Daily on Healthcare: Trump to fight insurers over Obamacare in court today

Trump to fight insurers over Obamacare in court today. The Trump administration is heading to court to battle several Obamacare insurers over money owed under the controversial law. The U.S. Court of Appeals for the Federal Circuit is set to hear oral arguments Wednesday on whether insurers are owed money under Obamacare’s risk corridor program. The risk corridor program forces insurers who make a certain amount of profit to pay into a program that gives money to Obamacare insurers with steep losses. It was designed to help mitigate losses from insurers entering a totally new market when the law’s exchanges went online on the individual market. But the program, which expired in 2016, did not anticipate the massive, industry-wide losses under Obamacare, which meant that not enough money was going into the system to make payments to all of the insurers seeking reimbursement. For instance, in 2014 insurers asked for nearly $3 billion in payments but received only about $360 million. The Republican-controlled Congress, fearing that the program could become an open-ended bailout, required that the program pay out only as much money as it took in, ensuring the major shortfall couldn’t be plugged with taxpayer dollars.The now-defunct Land of Lincoln insurer is one of the insurers who sued the federal government. A lower court struck down that lawsuit, which was for $70 million, but another lower court ruled in favor of a lawsuit from Moda Health Plan, which received $216 million in a ruling that was appealed by the federal government. Some smaller insurers have cited risk corridors as a reason for leaving Obamacare altogether or shutting down, and the program still faces $12.3 billion in claims from insurers.

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Next spending bill unlikely to include Obamacare measures. The next spending deal to fund the government will not include measures intended to stabilize Obamacare, while lawmakers have not reached a deal on long-term funding for children’s health insurance. Sen. Susan Collins, R-Maine, said two bills aimed at stabilizing Obamacare’s insurance exchanges are not going to be in the deal. Meanwhile, talks continue on finding a long-term solution for the Children’s Health Insurance Program, which lawmakers from both parties want to get done but have not agreed on funding. Collins told the Washington Examiner Tuesday that she never looked at the next spending bill as the vehicle for the two Obamacare bills. Congress must pass a spending deal by Jan. 19 to avert a partial government shutdown, which likely could be another short-term continuing resolution.

Psychiatric association warns against diagnosing Trump without a medical exam. The American Psychiatric Association urged members of its profession to uphold its decades-long principle that psychiatrists should never offer diagnostic opinions about people they haven’t personally examined, in light of President Trump’s impending medical exam and questions about his mental fitness. “We at the APA call for an end to psychiatrists providing professional opinions in the media about public figures whom they have not examined, whether it be on cable news appearances, books, or in social media,” the group wrote. “Arm-chair psychiatry or the use of psychiatry as a political tool is the misuse of psychiatry and is unacceptable and unethical.” The rebuke came Tuesday as politicians and members of the media were ratcheting up their rhetoric about Trump’s mental health.

Trump’s HHS pick praises Obamacare repeal bill. President Trump’s nominee to serve as his top health official praised an Obamacare repeal plan, saying that it empowers states. Alex Azar, Trump’s pick to lead the Department of Health and Human Services, was before the Senate Finance Committee Tuesday for his second confirmation hearing. He was asked about his thoughts on an Obamacare repeal bill that some Republicans want to revisit this year. The bill led by Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C., fell short in late September because of insufficient support from GOP senators. Sen. Dean Heller, R-Nev., asked Azar about the bill that he also co-sponsors. Azar said the block grant portion was a positive element. “Right now we have the matching system where if a state comes up with more money it increases with the federal government,” he said. “It is not all their money.” He said a block grant would mean all the funding would be all under the direction of the states and would empower them to use it in better and more creative ways.

Manchin to support Azar, likely ensuring confirmation. Sen. Joe Manchin, D-W.Va., said he will support Azar’s nomination, ensuring a likely confirmation. The support from a Democrat helps Azar as the GOP has a narrower margin in the Senate this year after the swearing in of Sen. Doug Jones, D-Ala., who replaced Republican Luther Strange. The GOP now holds a 51-49 margin in the Senate, and Vice President Mike Pence can break a 50-50 tie. Azar has earned plaudits from Republicans for his tenure at HHS and was praised by Republicans at his confirmation hearing Tuesday. But Azar’s nomination has earned widespread disdain from Democrats, who are skeptical he will rein in high drug prices, citing his tenure leading the U.S. division of drug maker Eli Lilly.

Ryan to speak to March for life. House Speaker Paul Ryan will address the annual March for Life rally in Washington D.C. this month, the organizers announced Wednesday. Ryan, R-Wis., is among a handful of lawmakers scheduled to speak at the Jan. 19 event that starts with a march from the National Mall to the Supreme Court. “It is an honor to have Speaker of the House Paul Ryan address the 45th annual March for Life,” Jeanne Mancini, the march president, said in a statement. “Speaker Ryan has been an unwavering champion for the pro-life cause since taking office, and continues to utilize his post to promote the inherent dignity of the human person at all stages of life.”

