Health Brief: Senate HELP Leaders Race to Write Bill to Stabilize ACA Markets

Government Brief

  • Senate Health, Education, Labor and Pensions Committee leaders have just a few weeks to bridge deep partisan divisions in their push to negotiate a bill to bolster the Affordable Care Act’s exchanges by mid-September. It’s unclear what policies will take shape in the bill, but there is some bipartisan agreement that it should extend key cost-sharing reductions to insurers that President Donald Trump has threatened to cut off. (Politico)
  • At least six Republican governors are working with the Trump administration to make substantial changes to their state Medicaid programs. Some are looking to add work requirements, introduce drug testing for recipients and hike premium prices. (The Hill)
  • The Justice Department announced the creation of an Opioid Fraud and Abuse Detection Unit that will use data on opioid prescriptions in an effort to detect abuse. (Washington Examiner)

Business Brief

  • Molina Healthcare Inc. plans to exit the ACA exchanges in Wisconsin and Utah, and is also eliminating about 1,500 jobs in a restructuring plan it hopes will save $300 million to $400 million by late next year. (Bloomberg)
  • The Centers for Medicare and Medicaid Services will increase payments to inpatient hospitals by $2.4 billion in fiscal year 2018, an increase from the $746 million bump hospitals received in fiscal 2017. The agency also plans to move forward with a plan opposed by hospitals to change how it reimburses them for uncompensated care. (Modern Healthcare)
  • The next few weeks will be pivotal for health insurers, who have to decide whether to participate in the ACA exchanges next year and set premium prices without assurance from the White House that they will continue to receive cost-sharing reduction payments. (The Wall Street Journal)

Chart Review

Events Calendar (All Times Local)

Senate Finance Committee considers assistant HHS nominee Basset 10 a.m.
No events scheduled

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New bipartisan Obamacare push faces steep climb
Jennifer Haberkorn and Adam Cancryn, Politico

There’s never been a major bipartisan Obamacare bill, and the path to passing one now — after the death of Senate Republicans’ repeal effort — is steep. Senate HELP Chairman Lamar Alexander (R-Tenn.) and ranking Democrat Patty Murray of Washington are up against both time and history in their race to stabilize the shaky Obamacare markets and solidify their status as the chamber’s top dealmakers.

Stripping Health Care Benefits From Lawmakers Gets More Complicated
Niels Lesniewski, Roll Call

The man who could act on President Donald Trump’s behalf to slash health care benefits for members of Congress does not want the job. Trump’s nomination of George Nesterczuk to be director of the Office of Personnel Management was withdrawn Wednesday, according to a formal notification sent to the Senate.

The Latest: Medicaid Concern Influenced McCain’s Health Vote
The Associated Press

Republican Sen. John McCain of Arizona says he cast the crucial vote that sunk his party’s health bill last week because his state was — in his words — “about to get screwed.” McCain says he wasn’t being allowed to offer amendments sought by GOP Gov. Doug Ducey. McCain says he wanted to protect Arizona’s Medicaid program for the poor.

Stocks Retreat From Record; Euro Cools, Gold Falls: Markets Wrap
Samuel Potter, Bloomberg

Global stocks retreated from their recent unprecedented high amid declines across Asia and as energy shares pulled down the European index. The euro edged lower after its jump on Wednesday, and the dollar rose as traders await U.S. labor-market data.


GOP states move to cut Medicaid
Nathaniel Weixel and Rachel Roubein, The Hill

Republican governors are working with the Trump administration to do something Congress couldn’t accomplish — fundamentally alter their state Medicaid programs. At least six states with GOP governors— Arkansas, Kentucky, Arizona, Maine, Wisconsin and Indiana — have already drafted plans meant to introduce new rules people would have to meet to be eligible for Medicaid, which provides healthcare to the poor.

Molina to Cut Costs, Eliminate 1,500 Jobs Following Big Loss
Zachary Tracer, Bloomberg

Molina Healthcare Inc. is cutting costs, shrinking its headcount and exiting some Obamacare markets after the health insurer posted a steep second-quarter loss, three months after pushing out the brothers who’d led the firm their father founded. The company said it’s eliminating about 1,500 jobs as part of a restructuring plan that it hopes will save $300 million to $400 million by late next year.

Health Insurer Payments in Crosshairs
Louise Radnofsky and Michelle Hackman, The Wall Street Journal

The health industry is heading into a pivotal few weeks that will determine whether the White House keeps making billions in payments to insurers or whether Congress will take over responsibility for them—decisions that rest on complex political calculations. President Donald Trump regularly decries the “cost-sharing reduction” payments as insurer bailouts, but he has so far kept making them.

Medicare Part D premiums set to drop next year
Robert King, Washington Examiner

Premiums for Medicare’s Part D prescription drug program are expected to slightly decline in 2018, the first drop in five years, the Trump administration said Wednesday. The monthly Part D premium is projected to be $33.50 per month in 2018, down from $34.70 this year, according to the Centers for Medicare and Medicaid Services.

Former CEO joins insurer betting big on Obamacare
Sarah Kliff, Vox

One of the Obama administration’s top health care officials has joined an insurance company that is betting big on the Affordable Care Act’s marketplaces. Kevin Counihan worked in the Obama administration as the chief executive of, overseeing the federal insurance marketplace that covers 36 states, from August 2014 through January 2017.


