Health Brief: Democrats Hit Back at Trump Over ACA Insurer Payments

Washington Brief

  • Democrats are seeking to include “cost-sharing reduction” payments owed to insurers in a must-pass government spending bill after President Donald Trump threatened to use the payments to force them to negotiate a replacement to the Affordable Care Act. (The Washington Post)
  • The Trump administration released a final rule aimed at keeping insurers from leaving the Affordable Care Act’s individual market next year. The rule shortens the 2018 open enrollment period, but doesn’t address insurers biggest concern: whether the government would continue to make the “cost-sharing reduction” payments, which help them cover low-income people. (The Wall Street Journal)
  • Back in their districts, Republican lawmakers are lowering expectations about the timeline for and extent of an Obamacare replacement, even as Trump doubled down this week on completing a health care overhaul before moving to tax reform. (Politico)

Business Brief

  • St. Jude Medical failed to investigate problems with the batteries in its implantable defibrillators, and the cybersecurity of its at-home monitoring equipment, according to inspectors with the Food and Drug Administration.  (Star Tribune)
  • As a result of mounting unpaid bills from insured patients, a growing number of hospitals are pushing patients to pay before they can receive scheduled care, an unexpected consequence of Obamacare. (Reuters)
  • House Judiciary Committee Chairman Bob Goodlatte (R-Va.) is pushing for more oversight of trial lawyer ads targeting drugs, which doctor groups and drug companies claim are scaring patients into not taking their medications. (The Wall Street Journal)

Chart Review

Events Calendar (All Times Local)

Aspen Institute event on improving end-of-life care with former HHS Secretary Sebelius 12 p.m.



Obamacare repeal bill is the zombie GOP can’t kill — or bring back to life
Jennifer Haberkorn and Kyle Cheney, Politico

Republicans in Congress for the first time are lowering expectations for how much of Obamacare they can repeal and how quickly they can do it. As they meet constituents back home, GOP lawmakers seem trapped between the reality of their failed repeal effort and President Donald Trump’s renewed promises this week to finish off Obamacare before taking on tax reform.

Trump Shifts Back to Health Care
Louise Radnofsky et al., The Wall Street Journal

After losing a fight to revamp the health-care system, President Donald Trump said last month he was prepared to put the setback behind him and move on to the next challenge, rewriting the tax code. Three weeks later, he said he is determined to resurrect the health-care bill even if it means delaying the tax overhaul, telling The Wall Street Journal in an interview: “I want to get health care done…I think I will get it done.”

Trump Signs Law Taking Aim at Planned Parenthood Funding
Julie Hirschfeld Davis, The New York Times

President Trump signed legislation on Thursday aimed at cutting off federal funding to Planned Parenthood and other groups that perform abortions, a move cheered by conservatives who have clamored to impose curbs on reproductive rights. The measure nullifies a rule completed in the last days of the Obama administration that effectively barred state and local governments from withholding federal funding for family planning services related to contraception, sexually transmitted infections, fertility, pregnancy care, and breast and cervical cancer screening from qualified health providers — regardless of whether they also performed abortions.

U.S. Stocks Slide as Gains in Banks Fade, Energy Shares Decline
Oliver Renick, Bloomberg News

U.S. equities slid as investors studied banking results from JPMorgan Chase and Citigroup. In Europe, stocks declined for the third time this week as banks fell.


Trump Administration Takes Steps to Stabilize Health-Insurance Market
Michelle Hackman, The Wall Street Journal

The Trump administration took steps on Thursday to stabilize the Affordable Care Act’s individual health-care market, as insurers demand more certainty from the administration before deciding whether to remain in the law’s marketplaces next year. The Centers for Medicare and Medicaid Services, a division of the Department of Health and Human Services, published its final rule aimed at steadying the individual market, which has seen large premium increases and insurers retreating from unprofitable markets across the country.

Trump’s threat prompts Democrats to play hardball over Obamacare payments
Mike DeBonis, The Washington Post 

Democrats signaled that they will seek to secure payments owed to health insurers under the Affordable Care Act as part of pending negotiations over a government spending bill Thursday — a new wrinkle in sensitive talks that emerged a day after President Trump threatened to use the payments to force Democrats to negotiate a replacement for the ACA. The “cost-sharing reduction” payments are meant to subsidize out-of-pocket expenses for low-income Americans who receive insurance through ACA marketplaces, and the payments are seen as a key factor in maintaining the stability of the market for individual insurance in many states.

New Medicare model for paying doctors passes key test
Lauren Clason, The Hill Extra

A far-reaching Medicare payment proposal cleared a crucial hurdle this week, as the federal health program seeks to reward doctors for keeping patients healthy. The pitch from the American College of Surgeons would allow more than 75 different specialty doctors to participate in Medicare’s new value-based payment system.

Explaining the Health Payments That Trump Is Threatening to End
Reed Abelson and Margot Sanger-Katz, The New York Times

Cost-sharing reductions seem like an arcane aspect of the Affordable Care Act, but they could now make or break the Obamacare insurance marketplaces. Even President Trump is talking about them, as a possible bargaining chip for a new health bill.

