Health Brief: Ryan Looks to Change AHCA to Benefit Older People

Washington Brief

  • With a floor vote on the GOP Obamacare alternative expected Thursday, Speaker Paul Ryan (R-Wis.) is seeking to assuage concerns from moderate Republicans by tweaking the bill to increase tax credits to help older people buy health insurance. (Bloomberg News)
  • The White House began signaling to conservatives this weekend that some of their demands, such as phasing out Obamacare’s Medicaid expansion earlier and deregulating the insurance industry, are not going to be met. (Politico)
  • If Republicans do push forward with the House bill, they risk doing disproportionate harm to the older, working-class white voters who are increasingly vital to their electoral coalition. (The New York Times)

Business Brief

  • The federal government is investigating Aetna, Health Net, Humana and a division of Cigna over whether they submitted false claims to Medicare. (The Star Tribune)
  • Pharmacy benefit managers want a larger discount for Amgen’s cholesterol-lowering drug Repatha after new data suggested more patients should be treated with the drug. (Reuters)
  • The rate at which hospitals are hiring is slowing down, as the GOP Obamacare alternative could leave them with less money to pay staff. (Axios)

Chart Review

Events Calendar (All Times Local)

House Rules Committee holds hearing on H.R. 372 and H.R. 1101 5 p.m.
Senate HELP Committee hearing on FDA’s user fee agreements 10 a.m.
House Energy and Commerce oversight subcommittee hearing on fentanyl and the opioid crisis 10:15 a.m.
House Rules Committee hearing on AHCA TBD
House Energy and Commerce health subcommittee hearing on FDA’s prescription drug user fee program 10:15 a.m.
Cato Institute event on Obamacare 12 p.m.
NEHI event on value-based contracting for biopharmaceuticals 1 p.m.
No events scheduled



White House squeezes GOP hard-liners as Obamacare vote nears
Rachael Bade et al., Politico

The White House began signaling to conservatives this weekend that negotiations are closing on the GOP Obamacare alternative, nudging the far-right to get in line before a crucial Thursday House vote on the bill. During a meeting at Donald Trump’s Mar-a-Lago estate in Florida Saturday, the president’s top advisers told three of the most vocal conservative opponents of the bill — Sens. Ted Cruz (R-Texas) and Mike Lee (R-Utah) and House Freedom Caucus Chairman Mark Meadows (R-N.C.) — that they agree with some of their demands in principle, according to several sources familiar with the discussions.

Fired U.S. Attorney Preet Bharara Said to Have Been Investigating HHS Secretary Tom Price
Robert Faturechi, ProPublica

Former U.S. Attorney Preet Bharara, who was removed from his post by the Trump administration last week, was overseeing an investigation into stock trades made by the president’s health secretary, according to a person familiar with the office. Tom Price, head of the Department of Health and Human Services, came under scrutiny during his confirmation hearings for investments he made while serving in Congress.

On Health Law, G.O.P. Faces a Formidable Policy Foe: House Republicans
Emmarie Huetteman, The New York Times

Halfway through Congress’s 2013 summer recess, a letter landed on the desks of House Republican leaders demanding a new strategy to fight “one of the largest grievances in our time.” Give Congress the option to defund the Affordable Care Act, it said, or risk shutting down the government. Republican leaders condemned the idea, and the 80 House Republicans who signed the letter acquired a nickname, courtesy of the conservative commentator Charles Krauthammer — the “suicide caucus.”

Cruz, Collins are “no” on Trumpcare (for different reasons)
David Nather, Axios

Sen. Ted Cruz said this morning he can’t vote for the House Republican Obamacare replacement bill because it doesn’t lower health care premiums — and insisted Republicans need to try to repeal the law’s insurance mandates to drive down costs, even though GOP leaders don’t think that can be done in the budget “reconciliation” bill. “If Republicans hold a big press conference and pat ourselves on the back that we’ve repealed Obamacare, and everyone’s premiums keep going up, people will be ready to tar and feather us in the streets, and quite rightly,” Cruz said on CBS’s Face the Nation.

