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March 2018


March 30, 2018

This week, President Trump removed Veterans Affairs (VA) Secretary David Shulkin over frustrations with medical care for veterans.  The President wanted the VA to move more quickly to allow veterans access to private doctors; however, Secretary Shulkin penned an op-ed in the New York Times after his firing stating that “privatizing” VA health care would harm veterans.  To replace him, President Trump has chosen his personal physician Navy Rear Admiral Ronny Jackson to head the VA.

There was much speculation over the failed attempt to insert insurance market stabilization provisions into the omnibus spending bill.  Republicans were insisting on including the “Hyde” amendment prohibiting federal funds from being used to provide abortions.  That language was not written into the Affordable Care Act and Senator Murray (D-WA), the lead negotiator for Democratic senators on the stabilization language, refused to accept its inclusion fearing it would greatly expand abortion restrictions that could ultimately lead to disruptions in coverage in some markets.  Outlook for market stabilization legislative efforts do not look good after this latest round of negotiations.

Finally, HHS Secretary Alex Azar named Daniel Best as the senior adviser to the secretary on drug pricing reforms.  Best is a former executive at CVS Health and Pfizer.

  • House lawmakers hope to bring opioid legislation to vote before Memorial Day – STAT (Mar 29)
    “A key House committee will hold the last of three major hearings to address the opioid crisis on April 11, and hopes to bring a legislative package to the floor before the House breaks for Memorial Day on May 24, according to GOP aides on Capitol Hill. The third hearing of the House Energy and Commerce health subcommittee will focus on insurance coverage, payment issues, and prescription regulations for Medicaid beneficiaries. An initial session focused on enforcement issues and a second discussed public health, treatment, and prevention strategies.”
  • Inside the collapse of a bipartisan Obamacare deal – Politico (Mar 26)
    “Just seven months after Sens. Patty Murray (D-Wash.)and Lamar Alexander (R-Tenn.) heralded the beginning of a new bipartisan era on health care following the collapse of Obamacare repeal efforts, their lofty ambitions ended in much the same way as every Obamacare-related negotiation over the last eight years — with claims of betrayal, warnings of political fallout and no progress toward bridging the deep divide over the nation’s health care system. When Congress put its finishing touches on a $1.3 trillion spending bill late last week, there was one glaring omission: a proposal to head off huge premium spikes just before the November midterm elections.”
  • Azar taps former CVS executive to help lower drug prices – The Hill (Mar 29)
    “Health and Human Services Secretary Alex Azar is tapping a former CVS Caremark executive to lead the agency’s efforts to lower drug prices. According to HHS, Daniel Best will be Azar’s senior adviser for drug pricing reform. Best was most recently a vice president of industry relations for CVS’s Medicare Part D business. This included the company’s prescription drug plans, Medicare Part D plans and other clients.”
  • In emotional speech, CDC’s new leader vows to uphold science – Washington Post (Mar 29)
    “Robert Redfield Jr., the new director of the Centers for Disease Control and Prevention, gave a deeply personal agencywide address Thursday in which he repeatedly underscored the importance of science and data and said the CDC’s most critical public health mission is to protect Americans “from that which we don’t expect.””

March 23, 2018

Earlier today, the President signed the omnibus appropriations bill that funds the federal government for the rest of the fiscal year. There are several significant healthcare developments in the bill but there were not any health-related policy riders added to the bill.

The bill makes a significant investment in medical research being conducted at the National Institutes of Health (NIH). NIH is receiving a $3 billion increase from the bill on top of two previous $2 billion increases for the agency. Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Labor Chairman Roy Blunt (R-MO) said that the additional funding will help our country fight the most deadly and costly diseases.

The omnibus makes significant strides towards addressing the opioid crisis with nearly $3 billion in additional funding provided by the bill. Some of the funding is being diverted towards a new state opioid response grant being administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). There is also additional funding for addiction research at NIH and funding for the State Response to the Opioid Abuse Crisis Account created by the 21st Century Cures Act.

Finally, the appropriations bill includes language that states the Centers for Disease Control (CDC) has the authority to conduct research around gun violence. There remains a prohibition against the agency from conducting any advocacy on this issue, but Secretary Azar testified to the Appropriations Committee that CDC has the authority to do the research. The inclusion of this language could help pave the way for resuming research after a more than 20-year hiatus.

Secretary Azar has indicated his intention to name Robert Redfield as the Director of the CDC. Redfield is a professor of medicine at the University of Maryland School of medicine and is known for his extensive research experience with HIV/AIDS.

