Health Brief: Judge Rules Cigna Can Walk Away From Anthem Merger

Washington Brief

  • There is growing support among Senate Republicans to make the tax credits in the House-passed health care bill more generous by pegging them to income and providing more financial aid for poorer people. (Politico)
  • The most conservative members of the Senate GOP’s health care working group are pushing for changes that would force millions of adults off Medicaid, limit the value of tax credits to prevent them from being used to pay for abortions and weaken consumer protections for people with pre-existing conditions. (The Washington Post)
  • Following criticism for forming a 13-man working group on health care, Majority Leader Mitch McConnell (Ky.) privately told fellow Senate Republicans that women will be invited to attend all of its future meetings. (The Hill)

Business Brief

  • A Delaware judge ruled that Cigna Corp. is free to walk away from its $48 billion merger with Anthem Inc., almost three months after another court blocked the deal as anticompetitive. Anthem could be hit with $1.85 billion in breakup fees and $13 billion in damages to Cigna. (Bloomberg News)
  • A day after Aetna announced its exit from Obamacare, Kaiser Permanente Chief Executive Bernard Tyson said the managed-care system will stick with the Affordable Care Act markets next year. Kaiser Permanente health plans covered 11.7 million people as of February. (The Wall Street Journal)
  • After being mostly ignored by the House Republicans as they drafted their health care bill, some health industry groups are finding Senate Republicans more receptive to their concerns, and are working to steer the chamber away from steep cuts to Medicaid. (Axios)

Chart Review

Events Calendar (All Times Local)

Consumer Healthcare Products Association Regulatory Science and Quality Conference 8 a.m.
National Economists Club luncheon on the ACA and AHCA 12 p.m.



McConnell promises women can take part in healthcare meetings
Alexander Bolton, The Hill

Senate Majority Leader Mitch McConnell (R-Ky.) has provided assurance to GOP colleagues that women will be invited to attend future meetings of a special working group tasked with negotiating healthcare reform. The assurances made in private, backed up by a public statement earlier in the week, have quelled concern in the GOP conference that the rollout of the working group would be derailed by controversy over gender politics.

Health care industry finds a more receptive Senate
Bob Herman, Axios

The Trump administration and House Republicans mostly ignored hospitals, doctors, some health insurers and other health care industry players in the push to pass the American Health Care Act. But now that the more moderate Senate is handling the potential Affordable Care Act repeal effort, some health care groups are finding a seat back at the table.

Senate GOP’s agenda is at a moment of reckoning with unpredictable Trump
Sean Sullivan and Kelsey Snell, The Washington Post 

Senate Republicans are suddenly grappling with a demanding agenda riddled with political peril, as they prepare to try to confirm a new FBI director and reshape the nation’s health-care system — two challenges that have landed before them in rapid succession. President Trump’s abrupt firing of James B. Comey has raised concerns in both parties that threaten to linger in the effort to replace him.

Trump and Obama budget chiefs spar over Obamacare replacement, CBO
Kimberly Leonard, The Washington Examiner

Mick Mulvaney, President Trump’s budget chief, and Peter Orszag, who held the role for a time under former President Barack Obama, sparred Thursday about the Republican healthcare bill, the Congressional Budget Office and how to get drug prices under control. Mulvaney defended the House Republican plan to repeal and replace Obamacare, called the American Health Care Act, saying it would allow states to choose how they want to craft healthcare plans.

Trump shows his conflicted view on health care
David Nather, Axios

Take a look at The Economist’s interview with President Trump today, and you can watch him wrestle in real time with what he really wants on health care. That’s especially true on whether he’d continue those insurer payments that may determine whether they’ll stay in the Affordable Care Act marketplaces.

Senators push back on Trump’s proposed cuts to drug control office
Lev Facher, Stat News

The Trump administration’s proposal to nearly eliminate funding for White House office tasked with overseeing the nation’s opioid fight is getting fast and firm pushback from the Senate. A bipartisan group of 13 lawmakers, led by Senators Chuck Grassley (R-Iowa) and Dianne Feinstein (D-Calif.), warned President Trump this week that reducing the Office of National Drug Control Policy’s budget by nearly 95 percent would derail the fight against the opioid epidemic, hamper law enforcement efforts, and cost the government money in the long run.

