Health Brief: Deal Reached to Extend CHIP Funding

Government Brief

  • Senate Finance Committee leaders reached a deal on a five-year reauthorization of the Children’s Health Insurance Program, in a win for children’s health advocates who are seeking longer-term funding certainty for the program, which will expire at the end of the month without congressional action. The deal also gradually phases out the enhanced federal share of funding for state CHIP programs, which was increased under the Affordable Care Act by 23 percentage points. (The New York Times)
  • Sen. Bernie Sanders (I-Vt.) is set to unveil a much-anticipated “Medicare for all” bill that has put many Democrats in a difficult political situation, as they face alienating progressives if they oppose it, but open themselves up to Republican attacks if they endorse it. Meanwhile, GOP Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.) plan to roll out a last-ditch attempt to repeal and replace the ACA. The bills have little in common, other than that there’s almost no chance they’ll advance in this Congress. (The Associated Press)
  • The White House, despite hammering congressional Republicans for failing to repeal Obamacare, has only offered tepid support for the Graham-Cassidy proposal, which would give states the option of replacing or keeping Obamacare. Meanwhile, the Trump administration has also hinted it would oppose a bipartisan attempt to stabilize the ACA exchanges unless it includes other changes to the health care system. (The Wall Street Journal)

Business Brief

  • Centene agreed to acquire Fidelis Care’s plans in a deal worth $3.75 billion that will greatly expand its presence in New York state. Fidelis Care has more than 1.6 million members in the state on Medicaid, Medicare Advantage and Obamacare exchange plans. (CNBC)
  • Anthem Inc. could pull out from the Obamacare markets in Connecticut and Maine. The insurer is already planning to scale back or exit the Obamacare markets in 9 of 14 states where it sold plans this year. (Bloomberg)
  • Apple Inc. is working on a venture with American Well and Stanford University to test whether heart rate sensors on the new Apple Watch could be an effective tool at detecting cardiac abnormalities. (Fierce Healthcare)

Chart Review

Events Calendar (All Times Local)

The Hill event on the opioid epidemic 8 a.m.
Health Affairs briefing on innovation in medicine 9 a.m.
House Energy and Commerce subcommittee hearing on FDA’s regulation of OTC drugs 10:15 a.m.
House Energy and Commerce subcommittee hearing on Public Health Service Act workforce programs 10 a.m.
Senate HELP Committee hearing with health care stakeholders 10 a.m.
No events scheduled

Are middlemen really holding down the cost of medicines?

Biopharmaceutical companies set the list prices for their medicines, but it’s your insurer that ultimately determines how much you pay out of pocket. More than one-third of the list price of a medicine is rebated back to middlemen, like insurers and pharmacy benefit managers (PBMs). These rebates and discounts create savings of more than $100 billion, but these savings aren’t always shared directly with patients. Let’s talk about cost.


Sanders, GOP push banner health care bills
Alan Fram, The Associated Press

Liberal Sen. Bernie Sanders is ready to unveil his bill for starkly reshaping the country’s current hodge-podge health care system into one where the government provides medical insurance for everybody. Republican senators are preparing to roll out details of a last-ditch effort to repeal and replace President Barack Obama’s health care law.

Senate Health Bills Struggle to Win White House Backing
Louise Radnofsky and Stephanie Armour, The Wall Street Journal

Two Senate bills aimed at shaping the future of the Affordable Care Act are facing uncertainty, as the White House voices tepid support for an ACA repeal effort and opposition to a bipartisan bill to shore up insurance markets. Republican senators Bill Cassidy of Louisiana and Lindsey Graham of South Carolina on Wednesday plan to release the text of a bill letting states largely decide what to do about the 2010 health law known as Obamacare, following the collapse of a Republican bid to undo it.

