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Trump’s HHS pick leaves door open for Medicare negotiating drug prices. Alex Azar, President Trump’s pick to lead Health and Human Services, said during his confirmation hearing before the Senate Finance Committee that “all drug prices are too high in this country,” and that no company has ever lowered a price for a brand name drug because the current system doesn’t incentivize it. Azar, who is a former CEO of the U.S. division for drug maker Eli Lilly, faced sharp questioning from Sen. Ron Wyden of Oregon, the top Democrat on the committee, who pointed out that the cost of several drugs rose under Azar’s tenure at Lilly from 2012 to 2017. Wyden asked Azar if he signed off on a price decrease for a drug while he was the chairman of the company’s pricing committee. Azar did not respond to the question and instead bristled that “drug prices are too high. I said that when I was at Lilly.” He added that he doesn’t know of any brand name drug that has ever lowered in price. “Every incentive in this system is towards higher prices,” Azar said. “No one company is going to fix that system. That is why I want to be here working with you.” When asked by Sen. Debbie Stabenow, D-Mich., whether he supports giving Medicare negotiation powers to lower drug prices, Azar replied, “Where the government doesn’t have negotiation it is worth looking at that.” He added that Medicare Part D, the program’s drug plan that he helped implement while serving at HHS in the Bush administration, can negotiate for lower prices. However, Medicare Part B, which covers services such as doctor visits and hospitalization, cannot negotiate for lower drug prices. Allowing for direct negotiation is typically a liberal idea that would represent a step in the direction of a single-payer system. During the campaign, President Trump attacked high drug prices and broke with other Republicans in embracing the idea of Medicare negotiating drug prices, but he has not pushed the idea in office.

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Trump to sign executive order aimed at reducing veteran suicides. The president is set to sign an executive order Tuesday that will help veterans transition from military service back into civilian life, the White House said. The executive order will give administration officials 60 days to come up with a plan for helping veterans access mental health and suicide prevention services during their first year out of the military, the White House said Tuesday ahead of the signing. Reducing veterans' suicide is “one of our top priorities,” said Veterans Affairs Secretary David Shulkin, citing research that shows roughly 20 veterans take their life each day. "That is just an unacceptable number, and we are focused on doing everything that we can to try to prevent these veterans' suicides," Shulkin told reporters on a conference call Tuesday. "People may not realize the reason why we're doing this, is that the highest risk for veterans' suicide is in the 12 months following transitioning out of the service," Shulkin added. An administration official said the new efforts would cost "in the magnitude of a couple hundred million dollars a year," and said funding would come from existing resources at the Department of Veterans Affairs and the Defense Department. In addition to providing more accessible mental health services at the VA and in the private sector, the policy change will include a shift in the way the Pentagon helps service members as they leave the military. "The issue here is looking at the transition as a process and not an event," an administration official said.

Little-known part of Obamacare gets some sunshine. Sen. Chuck Grassley, R-Iowa, used his time for questioning Azar to get his thoughts on a little-known part of Obamacare called the Physician Payments Sunshine Act. The law requires drug and device makers to report payments they make to doctors or teaching hospitals to the federal government. The goal is to disclose financial relationships that underline the healthcare industry. It requires manufacturers to list payments, including travel and meal costs, to doctors to go to company-sponsored events and any money for educational materials. Grassley is a major opponent of Obamacare but loves the Sunshine Act, which he helped pass as part of the law. He asked Azar if he is committed to maintaining the law. Azar responded that he thinks such transparency is “extremely helpful.”

Azar receives bipartisan praise from former senators. In an opinion piece for Stat News, former Senate Majority Leaders Bill Frist and Tom Daschle wrote that they believed Trump had made the correct pick for his HHS secretary. “With such an extensive reach, the HHS secretary must be experienced managing complex and large organizations; possess broad knowledge across an array of issues; and demonstrate a record of solving difficult problems,” they wrote. “A person like this is hard to find, and the search is made even more difficult by the hyper-partisan nature of today’s politics, in which both parties too often view the other with deep suspicion.” They concluded that, even though they may not agree with him on every issue, “Alex Azar has the temperament, judgment and necessary focus” to be health secretary.

