Jimmy Carter attends Plains Peanut Festival

PLAINS, Ga. — Former President Jimmy Carter and his wife, Rosalynn, on Saturday made a surprise appearance at the Plains Peanut Festival in their Georgia hometown, the Carter Center wrote in a social media post on X, formerly known as Twitter.

The former president and his wife are seen in a reposted video riding through the festivities in a Black SUV.

“Beautiful day for President & Mrs. Carter to enjoy a ride through the Plains Peanut Festival! And just a week before he turns 99,” the Carter Center wrote on X after sharing the video taken by a spectator.

The former president is 98 and has been in home hospice care since February. He is set to turn 99 on Oct. 4. The former first lady has since been diagnosed with dementia. The couple this summer marked their 77th wedding anniversary, extending their record as the nation’s longest-married first couple.

“It was amazing considering that he is in hospice care, and he is tough enough to come out here. In my opinion, he is one of the toughest men to serve as President, and he is my favorite,” Reed Elliotte, a Corbin, Kentucky resident, told WALB-TV.

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Here’s what happens when the government shuts down

If Washington succumbs to its latest government shutdown threat next month, the damage will stretch far beyond shuttered parks and darkened panda cams.

The federal government is an essential player in medical research, food access for low-income families, funding new construction and other national priorities that soon-to-be furloughed workers keep humming along. Sending those employees home — most without pay — also threatens to eat up precious time the Biden administration has put into making rules after the deregulatory spree of the Trump years.

And since Congress hasn’t yet passed any of the 12 annual appropriations measures this year, just about every federal agency will get hit if a stopgap spending bill can’t be hoisted out of the morass that’s engulfed the Capitol.

The true implications of a shutdown will be determined by whether it lasts a few days or stretches into Halloween. After the five-week partial shutdown in 2018-19, the Congressional Budget Office estimated that the U.S. economy lost about $3 billion even after everything was turned back on.

While Social Security checks, mail and funds for Ukraine will still be delivered, millions of people will suffer financial losses. Federal workers will eventually get back pay, but those whose businesses depend on the federal government won't. And states will have to dip into their own accounts to make up for lost federal money, and some infrastructure projects will sit idle.

Here’s how a potential shutdown will hit Washington, people across the country and the overall economy:

HEALTH

The Department of Health and Human Services was among a handful of agencies Congress funded during the 2018-19 partial shutdown. But according to a contingency plan updated on Sept. 21, the agency expects to furlough about 42 percent of its workforce, including support staff, grant processors and others, if the government shutters.

Staffers who remain on the job will keep essential services running: Medicare and Medicaid are mandatory programs that aren’t subject to annual appropriations, therefore payments to doctors, hospitals and beneficiaries would continue. Clinical trials will continue and the Obamacare exchanges will remain open — albeit with a limited number of staff behind them. HHS agencies have previously appropriated emergency funds to keep programs combating Covid-19, like vaccine development, running.

Still, Medicaid could be affected if a shutdown really drags out: HHS’ shutdown contingency plan released earlier this week said Centers for Medicare and Medicaid Services will have enough funding for only the remainder of the calendar year.

The shutdown could also slow down the implementation of the administration’s Medicare drug pricing negotiations, HHS Secretary Xavier Becerra told reporters Friday.

“[HHS employees] have to compile information from the manufacturers. We have to share information with the manufacturers. A lot of that takes people who would be impacted by a shutdown,” Becerra said.

During the 16-day shutdown in October 2013, the National Institutes of Health briefly closed its portal to register new clinical trials and couldn’t enroll new patients, according to a GAO report. CMS also lost discretionary funding to combat waste, fraud and abuse, and states were forced to use their own money for formula grant programs like Temporary Assistance for Needy Families, the federal cash welfare program for lower-income people.

The timing of the shutdown matters. October and November are a busy time for external research funding, including a big grant deadline. "A shutdown is incredibly disruptive to that process," said Carrie Wolinetz, who worked closely with NIH during the 2013 shutdown. (Grant-issuing operations at several other agencies, including the National Science Foundation, would also go dark.)

FOOD

The FDA oversees approximately 80 percent of the U.S. food supply and a government shutdown could put its safety work in jeopardy, former FDA Deputy Commissioner Frank Yiannas warned.

