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January 2017

January 30, 2017

Tomorrow the Senate Finance Committee is planning to report the nomination of Dr. Tom Price to be Health and Human Services (HHS) secretary. The full Senate vote on the nomination can occur as soon as three days after the committee vote, but the exact timing of the vote will depend on how quickly the Senate can approve other pending nominations. For example, the Senate Finance Committee  had been  expected to vote on Steven Mnuchin’s nomination to be Treasury Secretary, but Senate Democrats used procedural measures to block the committee from meeting; the vote is now expected to be held tomorrow.

The so-called beachhead team for HHS was announced late last week. This is the team that will begin to set up the department for Dr. Price. Some of the individuals will find permanent roles at the department or agencies within the department and some will return to their current job. The team is comprised of a number former Price Congressional staffers, former staff of Vice President Pence, staff from House and Senate committees, and some veterans from the Trump campaign.

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

  • Senate Finance Committee to vote on Representative Price on Tuesday – Reuters (Jan 29)
    “The Republican-majority U.S. Senate Finance Committee will vote on Tuesday on the nomination of Representative Tom Price to head the Department of Health and Human Services, the panel’s chairman, Senator Orrin Hatch, said on Sunday.”
  • Republicans roll out their Obamacare replacements – Washington Examiner (Jan 30)
    “Republicans have been rolling out their suggestions for replacing Obamacare, providing lots of ideas for leadership to draw from but also highlighting intra-party divisions over how it should be done. Some lawmakers want to provide people with tax credits to buy coverage, while others want deductions. Some House conservatives are suspicious of phasing out Obamacare gradually. And a growing group of senators are stressing that replace must happen at the same time as repeal.”
  • Exchange Stabilization Bills Represent New GOP Approach to ACA – Health Affairs Blog (Jan 28)
    “As January draws to a close, it appears that a new strategy is coming to the fore: to adopt piecemeal replacement legislation even as repeal legislation proceeds through reconciliation. On January 27, 2017, House Republicans released four bills meeting this description that will be considered at a House Energy and Commerce Committee hearingon February 2, 2017.”
  • Medicaid could struggle to cover breakthrough treatments under GOP’s plans – Stat (Jan 30)
    “Under the GOP’s vision for overhauling Medicaid, the program could struggle to afford expensive breakthrough treatments, cutting off its recipients from the latest medical innovations, warn policy experts and patient advocates.”
  • Key part of GOP health plans may raise out-of-pocket costs – Axios (Jan 30)
    “Most Republicans agree on one part of their Obamacare replacement: It will include greater use of health savings accounts. But after years of outcry over rising deductibles and out-of-pocket spending under Obamacare, they could face their own backlash over this policy — because it’s built on, well, high deductibles and out-of-pocket spending.”
  • Obamacare anxiety grows for insurers – The Hill (Jan 29)
    “The Trump administration’s cancellation of Obamacare ads is adding to the uncertainty facing insurers as they wait for congressional Republicans to repeal the law. Republicans have vowed a smooth transition away from Obamacare and promised that no one now enrolled will lose coverage.”
  • Trump Orders Two Regulations Cut for Each One Adopted – CQ (Jan 30)
    “President Donald Trump signed an executive order Monday that he said would “massively” cut regulations for small businesses, but neither his statement nor the order clarified how he would achieve that goal. The order makes no mention of a business’s size. It requires that any department or agency in the executive branch eliminate two existing regulations for every new regulation. It also mandates that the cost of this two-for-one swap not impact businesses.”

January 27, 2017

Republican members of the House and Senate held their issues retreat at the Loews Hotel in Philadelphia this week. There are typically formal presentations from leaders, President Trump addressed the group, and sessions held to facilitate discussion around specific issues. The session on healthcare was entitled “Keeping our Promise on Health Care.” These retreats are not intended to produce specific policy recommendations or timeframes for consideration of those policies but rather an opportunity to make sure all of the voices are heard before plans are put in place.

Nevertheless, we were able to glean some insights into how Congress and the Trump Administration are likely to proceed with their plans to “repeal and replace” the Affordable Care Act. Speaker Ryan spoke to the group about three distinct actions as part of this effort.

First, Congress is expected to use the reconciliation process to repeal the portions of the law the Republicans find most troubling. There was speculation coming out of Philadelphia that this first step could be completed by the end of next month.

