Health Brief: Administration Considers New Rules for ACA Enrollments

Washington Brief

  • The Trump administration is considering new rules for Affordable Care Act enrollments, including slashing the length of open enrollment and allowing insurers to charge older patients more. (Politico)
  • Two top Republicans say they’re still working to repeal Obamacare this spring, even after President Donald Trump suggested repealing and replacing the health care law could stretch into next year. (The Hill)
  • Conservatives are growing increasingly frustrated at the pace at which Obamacare repeal is moving on Capitol Hill. (CNN)
  • Sens. Ted Cruz (R-Texas) and Bernie Sanders (I-Vt.) are set to square off in a debate on health care tonight on CNN.

Business Brief

  • Pharmaceutical companies are increasingly advocating for performance-based pricing programs, in which they would refund money for drug treatments that don’t work effectively. (Bloomberg News)
  • TeamHealth, a physician staffing company, will pay $60 million to settle allegations that it overcharged the Centers for Medicare and Medicaid Services. (Modern Healthcare)
  • Teva Pharmaceuticals lost its third CEO this decade, and stocks fell 1.8 percent in Tel Aviv trading. Chairman Yitzhak Peterburg will serve as interim CEO. (Bloomberg News)

Chart Review

Events Calendar (All Times Local)

Tuesday
House Energy and Commerce Subcommittee Mark up Medicaid bills 10 a.m.
House Small Business Committee Hearing on Small Business Insurance Exchange 11 a.m.
Wednesday
No events scheduled
Thursday
Brookings Institution event on Obamacare markets 9 a.m.
Friday
No events scheduled

 

General

ACA Repeal Seen Thwarting State Addiction Efforts
Christine Vestal, Stateline

In the three years since the Affordable Care Act took effect, its federally funded expansion of Medicaid to low-income adults has become the states’ most powerful weapon in the battle against the nation’s worsening opioid epidemic. Now, as Congress and President Donald Trump debate potential replacements for the law, governors, health care professionals and advocates for the poor are cautioning that any cut in federal funding for addiction treatment could reverse much of the progress states have made.

Dollar Jumps, Gold Falls as Demand for Havens Ebbs: Markets Wrap
Natasha Doff, Bloomberg News

The dollar strengthened against all of its major peers on the prospect of a U.S. interest rate increase as soon as March. Weakness in the euro helped European stocks shrug off some disappointing corporate results.

Payers

Republicans begin to grumble: Why haven’t we repealed Obamacare yet?
MJ Lee, CNN

Donald Trump vowed as a candidate to kill Obamacare in short order. But more than two weeks into his presidency, some Republicans are starting to ask: What happened to repealing the law quickly

Republicans: ObamaCare repeal starts this spring
Peter Sullivan, The Hill

Two of the top Republicans in Congress on Monday said they are pushing ahead with the plan to begin repealing ObamaCare this spring, despite any confusion caused by President Trump saying the process could spill into next year. House Ways and Means Committee Chairman Kevin Brady (R-Texas) told reporters that he is working off of Speaker Paul Ryan’s (R-Wis.) timeline of moving repeal legislation by the end of March.

Trump administration weighs Obamacare changes sought by insurers
Dan Diamond et al., Politico

The Trump administration is considering major changes to Obamacare that may help convince insurers to remain in the law’s marketplaces while Congress drafts a replacement plan — but the proposals may also limit enrollment and increase costs for older Americans, according to documents obtained by POLITICO. The administration is looking to alter rules around insurers charging older customers more, how much cost they can shift onto customers, and who’s allowed to sign up outside the standard enrollment window.

From ‘Repeal’ to ‘Repair’: Campaign Talk on Health Law Meets Reality
Michael D. Shear and Robert Pear, The New York Times

Asked at a confirmation hearing two weeks ago if he was working with President Trump on a secret plan to replace the Affordable Care Act, Representative Tom Price, Mr. Trump’s nominee for secretary of health and human services, smiled broadly and answered: “It’s true that he said that, yes.” The committee room, filled with health care lobbyists, consumer advocates and others with a vital stake in the future of the health care law, erupted with knowing laughter at Mr. Price’s careful formulation.

