POLITICO Pulse, presented by UnitedHealth Group: Tom Price's big test: Keep Obamacare afloat — CMS punts on key Obamacare payments — Trump goes big (again) on Obamacare repeal

By Adam Cancryn | 04/19/2017 10:00 AM EDT

President Donald Trump doubles down on his repeal rhetoric, insurers are still awaiting key Obamacare funding and new disclosures highlight two lawmakers who are raking in the health care cash.

But first: Tennessee is ground zero for the urgent challenge facing HHS Secretary Tom Price.

TOM PRICE'S BIG TEST: KEEP OBAMACARE AFLOAT - The Trump administration hired Tom Price to supervise its dismantling of Obamacare. Instead, Price is spending his first months in office trying to keep the law intact. The HHS secretary faces the unenviable task of ensuring Obamacare remains functional until Republicans find a way to repeal and replace it, a tightrope act that's becoming more difficult by the day, Pro's Jennifer Haberkorn and Rachana Pradhan report.

Nowhere is that more apparent than in the 16 counties surrounding Knoxville, Tenn., where people are facing the prospect of having no options on Obamacare's exchange. Tennessee insurers bogged down by financial losses and uncertain what the political future holds have fled the market. It's in large part up to Price to decide whether to go all out in hopes of luring a company back - or simply let the exchange fail.

That dilemma has generated plenty of finger pointing, but what it hasn't done yet is produce a solution. More from Jen and Rachana here.

CMS PUNTS ON KEY OBAMACARE PAYMENTS - Insurers headed to a meeting with CMS Administrator Seema Verma hoping to return with a big prize: A commitment that the White House will fund the Obamacare cost-sharing subsidies - worth $7 billion a year - due to insurers in the individual insurance market.

But they left empty-handed and still no closer to resolving the central issue creating uncertainty within the individual insurance market. Verma told the insurance execs that she didn't have any new information on the money, multiple sources told POLITICO, and stressed that the decision on the funding is out of her purview, even as she acknowledged how much difficulty the uncertainty creates for insurers.

In a statement afterward, AHIP emphasized how important the subsidies are to keeping the Obamacare exchanges viable. "We are committed to working with Administrator Verma, the Administration and Congress to ensure [cost-sharing reduction] funding is addressed quickly to provide clarity for consumers in 2017 and 2018," AHIP spokeswoman Kristine Grow said. More from Paul Demko and me here.

UnitedHealthcare pulling out of Virginia's exchange? PULSE has heard rumblings that the nation's largest health insurer - which participated in just three state exchanges this year, down from 34 exchanges in 2016 - may be on the verge of dropping out of Virginia too.

While United's dropout would be another symbolic blow to the ACA, it might have minimal practical impact, brokers tell PULSE; United stopped selling PPO plans in the state last year (but has continued to sell HMO plans) and nine other carriers participated in the Virginia exchange last year. The deadline for health insurers to submit forms to sell plans on the state's exchange is today, according to Virginia's Bureau of Insurance.

TRUMP GOES BIG (AGAIN) ON OBAMACARE REPEAL - If there's one person who isn't copping to any concerns about health care, it's Donald Trump himself. Trump vowed once again to get Obamacare repeal passed quickly, suggesting during a speech in Wisconsin that it's the first of several big legislative projects that the White House and Congress are prepared to speed through.

"We're also working with Congress on tax reform and simplification, and we're on time, if we get that health care approval, so press every one of your congressmen," the president said, telling supporters to encourage their lawmakers to push through repeal legislation.

Trump has expressed confidence in Republicans' ability to roll back Obamacare in the wake of the first failed attempt, even as factions within the GOP continue to disagree over fundamental parts of the House's repeal bill - a divide that's prompted Trump to threaten to support primary opponents against the Republican holdouts, as well as to strike a compromise with Democrats on a new health care law. More on Trump's speech here.

