Daily on Healthcare: Trump makes insurer payments, for now

Trump to pay Obamacare insurers this month, but after that no promises. The Trump administration said it will pay insurers in August for reducing out-of-pocket costs for low-income Obamacare insurers, but is still quiet on whether it will make payments in September or thereafter. The decision, relayed by a White House aide, comes about a day after the nonpartisan Congressional Budget Office estimated that if the Trump administration doesn’t make the payments next year, it could lead to higher premiums for Obamacare customers.

While the Trump administration has been making the payments this year, insurers have been pushing for a commitment for 2018 as they are finalizing plans for next year now. Some insurers have said they would raise premiums if the payments were not made in 2018, since they still have to lower out-of-pocket costs under the law.

Payments highlight differences among Republicans. A key House lawmaker criticized the Trump administration’s decision to pay insurers this month. But a Republican senator tasked with spearheading a bipartisan deal to fund the payments in 2018 praised the decision. The reactions from Rep. Mark Walker, R-N.C., and Sen. Lamar Alexander, R-Tenn., illustrate the potential division within the GOP over the payments. Alexander is working on a bipartisan deal in the Senate to make the payments and hopes to have something done by the end of next month. Alexander, head of the Senate Health, Education, Labor and Pensions Committee, said abruptly cancelling the payments could raise premiums and out-of-pocket costs. But Walker, the head of the 170-member Republican Study Committee, said that the payments were unconstitutional. “We cannot dig our hands into a hole $20 trillion in deep to bail out insurance companies,” Walker said. The Trump administration has not made a plan on whether to make the payments for 2018.

The Senate is expected to start work when they return on a bipartisan deal for the payments, with Alexander and Sen. Patty Murray, D-Wash., taking the lead. But a large number of Republicans, especially in the House, want the Senate to try again on repealing Obamacare instead of a short-term fix to continue insurer payments. The conservative House Freedom Caucus filed a discharge petition to force a vote in the House on a 2015 bill that repealed Obamacare without an immediate replacement. The bill was passed by Congress in 2015 but vetoed by former President Barack Obama. The Senate took up the bill late last month as part of a debate on Obamacare repeal but the straight repeal bill failed 45-55. House Speaker Paul Ryan likely has enough votes for a bipartisan deal to pass in the House, but it may not meet the requirements of the Hastert Rule, an informal guideline that any bill brought up in the House be supported by a majority of Republicans.  

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 [email protected] 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.

Trump dissolves two panels of business leaders. Pressure mounted on CEOs after Trump’s Tuesday press conference, which was met with outcry after he said “both sides” bore some responsibility for the violence that erupted in Charlottesville, Va., involving white supremacists and nationalist protesters and their counter-protesters. Seven business leaders on the manufacturing council resigned following the initial exit by Kevin Frazier, CEO of pharmaceutical giant Merck. As more exits were announced, Trump said he would be disbanding the group, along with his Strategy & Policy Forum, “rather than putting pressure” on them. Johnson & Johnson said afterward that the company’s CEO had planned to resign following Tuesday’s remarks, walking back an earlier position. “The president’s most recent statements equating those who are motivated by race-based hate with those who stand up against hatred is unacceptable and has changed our decision to participate in the White House Manufacturing Advisory Council,” the company said. After Trump’s press comments Tuesday, members of the strategy and policy forum also said they planned to resign, and reportedly were waiting to make the announcement public so they could tell the White House first. Included in the group was Dr. Toby Cosgrove, CEO of the Cleveland Clinic in Ohio.

NARAL: White supremacists ‘have close ties’ with Trump, the GOP and anti-abortion advocates. The pro-abortion rights advocacy group sparked a social media storm Wednesday when it tweeted about the possible connection among white nationalists, the Republican Party and anti-abortion organizations. “THREAD: White supremacists at #Charlottesville have close ties not just to Trump, but GOP & anti-choice groups,” the organization wrote. NARAL then outlined its argument that white nationalists and anti-abortion groups shared a common interest in wanting “to control women’s bodies,” using the example of two Charlottesville attendees — James Allsup and Matthew Heimbach — as evidence. “It should be no surprise why white supremacists promote #antichoice policies,” the organization continued. “They disproportionately harm women of color.” While many of NARAL’s followers online agreed with the sentiment, some did not. “That’s an outrageous conflation. You’d hate Margaret Sanger if she were a Republican. Disgusting,” Dan Kimbler wrote, referring to the American birth control activist.

Appeals court: Arkansas can block Planned Parenthood funding. A federal appeals court ruled Wednesday that Arkansas could block Medicaid funding for Planned Parenthood. The ruling comes as more states and Congress try to defund the women’s health and abortion provider. Republican Gov. Asa Hutchinson aimed to defund Planned Parenthood in 2015 after a series of undercover videos were released by anti-abortion activists. The 8th Circuit Court of Appeals ruled Wednesday that the lawsuit from the three patients was unlikely to succeed. An injunction must be issued based on the likelihood of success, and therefore the lawsuit against Arkansas should be lifted, the court ruled. The appeals court found that the patients didn’t have a federal right to sue to keep Planned Parenthood funded. It found that the Medicaid provision to offer quality health plans is directed only at the federal agency charged with approving state Medicaid plans.

