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With Ben Leonard, Daniel Lippman, Megan Messerly and Megan R. Wilson

‘WHIRLWIND OF CHAOS’ — Arkansas is more than a third of the way through its six-month plan for redetermining whether people who remained on Medicaid during the pandemic should be able to keep their health insurance. More than 140,000 people have already lost their coverage — mostly because they have missed letters or have been snarled in paperwork problems and not because they earn too much, Megan Messerly reports.

Republican Gov. Sarah Huckabee Sanders has touted the state’s plan to complete the redetermination process in six months — a law passed by the legislature and signed by her predecessor — as a fiscally responsible measure to free up resources for the state’s most vulnerable residents. The Biden administration has recommended states take 12 months and this week urged governors to implement new policies to stop people from losing coverage for what are known as procedural reasons and not to rush the process.

But Megan’s interviews with nearly 30 Medicaid recipients, lawyers, patient advocates, health care providers, insurance agents and state eligibility workers across Arkansas reveal how the state’s compressed timeline makes it harder to keep people from falling through the system’s cracks.

“Right now, we’re in the whirlwind of chaos,” said Victoria Frazier, an attorney with Legal Aid of Arkansas.

WELCOME TO WEDNESDAY PULSE. As if the smoke in the Beltway area wasn’t bad enough last week, we may be looking at water shortages ahead. Send us your thoughts, tips and feedback to Katherine Ellen Foley at [email protected] and to your regular Pulse author Daniel Payne at [email protected].

TODAY ON OUR PULSE CHECK PODCAST, host Kelly Hooper talks with Daniel Payne about outgoing CDC Director Rochelle Walensky, who fielded questions from Congress on Tuesday about the agency’s lessons learned from the pandemic, while at the same time making a case for lawmakers to support her new vision for the agency to do to better serve the public.

WALENSKY’S WISHLIST — Outgoing CDC Director Rochelle Walensky, through two hours of congressional grilling, made her case for lawmakers to support a new vision for the agency.

Funding and authority were the points Walensky drove home for lawmakers, saying Congress needed to act to aid the CDC in implementing lessons learned from the pandemic. She argued that:

— The authority to capture more data could help the agency collect and consolidate information on emerging diseases and health threats nationwide.

— Funding for data programs and a larger public health workforce will be important for the agency to build on the progress made through the pandemic.

The asks come as Walensky has been working to better the CDC’s infrastructure and increase internal efficiency.

“I am deeply motivated to make improvements based on what I’ve seen,” she said at the hearing. “Too many lives are at stake.”

But getting Congress to agree on CDC legislation could be difficult. Tuesday’s hearing also demonstrated a deep partisan divide on the biggest issues facing the agency:

— Democrats focused mainly on areas the administration has sought to build up, such as adult vaccine programs or pandemic preparedness — though some looked back to criticize the Trump administration’s actions early in the pandemic.

— Republicans largely focused on the declining trust in public health officials — and what they saw as wrongdoing from the CDC under the Biden administration, especially crafting school reopening policies using the input of a teachers’ union and leaning on social media companies to do more about misinformation.

The issue of public trust is also a focus for the agency. Walensky told lawmakers the CDC was messaging for a new audience coming out of the pandemic by shifting its tone to serve the general public instead of directing its communications at just public health and medical professionals.

Beyond Congress, the agency’s future has another major variable: how Mandy Cohen, expected to be the next director of the CDC, will approach the post-pandemic changes, both planned and underway.

HOUSE GOP: DON’T CALL IT BIG PAHPA — Partisan tensions boiled over during a House subcommittee hearing on Tuesday concerning legislation meant to ensure the U.S. is able to respond to future pandemics and other national threats, POLITICO’s David Lim and Megan R. Wilson report.

It could threaten a timely reauthorization of the Pandemic and All-Hazards Preparedness Act, or PAHPA, which has historically been a bipartisan effort. Many of its programs expire on Sept. 30.

