talks with Robert King about his reporting on some House Republicans who oppose a cost-cutting proposal from the Center for Medicare and Medicaid Innovation that would reduce payments for drugs that have won FDA approval but haven’t yet proven their clinical benefit.

ANOTHER ONE BITES THE DUST— The leading lobbying group for drugmakers has lost its third member in six months, POLITICO’s Megan R. Wilson reports.

AstraZeneca is leaving the Pharmaceutical Research and Manufacturers of America, effective July 1, the company and group confirmed.

It will join the ranks of AbbVie and Teva, which also left the association in recent months.

“We regularly evaluate our memberships with industry trade associations to ensure alignment with our purpose to accelerate the delivery of life-changing medicines that create enduring value for patients and society. Given the significant investment, we want to ensure it is the most productive and effective use of our resources,” an AstraZeneca spokesperson wrote in a statement. “Based on a recent assessment, we have made the decision not to continue our membership with PhRMA.”

Almost all of PhRMA’s $609 million annual revenue comes from member dues, according to its most recent tax forms. The departure is another blow to its balance sheet.

But drugmakers have been reeling since the August passage of the Inflation Reduction Act, which allows Medicare to negotiate the price of some high-cost medicines — a policy they had been fighting for decades.

ANIMAL RIGHTS AND ABORTION BANS — A Supreme Court case over pigs’ living conditions may hold a clue about the future of abortion access across the country, POLITICO’s Josh Gerstein reports.

The case over the treatment of animals in factory farms splintered the justices Thursday, resulting in five separate opinions. The ultimate outcome was a victory for the right of California voters to dictate requirements for meat sold in their state, even if much of it is produced elsewhere.

But experts say the case’s core issue — the ability of states to take actions with clear impacts beyond their borders — could spill over into the battle over reproductive rights.

At the heart of the animal rights case was an obscure and murky constitutional doctrine called the dormant commerce clause — which has been interpreted to limit states’ ability to make policies that could interfere with economic activity outside their borders.

Based on that thinking, states could be emboldened, for instance, to crack down on the mailing of abortion pills. States with strong prevailing views on abortion could even seek to restrict the sale of goods from states with contrary views, according to experts.

A ROADBLOCK IN MEXICO — U.S. officials find themselves at odds over how to deal with Mexico’s president — who they believe is key in dealing a blow to drug cartels flooding America with fentanyl, POLITICO’s Carmen Paun reports.

But President Andrés Manuel López Obrador has repeatedly denied that fentanyl is produced in his country, accusing U.S. lawmakers of scapegoating.

Now, the Biden administration looks to continue along the path of diplomacy, even as some Republican lawmakers argue tougher steps must be taken — like bombing clandestine labs or designating cartels as terrorist groups.

ABORTION BAN VETOED — North Carolina Governor Roy Cooper Saturday vetoed a bill that would ban abortions after the first trimester, POLITICO’s Megan Messerly reports.

But the ban could still pass, with a Republican supermajority in the state’s legislature.

Still, the margin is thin. Cooper emphasized that only one Republican would have to act to stop the bill from becoming law.

The Democratic governor implied four moderate Republicans — if not more — who may be considering withholding support for the ban.

A NARROW RECOMMENDATION — An FDA panel of independent experts voted 8-6 Friday to recommend the agency approve a novel gene therapy to treat Duchenne muscular dystrophy, POLITICO’s Katherine Ellen Foley reports.

Sarepta Therapeutics, the company that makes the therapy, asked the FDA to grant it accelerated approval in November. Results of a midstage clinical trial showed that the one-time therapy could make the fatal disease’s symptoms milder, the company said. Experts concluded that the drug’s potential benefits outweighed its risks.

FDA scientists have signaled concern, though, saying in briefing documents that “the clinical studies conducted to date do not provide unambiguous evidence that [the drug] is likely beneficial.”

Sarah Varney, a senior correspondent for KFF Health News, will study the journalistic framing and ethics of abortion coverage in the United States as a Nieman Fellow at Harvard University.

The Washington Post reports on the continuing efforts of hospitals in Ukraine.

Axios reports that Planned Parenthood is calling for major judicial reforms.

The New York Times reports on the end of the Covid public health emergency leading to a shift in viral surveillance.