What Trump’s budget would mean for healthcare

What Trump’s budget would mean for healthcare. President Trump on Monday released his proposed fiscal 2020 budget. Here are some highlights of his healthcare proposals.

*Agency cuts. The Department of Health and Human Services would see a 12 percent decrease from 2019 spending levels, to $87.1 billion.

*Add co-pays, work requirements to Medicaid. The budget called for people on Medicaid to pay more for medical care, including co-pays, when they go to the emergency department for non-emergency care. In most states people on Medicaid. The administration also wants to have Medicaid implement work, volunteer, and training requirements across the board for able-bodied adults as a condition of staying enrolled in the program. Seven states already have been approved to implement the requirements, and eight more are pending. Only one — in Arkansas — is up and running.

*Moving Medicaid to a block grant. The Trump administration still supports moving Medicaid to a block grant program, in which states get a lump sum in exchange for more flexibility. When states apply for the program they would need to explain when they apply for the grants how they would use the funds to protect patients with pre-existing illnesses. This arrangement, OMB said, would “eliminate inefficient Medicaid spending, including repeal of the Medicaid expansion, and reducing financing gimmicks such as provider taxes.”

*Elements of Obamacare repeal and replace. Trump continues to support the Graham-Cassidy-Heller-Johnson “repeal and replace” bill that hands the power of implementing healthcare programs to states.

*Cost-sharing for Obamacare customers. The budget calls for everyone who gets a subsidy from Obamacare to have to pay something for their coverage if they are getting it through the federal exchange.

*Fighting the opioid epidemic. The budget calls for additional legislation toward prevention, treatment, research, and recovery. The budget calls for $1.5 billion toward state grants, $1 billion toward medical research, and $221 billion to get more workers in the field.

*Prescription drugs. The president called for an out-of-pocket spending cap on prescription drugs for Medicare beneficiaries.

*Ending HIV transmission. The Trump administration is calling for $291 million in funding to HHS toward the goal of ending HIV transmission in a decade.

*Slashing medical research spending. Research priorities include addressing the opioid crisis and working on a universal flu vaccine. The budget calls for $33 billion on medical research, a cut from the agency’s current level of $39 billion.

*Setting abortion exclusions. The president called for passing legislation that would let healthcare workers opt out of providing abortions.

*Paid parental leave. The proposal would let states set up their own parental leave programs. Most states that have done so have implemented a payroll tax.

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Azar prepares to take questions about Trump’s budget in three hearings this week. Health and Human Services Secretary Alex Azar will testify Tuesday before the House Energy and Commerce Committee, Wednesday before the House Appropriations Committee, and Thursday before the Senate Finance Committee. While Azar is expected to field questions about the budget, the hearings offer an opportunity for lawmakers to publicly question him about other topics, including the Trump administration’s cuts to Obamacare marketing, its Title X rule taking funds away from abortion providers, and proposals it has released to curb prescription drug prices. “This budget will help deliver on the president’s vision for a fiscally sustainable federal budget, a stronger economy, and a healthier America,” Azar said in a statement following the budget release.

Finance Committee Republicans say oversight of Medicaid payments falling short. Senate Finance Committee Chairman Chuck Grassley, R-Iowa, and Finance Subcommittee on Healthcare Chairman Pat Toomey, R-Pa., are pushing the Centers for Medicare and Medicaid Services to increase its oversight of Medicaid payments to make sure fewer payments are made erroneously, meaning covering people who aren’t in face eligible for the program. According to a letter the senators sent to CMS Administrator Seema Verma, nearly 10 percent of Medicaid spending is improper, but CMS hasn’t worked to recoup funds since 1992. “The apparent lack of effort in recouping misspent federal money is problematic,” the senators wrote. They asked CMS for data on recovering the funds and to examine how often funds go out incorrectly.

Genetically-modified salmon headed to US grocery stores. Genetically modified salmon will soon hit dinner plates. The Food and Drug Administration announced Friday that it would be allowing the genetically modified fish, known as AquAdvantage salmon, to be imported to the U.S., lifting a ban that has been in place since 2016. Manufacturer AquaBounty Technologies genetically engineered the fish so that it grows almost twice as fast as traditional Atlantic salmon despite not needing to eat as much. All the fish it grows are female and therefore cannot breed with each other. The FDA concluded in 2015 that the genetically modified salmon was “safe to eat,” and that the genetic engineering methods were safe for the fish, FDA Commissioner Scott Gottlieb said in a statement. Despite the approval, the fish weren’t allowed to come to market for a few years because Congress asked the FDA to hold off until regulators set rules about how the food should be labeled. Last year, the Department of Agriculture stipulated that all bioengineered food has to be labeled as such, resolving the issue for salmon and allowing the FDA to approve it in the action announced Friday.

FDA to review safety of surgical staplers. The FDA wrote a letter to healthcare providers on Friday to say that the agency would review and address safety issues with surgical staplers following an investigation by Kaiser Health News that found seven years’ worth of hidden reports. The staplers, which are commonly used in surgeries, have failed to fire properly, have misfired, have gone into the wrong part of the body, or have caused the stitching to open up. This can cause serious harm in patients, whether bleeding, infection, or even death. The FDA publicly reported less than 100 issues with the staplers in 2016 even though KHN found nearly 10,000 instances of malfunction in 2016. The agency said it would consider changing the way it approves the devices, pledged to host a meeting soon to receive outside input, and said it would provide updated recommendations to address the risks of the devices.

