Health Brief: CBO Score of GOP Health Bill Expected This Week

Washington Brief

  • The Congressional Budget Office could release its analysis of the GOP health care bill as soon as today, which Republicans say they expect will show fewer people would have insurance coverage. The CBO score is expected to set off another round of fights related to the bill. (The Associated Press)
  • Republicans are defending their proposal to scrap the coverage mandate as part of why fewer people may have insurance under their proposal. They also argue that health care would be more affordable under their proposal. (The Washington Post)
  • President Donald Trump said he would name Scott Gottlieb to lead the Food and Drug Administration, a move cheered by the pharmaceutical industry. Gottlieb, who held different posts at the agency during the George W. Bush administration, would lead an agency that Trump has frequently said he wants to overhaul. (Stat)

Business Brief

  • Violence in health care workplaces has risen in recent years, demanding that executives and policymakers take action such as legislation establishing anti-violence protocols and new technologies to protect employees and others. (Modern Healthcare)
  • Humana’s decision to withdraw from the Obamacare exchanges has sparked concerns about whether the individual market could implode if another insurer makes a similar decision. If Anthem decided to withdraw, it would leave 256,000 people nationwide without a policy option, causing disruption. (Axios)
  • House committees are considering a bill that would make it easier for employers to obtain data about the health of their employees and their families if it is part of wellness programs. Advocacy groups are already pushing against the legislation. (The New York Times)

Chart Review

Events Calendar (All Times Local)

Healthcare Leadership Council Briefing on IPAB 12 p.m.
No events scheduled
The Atlantic Policy Briefing on Biosimilars 8 a.m.
House Budget Committee Markup on Reconciliation Bill 10 a.m.
Center for American Progress Event on Women’s Reproductive Health 11 a.m.
Senate Aging Committee Hearing on Families in the Opioid Crisis 2:30 p.m.
Roll Call Live Discussion on Health Care 8 a.m.
Heritage Foundation Event on Tobacco Control in E-Cigarettes 12 p.m.
RAND Corporation Briefing on the ACA Future 12 p.m.



Trump will nominate Scott Gottlieb to lead FDA
Sheila Kaplan, Stat

President Trump will nominate Dr. Scott Gottlieb, a longtime drug industry financier and advocate for deregulation, to run the Food and Drug Administration, the White House said Friday. Gottlieb, 44, is a physician and resident fellow at the conservative American Enterprise Institute.

The G.O.P.’s High-Risk Strategy for Health Law Repeal
Robert Pear and Thomas Kaplan, The New York Times

President Trump and House Republicans are pressing forward with a high-risk strategy to repeal and replace the Affordable Care Act, disregarding the views of medical professionals and potentially imperiling the party’s political future in conservative states where many voters stand to lose their health care. The effort could cause upheaval in an already roiled insurance market next year, as Republicans face voters for the first time with Mr. Trump in the White House — though that turmoil would happen only if the plans manage to clear a divided Senate.

Will Obamacare repeal break the Freedom Caucus? It depends on Trump.
David Weigel et al., The Washington Post

The internal Republican battle over replacing the Affordable Care Act has become the GOP’s first chance to break the House Freedom Caucus, the bloc of more than two dozen conservative lawmakers who have frustrated leadership for two years. And President Trump is likely to play a leading role.

Conservatives escalate threats to tank Obamacare repeal
Rachael Bade, Politico

So much for President Donald Trump’s charm offensive with conservatives. Conservative Hill leaders warned on Sunday that they won’t support the House GOP Obamacare alternative as it’s written, saying they’ll let the bill fail if they don’t get concessions.

GOP Health Plan Risks Backlash From Seniors
Kristina Peterson and Michelle Hackman, The Wall Street Journal

House Republicans’ health-care proposal is running into a new political problem: opposition from older people. One day after House GOP leaders unveiled their plan to repeal and replace the Affordable Care Act, AARP, the politically potent advocacy group for Americans over 50 years old, came out in opposition.

Democrats to turn Obamacare attacks against GOP in 2018
Burgess Everett and Heather Caygle, Politico

The past four election cycles, Democrats have been battered and bruised by political attacks over Obamacare. Now, they say, the time has finally arrived to take the fight to Republicans.

Trump stumping for AHCA? Democrats aren’t worried.
David Weigel, The Washington Post

The three-phase Republican plan to replace the Affordable Care Act is intended to end with massive political pressure on Senate Democrats, who’ll face a choice: Vote with them on individual replacement bills, or be blamed for the American Health Care Act’s implementation going awry. The crux of the theory is that 10 Democrats face reelection next year in states won by Trump.

Another key Republican senator knocks GOP Obamacare plan
Burgess Everett, Politico

Sen. Dean Heller (R-Nev.) panned House Speaker Paul Ryan’s bill to repeal and replace Obamacare during a closed meeting with constituents on Saturday, according to audio obtained by POLITICO. The remarks by Heller, the most vulnerable GOP senator on the ballot next year, are another sign of the difficult prospects the House bill faces in the other chamber.