CMS’ Verma recuses self from Indiana, Iowa waiver talks
Virgil Dickson, Modern Healthcare

CMS Administrator Seema Verma has recused herself from weighing in on any decisions involving Indiana and Iowa’s Medicaid expansion waivers, according to an agency spokeswoman. The news comes just days after Kaiser Health News reported that she had recused herself from talks around Kentucky’s pending waiver to convert its Medicaid expansion program from a straightforward eligibility expansion to a program that includes conservative principles such as premiums and a work requirement.

How Alaska fixed Obamacare
Sarah Kliff, Vox

Last year, Alaska’s Obamacare marketplaces seemed on the verge of implosion. Premiums for individual health insurance plans were set to rise 42 percent. State officials worried that they were on the verge of a “death spiral,” where only the sickest people buy coverage and cause rates to skyrocket year after year.

Florida gets $1 billion boost from the CMS to pay for uncompensated hospital visits
Maria Castellucci, Modern Healthcare

Florida will get $1 billion from the CMS to fund its supplemental Medicaid payments, reversing the Obama administration’s decision to cut payments in June. The Trump administration announced Wednesday that it will boost Florida’s supplemental Medicaid payments to more than $1.5 billion from the $600 million in federal funding the state was granted last year.


Ballooning bills: More U.S. hospitals pushing patients to pay before care
Jilian Mincer, Reuters

Last year, the Henry County Health Center in Iowa started providing patients with a cost estimate along with pre-surgery medical advice. The 25-bed rural hospital in the southwest corner of the state implemented the protocol because of mounting unpaid bills from insured patients, a group that had previously not raised red flags.

HHS’s Price Urges Doctors to Submit Ideas for Medicare Pay Models
Mindy Yochelson, Bloomberg BNA

Doctors should step up and recommend more payment alternatives to fee-for-service Medicare, the HHS secretary said April 11. Health and Human Services Secretary Tom Price said innovative payment models could work better than fee-for-service Medicare and might stop doctors from leaving the profession at middle age because they feel “burned out.”

Virtual reality takes doctors on a ‘fantastic voyage’ inside hearts
Charles Piller, Stat News

Stanford University offers doctors a “room” with a unique view — the inside of an infant’s beating heart, valves opening and closing, blood cells rushing past. (Well, it’s unique if you discount the campy 1966 sci-fi thriller, “Fantastic Voyage.”) The virtual reality project tackles what has always been a major challenge for medical trainees: how to visualize a heart in action in three dimensions.

Pharma, Biotech and Devices

FDA sends St. Jude a warning over two high-profile device issues
Joe Carlson, Star Tribune

Inspectors with the U.S. Food and Drug Administration on Wednesday slapped St. Jude Medical with a warning letter accusing the medical device maker of failing to properly investigate problems with the batteries in its implantable defibrillators and the cybersecurity of its at-home monitoring equipment. The inspectors said that company officials systematically underestimated the true risks facing heart-device patients, even after one person died in 2014.

Have You or Your Loved Ones Been Hurt by This Ad? Congressman Wants to Know
Sara Randazzo and Jonathan D. Rockoff, The Wall Street Journal

Plaintiffs’ lawyers have long solicited clients through television advertisements that warn of a drug’s potentially harmful side effects. Now, a powerful congressman, backed by the leading doctors’ group and some drug companies, is pushing back, saying the ads are to blame for patients suffering harm or even dying after dropping treatment.

Pharmaceutical firms ask court to stop their drugs from being used in Arkansas executions
The Associated Press

Two pharmaceutical companies asked a federal judge Thursday to prevent Arkansas from using their drugs to execute seven inmates by the end of the month, saying they object to their products being used for capital punishment. Fresenius Kabi USA and West-Ward Pharmaceuticals Corp. were granted permission to file a friend of the court brief in a lawsuit by the inmates aimed at halting the unprecedented execution schedule, set to begin Monday with the lethal injection of two condemned killers.

Health IT

University of California files appeal over CRISPR patents
Julie Steenhuysen, Reuters

The University of California is appealing a U.S. patent ruling over the game-changing gene editing technology known as CRISPR that favored the Broad Institute, a research affiliate of Harvard University and the Massachusetts Institute of Technology. The appeal filed in the U.S. Court of Appeals for the Federal Circuit was announced Thursday by the UC, the University of Vienna and handful of startup companies that have licensed its patents.

Opinions, Editorials and Perspectives

Taking on Women’s Heart Health the Old-Fashioned Way
Bernadette Mazurek Melnyk, Morning Consult 

Heart disease claims the lives of more women than any other illness — more than all types of cancer combined — so let’s set straight the myth that heart disease is a man’s disease. While an estimated 80 percent of heart disease is preventable, cardiovascular disease among women remains an invisible disease in the national conversation.

Can Trump Take Health Care Hostage?
Paul Krugman, The New York Times

Three weeks have passed since the Trumpcare debacle. After eight years spent denouncing the Affordable Care Act, the G.O.P. finally found itself in a position to do what it had promised, and deliver something better. But it couldn’t.

Research Reports

Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes
Aidin Rawshani et al., The New England Journal of Medicine 

In Sweden from 1998 through 2014, mortality and the incidence of cardiovascular outcomes declined substantially among persons with diabetes, although fatal outcomes declined less among those with type 2 diabetes than among controls. (Funded by the Swedish Association of Local Authorities and Regions and others.)