Health Brief: Senate Bill Likely to Differ from House on Pre-Existing Conditions, Cost-Sharing Payments

Washington Brief

  • Senate Republicans’ health care bill is likely to diverge from the House’s by maintaining pre-existing health condition protections and cost-sharing reduction payments that are essential to insurers. The proposals are likely to be favored by GOP senators who have been critical of the House bill, but they could alienate the chamber’s most conservative members. (The New York Times)
  • President Donald Trump’s senior advisers are split on whether the administration should take steps to stabilize the insurance marketplaces. Vice President Mike Pence and Budget Director Mick Mulvaney have argued against intervention, while Health Secretary Tom Price backs providing federal support if congressional Republicans fail to pass a health care bill this summer. (The Washington Post)
  • Centrist GOP Sens. Rob Portman (Ohio) and Shelley Moore Capito (W.Va.) have proposed phasing out Obamacare’s Medicaid expansion over seven years, beginning in 2020 and ending in 2027. The House bill ends federal expansion payments to states by 2020. (The Hill)

Business Brief

  • Many health care experts and insurers say Republican actions over the past five months are to blame for much of the instability in Obamacare marketplaces across the country. (Politico)
  • About 300,000 people could find themselves without any coverage option next year if Anthem decides to exit all the Obamacare marketplaces where it currently offers plans. (Bloomberg News)
  • The American Medical Association will vote on a resolution to demand that drug makers disclose product prices in ads that are aimed at consumers. (Stat News)

Chart Review

Events Calendar (All Times Local)

Jefferies Global Health Care Conference 9 a.m.
Senate Finance Committee hearing on HHS FY18 budget request 10 a.m.
House Energy and Commerce Subcommittee hearing on HHS and cybersecurity 10:15 a.m.
Better Medicare Alliance Lunch Briefing 1 p.m.
House Ways and Means Committee Hearing on HHS FY18 Budget Request 1 p.m.
Jefferies Global Health Care Conference 9 a.m.



Senate Health Bill May Alienate G.O.P. Conservatives
Jennifer Steinhauer and Robert Pear, The New York Times

Senate Republicans are closing in on a bill to repeal President Barack Obama’s signature health care law, diverging from the House on pre-existing medical conditions and maintaining federal subsidies that proponents see as essential to stabilizing insurance markets around the country. The changes appear largely designed to appeal to Republican senators who hail from states where the Affordable Care Act is popular and who were critical of the House bill, which would eliminate insurance for millions of Americans covered under the current law, according to the Congressional Budget Office.

Trump ‘all in’ on Senate Obamacare repeal
Burgess Everett and Josh Dawsey, Politico

President Donald Trump is increasingly invested in Senate passage of a bill to repeal Obamacare, realizing that a successful vote in the upper chamber will provide a major boost to his domestic agenda, say Republicans who have spent time with him recently. At a meeting with congressional leaders on Tuesday, Trump urged Senate Majority Leader Mitch McConnell (R-Ky.) to follow through on an aggressive timetable for repealing the law in order to quickly turn to tax reform and help avoid a calamitous autumn full of key fiscal deadlines, according to multiple sources familiar with the meeting.

They’re on Obamacare, they voted for Trump, and they’re already disappointed
Sarah Kliff, Vox

There have been no marches against the Republican bill to repeal and replace Obamacare here. No raucous town halls.

Investors Avoid Big Moves as Key Events Draw Near: Markets Wrap
Adam Haigh and Cecile Gutscher, Bloomberg News

Financial markets were mostly steady as investors avoided adding big positions ahead of key events in Europe and the U.S. Oil recovered from the steepest decline in more than a year Wednesday, while U.K. government bonds led the region’s debt lower as the nation goes to vote in a general election. European stocks rose while U.S. futures edged higher before the ECB’s policy decision, the U.K. election and former FBI Director James Comey’s testimony before a Senate committee.


Key GOP centrists open to ending Medicaid expansion
Rachel Roubein and Peter Sullivan, The Hill

GOP moderates in the Senate are open to ending federal funding for ObamaCare’s Medicaid expansion, but want a longer deadline for ending the additional funding than their leadership has proposed. Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.Va.) have proposed a seven-year phase-out of federal funding for the Medicaid expansion, beginning in 2020 and ending in 2027.

White House touts the ACA’s demise even as insurers seek help in stabilizing its marketplace
Juliet Eilperin and Abby Phillip, The Washington Post

The event Wednesday on an airport tarmac in Cincinnati was just the latest opportunity for the White House to disparage and undercut a law it officially must carry out. Standing in front of Air Force One along with two small-business owners, President Trump recounted how they “have had their lives completely upended by the disaster known as Obamacare.”

GOP uncertainty over Obamacare drives out insurers
Paul Demko, Politico

Obamacare markets are undergoing a slow-motion meltdown as Republicans stoke a climate of uncertainty while struggling to agree on their own plan for overhauling American health care. The steady march of insurers that have announced plans to exit marketplaces in recent weeks leaves Obamacare customers in wide swaths of the country with potentially no options for purchasing subsidized coverage in 2018.

Anthem’s Obamacare Exit Could Leave 300,000 Without Options
Anna Edney et al., Bloomberg News

Anthem Inc.’s decision to quit Ohio’s Obamacare market will leave 13,000 people without any coverage option under the program next year. That number may rise to 300,000 if the health insurer follows suit in the rest of the states where it sells.

If Insurance Market Crashes, Can Lawmakers Put The Pieces Back Together?
Julie Rovner, Kaiser Health News

In his high-stakes strategy to overhaul the federal health law, President Donald Trump is threatening to upend the individual health insurance market with several key policies. But if the market actually breaks, could anyone put it back together again?

