Health Brief: House Freedom Caucus Takes Hard Line on Bill to Gut ACA

Washington Brief

  • The 40 or so members of the House Freedom Caucus are banding together to oppose any Obamacare repeal bill that doesn’t gut major parts of law, including rollback the Medicaid expansion that is popular in many red states. (The Huffington Post)
  • The Senate voted unanimously to confirm David Shulkin, President Donald Trump’s pick to head the Veterans Affairs Department. Shulkin is the sole holdover from the Obama administration, having served 18 months as the VA’s undersecretary for health. (The Washington Post)
  • Republicans say they are not panicked over protests about their plans to repeal Obamacare, even though Democrats are using the GOP’s own playbook from the Tea Party movement to exploit grassroots anger. (Axios)

Business Brief

  • Health insurers, according to a document presented to the Trump administration by Blue Cross Blue Shield Association lobbyists, want to retain the individual mandate until high-risk pools are funded. They also want cost-sharing subsidies kept in place, and to have Obamacare taxes on them repealed. (Axios)
  • Marathon Pharmaceuticals delayed the launch of a muscular dystrophy drug amid criticism of its $89,000 price tag, and an investigation by two Democrats on Capitol Hill. (The Wall Street Journal)
  • Allergan agreed to buy Zeltiq Aesthetics, which has a line of weight-loss products that freeze fat away, for $2.48 billion in cash. (Reuters)

Chart Review

Events Calendar (All Times Local)

Headache & Migraine Policy Forum luncheon 12 p.m.
KPMG event on the health IT agenda 8:30 a.m.
Senate Appropriations Committee hearing on mental health care treatment and services 10:30 a.m.
Families USA Health Action 2017 8:30 a.m.
House Judiciary subcommittee hearing on competitive health insurance Reform Act of 2017 10 a.m.
CAHC event on ACA replacement and subsidy portability 10 a.m.
Senate Finance Committee confirmation hearing on Seema Verma’s nomination to lead CMS 10 a.m.
Families USA Health Action 2017 7:30 a.m.



Conservatives Take A Hard Line On Obamacare Repeal, Putting GOP In A Bind
Matt Fuller, The Huffington Post 

Conservatives in the House Freedom Caucus voted among themselves Monday night to band together and support only an Obamacare repeal that is at least as aggressive as a bill the House and Senate passed in 2015, putting GOP leaders in a bind with their conference and perhaps even threatening the possibility of passing a repeal. The group of roughly 35 to 40 House conservatives voted to take this official position ― meaning it received the support of at least 80 percent of the members and is therefore supposed to be the position of all lawmakers in the group ― amid some GOP consternation that Republicans ought to focus more on repairing the law rather than repealing it, as well as amid heavy voter pressure in many districts to leave the law intact.

Shulkin unanimously confirmed to head Veterans Affairs
Lisa Rein, The Washington Post

David J. Shulkin, an internist and longtime health administrator, was unanimously confirmed Monday to lead the troubled Veterans Affairs Department, becoming the first of President Trump’s Cabinet picks to be embraced by all Republicans and Democrats. He is the sole holdover from the Obama administration.

Republicans should fear health care protests
Jim VandeHei and David Nather, Axios

Republicans aren’t panicked about the protests over their Obamacare repeal plans. They should be.

How repealing Obamacare could splinter neighborhoods
Alvin Chang, Vox

In the early 1990s, one of Florida’s most populous counties had a problem. So many uninsured residents were using the public hospital that it was costing the county more and more money.

After Health Care Law Repeal, What? Wisconsin Republican Can’t Say
Thomas Kaplan, The New York Times

Michelle Roelandts had a question for her congressman: If the Affordable Care Act and its premium subsidies were repealed, what would happen when her daughter turns 26 this year and needs to get her own health insurance while attending law school? Representative Jim Sensenbrenner, a durable Wisconsin Republican who has served in the House since 1979, had little to offer in response.

Uncertainty over Obamacare’s future makes it harder to plan Pennsylvania’s budget
Kate Giammarise, The Pittsburgh Post-Gazette

Congressional Republicans’ lack of a clear plan on how to best replace the Affordable Care Act has everyone from health insurance companies to hospitals to those who gained insurance coverage under Obamacare uncertain about what the future holds. Add legislators and policymakers in Pennsylvania who are in the process of working on the state budget to the list of those who want answers.

The Rise and Fall of a K Street Renegade
Brody Mullins, The Wall Street Journal

Few outside Washington had ever heard of Evan Morris. Yet in the capital of wheeling and dealing, he was one of its most gifted operators.

He vowed to cure cancer. But this billionaire’s moonshot is falling far short of the hype
Rebecca Robbins, Stat

The world’s richest doctor had a very bold plan. He’d assemble an unprecedented collaboration of companies, researchers, and doctors.

Stocks, Dollar Falter as Investors Await Yellen: Markets Wrap
Chikako Mogi and Adam Haigh, Bloomberg News

A global rally that sent U.S. benchmarks surging to a fresh round of records faltered, as equities from London to Tokyo slid and the dollar dropped amid fresh questions how effective the Trump administration will be in spurring growth. Treasuries steadied.


Top priority for insurers: Keep Obamacare’s coverage mandate and subsidies
Bob Herman, Axios

The Trump administration’s highly anticipated Obamacare “market stabilization” regulation, which could come as soon as this week, may help insurers by tightening the enrollment rules. But that’s not what’s at the top of health insurers’ wish list.

Employers Balk at Curbs on Generous Health Plans
Anna Wilde Mathews, The Wall Street Journal

The Affordable Care Act’s tax on high-cost employer health plans faced sharp opposition from employers and unions. Now, Republicans are drawing equal fire for ACA replacement proposals that those groups say would have some of the same effects.

