August 18, 2017
Healthcare Today will be taking a summer break for the next two weeks. The next edition will be on Friday, September 8th, when Congress is back in town.
This week, the Congressional Budget Office (CBO) released a study on the impact of eliminating the cost-sharing subsidies under the Affordable Care Act (ACA). The report finds that eliminating these payments will increase the federal budget deficit by $194 billion over the next ten years. CBO cites two reasons for the spike in the deficit: subsidies for purchasing insurance will be greater, and more people will be receiving subsidies. CBO projects the subsidies would increase by $247 billion which is partially offset from some higher revenues from changes to taxable wages and additional penalties paid.
CBO is projecting the marketplace would remain stable but that insurance premiums would rise by 20 percent under this policy. The report also states that the uninsured population would decrease slightly because of the subsidies for purchasing insurance becoming more generous.
- Trump administration will make this month’s Obamacare payments but leaves program’s future in limbo – Politico (Aug 16)
“The Trump administration will make this month’s Obamacare payments to insurers, a White House spokesman confirmed today, despite the president’s repeated threats to cut off the subsidies and potentially tip the insurance markets into turmoil. It’s widely anticipated that insurers would jack up premiums or exit the Obamacare markets altogether if the subsidies, worth about $7 billion this year, are eliminated. Insurance premiums for the most popular Obamacare plans would likely rise by 20 percent next year if the payments are stopped, according to a Tuesday CBO analysis.”
- CBO: Pulling Obamacare subsidies would drive up premiums, increase deficit – Politico (Aug 15)
“Scrapping Obamacare’s cost-sharing subsidies would increase premiums on the most popular plans by 20 percent next year and swell the deficit by $194 billion over a decade, according to an analysisby the Congressional Budget Office.”
- Dems ask Trump officials for briefing on ObamaCare – The Hill (Aug 18)
“Top Democrats of committees overseeing healthcare are requesting a briefing on the administration’s plans for ObamaCare’s open enrollment season, which begins Nov. 1, amid uncertainty over how President Trump will administer the law. In a letter sent to Health and Human Services Secretary Tom Priceand Centers for Medicare and Medicaid Services Administrator Seema Verma, the lawmakers expressed concerns over what they see as the White House’s efforts to undermine the Affordable Care Act’s marketplaces.”
August 11, 2017
Last night, the White House announced that the President is instructing his administration to use all appropriate emergency authorities to respond to the opioid epidemic. This allows the federal government to waive certain rules governing how state and local governments respond to the crisis. It may result in the Public Health Service being deployed in the most affected areas of the country where there is not enough necessary medical staff present to respond.
The President received a briefing this week on the issue from Secretary of Health and Human Services (HHS) Dr. Tom Price. Reportedly, the President is still reviewing the draft report of his Commission on Combating Drug Addiction and the Opioid Crisis to determine which of the recommendations his administration will act upon.
The Centers for Medicare and Medicaid Services (CMS) issued a memo yesterday allowing more time for insurance companies to submit premium rate requests for plans sold on the exchanges under the Affordable Care Act. The deadline has been pushed back from August 16 until September 5. Under the new deadline, insurance companies will know the status of the cost sharing subsidies as the next payments are scheduled to be made on August 22.
We are expecting the Congressional Budget Office (CBO) to release a report on the impact of the cost sharing subsidies next week. Though August is usually a relatively quiet month in Washington D.C., there will likely be some drama building up to the scheduled payments as the administration has threatened to cancel them.
- Bipartisan health policy coalition urges Congress to strengthen the ACA – Washington Post (Aug 11)
“An unlikely coalition of liberal and conservative health-policy leaders is calling on Congress to strengthen the existing health-care law in a variety of ways to help Americans get and keep insurance. In particular, the group is urging the government to continue paying all the federal subsidies provided under the Affordable Care Act and to help Americans enroll in coverage.”
- Tax writers see peril in Trump’s Obamacare persistence – Politico (Aug 7)
“Republicans acknowledge that the aggressive timeline they have set up for overhauling the tax code this fall leaves them little room for error. There could be one problem with that: Obamacare isn’t going away. President Donald Trump has dropped hints that he might stop the Affordable Care Act’s cost-sharing reduction payments, through which federal funds flow to insurance companies to keep down coverage costs for low-income people.”
- The tantalizing link between obesity and depression – Politico (Aug 9)
“About 15 years ago, Sue McElroy, a psychiatrist in Mason, Ohio, started noticing a pattern. People came to see her because they were depressed, but they frequently had a more visible ailment as well: They were very overweight. McElroy was convinced there had to be a connection. “Many of my [depressed] patients were obese. And they were very upset by obesity,’’ McElroy recalled. “I looked into the literature, and it said there was no relationship. It didn’t make sense.””
