Health Brief: Some Navigators Shut Down Ahead of ACA Enrollment Period

Government Brief

  • In private negotiations with Senate Democrats, Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.) has reportedly suggested substantial changes that would make it easier for states to waive some of the Affordable Care Act’s consumer protections and benefits. The proposals are staunchly opposed by Democrats, and could stall a crunch-time effort to stabilize the health insurance marketplaces. (Axios)
  • The Democratic Party’s embrace of “Medicare for all” carries immense political risks, as nearly any single-payer plan would require a radical change in the nation’s health care system, from upending the insurance arrangements of the roughly 156 million Americans who get coverage through their employer to changing how providers and makers of drugs and other medical products are paid. (The New York Times)
  • Sens. Lindsey Graham (R-S.C.) and Bill Cassidy’s (R-La.) forthcoming health care plan attempts to equalize funding for states that expanded Medicaid under the Affordable Care Act and those that opted not to, according to a draft summary of the bill. An intraparty dispute over phasing out the Medicaid expansion was a key factor in the collapse of Republicans’ previous attempts to repeal Obamacare. (NBC News)

Business Brief

  • Several navigator organizations, including one that received the largest federal grant for Obamacare enrollment activities in 2016, are suspending operations ahead of the 2018 open enrollment season because they haven’t received contracts for funding from the Department of Health and Human Services, which could cause enrollment to plummet. The Trump administration announced plans last month to cut funding for navigator groups by about 40 percent, but health officials haven’t said whether the grants would end altogether. (Modern Healthcare)
  • In a unanimous recommendation, a Food and Drug Administration panel declared that the addiction risk of letting children use cough medications that contain certain opioids far outweighs the benefits. The panel’s recommendation is part of an agency effort to determine whether and how opioids should be used in medicine for children. (Stat News)
  • Equifax Inc., which suffered a cyber-breach last week that it said exposed the personal data of roughly 143 million people, has a $329 million contract with the federal government to check income and other private information of individuals who purchased health insurance on the Obamacare exchanges. An HHS spokesperson said the department was informed that the ACA data wasn’t part of the breach. (Bloomberg)

Chart Review

Events Calendar (All Times Local)

The Hill event on gene therapy 8 a.m.
Senate Finance Committee hearing on health care issues impacting costs and coverage 10 a.m.
Senate HELP Committee hearing on state flexibility 10 a.m.
The Hill event on the opioid epidemic 8 a.m.
Health Affairs briefing on innovation in medicine 9 a.m.
House Energy and Commerce subcommittee hearing on FDA’s regulation of OTC drugs 10:15 a.m.
House Energy and Commerce subcommittee hearing on Public Health Service Act workforce programs 10 a.m.
Senate HELP Committee hearing with health care stakeholders 10 a.m.
No events scheduled

Ever wonder who decides what you pay for your medicines? It’s not who you might think.

Biopharmaceutical companies set the list prices for their medicines, but it’s your insurer that ultimately determines how much you pay out of pocket. More than one-third of the list price of a medicine is rebated back to middlemen, like insurers and pharmacy benefit managers (PBMs). These rebates and discounts create savings of more than $100 billion, but these savings aren’t always shared directly with patients. Let’s talk about cost.


How Single-Payer Health Care Could Trip Up Democrats
Margot Sanger-Katz, The New York Times

Many Democrats giddy from their recent health policy successes are starting to reach enthusiastically for a mountaintop goal: establishing a single-payer system for all Americans. But they may want to learn the lessons of their opposition.

Two GOP Senators Give Obamacare Repeal One More Try
Leigh Ann Caldwell, NBC News

Two Republican senators are launching yet another attempt at repealing Obamacare, preparing to offer legislation that would try to bridge one of the key dividing elements of an effort that has twice failed to pass the senate, according to a section-by-section analysis obtained by NBC News. It’s too early to gauge whether or not the approach could muster enough support to pass either the Senate or the House, or even if GOP leadership would take it up, but it’s a last-ditch effort by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., to repeal the Affordable Care Act.

Paul: Cassidy-Graham health care bill not ‘going anywhere’
Peter Sullivan, The Hill

Sen. Rand Paul (R-Ky.) said Monday that he opposes a new Republican ObamaCare replacement effort, saying it does not go far enough to repeal the law. Paul told reporters that the bill from GOP Sens. Bill Cassidy (La.) and Lindsey Graham (S.C.) would “probably” be worse than doing nothing at all on the health law.