Conservative Republicans Double Down on Push to Repeal Health Law
Kristina Peterson and Louise Radnofsky, The Wall Street Journal

Conservative Republicans, worried about growing voices within the party advising or accepting a slower pace for repealing the Affordable Care Act, are redoubling their push to speed the GOP’s long-desired goal. President Donald Trump on Sunday became the latest top Republican to sound cautious notes about the party’s ability to rapidly repeal large swaths of the 2010 health law and enact its own vision.

Arizona and Texas hope Trump will approve waivers Obama rejected
Virgil Dickson, Modern Healthcare

Arizona and Texas officials hope the Trump administration will be more receptive to Medicaid waivers that would fund care for the uninsured, impose work requirements and place a life cap on enrollment. Texas state officials want a 21-month extension waiver that will help cover the unpaid bills of Medicaid-eligible and uninsured patients in the state.

Zenefits Picks Jay Fulcher as New CEO
Rolfe Winkler, The Wall Street Journal

Zenefits chose software executive Jay Fulcher as its new chief executive, the third person to lead the embattled health-benefits broker since early 2016. Mr. Fulcher, a former CEO of software startup Ooyala Inc. and Agile Software Corp., will replace David Sacks, who in early December said he would step down less than a year after taking the reins from Zenefits co-founder Parker Conrad.

Obamacare Helped The Homeless, Who Now Worry About Coverage Repeal
Pam Fessler, NPR News

Everyone expects Congress to change the Affordable Care Act. But no one know exactly how. The uncertainty has one group of people especially concerned — the homeless. Many of these people received health coverage for the first time under Obamacare.

Providers

TeamHealth will pay $60 million to settle CMS overbilling claims 
Maria Castellucci, Modern Healthcare

Physician staffing giant TeamHealth Holdings will pay $60 million to settle allegations that a hospitalist services provider it acquired overcharged the CMS. IPC, a physician group practice TeamHealth purchased in 2015, allegedly encouraged its hospitalists to overbill Medicare and Medicaid, according to the U.S. Justice Department.

Trump’s Travel Ban, Aimed at Terrorists, Has Blocked Doctors
Donald G. McNeil, Jr., The New York Times

The Trump administration has mounted a vigorous defense of its ban on travel from seven majority-Muslim nations, saying it is necessary to prevent terrorists from entering the United States. But the ban, now blocked by a federal judge, also ensnared travelers important to the well-being of many Americans: doctors.

Pharma, Biotech and Devices

Big Pharma’s Offer to Trump: Discounts When Drugs Don’t Work
Jared S. Hopkins et al., Bloomberg News 

President Donald Trump says drug prices are astronomical and something needs to be done. Pharmaceutical giants have an answer that doesn’t involve lowering list prices: refunding some of the money to insurers if a drug doesn’t work as expected.

Report: Drug price increases were tame in 2016
Adam Rubenfire, Modern Healthcare

Per-person prescription drug spending increased 3.8% for health plans covering employees and their families, a tame increase when compared to the prior year, according to a new report from Express Scripts. The St. Louis-based pharmacy benefits manager said the increase was 26.9% less than the 5.2% increase observed in 2015.

FDA proposal on biotech drugs sparks criticism
Sarah Chacko, The Hill Extra

An FDA plan to give biotech drugs more distinct names is facing criticism from multiple sides, including some drugmakers and the federal agency in charge of competition. At issue is guidance that calls for the addition of different suffixes to the names of original brand name biologics — complex drugs made from living materials — and their copies, called biosimilars.

Picking the Right Over-the-Counter Pain Reliever
Christopher Mele, The New York Times

Picking the pain reliever that’s best for you can be a confusing task. Pharmacy and supermarket shelves are lined with a dizzying array of boxes, names and labels describing the symptoms the medications are intended to address. While they all share the same goal, making you feel better, their active ingredients vary, and all have potential drawbacks.