“Essential government services” only allowed the FDA to respond to foodborne outbreaks during the 2018-19 shutdown, he said, but prevented the agency from conducting proactive inspections.

“While we worked hard to try to expand the definition of ‘essential services’ last time to include the inspection of high-risk food facilities, the reality is another shutdown would be extremely disruptive and it would result in a ripple throughout the food system ranging from inspections, food testing, interactions with other regulators, and the necessary interactions and consultation with the food industry at large,” Yiannas said.

The Supplemental Nutrition Assistance Program would remain in operation during a shutdown, but it’s unclear what might happen if it drags out. During the last shutdown, the government nearly ran out of funds for SNAP, which would’ve yanked benefits from 40 million people.

And according to USDA, nearly 7 million pregnant and postpartum recipients of supplemental food aid and their children could lose access to the Women, Infants, and Children program.

“USDA Food and Nutrition Service likely does not have sufficient funding to support normal WIC operations beyond a few days into a shutdown,” an agency spokesperson said.

Advocates for the program warn a shutdown would trigger a "rolling crisis" for families who rely on WIC, as individual state programs run out of funds. The USDA spokesperson noted that states will have to rely on carryover funds or their own state funds "to continue program operations for different amounts of time."

SCHOOLS

While K-12 schools themselves are largely funded locally, programs like Head Start — which offers academic and other support for 3- and 4-year-olds — and free and reduced lunch programs at schools across the nation, would pause quickly.

Some Head Start agencies could be affected by a hold on HHS grants, and a larger share of students would feel it if the shutdown runs through November. During the 2018-19 shutdown, which lasted 34 days, school leaders were concerned about how they would pay for free and low-cost meals for children without a check from the federal government. And thousands of kids also became newly eligible for these meals when their parents were furloughed.

Some education groups are also concerned about a hiatus in Impact Aid program, which funds the nearly 1,200 school districts on military bases, Native American reservations and other places where the federal government owns land. Funds from the program are appropriated annually and disbursed directly to school districts.

ENERGY

President Joe Biden has made energy and climate issues a top priority of his administration and a shutdown would wreak havoc with that agenda, Democrats’ Inflation Reduction Act and even some top Republican priorities.

“Businesses are mobilizing now to incorporate IRA programs into their work,” Erin Duncan, vice president of congressional affairs for the Solar Energy Industries Association said in a statement. “Delays in implementation mean delays in investment and, importantly, delays in hiring thousands of workers.”

An offshore oil and natural gas drilling proposal Republicans have been pushing the Interior Department to release — a five-year plan already four years behind schedule — is also likely to sit idle even longer if agency funding lapses in a few days.

An Interior Department spokesperson declined to offer clues on Thursday about what, if anything, the agency has planned in case of a shutdown.

Biden’s lieutenants have also been steadily churning out regulations and even a few weeks’ delay could spell trouble by hampering the administration’s ability to defend them in court or by making them vulnerable to reversals in the next Congress if Republicans make sweeping wins in 2024.

New regulations limiting methane emissions from the oil and gas sector and a long-awaited proposal targeting lead pipes could face delays. Other rules in the pipeline for the coming months include those related to planet-warming hydrofluorocarbons, lead emissions from aircraft and restrictions on several toxic chemicals.

INFRASTRUCTURE

FAA is by far the Transportation Department’s largest division and on a normal day houses more than 80 percent of the agency’s employees. More than one-third of them would be furloughed during a shutdown.

According to the plan from September 2022, 24,822 FAA employees would stay on the job in case of a shutdown because their work is “necessary to protect life and property,” along with 628 officials from other agencies. Thousands of others would stay on the job because they’re not paid out of annual appropriations — if the agency’s reauthorization, which also needs to be passed by Sept. 30, doesn’t lapse.

But the training of new air traffic control specialists would cease. So would aviation rulemaking, facility security inspections, the development and testing new technologies and safety standards, law enforcement assistance support and most functions related to finance, budgeting and administration. Three-quarters of DOT’s inspector’s general’s office would be furloughed.

Air traffic controllers would continue working through a shutdown since they’re deemed as “essential” workers, but technicians and some inspectors that work for the FAA as contractors would likely be furloughed right away.

