By Adam Cancryn | 04/20/2017 10:00 AM EDT
State insurance regulators join the hand-wringing over Obamacare's subsidy funding, Tom Price takes action on opioids and Pfizer gets pulled into a federal investigation.
But first: House Republicans are signaling new plans to resuscitate their Obamacare repeal bill.
THE HOUSE REPEAL BILL ISN'T DEAD YET - Stop us if you've heard this one before: Republicans are racing to put the finishing touches on legislation dismantling large parts of Obamacare in hopes of getting it to the House floor for a vote shortly after lawmakers return to Washington. That's according to Speaker Paul Ryan, who told an audience in London that the GOP is on the verge of a deal on Obamacare repeal.
"We're in the midst of negotiating finishing touches, because our members want to make sure that we lower premiums," he said during a speech at the U.K. think tank, Policy Exchange. "It's difficult to do. We're very close."
Ryan didn't put a timeline on the effort, but claimed again that Obamacare is "collapsing" and that Republicans are under the gun to solve the nation's health care "crisis."
GOP leadership is also hitting up against some more concrete deadlines: Congress will have just four days after it returns to strike a deal to keep the government open. And April 29 marks President Donald Trump's 100th day in office - a milestone that risks passing without clear progress on repealing Obamacare. See Ryan's full speech here; the health care portion starts around the 20-minute mark.
All eyes on MacArthur's big idea. House Republicans left Washington nearly two weeks ago deeply divided over the repeal bill - and despite the confident talk, there's little sign they've made any major progress since then. But Rep. Tom MacArthur (R-N.J.) is trying to offer a glimmer of hope, after spending the recess working on an amendment he's suggested could reunite the party. The proposal - developed in consultation with GOP leaders and the White House - is aimed at bridging the gap between the party's more moderate wing and its hardline conservatives. But it remains unclear whether any tweaks around the edges can convince either side to overlook their more fundamental misgivings about the bill.
STATE REGULATORS JOIN CALL FOR OBAMACARE SUBSIDY FUNDING - Congressional Republicans are juggling their repeal talk alongside another pressing health care issue - whether to earmark money for Obamacare's cost-sharing subsidies in the continuing resolution for 2017, as well as for 2018. State insurance regulators are the latest group to push for the appropriation, warning House and Senate leaders in a letter that the billions in funding are "critical to the viability and stability of the individual health insurance markets." Without it, the National Association of Insurance Commissioners predicts insurers will seek double-digit premium increases in 2018, Pro's Rachana Pradhan reports. More from Rachana here.
Whither the White House? The Trump administration is sending mixed signals on whether it'll fund the subsidies, and if it does, for how long. Attorney General Jeff Sessions told FOX News on Wednesday that the "legal process will continue" when asked whether the White House plans to keep appealing the court verdict striking down the current subsidy funding.
But in private, the administration's health officials are telling stakeholders that - at least for now - the funding is a congressional issue and not up to them, sources familiar with the matter tell PULSE.
PRICE URGES NEW APPROACHES IN OPIOID BATTLE - HHS Secretary Tom Price is pushing for a broader review of the agency's approach to opioids, and urging doctors to rethink how they manage patients' pain, Pro's Sarah Karlin-Smith reports. Price, in a speech at the National Rx Drug Abuse and Heroin Summit, announced $485 million in new HHS funding for prevention and treatment grants targeted at opioid addiction - money made available through the 21st Century Cures Act. He also faulted pain management concerns for fueling the opioid crisis, arguing that doctors are over-prescribing for fear of leaving patients unsatisfied with their treatment. More from Sarah here.
RISK CORRIDOR LAWSUIT TOSSED - A judge has dismissed Blue Cross and Blue Shield of North Carolina's lawsuit seeking $140 million from the federal government in unpaid risk corridor claims from 2014. The reason: the case isn't ripe for consideration until the program has ended. Insurers have filed around two dozen cases seeking to recover unpaid risk corridor funds, which total more than $8 billion for 2014 and 2015.