The disagreements spilled over in the House Energy and Commerce Health Subcommittee hearing, in which top Democrats insisted that Congress use the reauthorization to equip the FDA with new authorities they argue are needed to ensure the U.S. can rapidly identify and respond to drug and medical device shortages. Republicans counter that those demands are outside the bill’s scope.

What’s next: Reps. Richard Hudson (R-N.C.) and Anna Eshoo (D-Calif.), the lawmakers negotiating the deal, have vowed to continue working together, but it remains to be seen what kind of compromise could be forged between Republicans and Democrats.

VETERAN GROUP PETITIONS CONGRESS FOR PSYCHEDELIC REFORM — The Veteran Mental Health Leadership Coalition began a three-day fly-in today to take its case for easing regulations on psychedelic drugs directly to lawmakers, Daniel Lippman reports. The coalition is one of several groups advocating for more research into the therapeutic use of drugs like psilocybin, the hallucinogen found in magic mushrooms, that has landed some powerful allies on K Street in recent years.

The coalition looks to rally support for bipartisan legislation that would make it easier for the DEA to reschedule classes of substances designated as a breakthrough therapy like psychedelics to remove a key barrier for researchers and patients alike.

QALY VOTE NEXT MONTH? Rep. Cathy McMorris Rodgers (R-Wash.) is eyeing a House vote next month on her legislation that would prohibit federal agencies from using quality-adjusted life years to evaluate the cost-effectiveness of drugs and treatments, she told Ben on Tuesday.

Rodgers argues the metric discounts the benefit drugs and treatments provide to people with disabilities and older adults by undervaluing how much they help them. The Energy and Commerce Committee, which Rodgers chairs, advanced the legislation to the full House in March, but no Democrats joined to support it.

She told Pulse on Tuesday that talks with Democrats are still a “work in progress,” though. Committee ranking member Frank Pallone (D-N.J.) has raised concerns that banning the metric could get in the way of Medicare drug pricing negotiations by barring other cost-effectiveness measures. Rep. Anna Eshoo (D-Calif.), the ranking member of the panel’s health subcommittee, previously expressed support for banning QALYs and asked to delay the March vote to allow more time to negotiate.

HOUSE MARKS UP AG-FDA APPROPRIATIONS BILL — The full House Appropriations Committee will be discussing the fiscal 2024 FDA funding bill today, shortly after chair Kay Granger (R-Texas) said that the committee would limit spending bills to overall totals from fiscal 2022.

WORRIES OVER PANDEMIC TREATY NEGOTIATIONS — Health Commissioner Stella Kyriakides warned European health ministers Tuesday that negotiations on a pandemic treaty risk being derailed by disagreements, POLITICO’s Ashleigh Furlong reports. Countries remain deeply divided on the more controversial aspects of the text, including intellectual property rights and sharing the benefits of vaccines and other health products.

Biogen made several changes to its board of directors: Susan Langer, president of Souffle Therapeutics, will be up for election to the company’s board, and members Alexander Denner, William Jones and Richard Mulligan will not seek re-election. The board will vote later this month.

Sejal Hathi left her post as the senior policy adviser for public health within the White House’s Domestic Policy Council, she confirmed to POLITICO, to be New Jersey’s state health officer and deputy commissioner of health, overseeing public health services in the state, Megan R. Wilson scoops.

James McDonald has been confirmed by the state Senate as New York health commissioner. His appointment and confirmation come after Mary Bassett stepped down from the role late last year.

Chatbots are helping harried clinicians work on their bedside manner, Gina Kolata reports for The New York Times.

As the overdose crisis continues, lawmakers disagree about how to classify cousins of fentanyl, David Ovalle and Rachel Roubein report for The Washington Post.

For the Houston Chronicle, Sarah Smith documents the life of a former ER nurse who spent days on her feet until she contracted Covid on the job — and hasn’t recovered since.