Health Law’s Woes, Real or Perceived, Drive Calls for Repeal
Ricardo Alonso-Zaldivar, The Associated Press

President Donald Trump and Republican leaders say drastic action is needed because the Obama-era health care overhaul is a disaster, with soaring premiums and insurers bailing out. It’s true that major parts of the 2010 law are clearly troubled, but others are working fairly well.

GOP healthcare bill hangs in the balance
Jessie Hellman, The Hill

House Republicans are taking fire from all sides as they seek to push through their plan to repeal and replace ObamaCare, known as the American Health Care Act (AHCA). Speaker Paul Ryan (R-Wis.) has guaranteed the bill will pass Congress, but it won’t be a smooth ride to President Trump’s desk.

Packed Calendar Has Investors in Holding Pattern: Markets Wrap
Adam Haigh and Samuel Potter, Bloomberg News

Markets were largely range-bound on Monday as investors enter a week packed with crucial central bank meetings, economic data releases, a national election in Europe and potentially the formal start of Brexit. Stocks edged higher, the dollar weakened and bonds advanced.


Republicans Brace for Downbeat CBO Analysis of Health Bill
Hope Yen, The Associated Press

Republicans pushing a plan to dismantle Barack Obama’s health care law are bracing for a Congressional Budget Office analysis widely expected to conclude that fewer Americans will have health coverage under the proposal, despite President Donald Trump’s promise of “insurance for everybody.” House Speaker Paul Ryan said he fully expects the CBO analysis, set to be released as early as Monday, to find less coverage since the GOP plan eliminates the government requirement to be insured.

Trump said no Americans would lose coverage under Obamacare repeal. Paul Ryan won’t make that promise.
Kelsey Snell, The Washington Post

House Speaker Paul D. Ryan (R-Wis.) said Sunday that he doesn’t know how many Americans would lose coverage under his proposal to revise the Affordable Care Act, which is under fire from fellow Republicans, AARP and virtually every sector of the U.S. health care industry. “I can’t answer that question,” Ryan said in an appearance on CBS’s “Face the Nation.”

The Obamacare nightmare scenario
Bob Herman, Axios

The nightmare scenario for Obamacare is a meltdown of the individual health insurance market. If health insurers lose confidence as Republicans struggle with their repeal efforts — or because of the turmoil and price hikes that have already been underway — even more could withdraw, leaving Obamacare customers with nowhere to turn to keep their coverage.

How Healthy Are You? G.O.P. Bill Would Help Employers Find Out
Reed Abelson, The New York Times

A bill in Congress could make it harder for workers to keep employers from getting access to their personal medical and genetic information and raise the financial penalties for those who opt out of workplace wellness programs. House Republicans are proposing legislation aimed at making it easier for companies to gather genetic data from workers and their families, including their children, when they collect it as part of a voluntary wellness program.

The Five Big Numbers to Look For in the C.B.O. Report on Health Care Reform
Kevin Quealy and Margot Sanger-Katz, The New York Times

The Republican plan to replace the Affordable Care Act  was releasedearly last week, and it has already marched through consideration in two important committees. Yet members of Congress debated the policy details without essential information: The bill had not yet been “scored” by the Congressional Budget Office, a nonpartisan group of budget analysts and economists whose job is to forecast the bill’s consequences over the next decade or so.

Sleeper issue of Medicaid’s future could prove health-care plans’ stumbling block
Amy Goldstein and Juliet Eilperin, The Washington Post

As House Republicans hurtle toward shifting the nation’s health-care system onto a more conservative path, nearly lost so far in the roiling debate over their plans is the profound impact they would have on insurance for the nation’s poorest and most vulnerable residents. The proposed American Health Care Act would break with the government’s half-century compact with states in helping to finance Medicaid, which covers 68 million low-income people, including children, pregnant women and those who are elderly or disabled.

GOP Medicaid overhaul will hit insurers where it hurts
Shelby Livingston, Modern Healthcare

The Affordable Care Act’s insurance marketplace has been tough on payers looking to make a profit on that business, but Medicaid expansion funneled millions of new members to insurers, boosting revenue. That soon may change.

GOP Health Plan Would Hit Rural Areas Hard
Anna Wilde Mathews and Dante Chinni, The Wall Street Journal

The House Republican effort to overhaul the Affordable Care Act could hit many rural areas particularly hard, according to a new analysis, sharply increasing the cost for some residents buying their own insurance. In extreme cases, the amount a consumer might owe for a plan could exceed that person’s annual income.

Republican Health Plan Could End Insurance Coverage of Abortion
Katie Zerinke, The New York Times

The Republican proposal to replace the Affordable Care Act would bar people from using federal tax credits to buy health insurance plans that cover abortion. If the measure is passed, abortion rights advocates fear it could compel insurers to stop offering abortion coverage at all.

By Law, Hospitals Now Must Tell Medicare Patients When Care Is ‘Observation’ Only
Susan Jaffe, Kaiser Health News

Under a new federal law, hospitals across the country must now alert Medicare patients when they are getting observation care and why they were not admitted — even if they stay in the hospital a few nights. For years, seniors often found out only when they got surprise bills for the services Medicare doesn’t cover for observation patients, including some drugs and expensive nursing home care. The notice may cushion the shock but probably not settle the issue.


