Daily on Healthcare: House tax bill keeps individual mandate, dumps medical expenses deduction and drug research tax credit

Tax bill tosses some healthcare provisions. The House bill would eliminate the deduction for medical expenses and a drug research tax credit. Some experts believe eliminating the deduction for medical expenses would hurt people with chronic diseases. “A big component of the medical expense deduction is likely long-term care expenses for people who are chronically ill,” tweeted Larry Levitt, senior vice president at nonpartisan Kaiser Family Foundation. However, the bill also increases the standard deduction and bring down rates. Meanwhile, House Republicans would get rid of a drug research tax credit. Currently a drug maker can claim a credit of equal to 50 percent of qualified clinical testing expenses, according to a summary of the bill. However, that credit for testing on certain drugs for rare diseases would be repealed, a move that the GOP estimates would save $54 billion from 2018 to 2027.

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Most counties to have free Obamacare plans for low-income buyers: Analysis. A large portion of U.S. counties will have a free healthcare plan available for low-income customers, an indirect result of President Trump’s decision to stop making Obamacare payments, according to an analysis published Thursday by the consulting firm Avalere Health. Healthcare.gov customers can find a bronze plan at no cost to them. The plans will be subsidized by the federal government, making them cheaper for those making 150 percent of the federal poverty level, which is $18,090 a year for an individual. Though Trump stopped making payments to insurers known as cost-sharing reduction subsidies, the main subsidies that the federal government uses to help individuals purchase health insurance are still on the books. Because those subsidies, by law, are tied to the premiums of the benchmark silver plans, state regulators allowed insurers to raise silver plan premiums significantly, which in turn triggered higher federal subsidies.

House panel advances child insurance, Obamacare bills to full House. Bills to reauthorize the Children’s Health Insurance Program, or CHIP, and repeal a controversial Obamacare panel advanced to the House floor on Wednesday after a fiery, partisan debate. The House Rules Committee advanced the bills via a party-line vote during a hearing Wednesday, and the full House is expected to vote on them this week. Both bills face an uncertain future in the Senate. The hearings featured major partisan debates tinged with anger over Obamacare as Democrats charged Republicans with using the bills to chip away at the Affordable Care Act after congressional efforts to repeal the law failed. “I have to be honest and say this is part of an effort on the part of your party to continue this repeal effort,” said Rep. Frank Pallone of New Jersey, the top Democrat on the House Energy and Commerce Committee. The bill would reauthorize CHIP for five years and community health centers for two years. It will also repeal the Independent Payment Advisory Board, created by Obamacare that would recommend cuts to Medicare if spending reaches a certain level.

This is the latest funding battle over CHIP. Republicans plan to pay for CHIP by charging wealthy Medicare seniors higher premiums, raiding an Obamacare disease prevention fund and shortening a  grace period for Obamacare customers to pay premiums before their insurance is cut off. The House Energy and Commerce Committee passed the CHIP reauthorization bill by a party-line vote last month, but Chairman Rep. Greg Walden postponed advancing it to reopen bipartisan talks on new funding offsets. Those talks collapsed after accusations from Republicans that Democrats gave no serious offer and Democrats charging Republicans won’t budge from touching Obamacare and Medicare.

The bill’s fate beyond the House remains in doubt. It appears unlikely the bill will be able to get 60 votes in the Senate even as it gets through the House. Rep. Frank Pallone, D-N.J., ranking member of the Energy and Commerce Committee, said the bills are going nowhere. “I know that in effect what we are doing today with all two of these bills, both CHIP and IPAB, is essentially punting until the end of the year,” Pallone said, referring to a looming deadline to pass spending and debt ceiling legislation. “The Senate isn’t going to take these bills up.” Senate negotiators are still working on their own funding offsets.

Orrin Hatch, Kevin Brady introduce their own Obamacare stabilization bill. House and Senate Republican committee leaders introduced an Obamacare stabilization package, which is more conservative than a bipartisan package that has stalled in the Senate. Senate Finance Committee Chairman Orrin Hatch and House Ways and Means Committee Chairman Kevin Brady introduced the Healthcare Market Certainty and Mandate Relief Act on Wednesday. It would delay enforcement of Obamacare’s individual and employer mandates in exchange for insurer payments that President Trump has halted and led to major increases in premiums. The bill from Hatch and Brady, R-Texas, would delay enforcement of the individual and employer mandates for the next few years. It also would expand use of health savings accounts. It goes further than a deal from Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., that makes the payments for two years in exchange for more state flexibility from the law’s regulations.

Trump administration says little about Obamacare’s open enrollment on opening day. The president did not issue any tweets or statements telling people to sign up for coverage, though he did call for repeal of Obamacare’s individual mandate to be included in the tax bill. The Twitter accounts for the Department of Health and Human Services and for healthcare.gov each sent one tweet notifying of open enrollment, but none were sent by Seema Verma, Centers for Medicare and Medicaid Services administrator, or by Eric Hargan, the acting secretary for the Department of Health and Human Services.

