Health Brief: ACA Replacement Bill Tests Ryan-Trump Relationship

Washington Brief

  • The complicated party politics surrounding repealing and replacing Obamacare presents an essential test of the alliance between President Trump and Speaker Paul Ryan (R-Wis.). (The New York Times)
  • The House GOP’s Obamacare replacement bill narrowly cleared the Budget Committee by one vote. The panel also voted along party lines to recommend the bill be changed to include steeper cuts to Medicaid and work requirements for “able-bodied” participants. (The Washington Post)
  • The House Freedom Caucus is bypassing Ryan in negotiating for conservative changes to the GOP bill, and has found a sympathetic ear in Trump’s Chief Strategist Steve Bannon. (Politico)

Business Brief

  • Marathon Pharmaceuticals’ controversial $89,000-a-year muscular dystrophy drug is being purchased by PTC Therapeutics for $140 million. The drug’s new price was not announced. (Kaiser Health News)
  • The Medical Group Management Association sent a letter to CMS saying doctors could potentially lose millions in Medicare reimbursement dollars due to a lack of MACRA-related guidance from the agency. (Modern Healthcare)
  • Insurers see premiums rising in 2018, a concerning sign for Republicans seeking to rally support to replace Obamacare. (The Wall Street Journal)

Chart Review

Events Calendar (All Times Local)

RAND Corporation Briefing on the ACA Future 12 p.m.



Trump and Ryan: Health Bill May Test Marriage of Convenience
Matt Flegenheimer and Maggie Haberman, The New York Times 

President Trump, once the master pitchman for namesake vodka, steaks and now-moldering casinos, seems disinclined to attach his surname to the health care bill some allies have derided as “Ryancare.” He assured Americans on Thursday of the “improvements being made” to legislation that Speaker Paul D. Ryan initially suggested would scarcely change, amid grumblings that the White House is fuming over the plan’s star-crossed rollout.

Freedom Caucus aligns with Bannon in risky Obamacare gambit
Rachael Bade et al., Politico

Steve Bannon was furious. Last weekend, the Washington Examiner published a story claiming that President Donald Trump had vowed to back primary challengers to run against Republicans who oppose the GOP’s health care plan.

GOP health-care plan: Key House panel calls for work requirements, additional cuts in Medicaid
Mike DeBonis and Sean Sullivan, The Washington Post 

The Republican proposal to overhaul the Affordable Care Act cleared a key hurdle Thursday, as the House Budget Committee narrowly voted to move it to the House floor and recommended a series of changes to the plan reflecting concerns from conservatives and centrists. All of the panel’s Republicans and five Democrats supported a motion to change the system of tax credits created under the plan to ensure they are “afforded to the population that they are intended to serve,” an idea embraced across the ideological spectrum, including among centrists whose votes could be key.

Sen. Collins says she can’t support House health care plan in current form
Joe Lawlor, The Portland Press Herald

Sen. Susan Collins of Maine said Thursday that she opposes the House Republican health care bill being debated in Congress. Though the moderate Republican previously has raised concerns about the bill to replace the Affordable Care Act, she had not previously said she was against it.

GOP faces major hurdles in reducing repeal bill’s coverage losses
Harris Meyer, Modern Healthcare

Efforts by Senate Republicans to reduce the number of Americans who would lose coverage under the GOP healthcare reform bill face some stark political arithmetic: Restoring coverage for many or most of the 24 million people projected to lose it would cost lots of money conservatives don’t want to spend. On top of that, a higher price tag for the bill could jeopardize its ability to meet the Senate’s strict budget reconciliation rules, through which Republicans hope to avoid a Democratic filibuster and pass the bill on a strictly party-line vote.

The sleeping giants of the Obamacare debate: Republican moderates in the House
Paul Kane, The Washington Post 

Arch conservatives have come to define the House Republican brand this decade, pushing the Treasury to the edge of default in 2011, shutting down the government in 2013 and supporting the most right-wing contenders in last year’s presidential primary. Now, however, Speaker Paul D. Ryan (R-Wis.) is dealing with a different rebellious flank within the House Republican Conference as he pushes a massive health-care bill toward the floor next week.