Border wall fight could mean another short-term spending deal. With just a few legislative days remaining to reach a grand but elusive spending and immigration deal with Democrats, Republican leaders are warning another stopgap spending bill may be needed to keep the government running beyond a Jan. 19 deadline. “Right now the Democrats are holding the whole spending bill hostage for a DACA solution,” Majority Whip John Cornyn, R-Texas, said Monday, referring to the expiring Deferred Action for Childhood Arrivals that allows young people who arrived in the U.S. illegally as children to stay. The two measures are on separate negotiation tracks, partly because the DACA program doesn’t expire until March 5. But Democrats are threatening to vote against a must-pass government funding bill unless the Senate agrees to an immigration bill that meets their terms. Cornyn said passing a third stopgap spending bill, or continuing resolution, may be all the two parties can agree on by the end of next week because of the significant and numerous disagreements. “That’s kind of where we are,” Cornyn said. “We may not be able to meet that deadline. We may be looking at another CR.”

Hatch urges long-term funding for CHIP in Jan. 19 deal. Sen. Orrin Hatch, R-Utah, said Tuesday that the Children’s Health Insurance Program should be extended as part of the next must-pass spending bill. “Congress has passed patches and fixes, but the time for short-term solutions for CHIP is over,” he said at the confirmation hearing for Azar. “CHIP needs to be extended by Jan. 19, and I’m going to do all I can to make sure we get it done.” Sen. Ron Wyden, D-Ore., the Senate Finance Committee’s ranking member, echoed Hatch’s urgency for long-term funding. “We all understand that we’ve got to get this done and we’ve got to get it done quickly,” Wyden said. CHIP expired Sept. 30. The program gives block grants to states to provide insurance to low-income children. States began running out of CHIP funding at the end of 2017, but Congress included a short-term funding patch of nearly $3 billion.

Maryland lawmakers introduce replacement for Obamacare individual mandate. The proposal in Maryland is being described as a "down payment plan" that would give people the option to put the money they would pay in a penalty toward a health insurance plan. It also contains components that automatically enroll people in coverage. The state would notify uninsured taxpayers beginning in 2020 they can use the money from the penalty toward an Obamacare plan. From there, customers would be split into two categories: Those who can receive coverage at no cost because of federal subsidies would be automatically enrolled in a plan, and those who would have to kick in more would be told they can enroll in coverage during open enrollment, which begins in November.

Centene: 1.4 million signed up for Obamacare plans. Health insurer Centene Corp. announced Monday that 1.4 million people have signed up for the plans it offers under Obamacare. “The growth in the exchange has been so dramatic ... We had planned on incremental growth, but not that much,” the company's CEO, Michael Neidorff said, adding, “We’ve had people working all weekend, playing catch-up.” The exchanges allow low- and middle-income people to purchase health insurance that is subsidized by the federal government. Centene is known for its participation in the Medicaid program, which largely covers low-income people. In March, Centene announced it covered 1.2 million people in Obamacare exchange plans. Centene's totals, as of Jan. 7, were made during a presentation at the JPMorgan Healthcare Conference in San Francisco. Centene was one of the few insurers to not only continue offering Obamacare plans but also to expand into more states, while companies such as Aetna, Humana and UnitedHealth Group scaled back or exited altogether.

Senate vote on 20-week abortion ban coming this month. The Senate is likely to vote this month on a bill that would ban abortion after 20 weeks of gestation, sources familiar with the matter told the Washington Examiner. Anti-abortion groups are pressing for the vote to happen the same day as the March for Life rally on Jan. 19, which happens every year close to the anniversary of Roe v. Wade, the 1973 Supreme Court decision that made abortion legal nationwide. The House passed the 20-week abortion ban in October. The bill, the Pain-Capable Unborn Child Protection Act, would penalize medical providers who perform abortions after 20 weeks of gestation with fines or with up to five years in prison, or both, although it does have several exceptions. The White House said in a statement of administration policy ahead of the House vote that if the bill were to reach Trump’s desk his team would recommend he sign it into law. But the legislation will need at least 60 votes in the Senate and is not expected to pass.

