Health Brief: Ryan Open to Health Bill Changes

Washington Brief

  • House Speaker Paul Ryan conceded that changes will have to be made to the House bill to replace Obamacare, as lingering GOP divisions threaten to tank the legislation, which is still expected to be marked up today by the Budget Committee in its current form. (Morning Consult)
  • Republicans are mulling whether to drop a provision that would require insurers to charge a 30 percent penalty for people who have a gap in coverage longer than two months. (Bloomberg News) Conservative Republicans are also pushing for an amendment to institute work or education requirements for Medicaid. (Morning Consult)
  • President Donald Trump’s budget proposal calls for a $5.8 billion cut to the National Institutes of Health, equal to about 19 percent of its current $30.3 billion discretionary budget. (The Washington Post)

Business Brief

  • About 12.2 million Americans enrolled in Obamacare health plans in the 2017 open enrollment period, a decline in total signups for the first time. (The Los Angeles Times)
  • The Mayo Clinic plans to start prioritizing care of privately insured patients over Medicare and Medicaid enrollees because of tighter profit margins. (Stat News)
  • Anthem’s CEO Joseph Swedish met with Trump and Health and Human Services Secretary Tom Price, where he sought to ensure that Republicans adequately fund Medicaid and continue the cost sharing subsidies that help consumers afford insurance. (Modern Healthcare)

Chart Review

Events Calendar (All Times Local)

Roll Call Live Discussion on Health Care 8 a.m.
House Budget Committee Markup of Reconciliation Bill 10 a.m.
Heritage Foundation Event on Tobacco Control in E-Cigarettes 12 p.m.
RAND Corporation Briefing on the ACA Future 12 p.m.



Ryan Open to Changing Health Bill As GOP Struggles to Reach Agreement
Mary Ellen McIntire, Morning Consult 

House Speaker Paul Ryan said Wednesday that the GOP health care bill would be amended before the measure came to the floor. The House Budget Committee is still expected to mark up the current version of the Republican bill to overhaul the Affordable Care Act on Thursday, but more changes would come afterwards, before the House Rules Committee takes its stab at the measure.

Republicans Mull Dropping Surcharge for Uninsured in Bill
Sahil Kapur and Billy House, Bloomberg News

Republican leaders in Congress may scrap a provision in the House GOP’s Obamacare replacement bill that would require insurers to charge a 30 percent penalty to customers who go without coverage for at least 63 days. “There was discussion of the 30 percent penalty for people” who don’t maintain continuous coverage, said Representative Phil Roe of Tennessee, a medical doctor and member of the GOP Doctors Caucus.

NIH would see huge budget cut under president’s proposal
Lenny Bernstein, The Washington Post 

The National Institutes of Health would absorb an enormous $5.8 billion cut under President Trump’s first budget proposal — equal to about 19 percent of its current $30.3 billion discretionary budget. The plan “includes a major reorganization” of NIH’s 27 institutes and centers and would eliminate the Fogarty International Center, a $69.1 million program dedicated to building partnerships between health research institutions in the United States and abroad.

Obamacare enrollment drops, to 12.2 million, as Congress debates repeal
Noam N. Levey, The Los Angeles Times

Driven by a drop-off in enrollment after President Trump took office, total sign-ups for Obamacare health plans fell this year for the first time, a new report released by the Trump administration Wednesday indicates. A total of 12.2 million Americans enrolled in a plan through one of the healthcare law’s marketplaces during the 2017 open enrollment period, according to the report, which provides a final tally of this year’s signups.

HHS Secretary vows GOP health care bill is ‘so much better’ than Obamacare
MJ Lee and Lauren Fox, CNN

Health and Human Services secretary Tom Price — a former congressman and a longtime critic of Obamacare — forcefully defended the House Republican plan to repeal and replace Obamacare on Wednesday night, even as the legislation continues to face fierce backlash and bleed support. “We believe strongly, strongly, that the plan we put together is so much better than the one that’s there now,” Price said a special CNN town hall event moderated by CNN’s Wolf Blitzer and Dana Bash.

GOP health overhaul puts pressure on state governments
Geoff Mulvihill, The Associated Press

The Republican health care plan means less money for states and gives them a tough choice: Find a pot of cash to make up the difference or let coverage lapse for millions of lower-income Americans. Governors and state lawmakers analyzing the Republican plan to replace former President Barack Obama’s Affordable Care Act fear a return to the past, when those without health coverage used emergency rooms for their medical needs.

Trump Urges Supporters to Unite Behind G.O.P. Health Plan
Julie Hirschfeld Davis, The New York Times

President Trump made a plea on Wednesday for his supporters to unite behind the Republican plan to overhaul Americans’ health care as the only way to squelch Democratic attempts to scuttle the plan. At the same time, facing resistance to the bill from within his own party, House Speaker Paul D. Ryan said it would be refined and improved.

House conservative face robocalls urging support for Obamacare replacement
Kyle Cheney, Politico

American Action Network, the nonprofit aligned with House GOP leadership, is launching a pressure campaign aimed at conservative House members lawmakers who have been reluctant to support the leadership-backed plan to replace Obamacare. AAN will run 1 million robocalls in 30 congressional districts held predominantly by members of the arch-conservative House Freedom Caucus.