Trump proposes shuttering NIH program that promotes medical research overseas
Max Blau, Stat News

One of the National Institutes of Health’s only programs devoted to global health research and training is on the chopping block as part of President Trump’s vision for an overhaul of some government agencies. The administration’s budget blueprint, released Thursday, lays out sweeping cuts, including the elimination of the NIH’s Fogarty International Center.

Emerging Stocks Shine Even as Global Rally Slows: Markets Wrap
Adam Haigh et al., Bloomberg News

Emerging markets headed toward the best week in eight months even as the global equities rally spurred by the Federal Reserve’s outlook lost momentum. The dollar was poised for its biggest weekly loss since February.


Insurers See Health-Care Premiums Increasing Significantly in 2018
Anna Wilde Matthews, The Wall Street Journal

Republicans seeking to overhaul the Affordable Care Act face growing signs that there could be big increases in premiums for individual plans next year, which poses a challenge as the lawmakers try to rally support for the replacement legislation. According to a nonpartisan report released by the Congressional Budget Office on Monday, the House Republicans’ bill, known as the American Health Care Act, could raise premiums by 15% to 20% for individual plans in 2018, compared with rates without the bill.

Ne​xt up in ​House: health insurance across state lines
David Nather, Axios

House Energy and Commerce Committee chairman Greg Walden is teeing up one of the next bills in the Republicans’ “Phase 3” of replacing Obamacare: selling health insurance across state lines. The health subcommittee is preparing to hold a hearing on the idea in the next few weeks, probably before the Easter recess, a committee aide tells Axios.

GOP Health Plan Risks Sticker Shock for Trump’s Base
Dante Chinni, The Wall Street Journal

The House Republican plan to “repeal and replace” the Affordable Care Act has exposed a divide that runs through the middle of the current Republican Party. On one side are the desires of the establishment GOP, represented by Rep. Paul Ryan and the House leadership, and on the other are the concerns of the populist GOP that propelled President Donald Trump to the White House.

Ala., Tenn. Blues join risk-corridor lawsuit fray
Maria Castellucci, Modern Healthcare

The fight by health insurers to recover losses from the Affordable Care Act’s risk-corridor programs continues. Blue Cross and Blue Shield affiliates in Alabama and Tennessee were the latest plans to sue the federal government to force payment under the program.

Too young for Medicare, some seniors could pay more under the Obamacare replacement
Casey Ross, Stat News

Erika Snyder thought she was in the clear. An Obamacare policy covered surgery to remove a tumor from her lungs, leaving her with minimal costs for the $200,000 ordeal and a chance for a manageable semi-retirement. But now, the 63-year-old Denver resident said she is not just worried about the cancer coming back.

GOP faces dilemma over ObamaCare tax credits in red states
Lauren Clawson, The Hill Extra

Nine of the 10 states using the most ObamaCare tax credits were won by President Trump, new data show, highlighting the divisions his party faces as it seeks to remake the health law. Alabama, Alaska, Florida, Mississippi, Nebraska, North Carolina, Oklahoma, South Carolina and South Dakota had the highest use of the law’s tax credits during the 2017 open enrollment, according to data released Wednesday by the Trump administration.


Docs left in the dark by CMS over MACRA compliance requirements
Virgil Dickson, Modern Healthcare

Doctors are potentially facing a loss of millions in Medicare reimbursement dollars due to lack of MACRA-related guidance from the CMS, according to a letter to the CMS from the Medical Group Management Association. In a final rule announced last year, the CMS said it would exempt physician practices with less than $30,000 in Medicare charges or fewer than 100 unique Medicare patients per year from complying with the Merit-based Incentive Payment System outlined under MACRA.

American Medical Association urges GOP to go ‘back to the drawing board’
Peter Sullivan, The Hill

The head of the American Medical Association (AMA) delivered a sharp warning Thursday to congressional Republicans, telling them to go “back to the drawing board” on their ObamaCare repeal-and-replace bill and warning that the bill’s current version would take needed coverage away from people. Dr. Andrew Gurman, the president of the AMA, the country’s largest doctors group, delivered an “urgent call to congressional leaders to go back to the drawing board” on their bill to repeal and replace ObamaCare, legislation the GOP has dubbed the American Health Care Act.

