| A Senate committee unexpectedly delayed votes Thursday on two Trump administration health nominees, with one running into procedural hurdles and the other facing unresolved concerns from lawmakers. The move likely knocks both out of a large batch of nominees the Senate hopes to confirm before the August recess. Erica Schwartz, President Donald Trump’s pick to lead the Centers for Disease Control and Prevention, likely has the votes to advance. But a failed attempt to vote on her nomination Thursday left the committee without the votes needed to move forward. Sean Kaufman, the choice to lead a federal office in charge of preparing for pandemics and biohazards, faced a different setback, and his fate remains more tenuous. His vote was postponed until next Thursday amid what a spokesperson for the Senate Health, Education, Labor and Pensions Committee described as “ongoing conversations with the administration on the path forward.” Sen. Bill Cassidy (R-Louisiana), who leads the committee, has tried to move forward with the vote on Schwartz as planned — in a vestibule off the Senate floor instead of within the official hearing room — but couldn’t muster enough “yes” votes to advance the nomination. Sen. Lisa Murkowski (R-Alaska) was absent due to a family issue, Cassidy told reporters, and Sen. Rand Paul (R-Kentucky) didn’t show up — which meant Schwartz didn’t have the votes to advance, according to two people familiar with the committee process, who spoke on the condition of anonymity to discuss internal details. A spokesperson for Paul tells me he supports Schwartz’s nomination and intends to vote for her. But the delay essentially means Schwartz will miss a deadline to be included in a large batch of other nominees the Senate will vote to confirm before the August recess. While Schwartz appears to have sufficient support to clear the committee once a vote is held, Kaufman’s path remains less certain. A spokesperson for the Department of Health and Human Services tells me that they fully expect Kaufman to move forward, but wouldn’t comment on any assurances the administration may be making to secure Cassidy’s vote. → It comes one week after Cassidy aggressively questioned both nominees over their views on vaccines and whether they would push back if Health Secretary Robert F. Kennedy Jr. sought to override scientific evidence. At the end of the hearing, Cassidy told Schwartz he felt she was dodging his questions. However, Cassidy changed course Thursday, saying he now trusted Schwartz to defend science after further talks with her. “I am confident that she knows what she is doing and will stand against those who don’t,” Cassidy said in an opening statement, adding that he is encouraged by federal health officials making what he called a “good faith” change to the CDC’s controversial vaccines-and-autism webpage. “There is more to do to repair the damage that has been done to the U.S. public health response, but this is a start,” Cassidy said. The problem: Lena H. Sun in The Post’s newsroom went to check out the changes and found them to be underwhelming. In fact, the page still suggests a possible link between vaccines and autism. Kennedy personally directed the CDC to revise its webpage last year to contradict the long-settled scientific conclusion that vaccines do not cause autism. The CDC page has a changed footnote beneath the headline “Vaccines do not cause autism,” replacing a reference to Cassidy with language saying scientists have not identified the causes of autism and that the agency will update the page as new evidence emerges. The page’s central claims otherwise remained intact. If confirmed, Schwartz would take over a CDC that has been battered by months of leadership turnover, staffing and funding cuts, and declining morale. She would also have to navigate sweeping overhauls of vaccine policy ordered by Kennedy. Kaufman, nominated to lead the Administration for Strategic Preparedness and Response, faced tough questions about his past anti-vaccine statements — including comments questioning the hepatitis B birth dose and opposing covid vaccines for healthy children — and his defense of cuts the administration has made to research new mRNA vaccines. Dan Kueter, the CEO of UnitedHealthcare Employer & Individual, a division of UnitedHealthcare, met with a small group of reporters Thursday where he discussed potential changes to the No Surprises Act, which protects patients from some unexpected out-of-network medical bills. The law created a system to settle disputes between health plans and medical providers. The current situation: If the two sides disagree on payments, both submit a final offer. The arbiter then selects one. Insurers want to update the law because health care providers are winning the majority of the disputes, sometimes with eye-popping awards. WP Intelligence Lead Health Care Analyst Rebecca Adams was there, and sent the top questions Kueter answered at the meeting. The interview has been edited for clarity and brevity. Kueter started by saying: The No Surprises Act is functioning for the benefit of consumers, largely as Congress intended. It’s the independent dispute resolution process that is not functioning as Congress intended. The process today lacks a filter at the front end that determines whether a claim is suitable or applicable. It seems to me that, with the technology that we have, we ought to be able to put a filter at the front end of the process to eliminate whatever that percentage is. We think 40 percent of those shouldn’t be there. A similar system could easily categorize the offers and financially identify the offers of the proposals of the two sides in this baseball-style arbitration so that we can reduce administrative errors. Are you expecting any changes from the administration on the arbitration process? I don’t know. I am encouraged by what the Centers for Medicare and Medicaid Services said Wednesday. [Note: A CMS spokesman said, “While patients are now protected from surprise bills, the system is being gamed to get higher prices, and CMS is actively working to clean it up.”] I would not be surprised if the administration has heard about it from state and local governments because they are impacted by this. How stable does the individual exchange market, for those who don’t get health insurance through their employer, feel to you long-term? We saw last year a rather significant morbidity shock in the pool of people within the individual exchange that had a significant impact on the industry, because the morbidity shock only became apparent after all carriers had submitted, and all states had approved the rates. More will be written as the rates become apparent for 2027. The rate-approval process is underway right now. I believe they will all be out by, shall we say, the middle of August. And, at that time, each carrier has the opportunity to evaluate the rates that they submitted against what was approved, and decide whether to stay in that market. Our orientation at this point is to remain in all the markets that we’ve been in, and perhaps modestly extend our footprint on a county-by-county basis in some of those 30 states in which we participate. One of the drivers of change to the risk pool has been a very appropriate, increased focus on fraud, waste and abuse in the enrollment process. That has led to changes in the enrollment pool. We’ve seen some information that the underlying cost trend is worse in the employer-sponsored market for 2027 than in the exchanges. Do you want to comment? Our commercial trend is above 11 percent. So that will translate into average insured group increases above 11 percent. “Anthony Fauci, Rand Paul to face off again in Senate hearing next week,” The Post’s Dan Diamond reports. “Trump Administration Says Surprise Billing Law Is Being ‘Gamed’ by Doctors,” Sarah Kliff, Margot Sanger-Katz and Alicia Parlapiano report for the New York Times. “Eli Lilly says it will file for approval of next-generation obesity drug in 2027 as it clears two more trials,” Annika Kim Constantino reports at CNBC. “Biogen bets newly acquired Apellis can paper over Leqembi’s disappointing sales into 2027,” Max Gelman reports at Endpoints News. This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from The Washington Post newsroom. Learn more about WP Intelligence. | 