Transportation Secretary Pete Buttigieg said his top concern with a government shutdown is halting air traffic control training just as the FAA begins to curb a talent drain exacerbated by the pandemic.

“I’d say the ATC training is the thing we’re watching most closely but right now we’re watching all the parts of the agency that could be affected,” Buttigieg said. “A shutdown would be a really difficult situation.”

Even some of the tech industry's biggest priorities in Washington on manufacturing and infrastructure are also in jeopardy as Capitol Hill barrels toward a shutdown.

Failure to reach a stopgap funding bill by Oct. 1 will mean freezing $52.7 billion in subsidies aimed at bolstering the domestic microchip industry and likely stymie efforts to coordinate and award broadband grants to state governments.

Commerce Secretary Gina Raimondo told lawmakers on the House Science Committee Tuesday that her agency is “literally working seven days a week” to finalize the first tranche of dollars from the CHIPS and Science Act funding.

“If there’s a shutdown, it’ll come grinding to a halt,” Raimondo warned. Any delay in funding could imperil a bipartisan effort to bring microchip manufacturing back to U.S. shores, which is seen as a check on China’s tech ambitions.

TAX, FINANCE AND HOUSING

The Treasury Department has yet to release an updated contingency plan for the IRS, but the agency may escape a government shutdown this time because of new funds it received from the Inflation Reduction Act last year.

The IRS contingency plan published last year states the agency would be kept fully operational with those new funds and all employees would be kept on payroll during a shutdown. Yet, there’s uncertainty from their union.

National Treasury Employee Union President Doreen Greenwald told reporters earlier this month that initial conversations with the IRS leadership indicated that employees would continue to work and be fully paid. But a few days later, Greenwald said NTEU members told the union that the IRS was developing a new plan that involved furloughing some workers. Treasury declined to comment.

Wall Street regulators are also bracing for both their rulemaking and enforcement work to come to a near standstill if a shutdown happens, even as financial markets would stay open.

Corporate America has been expecting a host of sweeping new regulations from the Securities and Exchange Commission this fall, including a landmark climate risk reporting rule and new disclosures for short sellers.

The SEC and Commodity Futures Trading Commission — the agencies in charge of overseeing stock, futures and some cryptocurrency trading — expect to go to skeleton crews during a shutdown, with more than 90 percent of both staffs likely to be furloughed. Staff that is kept on will deal with emergency enforcement matters and litigation, among other issues, at both agencies.

And while many federal housing programs — homeless assistance grants and supportive housing for veterans and people with AIDS — will continue amid a shutdown, most Department of Housing and Urban Development staff will be sent home.

A contingency plan updated last month, also noted that monthly assistance programs, including public housing operating subsidies, housing choice voucher subsidies and multifamily assistance contracts, will still operate “for as long as the funding remains available.” Although most of the Federal Housing Administration’s work will continue, “the processing or closing of FHA-insured loans may be delayed” due to reduced staff, according to the HUD document.

But again, it’s all about duration.

“Because we are able to endorse most single-family loans, we do not expect the impact on the housing market to be significant, as long as the shutdown is brief,” FHA said in the contingency plan. “With each day the shutdown continues, we can expect an increase in the impacts on potential homeowners, home sellers and the entire housing market. A protracted shutdown could see a decline in home sales.”

Darius Dixon, Chelsea Cirruzzo, Lauren Gardner, Kelly Hooper, Robert King, David Lim, Carmen Paun, Erin Schumaker, Bianca Quilantan, Ben Lefebvre, Annie Snider, Alex Guillén, Kelsey Tamborrino, Alex Daugherty, Oriana Pawlyk, Tanya Snyder, Marcia Brown, Meredith Lee Hill, Ari Hawkins, Brendan Bordelon, John Hendel, Katy O’Donnell, Declan Harty, and Benjamin Guggenheim contributed to this report.

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‘It’s everywhere‘: Fighting the war against fentanyl

Democratic elected officials are distancing themselves from progressives critical of law enforcement as tens of thousands of Americans continue to die each year from drug overdoses.

Rep. Henry Cuellar, who represents a Texas border district, Oregon Attorney General Ellen Rosenblum and Texas state Sen. Royce West of Dallas joined POLITICO on Saturday at the Texas Tribune Festival in Austin to talk about the next steps needed to confront America’s current opioid crisis.

