Cancer Policy Roundtable

Some of the most vocal critics of scientists and science agencies like the NIH and the CDC, including Sen. Rand Paul of Kentucky, are poised to ascend to powerful committee chairmanships that will enable them to conduct sweeping investigations and put health officials on public trial. The new chairmanships could also give them the ability to tighten the purse strings for health agencies’ budgets — and to deny funding outright for new Covid-19 measures or other Biden health priorities. At the same time, some of the Republican party’s biggest defenders of science and science policy are poised to retire.

Anthony Fauci is an obvious and already-declared target. But beyond the expected litany of coronavirus-related probes, Republican staffers and lobbyists familiar with the discussions tell STAT that Republican leaders plan to throw the spotlight on spending and transparency at health agencies from the Centers for Disease Control and Prevention to the Centers for Medicare & Medicaid Services.

The agenda reflects building GOP frustration over what many conservative lawmakers argue is unbridled Covid-19 spending and unfettered federal power during the pandemic. It stands in stark contrast to the broad, bipartisan support that science agencies enjoyed before the pandemic; the National Institutes of Health, for example, saw its budgets increase repeatedly for the last seven years.

Those probes are going to be “early, high-profile, and a lot of noise,” said Michael Werner, a partner at Holland & Knight. “Then the question will be: Can both sides put that aside and … work through substantive issues?”

The Republican caucus is also keenly aware that even if they win both chambers, veto power sits with President Biden. Subsequently, the party’s overall agenda is less about legislation that tears down Biden’s recent record — like a sweeping reform to let Medicare negotiate drug prices — and tipped more toward oversight.

Though polling suggests the House is more likely to flip than the Senate, it is an upper chamber change that would have the biggest impact on science.

In the Senate, longtime pandemic preparedness advocate and Health, Education, Labor, and Pensions committee ranking member Richard Burr (R-N.C.) is retiring, leaving a hole that Kentucky Republican Sen. Rand Paul has vied to fill.

The libertarian senator has made his agenda clear: Go after longtime National Institutes of Allergy and Infectious Diseases Director Anthony Fauci and probe the origins of the coronavirus pandemic.

“When we win the House, and when we win the Senate,” Paul told a Kentucky crowd as he rallied for the state’s gubernatorial GOP candidate Daniel Cameron, “I will be the chairman of a committee and I will have the power to subpoena records. And I promise you I will subpoena every last record from Dr. Fauci.”

The 81-year-old’s upcoming retirement this December has not mollified Paul. “Fauci’s resignation will not prevent a full-throated investigation into the origins of the pandemic,” the senator tweeted shortly after the news. “He will be asked to testify under oath regarding any discussions he participated in concerning the lab leak.”

Paul’s accusations that Fauci downplayed NIH-funded coronavirus research in China and misrepresented the virus’ risk have been a hallmark of Senate hearings during the pandemic and a hint of what’s to come. The two have regularly sparred over the past two years, with Fauci calling Paul’s rhetoric “irresponsible” messaging that “kindles the crazies.”

“That is not going to be helpful to improve the health of the public,” said Georges Benjamin, executive director of the American Public Health Association, who expressed concern about partisan divides on topics like pandemic response funding — particularly with Burr’s impending retirement.

“He’s been one of the real champions of public health preparedness. That’s a real loss,” said Benjamin. “And I would hope that we would get a Republican that would pick up that mantle and go forward.”

That’s not to say that public health experts don’t see a need for accountability around the Covid-19 response. Benjamin described hopes for a bipartisan, 9/11-style commission to examine spending, management, and gaps in the federal response.

The prospects of that type of cooperation remain hazy at best, particularly because there are unresolved questions about the future of the House’s select committee on the coronavirus under a GOP majority. Current House Minority Leader Kevin McCarthy has not signaled whether he plans to keep the committee running, establish a new group or leave various existing committees to launch their own probes.

Even if Democrats maintain their Senate majority, health care organizations are bracing for a tone shift on the Health, Education, Labor and Pensions Committee. Progressive firebrand Sen. Bernie Sanders (I-Vt.) has signaled he wants to lead the powerful committee if current chair Patty Murray (D-Wash.) leaves the post to lead the Appropriations committee.

And beyond Burr, the Senate Republican caucus is also losing another moderate Republican who has helped advance science funding, Sen. Roy Blunt (R-Mo.). Blunt was a driving force for year-over-year funding increases for the NIH, and also supported funds for hospitals in his home state.

The two retirements will likely bode poorly for any nominations President Biden makes to fill vacant positions in science leadership. The director position at NIH remains vacant, and a new permanent leader would have to be confirmed by the Senate.

Burr and Blunt were critical votes to confirm Robert Califf as commissioner of the Food and Drug Administration, as some Democrats opposed the nominee and Biden needed some Republican support. Health and Human Services Secretary Xavier Becerra’s confirmation was similarly razor-thin. If the Senate flips, losing even a couple of Republicans willing to work across party lines will be a blow to the Biden administration.

In the House, Rep. Cathy McMorris Rodgers (R-Wash.) is in line to chair the powerful Energy and Commerce Committee in a Republican majority, a role that puts her on top of oversight and legislation for federal health agencies.

McMorris Rodgers and other House Republicans have drafted a list of oversight hearings that will quickly put them at odds with Biden officials and Democrats.

Those include investigations into the origins of the coronavirus pandemic, Biden administration Covid-19 policies such as remote schooling recommendations and coronavirus spending. Outside of the pandemic, Republicans also plan to question Becerra and CMS Administrator Chiquita Brooks-LaSure about plans to implement drug price negotiations in Medicare, said the aide.

Brooks-LaSure has not testified before Congress since her Senate confirmation. Becerra has appeared before various committees to field questions about the agency’s sweeping budget, but will be set for a series of grillings under new leadership.

In a September markup in the Energy & Commerce Committee, Republicans unsuccessfully pushed resolutions demanding documents from HHS related to ivermectin and Covid-19 vaccines, funding for Puerto Rico’s Medicaid program, and White House communications about a pandemic-related public health declaration at the U.S.-Mexico border, to name a few.

McMorris Rodgers also supported the Supreme Court’s decision to overturn Roe v. Wade, and often invokes her son who has Down Syndrome when discussing reproductive rights.

However the Washington Republican is still hopeful for a bipartisan path on several health priorities such as hospital prices, onshore manufacturing and legislation on pharmacy benefit managers, a GOP aide told STAT. Rep. Jim Banks (R-Ind.), who jockeying for a leadership position if Republicans take the House, last Congress released a substantive hospital pricing reform plan that would regulate what hospitals charge commercial insurers, beef up the Federal Trade Commission’s scrutiny of hospital mergers, and reduce financial incentives for hospitals to buy up physician practices.

Outside McMorris Rodgers’ agenda, the House Republican caucus has been relatively mum on health care priorities. House Minority Leader McCarthy released a plan dubbed the House Republicans’ “Commitment to America” last month, including pledges to crack down on fentanyl, “personalize care to provide affordable options,” boost telehealth access and lower prices through “transparency, choice and competition.” That language is echoed in House Republicans’ Healthy Futures Task Force.

Though some Republicans, such as Sen. Mike Lee (R-Utah) have called to repeal the Democrats’ recent law allowing Medicare to directly negotiate drug prices, others say that is a doomed task.