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Health Brief: Trump Expected to Sign Executive Order Today Targeting ACA


Government Brief

  • Frustrated with congressional Republicans’ multiple failures to overhaul the Affordable Care Act, President Donald Trump is poised to sign an executive order today targeting the 2010 law. The order will direct federal agencies to allow the sale of cheaper, less comprehensive health plans that are exempt from Obamacare requirements, changes that could expand coverage options for healthy customers but raise costs for high-risk individuals. (The Wall Street Journal)
  • Republicans on the House Energy and Commerce Committee are ramping up scrutiny of the 340B Drug Discount Program, which they say has ballooned in size in recent years without proper oversight from the federal government. GOP lawmakers are considering taking legislative action to ensure federal oversight officials have effective tools to track where savings generated from the program are going. (Morning Consult)
  • New bipartisan negotiations on funding offsets to renew the Children’s Health Insurance Program are unlikely to yield a deal by the end of the week, said Rep. Frank Pallone (D-N.J.), the top Democrat on the House Energy and Commerce Committee. Committee Chairman Greg Walden (R-Ore.) decided to delay sending the legislation to the full House in the hopes of reaching a bipartisan deal with Democrats, but said he would advance the bill out of committee if an agreement isn’t reached by the end of the week. (Washington Examiner)

Business Brief

  • California’s Obamacare exchange said it plans to impose a 12.4-percent surcharge on silver-level health plans in 2018 because the Trump administration has not committed to making key insurer payments known as cost-sharing reductions. With the surcharge, average rates for silver-level plans will be about 25 percent higher next year, according to Covered California. (Kaiser Health News)
  • Just four years after expanding to the Chicago area, for-profit hospital giant Tenet Healthcare is looking to exit the region entirely. The health system reached a deal to sell one of its Illinois hospitals to Loyola Medicine, and is looking to sell its three other hospitals in the Chicago area, all of which have struggled in a region dominated by non-profit hospital networks. (Crain’s Chicago Business)
  • Merck said it would no longer seek regulatory approval of an experimental cholesterol drug after mediocre test results, in what marks the fourth time a drugmaker has scrapped efforts to develop this type of treatment, a so-called CETP inhibitor called anacetrapib. (The Associated Press)

Chart Review

Events Calendar (All Times Local)

Thursday
National MACRA MIPS/APM summit 7 a.m.
U.S. Chamber of Commerce event on the opioid epidemic 8:30 a.m.
Friday
National MACRA MIPS/APM summit 7:30 a.m.
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General

Liberal groups plan to hammer vulnerable Republicans on birth control
Elise Viebeck, The Washington Post

Liberal groups are seizing on Republican attempts to roll back health coverage and limit access to birth control, as they seek to galvanize women voters ahead of next year’s midterm elections. Organizations such as Planned Parenthood Action Fund and Emily’s List believe the Trump administration handed them a potent political issue Friday when it carved out wide exceptions to the Affordable Care Act’s promise of no-cost contraception.

An old-school pharmacy hand-delivers drugs to Congress, a little-known perk for the powerful
Erin Mershon, Stat News

If House Speaker Paul Ryan comes down with the flu this winter, he and his security detail won’t be screeching off toward the closest CVS for his Tamiflu. Instead, he can just walk downstairs and pick up the pills, part of a little-known perk open to every member of Congress, from Ryan and Majority Leader Mitch McConnell down to the newest freshman Democrat.

FDA bans free samples of e-cigarettes
Lydia Wheeler, The Hill

The Food and Drug Administration (FDA) finalized guidance Wednesday that includes electronic cigarettes in its ban on free tobacco product samples. The FDA said in the 10-page guidance document that its ban on free samples of tobacco products applies to any tobacco product that is subject to FDA regulation, including components and parts of tobacco products like “e-liquids” and the refillable cartridges for electronic cigarettes.

Treasuries Gain on Fed as Dollar Drifts; Oil Falls: Markets Wrap
Cormac Mullen, Bloomberg

European stocks struggled for traction and bonds pared gains as investor focus switched back to central banks after the release of minutes of last month’s Federal Reserve meeting. Treasury yields nudged lower and the dollar drifted after halting a decline to a one-week low.

Payers

In Start to Unwinding the Health Law, Trump to Ease Insurance Rules
Louise Radnofsky et al., The Wall Street Journal

President Donald Trump is planning to sign an executive order Thursday to initiate the unwinding of the Affordable Care Act, paving the way for sweeping changes to health-insurance regulations by instructing agencies to allow the sale of less-comprehensive health plans to expand. Mr. Trump, using his authority to accomplish some of what Republicans failed to achieve with their stalled congressional health-care overhaul, will direct federal agencies to take actions aimed at providing lower-cost options and fostering competition in the individual insurance markets, according to a Wall Street Journal interview with two senior White House officials.

Bipartisan push on funding children’s insurance program off to rough start
Robert King, Washington Examiner

New bipartisan talks on funding the Children’s Health Insurance Program got off to a rocky start Wednesday as a top Democrat doubted lawmakers would reach a deal by the end of the week. Democrats are highly skeptical of Republican efforts to pay for the insurance program by charging wealthy seniors more for Medicare, which some say is part of a larger effort by Republicans to cut the entitlement program.

California Slaps Surcharge On ACA Plans As Trump Remains Coy On Subsidies
Chad Terhune, Kaiser Health News

California’s health exchange said Wednesday it has ordered insurers to add a surcharge to certain policies next year because the Trump administration has yet to commit to paying a key set of consumer subsidies under the Affordable Care Act. The decision to impose a 12.4 percent surcharge on silver-level health plans in 2018 means the total premium increase for them will average nearly 25 percent, according to Covered California.