They agreed that stopping drugs at the border, and prosecuting dealers, is part of the answer, along with treatment and prevention.

The backdrop for their alarm is an increase in fatal drug overdoses during the Covid pandemic that has refused to abate.

The Centers for Disease Control and Prevention estimates that illegal drugs killed 110,000 people last year, most of it driven by illicit fentanyl.

Emergent BioSolutions, the maker of the opioid overdose reversal drug Narcan, sponsored the forum.

Here are three takeaways from the event, moderated by POLITICO’s Megan Messerly:

Some Democrats still want to throw the book at dealers

Progressives see a direct line between the war on drugs and mass incarceration and have pushed Democrats to legalize drugs, defund police and exercise prosecutorial discretion to alleviate the war’s costs, particularly for people of color.

But the three Democrats at POLITICO’s forum said they still see a place for law enforcement.

West defended a new Texas law that permits prosecutors to charge fentanyl dealers with murder and increases criminal penalties for the manufacturing or delivery of the drug.

“We've got to make certain that persons that deal with this issue understand that there are consequences,” West said.

Oregon’s Rosenblum acknowledged the fentanyl problem in Portland that’s grown worse since state voters legalized possession of small amounts of hard drugs in 2020.

“It’s everywhere. No one can deny it. If you do, you’ve just got blinders on,” she said, explaining that her office was “very strong on the interdiction of drugs, and very strong on prosecution” of dealers.

Asked about the drug war’s legacy, Cuellar said, “You can argue if it’s been successful or not successful.”

Mexico could do more

Cuellar rejected the call from some Republican hardliners to bomb the Mexican cartels.

But the border district lawmaker said that he, too, is frustrated with a lack of cooperation from the Mexican government, and with the Biden administration’s diplomacy.

“They can certainly do a lot more. We just need the administration to be a little firmer with Mexico,” Cuellar said.

Chemicals used to manufacture fentanyl from China enter Mexico through two ports on its Pacific coast, said Cuellar. Then criminal organizations make it into fentanyl.

Catching the drug at the U.S.–Mexico border, where tens of thousands of trucks, cars and trains pass every day, is difficult because the technology used to find drugs is designed to catch larger illegal drug shipments, he said.

Fentanyl comes in small quantities. It’s so potent that tiny amounts are enough to manufacture many counterfeit pills.

Mexican President Andrés Manuel López Obrador has at times extended a hand and at others denied that fentanyl is produced in his country, accused U.S. lawmakers of scapegoating and said the U.S. might not have an overdose crisis if Americans hugged their children more.

“They do work with us,” Cuellar said of the Mexican government, but “the action doesn’t match the words.”

Naloxone and fentanyl test strips can save lives but resistance to the latter lingers

The panelists agreed there’s a need to make naloxone, the opioid overdose reversal drug that now comes as an over-the-counter nasal spray, available around the country, from schools to businesses.

“When you go now to places, fire stations in Laredo, and they have a dispensing place there where you can get Narcan, you know things have changed,” Cuellar said, using the brand name for naloxone.

Test strips, which people can use to check if the pills or drugs they plan to use are tainted with fentanyl, can also save lives, the speakers agreed.

But while most states have decriminalized them, some, including Texas, continue to treat them as drug paraphernalia.

A bill making strips legal, supported by Texas Republican Gov. Greg Abbott, died in the Texas Senate recently because some lawmakers believe legalization will give people more confidence to abuse drugs, the Dallas Morning News reported.

West, who also introduced a bill to decriminalize strips, said there’s not yet a consensus in the Texas Senate to do so.

“And, unfortunately, what will probably happen, the more and more deaths that are occasioned by the use of fentanyl, then the more there will be a willingness in order to decriminalize it,” he said.

“It is moving, and I think, ultimately, it will get done,” West added.

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Fetterman calls for Menendez to resign

Sen. John Fetterman (D-Penn.) called for Sen. Bob Menendez (D-N.J.) to resign from the Senate on Saturday, making him the first senator to call for his resignation.

“Senator Menendez should resign,” Fetterman said in a post on X, formerly known as Twitter. “He’s entitled to the presumption of innocence, but he cannot continue to wield influence over national policy, especially given the serious and specific nature of the allegations.”