Rand Paul says GOP health care bill unlikely to pass in Congress
Quinn Scanlan, ABC News

Republican Sen. Rand Paul said the House GOP health care bill is unlikely to pass in Congress because there are “enough conservatives that don’t want ‘Obamacare lite.’” The Kentucky senator told ABC News chief anchor George Stephanopoulos on “This Week” Sunday that the Republican-led Congress should repeal Obamacare in its entirety.

Tom Cotton: ‘It’s Going To Take A Lot Of Work’ To Fix Republican Health Care Bill
Esme Cribb, Talking Points Memo

Sen. Tom Cotton (R-AR) on Sunday called for Republicans to put in “a lot of work” to fix problems with their bill to repeal Obamacare instead of “trying to rush to some arbitrary deadline.” “I simply think that it’s not going to work to bring down premiums for working Arkansans and working Americans all across the country,” Cotton said on CNN’s “State of the Union.”

U.S. Rep. Pete Sessions faces rowdy town hall
Patrick Svitek, The Texas Tribune 

U.S. Rep. Pete Sessions, R-Dallas, faced a raucous town hall Saturday as he sought to defend the GOP’s plan to repeal and replace Obamacare, among other issues that have spawned fierce opposition under President Donald Trump. Addressing over 2,000 people, Sessions was frequently drowned out by boos and angry outbursts from the audience.

Oil Weighs on Europe Stocks as Dollar Pares Drop: Markets Wrap
Adam Haigh and Eddie Van Der Walt, Bloomberg News

Weaker oil prices helped drag European shares lower while a gauge of the U.S. dollar flirted with its longest losing streak since Donald Trump won the election. The yield on 10-year U.S. Treasuries steadied after Friday’s decline to the lowest in two weeks.


Ryan Plans Tweaks to Health-Care Bill to Help Older People
Ben Brody and Anna Edney, Bloomberg News

House Speaker Paul Ryan said he would “most likely” bring a health-care bill forward for a floor vote on Thursday, even as he seeks to increase tax credits to help older people buy insurance to tamp down concerns about moderate Republicans. “We believe that we do need to add some additional assistance to people in those older cohorts,” Ryan said of the bill, known as the American Health Care Act, on “Fox News Sunday.” “That’s one of the things we’re looking at.”

G.O.P.’s Health Care Tightrope Winds Through the Blue-Collar Midwest
Abby Goodnough and Jonathan Martin, The New York Times

James Waltimire, a police officer on unpaid medical leave, has been going to the hospital in this small city twice a week for physical therapy after leg surgery, all of it paid for by Medicaid. Mr. Waltimire, 54, was able to sign up for the government health insurance program last year because Ohio expanded it to cover more than 700,000 low-income adults under the Affordable Care Act.

Feds investigate insurers’ Medicare billing for possible fraud
Christopher Snowbeck, The Star Tribune

The federal government is investigating whether four health insurers have submitted false claims to Medicare, much as Minnetonka-based UnitedHealth Group was accused of doing in a whistleblower case unsealed last month. In February, prosecutors joined a lawsuit alleging that UnitedHealth Group and health plans that hired one of the company’s subsidiaries received hundreds of millions, if not billions, in overpayments due to false claims and statements relating to risk adjustment payments in Medicare.

How to fix Obamacare with this one amazing trick
Paul Demko and Adam Cancryn, Politico

One simple way to fix Obamacare is to do something that no one is willing to do: Kick hundreds of thousands of young, mostly healthy Americans off their parents’ coverage. Obamacare allowed young adults to stay on their parents’ plans until they turn 26. It’s a wildly popular feature and a successful one.


AHA moves lobbying effort to stop ACA repeal to Senate
Virgil Dickson, Modern Healthcare

Feeling unheard in the House, the American Hospital Association is turning to the Senate to stop the American Health Care Act from becoming law. The hospital industry’s largest lobbying organization met and shared its concerns with House leadership about provisions of the law it feels will result in millions of people losing coverage, which could ultimately harm the financial stability of many hospitals when their uncompensated-care costs soar.