Quelling a storm of violence in healthcare settings
Elizabeth Whitman, Modern Healthcare

Last December, at about 2 a.m. in the intensive-care unit, Allysha Shin’s patient attacked her. Shin, a neuroscience nurse, was carefully monitoring the patient, a woman in her 20s who’d suffered a hemorrhagic stroke.

First-year doctors will be allowed to work 24-hour shifts starting in July
Lenny Bernstein, The Washington Post

First-year doctors will be allowed to work 24-hour shifts in hospitals across the United States starting July 1, when a much-debated cap that limits the physicians to 16 consecutive hours of patient care is lifted, the organization that oversees their training announced Friday. The Accreditation Council for Graduate Medical Education said the change will enhance patient safety because there will be fewer handoffs from doctor to doctor.

Docs warn that Medicare crackdown will hurt pain patients
Arthur Allen, Politico

A group of prominent pain and addiction specialists are pushing back against the federal opioid crackdown by asking CMS to withdraw a notice that would make it extremely difficult for Medicare patients to get painkiller prescriptions above a certain strength. More than 80 physicians, including four who helped create the 2016 CDC guidelines on opioid prescribing, wrote to acting Medicare director Cynthia Tudor about the notice, which would require pharmacists to refuse prescriptions over 90 milligrams of morphine or its equivalent unless the patient first went through a complex, time-consuming review.

Pharma, Biotech and Devices

Missouri PDMP fight reignites debate over national program
Steven Ross Johnson, Modern Healthcare

The ongoing fight to establish a program to track opioid prescribing in Missouri has once again raised discussion on whether the country would be best served by a national monitoring system. Missouri remains the only state in the country without a prescription drug monitoring program, which collects information to warn physicians that they may overprescribe opioids and prevent a patient from seeking prescriptions from multiple physicians.

HMO Doctors Take Pains To Slash Opioid Prescriptions
Sam Quinones, Kaiser Health News

On a summer afternoon in 2009, eight Kaiser Permanente doctors met in Pasadena to review the HMO’s most prescribed drugs in Southern California. Sun blasted through the windows and the room had no air conditioning, but what unsettled the doctors most were the slides a pharmacist was presenting. “We were doing so much work treating people with hypertension and diabetes, we thought those drugs would be on the list,” said Dr. Joel Hyatt, then Kaiser’s quality management director in Southern California.

Health IT

Better security, greater patient control could prevent patients from withholding data
Evan Sweeney, Fierce Healthcare

Despite the distinct and universally acknowledged benefits of data sharing, the very real possibility that patients will withhold their health data should be a primary concern for the healthcare industry that increasingly relies on health information exchanges to improve care and reduce costs. Healthcare organizations need to focus on improving data security and provide patients more control over their data to preempt complications that could arise from data withholding, wrote David Blumenthal, M.D., president of the Commonwealth Fund in an op-ed for The Milbank Quarterly.

A Message from PhRMA:

Myth About Importation: No one has been hurt by imported drugs.

Fact About Drug Importation: There have been a number of instances of harm caused to patients because of imported or online-purchased drugs, including death for patients in the United States, the UK and Canada, among others. Get the facts at

Opinions, Editorials and Perspectives

340B Is a Good Idea Gone Bad
Debra Pratt and Jeff Vacira, Morning Consult

Defenders of the 340B Drug Discount Program say it is vital to safety net hospitals and the patients they serve. On that, we agree wholeheartedly.

A Doctor to Heal the FDA
The Editorial Board, The Wall Street Journal

Scott Gottlieb may have landed the toughest job in Washington: President Trump has selected the physician and policy expert to run the Food and Drug Administration, where a culture of control strangles innovation. An iron triangle of interest groups, the bureaucracy and the press will resist change, but Dr. Gottlieb could save lives by renovating FDA’s drug-approval processes.

The House GOP Health Plan Makes ObamaCare Look Good
Alan S. Blinder, The New York Times

Speaker Paul Ryan, Rep. Kevin Brady and Rep. Greg Walden unveiled their plan to repeal and replace ObamaCare last week, and jammed it through Mr. Brady’s and Mr. Walden’s committees. Maybe they should have given it an out-of-town tryout first, because it bombed in Washington on opening night and is drawing bad reviews from left and right.

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

The Impact of Public and Private Research Support on Premature Cancer Mortality and Hospitalization in the U.S., 1999-2013
Frank R. Lichtenberg, National Bureau of Economic Research

We use data from PubMed and other sources to examine the impact of public and private research support on premature (before ages 75, 65, and 55) cancer mortality and hospitalization, by estimating difference-in-differences models based on longitudinal, cancer-site-level data on about 30 cancer sites. The estimates indicate that cancer sites about which more research-supported articles were published since the 1970s had larger reductions in premature mortality and hospitalization during the period 1999-2013, controlling for the change in the number of people diagnosed.