Menendez was indicted Friday for allegedly accepting bribes to use his influence as chair of the Foreign Relations Committee to benefit the Egyptian government and businessmen. Menendez has since stepped down from his position on the committee, in compliance with Senate Democrat bylaws.

However, Menendez — who has faced multiple calls for resignation from other New Jersey Democrats — said he plans on continuing his role as senator.

"I am not going anywhere,” Menendez said in a statement Friday.

Fetterman, a freshman Democrat from Pennsylvania, said he hopes Menendez “chooses an honorable exit and focuses on his trial.”

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Ukraine targets a key Crimean city a day after striking Russia’s Black Sea Fleet headquarters

KYIV, Ukraine — Ukraine on Saturday morning launched another missile attack on Sevastopol on the occupied Crimean Peninsula, a Russian-installed official said, a day after an attack on the headquarters of Russia’s Black Sea Fleet that left a serviceman missing and the main building smoldering.

Sevastopol was put under an air raid alert for about an hour after debris from intercepted missiles fell near a pier, Gov. Mikhail Razvozhayev wrote on the messaging app Telegram. He later added that another missile fragment fell in a park in northern Sevastopol, parts of which had to be cordoned off. Ferry traffic in the area was also halted and later resumed.

Loud blasts were also heard near Vilne in northern Crimea, followed by rising clouds of smoke, according to a pro-Ukraine Telegram news channel that reports on developments on the peninsula. Crimea, illegally annexed by Russia in 2014, has been a frequent target for Ukrainian forces since Russian President Vladimir Putin ordered a full-scale invasion of Ukraine in February 2022.

Ukraine’s intelligence chief, Kyrylo Budanov, told Voice of America on Saturday that at least nine people were killed and 16 others wounded as a result of Kyiv’s attack on the Black Sea Fleet on Friday. He claimed that Alexander Romanchuk, a Russian general commanding forces along the key southeastern front line, was “in a very serious condition” following the attack.

Budanov’s claim couldn’t be independently verified, and he didn’t comment on whether Western-made missiles were used in Friday’s attack. The Russian Defense Ministry initially said that the strike killed one service member at the Black Sea Fleet headquarters, but later issued a statement that he was missing.

Ukraine’s military also offered more details about Friday’s attack. It said the air force conducted 12 strikes on the Black Sea Fleet headquarters, targeting areas where personnel, military equipment and weapons were concentrated. It said that two anti-aircraft missile systems and four Russian artillery units were hit.

Crimea has served as the key hub supporting Russia’s full-scale invasion of Ukraine. Sevastopol, the main base of Russia’s Black Sea Fleet since the 19th century, has had a particular importance for navy operations since the start of the war.

Ukraine has increasingly targeted naval facilities in Crimea in recent weeks while the brunt of its summer counteroffensive makes slow gains in the east and south of Ukraine, the Institute for the Study of War said. Military experts say it is essential for Ukraine to keep up its attacks on targets in Crimea to degrade Russian morale and weaken its military.

In other developments, President Joe Biden told his Ukrainian counterpart at their White House meeting Thursday that the U.S. would give Ukraine a version of the longer-range ATACMS ballistic missiles, without specifying how many or when they would be delivered, according to two U.S. officials who spoke on condition of anonymity because they were not authorized to publicly discuss the matter before an official announcement.

Ukraine’s president, Volodymyr Zelenskyy, and other Ukrainian leaders have long pushed the U.S. and other Western allies to provide longer-distance weapons that would enable Kyiv to ramp up its strikes behind Russian lines while themselves staying out of firing range.

The U.S. has balked so far, worried that Kyiv could use the weapons to hit deep into Russian territory and escalate the conflict. The Army Tactical Missile System, known as ATACMS, could give Ukraine the ability to strike Russian targets from as far away as about 180 miles, but the U.S. also has other variants of the missile that have a shorter range.

Elsewhere, Ukraine’s military said Saturday that Russia launched 15 Iranian-made Shahed drones at the front-line Zaporizhzhia region in the southeast, as well as Dnipropetrovsk province farther north. It claimed to have destroyed 14 of the drones.

Separately, Zaporizhzhia regional Gov. Yuri Malashko said that Russia over the previous day carried out 86 strikes on 27 settlements in the province, many of them lying only a few miles from the fighting. Malashko said that an 82-year-old civilian was killed by artillery fire.