Obamacare Pushed Nonprofit Hospitals To Do Good Beyond Their Walls. Now What?
Shefali Luthra, Kaiser Health News

For the past six years, Mardi Chadwick has run a violence prevention program at Boston’s Brigham and Women’s Hospital. The program’s goal is to address broader, community-based health issues and social problems that make people ill or prone to repeated injury from gunshots, stabbings or environmental causes.

Pharma, Biotech and Devices

$89,000 Orphan Drug Gets A New Owner — And Likely A New Price
Sarah Jane Tribble, Kaiser Health News

Marathon Pharmaceuticals’ controversial $89,000-a-year drug that has drawn outrage from patients and intense questioning from Congress is getting a new owner. After striking a deal Wednesday evening, PTC Therapeutics announced plans early Thursday to buy the Duchenne muscular dystrophy drug Emflaza from Marathon for $140 million in cash and stock. The drug’s new price was not announced.

Health IT

VA healthcare remains a high waste and management risk
Rachel Z. Ardnt, Modern Healthcare

The Veterans Administration’s healthcare IT continues to be outdated, inefficient and without sufficient interoperability, and the agency needs to take significant steps before it’s no longer considered a high risk of fraud and abuse, the U.S. Government Accountability Office told a Senate panel on Wednesday. VA healthcare will remain designated high-risk by GAO until it sufficiently addresses its unclear policies, process variability and other mismanagement issues, said Debra Draper, director of healthcare for the GAO, in testimony before the Senate’s Committee on Veterans’ Affairs.

A Message from PhRMA:

More than a third of the initial list price of brand medicines is rebated back to insurance companies, PBMs and the government, or retained by the supply chain. And the gap between list and net prices is growing every year.

Opinions, Editorials and Perspectives

Let the ‘Buyer Beware’ for Health Care Purchases
Robert Popovian, Morning Consult 

Will patients ever shop for health care the way consumers do for a new mobile phone? Injecting consumerism into health care purchasing has been the rage for the past several decades.

Three Criteria for Health Reform
Ted Cruz and Mark Meadows, The Wall Street Journal

Republicans have a historic opportunity to follow through on our promise to repeal ObamaCare. The recent elections that focused on the law’s repeal—2010, 2014 and 2016—were massive GOP victories.

Repeal and Replace: What Would Reagan Do?
Robert Pittenger, The Wall Street Journal

Almost 30 years after leaving office, Ronald Reagan is widely considered one of America’s greatest leaders and the icon of the conservative movement. As a Republican member of Congress, I often speak at Lincoln-Reagan Day dinners and other events honoring his legacy.

How to save the GOP health-care plan
Hugh Hewitt, The Washington Post 

The American Health Care Act is in trouble, with House Speaker Paul D. Ryan (R-Wis.) admitting Wednesday that the bill must change to make it through Congress. The reason? The Republican right and the Republican center want different things, and the rules under which the proposed Obamacare replacement can pass the Senate by a simple majority make it extremely hard to satisfy both sides.

The G.O.P. Health Care Plan’s Fatal Flaw
Daniel Hemel and David Herzig, The New York Times 

Senator Robert Byrd helped save the Affordable Care Act once already. In December 2009, the wizened West Virginia Democrat overcame fragile health to cast a crucial vote for the act’s passage.

How to Repair ObamaCare’s Fiscal Damage
Charles Blahous, The Wall Street Journal

Most of the debate about the Affordable Care Act has centered on how it affects health care. It’s time to pay attention to how ObamaCare has damaged federal finances.

A Message from PhRMA:

Share of gross (based on list price) medicine spending kept by brand biopharmaceutical companies is falling. After accounting for discounts and rebates, brand biopharmaceutical companies retained just 63 percent of total list price spending on brand medicines. The rest was rebated back to PBMs, health plans and the government, or retained by other stakeholders in the biopharmaceutical supply chain. Read the first-of-its-kind study here.

Research Reports

Regulatory Implications of the American Health Care Act 
Sam Batkins, American Action Forum 

With the formal introduction of the “American Health Care Act,” (AHCA) Congressional Republicans have made their first foray into health care reform this year. From a regulatory perspective, by eliminating many of the taxes and exchange-related components of the Affordable Care Act (ACA), the AHCA could generate significant regulatory savings.