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Republicans going their separate ways: Republicans have spent 2017 laser-focused on trying to come up with a way to repeal and replace Obamacare. Now that the effort is on ice, the individual lawmakers are pursuing different paths on healthcare. On the one hand, you have a number of Republicans still clinging to the hope that they can revive the effort to repeal and replace Obamacare in the Senate, just as it happened in the House after the effort seemed dead. On the other hand, you have Republicans turning toward bipartisan efforts to try and rescue Obamacare by pumping money into insurance markets.
Rep. Mark Meadows says Obamacare repeal and replace isn’t over. Meadows, the chairman of the House Freedom Caucus, signaled that the Trump administration and other members of Congress aren’t ready to give up the fight. “We’re not done with that,” the North Carolina Republican said about healthcare efforts, speaking at an event Wednesday on tax reform at the Newseum. Meadows said he had been working with leadership and with the administration on repeal and replacement efforts “as recently as this morning.”
Sen. Lamar Alexander maps out ‘limited’ bipartisan Obamacare deal. The Tennessee Republican laid out his goals for a bipartisan deal to stabilize Obamacare’s exchanges by the end of September. “I hope to get a consensus about how to stabilize the individual market, keep premiums down, keep insurance companies in the individual market so that people can buy affordable insurance in 2018,” he said. As a result of those discussions, Alexander said he hopes to put out a bill that is “limited, bipartisan and needs to go into effect by the end of September.” The timing is important so that “insurance companies can see it and I expect them to lower prices on a result of the certainty that has been provided.”
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Senate Republicans talking about tax reform and healthcare on parallel tracks. Some Senate Republicans say they are not abandoning Obamacare repeal, although any progress is likely months away. Since the Senate failed last week to pass a “skinny” repeal bill, Senate GOP leadership has sent a clear message it is moving on to tax reform and bipartisan talks for a short-term Obamacare market stabilization bill. But some Republicans are not giving up on the years-long promise of repeal despite questions over whether the GOP conference can reach a consensus. “Unless there is some breakthrough on healthcare reform that gets us 50 votes in the Senate, then the plan is to go into tax reform,” Sen. John Thune, R-S.D., a member of Senate leadership, said Wednesday. “If we had a breakthrough on healthcare reform, I think everybody is ready to turn to it and get it done.” Several senators said they aren’t abandoning their repeal efforts, but they need to start work on tax reform. “We’ve gotta start forming up consensus around tax reform,” said Sen. Thom Tillis, R-N.C. “That takes time. [Senate Majority Leader Mitch McConnell] has to get that track moving.” Sen. Rand Paul, R-Ky., said the chamber is at an “impasse” now. “We should continue on the tax front, but we should continue negotiating on the health front,” he said.
Sen. John McCain on his healthcare no vote: ‘There was repeal, but not replace.’ In his first interview since being diagnosed with brain cancer, the Arizona Republican said “we did not have a plan” when he voted against the stripped-down healthcare bill. “What we were going to do, and I’m sure that … I guess [it’s] a little arcane, but take a skinny bill as they called it, and give it to a conference of House and Senate people. But no input, no amendments, and then have them put out a product that was going to be an up and down vote in both the House and Senate.” McCain said he was “confident” that a healthcare bill could be put before Trump to sign by the end of the year. “I believe that there’s no doubt in anybody’s mind that we can put in the right fixes,” he said. “And the best way to do that – have a committee, and by the way I’m not a member of that committee — put it through the committee, have the debate, have the amendments, put out a product, bring it to the floor, have more amendments, and then when we have the final vote, then it would carry. The normal way we’re supposed to do business.”
Senate Finance Committee plans hearings. The committee is expected to hold bipartisan hearings on healthcare when it returns to Washington next month and to start the process for reauthorizing the Children’s Health Insurance Program. Finance Committee Chairman Orrin Hatch said Thursday that the panel will hold bipartisan hearings when it returns after the August recess. Hatch did not specify the hearing’s topic. The Utah Republican said the committee would hold a separate hearing on reauthorizing CHIP before the program expires at the end of the federal fiscal year on Sept. 30.
Obamacare insurer payments still in jeopardy despite snag for Trump. The president can still cut off the billions of dollars in funding and trigger more instability in the exchanges. A ruling by the D.C. Circuit Court of Appeals on Tuesday no longer gives Trump the option to drop an appeal on the disputed funds called cost-sharing reduction subsidies, but allows more than a dozen state attorneys general to defend the payments and argue why they would be harmed without them. “It complicates the public signaling that the Trump administration might give,” said Nicholas Bagley, a health law expert at the University of Michigan Law School. “It would have been convenient to say that the Trump administration was only doing what the court told it to do.”
Obamacare insurer Molina to leave two states, raise premiums by 55 percent. Molina Healthcare, an insurer once heralded as an Obamacare success story, said Wednesday that it planned to increase premiums by 55 percent and leave two states altogether, as its huge bet on the government exchanges ended up leading to massive losses. The company lost $230 million overall during the second quarter and announced that it will not be selling plans in Utah and Wisconsin for 2018. Other states where it sells plans would be “under review,” Molina said in a news release, noting that performance in Florida, Utah, Washington and Wisconsin was “most disappointing.” For the states will continue selling coverage, Molina plans to request an increase in premium rates of 55 percent for next year. The price tag assumes the payment of cost-sharing reduction subsidies from the Trump administration will be cut off, but if the funds are allocated, Molina plans to request an increase in premiums of 30 percent.