In the neighboring Kherson region, Gov. Oleksandr Prokudin said that a 65-year-old woman was killed on Saturday as a Russian shell struck her yard, while a 78-year-old man was hospitalized with life-threatening injuries after a Russian drone dropped explosives.

Prokudin said earlier in a separate statement that at least one person died and three other people were wounded over the previous day because of Russian shelling. Russia fired 25 shells targeting the city of Kherson, which lies along the Dneiper River that marks the contact line between the warring sides, Prokudin said.

Residential quarters were hit, including medical and education institutions, government-built stations that serve food and drinks, as well as critical infrastructure facilities and a penitentiary, he added.

In the eastern Donetsk region, where heavy fighting is ongoing on the outskirts of Bakhmut, Russian shelling killed one civilian and wounded another on Friday and overnight, local Gov. Ihor Moroz reported Saturday.

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Biden receives updated Covid shot amid rocky rollout, vaccine polarization

President Joe Biden received the updated Covid-19 vaccine, according to a memo from White House physician Kevin O’Connor released Saturday.

“As we enter the cold and flu season, the President encourages all Americans to follow his example and to check with their healthcare provider or pharmacist to assure that they are fully vaccinated,” O’Connor wrote in the memo.

The president received the Covid vaccine alongside the annual flu vaccine Friday, O'Connor wrote. First lady Jill Biden experienced "mild symptoms" when she contracted Covid earlier this month. The president tested negative.

The updated shot was approved by the FDA earlier this month and the CDC recommended it for all individuals six months and older — however, the rollout has been rocky.

With the federal government no longer purchasing and distributing the shot, logistical hiccups and confusion over insurance coverage have presented obstacles to people seeking the vaccine.

Covid hospitalization data published by the CDC show that virus levels have surged recently. However, the CDC stopped recording individual cases when the public health emergency ended in May, so the exact number of cases is uncertain.

The White House has also struggled to combat growing anti-vaccine sentiment in a polarized political environment.

Vaccine skepticism is increasingly pronounced in the GOP, polls show. A new POLITICO | Morning Consult poll showed that Republican voters were less likely than Democrats or independents to say vaccines are safe for children and only 27 percent of Republicans said the Covid vaccine is “very safe” for adults — while nearly as many, 23 percent, said it’s “very unsafe."

GOP presidential candidates, in contrast to Biden, have disavowed the vaccine. Biotech entrepreneur Vivek Ramaswamy has said he regrets taking the vaccine (although his wife, a surgeon, has disagreed) and Florida Gov. Ron DeSantis has leaned into Covid skepticism.

Biden's primary challenger, Robert Kennedy, Jr., is also a prominent vaccine skeptic.

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Rough start for Covid vax rollout

The fourth major rollout of Covid-19 vaccines has hit speed bumps now that the federal government is no longer purchasing and distributing the shots.

Most Americans with public and private health insurance can still get the shot for free, as long as they visit in-network providers. But as the vaccines make their debut on the commercial market, a mix of distribution hiccups and confusion over insurance coverage has led people to walk out of pharmacies without their Covid shot.

In some cases, the pharmacies have no shots to give; in others, people are being asked to fork over hundreds of dollars for what they thought would be covered by their insurance.

The early stumbles are a threat to an administration hoping for robust uptake of the newest vaccine and an improved performance over last season’s shot when roughly 17 percent of the U.S. got it, according to the CDC figures from May. Health experts already fear the effects of pandemic fatigue and a growing wave of anti-vaccine sentiment on this shot’s uptake; a troubled rollout could turn more Americans off.

“We’re really worried that if a patient's vaccine is not covered and they leave, they may not come back, and that's a lost opportunity,” said Ilisa Bernstein, senior vice president for pharmacy practice and government affairs at the American Pharmacists Association.

While the nation is no longer in a pandemic, there’s been a steady uptick of cases and hospitalizations in recent months. And the Biden administration is concerned enough about the virus to announce this week a restart of its mail-order Covid test program.

The early problems prompted finger-pointing over who bears responsibility: Insurers blamed pharmacists for miscoding the vaccines, pharmacists blamed suppliers for not delivering enough shots.