Trump healthcare order could face strong legal objections
Brendan Pierson and Nate Raymond, Reuters

U.S. President Donald Trump’s expected plan to let Americans buy insurance across state lines could violate federal law governing employee benefit plans and will almost certainly be challenged in court, several legal experts said. Trump said on Tuesday he would likely sign an executive order this week allowing people to cross state lines to obtain “great, competitive healthcare” that would cost the United States “nothing.”

Medicare Advantage star ratings show insurers’ performance hasn’t improved
Maria Castellucci, Modern Healthcare

The CMS’ release of its Medicare star ratings reveals that performance among insurers overall in Medicare Advantage remains largely unchanged year-over-year. The latest data, released Wednesday, show that the number of Medicare Advantage plans that performed well in the CMS’ star ratings program dropped slightly from last year.

Providers

House Republicans Ramp Up Scrutiny of Providers in Drug Discount Program
Jon Reid, Morning Consult 

House Republicans are intensifying scrutiny of a federal program that gives thousands of safety-net providers hefty discounts on prescription drugs but that they say doesn’t have effective tools to track where the savings are going. The 340B Drug Pricing Program makes some providers, such as children’s hospitals, federal health centers and specialty clinics, eligible for discounts of between 25 to 50 percent on outpatient drugs.

As Loyola buys MacNeal Hospital, parent Tenet eyes Chicago exit
Kristen Schorsch, Crain’s Chicago Business

Loyola Medicine has a deal to acquire MacNeal Hospital in Berwyn, a community facility owned by for-profit giant Tenet Healthcare. And Dallas-based Tenet is looking to sell its other three hospitals here and exit the Chicago market entirely, just four years after it arrived, a source close to the company said. Tenet, with nearly 80 hospitals nationwide, also owns Weiss Memorial Hospital in the Uptown neighborhood, Westlake Hospital in Melrose Park and West Suburban Medical Center in Oak Park.

Hospitals scramble to avert saline shortage in wake of Puerto Rico disaster
Laurie McGinley, The Washington Post

The hurricane that wreaked havoc on Puerto Rico last month has disrupted production of widely used IV solutions. Several prominent hospitals across the country are scrambling to find alternative supplies, change the way they administer drugs and devise backup plans to make the fluids themselves.

Pharma, Biotech and Devices

Merck scraps disappointing experimental cholesterol drug
Linda A. Johnson, The Associated Press

Merck has decided to abandon efforts to market a closely watched experimental cholesterol medicine after mediocre test results. Merck’s decision Wednesday to not seek regulatory approval after years of testing marks the fourth time this type of once-promising drug has been scrapped.

An FDA program to approve old drugs causes higher prices and shortages
Ed Silverman, Stat News

In 2006, the Food and Drug Administration launched a program to require drug makers to win approval of medicines that — believe it or not — were being sold without the agency’s imprimatur or remove them from the market. At the time, hundreds of treatments were readily available because some companies failed to comply with a 1962 law mandating companies prove drugs were effective.

How Amazon becoming a pharmacy could lower the price of drugs, according to Morgan Stanley
Christina Farr, CNBC

Morgan Stanley has a new report out for investors that outlines how Amazon’s potential push into pharmacy would benefit consumers. In the first phase, the authors speculate that Amazon could open “virtual retail pharmacies,” leveraging its Prime Now network for millions of U.S. consumers to buy drugs online.

Health IT

More than 316,000 patient blood tests exposed in breach linked to home monitoring company
Evan Sweeney, FierceHealthcare

Medical information, including blood test results associated with more than 150,000 people that used an in-home testing service, were leaked after an Amazon-hosted cloud repository was misconfigured to allow public access, according to a cybersecurity firm. The vulnerability was discovered by Kromtech Security Researchers on Friday, Sept. 29.

Opinions, Editorials and Perspectives

Ten Years Later, Patients Continue to Praise Medicare’s ‘Six Protected Classes’
Chuck Ingoglia and Jim Gleason, Morning Consult 

A decade after its implementation, Medicare’s prescription drug benefit (commonly known as Part D) is a bright spot in the federal health care policy chaos — a widely shared opinion among policymakers, actuaries, and most importantly, Medicare beneficiaries. Part D consistently receives bipartisan praise for bringing market-based principles to the delivery of necessary medical benefits.

Trump’s Cure for Obamacare Is Worse Than the Disease
Ramesh Ponnuru, Bloomberg

On Twitter, President Donald Trump said he would be “using the power of the pen to give great HealthCare to many people — FAST.” He isn’t bluffing.

Psychiatrists Can’t Stop Mass Killers
Richard A. Friedman, The New York Times

In the wake of the Las Vegas massacre, politicians are once again promoting the politically expedient notion that better mental health care could stop such mass killings. Paul D. Ryan, the speaker of the House, said last week that “mental health reform is a critical ingredient to making sure that we can try and prevent some of these things from happening in the past.”

Research Reports

Analysis of the Impacts of the ACA’s Tax on Health Insurance in 2018 and Beyond – Revised
Chris Carlson et al., Oliver Wyman

Oliver Wyman was commissioned by UnitedHealth Group to analyze the impact of the ACA’s tax on health insurance premiums. The primary audience for this report includes health insurers that are responsible for paying the tax on health insurance premiums and other interested parties.