Uninsured Rate Fell in 2016 as More People Aged Into Medicare
Louise Radnofsky, The Wall Street Journal

The share of people in the U.S. who lacked health insurance for the whole of 2016 declined to 8.8%, the Census Bureau said Tuesday, down from 9.1% the previous year, largely due to Americans aging into the federal Medicare program for people 65 and older. The rate reflects around 28.1 million people without health coverage, a decrease from 29 million a year earlier, hitting a new low that has also been reflected in other government and private surveys.

Former U.S. CDC director takes aim at outbreaks, heart disease
Julie Steenhuysen, Reuters

Former U.S. Centers for Disease Control and Prevention director Dr. Tom Frieden on Tuesday announced the start of a new public health initiative funded by private philanthropies to fight heart disease and stroke and shore up infectious disease capabilities around the world. The new initiative, called Resolve, will be funded by $225 million in backing from Bloomberg Philanthropies, the Chan Zuckerberg Initiative and the Bill & Melinda Gates Foundation.

Opioid Epidemic Continues to Ravage the Midwest
Joe Williams, Roll Call

Despite action by Congress to address the opioid addiction epidemic, hard-hit areas of the country like this one in the Midwest are finding it difficult to keep up with the fallout from the unfolding situation. In July, here in Wisconsin’s Jackson County, for instance, 34 children who were taken out of their homes, many a result of a parent’s opioid addiction, remained in foster care.

Stock Rally Eases as Dollar Edges Lower; Oil Gains: Markets Wrap
Andreea Papuc and Robert Brand, Bloomberg

The equities rally that pushed stocks to records around the globe eased on Wednesday as some investors cautioned that gains had gone too far, too fast. The dollar snapped a two-day advance as Treasury yields inched lower.


Deal Struck to Extend Financing for Children’s Health Program
Robert Pear, The New York Times

The chairman of the Senate Finance Committee and the top Democrat on the panel announced on Tuesday night that they had reached agreement on a plan to prevent the imminent exhaustion of federal funds for the Children’s Health Insurance Program. The current appropriation runs out at the end of this month, and many states will exhaust their allotments of federal money later this year or early next year.

Centene in a $3.75 billion deal for New York Medicaid leader Fidelis Care
Bertha Coombs, CNBC

Centene is making a big move into New York state, with a deal to acquire non-profit insurer Fidelis Care’s plans for $3.75 billion. The asset purchase will bring Centene more than 1.6 million new members in the state, spread across the Medicaid, Medicare Advantage and Obamacare exchange markets.

Obamacare Heavyweight Anthem Considers Retreating From More States
Zachary Tracer and Anna Edney, Bloomberg

Anthem Inc. said it may pull back from more state Obamacare markets even as U.S. lawmakers debate steps to shore up the health law. The health insurer is in talks with officials in some states ahead of deadlines later this month to decide whether to sell coverage in 2018, Chief Executive Officer Joseph Swedish said on Tuesday.


Providers at odds over CMS joint replacement proposal
Virgil Dickson, Modern Healthcare

A CMS proposal to allow surgical centers to perform knee replacement surgeries has divided the medical community, with some saying it puts patient safety at risk and others saying the move empowers beneficiaries to receive care in cheaper, more comfortable settings. In July, the CMS proposed to allow Medicare to pay for total knee arthroplasty at ambulatory surgical centers starting in 2018.

‘Whatever it takes’: Hospitals get creative in hiring nurses amid a national shortage
Max Blau, Stat News

It’s hard to find a nurse who’ll move to West Virginia. That’s what Doug Mitchell realized after becoming the chief nursing officer of WVU Medicine in late 2015.

Pharma, Biotech and Devices

WATCH: Scott Gottlieb vows to shake up the FDA, backing a trend toward faster drug development
John Carroll, Endpoints News

FDA commissioner Scott Gottlieb has sounded a crystal clear warning over the high — and growing — cost of drug development. And in a speech to regulatory execs on Monday, Gottlieb committed the FDA to backing up more efficient drug development programs with new measures to clear the regulatory path for developers barreling ahead to relatively swift pivotal data in search of an accelerated OK.