WHO launches global strategy to fight flu outbreaks. The World Health Organization today released a Global Influenza Strategy for 2019-2030 aimed at protecting people from influenza. WHO called for every country to have a specific influenza program and to create better tools to prevent, find, control, and treat the flu by setting up vaccine policies and distributing antiretrovirals. The goal of the strategy is to prevent seasonal influenza, control the spread of influenza from animals to humans, and prepare for the next influenza pandemic. Every year, an estimated 1 billion people get the flu. Of these, 3 to 5 million are severe cases and 290,000 to 650,000 result in death.

Iowa Supreme Court rules that Medicaid must cover sex reassignment surgeries. The Iowa Supreme Court ruled unanimously Friday that Medicaid must cover sex reassignment surgeries, reasoning that the procedures are medically necessary. Eerie Anna Good and Carol Ann Beal, transgender women backed by the ACLU, had sued the Iowa Department of Human Services for its policy against funding transition surgeries, calling it discriminatory. The DHS had considered transition surgery to be cosmetic without medical purpose. Iowa Supreme Court Justice Susan Christensen wrote that the DHS’ existing “bar on Medicaid coverage for gender-affirming surgical procedures discriminates against transgender Medicaid recipients in Iowa” under Iowa civil rights laws.The Supreme Court’s decision was to uphold a lower court ruling to undo the ban, which had been appealed by the state. “I look forward to the day when someone fighting to get the transition-related medical care they need isn’t in the news because they had to go to court to fight for it,” Beal said to the Iowa ACLU.

Pentagon tells currently serving transgender troops they can stay. The Pentagon says currently serving transgender troops can stay while the legal battles continue following the federal court hearing that Trump’s ban on transgender troops will stand. On Thursday, a federal judge in Maryland ruled that a January decision by the Supreme Court meant he could no longer block the Trump administration from putting its policy in place while various legal challenges make their way through the courts. New recruits and troops who have not transitioned may serve if they do so in the gender they were assigned at birth. How they dress and what they do in their off-duty time is up to them, so long as they don’t have surgery or other transgender treatment, a Pentagon spokesperson said.

Kansas doctor given life sentence after patient’s opioid overdose death. A Wichita doctor, Steven R. Henson, 57, was sentenced to life in prison Friday by federal courts after he was found guilty of illegally selling opioids that led to one of his patient’s death. The death of his patient, Nick McGovern, in 2015 was a result of intoxication of alprazolam and the opiate methadone — two deadly and highly addictive prescription drugs. U.S. District Judge Thomas Marten, who oversaw Henson’s sentencing, said that the doctor consistently avoided the truth with his patients, refusing to discuss drug addiction and instead re-filling opioid prescriptions at the patients’ request. “There was ample evidence that Henson was prescribing opioid medications in amounts likely to lead to addiction, and in amounts so expensive that the patients would likely be forced by economic circumstances to support their addiction by selling some of the drugs to others,” the judge said in the sentencing hearing.

The Rundown

Kaiser Health News Military doctors in crosshairs of a budget battle

Reuters Mumps, other outbreaks force U.S. detention centers to quarantine over 2,000 migrants

The Associated Press FDA approves 1st immunotherapy drug to treat breast cancer

The Boston Globe Most doctors don’t screen for dementia, but that may change in Massachusetts

The San Francisco Chronicle After daughter’s suicide, grieving parents denounce gaps in access to mental health care

Calendar

MONDAY | March 11

House and Senate in session.

Noon. 214 Massachusetts Ave NE. Heritage Foundation event on “Affirming Ethical Options for the Terminally Ill.” Details.

TUESDAY | March 12

10 a.m. 2154 Rayburn. House Committee on Oversight and Reform hearing on “Examining the Public Health Risks of Carcinogens in Consumer Products.” Details.

10 a.m. National Press Club. 529 14th St. NW. VA Secretary Robert Wilkie and Sanford Health CEO Kelby Krabbenhoft to announce precision medicine partnership. Details.

10:15 a.m. 2175 Rayburn. House Education and Labor Committee Subcommittee on Civil Rights and Human Services hearing on “Growing a Healthy Next Generation: Examining Federal Child Nutrition Programs.” Details.

Noon. 2123 Rayburn. Health and Human Services Secretary Alex Azar to testify about the agency’s budget before the House Energy and Commerce Committee. Details.

WEDNESDAY | March 13

March 13-16. American Bar Association 20th Annual Emerging Issues in Healthcare Law Conference. Agenda.

March 13-14. America’s Health Insurance Plans health policy conference. Agenda.

10 a.m. 2123 Rayburn. House Energy and Commerce Committee hearing on “Lowering the Cost of Prescription Drugs: Reducing Barriers to Market Competition.” Details.

2 p.m. 2358-C Rayburn. Health and Human Services Secretary Alex Azar to testify about the agency’s budget before the House Appropriations Committee. Details.

THURSDAY | March 14

March 14-15. Meeting of the Presidential Advisory Council on HIV/AIDS. Details.

10 a.m. Arkansas Medicaid work requirement oral arguments in the U.S. District Court for the District of Columbia. Kentucky oral arguments follow at 11 a.m.

10:15 a.m. 215 Dirksen. Health and Human Services Secretary Alex Azar to testify about the agency’s budget before the Senate Finance Committee. Details.