Finally, the Energy and Commerce Committee held a two-day hearing to examine more than two dozen pieces of legislation aimed at combating the opioid crisis by boosting public health and prevention efforts.  Full video of the hearing as well as texts and details of the legislation discussed are available on the committee website.

  • Analysis: Omnibus Bill Signals Policy Areas Congress Will Punt On – CQ Roll Call (Mar 23)
    “The omnibus does tackle some pressing issues for members like additional funding to help bolster the security of the U.S. electoral system — but provisions related to hot-button topics including health insurance and immigration were not included. And given the hyper-partisan political environment and upcoming midterms, legislation on those issues is not expected to advance in the coming months.”
  • Longtime AIDS researcher Robert Redfield picked to lead CDC – Washington Post (Mar 21)
    “The decision had been expected since Redfield emerged late last week as the front-runnerto become CDC director, a job for which he also was considered when George W. Bush was president. The position does not require Senate confirmation, and Redfield, a professor of medicine at the University of Maryland School of Medicine and a former Army researcher, is expected to be sworn in and take up his job in only a few days.”
  • Obamacare insurers just had their best year ever — despite Trump – Politico (Mar 17)
    “After three years of financial bloodletting under the law — and despite constant repeal threats and efforts by the Trump administration to dismantle it — many of the remaining insurers made money on individual health plans for the first time last year, according to a POLITICO analysis of financial filings for 29 regional Blue Cross Blue Shield plans, often the dominant player in their markets.”
  • FDA seeks data on role of flavors in tobacco addiction – Reuters (Mar 20)
    “The U.S. Food and Drug Administration on Tuesday asked for data, research and public comment on the role that flavors such as menthol play in tobacco addiction, the agency’s latest move to curb nicotine addiction in the country. The health regulator said it would seek more information about the pros and cons of flavors in drawing youth towards tobacco and getting adult smokers to quit or transition to potentially less harmful products.”
  • DOJ weighing ‘major litigation’ against opioid makers, Trump says – STAT (Mar 19)
    “President Trump spoke Monday of using federal prosecutors to pursue “major litigation” against drug manufacturers alleged to have played a role in creating a nationwide epidemic of opioid abuse. Speaking in New Hampshire at the White House’s rollout of a national opioids strategy, the president expanded upon a Department of Justice release last month in which Attorney General Jeff Sessions pledgedto “hold accountable those whose illegality has cost us billions of taxpayer dollars.””

March 16, 2018

The Chairmen and Ranking Members of the House and Senate Appropriations Committees are working to resolve the final issues in the omnibus appropriations bill so it can be voted on next week before the current continuing resolution expires on Saturday. The Labor-Health and Human Services bill’s riders on family planning remain one of the final issues to resolve. We are told that the Appropriations Committees are prepared to begin their read out of the bill this weekend in order to file it early next week.

Senators Alexander (R-TN) and Collins (R-ME) hope to add in their plan for stabilizing insurance markets by authorizing the cost-sharing reduction (CSR) payments and providing funding for reinsurance programs. It is not clear whether Senate leadership will allow this as an amendment to the omnibus appropriations bill or have it considered as a stand-alone measure in the Senate.

The House defeated a “right to try” bill that allows terminal patients to have access to treatments not yet approved by the Food and Drug Administration (FDA). The Senate passed Senator Johnson’s (R-WI) “right to try” bill last year. However, FDA Commissioner Gottlieb had expressed reservations over the bill as he thought it was too broadly written. The House bill was more narrow than the Senate bill. However, it still met spirited opposition from many Democratic members. The bill was considered under a fast-track procedure for considering legislation known as the suspension calendar. Bills on the suspension calendar needs to pass with two thirds of the members voting in favor of it. Republican leadership indicated they will bring the bill back up under normal procedures where only a simple majority is required for passage.

The drumbeat on changes to the 340B program continued this week with the Senate Health, Education, Labor, and Pensions (HELP) Committee holding a hearing on the program. Committee Chairman Alexander (R-TN) expressed a desire for more transparency in the program so that it is clear hospitals are using the discounts from the program for providing care to the poor. Senator Cassidy (R-LA) questioned whether hospitals were providing the charity care intended behind the program. Senator Cassidy has a bill (S.2312) to increase transparency and reporting requirements in the program.

