Health Brief: Despite Revisions, Senate Health Bill Still Faces Some GOP Opposition

Washington Brief

  • Two Republican senators immediately opposed the latest version of GOP leaders’ health care bill, imperiling Senate Majority Leader Mitch McConnell’s effort to begin floor debate on the legislation next week. (The Wall Street Journal)
  • The new version still has fundamental changes to Medicaid that were opposed by moderate Republican senators in the original draft. Conservatives were given a major win with the inclusion of a proposal that would let insurers sell skimpier, cheaper coverage if they offer at least one plan that adheres federal consumer protections. (The New York Times)
  • The financial outlook for Medicare’s hospital insurance trust fund improved slightly from last year due to health care costs rising more slowly than expected and predictions that enrollees will use hospital services less often, according to an annual government report. (Kaiser Health News)

Business Brief

  • The revised Senate legislation adds $70 billion to a fund to help states control patients’ out-of-pocket expenses. But cuts elsewhere in the measure could still drive up upfront costs for consumers. (Bloomberg)
  • Federal law enforcement agencies announced the largest crackdown on opioid-related health care fraud in U.S. history, arresting 120 people, including doctors allegedly running pill mills and the operators of fraudulent treatment centers. (Stat News)
  • The Trump administration wants to reduce 340B drug payments to hospitals and allow Medicare to pay for hip and knee procedures at outpatient facilities. (Modern Healthcare)

Chart Review

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New Senate Health Bill Aims to Bridge GOP Gaps, But Resistance Remains
Stephanie Armour and Kristina Peterson, The Wall Street Journal

Senate Republicans unveiled a revised health bill Thursday in an effort to shore up its faltering GOP support, but its future remained precarious as at least two Republicans quickly vowed to oppose it, bringing the proposal within a single vote of potential collapse. Senate Majority Leader Mitch McConnell (R., Ky.) implored his fellow Republican lawmakers to at least support a procedural measure next week that would allow debate to begin on the bill, which aims to topple large parts of the Affordable Care Act.

First on CNN: Graham, Cassidy unveil details of alternative health care plan
Dana Bash, CNN

With the prospects for passing the current Senate Republican health care bill still in jeopardy, Sen. Lindsey Graham, R-South Carolina, and Sen. Bill Cassidy, R-Louisiana, are working with their GOP colleagues on an alternative approach to replacing Obamacare: keeping much of the federal taxes in place and sending that money to the states to control. “Here is what will happen,” Graham said in an exclusive interview with CNN’s Kate Bolduan. “If you like Obamacare, you can re-impose the mandates at the state level. You can repair Obamacare if you think it needs to be repaired. You can replace it if you think it needs to be replaced. It’ll be up to the governors. They’ve got a better handle on it than any bureaucrat in Washington.”

Feds announce largest-ever crackdown on opioid-related health care fraud
David Armstrong, Stat News

Federal law enforcement agencies announced Thursday what they called “the largest opioid-related fraud takedown in history” with the arrest of 120 people across the country, including doctors allegedly running pill mills and the operators of fraudulent treatment centers. “Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” Attorney General Jeff Sessions said in announcing the arrests. “Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start.”

Cory Gardner: a swing-state case study of the GOP health-care bind
Paul Kane, The Washington Post

Sen. Cory Gardner faces one of the tougher political predicaments of any Republican deciding how to vote on the GOP health-care bill. The Coloradan, a rising star who defeated a Democratic incumbent in 2014, leads the campaign committee responsible for protecting and expanding the GOP majority.

NIH fetal tissue research would be barred under House panel’s spending plan
Lev Facher, Stat News

A House subcommittee’s draft 2018 spending plan would prohibit federal funds from being spent on research that uses fetal tissue, a symbolic win for conservatives who are also taking aim at money for family planning and public health programs around the country. The proposal from the House Appropriations health subcommittee is unlikely to be enacted, and the restriction would impact a tiny portion of the National Institutes of Health’s roughly $33 billion budget — in 2016, the agency spent roughly $103 million on research involving fetal tissue.

Europe Stocks Steady After Asia Rally, Bonds Rise: Markets Wrap
Adam Haigh, Bloomberg News

European stocks were little changed after Asia’s strongest week since March, as investors awaited U.S. inflation data and earnings from some of America’s biggest banks. Asian shares advanced and the Australian dollar was at its highest this year in the wake of dovish comments from U.S. policy makers that also weighed on the dollar.


Revised Senate Health Bill Tries to Win Votes, but Has Fewer Winners
Margot Sanger-Katz, The New York Times

The revised Senate health bill has a dwindling list of winners and a bigger pool of potential losers. It would still make insurance much less affordable for poorer and older Americans who don’t get coverage through work or Medicare.

New GOP Health Bill Leaves Big Problem Untouched: Patient Costs
Zachary Tracer and Anna Edney, Bloomberg

Republican senators’ latest effort to repeal and replace Obamacare still fails to address a key complaint about the 2010 health law: Patients are using too much of their own money to pay for care. The bill, rolled out anew on Thursday after a raft of Republican defections threatened to sink the original legislation, faces a tough path to becoming law. Senate Majority Leader Mitch McConnell wants a vote next week, but two GOP lawmakers immediately rejected the revised plan, and losing the support of a third Republican could doom the measure.