The fight over NIH research on gun violence. The fight over government-funded research on gun violence is heating up after several mass shootings during Trump's first year in office. Some Democratic lawmakers are pressuring the Trump administration to send a clear message that it will fund gun violence research, while others say it's time to rewrite the Dickey Amendment, a 1990s-era law banning tax dollars from going toward advocating or promoting gun control. But without a majority in Congress or lack of support from the administration, they may run up against a wall. The National Rifle Association opposes the changes, saying the law is defined narrowly enough, while Republicans have been largely silent on research possibilities, focusing instead on legislation that would keep guns from ending up in the wrong hands. One vehicle Democratic lawmakers have targeted is a National Institutes of Health call for research projects on gun violence that expired as planned on Jan. 8, 2017, shortly before Trump was inaugurated. It was issued in 2013, when former President Barack Obama told health agencies to fund or carry out research "into the causes of gun violence and the ways to prevent it," following the mass shooting at Sandy Hook Elementary School in Newtown, Conn. Democratic senators sent an October letter urging the NIH to "renew the gun violence research program as soon as possible." Democratic House members sent their own letter in November, inquiring about whether the funding had been discontinued and why, but they haven't heard back.

Maryland to fight pharmacist 'gag rule' on drug costs. Maryland wants to eliminate a “gag rule” that prevents pharmacists from telling consumers that they can pay less for their prescription drugs, joining a nationwide movement to rein in soaring costs. If Maryland succeeds, it would mean that pharmacies would be allowed to inform customers they can pay less for a drug out of pocket than through their insurance. Maryland would join five other states — Connecticut, Maine, Louisiana, North Dakota, and Georgia — that have banned the "gag rule" that some pharmacy benefit managers put in their contracts with pharmacies. The issue is that a customer can pay less for a drug if he pays out-of-pocket instead of using insurance if the co-pay set by the pharmacy benefit manager is higher than the cost of the drug. However, the pharmacy benefit manager's contract provisions prohibit pharmacists from telling the consumer about that option.

Scalise to undergo planned surgery as part of recovery from shooting. House Majority Whip Steve Scalise, R-La., announced Tuesday that he will have surgery Wednesday as part of his recovery from a near-fatal gunshot to his hip in June during practice for the Congressional Baseball Game. “I have been fortunate to make tremendous progress in my healing from last June's shooting, and tomorrow I will undergo a planned surgery as part of my ongoing recovery process," Scalise said in a statement. "I will remain fully engaged in my work as I heal from this procedure, and I look forward to returning to the Capitol as soon as I can within the coming weeks." The Louisiana Republican returned to work in September after months of recovery from the gunshot wound, which he said almost killed him.

RUNDOWN

Politico HHS nominee’s mission is to finish the job on Obamacare

Wall Street Journal Republicans scale down agenda for safety net hospitals

Axios Healthcare companies are thrilled about tax overhaul

Kaiser Health News Despite prod by ACA, tax-exempt hospitals slow to expand community benefits

NPR Hospitals in states that expanded Medicaid less likely to close

STAT News How to determine Trump’s mental fitness for office? Experts point to reliable cognitive tests

New York Times A heart risk factor even doctors know little about



Calendar

TUESDAY | Jan. 9

Jan. 8-11. San Francisco. 36th annual JP Morgan conference. Details.

Senate Finance Committee confirmation hearing for Alex Azar, President Trump’s pick for Health and Human Services Secretary. Began 10 a.m. Watch live.

THURSDAY | Jan. 11

Jan. 11-12. 1300 Pennsylvania Ave NW. MedPac January public meeting. Details.

8:30 a.m. Kaiser Family Foundation. 1330 G St. NW. Event on “Health Reform 2020: Towards Affordable, Quality Care for All Americans.” Details.

FRIDAY | Jan. 12

Walter Reed National Military Medical Center. President Trump to undergo routine medical exam. Details.