Health Brief: CBO Score Could Derail Health Bill

Washington Brief

  • The Congressional Budget Office score of Republicans’ health care bill could further complicate the leadership’s push to pass an overhaul of the Affordable Care Act in the next several weeks. Moderates are awaiting details about how many people would be covered under the plan, while conservatives are wary of spending, setting up more potential pushback from one or both of the party’s flanks. (Politico)
  • Two House committees advanced the Republican legislation to repeal and replace the ACA, as President Donald Trump is taking steps to bring wary conservatives on board with the legislation. The Trump administration is open to some of the changes that conservatives are asking for, specifically related to Medicaid expansion, but that risks alienating moderates. (The New York Times)
  • Two of the changes conservatives are pushing for are to freeze the ACA’s Medicaid expansion enrollment at the end of this year and institute work requirements for some Medicaid beneficiaries. Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee, said he’d support the measure if both were added. (The Hill)

Business Brief

  • Anthem CEO Joseph Swedish praised parts of the Republican health care bill and called for swift action in a letter to two GOP committee chairmen. He called for additional reforms outside of the budget reconciliation process, such as appropriating funding for the ACA’s cost-sharing reduction program. (Morning Consult)
  • Hospitals could take a financial hit and see the credit worthiness of their debt downgraded under health care legislation that Republicans on two House committees advanced Thursday, groups such as Moody’s Investors Service and S&P Global ratings have said. (Modern Healthcare)
  • Lawyers have filed lawsuits on behalf of two West Virginia counties against some of the nation’s largest drug distributors, including McKesson Corp., Cardinal Health, AmerisourceBergen, Walgreens and CVS, accusing the companies of creating a public health and safety hazard by sending large amounts of prescription opioids into the counties. (The Washington Post)

Chart Review

Events Calendar (All Times Local)

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Why Trump Supporters Have the Most to Lose With the G.O.P. Repeal Bill
Nate Cohn, The New York Times

The people who stand to lose the most in tax credits under the House Republican health plan tended to support Donald J. Trump over Hillary Clinton in the 2016 election, according to a new Upshot analysis. Over all, voters who would be eligible for a tax credit that would be at least $1,000 smaller than the subsidy they’re eligible for under Obamacare supported Mr. Trump over Hillary Clinton by a seven-point margin.

After Halting Start, Trump Plunges Into Effort to Repeal Health Law
Maggie Haberman and Robert Pear, The New York Times

President Trump, after a halting start, is now marshaling the full power of his office to win over holdout conservatives and waffling senators to support the House Republicans’ replacement for the Affordable Care Act. There are East Room meetings, evening dinners and sumptuous lunches — even a White House bowling soiree.

Obamacare revision clears two House committees as Trump, others tried to tamp down backlash
Mike DeBonis et al., The Washington Post

A Republican proposal to ­revise the Affordable Care Act claimed its first major victories Thursday amid a backlash that both Republican leaders and President Trump spent the day trying to tamp down. Trump met with conservative critics of the plan, signaling both a willingness to negotiate its details and that it does not yet have enough votes to emerge from the House.

House GOP Leaders Surprised by Conservative Opposition to Health Plan
Stephanie Armour et al., The Wall Street Journal

Rep. Mark Meadows, who leads a group of conservative House lawmakers, was home in North Carolina about two weeks ago when he learned details of the emerging Republican health-care plan. Mr. Meadows jumped in the car and drove back to Washington, where he said he warned White House officials he couldn’t support the bill being pushed by House Speaker Paul Ryan.

Conservative demands threaten to derail Obamacare repeal
Rachael Bade and Kyle Cheney, Politico

Hill conservatives were just handed the opening they’ve been waiting for: An invitation from President Donald Trump to “negotiate” on an Obamacare replacement. There’s just one big problem: They’re all over the place on what they want.

Trump’s Obamacare moves cause chaos in Congress
Rachael Bade and Burgess Everett, Politico

President Donald Trump’s early efforts to court conservatives opposed to the GOP’s Obamacare replacement is backfiring in Congress — emboldening the far right to demand changes that could repel centrists critical to its passage. While the president has given a full-throated endorsement of the bill, he’s also suggested he’s open to “negotiations.”

Women’s Health Services Face Cuts in Republican Bill
Mary Clare Jalonick, The Associated Press

Women seeking abortions and some basic health services, including prenatal care, contraception and cancer screenings, would face restrictions and struggle to pay for some of that medical care under the House Republicans’ proposed bill. The legislation, which would replace much of former President Barack Obama’s health law, was approved by two House committees on Thursday.

