Health Brief: Effort to Shore Up ACA Exchanges May Come Too Late


Government Brief

  • Bipartisan efforts in Congress to shore up the Affordable Care Act’s individual exchanges could come too late for insurers, who need to finalize premium prices in most states within the next two weeks and sign final contracts for 2018 by the end of September. (Politico)
  • Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.), who is spearheading the Senate effort, faces formidable policy and political challenges in getting a bipartisan bill through Congress by mid-September. To reach a broad consensus in Congress, the bill, he said, will have to be “simple.” (The New York Times)
  • Former Obama administration officials have formed an informal, yet organized, network to continue advocating for the Obama science agenda during the Trump administration. (Stat News)

Business Brief

  • Some pharmaceutical companies are cutting deals with insurers to favor their brand-name drugs over cheaper generic competition. The business practice can sometimes mean that insurers pay less, but consumers pay more. (ProPublica and The New York Times)
  • Despite the controversy over the high price of EpiPens, the brand-name product still accounts for more than one-quarter of the market more than seven months after the introduction of a cheaper generic alternative. (The Wall Street Journal)
  • Consumer groups are making a last-ditch effort to stop the Trump administration from rolling back an Obama-era rule that gives nursing home residents and their families the right to take facilities to court over alleged abuse, neglect or sexual assault. (The Hill)

Chart Review

Events Calendar (All Times Local)

Monday
National Association of Insurance Commissioners summer national meeting 8 a.m.
Tuesday
National Association of Insurance Commissioners summer national meeting 8 a.m.
National Academy of Social Insurance event on health insurance 8:30 a.m.
National Business Group on Health event on large employers 10 a.m.
Wednesday
National Association of Insurance Commissioners summer national meeting 9 a.m.
Thursday
Center for Global Development event on implementing clinical trials during epidemics 12:30 p.m.
Friday
No events scheduled
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General

Republican Senator Is on a Mission to Rescue the Health Care Law
Carl Hulse, The New York Times

Senator Lamar Alexander voted to repeal the Affordable Care Act numerous times and wanted it gone. Now he is trying to save it — at least for the moment.

With Trump in the White House, Obama science experts operate shadow network to press their positions
Lev Facher, Stat News

Nearly all of the Obama administration’s science staff has departed the White House since January, and the Trump administration has moved slowly to replace them. In the meantime, however, an unofficial shadow office, stocked with Obama loyalists, is quietly at work.

Congressional Recess, Full Plate Keep the Heat on GOP Lawmakers
Siobhan Hughes and Janet Hook, The Wall Street Journal

Congressional Republicans plan to use the next four weeks away from Washington making a public case for a sweeping rewrite of the tax code, an ambitious legislative undertaking they hope will heal divisions that opened when the party’s signature health-care bill collapsed. But at home in their districts, they face pressures that could make it hard to focus on taxes.

Tax writers see peril in Trump’s Obamacare persistence
Bernie Becker and Aaron Lorenzo, Politico

Republicans acknowledge that the aggressive timeline they have set up for overhauling the tax code this fall leaves them little room for error. There could be one problem with that: Obamacare isn’t going away.

Govs. Hickenlooper, Kasich urge bipartisan effort to move forward on health care
Emily Tillett, CBS News

Colorado Governor John Hickenlooper and Ohio Governor John Kasich say the next step toward changing the Affordable Care Act — after lawmakers failed to follow through on health care reform — should now include a bipartisan effort. “Let’s get a bipartisan group of people together, and include some governors, who are the guys who have to- the people who have to implement these plans, and look at how do we stabilize private markets, how do we, you know, deal with these high-cost pools, and what’s the best way,” Democratic Gov. Hickenlooper said on CBS News’ “Face the Nation” on Sunday.

Big Tobacco’s Next Big Thing? Tobacco
Saabira Chaudhuri, The Wall Street Journal

Big Tobacco is working on its next act, as cigarette sales decline around the world and once-breakneck growth from the first wave of e-cigarettes fades. Three of the world’s biggest tobacco firms are rolling out new, electronic tobacco-heating devices they say are healthier alternatives to traditional smoking, but feel more like puffing on a real cigarette.

Euro Shrugs Off German Data to Rise; Crude Drops: Markets Wrap
Robert Brand, Bloomberg

The euro resumed gains against the dollar even as data showed German industrial production unexpectedly fell in June. Crude dropped as OPEC nations met with their allies.

Payers

GOP efforts to stabilize Obamacare markets might come too late
Paul Demko, Politico

Republicans now say they want to stabilize the distressed Obamacare markets for 2018, but it may be too late. Insurers have warned for months that they need certainty from Washington in order to decide where they will sell Obamacare plans and how much to charge.

Take the Generic Drug, Patients Are Told — Unless Insurers Say No
Charles Ornstein, ProPublica, and Katie Thomas, The New York Times

It’s standard advice for consumers: If you are prescribed a medicine, always ask if there is a cheaper generic. Nathan Taylor, a 3-D animator who lives outside Houston, has tried to do that with all his medications.

