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April 2017


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April 28, 2017

Legislative language for the MacArthur amendment to the American Health Care Act (AHCA) emerged this week. A small kerfuffle arose when it was discovered the amendment protected certain plans from state exemption, such as those set up under the state innovation waiver of the Affordable Care Act. The protected plans that caused the most controversy were the plans for members of Congress and their staff. To correct this, Congresswoman McSally (R-AZ) filed an amendment to deny the protection for the plans for Members of Congress and their staff.

The Freedom Caucus was encouraged by the MacArthur amendment, enough that they decided to endorse the newly-amended AHCA – a significant wrinkle in the story as the Freedom Caucus will only endorse a bill if 80% of their members are in support of the legislation. However, their endorsement alone did not produce enough votes to pass the bill in the House.

Many moderates in the House Republican Conference are concerned about voting for the amended AHCA because of the potential disruptions in coverage for many of their constituents. We believe the bill is inching towards passage in the House, but it will require further work before it can near the finish line.

The Trump Administration continues to build out the team at Health and Human Services with the announcement of Dr. Charmaine Yoest to be Assistant Secretary for Public Affairs.

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

  • Key Provisions of Proposed GOP Health Care Compromise – Associated Press (Apr 26)
    “House Republicans are debating a proposed compromise that might help them revive stalled legislation to roll back much of Democratic President Barack Obama’s health care law. The broader bill would rework subsidies for private insurance, limit federal spending on Medicaidfor low-income people and cut taxes on upper-income individuals used to finance Obama’s overhaul. Here’s a look at key elements of the compromise, authored by Rep. Tom MacArthur, R-N.J.”
  • Trump names anti-abortion leader Yoest to top HHS post – Politico (Apr 28)
    “President Donald Trump on Friday said he would name one of the most prominent anti-abortion activists in the nation to a top communications post at the Department of Health and Human Services. Charmaine Yoest, tapped to be to be assistant secretary of public affairs, is a senior fellow at American Values. She is the former president of Americans United for Life, one of the most prominent anti-abortion groups in the country, which has been instrumental in advancing anti-abortion legislation at the state level to restrict access to the procedure.”
  • Physicians ask the CMS to cut Medicare red tape – Modern Healthcare (Apr 25)
    “In response to a request by the CMS to find ways to attract and retain Medicare providers, physicians want less red tape. Doctors are asking the CMS to better synchronize policies for Medicare Advantage, Medicare fee-for-service and accountable care organizations as a way to reduce their regulatory burden.”
  • America’s Other Drug Problem – ProPublica (Apr 27)
    “If you want to know why the nation’s health care costs are among the highest in the world, a good place to start is with what we throw away. Across the country, nursing homes routinely toss large quantities of perfectly good prescription medication: tablets for diabetes, syringes of blood thinners, pricey pills for psychosis and seizures. At a time when anger over soaring drug costs has perhaps never been more intense, redistributing discarded drugs seems like a no-brainer. Yet it’s estimated that American taxpayers, through Medicare, spend hundreds of millions of dollars each year on drugs for nursing home patients — much of which literally go down the tubes.”
  • The fatal flaw in the GOP’s lurching Obamacare-repeal push – Washington Post (Apr 28)
    “The GOP’s on-again, off-again health-care push is apparently stalled again. After the bill was amended to address the concerns of the very conservative House Freedom Caucus this week, some of those members got onboard — apparently breathing new life into the effort. But then a bunch of moderate Republicans signaled their opposition Thursday, and House Majority Leader Kevin McCarthy (R-Calif.) announced late that night that there would be no vote this week.”
  • GOP senators not so keen on House’s Obamacare repeal – Politico (Apr 27)
    “The hurdles in the upper chamber were on vivid display Wednesday as House Republicans celebrated their breakthrough on the stalled repeal effort. The compromise cut with House Freedom Caucus members won over the right flank, but the changes will almost surely make it harder to pick up votes in the more moderate-minded Senate.”

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.