- HHS Secretary Statement on President Trump’s Opioid Announcement Today – HHS (Aug 10)
“President Trump is taking strong, decisive action in directing the Administration to use all appropriate emergency and other authorities to respond to the crisis caused by the opioid epidemic. Today’s announcement demonstrates our sense of urgency to fight the scourge of addiction that is affecting all corners of this country.”
August 4, 2017
Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) announced this week that the committee will hold hearings and attempt to markup legislation to “repair” the Affordable Care Act (ACA). It sounds as though their focus will be on stabilizing the individual and small group markets using measures such as formally authorizing the cost sharing subsidies and possibly designing a reinsurance program for the markets. There is some discussion of offering states more flexibility from the ACA, but probably not as far as the House-passed bill went.
It is unclear whether Senators Alexander and Murray can build bipartisan consensus in their committee on these issues. It will certainly be difficult, given the political spectrum of committee members from Senator Sanders (I-VT) to Senator Paul (R-KY). However, Alexander and Murray recently wrote a consensus bill to reauthorize the Food and Drug Administration’s user fees and last Congress, the pair authored a rewrite of the controversial No Child Left Behind education bill – both of which made it through committee. Even if a bipartisan bill emerges from committee, it is yet to be seen whether Majority Leader Mitch McConnell (R-KY) will want to dedicate floor time to the bill.
On the House side, the Problem Solvers Caucus has developed a bill to stabilize individual and small group insurance markets, repeal the medical device tax, and grant states more flexibility under the ACA. The caucus comprises of members from both parties who have agreed to develop policy positions to impact legislation in the House. The Problem Solvers Caucus has agreed to internal rules wherein if a majority of members from each party support a particular policy position, they will all vote for it on the House floor. The caucus is 45 members strong – a significant voting bloc in the House that should not be discounted.
Meanwhile in the White House, the Trump administration has been suggesting that the President may end the cost sharing subsidies through administrative action. The next payment is due on August 22nd. Because of the impulsive tendencies of this administration, everyone is paying close attention to what action may come from the White House on this issue.
Elsewhere in healthcare:
- New bipartisan Obamacare push faces steep climb – Politico (Aug 3)
“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. Lamar Alexander (R-Tenn.), chairman of the Senate Committee on Health, Education, Labor and Pensions, 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 deal-makers.”
- Senate passes ‘right to try’ bill to help terminally ill patients get experimental drugs – Washington Post (Aug 3)
“The “right-to-try” legislation has been championed by the libertarian Goldwater Institute, which has worked to pass similar legislation in 37 states. The federal version, now headed to the House, would bar the government from blocking patients from getting access to medications that have undergone only preliminary testing in humans. Patients first would have to try all other available treatments and be ineligible for clinical trials.”
- GOP states move to cut Medicaid – The Hill (Aug 3)
“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 low-income Americans and those with certain disabilities. Some want to add work requirements or introduce drug testing for recipients. Others want to raise premium prices.”
- Trump decision looms on crucial Obamacare payments – Politico (Jul 31)
“President Donald Trump at any time could make good on a threat to scrap crucial Obamacare payments to insurers — a decision that could raise Obamacare customers’ costs and potentially leave tens of thousands more without any coverage options next year.”
July 28, 2017
What a week to be in Washington, D.C. One might say there was more drama in the Capitol building this week than there is during an entire season of House of Cards.
Last week, “conventional wisdom” dictated that there were not enough Republican votes to proceed to the bill on the Senate floor. But in a tense afternoon on Tuesday, Senator John McCain (R-AZ) walked on to the floor to a loud ovation of applause from both sides of the aisle to cast the 49th vote for the motion to proceed to debate. Senator Ron Johnson (R-OH), after a heated exchange with Senator Mitch McConnell (R-KY) and realizing that the bill’s fate was now in his hands, voted to be the 50th vote in favor setting up Vice President Pence to break the tie.
The Senate went on to consider several amendments and motions ranging, from the “repeal only” bill that passed the last Congress to an amendment calling for a single payer health care system to motions to send the bill back to committee. The expectation was that while the Senate did not have the votes to pass a bill like the one that passed the House, the Senate could at least pass a minimalist approach to the “repeal and replace” effort, dubbed “skinny repeal”, which would be repeal of the employer and individual mandates and the unpopular tax on medical devices.
However, the effort to pass the skinny repeal fell one vote short, despite assurances from the House that they would not take up the Senate-passed bill and send it to the President, but instead convene a conference committee with the Senate to attempt to come up with acceptable policies to both chambers.