Wisconsin submits plan to become first state to drug screen some Medicaid enrollees
David Wahlberg, Wisconsin State Journal

Gov. Scott Walker on Wednesday asked President Donald Trump’s administration to let Wisconsin become the first state to require drug screening for poor childless adults who seek Medicaid and impose a time limit on coverage unless they work. Walker’s administration softened its initial plan in response to public comments, however, reducing premiums and emergency room co-payments and letting people skip drug tests and sign up for Medicaid when they’re ready to start drug treatment.


AMA will vote on requiring drug makers to disclose prices in consumer ads
Ed Silverman, Stat News

In its latest bid to restrain pharmaceutical advertising, the American Medical Association will vote on a resolution to demand that drug makers disclose pricing in ads that are aimed at consumers. The proposal, which will be heard at the annual AMA meeting next week in Chicago, was made in response to concerns over rising drug costs and an unsuccessful bid by the medical organization to convince Congress to ban so-called direct-to-consumer advertising altogether.

Financial counselors help patients navigate costly care
The Associated Press

The financial counselor will see you now. Many people hit with a terrifying medical diagnosis like cancer also have to deal with another worry: whether the care will bankrupt them.

Faith-based hospitals not out of the woods over ERISA exemptions
Alex Kacik, Modern Healthcare

Faith-based hospitals scored a major win on Monday when the U.S. Supreme Court upheld their exemption from federal pension regulations, but the legal battles over the policy are far from over, legal experts said. The high court ruled unanimously Monday that providers like Dignity Health, Advocate Health Care and St. Peter’s Healthcare System do not have to meet pension guidelines set by the Employee Retirement Income Security Act, preserving the exceptions those organizations have relied on to establish and maintain their pension plans for more than 35 years.

Children’s Hospital Association CEO: Medicaid cuts put kids in “the firing line”
Bob Herman, Axios

The Republican health care bill would slash Medicaid funding by $834 billion over the next decade, and hospitals have not taken kindly to that proposal. One hospital subgroup would be especially hurt by those cuts — children’s hospitals.

Pharma, Biotech and Devices

House committee approves FDA bill, puts off drug price debate
David Nather, Axios

The House Energy and Commerce Committee approved its bill to reauthorize the Food and Drug Administration’s user fees this afternoon, but a broader drug price debate will have to wait. A handful of Democrats and Republicans tried to add amendments to address rising drug prices, but committee Chairman Greg Walden said the legislation already takes steps to address that issue by cutting the backlog of unapproved generic drug applications at the FDA.

Former Pharma Reps’ New Mission: To School Docs On High Drug Costs
Jay Hancock, Kaiser Health News

As a drug salesman, Mike Courtney worked hard to make health care expensive. He wined and dined doctors, golfed with them and bought lunch for their entire staffs — all to promote pills often costing thousands of dollars a year.

Novartis touts new T-cell therapy data in race for FDA approval
John Miller, Reuters

Novartis on Wednesday touted new data from its T-cell therapy CTL019, saying it is on a par with results of experimental molecules from Kite Pharma and Juno Therapeutics that also target aggressive blood cancers. Three months after infusion, the overall response rate (ORR)among 51 adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) was 45 percent, Novartis said, with 37 percent complete responses (CR), or no sign of disease.

Health IT

New research shows patients value the convenience of telehealth—even for bad news
Evan Sweeney, Fierce Healthcare

Patients appear to be climbing aboard the telehealth bandwagon for the convenience of staying at home, and doctors are keen on the ability to use video consultations for follow-up care. All 19 telehealth patients at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia indicated they were satisfied with their telehealth visit, according to a series qualitative interviews published in the Annals of Family Medicine.

A Message from PhRMA:

Have you heard of immuno-oncology? This new wave of immunotherapies specifically targeting cancers is giving patients new hope. A new report found there are more than 240 immuno-oncology therapies in development today. Get the facts.

Opinions, Editorials and Perspectives

Reinventing Claims Payment for a Value-Based World
Amy Larsson, Morning Consult 

The U.S. health care industry’s claims payment system is frustrating to providers, payers, and patients alike. Inefficiency and a system-wide tendency for error wastes precious resources, worsens miscommunication and mistrust among all stakeholders, and inhibits the ability to transition to value-based models.

The Trump administration’s birth control overhaul could do serious harm
The Editorial Board, The Washington Post

ONE OF the most popular — and successful — aspects of the Affordable Care Act has been the access it has given women to no-cost birth control. Not only has it saved women millions of dollars, but also the increased use of birth control has corresponded to significant drops in the rates of unintended pregnancies and abortions.

It’s time to get serious about the safety of medical devices
Diana Alame, Stat News

The now-infamous superbug outbreak related to a medical device that seriously sickened 350 people and killed at least 20 illustrates a huge problem in our medical system: poor monitoring of the safety of medical devices. The episode in question lasted several years and involved a widely used duodenoscope, a flexible tube inserted in the mouth in order to reach the small intestine, made by Olympus.

A Message from PhRMA:

248 Immuno-Oncology Treatments in Development: A new report takes a closer look at immune-oncology and how these treatments can help unleash a patient’s own immune system against cancer, with the potential for lasting results. Today, more than 4.8 percent of the U.S. population is cancer survivors, and America’s biopharmaceutical companies are committed to continuing the search for new cancer treatments and potential cures for patients. Check out the report.

Research Reports

Rural Health Report
Jack Hoadley et al., Georgetown University Center for Children and Families and the University of North Carolina NC Rural Health Research Program

Medicaid is a vital source of health coverage nationwide, but the program’s role is even more pronounced in small towns and rural areas. Medicaid covers a larger share of nonelderly adults and children in rural and small-town areas than in metropolitan areas;
this trend is strongest among children.