Health Brief: CBO Score Shows More Uninsured, Lower Deficit Within Decade

Washington Brief

  • A Congressional Budget Office analysis showed that a Republican health care bill being considered in the House would decrease the number of insured people by 24 million over the next decade, and would lower the federal deficit and premiums by the end of the decade. While the White House largely dismissed the report, House Speaker Paul Ryan pointed to its projections that the bill would eventually lower premiums by 10 percent. (The New York Times)
  • A group of conservative Senate Republicans are set to visit the White House today, including Sen. James Lankford (R-Okla.), who said they will offer ways to improve the health care bill currently moving through House committees. (Politico)
  • The Senate voted 55-43 Monday to confirm Seema Verma as administrator of the Centers for Medicare and Medicaid Services. (The Associated Press)

Business Brief

  • Democrats courted industry groups for their support of the Affordable Care Act, while Republicans left those groups little time to consider their replacement proposal before committees began marking it up. Republicans say they are focusing on policy, but risk passing a bill that industry groups don’t buy into. (The Washington Post)
  • The Department of Justice urged an appeals court not to overturn a lower court’s decision to block a proposed merger between Anthem and Cigna, easing some outside groups’ concerns that the Trump administration would take a softer stance than the former DOJ. (Modern Healthcare)
  • Bill Ackman Pershing Square Capital Management sold his stake in Valeant Pharmaceuticals, a controversial company he continued to defend, at a loss and announced he would leave its board. (Bloomberg News)

Chart Review

Events Calendar (All Times Local)

American College of Emergency Physicians Leadership and Advocacy Conference 8 a.m.
American College of Emergency Physicians Leadership and Advocacy Conference 7:30 a.m.
The Atlantic Policy Briefing on Biosimilars 8 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.
House Budget Committee Markup of Reconciliation Bill 10 a.m.
Heritage Foundation Event on Tobacco Control in E-Cigarettes 12 p.m.
RAND Corporation Briefing on the ACA Future 12 p.m.



Senate Confirms Trump Pick to Head Medicare and Medicaid
Ricardo Alonso-Zaldivar, The Associated Press

President Donald Trump’s pick to run Medicare and Medicaid won confirmation Monday from a divided Senate as lawmakers braced for another epic battle over the government’s role in health care and society’s responsibility toward the vulnerable. Indiana health care consultant Seema Verma, a protégé of Vice President Mike Pence, was approved by a 55-43 vote, largely along party lines.

GOP Senate critics of Obamacare repeal bill to visit White House
Burgess Everett, Politico

A bloc of Senate conservatives will visit the White House on Tuesday as the party’s right flank threatens to tank the Obamacare repeal effort supported by President Donald Trump. Members of the Republican Steering Committee, which is chaired by Sen. Mike Lee (R-Utah), will visit the White House to discuss Obamacare strategy along with Sens. Rand Paul (R-Ky.), James Lankford (R-Okla.) and Ted Cruz (R-Texas).

GOP does damage control over healthcare score
Peter Sullivan, The Hill

Leading House Republicans are fighting to defend their ObamaCare replacement bill in the face of a Congressional Budget Office (CBO) report that found the measure would result in millions of people becoming uninsured. Democrats are on the attack, hoping the findings — and the eye-popping estimate that 24 million additional people will be without coverage by 2026 — will stop ObamaCare repeal in its tracks.

Mike Lee Doubts House GOP Health Plan Complies With Senate Rules
Lesniewski, Roll Call

Sen. Mike Lee is suggesting that a ban on federal funding for abortion in the House health care bill might not survive a procedural challenge on the Senate floor. In an opinion piece for The Heritage Foundation’s Daily Signal, the Utah Republican wrote that under Senate rules, the House health care bill might not be compliant as a reconciliation bill (a budget measure that only requires a majority vote).

Trump looks to woo conservatives on Obamacare repeal
Josh Dawsey et al., Politico

President Donald Trump’s White House is increasingly likely to support some conservative-backed changes to the House Obamacare alternative, two administration officials said Monday — a move that comes after a nonpartisan budgetary analysis showed 24 million people could lose insurance under the bill. One senior administration official, speaking on the condition of anonymity to describe internal discussions, said the White House is weighing ideas for a “significant” manager’s amendment to the bill before it hits the House floor next week.

HHS secretary expresses concern on bill allowing employers to demand genetic tests
Andrew Joseph, Stat

President Trump’s top health official suggested that there would be “significant concerns” with a House bill that would allow companies to require employees to undergo genetic testing, but said the administration had not yet examined the issue. Tom Price, the secretary of Health and Human Services, was asked about the bill on NBC’s “Meet the Press” over the weekend.

