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Mulvaney opens fire on the CBO: In an interview with the Washington Examiner from his office at the Old Executive Office Building, Mick Mulvaney, the White House budget director, went guns blazing after the Congressional Budget Office. "At some point, you've got to ask yourself, has the day of the CBO come and gone?" Mulvaney said. "How much power do we give to the CBO under the 1974 Budget Act? We're hearing now that the person in charge of the Affordable Health Care Act methodology is an alum of the Hillarycare program in the 1990s who was brought in by Democrats to score the ACA." The later was a reference to Holly Harvey, who has been the head of the CBO's health analysis division since 2009 and had served during the Clinton administration as a senior analyst in the office of the assistant secretary for planning and evaluation at the Department of Health and Human Services. Mulvaney’s issue was not so much that the CBO exists, but that it is granted so much power over determinations regarding the use of budget reconciliation and “pay as you go” rules. He was particularly critical of the way the CBO assumed the individual mandate was so influential in getting individuals to sign up for coverage as part of its estimate that 23 million fewer Americans would obtain insurance if the House-passed healthcare bill became law. "You recognize of course that they assume that people voluntarily get off of Medicaid? That's just not defensible. It's almost as if they went into it and said, ‘OK, we need this score to look bad. How do we do it?'"

Is the CBO broken? There’s no reason to accuse the CBO of partisan bias, as Mulvaney does, to raise questions about its limitations. (Note: Secretary of Health and Human Services Tom Price had tapped CBO director Keith Hall when Price was chairman of the House Budget Committee, and even issued a press release touting his appointment.) Even assuming CBO analysts have the utmost integrity and are working hard to come up with the best estimates possible, their analysis inevitably involves some degree of guesswork, and the more variables that are introduced by a given piece of legislation, the more difficult it is to come up with a reliable estimate. Bloomberg’s Megan McArdle wrote last week that “Republicans have broken the CBO.” Her point was that the final House healthcare bill exposed the weaknesses of the CBO model. It wasn’t in a position to predict, for instance, how the political environments in 50 different states would affect whether, or to what extent, they decided to take advantage of the bill’s waivers from Obamacare regulations. Also, the CBO always aims to release specific estimates rather than ranges, but there is also a wide degree of variability in estimates. Providing a specific estimate became impossible to do when it came to estimating premiums in states that waive Obamacare regulations, due to the wide variation of costs for healthy and sicker individuals.

The difficulty of predicting which states would apply for waivers and then estimating premiums made it more difficult to make projections about how much the bill would spend and how many people it would cover. The CBO ended up predicting that states representing half of the population would not request waivers; one-third would request some waivers; and one-sixth would request all of the available waivers. The CBO itself acknowledged, “In the current analysis, estimates of states’ responses to the legislation are more uncertain than in the agencies’ previous cost estimates. In addition to the challenge of estimating the fraction of the population living in states for which the different waivers would be approved, predicting the overall effects of the myriad ways that states could implement those waivers is especially difficult.”

Welcome to Philip Klein’s Daily on Healthcare, compiled by Washington Examiner Managing Editor Philip Klein (@philipaklein), Senior Healthcare Writer Kimberly Leonard (@LeonardKL) and Healthcare Reporter Robert King (@rking_19).  Email for tips, suggestions, calendar items and anything else. If a friend sent this to you and you’d like to sign up, click here. If signing up doesn’t work, shoot us an email and we’ll add you to our list.

Senate Majority Whip John Cornyn says Obamacare repeal will happen by July “at the latest.” "It's May 31 and we're not running out of time," the Texas Republican said on a local radio show. "We do need to take care of our business. You mention healthcare and that's certainly front and center in the United States Senate, something that we will have to get resolved here in the next few weeks and I expect that we will." When asked how difficult it would be to get the 50 votes in the Senate needed to pass a bill under reconciliation, assuming a tie-breaking vote by Vice President Mike Pence, Cornyn replied: "We need to come up with a consensus bill. One thing I'm sure of: It won't be perfect, but if it's better than Obamacare I think we will have fulfilled our promise that we made election after election to repeal Obamacare."

Democratic congresswomen urge Trump administration to rethink plans for Obamacare's contraception mandate: The leaked draft proposal would allow any employer to opt out the obligation to cover all forms of contraception approved by the Food and Drug Administration. “Contraception is healthcare that is essential to many but not affordable to all," they said in an emailed statement. "That is why the Affordable Care Act’s contraception mandate matters so much – it makes access a reality. ... Affordable access to contraception is part of why unintended pregnancy and abortion rates are at an historic low. But with this interim final rule, President Trump is threatening to roll back all of that progress by giving any employer veto power over a woman’s healthcare decisions. And let’s be clear: this is an attack on women’s health. This rule would subject a woman’s choice and the opinion of her doctor to the whims and judgments of her employer."

Medical device industry met with Commerce Secretary Wilbur Ross and HHS Secretary Tom Price. Topics discussed Wednesday included repeal of Obamacare’s medical device tax and regulatory policies. “The medical technology industry is poised for some seismic advances and growth in the coming years, resulting in lasting change both for patients specifically as well as the healthcare ecosystem more broadly,” Scott Whitaker, AvaMed CEO, said in an emailed statement. “Our message to Secretaries Price and Ross today was simple: We can be a force multiplier for innovation, job growth and value. And we stand ready to work with this administration and its team to remove barriers and foster a climate for these life-changing technologies.”