Trump’s opioid commission recommends ‘aggressive’ outreach on opioid awareness. The commission recommended that the federal government roll out an aggressive multimedia campaign that would tell children about the dangers of drugs and frame addiction as a disease rather than a moral failing. “People need to be aware of the health risks associated with opioid use, and they must stop being afraid or ashamed of seeking help when facing their addiction,” wrote New Jersey Gov. Chris Christie, chairman of the president’s commission on Combating Drug Addiction and the Opioid Crisis. The commission recommended a similar campaign to the one issued during the AIDS epidemic. The 56 recommendations, released Wednesday, are part of the commission’s final report on how the Trump administration should tackle the drug epidemic.

Trump administration announces opioid waivers for states. The Trump administration has approved Medicaid waivers in Utah and New Jersey that their governors say will expand access to treatment for residents with opioid addiction. The Centers for Medicare and Medicaid Services also announced Wednesday that it would allow states to design other proposals that would help their residents get access to treatment for opioid and other drug addictions. New Jersey’s waiver will allow Medicaid funds to go toward residential treatment, management of withdrawal symptoms, medication that helps people with opioid addictions, and toward providers who help manage people’s various medical and other needs. New Jersey Gov. Chris Christie said the waiver would allow “thousands more” in the state receive access to treatment. The Utah waiver helps people who have an opioid addiction and are homeless or in prison or jail. It is expected to expand treatment to as many as 6,000 Utah residents.

Cigna beats profit estimates during third quarter. Health insurer Cigna’s third-quarter profits were higher than expected due to more customers enrolling in its offerings and lower costs in its commercial business. Overall, Cigna’s net income rose to $560 million, or $2.21 per share, in the third quarter ended Sept. 30, from $456 million, or $1.76 per share, at the same time last year. As of Sept. 30, the company’s membership rose about 4 percent to 15.8 million. Its commercial medical loss ratio, which is the percentage of premiums spent on claims, was 78.6 percent in the third quarter, compared with 79.4 percent during the third quarter last year. Cigna is one of the only larger health insurers that will continue selling coverage in the Obamacare exchanges next year for the open enrollment period that began Wednesday.

RUNDOWN

Axios One big thing people don’t know about single payer

Bloomberg EpiPen failures cited in seven deaths this year, FDA files show

Washington Post Here’s the next way the Trump administration could go after abortion providers

The Hill Blue Dog Democrats back bipartisan health bill

Wall Street Journal Drug maker Teva cuts outlook again in perfect storm of problems

New York Times 56 ways to fight the opioid plague, but is that enough?

STAT News FDA edges gingerly toward regulating tens of thousands of medical tests

Reuters Puerto Rico seeks help as Medicaid crisis deepens after Hurricane Maria

Calendar

THURSDAY | Nov. 2

Oct. 31-Nov. 2. Crystal Gateway Marriott. PCORI’s Annual Meeting. Details.

Nov. 1-3. Renaissance Hotel Downtown. U.S. News & World Report Healthcare of Tomorrow event. Details.

Nov. 2-3. Ronald Reagan Building. MedPac public meeting. Details.

PhRMA scientists and researchers meeting with senior Hill staffers.

3 p.m. 325 Russell. Discussion among Sens. Rob Portman, R-Ohio, Sheldon Whitehouse, D-R.I., Jeanne Shaheen, D-N.H. on “Across the Aisle: A Conversation on our Nation’s Opioid Epidemic.” Details.

3 p.m. Kaiser Health News to hold Facebook live events on consumer questions about Obamacare’s open enrollment. Watch stream.

FRIDAY | Nov. 3

7:30 a.m. 5600 Fishers Lane. Rockville, MD. National Advisory Council for Healthcare Research and Quality meeting. Agenda.

9:30 a.m. 1775 Massachusetts Ave. NW. Brookings Institution discussion on “Policy Approaches to the Opioid Crisis.” Details.

Noon. National Press Club. 529 14th St. NW. Luncheon with FDA commissioner Scott Gottlieb. Details.

SATURDAY | Nov. 4

Nov. 4-8. American Public Health Association 2017 Annual Meeting and Expo. Theme: Creating the Healthiest Nation: Climate Changes Health. Details.

SUNDAY | Nov. 5

Nov. 5-7. Ritz-Carlton Half Moon Bay. San Francisco. Technomy. Details.

Daylight saving time ends. You should have set your clocks back one hour.

MONDAY | Nov. 6

Noon. National Press Club. 529 14th St. NW. Luncheon with VA Secretary David Shulkin. Details.