HHS said Thursday it’s aware of coverage denials and has reached out to insurance plans to make sure their systems are up to date.

"Our message is simple, if you are being turned away for no coverage, please call your insurance for details about in-network coverage to receive the updated COVID-19 vaccine,” an HHS spokesperson wrote in an email.

One of the central issues has been that pharmacists unfamiliar with the new procedures were inputting incorrect information — such as mixing up insurance codes for the new vaccine with those for last year's bivalent vaccine — prompting insurers to deny coverage, said two Biden officials familiar with the matter, granted anonymity to freely discuss the rollout.

Some insurers also have not updated their systems to account for the new vaccine, resulting in similar errors.

“The rollout of new things can be challenging,” said Jen Kates, senior vice president at KFF, who’s tracking the vaccine rollout. “It’s hard to know how pervasive these challenges are.”

HHS Secretary Xavier Becerra downplayed the significance of the glitches and confusion reported across the country, insisting on Wednesday that pharmacies were resolving the problems and encouraging people to contact their insurers if they ran into trouble.

Spokespeople for Cigna, Blue Cross Blue Shield and Elevance Health told POLITICO that most members can get the vaccine for free. A Cigna Healthcare spokesperson said the company updated its codes about two weeks ago, and that some pharmacies are submitting claims incorrectly.

United and Humana didn’t respond to requests for comment.

America’s Health Insurance Plans told POLITICO in a statement that its members are covering Covid-19 shots when administered through in-network providers.

“We are working closely with the federal government, pharmacies and other partners to quickly ensure patient access to COVID-19 vaccines with $0 cost sharing and address any issues relating to newly added billing codes quickly,” the group said.

Some people with insurance may still have out-of-pocket expenses if they go to a provider that is outside their network, Kates said, unless no providers in the plan’s network carry the shot.

Pharmacies, meanwhile, expect most issues to be quickly resolved.

Rite Aid spokesperson Catherine Carter said the chain hasn’t experienced any coding or billing issues with the new vaccines, which are expected in stores by this weekend, but in some instances there aren’t enough shots.

“In many stores, demand for the new COVID-19 vaccine has exceeded the supply allocated by the manufacturer,” she said in a statement.

Walgreens spokesperson Erin Loverher said most of the chain’s stores have enough doses to ensure existing appointments can be kept, though some locations have seen supply delays and have paused online scheduling.

CVS stores are receiving the new shots on a rolling basis, said spokesperson Matt Blanchette, and some appointments may need to be moved “due to delivery delays to select stores.”

Pharmacists who spoke to POLITICO said they expect the supply and coverage issues to smooth out in the coming weeks as more vaccines make their way to providers and as insurers and pharmacies update their systems.

The FDA and the CDC last week signed off on the approved Pfizer and Moderna vaccines, which have been updated to target the Covid strain that circulated in late spring and early summer. Manufacturers began shipping doses as soon as CDC Director Mandy Cohen’s recommendation became official.

But now that pharmacies have to pay for doses upfront, stores must balance those costs with anticipated demand and questions around reimbursement from payers.

Brian Caswell, a pharmacist in Baxter Springs, Kan., hasn’t been able to test those issues because his Moderna order has yet to arrive. He said he’s seen TV ads claiming the vaccines are available in local pharmacies.

“That’s funny, because they’re not here in my pharmacy or in any of my pharmacies,” Caswell told POLITICO.

Spokespeople for Pfizer and Moderna said they have plenty of doses to distribute, with each company shipping millions of doses so far.

The early difficulties follow months of preparation inside the administration for the transition to a commercialized system.

Biden officials voiced concerns earlier this summer that the shift could be bumpy, a Biden official involved in internal conversations who was not authorized to speak on the record said. The officials urged HHS leaders to work closely with insurers and pharmacies to ensure their workers were trained and prepared.

In July, CMS sent a letter to payers, advising them to prepare for the shift and in August, the American Medical Association published new codes for payers to use for the new shots. Following the shots’ authorization, CMS sent another letter to payers with those new codes. In September, HHS launched the Bridge Access Program, which will provide free vaccines to the uninsured.

APhA’s Bernstein said “growing pains” between pharmacy and plan systems aren’t unusual when a new medical product hits the market.

“It’s just kind of this perfect storm of a lot of things happening at once,” she said.

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