Judges have split on the merits of the cases. Moda Health prevailed in February, with a judge ordering the federal government to pay the company $214 million. But Land of Lincoln Health's case was dismissed last year. That split means an appellate court is likely to ultimately determine whether the claims have merit. ACA legal expert Timothy Jost shares some thoughts on the latest legal development at Health Affairs.
Good Thursday morning and thanks for reading PULSE, where this marks the end of my brief joyride behind the wheel of Pulse. Be sure to send tips to Brianna Ehley at email@example.com.
With help from Paul Demko (@pauldemko), Sarah Karlin-Smith (@SarahKarlin), Vicky Colliver (@vcolliver) and Renuka Rayasam (@RenuRayasam)
NEW IN TOWN: HOME-BASED HEALTH CARE GROUP FORMS - A new trade group representing home-based health care agencies is setting up shop under the umbrella of the Visiting Nurses Association of America. The group, called ElevatingHOME, will work on behalf of more than 12,000 home health agencies and 4,000 hospice organizations. Joseph Scopelliti, who heads VNA Health System of Shamokin, Pennsylvania, will chair the association's board. And the Council of State Home Care Associations has signed on as a founding member.
** 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 to help with 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. **
ON THE CALENDAR
Humana faces its shareholders. The health insurer's annual shareholders meeting is this morning, where it'll lay out its strategy for the year and likely field questions from investors about its decision to exit the Obamacare markets entirely in 2018. Humana currently sells plans on individual insurance exchanges in 11 states, but is pulling out next year over concerns about the market's stability - a move Republicans have seized on as evidence Obamacare is failing.
First-quarter numbers on health lobbying in the Trump era. It's deadline day for congressional lobbying disclosures, which offera first peek at how much health care groups spent amid the push to repeal Obamacare. Most companies and trades haven't filed their reports yet. But if the early submissions are any indication, some big money was spent in the year's first few months.
- Federation of American Hospitals: The investor-owned hospital trade group spent $1.18 million in the first quarter, up from $690,000 in the same period last year.
- America's Essential Hospitals: The safety net hospital group spent $300,000, compared with $250,000 last year.
- Blue Cross and Blue Shield of Florida racked up $360,000, more than double its first-quarter tally in 2016.
EYE ON PHARMA
DOJ subpoenas Pfizer amid concern over saline shortage and rising prices. Pfizer is the third drug company to receive a grand jury subpoena from the Justice Department in connection with an antitrust investigation focused on drugmakers that market IV saline, according to Reuters. In 2015, a bipartisan group of U.S. senators raised concerns that since a saline shortage began two years prior, the prices of the drugs had risen 200 to 300 percent.
Baxter and Hospira, which was recently acquired by Pfizer, are the subject of an antitrust class-action lawsuit accusing the companies of intentionally creating the shortage so they could jack up prices. Baxter disclosed it received a subpoena Friday. Sen. Amy Klobuchar (D-Minn.), one of the lawmakers who originally raised concerns about the issue, praised the Justice Department for moving forward on the investigation.
Want to protest drug prices? There's an app for that. Doctors Without Borders is releasing a tool later this morning that will let people easily search their mutual fund holdings to see if they include investments in Pfizer and GlaxoSmithKline. If they choose, they can then use their investor status to put pressure on the companies over drug pricing, including via Twitter. The application is aligned with a campaign calling for the two companies to reduce the price their pneumonia vaccines.
Drug company tries to downplay price of new drug. When biotech firm Tesaro announced the cost of its recently approved ovarian cancer drug, it said the price tag was $9,833 for a one-month supply at a dose of 200 mg per day. But here's the catch: The approved starting dose for the drug is actually 300 mg per day, meaning its starting list price is $14,749.50 a month - or close to $177,000 a year. That makes it unlikely people will start with the lower dose of 200 mg per day, which is what was studied in the drug's late-stage trials, but not the dose approved by FDA. According to The Street, the price announced by the company also makes the drug look cheaper than its competitor, when in fact, it's more expensive.
Spotted: Stephen Ubl at the Pats' White House ceremony. The PhRMA CEO snagged an invite to the New England Patriots' White House visit, tweeting a photo of him and his son at the event.