Stocks Drop Before Fed as Pound Slumps on Brexit: Markets Wrap
Garfield Clinton Reynolds and Samuel Potter, Bloomberg News

Most European stocks retreated as signs of caution started to show in markets before this week’s packed schedule of events, which includes a U.S. interest rate decision. The pound tumbled as the British Prime Minister won permission to trigger the country’s departure from the EU.


Health Bill Would Raise Uninsured by 24 Million but Save $337 Billion, Report Says
Thomas Kaplan and Robert Pear, The New York Times

The House Republican plan to replace the Affordable Care Act would increase the number of people without health insurance by 24 million by 2026, while slicing $337 billion off federal budget deficits over that time, the nonpartisan Congressional Budget Office said Monday. Republicans had been bracing for what was almost certain to be a bleak accounting of the legislation’s projected effects.

Trump Justice Department stays strong against Anthem-Cigna merger appeal
Erica Teichert, Modern Healthcare

The U.S. Justice Department and several states on Monday urged a federal appeals court not to overturn a decision blocking Anthem and Cigna’s proposed $54 billion merger. In a brief to the U.S. Court of Appeals for the District of Columbia Circuit, the Trump administration Justice Department said there was “overwhelming evidence” showing the blocked merger would never create any of the proposed efficiencies that Anthem touted.

White House analysis of Obamacare repeal sees even deeper insurance losses than CBO
Paul Demko, Politico

A White House analysis of the GOP plan to repeal and replace Obamacare shows even steeper coverage losses than the projections by the Congressional Budget Office, according to a document viewed by POLITICO on Monday. The executive branch analysis forecast that 26 million people would lose coverage over the next decade, versus the 24 million CBO estimates.

White House calls CBO health care report bogus
Nolan D. McCaskill, Politico

Unbelievable, wrong and “virtually impossible.” That was how President Donald Trump’s administration responded Monday to the Congressional Budget Office’s politically damaging score of House Republicans’ plan to repeal and replace Obamacare.

C.B.O. Analysis: Republican Health Plan Will Save Money but Drive Up the Number of Uninsured
Hayeyoun Park et al., The New York Times

The Republican health care plan being considered by Congress will significantly increase the number of uninsured people, but save the federal government hundreds of billions of dollars, according to an analysis by the Congressional Budget Office. Here are the key findings from the report.

CBO: Defunding Planned Parenthood would lead to thousands more births
Sandhya Somashekhar, The Washington Post

A congressional plan to make Planned Parenthood ineligible for federal funding would leave many women without services to help them avoid pregnancy, resulting in thousands of additional births, according to a new federal budget analysis. The prediction came Monday as part of a much-awaited analysis from the nonpartisan Congressional Budget Office, which assesses the fiscal impact of major legislative bills.

No Magic in How G.O.P. Plan Lowers Premiums: It Penalizes Older People
Margot Sanger-Katz, The New York Times

There are a lot of unpleasant numbers for Republicans in the Congressional Budget Office’s assessment of their health care bill. But congressional leadership found one to cheer: The report says that the bill will eventually cut the average insurance premiums for people who buy their own insurance by 10 percent. House Speaker Paul Ryan pressed that point in a series of appearances Monday night, suggesting that the budget office had found that the House bill would increase choice and competition and lead to lower prices.

Proposed surcharge for dropping health coverage is no real stick, CBO projects
Juliet Eilperin, The Washington Post

The House Republicans’ mechanism for persuading healthy Americans to stay insured would be largely ineffective, according to the new Congressional Budget Office analysis released Monday, and it would ultimately lead to about 2 million fewer Americans buying insurance each year. GOP lawmakers are determined to repeal the individual mandate Democrats crafted under the Affordable Care Act, which aimed to compel consumers to have coverage by imposing a penalty if they could not provide proof of insurance when they filed their taxes each year.

Trump’s Counties Lose Out to Clinton’s in GOP Health Tax Cuts
John McCormick, Bloomberg News

The very first individual tax cuts officially endorsed by President Donald Trump don’t offer great news for most of his supporters: Counties that backed him would get less than a third of the relief that would go to counties where Democrat Hillary Clinton won. The two individual tax cuts contained in the Republican plan to replace Obamacare apply only to high-earning workers and investors, roughly those with incomes of at least $200,000 for individuals and $250,000 for married couples.

Trump Warns It Could Take Several Years for Health Costs to Drop
Shannon Pettypiece, Bloomberg News

President Donald Trump said it could take several years for health insurance prices to start to drop under an Obamacare replacement plan he is promoting, creating a rocky transition period that could pose a risk for members of Congress up for re-election next year and Trump’s own bid for a second term in 2020. In a meeting at the White House Monday with a group of small business owners, doctors and individuals who said their plans were canceled or that they saw a spike in health-insurance costs since Obamacare was enacted, Trump offered reassurances but warned that any relief won’t be immediate.

