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Healthcare Today

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April 21, 2017

With Congress out of town for the past two weeks, it has been a little quieter on the health care policy front in Washington.  Nevertheless, there were some significant developments during recess.

Starting with the American Health Care Act (AHCA), we learned that yet another amendment to the bill developed this past week.  An outline, but no legislative language, surfaced on the amendment to the AHCA from Congressman MacArthur (R-NJ) that would give states the option to seek waivers from the Essential Health Benefits and community ratings rules from the Affordable Care Act (ACA).  The community ratings waivers would not be granted for gender, age beyond the 5 to 1 ratio in the AHCA, nor health status unless the state is participating in a high risk pool.

The House Republican Leadership scheduled a telephonic Conference meeting for tomorrow to discuss this potential amendment to the AHCA.  The Leadership will also likely discuss the omnibus appropriations bill that is being shaped for consideration next week before the current continuing resolution expires.  We expect Democratic Members will want to see funding for ACA cost sharing subsidies included in the omnibus bill.  The subsidy funding likely will appear in the bill as we expect Republicans will need Democratic votes to pass the bill in both the House and Senate.

A telephonic meeting will not likely be sufficient to garner a credible whip count on the AHCA.  However, there has been talk this week of scheduling a vote on AHCA as early as the middle of next week.

The Trump Administration also finalized the Market Stabilization rule that was proposed in February.  The final rule largely followed the proposed rule with some modifications made based upon comments received.  The Administration believes this rule will allow insurers  to provide stability in the marketplace and potentially lower costs by reducing opportunities for adverse selection.

Below are some highlights from the press about the past week’s developments in healthcare policy:

“By all accounts, the expansion — known as the Healthy Indiana Plan 2.0 — has made a difference. Health officials in Scott County, Ind., a poverty-stricken community about 30 miles from Louisville, Ky., paint a picture of a program that’s bolstered a patchy social safety net — especially during a major HIV outbreak triggered by the opioid epidemic — without bankrupting the Hoosier State or punishing enrollees.”

  • Trump advisers call for expanded access to treatment in war on opioid addiction – STAT (Apr 19)
    “Health and Human Services Secretary Tom Price told advocates gathered here at a summit on drug abuse that his agency would boost access to opioid treatment, support “cutting-edge research” on new treatment, and push for better practices to help patients manage their pain, to cut down on prescriptions of powerful opioids.”
  • Lawmakers Strike Deal To Reauthorize FDA User Fee Agreements – Kaiser Health (Apr 17)
    “The bipartisan leaders of the Senate’s and U.S. House of Representatives’ health committees released a draft of the bipartisan Food and Drug Administration Reauthorization Act Friday. The act would reauthorize the FDA’s four user fee agreements that renew the FDA’s authority to collect user fees from the makers of prescription brand drugs, medical devices, generic drugs and biosimilars, and several crucial programs at the FDA.”
  • Republicans can’t find a way to repeal Obamacare because too many of them secretly love it – Washington Post (Apr 14)
    “…that brings us to the GOP’s real problem. It’s that a lot of Republicans secretly kind of like Obamacare, or at least they like what it does. They don’t want to get rid of the way it’s covered sick people or expanded coverage or let kids stay on their parent’s insurance until they’re 26 years old. The only thing they do want to change — well, other than the name and the individual mandate — is the way that premiums and deductibles have continued to march ever higher.”

April 7, 2017

The filing of the Schweikert-Palmer amendment to the American Health Care Act (AHCA) created some buzz this week. The action by the House Rules Committee to vote to include the Schweikert-Palmer language in the base AHCA bill provided Republican leadership some momentum heading into the recess even without having a vote on the House floor. The White House and Republican leadership maintain that discussions will continue over the next two weeks even with Congress out of session, and that if any agreement is reached, Congress will return early to vote on the bill. However, we remain skeptical that an agreement can be reached while members of Congress are back in their home states.

Scott Gottlieb performed well at his confirmation hearing before the Senate Committee on Health, Education, Labor and Pensions. The biggest policy issues raised during the hearing were the opioid epidemic and drug pricing. Gottlieb was assertive that much more needs to be done to address the problems with opioids, including efforts to replace drugs that don’t have abuse-deterrent features from the market with drugs that do and further researching alternatives to opioids.