Doctors criticize Express Scripts for plan to limit opioids. The American Medical Association opposes pharmacy benefits manager Express Scripts’ plan to limit the number and strength of painkillers that it will allow doctors to prescribe to first-time patients. Those decisions, the AMA said, should be left to doctors and their patients. Under the new plan, first-time opioid users will not be able to receive more than seven days of prescription painkillers, even if the doctor requests a longer prescription. The new plan also will limit prescriptions to short-acting drugs and limit the dosage. Express Scripts plans to monitor prescribing data to see if patients are “pill shopping,” meaning going to different doctors’ offices to stock up on the same medication. Dr. Patrice Harris, a chairwoman for the American Medical Association’s Opioids Task Force, said doctors already are working on addressing the opioid epidemic, reducing prescriptions by 17 percent in recent years, and are referring patients with chronic pain to physical therapists and cognitive behavioral therapy.

Drugs speedily approved lack timely follow-up studies. Makers of drugs that were quickly approved by the Food and Drug Administration took longer to conduct follow-up studies to confirm that the drugs were safe and effective than pharmaceuticals approved through the normal process, according to a new study. The study looked at mandated trials of drugs after they were cleared through accelerated approval from 2009 to 2013. The FDA gave accelerated approval to 22 drugs for 24 sicknesses — 19 of which were for cancer — according to the study published in the Journal of the American Medical Association on Wednesday. Under the accelerated approval process, manufacturers are supposed to conduct studies afterward to confirm the effectiveness of the drugs, and they must be completed within three years. Manufacturers did 38 trials for the 22 drugs. Of those 38 trials, only 19 were completed within three years. Of the trials that were completed, most showed some benefit, but the design of the trial wasn’t as robust as standard clinical trials. Faster drug approvals is a key reform that both Democrats and Republicans say can help lower high drug prices.

Food and Drug Administration chief outlines anti-tobacco plan. Dr. Scott Gottlieb wrote in the New England Journal of Medicine that the FDA will use peer-reviewed studies to set a nicotine limit on cigarettes and that the agency will continue to conduct studies to assess whether e-cigarettes are harmful and to discover to what extent they can help traditional smokers quit.

Democrats accuse MS drug makers of ‘shadow pricing.’ Two House Democrats on Thursday accused makers of multiple sclerosis drugs with raising prices on older drugs to match the price of newer drugs from their competitors. Reps. Elijah Cummings, D-Md., and Peter Welch, D-Vt., sent letters to seven drug makers seeking answers about price hikes for MS drugs. The lawmakers, who have been investigating high drug prices, say the prices for MS drugs are rising to meet, or shadow, the prices of newer entrants in the market. The lawmakers pointed to a study that shows that annual sales of MS drugs doubled from $4 billion in 2008 to nearly $9 billion in 2012, and indicated that higher prices on older drugs are contributing to those increases.

Iowa’s lone Obamacare insurer may raise rates if Trump doesn’t make payments. Iowa insurer Medica said it would raise its 2018 Obamacare rates by roughly 14 percentage points if President Trump doesn’t commit to payments to insurers. Medica, the only Obamacare insurer in the state, has requested a 56.7 percent rate increase for 2018, up from the 43.5 percent rate hike it originally requested. The refiled rates affect only silver plans, the most popular of Obamacare’s three plan choices. Medica said the request is because of uncertainty about federal cost-sharing reduction payments that reimburse insurers for reducing out-of-pocket costs for low-income Obamacare customers.

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Calendar

THURSDAY | Aug. 17

Aug. 15-17. Hyatt Regency Atlanta Hotel. National Conference on Health Communication, Marketing and Media. Details.

9 a.m. PST/Noon EST. USC Caruso Center. Los Angeles. National Hispanic Medical Association leadership summit on “Cardiovascular Disease and Hispanics.” Details.

10 a.m. MDT/noon EST. Kimball Public Library. Sen. Deb Fisher, R-Neb., to hold town hall. Details.

1 p.m. MDT/3 p.m. EST. Best Western Inn. Sen. Deb Fisher, R-Neb., to hold listening session. Details.

3:30 p.m. MST/5:20 p.m. EST. Springhill Suites. Sen. Mike Rounds, R-S.D., to hold “Coffee and Conversation” event. Details.  

FRIDAY | Aug. 18

9 a.m. MDT/11 a.m. EST. Prairie Winds Community Center. Sen. Deb Fisher, R-Neb., to hold a listening session. Details.

Noon CDT/1 p.m. EST. American Legion Post. Sen. Jerry Moran, R-Kan., to hold a listening tour. Details.  

2 p.m. CDT/ 3 p.m. EST. Cass County Justice Center. Sen. Claire McCaskill, D-Mo., to hold a town hall. Details.

3 p.m. MDT/5 p.m. EST. Bean Broker. Sen. Deb Fisher, R-Neb., to hold a listening session. Details.

MONDAY | Aug. 21

9 p.m. House Speaker Paul Ryan to appear in CNN town hall. Details.