Senator McConnell never called the question on passage of the House-passed bill so the bill remains on the Senate calendar. He can now turn back to the bill should a solution acceptable to 50 senators can be put together. What is not clear, however, is whether this will continue to be a partisan exercise or whether a bipartisan plan can be put together to address some of the challenges of the Affordable Care Act without repealing the law or significant portions of it.
For now, at least, Senator McConnell plans to move on to other agenda items in the Senate and take a pause on this bill. Those items are likely to include cloture on 11th Circuit Court nominee Kevin Newsom (already scheduled for Monday at 5:30 pm), FDA user fee reauthorization, the nomination of FBI Director Christopher Wray, and the Coast Guard reauthorization.
Elsewhere in healthcare:
- GOP Obamacare repeal bill fails in dramatic late-night vote – CNN (Jul 28)
“Washington (CNN)The Senate has dealt a devastating setback to Republican efforts to repeal and replace Obamacare, defeating a GOP “skinny repeal” bill early Friday morning. Sens. John McCain, Lisa Murkowski and Susan Collins joined with Democrats to oppose the measure, a major blow to President Donald Trump and the Republican congressional agenda.”
- HHS Unveils Improved Web Tool to Highlight Recent Breaches of Health Information – HHS (Jul 25)
“The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) today launched a revised web tool that puts important information into the hands of individuals, empowering them to better identify recent breaches of health information and to learn how all breaches of health information are investigated and successfully resolved.”
- NIH Contractor Dispute Underscores Agency Conflicts – Roll Call (Jul 25)
“A key contractor at the National Institutes of Health is urging employees to forgo compliance with federal guidelines, citing consent agreements signed by patients that acknowledge the risk of participating in clinical research at the agency, Roll Call has learned. The agency denies the contractor’s actions and that it would ever relax compliance.”
- Thune: Senate won’t give up on Obamacare repeal if bill fails this week – Politico (Jul 23)
“If the Senate’s latest Obamacare repeal efforts collapse this week, Republicans will “go back to the drawing board” and try again, Senate GOP Conference chairman John Thune said on Sunday. As Republicans’ efforts to undo the 2010 health care law hit seemingly insurmountable roadblocks, members of the party have floated working with Democrats to stabilize insurance markets or moving on to other priorities. But Thune, a Republican senator from South Dakota, insisted Sunday that the GOP is committed to dismantling the law that was the signature achievement of former President Barack Obama.”
July 21, 2017
All eyes are on the Senate where they are on track to have a vote on the motion to proceed to the House-passed American Health Care Act (AHCA). The motion to proceed is not debatable and is a simple 50-vote test. While Majority Leader McConnell will need to tell senators what he intends to do should the Senate proceed to the bill, the motion itself is not tied to any specific proposal.
Leader McConnell was planning to offer a version of the Better Care Reconciliation Act (BCRA) as a substitute amendment but there is not sufficient support for that proposal. There was some talk about having Senator McConnell instead offer the reconciliation bill that passed in the last Congress to just repeal the Affordable Care Act (ACA) but similarly, it is not clear there are sufficient votes.
Senator McConnell has the option of just offering a more modest proposal such as just repealing the individual and employer mandates, thus achieving the necessary savings to meet the reconciliation instructions. But it is not clear whether an approach like that would win over 50 Republican senators.
We hear that if the motion to proceed fails there are a significant number of Democrats who are willing to work with Republicans on a bill to fix the ACA but it is not clear if that approach would be acceptable to Leader McConnell.
Trying to predict Senate actions is feeling a lot like forecasting the weather in Washington, where even conservative estimates can be way off base.
- Cloud of confusion hangs over health-care bill – Washington Post (Jul 20)
“Senate Republican leaders’ latest attempt to salvage support for a GOP health-care bill floundered Thursday as leaders struggled to explain to rank-and-file members what exactly they would be voting on next week. Senators left town for the weekend under a cloud of confusion after Senate Majority Leader Mitch McConnell (R-Ky.) reopened talks on a discarded plan to repeal and replace the Affordable Care Act under heavy pressure from President Trump. The White House intervention sparked a flurry of meetings and activity, but the rush produced no new evidence that the bill can pass.”
- Senate ‘repeal only’ bill would leave 32 million more uninsured, CBO says – Politico (Jul 19)
“A revived bill that would dismantle large parts of Obamacare without an immediate replacement would leave 32 million more people uninsured and double premiums over a decade, the Congressional Budget Office said in a report Wednesday.”
