Health Brief: House GOP Leaders Outline Plan to Replace Obama Health Care

Washington Brief

  • House Republican leaders presented rank-and-file lawmakers an outline of their plan to replace Obamacare that leans on tax credits to help consumers purchase health insurance and would rollback the law’s Medicaid expansion. The blueprint does not say how the bill, which Speaker Paul Ryan said he intends to introduce after the recess next week, would be paid for. (The New York Times)
  • In an early-morning Tweet, President Donald Trump said the Obamacare repeal is “moving fast.” (Politico)
  • Seema Verma, Trump’s nominee for Centers for Medicare and Medicaid Services, said at her confirmation hearing that she supports rolling back Obamacare’s maternity care requirement. She also declined to weigh in on the GOP debate over how to fund Medicaid programs. (Morning Consult)

Business Brief

  • The Justice Department joined a lawsuit accusing UnitedHealth Group and affiliated plans of fraudulently collecting millions of dollars by claiming patients were sicker than they really were. (Modern Healthcare)
  • Embattled blood-diagnostics company Theranos had less than a quarter of the funding it raised from investors and partners at the end of 2016.  (The Wall Street Journal)
  • Tad Lipsky was appointed the acting director of the Federal Trade Commission’s Bureau of Competition, which polices mergers and acquisitions for most of the health care industry. Former FTC staffers describe him as a pro-business conservative. (Axios)

Chart Review

Events Calendar (All Times Local)

Families USA Health Action 2017 7:30 a.m.



House G.O.P. Leaders Outline Plan to Replace Obama Health Care Act
Robert Pear and Thomas Kaplan, The New York Times

House Republican leaders on Thursday presented their rank-and-file members with the outlines of their plan to replace the Affordable Care Act, leaning heavily on tax credits to finance individual insurance purchases and sharply reducing federal payments to the 31 states that have expanded Medicaid eligibility. Speaker Paul D. Ryan and two House committee chairmen stood with the new secretary of health and human services, former Representative Tom Price of Georgia, preparing Republican lawmakers for a weeklong Presidents’ Day recess that promises to be dominated by angry or anxious questions about the fate of the health law.

Trump says Obamacare repeal ‘moving fast’
Madeline Conway, Politico

President Donald Trump asserted Friday that Republican plans to repeal and replace Barack Obama’s healthcare reform law are “moving fast,” a counter to reports of division among Capitol Hill Republicans on the process. Trump, noting that his pick for health and human services secretary, former Rep. Tom Price, had been confirmed, also took a dig at Democrats in an early-morning tweet, writing at about 5:15 a.m. that they had engineered “long delays” in confirming him.

How the FTC’s new competition chief could affect health care
Bob Herman, Axios

President Trump’s acting Federal Trade Commission chairwoman, Maureen Ohlhausen, is wasting no time shaking up the agency. She named Tad Lipsky the new acting director of the FTC’s Bureau of Competition yesterday — the office charged with policing mergers and acquisitions for most of the health care industry.

Republican Health Proposal Would Redirect Money From Poor to Rich
Margot Sanger-Katz, The New York Times

Republicans in Congress have been saying for months that they are working on a plan to repeal and replace Obamacare in the Trump era. Now we have the outline of that plan, and it looks as if it would redirect federal support away from poorer Americans and toward people who are wealthier.

Ted Cruz Wants to Repeal Obamacare Now, Then Work Out Replacement Details
Niels Lesniewski, Roll Call

Even no with no consensus replacement for Obamacare in sight, Sen. Ted Cruz is pushing for action on the repeal long promised by Republicans. “What I think is critical at the outset is that we honor the promise we’ve made to voters for six years running now to repeal Obamacare. We’ve had three elections — 2010, 2014 and 2016 — that were referenda on repealing Obamacare, and we need to honor that promise,” Cruz said. “Once Obamacare’s repealed, then we need common sense health care reform that expands choices, that lowers prices, and empowers patients to make their own health care decisions.”

Lawmakers seek to help e-cigarette makers escape new regulations
Sheila Kaplan, Stat News

Congressional supporters of the tobacco industry have wasted no time in proposing legislation to help e-cigarette companies escape rules adopted under President Barack Obama. In what Republican Reps. Tom Cole (Okla.) and Sanford Bishop (Ga.) described as a “clarification,” the two introduced a bill Thursday that would revise Food and Drug Administration rules governing the sale and advertising of e-cigarettes and cigars.