Senate Advances Trump’s Medicaid, Medicare pick
Jordain Carney, The Hill

The Senate is advancing Seema Verma, President Trump’s nominee to lead the Centers for Medicare and Medicaid Services. Senators voted 54-44 Thursday on her nomination, which needed only a simple majority to overcome the initial procedural hurdle.

Stocks Gain as U.S. Debt Nears Worst Run Since ’74: Markets Wrap
Samuel Potter, Bloomberg News

Energy stocks rallied, leading a third day of gains for European equities as crude prices bounced. Treasuries flirted with the longest losing streak in more than four decades before a U.S. jobs report expected to bolster the case for a rate hike next week.


Budget referee may call foul on Obamacare repeal
Rachana Pradhan, Politico

The fate of Obamacare may lie in the hands of a number-crunching Republican appointee whose bottom line might single-handedly blow up the GOP quest to repeal and replace it.  Congressional Budget Office Director Keith Hall was handpicked two years ago by top Republicans in Congress — including now Health and Human Service Secretary Tom Price — to lead a nonpartisan office that will soon release its estimate of how many Americans the Republican health care bill will cover and whether it shrinks or balloons the federal deficit.

Anthem CEO Praises GOP Health Bill, Calls for Swift Action
Mary Ellen McIntire, Morning Consult

Anthem CEO Joseph Swedish called several provisions of the Republican health care bill “essential,” and called for their quick passage in a Thursday letter to two House committee chairmen obtained by Morning Consult. Swedish’s support for the proposal comes as many doctors and hospital groups have said they don’t support the bill as it’s currently written. Other advocacy groups like AARP and conservative organizations have also slammed the proposal.

Conservative chairman: I’d back health plan with Medicaid

Peter Sullivan, The Hill

The chairman of the conservative Republican Study Committee says that if the House adopted two Medicaid amendments he is pushing, he would vote yes on GOP leadership’s ObamaCare repeal bill, and if he got one, he would “lean yes.” Rep. Mark Walker (R-N.C.) is pushing amendments to move up the end of ObamaCare’s Medicaid expansion for new enrollees to 2018 instead of 2020, as it is in the current bill.

‘Is that not correct?’: Male GOP lawmaker asks why men should
pay for prenatal coverage

Elise Viebeck, The Washington Post

In the 27 hours the House Energy and Commerce Committee spent debating Republicans’ Obamacare revision plan, a handful of moments stand out. This is one of them.

Trump says privately second healthcare bill ready as early as next week
Sarah Westwood and Gabby Morrongiello, The Washington Examiner

President Trump told a closed-door meeting of grassroots conservative leaders on Wednesday to expect another, companion healthcare bill to hit the House as early as next week, according to sources present for the meeting. The new legislation would differ from the plan presently working its way through the House in that it would not proceed through budget reconciliation and would therefore require cloture in the Senate.

House will consider a second health bill the same week as Obamacare repeal
Caitlin Owens, Axios

The House will consider a second health care bill the week it votes on the Obamacare repeal and replacement, Speaker Paul Ryan said Thursday on the Sean Hannity Show. Republicans have long said the plan is to do repeal and replace in three “buckets,” or phases.

Republican Study Committee backs two Medicaid changes to Obamacare repeal bill
Jennifer Haberkorn and Rachael Bade, Politico

The Republican Study Committee is backing two proposed changes to the Obamacare repeal bill that could help win over conservatives to the measure, which has been in a markup before the House Energy and Commerce Committee for nearly 24 hours. The group, which rarely takes positions on amendments in committee, supports a proposal from Reps. Joe Barton (R-Texas) and Marsha Blackburn (R-Tenn.) that would freeze Medicaid enrollment under enhanced Obamacare rates at the end of 2017, two years sooner than the GOP repeal bill allows.


Obamacare replacement bill endangers hospital finances and bond ratings
Dave Barkholz, Modern Healthcare

Legislation that dismantles the Affordable Care Act and passed through two key House committees Thursday would hurt hospitals financially and possibly lead to debt downgrades, according to Moody’s Investors Service and S&P Global Ratings. The bill relies on per-capita Medicaid caps and tax credits instead of mandates for individual insurance.

This Obamacare Program Keeps You Out of the Hospital and  Saves Billions
Deena Shanker, Bloomberg News

The Republican replacement for the Affordable Care Act, now fighting its way through Congress, removes the individual insurance mandate at the heart of Obamacare and phases out the Medicaid expansion that accounts for millions of the newly insured.  One piece it appears to have spared, so far: the Medicare Hospital Readmission Reduction Program.