Teva Loses CEO, Leaving Investors to Guess What’s Next
Yaacov Benmeleh and Caroline Chen, Bloomberg News

The departure of Teva Pharmaceutical Industries Ltd.’s third CEO this decade leaves his successor with challenges on many fronts, from eroding profits and mounting competition to probes into its U.S. operations. Chairman Yitzhak Peterburg was named chief executive on an interim basis following Erez Vigodman’s sudden departure, and a search is underway for a successor, according to the Petach Tikva, Israel-based company.

Health IT

Claims that mHealth can save costs may miss the mark
Evan Sweeney, Fierce Healthcare

Proponents of mHealth apps often say the tools can help hospitals cut patient treatment costs by streamlining care. But a more detailed look shows there’s often inadequate evidence to support those assertions.

A Message from PhRMA:

It is not a video game. It is not a screen saver. Our latest #GoBoldy ad showcases how breakthrough immunotherapy treatments are destroying cancer cells inside the human body, revolutionizing how scientists fight this deadly disease. Watch now at www.GoBoldly.com

Opinions, Editorials and Perspectives

Medicaid Changes Should Include Care for Special Needs Children
Margaret A. Murray, Morning Consult

As the new Administration embarks upon its first hundred days, it and the Congress have come to Washington with the promise of big changes – big, quick changes – to the health care system. Congress has already begun to put together its budget for fiscal year 2017, and has signaled its intent to roll back several provisions of the Affordable Care Act in the near future.

Tom Price, Dr. Personal Enrichment
David Leonhardt, The New York Times

Each year, a publication called Medscape creates a portrait of the medical profession. It surveys thousands of doctors about their job satisfaction, salaries and the like and breaks down the results by specialty, allowing for comparisons between, say, dermatologists and oncologists.

The ObamaCare Cleanup Begins
The Editorial Board, The Wall Street Journal

All of a sudden the press is filled with stories about Republicans supposedly retreating from their promise to repeal and replace ObamaCare. Liberals are claiming vindication and conservatives are getting nervous, but the stampede to declare failure is premature.

Obamacare, Abortion and the Ease of Extremism
Megan McArdle, Bloomberg View

As Republicans struggle to find a way to repeal and replace Obamacare, and liberals and conservatives gear up for a battle over Supreme Court nominee Neil Gorsuch, it strikes me that the same lesson can be drawn from both phenomena: how much easier it is to hold radical opinions when you have no hope of passing legislation.

Yes, We Can Repeal Every Word of Obamacare
Dean Clancy, Conservative Review

As CR’s Daniel Horowitz has repeatedly warned, timid congressional GOP leaders have no intention of repealing Obamacare. Instead, they want to “fix” it — an impossible task. But last Friday, they lost their last excuse for not repealing every word of the ill-conceived, destructive health care law.

How Trump Can Keep His Pledge to Undo Obamacare Shenanigans
Michael F. Cannon, National Review

During the presidential campaign, candidate Donald J. Trump pledged, “On the first day of my term of office, my administration will … cancel every unconstitutional executive action, memorandum and order issued by President Obama.” Obama’s unconstitutional actions include several he took to rescue Obamacare.

A Message from PhRMA:

It is not a video game. It is not a screen saver. Our latest #GoBoldy ad showcases how breakthrough immunotherapy treatments are destroying cancer cells inside the human body, revolutionizing how scientists fight this deadly disease. Watch now at www.GoBoldly.com

Research Reports

Fact Sheet: Block-Granting Medicaid
The Commonwealth Fund

States would receive a fixed, preset amount of Medicaid funding—a block grant—each year to use to provide health coverage to their low-income residents. The federal contribution to state Medicaid programs in a given year would not change if the number of enrollees were to increase or if the cost of health care services were to rise.

Briefings

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