Health Brief: Centene Will Offer Plans in 3 More States

Washington Brief

  • Senate GOP leaders are increasingly dependent on their fragile alliance with Sen. Ted Cruz (R-Texas), amid growing skepticism among GOP aides and senators that Sens. Rand Paul (R-Ky.) and Mike Lee (R-Utah) can be persuaded to back the Senate health care bill. (The Washington Post)
  • President Donald Trump told 15 Senate Republicans that the House health care bill is “mean,” and urged them to craft a version that is more “generous.” (The Associated Press)
  • About 13 million more Americans would be uninsured over the next decade under the House-passed bill, according to the Centers for Medicare and Medicaid Services’ Office of the Actuary. The federal projection is well below the Congressional Budget Office’s estimate of 23 million more uninsured under the House version. (Politico)

Business Brief

  • Despite GOP claims that the Obamacare markets are in a “death spiral,” Centene announced that it would offer plans in three new states for the first time, as well as expand its offerings in six states where it currently sells insurance. (The New York Times)
  • Blink Health terminated a deal with Express Scripts amid a dispute over a price-discount program for diabetes patients taking Eli Lilly’s insulin. (The Wall Street Journal)
  • States that saw their insured rates increase the most under Obamacare also added the most health care jobs. (Axios)

Chart Review

Events Calendar (All Times Local)

NIH research conference on best practices 8 a.m.
Brookings Institution event on drug distribution chain 9 a.m.
Manhattan Institute, U.S. Chamber of Commerce forum on drug prices 9 a.m.
Senate Finance Committee confirmation vote on Deputy HHS Secretary Nominee Hargan 10 a.m.
House Energy and Commerce subcommittee hearing on extending health safety net programs 10:15 a.m.
House Appropriations subcommittee hearing on Indian Health Service 1 p.m.
NIH research conference on best practices 8 a.m.
Bloomberg Law event on the ACA 8:30 a.m.
Senate Appropriations subcommittee hearing on HHS budget request 10 a.m.
No events scheduled



AP sources: Trump tells senators House health bill ‘mean’
Alan Fram, The Associated Press

President Donald Trump told Republican senators Tuesday that the House-passed health care bill he helped revive is “mean” and urged them to craft a version that is “more generous,” congressional sources said. Trump’s remarks were a surprising slap at a Republican-written House measure that was shepherded by Speaker Paul Ryan, R-Wis., and whose passage the president lobbied for and praised.

Cruz’s fragile alliance with GOP leaders now pivotal in health-care push
Sean Sullivan and Kelsey Snell, The Washington Post

The Republican attempt to reshape the nation’s health-care system has grown increasingly dependent this week on the fragile alliance between Senate GOP leaders and a man they have clashed bitterly with for years: Sen. Ted Cruz (R-Tex.). Senate leaders are struggling to build conservative support for their emerging bill, with GOP aides and senators voicing growing skepticism that hard-right Sens. Rand Paul (R-Ky.) and Mike Lee (R-Utah) can be convinced to back it.

Senate Republicans Push to Reach Health Deal
Kristina Peterson et al., The Wall Street Journal

Senate Republicans raced Tuesday to bridge divisions over rickety insurance markets and billions of dollars in insurance subsidies in their pursuit of a health-care deal. While President Donald Trump predicted a deal would emerge, hard work remained behind the scenes.

States Rally to Save Public-Health Program Slated for Cuts in Overhaul Bill
Stephanie Armour et al., The Wall Street Journal

State officials and public-health groups are pushing the Senate to preserve billions of dollars that go to local health programs, from vaccines to antismoking campaigns, that would be halted under the House Republican bill to topple the Affordable Care Act. Officials from states led by both parties are rattled because the House-approved health-care overhaul would end almost $1 billion in annual payments to a prevention program at the Centers for Disease Control and Prevention.

Senate Democrats plan offensive to try to save Obamacare
Jennifer Haberkorn and Burgess Everett, Politico

Senate Democrats are preparing an all-out war to try to save the Affordable Care Act. With limited tools at their disposal, their plan is to hammer Senate Republicans for their secrecy, spotlight elements that would throw millions of people off their health coverage and fuel enough public outcry to make Republicans eyeing re-election fights very nervous.

