Health Brief: Senate Returns From Recess With Health Bill in Jeopardy

Washington Brief

  • Following a weeklong recess, Senate Republicans continue to be at loggerheads on legislation to overhaul the nation’s health care system. The intraparty split is so wide that they also can’t agree on what to do if they fail to pass the health care bill. (The Wall Street Journal)
  • While Republicans dealt with rallies, sit-ins and demonstrators over the July 4 recess, groups on the right that once fueled Republicans’ anti-Obamacare fervor were focused on other issues. (The New York Times)
  • Progressive group Save My Care is launching a seven-figure TV ad campaign in four states showing footage of GOP senators saying they would oppose a health care bill that would hurt their constituents. (Axios)

Business Brief

  • Drug users seeking addiction treatment are finding themselves being taken advantage of in a sprawling national network of insurance fraud, an investigation has found. (Stat News and Boston Globe)
  • The legal team for Martin Shkreli, who faces eight counts of securities and wire fraud related to price gouging, argues that his wrongdoing isn’t worth a criminal conviction because none of his investors lost money. (The Washington Post)
  • A little-discussed provision in the Senate health care measure would amend a rule that has sharply limited the number of hospital beds for psychiatric care, providing a long-sought victory for mental health advocates. But mental health groups aren’t celebrating the legislation because of its spending reductions to Medicaid. (Kaiser Health News)

Chart Review

Events Calendar (All Times Local)

Monday
No events scheduled.
Tuesday
Bipartisan Policy Center event on long-term care 10 a.m.
Wednesday
House Energy and Commerce subcommittee hearing on the opioid crisis 10 a.m.
House Energy and Commerce subcommittee hearing on medical product makers 10:15 a.m.
Town hall on opioid crisis hosted by Hazelden Betty Ford Foundation 7 p.m.
Thursday
Bipartisan Policy Center event on state flexibility 10 a.m.
Friday
No events scheduled.

 

General

Following Recess, GOP Health-Care Push Gets Trickier
Stephanie Armour, The Wall Street Journal

Senate Republicans returning from a July 4 recess are so divided over a health-overhaul bill that they are also struggling to agree on what to do if they fail to pass their legislation. Some conservative lawmakers say an implosion of the Republican legislation would give them a chance to return to their goal of fully repealing the Affordable Care Act, putting off until later a decision about what system to put in its place.

Why Obamacare’s Loudest Critics Aren’t as Loud Anymore
Kate Zernike, The New York Times

Members of Congress returning home for the July 4 recess last week were met with rallies, sit-ins and Independence Day demonstrators, as activists on the left intensified their push to defeat Republican legislation to repeal and replace the Affordable Care Act. The groups on the right that once fueled the party’s anti-Obamacare fervor might as well have been on vacation.

Scoop: The next wave of Dem health care attacks
Jonathan Swan, Axios

As if things weren’t rough enough already… On Monday, the progressive group Save My Care will air a new seven-figure TV campaign across four key states, showing footage of Republican Senators promising they won’t back a health care repeal bill that would hurt their constituents.

New CDC Head Fitzgerald Peddled Controversial ‘Anti-Aging Medicine’ Before Leaving Private Practice
Rita Rubin, Forbes

Dr. Brenda Fitzgerald, appointed Friday as director of the U.S. Centers for Disease Control and Prevention, is a board-certified obstetrician/gynecologist who saw patients for 30 years in private practice. Unlike any OB/GYN I know, Fitzgerald treated men as well as women.

Ted Cruz is suddenly in the hot seat to help pass a health-care bill
Sean Sullivan, The Washington Post

During a week most Republican senators spent in the political equivalent of the witness protection program, Sen. Ted Cruz willingly stood trial before his constituents all across this sprawling state over his push to repeal much of the Affordable Care Act. He debated a self-described “dirty liberal progressive.”

Stocks Advance as Mood Remains Buoyant After Data: Markets Wrap
Natasha Doff, Bloomberg News

Stocks rose and the dollar was steady as investors prepare to parse second-quarter earnings for more evidence global economic growth is back on track after a positive batch of data from Europe and the U.S. Real estate and food companies led European equities higher, following a similar advance across much of Asia and in U.S. futures.

Payers

Desperate for addiction treatment, patients are pawns in lucrative insurance fraud scheme
David Armstrong and Evan Allen, Stat News and Boston Globe 

Drug users, desperate to break addictions to heroin or pain pills, are pawns in a sprawling national network of insurance fraud, an investigation by STAT and the Boston Globe has found. They are being sent to treatment centers hundreds of miles from home for expensive, but often shoddy, care that is paid for by premium health insurance benefits procured with fake addresses.

Senate GOP Bill Aims To Add Psych Beds; Squeeze On Medicaid Signals Their Undoing
Liz Szabo, Kaiser Health News

A little-discussed provision in the Senate health care bill is designed to boost the number of hospital beds for psychiatric care, providing a long-sought victory for mental health advocates. The provision would amend an obscure Medicaid funding rule that has sharply limited the number of beds for those with schizophrenia, bipolar disorder or other mental illnesses.

The Hidden Subsidy That Helps Pay for Health Insurance
Kate Zernike, The New York Times

As Republican senators work to fix their troubled health care bill, there is one giant health insurance subsidy no one is talking about. It is bigger than any offered under the Affordable Care Act — subsidies some Republicans loathe as handouts — and costs the federal government $250 billion in lost tax revenue every year.