Dovish Fed, Dutch Vote Spur Stocks as Oil Advances: Markets Wrap
Min Jeong Lee et al., Bloomberg News

Stocks advanced with commodities as the U.S. Federal Reserve’s dovish message continued to feed into markets, and as pro-Europe parties claimed victory in the Netherlands election. The euro and Treasuries gave up some of Wednesday’s advance.


Medicaid Work Requirements in Focus for GOP Health Bill
Mary Ellen McIntire, Morning Consult 

A group of conservative House Republicans are pushing for an amendment to the Republican health care bill that would institute work or education requirements for Medicaid, hoping the change would get more conservatives on board and help the legislation move closer to becoming law. In a letter Tuesday, Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services Seema Verma appeared open to giving states waivers to make similar changes to their Medicaid programs.

Anthem CEO talks Medicaid funding, cost sharing subsidies with Trump
Shelby Livingston, Modern Healthcare 

In a private meeting with President Donald Trump on Tuesday, Anthem’s CEO Joseph Swedish sought to ensure that Republicans adequately fund Medicaid and continue the cost sharing subsidies that help consumers afford insurance. Swedish also discussed with Trump and HHS Secretary Tom Price parts of the American Health Care Act that Anthem would “like to see enhanced,” and the “elimination of the taxes, elimination of the fees” that it hopes will remain in the final draft, Anthem CFO John Gallina said Wednesday during the Barclays Global Healthcare Conference in Miami.

Putting the Republicans’ Health Plan on the Obamacare Scale
Robert Pear, The New York Times

President Trump and Republicans in Congress have pummeled the Affordable Care Act, complaining of high deductibles, soaring premiums and a shrinking menu of options for consumers. But does the Republican alternative solve these problems, or does it exacerbate them?


Mayo Clinic: Privately insured patients to get priority over Medicaid, Medicare patients
Casey Ross and Andrew Joseph, Stat News

Facing tighter profit margins, the chief executive of the Mayo Clinic recently told his employees that the prestigious health system will prioritize the care of privately insured patients over those on Medicare and Medicaid. That bold pronouncement by Dr. John Noseworthy — made in a speech to employees late last year — reflects the growing unease among hospital executives who are watching profits shrink due to steady increases in the number of government-insured patients. Medicaid, whose enrollment has increased dramatically under the Affordable Care Act, traditionally pays hospitals significantly less than commercial insurers.

Pharma, Biotech and Devices

Wyden Introduces Bill to Increase Transparency of PBMs
Jon Reid, Morning Consult 

The Senate Finance Committee’s top Democrat is leading a push to “lift the veil of secrecy” surrounding pharmacy benefit managers, the intermediaries in drug price negotiations between manufacturers, pharmacies and insurers. The legislation, which Sen. Ron Wyden rolled out on Wednesday, would force pharmacy benefit managers to disclose the total amount in rebates and discounts they receive from manufacturers to get their drugs listed on formularies.

Many at risk for stroke don’t get anti-clotting drugs
Lisa Rapaport, Reuters

More than four in five stroke patients with a history of heart rhythm problems didn’t get any blood thinners, or didn’t take enough to help prevent a stroke before they had one, a U.S. study suggests. Most strokes occur when a clot blocks an artery carrying blood to the brain, known as an ischemic stroke.

Health IT

Plans readied for boosting IT’s role in public health reporting
Joseph Conn, Modern Healthcare

The Zika virus’ spread to the United States motivated a federal initiative to better use health information technology in public health reporting. But an HHS task force is developing recommendations of health IT best practices for public health that will also address other disease outbreaks.

Health system creates venture fund
Rachel Watson, The Grand Rapids Business Journal

A local health system plans to invest $100 million over the next decade in health care and health technology-related companies. Grand Rapids-based Spectrum Health said last week it created an investment fund called Spectrum Health Ventures to partner with other health systems and companies to spur innovation and technology.

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

Rescue Medicare, Repeal IPAB
Pete Sepp, Morning Consult 

As Congressional Republicans seek fresh starting points to move health care reform forward, they would be well-served by opting to eliminate one of the most dangerous parts of Obamacare: the Independent Payment Advisory Board. Often derided as a “death panel,” even without the hype IPAB is a terribly conceived idea.

Win or Lose, Trumpcare Is Bad for Republicans
Albert R. Hunt, Bloomberg View

If House Republicans enact their health-care bill, they’re screwed. They’ll have lost the critical initial dialogue and left opponents salivating. If they fail to pass it, they’re screwed, too, having broken a commitment of the past four elections.

The Republican ObamaCare Choke
Daniel Henninger, The Wall Street Journal

Less than three months into full control of government and the chance to reshape the American system for a generation, Republicans are doing something no one thought possible: They are reinventing the circular firing squad. Even a politician of such limitless cynicism as Chuck Schumer is agog: “We are on offense and united.

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

Private Payer Participation In Coverage With Evidence Development: A Case Study
Sarah Rosenberg-Wohl, Health Affairs 

Driven by the escalating costs of both health care delivery and research, the concept of health care value is of increasing interest to both payers and providers. In this respect, the randomized controlled trial (RCT) often falls short.