The second phase is for the Secretary of Health and Human Services (Dr. Tom Price’s nomination is still pending before the Senate) to take administrative actions to “stabilize” the insurance market. The final step would be to put in place policies that are designed to replace the Affordable Care Act.

It is not clear yet whether Congress will attempt to move those replacement policies on a bipartisan basis. However, there are rumors of committees beginning to move discrete pieces of legislation with insurance market reforms.

These insights form the latest iteration of these plans and can change quickly.

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

  • Ryan: GOP will replace Obamacare, cut taxes and fund wall by August – Politico (Jan 25)
    “House Speaker Paul Ryan on Wednesday outlined a packed legislative agenda for this year in which Republicans would repeal and replace Obamacare by April, fund Donald Trump’s border wall shortly after that and approve a sweeping tax reform package by August.”
  • After Retreat, GOP Decided Little on Health Plan – Morning Consult (Jan 26)
    “PHILADELPHIA – After two days of meetings here, Republican lawmakers still have a lot of decisions to make about how they’ll repeal and replace Obamacare. Lawmakers are still mulling the details of health care reform, from how to repeal the taxes in the Affordable Care Act to what parts of a replacement plan could be included in reconciliation legislation.”
  • Medicaid Panel Eyes Challenge of Possible Shift to Block Grants – Roll Call (Jan 26)
    “An influential advisory panel is studying the myriad decisions that lawmakers would face if congressional Republicans carry through on their proposals for limiting the federal government’s financial responsibility for Medicaid.”
  • Behind closed doors, Republican lawmakers fret about how to repeal Obamacare – Washington Post (Jan 27)
    “Republican lawmakers aired sharp concerns about their party’s quick push to repeal the Affordable Care Act inside a closed-door meeting Thursday, according to a recording of the session obtained by The Washington Post. The recording reveals a GOP that appears to be filled with doubts about how to make good on a long-standing promise to get rid of Obamacare without explicit guidance from President Trump or his administration.”

 January 25, 2017

On January 24th, the Senate Finance Committee held a four-hour hearing to consider the nomination of Rep. Tom Price (R-GA) to be the Secretary of Health and Human Services (HHS). Once again, after opening statements by the committee chair and ranking member, Sen. Johnny Isakson introduced Rep. Price glowingly, while also attempting to deflect the numerous accusations that have been brought against Price since his nomination.

The hearing was more focused on policy than the courtesy hearing in the Senate Health, Education, Labor and Pensions (HELP) Committee, though the first question asked by Ranking Member Wyden was on Price’s investment in Innate Immunotherapeutics. From then on, the focus on the Democratic side was largely on trying to get answers on Price’s past positions and plans to turn Medicaid into a block grant program, as well as attempting to secure assurances that protections against discrimination towards those with preexisting conditions and disabilities, among others, would remain in place in any replacement plan offered.

Price, as he did in the HELP hearing, reiterated that his goal should he be confirmed would be to make sure that everyone would have access to the care they needed at the lowest possible price; an answer some Democrats interpreted as dodging the questions asked of him. He also deferred to Congress when asked about past positions, stating that it was the responsibility of Congress to pass the laws while he would hold an administrative role in implementing them. While Price appeared evasive, it does not seem likely that anything brought up in the hearing will do anything to stop his nomination passing through committee to the Senate floor.

Price was also asked numerous questions from the Democratic side about the President’s recent executive order that instructed federal agencies to “waive, defer, grant exemptions from or delay the implementation of any provision or requirement of the [Affordable Care Act]” that would place a burden on those affected by it, to include consumers, providers, insurers and drug companies. He replied that he would make certain that the individuals that lost coverage under the Affordable Care Act don’t lose coverage under whatever replacement plan comes forward.