Companies Behind Health Savings Accounts Could Bank On Big Profits Under GOP Plan
Chad Terhune and Julie Appleby, Kaiser Health News

Health savings accounts are poised for a major expansion by Republicans in Washington, D.C., and that could mean millions more customers — and fees — flowing to a handful of companies. Investors are betting on it, bidding up shares of HSA provider HealthEquity by about 35 percent since the November election.


The GOP’s dramatic change in strategy to pass its health-care

Carolyn Y. Johnson, The Washington Post

To get the Affordable Care Act passed, Democrats used a big-tent approach, convening health-care groups that did not normally talk to one another while cutting deals and strong-arming key industry players to build broad support for the plan. First, the drug companies got on board. Then came the hospitals and the doctors.

Study Suggests High-Spending Doctors Could Do Less Without Harming Patients
Melanie Evans, The Wall Street Journal

U.S. Medicare patients whose doctors spent more on tests, scans and consultations were as likely to die within a month of leaving the hospital as patients with more parsimonious physicians, new research shows. Patients of high-spending doctors were also as likely to return to the hospital within a month, according to the results, published by JAMA Internal Medicine.

Hospitals fear loss of Medicare contracts, patients due to observation notices
Virgil Dickson, Modern Healthcare

The CMS’ lack of guidance on a new requirement for hospitals to notify Medicare patients why they are receiving observation care could cause hospitals to lose billing privileges and patients, providers say. On March 8 hospitals had to begin giving out the notices, which alert patients that they received observation care rather than being admitted as an inpatient.

Pharma, Biotech and Devices

Ackman Sells Valeant Stake After at Least $2.8 Billion Loss
Beth Jinks et al., Bloomberg News

Bill Ackman has finally conceded defeat on Valeant Pharmaceuticals International Inc. After waging a costly and outspoken public defense of the controversial drugmaker, its once-biggest champion sold his entire stake in the company at a loss and said he will leave the board.

Vaccine Makers Ranked on Pricing and Research
Donald G. McNeil, The New York Times

The pharmaceutical companies GlaxoSmithKline and Sanofi sell the most vaccines and earn the most money doing so, while the Serum Institute of India sells the most vaccines at a discount, according to the first Access to Vaccines Index, which was released last week. The new index is produced by the Dutch foundation that issues the biennial Access to Medicines Index, which ranks drug manufacturers according to how easy it is for people in poor countries to get the companies’ lifesaving medications.

Trump’s FDA pick faces questions over drug-industry ties
Sarah Chacko, The Hill Extra

President Trump’s nominee to be FDA commissioner is drawing praise from some Democrats and Republicans, though his drug industry ties and policy positions will likely raise questions during the confirmation process. Several industry and patient groups, like the medical device trade group and Friends of Cancer Research, voiced their approval of the pick, former FDA deputy commissioner Scott Gottlieb.

Health IT

Big EHR vendors set their sights on smaller targets
Joanne Finnegan, Fierce Healthcare

Electronic health record system vendors are turning their attention to an untapped market: Physician practices and small and rural hospitals. Those healthcare settings present an opportunity for new sales of EHR systems, according to a report by Healthcare Dive.

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

Administration’s Proposed ACA Rules Create Legal Loopholes for Discrimination
Stacey Worthy, Morning Consult

Lawmakers set to “repeal and replace” the Affordable Care Act must face a new reality: More Americans support the ACA now than ever before. According to a Pew Research Center poll, 54 percent of the public (132 million adults) now favors maintaining the law. Contributing to this support is the provision that insurers cannot discriminate against anyone with a pre-existing condition either by dropping coverage or forcing those with chronic, rare, or debilitating diseases to pay more in out-of-pocket costs.

Trading Health Care for the Poor for Tax Cuts for the Rich
The Editorial Board, The New York Times

So much for President Trump’s pledge of “insurance for everybody.” The Congressional Budget Office said on Monday that next year 14 million fewer Americans will have insurance if the Affordable Care Act, or Obamacare, is repealed and replaced on the terms the president is seeking.

The CBO reveals Republicans’ health-care cruelty
The Editorial Board, The Washington Post

When it comes to understanding the Republican obsession to undo Obamacare, this number is about all you need to know: 24 million. That is how many people would lose coverage under the GOP’s supposedly choice-enhancing, access-increasing replacement plan.

CBO’s Prophecies, Demystified
The Editorial Board, The Wall Street Journal

The white smoke rose Monday afternoon from the Congressional Budget Office as the fiscal forecasters published their cost-and-coverage estimates of the GOP health-care reform bill. Awaiting such predictions—and then investing them with supposed clairvoyance—are Beltway rituals.

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

Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions
Sarah Miller and Laura R. Wherry, New England Journal of Medicine

By September 2015, a total of 29 states and Washington, D.C., were participating in Medicaid expansions under the Affordable Care Act. We examined whether Medicaid expansions were associated with changes in insurance coverage, health care use, and health among low-income adults.