- With collapse of GOP health care effort, Congress faces a long ‘to-do’ list for health policy – Stat (Jul 18)
“But the abrupt change of plans brings to the fore a laundry list of other health policy bills that remain on Congress’ agenda for the coming months. Some are must-pass items with rapidly approaching deadlines: agreements that represent about $1 billion in private funding for the Food and Drug Administration, as well as the authorizations for federal funding for the Children’s Health Insurance Program and several Medicare programs, all of which expire in September.”
- Medicaid shows its political clout – Politico (Jul 19)
“Medicaid may be the next “third rail” in American politics. Resistance to cutting the health care program for the poor has emerged as a big stumbling block to Obamacare repeal, and Republicans touch it at their political peril.”
- Trump threatens to gut Obamacare markets – Politico (Jul 18)
“Donald Trump holds a fuse in his hands — and he could decide to light it and blow up Obamacare insurance markets as soon as Thursday. That’s the deadline for sending out the next monthly Affordable Care Act subsidies to health plans to defray the cost of care for individuals with low incomes. The president has toyed for months with the idea of stopping the payments to force Democrats to the negotiating table to avoid the prospect of millions of vulnerable Americans losing access to health coverage.”
July 14, 2017
There are enough Republican Senators who are holding out their support for the Better Care Reconciliation Act (BCRA) that is outlook remains very murky. We are told there are continued negotiations and further changes are very likely to be made to the bill before it reaches the Senate floor.
If Leader McConnell is unable to get sufficient votes for BCRA, he could use the House passed bill as a shell to pass a tax bill in September so long as the bill includes $1 billion in savings from the Senate and HELP Committees’ jurisdiction. Under this scenario, Congress would not need to wrestle with a fiscal year 2018 budget resolution. There is not much speculation looking beyond health care but that certainly is an option for the leader.
- Senate Republicans one vote away from Obamacare repeal failure – Politico (Jul 11)
“Senate Republican leaders are praying that their fragile whip count holds over the weekend, as just one more “no” vote would doom the party’s Obamacare repeal effort from evencoming up for debate. Two GOP senators, Susan Collins of Maine and Rand Paul of Kentucky, said Thursday afternoon they will oppose a procedural vote next week to bring the bill to the floor. GOP leaders are putting immense pressure on about half a dozen other Republican senators not to join them and topple the entire effort. Another “no” is enough to kill the bill, and would also likely lead to mass defections.”
- The new things in the Senate health bill – Axios (Jul 13)
“Here’s what Senate Republicans have added to the latest version of their health care bill (summary here, text here)”
- Insurance experts question Cruz’s assertion about single risk pool – Politico (Jul 13)
“ Ted Cruz emphatically told fellow Republicans Thursday that his amendment to the Senate’s Obamacare repeal legislation would not split up healthy and sick people into two different risk pools,eliminating concern that an earlier version of his plan would drive up costs for sick people. But insurance experts say that’s not the case.
- Medicaid Still Key Sticking Point in GOP Health Debate – CQ Roll Call (Jul 13)
“Just hours after Senate Majority Leader Mitch McConnellunveiled an updated bill to overhaul the U.S. insurance system, lawmakers hesitant about the proposed changes to Medicaid huddled in the Kentucky Republican’s office in search of a solution. The members, which included Sens. Lisa Murkowskiof Alaska, John Hoeven of North Dakota, Shelley Moore Capito of West Virginia and Rob Portman of Ohio, were also joined by Centers for Medicare and Medicaid Services Administrator Seema Verma.”
- Half a million Medicare recipients were prescribed too many opioid drugs last year – Washington Post (Jul 13)
“Nearly 70,000 people on Medicare’s drug plan received “extreme” amounts of narcotic painkillers in 2016 and more than 22,000 others appeared to be “doctor shopping” for drugs, patterns that put both groups “at serious risk of opioid misuse or overdose,” a government watchdog reported Thursday. In all, about half a million people on the drug plan took amounts of the powerful drugs considered too large under standards set by the Centers for Disease Control and Prevention, according to the Inspector General’s office of the U.S. Health and Human Services Department. That number excludes people who had cancer or were in hospice, who may require large doses of painkillers.”
July 13, 2017
Senate Republican leadership just released an updated draft of the Better Care Reconciliation Act (BCRA). The most significant changes in the new bill include: leaving in place the Affordable Care Act’s (ACA) lifting of the limit on Medicare payroll taxes and the tax on passive income; allowing the purchase of health insurance from a health savings account (HSA); changing the inflation factor for the Medicaid Per Capita Cap program from the medical care component of the consumer price index for all urban customers to just the consumer price index for all urban customers; including $45 billion instead of $2 billion to fight the opioid epidemic; and providing additional funding to help vulnerable populations purchase insurance.