The Trump administration map of Obamacare failures is riddled with inaccuracies
Sarah Kliff, Vox

The Trump administration published a map Tuesday of projected health insurer participation in the Affordable Care Act marketplaces. It gets a lot wrong.

GOP Congressman Sees Health-Care Bill on President’s Desk by August
Michelle Hackman, The Wall Street Journal

A Republican congressman who helped shepherd the party’s health-care overhaul bill through the House last month predicted Tuesday that a final bill will pass the Senate and land on the president’s desk before August. House Energy and Commerce Chairman Greg Walden’s estimate, described at The Wall Street Journal’s CFO Network meeting in Washington, suggests he is optimistic that Senate leaders will be able to meet a self-imposed July 4 deadline for passing their health legislation.

FDA delays rolling out new nutrition facts label
Caroline Humer et al., Reuters

The U.S. Food & Drug Administration on Tuesday delayed indefinitely implementation of a new nutrition facts label that would enlarge calorie counts, itemize added sugar and bring serving sizes in line with actual average portions. The rule, which had been championed by former first lady Michelle Obama, had been scheduled to go into effect on July 26, 2018.

Tech Bounce Spurs Europe Stocks; Oil Drops on Data: Markets Wrap
Samuel Potter, Bloomberg News

European equity investors were in a bullish mood as technology companies extended their bounce, leading gains across almost all sectors. The dollar steadied and Treasuries rose, neither moving with conviction as traders tread water before the U.S. interest rate decision.


Federal actuary: 13M more uninsured under GOP repeal package
Paul Demko, Politico

The House-passed Obamacare repeal bill would leave 12.6 million more Americans uninsured over the next decade and reduce federal spending by $328 billion, according to an analysis released today by CMS’ Office of the Actuary. The coverage estimate is well below the 23 million more uninsured that the CBO has projected under the American Health Care Act.

Trump Says Market Is Failing, but One Insurer Bets Big on Obamacare
Margot Sanger-Katz and Reed Abelson, The New York Times

The Obamacare insurance markets aren’t as shaky as President Trump seems to believe. On Tuesday, the insurer Centene announced plans to expand aggressively into the state marketplaces established under the Affordable Care Act.

Under ACA, increased coverage paired with more jobs
Caitlin Owens and Chris Canipe, Axios

The more a state’s insured rate has increased since the passage of the Affordable Care Act, the more health care jobs that have been added in the state. That’s the pattern we found when we compared the data on the growth of health care jobs with the health insurance gains in each state.

Nevada’s GOP governor breaks with Heller on Medicaid expansion
Peter Sullivan, The Hill

Nevada’s Republican governor, Brian Sandoval, is breaking with Sen. Dean Heller (R-Nev.) and calling for ObamaCare’s Medicaid expansion to be preserved. Heller, who could be a key vote on the healthcare bill and is up for reelection next year, said last week that he supports a seven-year phase-out of the additional federal funding for Medicaid expansion.

House votes to bar undocumented immigrants from healthcare tax credits
Cristina Marcos, The Hill

The House passed legislation Tuesday to ensure that immigrants in the country illegally can’t access tax credits for health insurance premiums. Rep. Lou Barletta’s (R-Pa.) bill, approved in a largely party-line vote of 238-184, would require the Treasury Department to confirm that people applying for the tax credits are verified as U.S. citizens or legal residents by the Commissioner of Social Security or the Secretary of Homeland Security.

AARP: States Lag In Keeping Medicaid Enrollees Out Of Nursing Homes
Phil Galewitz, Kaiser Health News

States are making tepid progress helping millions of elderly and disabled people on Medicaid avoid costly nursing home care by arranging home or community services for them instead, according to an AARP report released Wednesday. “Although most states have experienced modest improvements over time, the pace of change is not keeping up with demographic demands,” said the report, which compared states’ efforts to improve long-term care services over the past several years. AARP’s first two reports on the subject were in 2011 and 2014.

House Republicans want to break Trump’s promise to not cut Medicare
Tara Golshan, Vox

President Donald Trump made the American people a promise over and over again: His administration would not touch Social Security and Medicare funding. Then Trump’s budget proposal to Congress included cuts to Social Security Disability Insurance.


CHS fires CEO of dissident Fort Wayne hospitals
Dave Barkholz, Modern Healthcare

Brian Bauer, the CEO of Community Health System’s Fort Wayne hospitals, has been fired in the wake of a failed physician effort to find a buyer for the eight hospitals. The removal is the latest sign of trouble in the most profitable market for CHS, which has been facing hard financial times itself.