  • Skepticism over benefits sinks Trump-backed drug bill in House – Politico (Mar 13)
    “House Republicans’ bid to lift the hopes of terminally ill patients failed in an unexpectedly tight vote Tuesday night. The House of Representatives failed to deliver the deciding vote for a right-to-try bill that President Donald Trump touted in his State of the Union address and would have given terminally ill patients — or those likely to die prematurely — access to experimental medicines without the FDA’s blessing. The Senate already passed its own version.”
  • Abortion fight holds up health deal – The Hill (Mar 14)
    “A contentious dispute over abortion is standing in the way of a rare bipartisan deal to stabilize ObamaCare. Republicans are insisting that a rule known as the Hyde Amendment, which restricts federal money from being used to fund abortion, be applied to new funds aimed at lowering ObamaCare premiums. Democrats are pushing back, arguing this would represent an expansion of the Hyde Amendment to a new area of funding, preventing the government from offering money to any insurance plan that offered abortion coverage at all.”
  • GOP support for Obamacare stabilization grows, but abortion policy still unresolved – Politico (Mar 15)
    “Congressional Republicans are growing more receptive to funding an Obamacare stabilization effort in the omnibus spending bill but remain divided over abortion restrictions. Some House Republicans who once opposed the idea of propping up Obamacare markets are coming around to the idea that they should act ahead of 2019, to avoid the risk of millions of Americans getting shocking premium increases in the fall, just before the midterm elections.”
  • Billions of Dollars on the Line as Insurers Await Obamacare Ruling – WSJ (Mar 15)
    “Health insurers and the Trump administration face a court decision shortly that will determine whether the government must pay insurers billions of dollars despite Republican efforts to block payments they view as an industry bailout. Insurers have filed roughly two-dozen lawsuits claiming the federal government reneged on promises it made to pay them under the Affordable Care Act. A decision could come at any time on pivotal litigation before a three-judge panel at the U.S. Court of Appeals for the Federal Circuit.”

March 9, 2018

The House and Senate Appropriations Committees are working hard to resolve the remaining differences on an omnibus appropriations bill.  As might be expected, some of the larger sticking points remain with the Labor/Health and Human Services/Education (Labor/HHS) bill.  Among the most objectionable riders is a provision that would go further than previous GOP efforts to defund Planned Parenthood and would cut all federal funding to the organization. Congressman Cole has also expressed strong reservations about a rider in the Senate reported bill that would not allow family planning funding from fiscal 2018 or earlier to be used to make regulation changes regarding division of grant funds.

There is also some disagreement over the additional funding for the opioid epidemic.  There are some pushing to grant states flexibility in their use of the additional funding while others want the funding directed to specific medication-assisted treatment programs and education programs.

Committee Chairs Blunt and Cole seemed optimistic the differences can be worked out as they were for fiscal year 2017, but the agreement has not yet been reached.  House Leadership was hoping to have the bill on the floor at the end of next week.

Elsewhere, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma announced an initiative to grant Medicare patients greater access to their health records at the Health Information and Management Systems Society (HIMSS) meeting in Las Vegas.  The initiative, known as “Blue Button 2.0” will allow seniors to access their claims data through secure apps or services.  Jared Kushner, who leads the White House Office of American Innovation, introduced Seema on the stage at the conference.

  • Trump administration warns Idaho against its rebel insurance plans – Washington Post (Mar 8)
    “The Trump administration issued a written warning to Idaho on Thursday that an audacious maneuver by the state to allow health plans that fall outside the Affordable Care Act’s insurance rules “may not be substantially enforcing” the law. The warning, in a letterto Idaho’s governor and insurance director by the administrator of the federal Centers for Medicare and Medicaid Services (CMS), does not immediately block the state’s unique decision to encourage insurers to sell health coverage lacking some benefits required by the law, such as maternity care or certain coverage of preexisting conditions. The letter is a strong signal, however, that the Department of Health and Human Services is unwilling to allow Idaho to move forward on its own.”
  • Planned Parenthood defunding threatens government spending package – Politico (Mar 7)
    “House Republicans are demanding a series of controversial abortion and health care policies in the annual health spending bill, setting up a showdown with Democrats and threatening passage of an omnibus spending package to keep the government open.”
  • White House pitch to bolster Obamacare includes tough trade-offs for Democrats – Politico (Mar 6)
    “The White House is seeking a package ofconservative policy concessions — some of which are certain to antagonize Democrats — in return for backing a legislative package bolstering Obamacare markets, according to a document obtained by POLITICO. The document indicates the administration will support congressional efforts to prop up the wobbly marketplaces, in exchange for significantly expanding short-term health plans and loosening other insurance regulations.”
  • Appeals court raises doubts on attempt to settle Obamacare litigation – Politico (Mar 5)
    “A federal appeals court is raising a potential hurdle to the settlement of a suit the House of Representatives brought against the Obama administration over billions of dollars in subsidies paid to insurers under Obamacare. The D.C. Circuit Court of Appeals issued an orderMonday questioning a deal the House, the Trump administration and liberal states announced last September to try to shut down the case.”
  • Arkansas wins federal permission to impose Medicaid work requirements – Washington Post (Mar 5)
    “Arkansas on Monday became the third state to win the Trump administration’s permission to compel tens of thousands of residents on Medicaid to work or prepare for a job. But the announcement in Little Rock demonstrated the polarizing politics that still swirl around the public insurance program for the poor in some conservative states.”

