FDA commissioner nominee Robert Califf. Photo: Sarah Silbiger/Bloomberg via Getty Images

Robert Califf, President Biden's nominee to lead the FDA, is facing a surprisingly tight confirmation vote in the Senate.

Between the lines: A handful of Democrats have already announced their opposition to him over concerns about his drug industry ties or the FDA's record on the opioid epidemic, and several others may be on the fence.

• But abortion politics — not to mention the opportunity to sink a Biden nominee — are complicating efforts to make up for these defectors with Republican votes.

Driving the news: The Senate Health, Education, Labor and Pensions committee is scheduled to vote on his nomination today, and it's likely to have the votes to pass.

• But whether his nomination has the votes to pass on the Senate floor is a stickier question, even though he was previously confirmed by an 89-4 vote to lead the agency during the last year of the Obama administration.
• Pro-life groups have urged members to vote against Califf's nomination, a wrinkle that certainly makes it a tougher decision for Republicans who may have otherwise been inclined to vote for him.
• "It's going to be a nail-biter until the end," said a senior HELP committee aide.

The big picture: The FDA has been without an approved commissioner for nearly a year — a gap that's become more obvious as the pandemic has dragged on.

• But the agency's recent decision to permanently allow patients to receive abortion pills by mail has drawn intense criticism from pro-life groups.
• They also accused Califf of having a "track record of rubber-stamping abortion industry demands" in a letter sent yesterday to senators.

State of play: At least three Democrats — Sens. Joe Manchin, Bernie Sanders and Maggie Hassan — have already said they won't vote to confirm Califf.

• Hassan announced her opposition this week, saying that Califf wouldn't do enough to change the FDA's approach to the nation's substance abuse epidemic. Sanders criticized him as being too close to the drug industry, and Manchin cited both of these concerns.
• Democratic Sen. Richard Blumenthal, who voted against Califf's confirmation in 2016, has said he has the same "grave reservations” as he did then. Manchin and Sen. Ed Markey also voted against him in 2016.

The intrigue: In an evenly split Senate, each Democratic defector must be replaced with a Republican vote in order for him to pass. So far, only three — Sens. Richard Burr, Susan Collins and Mitt Romney — plan to vote yes, according to the HELP committee aide. All are on the committee.

• Spokespeople for Collins and Romney didn't respond to requests for comment about their positions, although Collins told Politico last month she supports the nomination. Burr said at Califf's confirmation hearing that he intends to support him.

• Among the other 47, "work is being done to secure more votes," the aide said. Although Sen. Lisa Murkowski is viewed as a likely yes vote, her office didn't respond to a request for comment.
• The abortion-related concerns has made finding the votes much harder. A spokesperson for Sen. Roger Marshall, who told Politico last month that he supported Califf's confirmation, told Axios last night that he no longer does because of pro-life concerns.

Republicans' dilemma: If they allow Califf's nomination to fail, it's pretty unlikely they'd like Biden's next nominee any better.

• Califf is generally regarded as competent and a comfortable pick for the drug industry, at least relative to more progressive options. And Biden is certainly not going to nominate anyone who will roll back abortion rights via agency regulation.
• Some Republicans will support his nomination, it's "just unclear if that's enough to overcome D no votes," emailed a senior GOP Senate aide. "A little bit of the devil you know vs. the devil you don't mentality."

What they're saying: "We're confident he’ll be confirmed with bipartisan support and it is critical to have confirmed leadership in the midst of the pandemic," said White House spokesperson Chris Meagher.

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