Hospitals have a labor problem
Bob Herman, Axios

Hospitals across the country have benefited from Obamacare’s insurance expansions, and they hired physicians, nurses, technicians and others in droves to handle the influx of newly insured patients. But now hospitals face tough choices about what they should do with their increasingly expensive staffs if millions of Americans lose health coverage under the Republican Obamacare replacement.

Pharma, Biotech and Devices

Amgen discounts cholesterol drug, but payers want more
Deena Beasley and Caroline Humer, Reuters

Amgen Inc (AMGN.O) sells its cholesterol-lowering drug Repatha at a discount of about 30 percent to its U.S. list price of $14,000 a year, but the largest pharmacy benefit managers say they want lower prices after new data suggested more patients should be treated with the drug. Amgen, which on Friday presented data showing for the first time that Repatha cuts the risk of heart attack and stroke, said in a related presentation for investors that it is netting between $7,700 to $11,200 per annual treatment after discounts and rebates and believes those prices represent good value.

A Prescription Blood Thinner Beat Aspirin at Preventing Recurrence of Blood Clots, Study Finds
Betsy McKay, The Wall Street Journal

Long-term use of a blood-thinning drug is more effective than aspirin in preventing a recurrence of potentially life-threatening blood clots in patients at risk, according to a new study. A blood clot can be life-threatening if it develops in a deep vein or breaks loose and travels to the lung, where it can block the blood supply.

Health IT

Tapping telehealth for complex cases
Shelby Livingston, Modern Healthcare

Shortly after Thanksgiving last year, Ron Cobbley woke up with a stiff neck. Ibuprofen did nothing to help the South Jordan, Utah, resident.

A Message from PhRMA:

More than a third of the initial list price of brand medicines is rebated back to insurance companies, PBMs and the government, or retained by the supply chain. And the gap between list and net prices is growing every year.

Opinions, Editorials and Perspectives

Why Drug Importation Is Flawed Policy
Mike Leavitt, Morning Consult 

With the issue of prescription drug importation being debated on Capitol Hill again, mark me in the skeptical camp. As a matter of safety and practical policymaking, drug importation simply doesn’t work.

A proud welcome to President Trump
Mitch McConnell, The Courier-Journal

In his first visit to Kentucky since his Inauguration, I am proud to welcome President Trump to Louisville to discuss the future of health care. Every day, Kentuckians are hearing stories and seeing headlines that Obamacare is a failure.

Editorial: The American Health Care Act’s hidden costs will hurt everyone
Merrill Goozner, Modern Healthcare

It’s time to start calling the American Health Care Act by its true name—the Force Older and Poorer Americans to Postpone Health Care Act. That is what the legislation promoted by President Donald Trump and House Speaker Paul Ryan would accomplish.

Should healthy people have to pay for chronic illnesses?
David Cutler, The Washington Post

House Speaker Paul Ryan received a considerable dose of criticism for his comment that “the fatal conceit of Obamacare” is that “the people who are healthy pay for the people who are sick.” “This is literally how all insurance works,” Charles Pierce wrote for Esquire, calling Ryan a “rube.”

Medicaid is out of control. Here’s how to fix it.
Robert J. Samuelson, The Washington Post

It’s time to take control of Medicaid before it takes control of us. Unless we act — and there is little evidence that we will — Medicaid increasingly becomes another mechanism by which government skews spending toward the old and away from the young.

A Message from PhRMA:

Share of gross (based on list price) medicine spending kept by brand biopharmaceutical companies is falling. After accounting for discounts and rebates, brand biopharmaceutical companies retained just 63 percent of total list price spending on brand medicines. The rest was rebated back to PBMs, health plans and the government, or retained by other stakeholders in the biopharmaceutical supply chain. Read the first-of-its-kind study here.

Research Reports

The Impact of Information Technology on the Diffusion of New Pharmaceuticals
Kenneth J. Arrow et al., The National Bureau of Economic Research

How does information affect the diffusion of innovations? This paper evaluates the influence of physicians’ access to detailed drug information on their decisions about which products to prescribe.