Tuesday Group co-chair finalizing repeal bill tweak. A tentative sign of progress is coming from the GOP's moderate corner, where Rep. Tom MacArthur (R-N.J.) is wrapping up an amendment to the House repeal bill he hopes will unite the conference. MacArthur - who has so far opposed the House's health care legislation - hasn't revealed any details about the change, POLITICO New Jersey's Katie Jennings reports. But he said he's been working with Vice President Mike Pence and Speaker Paul Ryan on a way forward. "I'm told it's possible if we get this done that we could potentially have a vote next week," MacArthur told reporters.

Happy Wednesday and welcome to PULSE, where if MacArthur's speculation turns out to be correct, we're less than a week away from the next huge Obamacare repeal showdown. Get your last-minute amendments, early whip counts and juicy tips in now: acancryn@politico.com and @adamcancryn on Twitter.

With help from Renuka Rayasam (@renurayasam), Victoria Colliver (@vcolliver), Sarah Karlin-Smith (@SarahKarlin) and Dan Diamond (@ddiamond)

EX-CMS CHIEF OF STAFF HEADS TO GLOVER PARK GROUP - Aryana Khalid, who was CMS chief of staff and a senior advisor during the Obama administration, will be managing director of the Glover Park Group's health and wellness practice. POLITICO previously reported she was joining the group in an unknown role. Khalid played a role in Obamacare's implementation under then-CMS chief Marilyn Tavenner before leaving the agency in 2015 to serve as executive vice president for AHIP. At Glover Park Group, she'll be providing political and legislative counsel on various issues within the health and wellness practice.

DOWN TO OSSOFF AND HANDEL IN GEORGIA'S SIXTH - Barring a late surprise, it's looking like Democratic upstart Jon Ossoff will face former Georgia secretary of state Karen Handel in a run-off for the House seat vacated by Tom Price. In addition to vying to take over for Price, both candidates have health care ties - and for reasons that have put each on the defensive.

Ossoff this week waved off concerns that he lives outside of the sixth district, contending that he moved out of the area temporarily to live with his girlfriend, who is a full-time medical student at Emory University. "And as soon as she concludes her medical training, I'll be 10 minutes back up the street into the district where I grew up, but I want to support her and her career and do right by her," he told CNN on Tuesday.

Handel, meanwhile, resigned her position as a top official for Susan G. Komen for the Cure in 2012 amid criticism over the organization's short-lived decision to cut off funding to Planned Parenthood. A Republican, Handel played a role in halting the grants, briefly vaulting her onto the national stage as the subject of heavy criticism from women's health supporters who saw Susan G. Komen as a largely nonpolitical organization.

** A message from UnitedHealth Group: On the front lines of health care, there are always new challenges and opportunities. At UnitedHealth Group, we're built for both. To all those with a passion to improve health care, our question is: How can we help? UnitedHealth Group. Built for Better Health. Learn more at www.unitedhealthgroup.com. **

GRASSLEY FLAGS CAREFIRST'S BRAND DRUG PENALTIES - Sen. Chuck Grassley is looking into whether CareFirst BlueCross BlueShield is penalizing patients who are prescribed a brand name drug when a cheaper generic alternative is available, Pro's Sarah Karlin-Smith reports. In a letter to the company, Grassley raised concerns that CareFirst is charging customers a "brand penalty" - the price difference between the brand drug and its generic - rather than a co-pay or coinsurance. That penalty doesn't count toward a customer's deductible, the Iowa senator's office said, and could also violate federal law. More from Sarah here.

Universal Health Services also under the microscope. Grassley is also looking into how a facility owned by psychiatric hospital chain Universal Health Services ranked as a "top performer" in the eyes of a Medicare accreditation organization, after a BuzzFeed investigation exposed a series of issues including medication errors and reports of sexual misconduct.

"The alleged conduct raised in the article is particularly troubling and raises serious questions about UHS's ability to properly care for its patients," he wrote in a letter to The Joint Commission.

WAYS & MEANS' TIBERI SWIMMING IN CAMPAIGN CASH - The year's first campaign finance reports are out, and within the House committees charged with repealing and replacing Obamacare, one name stands out: Rep. Pat Tiberi (R-Ohio). The nine-term congressman pulled in nearly $1.4 million in campaign contributions in the first three months of 2017, amid rumors that he could seek a Senate seat next year. That brings his war chest to $6.3 million in total cash on hand.