Addiction specialists blast Price comment on opioids
Arthur Allen, Politico

Addiction specialists and public health officials on Thursday chided Health and Human Services Secretary Tom Price for belittling the use of medications considered the standard of care for the treatment of opioid addiction. The remarks irked specialists already worried by the Trump administration’s law-and-order stance on drug control and its tentative plans, leaked to POLITICO last week, to gut the White House Office of National Drug Control Policy.

U.S. hepatitis C cases soar on spike in heroin use
Bill Berkrot, Reuters

U.S. health officials said new cases of hepatitis C rose nearly 300 percent from 2010 to 2015, despite the availability of cures for the liver disease, fueled by a spike in the use of heroin and other injection drugs, according to a report released on Thursday. In 2015, the national reported rate of hepatitis C was 0.8 per 100,000 persons with nearly 34,000 new infections, according to the report by the Centers for Disease Control and Prevention.

Commodity Rout Shows Signs of Easing as Gold Rises: Markets Wrap
Robert Brand and Adam Haigh, Bloomberg News

Gold climbed a second day amid a rebound for metal prices that helped ease a commodity rout even as oil remained depressed. Bonds extended gains.


Cigna Wins Judge’s Approval to Walk Away From Anthem Merger
Jef Feeley, Bloomberg News

Cigna Corp. can walk away from its $48 billion merger with Anthem Inc., a Delaware judge ruled almost three months after another court blocked the deal as anticompetitive. The ruling on Thursday means Anthem could be on the hook for $1.85 billion in breakup fees and $13 billion in damages to Cigna, which had argued that its would-be partner was too stubborn to see that the concerns about competition were insurmountable.

Kaiser Permanente Chief Pledges to Remain in Affordable Care Act Markets
Melanie Evans, The Wall Street Journal

Kaiser Permanente Chief Executive Bernard Tyson said Thursday that the Affordable Care Act insurance markets are “still very unstable,” but repeated earlier statements that the managed-care system will stick with the markets next year. In remarks at a Wall Street Journal Future of Healthcare event in New York, Mr. Tyson rejected the characterization by Aetna Inc. Chief Executive Mark Bertolini earlier this year that the markets were in a death spiral.

Tax credits may provide rallying point for Senate Obamacare repeal
Jennifer Haberkorn, Politico

Senate Republicans are working on a potential breakthrough that could help push through an Obamacare repeal bill – by making insurance subsidies look a lot like Obamacare. There’s growing support for the idea of pegging the tax credits in the House repeal bill to income and making aid more generous for poorer people.

Senate hard-liners outline health-care demands with Medicaid in the crosshairs
David Weigel and Elise Viebeck, The Washington Post 

Senate conservatives, once seen as an impediment to the Obamacare repeal push, are instead lobbying for changes that would drop millions of adults from Medicaid, limit the value of tax credits over concerns about funding abortion and weaken or cancel consumer protections. Senators like Mike Lee (R-Utah) believe these changes will help reduce health-care spending, prevent tax-credit dollars from paying for abortions and expand access to health insurance by lowering premiums — all arguments supported by conservative advocacy groups.

Rural Shoppers Face Slim Choices, Steep Premiums On Exchanges
Michelle Andrews, Kaiser Health News

People living in sparsely populated areas who shopped for coverage on the state health insurance marketplaces in 2017 frequently had just one or two insurers from which to pick and often faced significantly higher premiums than did people in more urban areas, according to a new study. As insurers finalize plans for participating in the 2018 exchanges, policy experts have speculated that the uncertainty surrounding the Affordable Care Act will lead insurers to continue to pull back from some online marketplaces or exit them altogether, leaving a growing number of people with fewer, pricier options.

Senate GOP united on one thing: lowering premiums
Caitlin Owens, Axios

Senate Republicans have spent three days throwing around all kinds of health policy ideas, but they’re all united around Thursday’s topic du jour: lowing premiums. “There’s no reason that premiums on the individual market should double and triple in a state like mine. There was no reason for that other than Obamacare,” Sen. Ron Johnson of Wisconsin told reporters.

CMS Gives States Until 2022 To Meet Medicaid Standards Of Care
Phil Galewitz, Kaiser Health News

The Trump administration has given states three extra years to carry out plans for helping elderly and disabled people receive Medicaid services without being forced to go into nursing homes. Federal standards requiring states find ways of delivering care to Medicaid enrollees in home and community-based settings will take effect in 2022 instead of 2019, the Centers for Medicare & Medicaid Services announced this week.