David Shulkin: Veterans Affairs 'interested in looking at' medical marijuana use. VA officials will review research on whether medical marijuana could provide health benefits to veterans undergoing treatment at the VA. "There may be some evidence that this is beginning to be helpful, and we’re interested in looking at that," Shulkin said of medical marijuana. The VA secretary pointed out that federal law currently prohibits doctors at the department's facilities from prescribing medical marijuana for any condition.

Administration outlines strategy on opioid addiction in the New England Journal of Medicine. Dr. Nora Volkow, director of the National Institute on Drug Abuse, and Dr. Francis Collins, director of the National Institutes of Health, wrote in NEJM about the federal government’s planned partnerships with the private sector to find new medications to treat opioid addiction, to reverse an overdose and enter patients into treatment, and to find better approaches to managing chronic pain.  

Anti-abortion groups ask Justice to investigate Planned Parenthood. The groups, which include March for Life and Susan B. Anthony List, are echoing charges made by the Center for Medical Progress, an anti-abortion organization that secretly taped videos that purported to show Planned Parenthood staff discussing the sale of fetal tissue, which is illegal. The videos, which were released in July 2015, launched congressional hearings, a House select panel and various state investigations."The previous administration decided to turn a blind eye to the wrongdoing, which led to the creation of the select panel," the groups wrote in a letter to Attorney General Jeff Sessions and FBI Acting Director Andrew McCabe. "We request that the Justice Department continue the investigation into the practices surrounding this scandal."

Ohio’s attorney general sues drugmakers over prescription painkillers. The lawsuit accuses five companies of marketing prescription painkillers to patients who didn't need them and of committing fraud by downplaying their highly addictive effects. “Defendants broke the simple rules [of drug marketing] and helped unleash a healthcare crisis that has had far-reaching financial, social and deadly consequences in the state of Ohio,” the lawsuit said. It was filed against Endo, Johnson & Johnson's Janssen, Teva and Allergan, as well as Purdue Pharma, the maker of OxyContin.

Mylan fleeced taxpayers $1.27 billion for EpiPen, says Sen. Chuck Grassley, R-Iowa. Taxpayers overpaid for the allergy drug EpiPen over a decade, far more than the $465 million the drug's manufacturer previously reported, according to a letter Grassley received from the Department of Health and Human Services’ inspector general’s office. Grassley said Medicaid gave EpiPen maker Mylan too much money from 2006 to 2016 because Mylan misclassified the allergy antidote. The Obama administration also failed to adequately fix the issue, he added. 


Associated Press Painful words: How a 1980 letter fueled the opioid epidemic
Sun Sentinel
New Florida law provides certificates for miscarriages
The Des Moines Register
Iowa teen’s $1 million-per-month illness is no longer a secret
Dirty, dingy hospitals: Doctors blame debt-fueled takeover boom
Modern HealthCare
For the first time, less than half of physicians are independent
The two healthcare narratives in Mark Meadows' North Carolina district
Tom Price bought drug stocks. Then he pushed pharma’s agenda in Australia.
USA Today
Is chronic sleep deprivation impairing President Trump’s brain, performance?
New Hampshire Public Radio
With Republicans now in charge, N.H. will likely get fetal homicide law



June 2-6. Baltimore Convention Center. American Society of Echocardiography will host its 28th Annual Scientific Sessions. Program.

8 a.m. Georgetown University Law Center. 600 New Jersey Ave. NW. Discussion on health privacy. Details.

9:45 a.m. EST. Adair County Courthouse. 400 Public Square, Iowa. Sen Chuck Grassley, R-Iowa, holds town hall. Details.


Marriott Marquis. The Leukemia & Lymphoma Society Grand Finale Gala.


Senate back in session.


House back in session.

Tuesday, June 6, to Friday, June 9. New York. Jefferies 2017 Global Healthcare Conference. Details.

Facebook hosting a Health Summit for drug companies. Details.

9 a.m. American Enterprise Institute. 1789 Massachusetts Ave. NW. Discussion on report from AEI and the Brookings Institution on the “Project on Paid Family Leave.” Details.

10 a.m. 2226 Rayburn. Information Technology and Innovation Foundation discussion on “Speeding Cures for Patients: How Congress Can Update the Prescription Drug User Fee Act to Spur Biopharmaceutical Innovation.” Details.


Wednesday, June 7, to Friday, June 9. Austin, Texas. America’s Health Insurance Plans Institute and Expo. Agenda.

8 a.m. Newseum. Atlantic event on “The Next Drugs: An Atlantic Policy Update on Biosimilars.” Details.

10:30 a.m. American Enterprise Institute. 1789 Massachusetts Ave. NW. Discussion on policies around “Deaths of Despair: Opioid, Community and the Economy.” Details.

10 a.m. Bipartisan Policy Center. 1225 I St. NW. Discussion on “Preparing Health Care Providers for Obesity Care.” Details.


June 8-June 11. Boston. Annual scientific meeting for the American Headache Society. Webcast.

9 a.m. Reserve Officers Association. 1 Constitution Ave NE. Health Affairs media-only briefing on the future of the Affordable Care Act with Texas Republican Reps. Michael Burgess and Gene Green.