How 3-D Printing Is Changing Health Care
Aili McConnon, The Wall Street Journal

A year ago, an 11-year-old girl named London Secor had surgery at the Mayo Clinic to remove a rare tumor located in her pelvis. In the past, surgeons would have considered amputating one of Ms. Secor’s legs, given that the tumor had spread to the bone and nerves of her sacrum and was encroaching on her hip socket.

The race for a Zika vaccine slows, a setback for efforts to head off future outbreaks
Helen Branswell, Stat News

The development of a type of Zika vaccine that authorities had hoped to usher to the market has proven more challenging than some scientists and pharmaceutical companies had expected, people involved in the research have told STAT, posing a setback for efforts to avoid future outbreaks of the disease. Although vaccines typically take years to produce, test, and license, U.S. health officials had voiced confidence that Zika would not be a difficult target, and some predicted that a vaccine could be made and fully tested, ready for Food and Drug Administration assessment, within two to three years.

Health IT

Apple, Stanford and American Well reportedly testing Apple Watch to detect cardiac risks
Evan Sweeney, Fierce Healthcare

Apple CEO Tim Cook says the Apple Watch has saved lives by detecting heart rate irregularities. He’s about to test the merits of that claim by examining ways in which the company’s newest wearable can influence cardiac care.

A Message from PhRMA:

Ever wonder who decides what you pay for your medicines? It’s not who you might think. Biopharmaceutical companies set the list prices for their medicines, but it’s your insurer that ultimately determines how much you pay out of pocket. More than one-third of the list price of a medicine is rebated back to middlemen, like insurers and pharmacy benefit managers (PBMs). These rebates and discounts create savings of more than $100 billion, but these savings aren’t always shared directly with patients. Let’s talk about cost.

Opinions, Editorials and Perspectives

The Use of Real-World Evidence in Health Care Decision-Making
Jennifer Graff, Morning Consult

Health care experts are schedule to gather in Washington, D.C., on Sept. 13 to discuss how we can harness the data we gather in routine health care delivery in the real world and apply that information to support drug approvals, inform safety monitoring, and accelerate new health care innovations. Although many decision-makers are already using real-world data, the Food and Drug Administration is poised to take a significant step forward in how it considers and uses this information.

Bernie Sanders: Why We Need Medicare for All
Bernie Sanders, The New York Times

This is a pivotal moment in American history. Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?

Can the Democratic Party Survive BernieCare?
James Freeman, The Wall Street Journal

Thank goodness Hurricane Irma didn’t do as much damage as initially feared. But now the water is rising around one of America’s two major political parties.

Why Home Care Costs Too Much
Paul Osterman, The Wall Street Journal

As baby boomers age into long-term care facilities, Medicaid costs will go through the roof. Americans already spend—counting both public and private money—more than $310 billion a year on long-term support services, excluding medical care, for the elderly and the disabled.

The media gets the opioid crisis wrong. Here is the truth.
Anne Case and Angus Deaton, The Washington Post

Lawmakers and the media have devoted much of their attention recently to deaths from opioid overdoses, as well as to the broader “deaths of despair” that include suicides and deaths from alcoholic liver disease and cirrhosis. But despite the intense focus on the topic, misinformation about the epidemic runs rampant.

Blaming Medicaid for the Opioid Crisis: How the Easy Answer Can Be Wrong
Aaron E. Carroll and Austin Frakt, The New York Times

The theory has gained such prominence that a United States senator is investigating it. “Medicaid expansion may be fueling the opioid epidemic in communities across the country,” Senator Ron Johnson, Republican of Wisconsin, wrote recently.

Research Reports

Current Status of State Planning for the Future of CHIP
Kaiser Family Foundation

Federal funding for the Children’s Health Insurance Program (CHIP), which covered 8.9 million children in FY 2016, is set to expire on September 30, 2017. This fact sheet provides an overview of current state plans for CHIP amid continuing uncertainty about future federal funding for the program and discusses how states and children would be affected if Congress does not extend funding by the September 30, 2017 deadline.