New Hampshire Democrats call for $25 billion to tackle opioid epidemic. New Hampshire’s Democratic senators want $25 billion to be spent over two years to stave off tens of thousands of overdoses from heroin and prescription painkillers. Sens. Jeanne Shaheen and Maggie Hassan say they would like to see the funding included in a spending deal being worked out between Congress and the White House. Shaheen told reporters that they are working to bring along support from other Democrats but had not talked to the White House about their proposal. The call for greater funding comes as drug overdoses have contributed to a decreased life expectancy in the U.S. Opioid overdoses, in particular, killed 42,249 people in 2016, according to mortality data from the Centers for Disease Control and Prevention.

Major insurer leaves top insurance group. Insurance giant Humana is leaving the top insurance lobby America’s Health Insurance Plans, the latest big insurer to leave the group in the past several years. Humana joins Aetna and UnitedHealth in leaving the group over the past several years, sparking major questions over the clout of the top insurance lobbying group. The insurer told the Washington Examiner it has not participated in AHIP since early 2017. AHIP responded that Humana’s exit was due to a business decision “as opposed to any difference in policy,” said spokeswoman Kristine Grow. She said the group still has the majority of insurer giants in the fold and that it added 12 new members last year.

Hospitals to appeal court decision on drug pricing program. The American Hospital Association, the Association of American Medical Colleges and America’s Essential Hospitals on Tuesday notified the U.S. District Court for the District of Columbia that they intend to appeal the Dec. 29 decision that dismissed their lawsuit that sought to stop cuts to a drug discount program. The program, known as the 340B Drug Pricing Program, requires drug companies to give certain hospitals discounts for some drugs because they serve a large number of low-income patients and the hospitals are reimbursed by Medicare. The program under a final rule by the Centers for Medicare and Medicaid Services is set to undergo reductions in Medicare payments by about 30 percent, or $1.6 billion. The lawsuit says the final rule violates the law and should be set aside under the Administrative Procedure Act as unlawful and as an overreach by the HHS secretary. A judge previously dismissed the lawsuit because the cuts hadn’t occurred but did not rule on the merits of the argument.

CMS announces new bundled payment model. The voluntary program would allow medical providers to earn more payments if all the expenditures for a patient fall under a spending target that also results in better quality. The intent is to not only improve care for patients but also to reduce the amount of unnecessary care they receive. The program, called Bundled Payments for Care Improvement Advanced, was announced Tuesday by the Innovation Center at CMS.  “BPCI Advanced builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and towards paying for value,” CMS Administrator Seema Verma said. “Under this model, providers will have an incentive to deliver efficient, high-quality care.” The program will start Oct, 1 and run through December 31, 2023.

Families of diplomats attacked in Cuba may not get full medical care. Family members who were hit by the mysterious attacks on diplomatic personnel in Cuba last year might not receive comprehensive medical care, a senior State Department official acknowledged Tuesday. “There may be some limitation to family members,” Dr. Charles Rosenfarb, the medical director at the State Department’s Bureau of Medical Services, told a Senate panel. “Typically what happens is, employees who are injured in the course of duty would be covered by the workers’ compensation law, and family members would not be.” Sen. Bob Menendez, D-N.J., told Rosenfarb to report back on how Congress should authorize additional care to the affected individuals. “I think you want to send a global message to our men and women abroad that if they are attacked, they will be taken care of,” he said. The uncertainty about medical care for family members is just the latest question pertaining to a series of attacks on U.S. diplomats stationed in Havana. Twenty-four people were harmed between late 2016 and August 2017, prompting Secretary of State Rex Tillerson to cut the U.S. presence in the country to emergency levels. State Department officials still cannot explain the nature of the attacks, while lawmakers are frustrated at the government response.

RUNDOWN

Axios People spend their tax refunds at the doctor

The Hill Obamacare repeal fades from priorities list in the new year

STAT News Faced with public pressure, research institutions step up reporting of clinical trial results

Roll Call Healthcare overhaul appears unlikely before midterm elections

Kaiser Health News A poor neighborhood in Chicago looks to Cuba to fight infant mortality

Los Angeles Times Parents agonize over their kids’ health insurance as CHIP remains in doubt

Associated Press Trump faces presidential fitness test amid raised concerns

NPR Desperate cities consider ‘safe injection’ sites for opioid users

Wall Street Journal Tillerson orders review of U.S. response to mysterious illnesses in Cuba

Calendar

THURSDAY | Jan. 11

Jan. 8-11. San Francisco. 36th annual JP Morgan conference. Details.

Jan. 11-12. 1300 Pennsylvania Ave NW. MedPac January public meeting. Details.

8:30 a.m. Kaiser Family Foundation. 1330 G St. NW. Event on “Health Reform 2020: Towards Affordable, Quality Care for All Americans.” Details.

FRIDAY | Jan. 12

Walter Reed National Military Medical Center. President Trump to undergo routine medical exam. Details.