Below are some highlights from the press about the hearing and other significant developments in healthcare policy:

  • Democrats fail to draw blood from Price – Politico (Jan 24)
    “President Donald Trump’s point man on repealing and replacing Obamacare provided no new clues about how the administration intends to reshape the health system during an at times testy confirmation hearing Tuesday. Rep. Tom Price’s four-hour appearance before the Senate Finance Committee exasperated Democrats, coming just days after Trump issued a sweeping directive authorizing federal agencies to begin gutting the law.”
  • Key House committee will hold hearing on first Obamacare replacement bills next week – Washington Post (Jan 24)
    “In a sign that Republican lawmakers are set to move swiftly on plans to repeal and replace the Affordable Care Act, key House committees are scheduling hearings and drafting legislation to unravel former president Barack Obama’s major domestic achievement. On Tuesday, the House Budget Committee is holding a hearing titled “The Failures of Obamacare: Harmful Effects and Broken Promises,” while the Ways and Means Committee is set to examine the “effectiveness” of the individual mandateto buy insurance, a linchpin of the ACA’s model to expand insurance and make it more affordable.”
  • Don’t worry – the insurance industry has a plan – Axios (Jan 25)
    “America’s Health Insurance Plans, the main industry trade group, seems to be making peace with the idea that the individual mandate is going away. So it’s proposing a form of “continuous coverage,” an idea that’s also in a lot of Republican replacement plans — where people would only be guaranteed coverage for pre-existing conditions if they keep themselves insured.”
  • For Conservatives, A New Day In Health Care – Kaiser Health (Jan 25)
    “So what might the ultimate Republican replacement plan actually look like? And would it maintain some of the more popular pieces of the ACA? To find out, we spoke with leading conservative health care expert Lanhee Chen co-author of the influential American Enterprise Institute replacement proposal.”
  • Everything You Need To Know About Block Grants – The Heart Of GOP’s Medicaid Plans – Kaiser Health (Jan 24)
    “President Donald Trump’s administration made explicit this weekend its commitment to an old GOP strategy for managing Medicaid, the federal-state insurance plan that covers low-income people — turning control of the program to states and capping what the federal government spends on it each year… But what would this look like, and why is it so controversial? Let’s break down how this policy could play out, and its implications — both for government spending and for accessing care.”
  • GOP ‘accelerating the replacement’ of Obamacare – Axios (Jan 24)
    “House and Senate Republican leaders met Tuesday to get on the same page before the GOP leaves for its retreat tomorrow. While no final decisions were made about the timing for repealing and replacing Obamacare, Senate HELP Committee Chairman Lamar Alexander said everybody agrees they need to be done at the same time.”

 January 23, 2017

President Trump signed his first executive order shortly after the conclusion of his inaugural parade to make it clear that his administration will push strongly for the repeal of the Affordable Care Act. The executive order gives broad discretion to the departments and agencies charged with administering the Affordable Care Act to take whatever steps necessary to reverse the policies put in place by the law. It is yet to be seen how creative his administration will be in attempting to undo key provisions of the law by executive action, but there is potential for major changes to be made without congressional action. For example, broad waiver authorities for hardship waivers for the individual mandate can be granted. Broad innovation waivers for states could allow certain states to reshape minimum benefit requirements in their state. The executive order does recognize that agencies will have to promulgate new regulations in accordance with the Administrative Procedures Act to the extent their actions are seeking to replace existing regulations. Prime Policy Group will be monitoring the implementation of this executive order very closely.

Below are some highlights from the press of significant developments in healthcare policy:

  • Trump’s Health Plan Would Convert Medicaid to Block Grants, Aide Says – NY Times (Jan 22)
    President Trump’s plan to replace the Affordable Care Act will propose giving each state a fixed amount of federal money in the form of a block grant to provide health care to low-income people on Medicaid, a top adviser to Mr. Trump said in an interview broadcast on Sunday.
  • Donald Trump’s Health-Law Directive Spurs a Dash to Decode It – Wall Street Journal (Jan 22)
    Lawmakers, insurers and the health-care industry rushed over the weekend to decipher the full meaning and consequences of President Donald Trump’s executive order urging agency heads to do whatever they can to unwind some provisions of the Affordable Care Act.
  • GOP Governors Pitch Medicaid Reforms as Cornyn Pledges No Coverage Losses – Morning Consult (Jan 19)
    Republican governors told members of a key Senate panel on Thursday that they want more flexibility when it comes to Medicaid. That was the focus of a roughly two-hour, closed-door meeting among several GOP governors and Republicans on the Senate Finance Committee, which is set to play a key role in crafting legislation that would repeal and replace the Affordable Care Act.
  • GOP senators present Obamacare alternative – CNN (Jan 23)
    Two Republican senators introduced legislation Monday to replace Obamacare amid mounting pressure on the GOP to craft an alternative to the massive healthcare law. Sens. Bill Cassidy of Louisiana and Susan Collins of Maine unveiled a bill that they are describing as an “Obamacare replacement plan.” The duo is promising that the proposal would give more power to the states on health care policy, increase access to affordable insurance and help cover millions of Americans who are currently uninsured. At the core of their proposal: Any state that likes Obamacare can keep it.
  • Grassley hasn’t forgotten about prescription drug prices – Axios (Jan 23)
    Chuck Grassley has been one of the most consistent Republicans speaking out against rising prescription drug prices. As chairman of the Senate Judiciary Committee, he plans to push legislation this year making it easier for generics to get to market. He’s hoping that will add competi
    tion and drive down prices.
  • Trump speaks with top Dem about high drug prices – The Hill (Jan 21)
    President Trump told Rep. Elijah Cummings (D-Md.) at an inaugural luncheon Friday that the two needed to meet about the high cost of prescription drugs, according to a Cummings aide. Cummings is one of the most outspoken lawmakers in favor of government action to fight high drug prices. Trump’s apparent willingness to work with him on the issue is a further sign that the new president is upending the usual GOP position against government action on drug prices.