On drug pricing issues, he stated that part of the problem is the amount of capital required to get through the current approval process, thus putting upward pressure on pricing. Gottlieb suggested that a more efficient approval process could lead to lower capital costs and therefore lower pricing. When pushed on whether he supports drug reimportation, Gottlieb stated that he would investigate all options, but that he believes there are other ways to efficiently brings drugs to market other than reimportation.

Concerns were also raised about possible conflicts of interest and over whether Gottlieb would be willing to accept sound science over political pressure. Gottlieb addressed those questions directly but it is yet to be seen whether his answers satisfied the Democratic senators sufficiently to garner their support.

Below are some highlights from the press about the past week’s developments in healthcare policy:

  • GOP Leaders Add a Carrot to Health Bill – Wall Street Journal (Apr 6)
    “With their plan to dismantle the Affordable Care Act stalled, Republican House leaders on Thursday unveiled an amendment aimed at lowering premiums, a move to gain more support for their health-care effort before they head home for a two-week recess. The new provision would create a fund of $15 billion over the next decade to reimburse insurers for patients with costly pre-existing conditions. House leaders had planned to add it to legislation to replace the ACA, which they pulled just hours before a planned votelast month due to a lack of support.”
  • The GOP’s first step on health care is admitting it has a problem – Washington Post (Apr 7)
    “There is a simple explanation for why Republicans in Congress can’t agree, even among themselves, how to replace Obamacare, as demonstrated once again this week. On the most fundamental question — whether medical care is a right that should be guaranteed to all citizens, or merely another consumer good — the party’s elected representatives are hopelessly conflicted.”
  • GOP health bill in shambles, House commences two-week break – Associated Press (Apr 6)
    “The Republican health care bill remained in shambles Thursday as House leaders threw up their hands and sent lawmakers home for a two-week recess. GOP chiefs announced a modest amendment to curb premium increases, but internal divisions still blocked their promised repeal of former President Barack Obama’s law.”
  • GOP leaders and conservatives agree: Time for a Trumpcare break – Axios (Apr 5)
    “The Trumpcare blame game is getting worse, with Heritage Action blaming the moderate Tuesday Group for the lack of progress in last night’s talks and House GOP leadership blaming the conservative Freedom Caucus. But everyone seems to agree on one thing: Congress should give the talks a break and go on recess rather than meeting again today.”
  • Safety net insurers in a bind over Obamacare – Axios (Apr 7)
    Health insurance companies that predominantly cover low-income people face a difficult decision for 2018: drop out of the Obamacare marketplaces and ignore their missions, or stay in and raise premiums a lot to account for the uncertainty created by the Trump administration’s repeal efforts.

March 31, 2017

With the shift in the agenda, we will be moving to a weekly publication of Healthcare Today unless events and circumstances warrant more frequent publication. Starting this week, expect to see this newsletter every Friday afternoon for your healthcare-related news.

The reaction to what happened last week with the American Health Care Act (AHCA) has been hard to avoid; there has been wide-ranging speculation about what this means for the President, Republican House leadership and the congressional agenda. Let us offer some perspective and context for last week’s events with the benefit of some distance and a week of meeting with lawmakers and their staff members.

It’s important to note that the bill was not defeated last week.  Rather, the House failed to meet an arbitrary deadline set by Republican leadership for voting on the bill.  It is true they lacked the votes for the bill reported out of the Rules Committee, but crucially, no votes were cast on the legislation.  This does not mean Republicans are going to abandon their efforts to address the shortcomings they see within the Affordable Care Act (ACA).

As far as the connection of AHCA to other pieces of legislation, there is only one direct connection and that is to a possible tax reform bill.  AHCA repealed over $800 billion in taxes imposed by ACA.  To the extent tax writers would also want to repeal those same taxes in a revenue neutral tax bill, they would have to find those additional revenues in offsets.

It is more than fair to criticize the Republicans for how they rolled out AHCA and attempted to build support for the bill in the House, but there were also lessons learned from that process that could benefit Republicans in any future legislative actions.

We are hearing that Republicans in the House are going to take a few steps back from the AHCA and consider healthcare reforms more broadly than that bill.  We also are hearing there may be another bipartisan gang forming in the Senate to attempt to tackle this issue.

This issue is not over, but there is certainly a pause in action.  Once the pace of action picks up, we will return to more frequent publication of this newsletter.