Why high-risk pools won’t crack the pre-existing condition dilemma
Harris Meyer, Modern Healthcare

Some Republican leaders are promoting state high-risk pools as an alternative to the Affordable Care Act’s popular provision requiring health plans to accept consumers regardless of pre-existing medical conditions. They cite Wisconsin’s pre-ACA pool, the Health Insurance Risk-Sharing Plan, as a model.


Pilot program could open door to home-based Medicare coverage
Christine Ayala, The Hill Extra

A pilot program to fund home-based assistance for some Medicare Advantage patients could open the door for reimbursement under Medicare, where payment for nonmedical support services is largely off limits. Sens. Chuck Grassley (R-Iowa) and Ben Cardin (D-Md.) are pushing legislation to give the Centers for Medicare and Medicaid Services (CMS) the authority to test potential savings from offering home and community-based care to certain Medicare beneficiaries 65 and older.

A millionaire’s mission: Stop hospitals from killing their patients by medical error
Usha Lee McFarling, Stat News

Joe Kiani likes to point out that the most worn spot on most medical monitoring devices is the mute button. He’s out to change that — and, he hopes, to stop the epidemic of preventable hospital death that kills tens of thousands of Americans each year.

Robert Wood Johnson Foundation names Dr. Richard Besser CEO
Rachel Arndt, Modern Healthcare

The Robert Wood Johnson Foundation announced Monday that Dr. Richard Besser will be its next president and CEO. Besser, who is currently ABC News’ chief health and medical editor, is a former acting head of the Centers for Disease Control and Prevention, where he also was director of the Coordinating Office for Terrorism Preparedness and Emergency Response.

Lack of Obamacare replacement leaves Missouri hospital and business leaders in limbo
Deirdre Shesgreen, The News Leader

Missouri’s hospital leaders and business chiefs are growing increasingly nervous about the GOP’s plan to “repeal and replace” Obamacare, and some want congressional Republicans to fix the health care law, instead of scrapping it. “We think that the Affordable Care Act needs to be repaired, but not entirely replaced,” said Steven Edwards, the president and CEO of CoxHealth in Springfield.

Pharma, Biotech and Devices

Firm Delays Muscular Dystrophy Drug U.S. Launch Amid Criticism of $89,000 Price
Joseph Walker and Susan Pulliam, The Wall Street Journal

Marathon Pharmaceuticals LLC said it would delay the U.S. launch of its expensive muscular-dystrophy drug amid mounting criticism of its $89,000-a-year price, including from two members of Congress who launched an investigation Monday, and a powerful Republican member of the House of Representatives. In a statement posted on the website of a nonprofit group involved with muscular dystrophy, Marathon CEO Jeffrey Aronin said the company was “pausing our launch,” which had been scheduled for March.

Allergan to buy fat-fighter Zeltiq Aesthetics for $2.48 billion
Michael Erman and Natalie Grover, Reuters

Botox maker Allergan Plc <AGN.N,> agreed to pay $2.48 billion in cash for Zeltiq Aesthetics Inc, adding a system that it says helps people slim down by freezing fat away to the company’s line-up of aesthetic products. Allergan said it would benefit from the cross-selling opportunities for consumers of Zeltiq’s CoolSculpting System, which uses cooling to kill fat cells, as well as customers of its own facial injectible products.

Sharp Rise Reported in Older Americans’ Use of Multiple Psychotropic Drugs
Benedict Carey, The New York Times

The number of retirement-age Americans taking at least three psychiatric drugs more than doubled between 2004 and 2013, even though almost half of them had no mental health diagnosis on record, researchers reported on Monday. The new analysis, based on data from doctors’ office visits, suggests that inappropriate prescribing to older people is more common than previously thought.

Health IT

Docs look to Price for relief from regulatory burden, including MACRA
Joanne Finnegan, Fierce Healthcare

Not all doctors were behind the appointment of fellow physician Tom Price as the new secretary of the Department of Health and Human Services. But with Price’s confirmation to the post last week, some doctor’s groups are looking to Price to make changes that will benefit physicians, including easing MACRA requirements.

A Message from the Coalition for Affordable Prescription Drugs:

Federal programs, state governments, employers, unions and others partner with PBMs to address rising prescription drug costs, keep patients healthy and deliver value for the health system. Visit for more.

Opinions, Editorials and Perspectives

The Health Care Cure Must Include Prevention
Helen Durkin, Morning Consult 

It seems incongruous that obesity — which costs our nation an estimated $147 billion or more each year — is barely covered in medical school. A recent study found that medical students receive hardly any training in obesity.

Repair and retain Obamacare: Our view
The Editorial Board, USA Today

When President Obama was in office, Republicans made a mantra of their call to “repeal and replace” his signature health care program. But now that they are actually in position to do something, they’re flummoxed.

Games Drugmakers Play
Joe Nocera, Bloomberg News

One of my goals when I joined Bloomberg View a month ago was to dive into the contentious subject of drug pricing. I’d like to explain to readers why the pharmaceutical companies have been raising prices so relentlessly these past half-dozen years, even as the practice has become a huge issue on Capitol Hill and in the country.

A Message from the Coalition for Affordable Prescription Drugs:

Federal programs, state governments, employers, unions and others partner with PBMs to address rising prescription drug costs, keep patients healthy and deliver value for the health system. Visit for more.

Research Reports

Evaluating Measures of Hospital Quality
Joseph J. Doyle Jr., The National Bureau of Economic Research

In response to unsustainable growth in health care spending, there is enormous interest in reforming the payment system to “pay for quality instead of quantity.” While quality measures are crucial to such reforms, they face major criticisms largely over the potential failure of risk adjustment to overcome endogeneity concerns. In this paper we implement a methodology for estimating the causal relationship between hospital quality measures and patient outcomes.