Among the big health care donors at $5,000 each this quarter: The respective PACs for Aetna, Anthem, Humana and Cigna and the PACs representing Blue Cross Blue Shield and AHIP. The American Hospital Association PAC donated $10,000.

Walden nets a big haul. The first quarter of a non-election year can be a slow one for fundraising, but apparently not when you head the committee supervising major health care legislation. Energy and Commerce Chairman Greg Walden (R-Ore.) received more than $789,000, including contributions from all across the health care spectrum. Cigna's PAC stood out, spending $7,500, while the American Osteopathic Association shelled out $6,000. And despite the Koch Brothers' vehement opposition to the House's repeal bill, Walden still took in $6,000 from the Koch PAC in March.

TEXAS CONSIDERING 'MANDATE-FREE' PLANS - The Texas House Insurance Committee heard testimony on a bill that would allow health insurers to offer coverage plans without any state mandated benefits such as certain cancer screenings or childhood immunizations. The bill's author, Rep. Larry Phillips, said that it would bring health insurance costs down and keep people from paying for coverage they don't need. Most of those who testified on the bill worried that getting rid of mandated coverage would lower quality of employer plans.

"The floor is very low of what companies can offer," said Pat Brewer at the Texas Department of Insurance at the hearing. "We do have a concern that if there are no mandates, then those [fully mandated] plans would never be available."

The bill wouldn't apply to individual or small employer plans, which are subject to federal Affordable Care Act standards, but it would apply to large group plans. Though the state lowered coverage requirements for employer health plans in 2005, it still required those "consumer choice" plans to cover certain services.

CALIFORNIA TAKES ON DRUG PRICES - The state's latest and most high-profile effort to rein in drug prices - a bill that would require pharmaceutical companies to give purchasers notice before significantly raising a drug's price - goes before the state Senate Health Committee today. It's the first hearing for Senate Bill 17, authored by state Sen. Ed Hernandez, and the bill has drawn both powerful support and opposition with backers including billionaire activist Tom Steyer and, on the opposing side, PhRMA.

CANCER DOCS RAISE CONCERNS ABOUT PAYER STRATEGIES TO ADDRESS DRUG COSTS - The American Society of Clinical Oncology is out with a detailed policy statement outlining its position on the variety of strategies used by health insurance companies to control drug costs. Those approaches are step therapy, specialty tiers in drug formularies, restrictive formularies and non-parity of patient cost sharing for oral cancer drugs.

For example, ASCO said step therapy, or "fail first policies," which require patients to try one drug before they can get insurance coverage of another product, are usually inappropriate in oncology "due to the individual nature of modern cancer treatment and the general lack of interchangeable clinical options," ASCO said.

The statement comes as health costs and drug prices are on the rise and policy makers and insurers are increasingly thinking of how to best utilize health resources, the cancer group said. ASCO said it understands the needs to contain spending, but that such strategies must protect patient access to the most appropriate treatment for their cancer.

WHAT WE'RE READING by Rachana Pradhan

Medicare Advantage plans are under the microscope again due to a new letter from Sen. Chuck Grassley, Kaiser Health News reports.

A Wisconsin physician argues that Obamacare is working well in his state. More from the Journal Sentinel.

A top Utah cancer researcher is out at the University of Utah's Huntsman Cancer Institute, the Salt Lake Tribune reports.

The New York Times explores the costs of not adhering to medication.

The Zetema Projected hosted a conversation on health care between Democrat Bob Kocher, MD, who advised President Barack Obama, and Republican Lanhee Chen, who advised Mitt Romney. Watch it here.

** A message from UnitedHealth Group: On the front lines of health care, there are always new challenges and opportunities. At UnitedHealth Group, we're built for both. We're helping employers with data and insights to improve health outcomes; ensuring seniors have stability and choice in their benefits; and working with governments to expand access to care, lower health care costs and improve quality. To all those with a passion to improve health care, our question is: How can we help? UnitedHealth Group. Built for Better Health. Learn more at www.unitedhealthgroup.com. **

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