Aetna closes the door on participating in Obamacare’s exchanges. The company previously said it was leaving the possibility open in only one state, Nevada, because it was applying for Medicaid managed care contracts. The state gives extra consideration to insurers who participate in both programs. During its second-quarter earnings call on Thursday, however, Aetna said it was not moving forward with the recently awarded contract and would be leaving the exchange as well.
Senate set to speedily approve FDA user fee bill. The Senate is ready to hold a speedy vote on reauthorizing the Food and Drug Administration’s user fee program Thursday afternoon.
Senate leadership worked out a deal with Sen. Ron Johnson, R-Wis., to hold a separate vote on his legislation to allow people with terminal illnesses to gain access to experimental drugs in clinical trials. Johnson had said that he wanted to add the measure to the user fee program, potentially gumming up a quick vote on the bipartisan measure. The Senate passed the right-to-try bill through unanimous consent Thursday.
The FDA charges user fees for new drug and device applications, and in turn uses that money to hire new staff and speed approvals. The program must be reauthorized every five years by Congress and traditionally gets bipartisan support. However, the Obamacare repeal effort and other legislative priorities put the user fees on the back burner. For instance, in 2012, Congress passed the user fee legislation in June. Even though the legislation is set to pass Congress — the House passed it before it left — it is not known if the White House will put up some new obstacles. The White House has said it wants all of the FDA to be funded by user fees.
However, the pharmaceutical industry and device makers have negotiated the new user fee rates for more than a year. That makes going back to the negotiating table highly unlikely since the user fee program expires at the end of the federal fiscal year on Sept. 30. The FDA was prepared to send layoff notices to drug and device review staff funded by the user fees in case the fee program wasn’t reauthorized. However, FDA Commissioner Scott Gottlieb delayed sending out the notices, hoping that Congress and Trump would reauthorize the user fee program before the end of next month.
Provision in user fee bill targets ‘pharma bro’ and ‘hedge fund pharmas.’ The user fee bill includes a bipartisan amendment aimed at boosting competition for generic drugs to curb price gouging. The proposal from Sens. Susan Collins, R-Maine, and Claire McCaskill, D-Mo., aims to curb what Collins calls “hedge fund pharmas.” These are companies that wait until a patent has expired “and then buy the pharmaceutical drug and then virtually overnight impose egregious price increases,” Collins said on the Senate floor. The provision lets the FDA target a drug for faster approval if the drug has limited or no competition. The agency would have to approve the drug in eight months instead of the regular 10 months. Collins singled out Turing Pharmaceuticals, which acquired a decades-old antimalarial drug and proceeded to raise the price from $13 a pill to $750. The company was helmed by former CEO Martin Shkreli, called the infamous “pharma bro” because of his flippant and indignant attitude on social media. Shkreli at one point said he would have raised the price more if he could. Shkreli left Turing after being charged with securities fraud by the federal government from his time at another company. A jury is deliberating his case after a lengthy trial.
Trump unveils new telehealth effort for veterans. The Trump administration on Thursday announced a new effort to expand veterans’ access to telehealth services around the country, which includes a new app that will let veterans make healthcare appointments from their cellphones. The new effort aims to use telehealth services to help veterans seeking care wherever they are, including when they’re traveling. Department of Veterans Affairs Secretary David Shulkin told reporters that about 700,000 veterans used telehealth services last year, but said the goal is to expand that use over time.
Former Obamacare official Kevin Counihan joins health insurer Centene. The former CEO of Obamacare’s federal exchange, healthcare.gov, has accepted an executive role with health insurer Centene, a company that has said it is profiting from Obamacare and plans to expand its participation for 2018. Counihan will become regional vice president for Centene’s Midwest division and will work out of the company’s headquarters in Clayton, Mo. Unlike several other health insurers, Centene has said that it has profited from selling coverage on the exchanges. The company expects to sell plans on the Obamacare exchange in Kansas, Missouri and Nevada in 2018, and to expand in other states where it already sells plans, including in Florida, Georgia, Indiana, Ohio, Texas and Washington. All but Nevada and Washington use healthcare.gov to sell coverage.
Medicare Part D premiums set to drop next year. Premiums for Medicare’s Part D prescription drug program are expected to slightly decline in 2018, the first drop in five years, the Trump administration said Wednesday. The monthly Part D premium is projected to be $33.50 per month in 2018, down from $34.70 this year, according to the Centers for Medicare and Medicaid Services. The decline is the first in five years for average Part D premiums, the administration said. The decline comes despite surging spending in Medicare on specialty drugs, a trend that is also driving up overall Medicare costs.
RUNDOWN
Politico New bipartisan Obamacare push faces steep climb
The Hill Dem senator: Lawmakers need to define problem before attempting healthcare fix
Reuters U.S. scientists able to alter genes of human embryos
Kaiser Health News When wounds won’t heal, therapies spread to the tune of $5 billion
STAT News One state takes novel approach to opioid epidemic: Access to treatment for all inmates
CNN Millions of Americans live nowhere near a hospital, jeopardizing their lives
Associated Press After health vote, Maine governor calls state’s senators dangerous
Calendar
THURSDAY | AUG. 3
Aug 3-5. Walter E. Washington Convention Center. 801 Mount Vernon Place NW. American Psychological Association Annual Convention. Details.
FRIDAY | Aug. 4
8 a.m. Cigna second-quarter earnings call. Details.
10 a.m. 215 Dirksen. Senate Finance Committee considers nomination of Matthew Bassett to be an assistant secretary of Health and Human Services. Details.