Insurer Molina wins $52 million in Obamacare lawsuit
Kimberly Leonard, Washington Examiner

The federal government owes health insurer Molina $52 million for payments it was supposed to receive involving losses under Obamacare, the U.S. Court of Federal Claims ruled Friday. The payments, called “risk corridors,” were diminished as part of a spending bill advanced by Republicans, who referred to them as a “bailout” for the insurance industry.

Why A Pa. Insurer’s Collapse Could Whack Insurers, Policyholders Across the Country
Chad Terhune, Kaiser Health News

Among all the reasons for rising health insurance premiums, this one might be the most obscure: A long-term care insurer in Pennsylvania just went belly-up.

Providers

Fight over right to sue nursing homes heats up
Lydia Wheeler, The Hill

Consumer groups are making a last ditch effort to stop the Trump administration from stripping nursing home residents and their families of the right to take facilities to court over alleged abuse, neglect or sexual assault. The Centers for Medicare & Medicare Services (CMS) announced plans in June to do away with an Obama-era rule that prohibited nursing homes that accept Medicare or Medicaid funds from including language in their resident contracts requiring that disputes be settled by a third party rather than a court.

Health care marketing that hides the price
Bob Herman, Axios

Hospitals and health care companies often flood email inboxes and wire services with press releases that tout new procedures or devices. The marketing intent is clear — they want to attract patients to their facilities or get the word out on their new technology.

Pharma, Biotech and Devices

Behind the Push to Keep Higher-Priced EpiPen in Consumers’ Hands
Jonathan D. Rockoff, The Wall Street Journal

Something strange happened when Alice Bers went to the pharmacy earlier this year to fill her son’s EpiPen prescription: The doctor had prescribed the generic, but it would have cost her more out-of-pocket than the branded version. So the pharmacy asked her son’s doctor for a prescription for the brand-name EpiPen, and her health plan got a bill for $438.53, or $227.52 more than the generic would have cost it.

Tiny Biotech’s Tobacco Tinkering Makes It a Rare Winner
Anna Edney and Alan Bjerga, Bloomberg

An obscure biotechnology company in western New York with about 80 employees suddenly saw its popularity rise last week after the tobacco industry was shocked by an announcement the federal government was exploring lowering nicotine levels in cigarettes. That’s because tiny 22nd Century Group Inc. has something that’s suddenly in high demand — it grows tobacco plants with just 3 percent of the nicotine in typical tobacco plans.

Martin Shkreli Is Found Guilty of Fraud
Stephanie Clifford and Colin Moynihan, The New York Times

Martin Shkreli, 34, has confidently courted controversy in recent years, bulldozing his way into Wall Street and the drug industry, raising the price of a lifesaving drug by 5,000 percent overnight, boasting that he would outwit prosecutors in his federal fraud case, and live-streaming and tweeting throughout his five-week trial. But on Friday, after five days of deliberations, jurors convicted him on three counts of fraud in federal court, and he now faces up to 20 years in prison on each of the first two counts, and up to five years on the final count.

Health IT

GAO appoints 15 members to new HIT Advisory Committee
Evan Sweeney, Fierce Healthcare

The Government Accountability Office has released a list of 15 individuals selected to serve on a committee mandated by the 21st Century Cures Act that will offer guidance on health IT policies and standards. The appointments made by the U.S. Comptroller General to the new Health Information Technology Advisory Committee include various IT executives at provider organizations, including the Marshfield Clinic, the University of Utah Health and Advocate Health Care.

Opinions, Editorials and Perspectives

To Cut or to Reform Medicaid?
Chris Pope, Morning Consult 

The GOP’s attempt to repeal and replace the Affordable Care Act has generated intense opposition and run into repeated roadblocks on Capitol Hill, despite advancing many worthy reforms. The proposals are right to allow individuals without pre-existing conditions to obtain insurance from a freely-competitive market, right to shift able-bodied individuals from Medicaid to the exchanges, and right to restructure Medicaid so that the largest share of its funds is not captured by the wealthiest states that need it least.

Big Data Is Coming to Take Your Health Insurance
Cathy O’Neill, Bloomberg

For all its absurdity, the debate over Obamacare has accomplished something positive: It has educated people that insurance is really about risk pooling — as in you need both healthy and sick people to participate if it’s going to be affordable for the sick. Some believe that universal government health coverage is the only way to guarantee such risk-sharing.

Research Reports

Addressing the Opioid Epidemic: Is There a Role for Physician Education?
Molly Schnell and Janet Currie, The National Bureau of Economic Research

Using data on all opioid prescriptions written by physicians from 2006 to 2014, we uncover a striking relationship between opioid prescribing and medical school rank. Even within the same specialty and county of practice, physicians who completed their initial training at top medical schools write significantly fewer opioid prescriptions annually than physicians from lower ranked schools.