Pharma, Biotech and Devices

Blink Health Terminates Pact With Express Scripts for Lilly Insulin Price Discounts
Peter Loftus, The Wall Street Journal

A corporate dispute over a price-discount program for diabetes patients taking Eli Lilly LLY 0.43% & Co.’s insulin has resulted in an industry middleman’s exit from the deal—the latest sign of discord among players in a prescription-drug supply chain facing criticism for high prices. Blink Health LLC, a provider of consumer price discounts for prescription drugs, said it has terminated its relationship with Express Scripts ESRX 0.18% Holding Co., a pharmacy-benefit manager that helped arrange the new price break for Lilly’s insulin.

A Senate bill would require drug makers to justify price hikes
Ed Silverman, Stat News

Seeking to put a lid on rising drug prices, U.S. Sen. Ron Wyden has introduced a bill that would require drug makers to justify hefty price hikes, a move that resembles legislation being introduced in a growing number of state legislatures around the country. In this instance, the U.S. Department of Health and Human Services would track increases in list prices and notify manufacturers when those prices exceed certain benchmarks.

Do opioid drug-abuse deterrents actually work? FDA wants to know.
Laurie McGinley, The Washington Post

The Food and Drug Administration is ramping up scrutiny of anti-abuse features on opioid painkillers to try to determine if they actually do what they’re intended to do. On Tuesday, the agency announced a two-day public meeting that will focus on whether the agency has “the right information to determine whether these products are having their intended impact on limiting abuse and helping to curb the epidemic,” according to an accompanying statement by FDA Commissioner Scott Gottlieb.

Health IT

HIMSS, PCHAlliance want additional flexibility with FCC broadband regulations
Evan Sweeney, Fierce Healthcare

Arguing that the needs of rural healthcare facilities vary from one provider to the next, two health IT organizations are calling for more flexibility within broadband regulations. In a letter to the Federal Communications Commission (FCC) HIMSS and the Personal Connected Health Alliance (PCHAlliance) urged the agency to consider changes that would allow rural healthcare providers to pursue new technology like remote patient monitoring that allows for home-based treatment options.

A Message from PhRMA:

Key finding from investigation led by former FBI Director Louis Freeh: “Already overburdened law enforcement and regulatory capacity would be unable to ensure a safe prescription drug supply under importation.” Read the full report.

Opinions, Editorials and Perspectives

How States Can Innovate With Medicaid
Gerard A. Vitti, Morning Consult 

With the House of Representatives’ vote to repeal the Affordable Care Act and replace it with a slimmed down version of the American Health Care Act that was filed earlier this year, all eyes are now on the Senate to see what will emerge from that chamber. Regardless of the outcome, one thing is certain: Medicaid costs are ballooning for states that broadened eligibility under the Affordable Care Act, and the Trump administration and Congress are going to look for ways to rein in federal spending on Medicaid.

Big Pharma gives your doctor gifts. Then your doctor gives you Big Pharma’s drugs.
Nicole Van Groningen, The Washington Post 

The last time you left your doctor’s office with a new prescription, you probably assumed she thoughtfully selected it as the best treatment for your condition. But if your doctor — like half of American physicians — accepts visits and the occasional free lunch from pharmaceutical representatives, there’s a good chance that drug choice was heavily biased.

A Message from PhRMA:

Did you know? There are numerous recorded instances of contaminated or counterfeit drugs entering the United States through importation schemes. And the FDA has said repeatedly that it cannot verify the quality or safety of medicines procured through importation. Get the facts.

Research Reports

Estimated Financial Effect of the “American Health Care Act of 2017”
Paul Spitalnic, Centers for Medicare and Medicaid Services Office of the Actuary

This memorandum summarizes the Office of the Actuary’s estimates of the financial and coverage effects through 2026 of selected provisions of the “American Health Care Act of 2017” (H.R. 1628), which was passed by the House on May 4, 2017 and which is referred to in this memorandum as the AHCA. Included are the estimated impacts on net Federal expenditures, health insurance coverage, Medicaid enrollment and spending by eligibility group, gross and net premiums and out-of-pocket costs in the individual market, total National Health Expenditures,
and the financial status of the Medicare Hospital Insurance (HI) trust fund.