It is yet to be seen whether these changes will allow Senate Majority Leader Mitch McConnell (R-KY) to get the necessary votes to proceed to the bill where further changes could be made on the Senate floor if necessary to garner 50 votes for passage. We are hearing multiple senators are exploring further policy options, negotiating both individually and in groups.
July 7, 2017
The Senate returns next week to see if they can find the right policy options to adjust the Better Care Reconciliation Act (BCRA) to garner the necessary 50 votes for passage. We had heard that Senate Majority Leader Mitch McConnell (R-KY) had sent several policy options for scoring to the Congressional Budget Office (CBO), but is not clear whether all or any of those options put forward will wind up in the bill.
Among them was an idea being promoted by Senator Ted Cruz (R-TX) to allow insurance companies to offer plans that do not comply with the Affordable Care Act (ACA) so long as they offer one ACA-compliant plan. There was also talk of leaving in place the Medicare tax and the tax on unearned income as a way to fund more subsidies for vulnerable population.
Senate GOP leadership is aiming to have BCRA on the floor the week of July 17th. However, it is possible the bill will slip to the following week leaving it very close to the August recess.
A draft of the executive order addressing drug prices was leaked this week. The document outlines a wide number of possible regulatory reforms for several agencies to take action upon including: the Food and Drug Administration; the Centers for Medicare and Medicaid Services; Health Resources and Services Administration; the United States Trade Representative; the Patent and Trademark Office; and the Internal Revenue Service. The document also includes a number of legislative options for discussion. Critics lambasted the leaked order, suggesting it was too favorable to the pharmaceutical industry.
Below are some highlights from the press about the past week’s developments in healthcare policy:
- McConnell: If we can’t repeal Obamacare, we’ll fix it – Politico (Jul 6)
“Senate Majority Leader Mitch McConnell said Thursday that if the chamber’s fledgling Republican Obamacare repeal effort falls short, Congress will have to pass a more limited bill to shore up health insurance markets. “If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur,” McConnell said at a Rotary Club luncheon in Glasgow, Ky., the Associated Press reported. “No action is not an alternative. … We’ve got the insurance markets imploding all over the country, including in this state.””
- How the GOP and Democrats might begin to compromise on health care – Stat News (Jul 5)
“Senate Majority Leader Mitch McConnell warned last week that Republicans’ failure to pass comprehensive health care reform could have dire consequences. He even warned of one scenario rarely seen here lately: bipartisanship. There’s no guarantee that a holistic, bipartisan health care bill could succeed should McConnell’s nearly single-handed effortto repeal much of the Affordable Care Act fail. But Democrats at least claim they are willing to compromise.”
- The biggest winner in the current health-care debate: Single-payer – Washington Post (Jul 1)
“No, single-payer isn’t going to happen at the end of this debate — or even the end of this year or this decade, necessarily. But the logical foundations for it are being laid in our political debate just about every single day. And when you pair that with the rising public support for government-run health care, it’s clear in which direction this whole debate is trending.”
- How the GOP Medicaid overhaul could become the next fiscal cliff – Politico (Jul 3)
“The Senate health care bill, if it becomes law, would set in motion a massive rollback of Medicaid funding beginning in three years. But even some Republican supporters acknowledge the full cuts might never happen. Instead, they say it could become another Washington fiscal cliff, where lawmakers go to the brink of radical spending changes only to pull back — or have their successors pull back — just before the point of inflicting real pain in the face of intense pressure.”
- Kasich: Opioid money in Obamacare bill ‘like spitting in the ocean’ – Politico (Jul 2)
“An additional $45 billion to help combat opioid addiction in the Senate Republican Obamacare repeal and replacement bill isn’t enough, Ohio Gov. John Kasich said Sunday. In an interview on ABC’s “This Week,” Kasich, who was a contender for the 2016 Republican presidential nomination, called the extra money, which would be spent over a decade, “not enough” to stem the opioid crisis.”
- The Heroin Crisis in Trump’s Backyard – Politico Magazine (Jul 4)
“Across the bridge from Palm Beach’s oceanfront mansions and Mar-a-Lago, the private club owned by President Donald Trump, where he spent seven weekends this past winter golfing and entertaining visiting heads of state, it’s not uncommon to see teenage junkies nodding off on coffee shop couches or to come upon them shooting up in supermarket bathrooms. Palm Beach heroin addicts like to get high in public places because if they accidentally overdose, there’s somebody around to call an ambulance. Heroin’s cocoon-like embrace is a national affliction, but here, in the shadow of some of Florida’s priciest real estate, paramedics responded to 5,000 overdose calls last year, nearly 600 of them fatal.”
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 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 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.