January 19, 2017

On January 18th, the Senate Health, Education, Labor and Pensions Committee held a courtesy hearing on the nomination of Rep. Tom Price (R-GA) to be the Secretary of the Department of Health and Human Services (HHS). After opening statements, Sen. Johnny Isakson (R-GA) introduced Rep. Price and spoke highly of his experience and past achievements. He said that allegations about stock purchases were misguided and were the result of combining two facts and coming to a false conclusion. He urged committee members to respectfully listen to Price’s answers and that he was right man for the job.

The hearing was heated, with Democratic senators bringing up multiple examples of Price’s possible financial conflicts of interest during his time in Congress. Price, with the exception of his direction to his broker to buy stocks in Innate Immunotherapeutics, was steadfast in saying that he had no control over the investments made in health care related entities and that he did not direct his broker to make the purchases before he engaged in legislative action that they benefited from. That aside, Democrats attempted to drill down on his Affordable Care Act replacement package, the Empowering Patients First Act, and registered concern over many of the provisions that would repeal parts of the ACA that protect those with pre-existing conditions, provide dependent coverage for those under the age of 26, and defund Planned Parenthood, among many others.

Republicans were across the board laudatory of Price’s experience as a doctor and of his time as a legislator in the House of Representatives. They sought, largely, to secure assurances about Price’s intentions for the repeal and replacement of the ACA, specifically that it would not be rushed and that the repeal would not happen without a solid plan in place. A number of them, including Sen. Orrin Hatch (R-UT) and Sen. Isakson, also sought to defend the attacks on Price’s character, noting that other members within the committee had similar cases of investments in legislative areas that they worked on that had been approved and passed muster with the appropriate congressional rules.

Below are some highlights from the press coverage of the hearing and other significant developments in healthcare policy:

  • Choice for Health Secretary Is Vague on Replacing Affordable Care Act – NY Times (Jan 18)
    “Representative Tom Price, the man President-elect Donald J. Trump has chosen to lead the Department of Health and Human Services, promised on Wednesday to make sure people do not “fall through the cracks” if the Affordable Care Act is repealed, and set a goal to increase the number of people with health insurance.”
  • Price Faces Tough Questions on Stock Trading, Health Care Law – Roll Call (Jan 18)
    Tom Price sought in a contentious hearing Wednesday to defend his purchases of medical stocks against Democratic charges of conflicts of interest. Price told Sen. Patty Murray of Washington, the ranking Democrat on the Health, Education, Labor and Pensions Committee that held the hearing, that he bought Australian biotech Innate Immunotherapeutics shares after talking with Rep. Chris Collins, R-N.Y., about the company
  • Why Trumpcare might sign you up for health insurance without asking – Axios (Jan 19)
    “Republicans on the Hill are taking a close look at an idea they believe could actually expand health coverage: just enroll everyone in a health plan unless they opt out. Hill staffers and conservative health wonks have been tossing the idea around for awhile as a way to replace Obamacare’s individual mandate while continuing to cover everyone with pre-existing conditions — something that becomes too expensive without healthy people to cover the costs. Many now point to auto-enrollment as one of the best ways to cover more people without bleeding federal dollars.”
  • How We Can Repeal The ACA And Still Insure The Uninsured – Rep. Pete Sessions, Sen. Bill Cassidy, and John Goodman (Jan 18)
    “The two major political parties are in a contentious battle over the Affordable Care Act (ACA). Republicans would like to repeal and replace it. Democrats are doggedly defending it. But even if the ACA stays in place, there will still be almost 30 million people without health insurance and another 20 million or so who all too often face deductibles that are unreasonably high for moderate-income families and provider networks that are much too narrow for people with serious medical problems.”
  • Alexander: ACA ‘Rescue Plan’ Could Be Passed In 60-Vote Senate Regular Order – Inside Health Policy (Jan 18) (subscription only)
    “Senate health Committee Chairman Lamar Alexander (R-TN) said legislation could pass the Senate in regular order by a 60-vote threshold that would help people affected by high premiums under the ACA as a first step in repealing and replacing President Obama’s signature health care law.”
  • House Ways and Means Subcommittee to Hold Hearing on Replacing Individual Mandate – Committee Press Release (Jan 17)
    The House Ways and Means Subcommittee on Oversight will be holding a hearing entitled “Examining the Effectiveness of the Individual Mandate under the Affordable Care Act” on January 24th.

