By Dan Diamond | 05/17/2017 10:00 AM EDT
WITH WASHINGTON FOCUSED ON RUSSIA FALLOUT, WHAT HAPPENS TO HEALTH CARE? - Republican leaders are vowing that the growing swirl of questions around President Donald Trump's reported leak to Russia and firing of FBI director James Comey won't distract them.
"We could do with a little less drama from the White House, on a lot of things, so we can focus on our agenda," Senate Majority Leader Mitch McConnell told Bloomberg News earlier on Tuesday, adding that his chamber has been aggressively moving forward on health care. "We're in intense meetings in the Senate... three days a week."
Republicans drawn into the Russia-related investigation agreed that the party's agenda needs to come first, or at least move forward in parallel.
"We better be able to walk and chew gum at the same time," House Oversight Committee Chairman Jason Chaffetz, who is stepping up his investigation into Trump-Comey communications, told NBC News. "The government is always full of crisis ... but we have to still be able to pass meaningful legislation and get it to the president's desk."
Bipartisan talks are picking up steam, too. The talks to repair Obamacare are gaining traction among a group of Senate moderates, threatening to disrupt strategies from both parties' leaders to keep members in line, POLITICO's Jennifer Haberkorn and Elana Schor report.
At least three moderate Democrats held an initial sit-down with half a dozen Republicans late Monday evening - the most tangible sign yet of centrists' interest in finding common ground.
... The prospect of a bipartisan fix could chip away at GOP support for Majority Leader Mitch McConnell's plan to repeal Obamacare and endanger Minority Leader Chuck Schumer's vow to maintain Democratic unity in opposition. But senators in both parties said their leaders knew about the meeting and made no moves to stop it. Keep reading: More for Pros.
KAISER: 6.3 MILLION PEOPLE WITH PRE-EX CONDITIONS AT RISK UNDER GOP BILL - That's according to a new analysis from the Kaiser Family Foundation that warns these individuals could pay significantly higher premiums if the House's version of health care reform takes effect.
- How they got to 6.3 million people. According to researchers, 27 million Americans experienced a multi-month coverage gap in 2015, and of that population, about 23 percent had pre-existing conditions. Under the American Health Care Act, these individuals could face significant premium hikes if their state obtains a waiver that allows insurers to vary premiums by health status.
- But there's considerable uncertainty around the estimate. The analysis acknowledges that there are multiple variables - chiefly, whether state leaders decide to roll back what some Republicans have said is excessive regulation under the Affordable Care Act, or if insurers pressure them to pursue waivers in hopes of stabilizing the market.
"What states decide to do may ultimately have the greatest effect on how many people with pre-existing conditions face potentially unaffordable insurance premiums," the Kaiser researchers conclude. See the analysis.
HHS RELEASES CHECKLIST TO HELP STATES GET ACA WAIVERS - It's the latest effort by the administration to potentially weaken the law that, only months ago, HHS was aggressively promoting under the last president.
The ACA's so-called innovation waivers allow states to get permission from HHS to set up high-risk pools or set up reinsurance programs. The Obama administration had resisted waiver requests that officials saw as undercutting the law's often-expensive insurance market protections, but the Trump administration has openly welcomed those efforts. The new checklist is intended to expedite those state requests.
The checklist will help states "provide Americans relief from the damage Obamacare continues to inflict on health insurance markets," HHS Secretary Tom Price said. See the checklist.
REPORTER ARRESTED FOR SHOUTING AT TOM PRICE OFFERS HIS PERSPECTIVE - Dan Heyman, a West Virginia-based reporter for Public News Service who was jailed last week after repeatedly yelling questions at the visiting HHS secretary, said he was just trying to get answers. Local police said that Heyman was posing a physical risk, and Price said that police "did what they felt was appropriate."
Heyman was trying to pin down whether Republicans' proposed health reforms would hurt women who had been the victims of domestic violence. "As soon as this furor dies down, I hope to finish the story," Heyman writes in the Washington Post. "But I wasn't calling out to Price to score points - I was looking for answers about how the policy he was promoting would affect people in West Virginia and across the nation." More.
THIS IS WEDNESDAY PULSE - Where we're mulling this article from FORBES' Alice Walton on the brain scans of only children. On the positive side, kids without siblings tend to be more creative - but they're also less agreeable, seemingly because they get so much attention when growing up.
Your author is one of several siblings, so he's always feeling agreeable, but especially when tips come his way. Send them to firstname.lastname@example.org or @ddiamond on Twitter.