March 2, 2018

The White House convened a summit on the opioid epidemic this Thursday, where the President announced his administration will be rolling out big new policy initiatives in the next three weeks. The Justice Department also announced this week that it was engaging in a lawsuit filed in Ohio against manufacturers, distributors and dispenser of opioids. The House Ways and Means Committee released this week a request for information to key stakeholders on ways to prevent and treat opioid abuse in the Medicare program. In 2016, one third of the enrollees in the Medicare Part D program received a prescription for an opioid. House Energy and Commerce also held a hearing where they discussed several bills that would address the opioid epidemic.

Congress is getting closer to moving forward on an omnibus appropriations bill for fiscal year (FY) 2018. We are told many of the subcommittees have completed negotiations over their title of the omnibus. The only subcommittee that is having difficulty closing the gap is the Labor-Health and Human Services-Education (Labor-HHS) Subcommittee.

The disagreement is over how much savings can be used from making minor modifications in mandatory spending program to generate more dollars that can spent on discretionary programs in the bill. These changes, known as “Changes to Mandatory Programs or CHIMPS” have been used in previous years. However, conservatives in the House are pushing back over their use saying the savings the CHIMPS create are not true budget savings.

There is a lot of speculation over possible policy riders that might ride along with the omnibus appropriations bill. We are hearing that unless the provision is already in appropriations bill passed by the House or reported by the Senate committee, it will require broad bipartisan support to make it in the bill.

  • President Trump suggests executing drug dealers at summit on opioid crisis – Washington Post (Mar 1)
    “President Trump suggested that executing drug dealers could help solve the opioid crisis during a White House summit Thursday, an event the administration billed as a way to measure its progress in combating the nation’s drug problem. “Some countries have a very tough penalty, the ultimate penalty, and they have much less of a drug problem than we do,” Trump said. Trump also said that the administration will roll out unspecified “strong” policies on opioids over the next three weeks. He said he has spoken to Attorney General Jeff Sessions about “bringing a lawsuit against some of these opioid companies.””
  • 20 states sue over Obamacare mandate — again – Politico (Feb 26)
    “Twenty states have filed a lawsuit against the Trump administration over Obamacare’s individual mandate — again. Wisconsin, Texas and several other red states claim in the lawsuit filed today that since Congress repealed the individual mandate’s tax penalty for not having coverage, that means the mandate itself — and the whole health care law — is invalid.”
  • GOP eyes budget maneuver to pay for ObamaCare funds – The Hill (Mar 1)
    “Republicans are weighing whether to use a complicated budget maneuver to help pay for additional ObamaCare funding, sources say. The idea being considered by House Republican leaders is controversial because it would help fund key ObamaCare payments to insurers, something that many conservatives decry as a “bailout” of the law. Under the possible plan, the House Budget Committee would direct the Congressional Budget Office (CBO) to take ObamaCare payments to insurers known as cost-sharing reductions (CSRs) out of its “baseline” for projecting federal spending. Essentially, the agency would stop assuming that the ObamaCare payments would be made.
  • Medicaid Changes Require Tens of Millions in Upfront Costs – Roll Call (Feb 26)
    “The addition of work requirements and other sweeping changes to Kentucky’s Medicaid program could cost nearly $187 million in the first six months alone to get up and running. Republican Gov. Matt Bevin projects that the program will eventually yield savings but the changes require an upfront investment in administrative expenses. Much of that money is aimed at creating complex electronic systems and other changes needed to track work hours, monthly premium payments and other elements of Kentucky’s recently approved plan to revamp the government insurance program for low-income Americans.”
  • School Killings Spur Effort to Renew Government Gun-Violence Research – WSJ (Feb 28)
    “For more than 20 years, federal law has effectively halted the government’s ability to research gun violence. Now, the shooting that killed 17 at a Florida high school in February has prompted a bipartisan group of lawmakers to take another look at the restrictions. As lawmakers tangle over other gun-violence prevention measures, Democrats and some centrist Republicans are pushing to eliminate a provision tucked into spending bills that has restricted the Centers for Disease Control and Prevention’s ability to conduct research on the topic.”