Non-profit seeking to cure blindness up for $100M grant
Wilson Ring, The Associated Press

A Vermont-based nonprofit group that works to cure blindness in Nepal and other developing countries is one of eight semifinalists for a $100 million grant from the John D. and Catherine T. MacArthur Foundation. The Waterbury-based Himalayan Cataract Project, based out of a rented office in a church parsonage, has been working for years to train local health care providers to perform cataract and laser surgery in Nepal and other countries.

The 5 biggest disagreements Republicans have on Obamacare
Andrew Prokop, Vox

Deep uncertainty and serious divisions within the Republican coalition about the way forward on Obamacare have surfaced in the new Congress, and they’ve put the future of repeal and replace in doubt. It’s become evident that there is little GOP unity on how much a replacement plan should cost, how to pay for it, whether the Medicaid expansion should be rolled back, or how to fix the individual markets.

Stocks Decline With Commodities as Pound Slumps: Markets Wrap
Robert Brand and Eddie Van Der Walt, Bloomberg News

European stocks dropped for a second day as commodity producers tracked declines in oil and metal prices, while the pound weakened after a report showed U.K. retail sales fell in January. French bonds retreated and the euro weakened after two left-wing presidential hopefuls discussed a potential single candidacy that would bring about a showdown with Marine le Pen’s anti-euro National Front.


DOJ joins Medicare Advantage fraud lawsuit against UnitedHealth
Shelby Livingston, Modern Healthcare

The U.S. Justice Department has joined a whistleblower lawsuit claiming that UnitedHealth Group and affiliated health plans have been gaming the Medicare program and fraudulently collecting millions of dollars by claiming patients were sicker than they really were. The lawsuit, initially brought in 2011 and unsealed Thursday after a five year-long investigation by the Justice Department, alleges that Minnetonka, Minn.-based UnitedHealth has inflated its plan members’ risk scores since at least 2006 in order to boost payments under Medicare Advantage’s risk adjustment program.

CMS Nominee Verma Supports Making Maternity Coverage Optional
Jon Reid, Morning Consult 

Seema Verma, President Donald Trump’s pick to head the Centers for Medicare and Medicaid Services, said on Thursday that insurers should not have to provide maternity coverage, as is now required under the Affordable Care Act. Asked by Sen. Debbie Stabenow (D-Mich.) at her confirmation hearing, Verma said women should be able to choose between health plans that offer maternity coverage and others that do not.

Flake, Brat Head to White House to Talk Health Savings Accounts
Mary Ellen McIntire, Morning Consult 

Two Republican lawmakers met Thursday with National Economic Council Director Gary Cohn at the White House to discuss health savings accounts. Sen. Jeff Flake (R-Ariz.) and Rep. Dave Brat (R-Va.) were at the meeting.

Medicaid exposes rifts within the GOP over the program’s future after the ACA
Juliet Eilperin, et al., The Washington Post 

As congressional Republicans move from talking points to details of how to abolish the Affordable Care Act, behind-the-scenes jockeying over the future of Medicaid demonstrates the delicate trade-offs the GOP faces in trying to steer health policy in a more conservative direction. For years, many Republicans have railed against the ACA’s expansion of Medicaid, which has extended coverage to about 11 million people.

HHS rule delay does not slow launch of bundled payment models
Virgil Dickson, Modern Healthcare

The Trump administration’s move to delay the effective date for a rule that launched several new cardiac and orthopedic bundled payment models under Medicare will not slow the launch of the initiatives, an HHS spokesman confirmed Thursday. On Wednesday, a notice on the Federal Register delayed the effective date for a final rule that launches a new mandatory pilot that would make hospitals in 98 markets financially accountable for the cost and quality of all care associated with bypass surgery and heart attacks.


CHS sells eight hospitals to Steward Health Care
Dave Barkholz, Modern Healthcare

Community Health Systems has agreed to sell eight hospitals to subsidiaries of Steward Health Care System in its single biggest divestiture package to date, the companies announced Thursday. Terms were not immediately disclosed.

House votes to let states deny federal funds to abortion providers
Jessie Hellman, The Hill

The House voted Thursday to roll back an Obama-era regulation that barred states from defunding health care providers for political reasons. Former President Obama’s rule required that state and local governments distribute federal Title X funding for services related to contraception, fertility, pregnancy care and cervical cancer screenings to health providers, regardless of whether they also perform abortions.