HEALTH CARE EXECS BRACE FOR IMPACT - Health care executives and industry officials are skeptical the Trump administration will make much positive progress on the nation's health care system, according to a survey conducted by NEJM Catalyst, the online publication from the New England Journal of Medicine. Nearly three-quarters of those surveyed said patients will be negatively impacted by changes to the health care landscape under Trump, with roughly the same percentage predicting more people would go uninsured. The majority of respondents also believe premiums could rise or benefits could become skimpier as a result of any changes. See the full survey here.
TEXAS STATE SENATE PREPS FOR OBAMACARE REPEAL - The Texas Senate passed a bill that would create a committee to examine how the state should respond if Republicans succeed in repealing Obamacare, Pro's Renuka Rayasam reports. The measure cleared on the same day that the state Senate passed a one-sentence resolution encouraging Congress to roll back the health law. The resolution passed without debate, in a sign of the deep opposition to Obamacare within the Texas legislature. The study committee would need to submit a report to state lawmakers by December 2018 detailing how Texas should adapt to any changes made to Obamacare. More from Renu here.
CALIFORNIA ADVANCES DRUG TRANSPARENCY MEASURE - A state bill aimed at reining in prescription drug prices made it through its first major hurdle, passing the state Senate Health Committee on a 7-2 vote. The legislation would require companies to give notice before significantly raising medication prices, and calls on health plans to reveal how much of their premiums they spend on drugs.
"Patients who need access to a particular drug don't have the option to forgo treatment or find another option when the price gets too high," Sen. Ed Hernandez said in a statement after the vote. "They are forced to choose between paying for their prescriptions or paying their mortgage - and the public has had enough."
SOUTHERN POVERTY LAW CENTER PROBES HOSPITALS' FINANCIAL AID POLICIES - The civil rights organization is targeting six hospitals with allegations that they're failing to ensure that patients have access to financial assistance options. The Southern Poverty Law Center sent letters outlining the accusations to three facilities in Louisiana and three in Mississippi, citing evidence that the hospitals are violating federal regulations by not clearly posting their financial assistance policies. The SPLC is giving them three weeks to respond before filing formal complaints with the IRS. See the full details here.
DRY SPELL FOR HEALTH CARE MEGA DEALS - Health care companies largely shied away from big mergers and acquisitions in the first few months of the year, with insurers in particular opting to stand pat, new date from PricewaterhouseCoopers show. The firm's deal tracker counted just two transactions valued at more than $1 billion - and even those came with a cheaper price tag than in prior months. And in the pharmaceuticals sector, PwC said the scrutiny on drug pricing is chilling the appetite for deals. See the full health services breakdown here, and the pharmaceuticals report here.
ANTITRUST EXPERT: GOOD RIDDANCE TO ALL THAT DEALMAKING - Harvard Business School Professor and health care antitrust specialist Leemore Dafny is out with an unsparing post-mortem of the insurance deal frenzy that culminated with the DOJ's rulings against both the Aetna-Humana and Anthem-Cigna mergers. Dafny - who has long opposed big mergers - portrays the failed deals as a rejection of the core arguments health care companies typically rely on to justify massive tie-ups - and a repudiation of the insurers' tactics in building their cases.
"The judges in both cases not only rejected the insurers' arguments, they also admonished them for bad behavior," she wrote. If there is any silver lining, it's that other insurers will consider these precedents and devote more energy to growing by offering superior value, rather than by swallowing rivals." Read the full article here.
WHAT WE'RE READING
Theranos investors allege that the blood-testing company threatened to file for bankruptcy protection if they refused to give up their right to sue, Bloomberg reports.
Donald Trump vowed to take care of coal miners - and now 20,000 retired miners at risk of losing their government-funded health care are hoping he makes good on that promise, the New York Times reports.
A new study published in Health Affairs links medical marijuana laws to a drop in prescription drugs for Medicaid enrollees.
CNN's Sanjay Gupta interviews Tom Price on Obamacare repeal, and comes away with just as many questions as answers.
BuzzFeed examines the two distinct epidemics that are combining to make up the current opioid crisis.
** 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 to help with both. We're providing 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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