Pharma, Biotech and Devices

Opioid distributors sued by West Virginia counties hit by drug crisis
Scott Higham and Lenny Bernstein, The Washington Post

A new legal front is opening in the war against the nation’s opioid crisis as attorneys begin to pursue major corporations that distribute prescription painkillers. They are seeking billions of dollars in reimbursements for the devastation the drugs have caused in communities across the country.

To Save On Drug Costs, Insurer Wants To Steer You To ‘Preferred’ Pharmacies
Pauline Bartolone, Kaiser Health News

One of California’s largest insurers has proposed a change in the benefits of commercial plans next year that would require consumers to pay more for drugs at pharmacies outside an established network. Blue Shield of California wants to create “a tiered pharmacy network” in its 2018 small- and large-group plans, according to preliminary proposals the company submitted to the California Department of Managed Health Care (DMHC), a state health insurance regulator.

NFL abuse of painkillers and other drugs described in court filings
Rick Maese, The Washington Post

National Football League teams violated federal laws governing prescription drugs, disregarded guidance from the Drug Enforcement Administration on how to store, track, transport and distribute controlled substances, and plied their players with powerful painkillers and anti-inflammatories each season, according to sealed court documents contained in a federal lawsuit filed by former players.

Health IT

The future of artificial intelligence in healthcare relies on crowdsourced data
Evan Sweeney, Fierce Healthcare

Since the long-held potential for technology to assist in clinical decision-making has not come to fruition, researchers argue that the next generation of computerized support software requires more robust data to effectively identify disease patterns within specific patient populations. Physicians are trained to rely on probabilities to diagnose patients, but humans are generally poor performers when it comes to probabilistic reasoning, according to a viewpoint published in the Journal of Medical Internet Research by two informatics researchers, including one with the IBM TJ Watson Research Center.

A Message from PhRMA:

Myth About Importation: Canada will ensure medicines are safe.

Fact About Drug Importation: Canadian authorities have expressly stated they are not responsible for the safety and quality of prescription drugs exported from Canada into the United States. Get the facts at

Opinions, Editorials and Perspectives

Innovation Labs or Frankenstein’s Monster: States and Health
Care Legislation

Peter Pitts, Morning Consult

From Oregon to New York, Maryland to California and everyplace in between, states are proposing legislation to address pharmaceutical access, pricing and transparency. While such legislation is well intentioned, the devil is in the details.

John Kasich: End the Partisan Warfare on Health Care
Gov. John Kasich, The New York Times

Americans are relying on leaders in Washington to fix health care, not engage in yet another unproductive partisan standoff. In 2010, one side of the political aisle in Congress, the Democrats, chose to “fix” health care unilaterally, without bipartisan support.

The Republican Health Care Crackup
David Brooks, The New York Times

The Republican health care bill could represent the moment when the old order of American politics completely cracks up, the end of a certain era in American politics. That era began around 1974, when Ted Kennedy introduced a bill to supplement America’s employer-based insurance system with a government program.

The American Health Care Act is a good start
Douglas Holtz-Eakin, The Washington Post

The draft legislative texts that will make up the American Health Care Act cleared two House committees this week amid vociferous complaints about the legislation, seemingly from all quarters. At some level this is understandable.

GOP hard-liners’ Obamacare incoherence
Avik Roy, The Washington Post

On Monday evening, House Republican leaders unveiled their long-awaited Obamacare replacement, entitled the American Health Care Act. The plan was swiftly panned by observers from all over the ideological spectrum.

Republicans Should Take The Time Necessary To Improve The American Health Care Act
Joseph Antos and James Capretta, Health Affairs Blog

When Donald Trump was elected president last November, it became inevitable that Congress would move aggressively to roll back elements of the Affordable Care Act (ACA) and replace them with different provisions. Trump ran hard against the ACA, as did many elected members of the House and Senate.

A Message from PhRMA:

Allowing the importation of drugs from other countries into the U.S. would lead to potentially dangerous outcomes for patients and increase the burden on law enforcement to prevent unregulated medicines from harming Americans. Get the facts on the dangers of importation.

Research Reports

Outcomes for High-Needs Patients: Practices with a Higher Proportion of These Patients Have an Edge
Julia Adler-Milstein et al., The Commonwealth Fund

Patients with high health care needs enrolled in Michigan primary care practices that treat a large proportion of such patients had lower health care costs, fewer hospital admissions, and fewer emergency department visits than those enrolled in practices serving smaller proportions of high-need patients. Small practices—those with one or two physicians—exhibited lower overall spending for high-risk patients, though not lower utilization of services, compared with larger practices.