With help from Adam Cancryn (@adamcancryn), Paul Demko (@PaulDemko), Brett Norman (@BrettNorman), Victoria Colliver (@vcolliver) and Sarah Karlin-Smith (@SarahKarlin).
** A message from PhRMA: Patients share the cost of medicines. They should share the savings. Medicine costs increased just 3.8% in 2016 thanks to significant rebates and discounts negotiated between biopharmaceutical companies and insurers. So why are patients' out-of-pocket costs continuing to go way up? Find out at http://onphr.ma/2qekIyT. **
ON TAP TODAY - The House Appropriations Committee holds a 10 a.m. hearing on funding for the NIH, which the White House has proposed to cut by nearly $6 billion next year. NIH director Francis Collins and five other key officials like Tony Fauci and Nora Volkow are slated to testify.
The House Energy and Commerce Committee's Health Subcommittee holds an 10:15 a.m. hearing on legislation intended to advance public health.
EYE ON THE HUMPHREY BUILDING
Price pushes Congress to follow Trump plan for more FDA user fees. The HHS secretary is urging Senate leaders to make the FDA rely more on industry fees - and less on taxpayer dollars - for product evaluations, as lawmakers continue work on extending the agency's user fee programs, Pro's Sarah Karlin-Smith reports.
The request could threaten deals the agency already struck with name-brand, generic and biosimilar manufacturers, as well as device makers, by forcing the industries to ante up more than they had committed. But the request didn't sit well with both Republicans and Democrats.
Keep reading: More for Pros.
... Sen. Lamar Alexander's response to Price: 'Interesting proposal,' but not for this year. The Senate HELP Committee chairman tells PULSE that the request "can be considered the next time the FDA negotiates the user fee agreements with the manufacturers of drugs and devices, but it is way too late to have an impact on this year's agreements." Alexander added that his committee already approved those agreements - which were years in the making - and the House is expected to do the same within the coming weeks.
... One more reason why Price's proposal is too late. "The Congress needs to act and send the legislation to the president before the end of July or by law 5,000 FDA employees will receive notices they may lose their jobs in 60 days, cancer trials will be interrupted, and vital research will grind to a halt," Alexander said.
Groups urge Price to protect NIH research center. The Infectious Diseases Society of America and 27 other medical and research advocacy organizations wrote to the HHS secretary, asking him to protect NIH's Fogarty International Center, which would be eliminated under the proposed budget. The center focuses on global health research and emergency preparedness.
"The human capital created through Fogarty serves as a diplomatic resource for America, and the program's elimination would come at a cost to our nation's global standing," the organizations warned Price. Read the letter.
Sarah Lloyd Stevenson joins HHS as adviser to Price. Stevenson was with Sen. Roger Wicker's office for seven years, serving as his senior policy adviser on health care and global health and focusing on issues like Alzheimer's. She will be a policy adviser to Price.
Chris Collins faces ethics inquiry over biotech investments. The New York Republican is under scrutiny by ethics investigators for his role in soliciting investors for an Australian biotech company, the Buffalo News first reported.
The Office of Congressional Ethics is reportedly speaking to Buffalo-area investors in the company, Innate Immunotherapeutics, over Collins' role in finding investors. Several GOP lawmakers - including Secretary Price - bought shares in Innate Immunotherapeutics. Price made more than $225,000 on his purchase, more than tripling his initial stake, which became an issue during his confirmation hearings. More.
EYE ON INSURERS
U.S. joins second whistleblower suit against UnitedHealthcare. For the second time this year, the Justice Department is joining a suit that centers on whether United overbilled Medicare. More.
Surviving co-ops off to positive financial start. At least four of the remaining Obamacare co-ops operated in the black during the first quarter of this year.
- Maine's Community Health Options had the flushest balance sheet among the nonprofit startups, with revenues exceeding costs by $3.7 million
- Wisconsin's Common Ground Healthcare Cooperative reported $2.7 million in profits for the quarter.
- Meanwhile, revenues exceeded costs by less than $1 million for New Mexico Health Connections and Massachusetts' Minuteman Health.
While the positive balance sheets are good news for the surviving co-ops, it doesn't mean they won't see their financial prospects crater in the coming months, Pro's Paul Demko reports. Last year, New Mexico Health Connections turned a modest profit in the first quarter - but ended up losing $17.9 million for the entire year.
First quarter financial filings for the two other remaining nonprofit startups - Maryland's Evergreen Health and Montana Health Co-Op - had not yet been posted. Just six of the original 23 co-ops seeded with Obamacare loan dollars remain in business.
