Daily on Healthcare: Trump surrenders to Obamacare

Trump surrenders to Obamacare. President Trump effectively threw in the towel on his promise to repeal and replace Obamacare during his first official State of the Union speech. During the speech, Trump referred to Obamacare once, and it was telling both for what he did and did not say.”We repealed the core of disastrous Obamacare — the individual mandate is now gone,” Trump said. By touting the provision in the tax law that zeroed out individual mandate penalties as a repeal of the “core” part of Obamacare, Trump was effectively trying to elide the fact that the rest of the law — its taxes, spending and regulatory infrastructure — remains intact. That was Trump’s single mention of Obamacare. At no point did he follow up by saying that repealing the mandate was a start, but that he would continue to fight for repeal of the broader law. That’s a far cry from his promises to repeal and replace Obamacare during the campaign, and the rhetoric he used last February, during his first speech to a joint session of Congress. Trump’s words are somewhat of an acknowledgment of the reality in Congress, with most House Republicans lacking the appetite to have another go at repealing and replacing Obamacare, and still no consensus bill that could get 50 votes in the Senate. His words also offer a preview of what we can expect to hear from Republicans this year when pressed on why they failed to deliver a central promise they carried with them through four consecutive election cycles. Again and again, they will tell conservatives: “We repealed the core of disastrous Obamacare.” Conservative lawmakers Sen. Ted Cruz, R-Texas, and  Rep. Mark Meadows, R-N.C., leader of the conservative House Freedom Caucus, told the Washington Examiner following the speech that they weren’t too concerned, insisting that healthcare efforts could still be revived despites Trump’s failure to push repeal in his national speech.

CDC director resigns amid questions about tobacco investments. The director of the Centers for Disease Control and Prevention resigned from her post this morning after a report that she bought stock in a global tobacco company one month after she took the helm of the agency, which promotes smoking cessation. Politico reported Tuesday that Fitzgerald bought shares in a number of companies, including Japan Tobacco, not long after she became head of the CDC in July.

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Trump promises in speech that drug prices ‘will come down.’ Trump renewed a call to tackle high drug prices during his State of the Union address Tuesday night, calling price hikes an “injustice.” “In many other countries, these drugs cost far less than what we pay in the United States,” Trump said in his speech. “That is why I have directed my administration to make fixing the injustice of high drug prices one of our top priorities. Prices will come down. Watch.” Trump did not describe how his administration plans to do that.

Trump also declines to cite dollar amount needed for the opioid crisis. Trump didn’t specify how much money Congress should put into beating back the opioid crisis in his State of the Union address. He instead framed the problem as one that should be confronted by law enforcement, particularly by going after the illegal smuggling of drugs between the Mexico-U.S. border. “For decades, open borders have allowed drugs and gangs to pour into our most vulnerable communities,” Trump said. “In 2016, we lost 64,000 Americans to drug overdoses: 174 deaths per day. Seven per hour. We must get much tougher on drug dealers and pushers if we are going to succeed in stopping this scourge.” Trump went on to say that his administration also would be focused on treatment, and introduced a police officer who was his guest at the address. The officer and his wife adopted a baby whose mother had an addiction to opioids.

Trump endorses paid family leave to build on tax bill. The policy is one of his daughter’s top priorities. Ivanka Trump, who is also a senior White House adviser, has met with lawmakers to discuss the implementation of a paid family leave program, calling it “an investment in America’s working families” in a Wall Street Journal opinion piece. The president touted the tax bill that he signed into law and said other initiatives, including paid family leave, could add to his actions. “As tax cuts create new jobs, let us invest in workforce development and job training,” he said. “Let us open great vocational schools so our future workers can learn a craft and realize their full potential. And let us support working families by supporting paid family leave.” The U.S. does not have any mandatory paid family leave, which would allow parents to care for a newborn or adopted child. The Trump administration in the past has requested six weeks of paid family leave.

‘A healthier economy means a healthier America,’ says new HHS chief. ​ Alex Azar attended Tuesday’s speech and praised the president for his remarks. The Trump administration’s policies, he said, had resulted in “new opportunity and prosperity to the American people.​” He hinted at additional regulatory changes to Obamacare and other government healthcare programs. “​ A healthier economy means a healthier America, and we look forward to more such success in the coming year, including through reforms to make healthcare more affordable and accessible for all Americans,” he said. ​​He praised the president, as well, for “bringing a new level of awareness and commitment” to addressing the opioid crisis.” “I look forward to expanding and enhancing our aggressive approach to this scourge of addiction and overdose,” he said.

Several states face final day of Obamacare open enrollment. Open enrollment for Obamacare plans in most states ended Dec. 15, but some states set up their own deadlines to be more in line with previous years, when the sign-up period was longer. Residents in the District of Columbia, California and New York are able to sign up for coverage until midnight. A portion of other residents across the country do have more time to make decisions about their health insurance because of a rule that allows people to change coverage if the insurer they had in 2017 dropped out of the exchanges. According to Lori Lodes, who ran marketing for Obamacare under the former administration and now works at Get America Covered, enrollment in the state-based marketplaces so far is at 3,024,012, higher than last year’s final total of 3,014,198.

Senators prepare to make recommendations for Trump’s executive order on Obamacare. The proposal, released this month, would loosen the rules that allow individuals and small businesses to band together for the purpose of buying health insurance. Among the possible recommendations are specifying that someone who is older could not be charged more for medical coverage, requiring insurers to set aside a specific amount of funding so they do not become insolvent, and regular oversight and reporting requirements. The recommendations were discussed in a Senate Health, Education, Labor and Pensions Committee roundtable Tuesday, based on testimony from a group of healthcare experts and providers.  “As with most regulatory actions, there are advantages and disadvantages, there will be intended and unintended consequences, and there will be those who are financially better off and those who are not,” said Mike Sturn, principal and consulting actuary at actuarial firm Milliman, who spoke at the roundtable. But there was widespread disagreement during the discussion about what impact the rules would have.