CMS gives 800,000 docs a pass on MACRA requirement
Virgil Dickson, Modern Healthcare

More than 800,000 clinicians will not have to comply with Merit-based Incentive Payment System reporting requirements outlined in MACRA, which may save them millions collectively in compliance costs. The majority of physician practices were expected to use the Merit-based Incentive Payment System, known as MIPS, to comply with MACRA as opposed to alternative pay models.

Pharma, Biotech and Devices

FDA user-fee extension breezes through Senate committee
Alex Kacik, Modern Healthcare

A Senate committee easily passed a bipartisan bill to reauthorize the FDA’s ability to collect user fees from drug and device makers. The Senate’s Committee on Health, Education, Labor & Pensions voted 21-2 during a markup hearing to approve the bipartisan Food and Drug Administration User Fee Reauthorization Act.

Has Merck Lucked Into A $10 Billion Drug?
Matthew Herper, Forbes

Merck–and its cancer drug Keytruda–had a great day yesterday. First, rival drug giant Roche revealed that a clinical trial failed to show its Tecentriq, a drug similar to Keytruda, extended the lives of patients with bladder cancer.

Health IT

Slavitt takes on senior advisor role with healthcare innovation network AVIA
Beth Jones Sanborn, Healthcare Finance 

Former Acting Administrator for the Centers for Medicare and Medicaid Andy Slavitt has joined healthcare innovation network AVIA as a senior advisor, the company announced. “One of the principal areas I will focus on is what major healthcare organizations need to do differently for our country to succeed in transforming patient care. We have small scale innovation all over, but until physicians, patients, and systems can absorb and benefit at scale, our healthcare system will remain stalled,” Slavitt said.

A Message from PhRMA:

You don’t always pay full price for doctor or hospital visits. So why is a visit to the pharmacy different? Unlike care received at an in-network hospital or physician’s office, patients with high deductibles or coinsurance pay cost sharing based on the list price of a medicine, even if their insurer receives a steep discount. Insurers should share more of the rebates they receive with patients. Get the facts at

Opinions, Editorials and Perspectives

Decision to Rethink Regulation Shows Understanding of Home Health Value
Keith Myers, Morning Consult 

The Centers for Medicare & Medicaid Services recently announced plans to suspend the application of a mandatory regulation on providers of skilled home health care, which was widely praised by leaders in the Medicare post-acute care sector for demonstrating an increased recognition of the human, clinical and fiscal value home health offers the Medicare program and the 3.5 million older Americans who annually depend on the home health benefit. CMS had recently put forth a Pre-Claim Review Demonstration, which called for mandatory regulatory requirements imposed on America’s home health agencies in an attempt to reduce improper payments.

What Democrats Won’t Admit About Voters and Health Care
Tyler Cowen, Bloomberg View

Since the Republican House approved its replacement for Obamacare, critics of the bill have told us how it will take health insurance away from millions of people, while doing little to control medical costs or bring fiscal rectitude. Those arguments are mostly true, but the same commentators have neglected to acknowledge a crucial point.

Aetna Says Sayonara to ObamaCare
The Editorial Board, The Wall Street Journal

For all the media think pieces about the nature of truth in the Trump era, Democrats have their own alternative facts about ObamaCare. To undermine the GOP case for repeal and replace, they claim the entitlement is working beautifully.

A Message from PhRMA:

DID YOU KNOW more than 1/3 of the list price for brand medicines is rebated back to payers and the supply chain? Yet, unlike care received at an in-network hospital or physician’s office, patients with high deductibles or coinsurance pay cost sharing based on a medicine’s list price, even if their insurer receives a steep discount. Patients share the costs of medicines, so they should share the savings. Learn more at

Research Reports

21% Of U.S. Voters Approve Of Revised GOP Health Plan, Quinnipiac University National Poll Finds; Voters Reject Trump Tax Plan Almost 2-1
Quinnipiac University 

Only 21 percent of American voters approve of the Republican health care plan passed by the U.S. House of Representatives last week, a slight improvement over the 17 percent who approved of the first health care plan in March, according to a Quinnipiac University national poll released today. Overall, the current health plan goes down 56 – 21 percent.