January 17, 2017

President-elect Donald Trump promised over the weekend that his proposal to replace the Affordable Care Act will be finalized very quickly. We continue to believe that his proposal will not likely be made public prior to the confirmation of Representative Tom Price, M.D. (R-GA) as his nominee for Health and Human Services. Nevertheless, we expect the President-elect will press Congress for swift action on the Affordable Care Act.

Based upon Trump’s comments about access to health insurance and the cost of coverage not being an obstacle, we are expecting proposals for allowing the sale of insurance across state lines (the so-called association health plan policy) combined with some kind of tax incentive or other form of subsidy for voluntarily purchasing health insurance.

The President also repeated his call for negotiated pricing for prescription medications under the Medicare Part D program. This policy has traditionally been rejected by Congressional Republicans since the inception of the program. Congressional Republicans’ resistance to negotiated pricing, however, occurred before the public relations hits that drug manufacturers Turing and Mylan took over the pricing of their pricing of products Daraprim and EpiPen respectively. The Congressional Budget Office projects the savings from the policy of negotiated pricing to lower mandatory spending by $145 billion over a ten-year window making the policy potentially more attractive, particularly if considered as part of a much larger piece of legislation.

Below are some highlights from the press coverage of the efforts to repeal and replace the Affordable Care Act and other significant developments in healthcare policy:

  • House takes first step towards repealing Obamacare – CNN (Jan 13)
    “The House of Representatives began the process of dismantling the Affordable Care Act on Friday, approving a budget resolution on a mostly party line vote. The vote was 227-198. […] Top Republican leaders are also saying they plan to move to replace Obamacare along the same track, but they are still struggling to come up with the details on how it will work.”
  • First on CNN: Trump’s Cabinet pick invested in company, then introduced a bill to help it – CNN (Jan 16)
    “Rep. Tom Price last year purchased shares in a medical device manufacturer days before introducing legislation that would have directly benefited the company, raising new ethics concerns for President-elect Donald Trump’s nominee for Health and Human Services secretary. Price bought between $1,001 to $15,000 worth of shares last March in Zimmer Biomet, according to House records reviewed by CNN.” Rep. Price is scheduled for a confirmation hearing in front of the Senate HELP Committee this Wednesday.
  • Trump, Price and Hill GOP at odds on Obamacare – Politico (Jan 16)
    “Donald Trump and his pick to lead the Obamacare repeal effort, Rep. Tom Price, share a vision that the current health care system needs to be completely uprooted. But the two men have articulated wildly divergent visions for what comes next — and that’s making it hard for Hill Republicans to figure out where to start on a coherent replacement plan once Obamacare is gone.”
  • Trump spokesman says Obamacare replacement will harness marketplace competition – Washington Post (Jan 16)
    “A spokesman for Donald Trump sought Monday to elaborate on the president-elect’s plans to replace the Affordable Care Act, vowing that the new administration would lower health-care costs by infusing more competition into the marketplace, including by allowing insurers to sell health plans across state lines.

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.