Congress Rejects Trump Proposals to Cut Health Research Funds
Robert Pear, The New York Times

Back in March, when President Trump released the first draft of his budget proposal for the coming fiscal year, he asked lawmakers for deep cuts to one of their favorite institutions, the National Institutes of Health — part of a broad reordering of priorities, away from science and social spending, toward defense and border security. Six months later, Congress has not only rejected the president’s N.I.H. proposal; lawmakers from both parties have joined forces to increase spending on biomedical research — and have bragged about it.

Once Obamacare repeal is dead, the GOP has no plan B
Dylan Scott, Vox

After seven years of promises, seven years of warnings that Obamacare was perhaps the worst law that had ever been written, Republicans finally got their chance to repeal it. They failed, spectacularly, in late July.

Suggested plan for Dems in 2018: blame GOP for health care failures
Alexi McCammond, Axios

Protect Our Care — the coalition fighting the GOP efforts to repeal and replace the Affordable Care Act — held a briefing call about their latest poll for more than 100 progressive leaders and advocacy groups last Friday, Axios has learned from a source on the call.

Stocks Rise as Dollar Struggles to Sustain Rebound: Markets Wrap
Robert Brand, Bloomberg

European equities headed for the longest winning streak in five months after the S&P 500 Index led global stocks to a record high on Monday. The dollar struggled to build on a strong start to the week as concerns about lackluster inflation lingered before key U.S. data.


Senate’s ACA talks aren’t going as well as they seem
Caitlin Owens, Axios

Republicans and Democrats on the Senate HELP Committee disagree about the how far they should go in overhauling the Affordable Care Act’s “state innovation waivers” — a dispute that could spell trouble for the committee’s bipartisan talks about how to shore up the ACA. The committee’s public hearings have focused mainly on non-controversial changes to the waiver process.

With funding slashed and no contracts in hand, ACA marketplace ‘navigators’ are shutting down
Shelby Livingston, Modern Healthcare

Navigator groups that help educate and enroll consumers in the Affordable Care Act insurance exchanges are shutting down because the federal government isn’t paying them. Several navigator organizations, including the University of South Florida, which received the country’s largest federal grant for navigation services in 2016, are suspending education and outreach activities ahead of the 2018 open enrollment period that is slated to begin Nov. 1.

As Congress Debates Health Care, Study Finds Relationship Between Medicaid and Children’s Health Insurance
Shefali Luthra, Kaiser Health News

Efforts by Republican lawmakers to scale back Medicaid enrollment could undercut an aspect of the program that has widespread bipartisan appeal — covering more children, research published Tuesday in the journal Health Affairs suggests. The study focuses on the impact of Medicaid’s “welcome-mat” effect — a term used to describe the spillover benefits kids get when Medicaid eligibility is extended to their parents.

Dems accuse Trump of ObamaCare enrollment sabotage
Nathaniel Weixel, The Hill

A group of House Democrats is accusing the Trump administration of deliberately sabotaging ObamaCare enrollment efforts. In a letter sent Monday, the ranking Democrats on the House Energy and Commerce Committee demanded answers about the Trump administration’s decision to slash funding for ObamaCare outreach.


For One Hedge Fund, a Bet on the Affordable Care Act Sours
Julie Creswell and Reed Abelson, The New York Times

Wagering that the new federal health care law would be a boon, the billionaire investor Larry Robbins bet big on hospital stocks five years ago. Those investments helped propel his hedge fund, Glenview Capital Management, to the ranks of the top-performing funds in 2013.

Florida’s hospitals weather the storm
Amy Ellis Nutt, The Washington Post

Doctors, nurses and staff at hospitals up and down Florida’s Gulf and Atlantic coasts were nearly breathless with surprise and relief Monday: Their patients — and their buildings — had survived the monster named Irma. “We’re wonderful,” said Cheryl Garn, spokeswoman for Lee Health’s four hospitals in Fort Myers.

Providers reduce waste to work around ballooning drug prices
Alex Kacik, Modern Healthcare

Cleveland Clinic is one of the most prolific users of the heart drugs nitroprusside and isoproterenol, so when their respective prices surged 30-fold and 70-fold over a three-year span, it caught the provider’s attention. Doctors have long relied on the widely used drugs during life-threatening situations.