Medicaid Cuts Will Drive Up Cost Of Private Coverage, Montana Insurers Say
Eric Whitney, Montana Public Radio

Montana was among the last states to expand Medicaid, and its Obamacare marketplace has fared reasonably well. It has 50,000 customers, decent competition and no “bare counties,” where no insurers want to sell plans.

Why a GOP senator from Trump country opposes the Senate health bill
Adam Cancryn, Politico

Shelley Moore Capito is the most popular politician in a deep-red state that loves President Donald Trump and distrusts big government. And yet the West Virginia Republican is threatening to torpedo the GOP’s best shot at dismantling Obamacare, one of Trump’s top domestic priorities.

Providers

Health care’s widespread overbilling problem
Bob Herman, Axios

The health care system’s complex payment system gives doctors and hospitals lots of incentives to bill for more expensive services than they actually provide, a practice known as upcoding. Numerous settlements between health care companies and the Department of Justice indicate it’s a widespread problem.

The Patient Wants to Leave. The Hospital Says ‘No Way.’
Paula Span, The New York Times

Why would an older person essentially discharge himself from a hospital, defying a physician’s recommendation and signing a daunting form that acknowledges he is leaving A.M.A. — against medical advice? Attend the tale of William Callahan.

Pharma, Biotech and Devices

The fascinating legal argument at the heart of the Martin Shkreli ‘Pharma Bro’ trial
Renae Merle, The Washington Post

Not much Martin Shkreli has done the past two weeks has helped him in a trial that could put him behind bars for 20 years for eight counts of securities and wire fraud. He was personally rebuked by the judge for speaking to reporters about his case inside the Brooklyn courthouse and on the streets outside where jurors could potentially hear him.

Roche, Shire court fight underscores high stakes in hemophilia
John Miller, Reuters

Roche’s bid to muscle in on Shire’s share of the $11 billion hemophilia drug market took a new, contentious turn this weekend when the British drugmaker won a court injunction against how the Swiss drugmaker talks about its new medicine. Shire’s injunction on Sunday in a Hamburg, Germany, court alleges incomplete and misleading statements by Roche about its investigational emicizumab.

Health IT

Computer-Simulated Tests Eyed at FDA to Cut Drug Approval Costs
Anna Edney, Bloomberg News

Computer simulations may get a role alongside human testing as part of an effort to bring new medications and medical devices to market more quickly and cheaply. The U.S. Food and Drug Administration outlined a proposal Friday to help integrate computer modeling and virtual testing as part of the regulatory approval process for manufacturers — a step the agency said could save money while helping find cures for puzzling conditions such as Alzheimer’s disease.

Opinions, Editorials and Perspectives

The Future of Manufacturing a Medicine in America
Robert Popovian, Morning Consult 

Whenever biopharmaceutical experts and policymakers discuss medical innovation, they seem to focus only on drug discovery and development and access. While these aspects of innovation are critical to ensuring patients have safe and effective treatments, they don’t provide a complete picture of the biopharmaceutical innovation model and the total investment needed to get the right medicine to the right patient at the right time.

Mitch McConnell Bobs and Weaves Through Health-Care Fight
Siobhan Hughes, The Wall Street Journal

President Donald Trump’s ability to land his first major legislative achievement, on health care, now rests with a Republican who kept a studied distance from the party’s nominee during the campaign and since: Senate Majority Leader Mitch McConnell. The Kentuckian didn’t campaign with the president and rarely mentioned him.

Don’t Leave Health Care to a Free Market
Farzon A. Nahvi, The New York Times

When it comes to health care coverage, House Speaker Paul Ryan says, “We’re going to have a free market, and you buy what you want to buy,” and if people don’t want it, “then they won’t buy it.” In this model of health care, the patient is consumer, and he must decide whether the goods and services he wants to protect his life are worth the cost.

To my colleagues in Congress: I have MS. Don’t make my insurance unaffordable.
Donna F. Edwards, The Washington Post

I struggled over whether to write, but following the House passage of the American Health Care Act, and now the work that’s going on in the Senate, I knew I must. In March 2015, when I decided to run for U.S. Senate in Maryland, I felt great.

Direct Primary Care: A Big Winner In The Senate GOP Health Care Bill
Avik Roy, Forbes

The biggest problem with Obamacare is that it expanded health coverage through Medicaid, a program with notoriously poor access to doctors, because Medicaid pays doctors far less than private insurance. The Senate Republican health care bill aims to change that, by giving states the ability to offer an innovative new model to their poorest residents: direct primary care.

The GOP’s Ongoing Health-Care Confusion
James C. Capretta, National Review

Republican senators Ted Cruz and Mike Lee are pushing for an amendment to the Senate GOP’s Better Care Reconciliation Act (BCRA) that would substantially alter the current landscape of health-insurance regulation. They believe their amendment, which aims to give insurers much more freedom to offer any kind of product they want to customers, would go a long way toward restoring a free market to health care, and would result in lower premiums for millions of consumers.

Research Reports

Public Opinion on ACA Replacement Plans: Interactive
Kaiser Family Foundation

As Congress continues to work on a plan to repeal and replace the 2010 Affordable Care Act (ACA), this interactive tracks the public’s views of the replacement plans over the past several months. By collecting data from various surveys of adults in the U.S. conducted by Kaiser and others, we show how the public’s views have changed or remained stable as Congress considers major changes to the U.S. health care system and details of the plans have emerged from the House and the Senate.