Below are some highlights from the press about recent developments in healthcare policy:

  • House aims for second Obamacare repeal effort in April or May – Washington Examiner (Mar 29)
    “Conservatives who have revived the effort to repeal and replace Obamacare say their goal is to come up with a deal that the House could pass by May or even sooner, before lawmakers attempt to tackle tax reform. “I would have said on Tuesday morning there was a two in 10 chance we would be able to pass a bill, but today I give it a seven out of 10,” said Rep. Bill Flores, R-Texas, a top member of the conservative Republican Study Committee. “I feel good about it.””
  • Lamar Alexander proposes temporary Obamacare relief – The Commercial Appeal (Mar 29)
    “With healthcare reform stalled, Sen. Lamar Alexander announced Wednesday he intends to file legislation that would provide temporary relief for millions of people who live in areas where there are no insurers selling policies on the federal health insurance marketplace. Alexander’s proposal would let people who get government subsidies to buy insurance use that money to purchase any state-approved plan on the private market if there is no insurer selling policies on the federal exchange, or marketplace, in their area.”
  • Sorry, insurers — House isn’t dropping the Obamacare subsidies lawsuit – Axios (Mar 30)
    “House Speaker Paul Ryan says the House Republican lawsuit against Obamacare’s cost-sharing reduction subsidieswill go forward, but that the Trump administration can use its “discretion” to keep paying the subsidies until the lawsuit is resolved. “We don’t want to drop the lawsuit because we believe in the separation of powers,” Ryan told reporters this morning at his weekly press briefing.”
  • Ryan warns Republicans that Trump could turn to Democrats on health bill – Politico (Mar 30)
    “House Speaker Paul Ryan said he is worried that Republicans may push President Donald Trump right into the arms of Democrats on Capitol Hill if they are unable to come together on legislation to repeal and replace Obamacare. Since the collapse of Republicans’ American Health Care Act last week in the House, Trump has expressed a willingness to work with Democrats on reforming the nation’s healthcare system if the Republican caucus is willing to unify behind him.”
  • Trump administration still plans to undo parts of the ACA, Tom Price testifies – Washington Post (Mar 29)
    “In his carefully calibrated testimony before House appropriators, Health and Human Services Secretary Tom Price made one thing clear Wednesday: The administration is still intent on dismantling parts of the Affordable Care Act even if Republicans lack the votes to rewrite it.”
  • After GOP Health Bill’s Demise, More States Weigh Expanding Medicaid – WSJ (Mar 28)
    “A growing number of states are considering expanding their Medicaid programs under the Affordable Care Act, after last week’s abrupt collapse of the GOP health billand a development that could make it harder for Republicans to undo the law in the future.”

See All March 2017 Updates

See All February 2017 Updates 

See All January 2017 Updates 

Rich Meade

Rich Meade, a Vice Chairman at Prime Policy Group and Chair of the firm’s Healthcare Practice has over 25 years of experience in legislative, regulatory, political and public relations strategy. He previously served as Chief of Staff to the House Budget Committee. Rich has helped his clients navigate many complex regulatory and legislative landscapes to achieve many public policy successes including transitioning to a new Medicare payment and quality system, and developing, with the Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC), a health information exchange (HIE) on the Nationwide Health Information Network (NwHIN).


Vickie Walling

Vickie is Co-Chair of Prime Policy Group’s Healthcare Practice and also works with a variety of the firm’s clients, including domestic businesses, multinational corporations and trade associations on federal legislative and regulatory issues. She has over 40 years of legislative and political experience and is widely recognized for her assistance and guidance in the creation of the Blue Dog Coalition, a coalition of moderate Democrats where she provided strategic, legislative and fundraising counsel for 15 years.


Mitchell Vakerics

Mitchell has been delivering trusted counsel across a diverse practice of legislative, policy and political issues for more than a decade. During his long-standing tenure both in Congress and throughout the political and policy sphere of Washington, he has tackled some of the largest healthcare, energy and regulatory issues presented before the federal government. He has a massive range of relationships and strategic congressional partnerships has paid dividends for consecutive congressional sessions. Mitch is a member of Prime Policy Group’s healthcare practice.


Jacob Beaver

Jacob is a Client Executive at Prime Policy Group, where he is an integral member of the Firm’s research team.