Doctors who take pharmaceutical money use Twitter to hype drugs
Ronnie Cohen, Reuters

Some cancer doctors use Twitter to promote drugs manufactured by companies that pay them, but they almost never disclose their conflicts of interest on the social media platform, a new study shows. “This is a big problem,” said senior author Dr. Vinay Prasad, a professor at Oregon Health and Science University in Portland.

Pharma, Biotech and Devices

FDA panel says risk of opioid use in kids’ cough medicines outweighs benefits
Ike Swetlitz, Stat News

A federal advisory committee sent a strong message to the Food and Drug Administration on Monday, declaring nearly unanimously that the risks of using certain opioids in children’s cough medications outweighs the benefits. “We have a disease with a very low risk profile, yet we’re looking at a drug that has a risk of death,” said Dr. Christy Turer, an assistant professor of pediatrics, clinical sciences, and medicine at the University of Texas Southwestern.

New Gene-Therapy Treatments Will Carry Whopping Price Tags
Gina Kolata, The New York Times

The first gene therapy treatment in the United States was approved recently by the Food and Drug Administration, heralding a new era in medicine that is coming faster than most realize — and that perhaps few can afford. The treatment, Kymriah, made by Novartis, is spectacularly effective against a rare form of leukemia, bringing remissions when all conventional options have failed.

Pharma’s five favorite tricks to protect a monopoly
Damian Garde, Stat news

The trillion-dollar drug industry operates on a grand bargain. If you invent a wonder pill, you get a patent and thus a monopoly.

Health IT

Equifax Holds Contract to Verify Data of Obamacare Customers
Anna Edney and Paul Murphy, Bloomberg

Equifax Inc., which said last week it suffered a breach that exposed the personal data of 143 million Americans, holds a contract to check incomes and other data of people who bought health insurance in the Obamacare markets. The credit data firm has a $329 million, five-year government contract which ends in March to verify the incomes of people purchasing coverage through the health exchanges.

FDA begins digital health hiring efforts
Jeff Byers, Healthcare Dive

The FDA posted a job opportunity on Monday for its Digital Health Team. The position — Digital Health Advisor (Interdisciplinary Engineer) — is one of the first job opportunities posted as part of the agency’s plan to build a new team solely focused on digital health.

A Message from PhRMA:

Are middlemen really holding down the cost of medicines? Biopharmaceutical companies set the list prices for their medicines, but it’s your insurer that ultimately determines how much you pay out of pocket. More than one-third of the list price of a medicine is rebated back to middlemen, like insurers and pharmacy benefit managers (PBMs). These rebates and discounts create savings of more than $100 billion, but these savings aren’t always shared directly with patients. Let’s talk about cost.

Opinions, Editorials and Perspectives

Combating the Opioid Crisis: Energy & Commerce’s Next Steps
Rep. Greg Walden, Morning Consult 

The effects are disastrous and heartbreaking. The reach is from coast to coast.

5 Questions About Single-Payer Health Care
David Leonardt, The New York Times

I encourage you to make the Tampa Bay Times part of your Irma reading diet. The Times (formerly known as The St. Petersburg Times) has long been one of the country’s best regional papers, and it’s been doing vital work during the storm.

Five bipartisan steps toward stabilizing our health-care system
Bill Frist and Andy Slavitt, The Washington Post

At a meeting in California this spring, we sat down with a number of insurance company chief executives who are major participants in the Affordable Care Act exchanges. They asked us to carry back a message to Washington: Put partisanship aside and end federal uncertainty about support for the ACA; otherwise, they will end up setting premiums higher than necessary or withdrawing from markets across the country.

Single-payer isn’t the only progressive option on health care
Ron Pollack, Vox

Progressives and America’s families won a huge victory when Congress rejected GOP efforts to repeal the Affordable Care Act and to decimate Medicaid. Vigilance and unity are still needed to protect against attempts to undermine recent historic health improvements.

Research Reports

Stabilizing Individual Health Insurance Markets With Subsidized Reinsurance
Scott E. Harrington, Leonard Davis Institute of Health Economics

The Affordable Care Act (ACA) fundamentally transformed individual health insurance markets and significantly expanded coverage. But markets in many states remain unstable, partly due to disproportionate enrollment by older and sicker enrollees.