EYE ON HOSPITALS
Moody's: Hospital margins generally positive. The industry's excess margin in 2016 was 5.7 percent, a slight decline from 6.1 percent in 2015, according to a preliminary report from the ratings agency.
Margins and liquidity "remain in-line with historical levels while demand trends remain generally positive," the agency said.
... but pharma, labor costs weigh down performance. The industry's expenses grew 7.5 percent last year, overtaking a 6.6 percent increase in revenues - a trend that's likely to become the norm, Pro's Adam Cancryn points out. And while hospitals are still profitable as a whole, Moody's predicts their margins will come under more pressure in the coming years as providers spend more on salaries, pensions and for pharmaceuticals. Read the report.
EYE ON PHARMA
Group releases recs for lowering drug prices. The Council for Affordable Health Coverage is releasing a report this morning calling for industry-friendly regulatory reforms and market-based measures to bring down the costs of prescription drugs, Pro's Brett Norman reports.
Among the recommendations are many familiar ideas, including:
1) Faster reviews of applications at FDA, including a new priority review voucher for generic drugs that would address shortages or price spikes
2) Eliminating obstacles to insurers paying drug makers based on how much their products benefit patients, such as some anti-kickback provisions
3) Standardizing and improving data collection including electronic health records and medical claims needed for value-based purchasing arrangements
4) Giving consumers better information about costs and alternative options
The report also calls for rejecting policies that would undermine the market, including, according to CAHC, importation of drugs, price or benefit caps and interfering with private negotiations between drug makers and purchasers. Read the report.
AROUND THE NATION
Montana: Democratic challenger pivots to health care in search of House upset. Rob Quist, who's running for the open seat left by Interior Secretary Ryan Zinke, is pivoting hard to health care, POLITICO's Elena Schneider reports from Montana.
Health care "has taken over as the number one issue" for voters in the special election, Quist said at a rally as supporters waved handmade signs that said: "Save the ACA." Quist was attacking Republican Greg Gianforte's taped statement that he was "thankful" for the House GOP health care bill that passed earlier this month. His win would make for an unlikely red-state upset, Scott notes.
Keep reading: More for Pros.
Texas: Request for family planning funds could set trend. The state's pending request for Medicaid to fund a women's health program that excludes abortion providers will be the first major test of the Trump administration's willingness to let states cut off dollars to Planned Parenthood, POLITICO's Renuka Rayasam reports from Austin.
If the Texas request is approved, other conservative states could seek federal funds with similar restrictions on abortion providers. "This could have ramifications nationally," said Yvonne Gutierrez, executive director of Planned Parenthood Texas Votes.
Keep reading: More for Pros.
California: Healthy pension fund increases. Preliminary rates for health plans in the California Public Employees' Retirement System, known as CalPERS, will go up a weighted average of 3.24 percent next year, POLITICO's Victoria Colliver reports from California.
While board members were pleased by the relatively low increase - rates have gone up an average of 7.4 percent over the past three years - they expressed frustration at Tuesday's board meeting that some insurers had not provided enough information to justify their proposed increases.
... CalPERS has aggressively tried to control costs through such tactics as shifting care to lower-cost centers, expanding reference pricing and piloting different ways to reduce pharmacy costs. CalPERS' staff projected various benefit design changes have saved the program $5.4 million so far. Rates will be finalized in June.
- One reason why CalPERS is such a bellwether. It's the second largest public purchaser of health benefits behind the federal government, administering benefits for 1.4 million members and their families.
WHAT WE'RE READING by Rachana Pradhan
A Washington, D.C., hospital is facing allegations that a female patient was dumped from her wheelchair onto the street. More.
CNN looks at why hospitals are so vulnerable to ransomware attacks. More.
The state of Oregon may have dispensed millions of dollars in Medicaid assistance to ineligible recipients. More.
Louisiana Sen. John Neely Kennedy said he'd be introducing legislation to add work requirements to the Medicaid program. More.
Amazon is hiring staff, signaling that it's intending to break into the pharmacy market, CNBC's Christina Farr reports. More.
Wyoming has just one Planned Parenthood clinic - and it will close this summer for financial reasons, the Casper Star-Tribune reports. More.
** A message from PhRMA: You don't always pay full price for doctor or hospital visits. So why is paying for medicines any different? Unlike for care received from a network hospital or physician's office, insurers charge the full list price of a medicine when patients have a deductible, even if the insurer receives a steep discount. Insurance companies should #sharethesavings with patients. Learn more at http://onphr.ma/2qekIyT. **
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