Senators press DEA to speed up use of opioid tools. A trio of bipartisan senators are pushing for the Drug Enforcement Administration to give healthcare providers the ability to prescribe opioid addiction treatments over the phone or the Internet. The senators sent a letter Tuesday to DEA Director Robert Patterson asking for the agency to create a “special registration process” for prescribing opioid addiction treatments through telemedicine. The senators said telemedicine could help people in rural areas get access to treatments for opioid addiction and withdrawal. Republican Sens. Lisa Murkowski and Dan Sullivan of Alaska and Democratic Sen. Claire McCaskill of Missouri signed the letter. Current law requires that a doctor or nurse see a patient in person before writing a prescription for a controlled substance, which includes opioid addiction treatments.

FDA faces more lawsuits over vaping ‘Deeming Rule.’ The lawsuits by the Pacific Legal Foundation filed Tuesday argue that the Food and Drug Administration’s rule, which brings e-cigarettes under the same regulations as traditional cigarettes, violates the First Amendment because it extends to products that don’t contain tobacco. They write in court documents, “It is the would-be speaker who must bear the burden of convincing the agency that the truthful speech will improve public health. Such restrictions on truthful speech are presumed unconstitutional under the First Amendment, and it is the government — not the speaker — which must bear the heavy burden to overcome that presumption.” The foundation also said the rule wasn’t legal because it was issued by a career FDA employee rather than a presidential appointee. The lawsuits were filed on behalf of e-cigarette businesses in district courts in the District of Columbia, Minnesota and Texas.

Tax law raises Anthem’s revenue projections. Anthem, a subsidiary of Blue Cross Blue Shield, is the latest health insurer to raise its revenue projections for 2018 thanks to the Republican-led tax bill. The company recorded a one-time benefit of $1.1 billion from $368.4 million because of the tax law, which lowers the corporate tax rate. The results beat analysts’ estimates, reporting revenue of $22.4 billion in the fourth quarter, up 4.5 percent from a year ago and more than the $22.2 billion analysts expected. Its 2018 forecast included a net benefit of about $2 a share and it expects adjusted earnings to be more than $15 a share. Anthem did better than it expected in its Obamacare products, which are sold through exchanges and subsidized by the government for people who have to buy their own medical coverage because they don’t get it through their jobs or through a government program. Executives credited the result to the suspension of the health insurance tax, as well as lower claims filed by beneficiaries.

With $5 billion investment, Pfizer joins corporate icons spending tax-bill savings. Pfizer, the nearly 200-year-old drugmaker, plans to invest $5 billion in capital projects that include strengthening its U.S. manufacturing operations after the Republican tax bill reduced corporate tax rates. The investment, stretched over five years, puts New York-based Pfizer in the ranks of companies from JPMorgan Chase, the largest U.S. lender, to iPhone-maker Apple that are increasing their spending in the wake of massive tax cuts intended to buoy the U.S. economy. The law, championed by Trump, slashed the top corporate rate to 21 percent from 35 percent while allowing companies to bring earnings from overseas back to the country without penalty after a mandatory one-time fee of 15.5 percent on cash and 8 percent on other assets. Previously, companies paid U.S. taxes on overseas holdings moved to the U.S. even when they had been taxed in the country where they were held. “The system that had been in place put U.S.-based multinational companies at a competitive disadvantage vis-à-vis foreign competitors with regard to the tax rate and international access to the capital,” Pfizer CEO Ian Read told investors on an earnings call Tuesday. “The new tax code addresses these issues and helps level the playing field to make U.S. companies more competitive.”

Other job changes at HHS. The Senate on Tuesday confirmed Matthew Bassett to be assistant secretary of HHS by voice vote. Bassett was previously a senior executive at health companies myNEXUS and Davita. He also was a senior staffer in the House and was chief of staff in Kentucky’s health agency. Brian Neale, deputy administrator and director for the Center for Medicaid and CHIP Services, departed HHS that same day. “Had a bittersweet time saying goodbye to Deputy Administrator and Director of CMCS Brian Neale today,” tweeted CMS Administrator Seema Verma. “Brian is a dedicated public servant and a dear friend. His work has benefited millions of Americans and he will be sorely missed.”

RUNDOWN

Bloomberg Long-dreaded Amazon threat to drug middlemen draws closer

Modern Healthcare Fewer doctors are opting out of Medicare

The Hill Trump health chief faces an early test on enforcing Obamacare

Stat News Racing to replace opioids, biopharma is betting on pain drugs with a checkered past

Washington Post FDA wants to curb abuse of Imodium, ‘the poor man’s methadone’

Richmond Times-Dispatch Bill to give doctors way out of providing medically unethical treatment passes first committee

Newsweek 20.8 million prescription painkillers sent to West Virginia town with population of 2,900

CNN Coffee may come with a cancer warning in California

Calendar

WEDNESDAY | Jan. 31

Obamacare open enrollment ends in the District of Columbia, California and New York.

THURSDAY | Feb. 1

8:30 a.m. Cigna to release fourth-quarter earnings report. Details.

9 a.m. National Press Club. Health Affairs and National Pharmaceutical Council to hold live webcast on “Health Spending: Tackling The Big Issues.” Details.