CHI’s operating loss swells to $153.9M in Q2
Ayla Ellison, Becker’s Hospital Review

Catholic Health Initiatives, a nonprofit 103-hospital system based in Englewood, Colo., saw revenue increase in the second quarter of fiscal year 2017 but ended the period with an operating loss, according to recently released bondholder documents. CHI said operating revenues climbed to $4.2 billion in the second quarter of FY 2017, up from $4 billion in the same period of the year prior.

Pharma, Biotech and Devices

Theranos Had $200 Million in Cash Left at Year-End
Christopher Weaver, The Wall Street Journal

Theranos Inc., the embattled blood-diagnostics firm, is on life support. The Silicon Valley company had $200 million of cash on hand at the end of 2016, people familiar with the matter said, less than a quarter of the funding it raised from investors and partners.

Exclusive CRISPR licenses slow development of therapies, legal experts argue
Sharon Begley, Stat News

The exclusive licenses granted to three for-profit companies on key discoveries about the revolutionary genome-editing technology CRISPR-Cas9 threaten to “bottleneck” its use “to discover and develop useful human therapeutics,” patent experts argued in a paper published on Thursday. What the exclusive licenses have done “is give an entire industry to … companies that will never be able to fully exploit it,” Jorge Contreras of the University of Utah, a co-author of the paper in Science, said in an interview. “And that may hold back the development of therapies.”

Health IT

Microsoft Takes Another Crack at Health Care, This Time With Cloud, AI and Chatbots
Dina Bass, Bloomberg News

Microsoft Corp. is trying again in health care, betting its prowess in cloud services and artificial-intelligence can help it expand in a market that’s been notoriously hard for technology companies. A new initiative called Healthcare NExT will combine work from existing industry players and Microsoft’s Research and AI units to help doctors reduce data entry tasks, triage sick patients more efficiently and ease outpatient care.

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

Whether Repeal or Replace, Real People Are at the Center of the Policy Storm
LaVarne A. Burton, Morning Consult 

For millions of Americans, the future of their health insurance is a matter of intense national debate. Whatever your position on the Affordable Care Act, what should be front and center is that real people will face real consequences in this policy debate — and people with pre-existing conditions are particularly vulnerable to shifts in insurability.

Price Has the Prescription to Heal DC’s Health Care Woes
Jared Whitley, Morning Consult 

While the pun about President-elect Trump nominating former Rep. Tom Price (R-Ga.) to lead the Department of Health and Human Services is so obvious you just have to make it (indeed both Forbes and The Hill did a couple months ago), the sentiment is perfectly apt. In a time of shocking health care-related debt and unfunded obligations, the right person to oversee the federal government’s health care programs is a physician-budget hawk.

Time Waits for No Plan
David Blumenthal, The Commonwealth Fund

In the fall of 1964, Wilbur Cohen, then assistant secretary of legislation at the U.S. Department of Health, Education and Welfare (now the U.S. Department of Health and Human Services), was summoned to the White House along with his peers from throughout the fledgling Johnson Administration. Lyndon Baines Johnson had just been elected president in his own right after succeeding the slain John F. Kennedy as president in November 1963.

Big Pharma really, really doesn’t want you to know the true value of its drugs
David Lazarus, The Los Angeles Times

The latest poster child for cruel and inhuman drug pricing is Kaleo Pharma, maker of an emergency injector for a med called naloxone, which is used as an antidote to save the lives of people who overdose on painkillers. As America’s opioid crisis reaches epidemic levels, Kaleo has jacked up the list price for its Evzio auto-injector by 600%, soaring from $690 several years ago to $4,500, according to lawmakers.

A Sign That Obamacare Exchanges Are Failing
Megan McArdle, Bloomberg View

Yet more bad news for Obamacare this week: Molina Healthcare lost $110 million on the exchanges last year, and the CEO told investors, “There are simply too many unknowns with the marketplace program to commit to our participation beyond 2017.” At first glance, it’s hard to see why this piece of news is worth worrying about.

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

Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use
Michael L. Barnett, et al., The New England Journal of Medicine 

Increasing overuse of opioids in the United States may be driven in part by physician prescribing. However, the extent to which individual physicians vary in opioid prescribing and the implications of that variation for long-term opioid use and adverse outcomes in patients are unknown.