Medicare’s Financial Outlook Slightly Improved, Trustees Say
Phil Galewitz, Kaiser Health News

The Trump administration said Thursday that the financial outlook for Medicare’s hospital insurance trust fund improved in the past year due to health costs rising more slowly than expected and predictions that enrollees will use hospital services less often. The report said that trust fund would last through 2029, one year later than what was projected last year.

The new Senate health care bill — and the return of preexisting conditions — explained
Sarah Kliff, Vox

Senate Republicans introduced a revised version of their bill to repeal and replace the Affordable Care Act on Thursday, one that would allow insurers to once again deny coverage based on preexisting conditions, and to charge higher rates to sick people. The bill would keep most of the Affordable Care Act’s tax increases but repeal one aimed specifically at medical device manufacturers.

Cuts to Medicaid could worsen U.S. opioid crisis, governors warn
Scott Malone, Reuters

Proposals by U.S. Senate Republicans to phase out the expansion of the Medicaid health insurance program for low-income Americans could hurt state efforts to fight the country’s opioid drug addiction crisis, governors warned on Thursday. Democratic and Republican governors meeting in Rhode Island warned that many residents of their states were relying on Medicaid to get treatment for opioid addiction, which grips an estimated 3 million Americans and killed 33,000 people in the United States in 2015, according to federal data.

Insurance experts question Cruz’s assertion about single risk pool
Jennifer Haberkorn and Paul Demko, Politico

Sen. Ted Cruz emphatically told fellow Republicans Thursday that his amendment to the Senate’s Obamacare repeal legislation would not split up healthy and sick people into two different risk pools, eliminating concern that an earlier version of his plan would drive up costs for sick people. But insurance experts say that’s not the case.

Senate healthcare bill includes key provision for Alaska
Nathaniel Weixel, The Hill

The home state of a key undecided senator could receive hundreds of millions of dollars under an updated Senate GOP bill to repeal ObamaCare. Lisa Murkowski (R-Alaska) has withheld her support for the Senate’s Better Care Reconciliation Act, citing concerns over Medicaid cuts, Planned Parenthood funding and insurance affordability.


CMS proposes slashing 340B rates, allow joint procedures at outpatient facilties
Virgil Dickson, Modern Healthcare

The CMS wants to slash 340B drug payments to hospitals and allow Medicare to pay for hip and knee replacement procedures that take place in outpatient facilities, according to a proposal released Thursday. To agency proposes paying hospitals 22.5% less than the average sales price for drugs acquired under the 340B program.

‘Are you saying I’m dying?’ Training doctors to speak frankly about death
Max Blau, Stat News

The doctor pulls up a chair next to his patient, a 74-year-old woman with lung cancer. He tells her she doesn’t need more chemotherapy.

Pharma, Biotech and Devices

Drug Prices Under Fire, in the States
Charley Grant, The Wall Street Journal

All eyes are on Washington as the Senate grapples with health care legislation. Investors in drug companies should give some attention to state capitals, where a wave of bills designed to limit drug price increases are under consideration.

Health IT

ONC plans to lean on OCR for privacy support, which could shift the dynamics of the agency
Evan Sweeney, Fierce Healthcare

Facing a $22 million budget cut in 2018, the Office of the National Coordinator for Health IT (ONC) is planning to defund the office that oversees privacy and instead tap a federal enforcement agency as its primary resource for privacy and security issues. During a media briefing on Tuesday, ONC National Coordinator Don Rucker, M.D., acknowledged that privacy and security are “at the heart of interoperability,” which senior administrators highlighted as a key focal point for the agency in the coming years.

Opinions, Editorials and Perspectives

IT Innovation Makes Strides Treating PTSD
Rebecca Van Horn, Morning Consult 

Though many of our veterans returned home years ago, for the 20 percent who suffer from Post-Traumatic Stress Disorder, their experiences in service remain a haunting reality in their daily lives. PTSD is a mental health condition that can develop after an individual experiences or witnesses a life-threatening event such as combat, a car accident, or sexual assault.

ObamaCare Moment of Truth
The Editorial Board, The Wall Street Journal

Republican leaders unveiled a revised health-care bill on Thursday, setting up a Senate watershed next week. Few votes will reveal more about the principles and character of this Congress.

The Cruelty and Fraudulence of Mitch McConnell’s Health Bill
Paul Krugman, The New York Times

A few days ago the tweeter in chief demanded that Congress enact “a beautiful new HealthCare bill” before it goes into recess. But now we’ve seen Mitch McConnell’s latest version of health “reform,” and “beautiful” is hardly the word for it.

The new Senate health bill is terrible for anyone who is sick, has been sick, or will be sick
Ezra Klein, Vox

The revised Better Care Reconciliation Act was released today, and here’s the bottom line: It returns individual insurance markets to the bad old days when insurers competed on insuring the healthy and finding ways to avoid covering the sick. There are a host of changes in the new BCRA, most of which leave the fundamental thrust of the legislation intact.

The inequality at the heart of Medicaid
Chris Pope, Politico

Over the past few months, Democrats have hammered Republican health care reform proposals as dangerous and devastating for the poor. Sen. Elizabeth Warren exclaimed, “These cuts are blood money. People will die,” while others have suggested that they are the “real death panels.”

Research Reports

The Future of America’s Entitlements: What You Need to Know about the Medicare and Social Security Trustees Reports
Douglas Holtz-Eakin et al., American Action Forum

Today, the Medicare Trustees issued their annual report detailing the financial state of America’s two largest entitlement programs. The report echoed past conclusions: Medicare and Social Security are still going bankrupt.