CMS gives hospitals $2 billion raise, finalizes unpopular uncompensated-care plan
Virgil Dickson, Modern Healthcare

The CMS will give a $2.4 billion raise to inpatient hospitals in fiscal 2018. The increase is less than the $3.1 billion the agency proposed in April, but exceeds the $746 million bump hospitals received in fiscal 2017.

Cleveland Clinic, Molina Healthcare announce new Medicaid agreement
Lydia Coutré, Crain’s Cleveland Business

Molina Healthcare of Ohio will now include Cleveland Clinic in its Medicaid network, a move that comes as the Clinic faces the potential termination of its relationship with CareSource. The announcement on Wednesday, Aug. 2 marks the first time the Clinic and Molina have contracted together for Medicaid coverage.

Pharma, Biotech and Devices

Justice Department launches Opioid Fraud and Abuse Detection Unit
Kelly Cohen, Washington Examiner

Attorney General Jeff Sessions announced the creation of the Opioid Fraud and Abuse Detection Unit on Tuesday, a new Department of Justice pilot program that will crunch data on opioid prescriptions in an effort to detect abuse. In a speech to law enforcement officers and families in Columbus, Ohio, the attorney general called the current epidemic “the worst drug crisis in our history.”

Stryker adds former health system CEO (and customer) to board
Bob Herman, Axios

Medical device manufacturer Stryker has added Mary Brainerd to its board of directors. Brainerd, the retired CEO of HealthPartners, a $6 billion not-for-profit hospital and health insurance system in Minnesota, will get an annual $60,000 retainer fee and about $500,000 worth of stock options, according to a federal filing posted by Stryker.

FDA panel votes against approval of J&J arthritis drug
Toni Clarke, Reuters

The benefits of Johnson & Johnson’s experimental rheumatoid arthritis drug sirukumab do not outweigh the risks, an advisory panel to the U.S. Food and Drug Administration concluded on Wednesday. The panel voted 12-1 that the drug should not be approved, citing safety concerns, including an imbalance in the number of deaths in patients taking sirukumab compared with those taking a placebo.

Health IT

9 companies will play a huge role in shaping the FDA’s novel approach to digital health
Evan Sweeney, Fierce Healthcare

As the Food and Drug Administration begins a substantial overhaul of its approach to regulating health technology, a handful of software companies are poised to have a significant impact on the agency’s methodology moving forward. Last week, the FDA announced the launch of a software precertification program, drawing praise from some of the agency’s harshest critics.

A Message from PhRMA:

Myth About Drug Importation: Importation is safe. Fact: There are numerous recorded instances of contaminated or counterfeit drugs entering the United States through importation schemes. And the FDA has said repeatedly that it cannot verify the quality or safety of medicines procured through importation. Get the facts at

Opinions, Editorials and Perspectives

It’s Time for Congress to Repeal the Health Insurance Tax
John Mielke and Chuck Goodrich, Morning Consult 

The current national debate surrounding health care centers around two key components — how can we make health care more affordable and accessible for millions of Americans? While there is no “silver bullet” that will fix these issues, eliminating the sales tax on health insurance would lower the cost of coverage for hardworking Americans and small businesses.

Medicare-for-All Isn’t the Solution for Universal Health Care
Joshua Holland, The Nation

Within the broad Democratic coalition, it’s pretty clear that the discussion of health care has shifted to the left. Mainstream figures like Senator Kirsten Gillibrand, a potential presidential candidate in 2020, are embracing single payer.

Capitol Shocker: Democrats and Republicans Start Working Together on Health Care
The Editorial Board, The New York Times

Something unusual and important is happening in Congress: Republicans and Democrats are working together to improve the health care system. And they’re doing so in defiance of President Trump, who appears determined to sabotage the Affordable Care Act and the health insurance of millions of people.

The Coming ObamaCare Bailout
The Editorial Board, The Wall Street Journal

The Senate GOP’s health failure is a political debacle that will compound for years, and the first predictable fallout is already here: Republicans in Congress are under pressure to bail out the Obama Care exchanges, even as Donald Trump threatens to let them collapse. The GOP needs to get at least some reform in return if it’s going to save Democrats and insurers from their own failed policies.

A life-changing genetics breakthrough deserves celebration — and demands caution
The Editorial Board, The Washington Post

The news that researchers have carried out the first known attempt to create genetically modified human embryos is another signpost in an astounding revolution unfolding before our eyes. This is not the first breakthrough nor will it be the last, but it should serve as a reminder — an unmistakable one — that this realm of scientific inquiry, manipulating the tiny building blocks of life, demands caution as well as enthusiasm and encouragement.

Research Reports

Fees for Certification and Finances of Medical Specialty Boards
Brian C. Drolet and  Vickram J. Tandon, JAMA

The process of board certification has a central role in the self-regulation of physician quality standards.1,2 However, many physicians have objected to programs by the American Board of Medical Specialties (ABMS), particularly maintenance of certification (MOC), citing a lack of clinical relevance and evidence to support efficacy as well as high fees to participants.