SIGN UP! If you’d like to continue receiving Washington Examiner’s Daily on Healthcare newsletter, SUBSCRIBE HERE: http://newsletters.washingtonexaminer.com/newsletter/daily-on-healthcare/

States to fight low-cost health plans: A group of 13 states is fighting the Trump administration’s push to expand access to cheap, low-quality health plans that skirt Obamacare’s insurance regulations. “The Trump administration’s rule is nothing more than an end run around the consumer protections enshrined in the Affordable Care Act, part of President Trump’s continued efforts to sabotage the ACA,” said New York Attorney General Eric Schneiderman, who is leading the effort with Massachusetts Attorney General Maura Healey. The Democratic attorneys general commented Wednesday on a proposed rule to expand access to association health plans, which small employers and individuals band together to buy. The plans do not have to abide by Obamacare regulations requiring plans sold on the law’s marketplaces to cover benefits such as maternity care and mental health and prohibiting them from charging sicker people more money. The Trump administration has said the rule will help give people an opportunity to avoid high premiums on the exchanges. The states joining New York and Massachusetts are California, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maryland, New Jersey, Oregon, Pennsylvania and Vermont.

Health Chairman Roskam says Republicans must address ‘structural flaw’ that led to failure of Obamacare repeal and replace. Rep. Peter Roskam, R-Ill., who recently became chairman of the health subcommittee on the House Ways and Means Committee, has spent some time reflecting on why the GOP succeeded in passing a tax bill but failed in efforts to repeal and replace Obamacare. “I came to appreciate the amount of time it takes to normalize a concept,” Roskam said in a meeting with the Washington Examiner Wednesday. He argued that heading into 2017, Republicans never did the “hard work” of building consensus around an aspirational bill that could be the starting point for discussions as they tried to formulate a strategy for getting legislation through Congress, making for a “structural flaw” that doomed the healthcare effort. “The Obamacare debate was all about repeal, repeal, repeal, and the replace discussion would quickly lapse into platitudes.” Roskam said he aims to change this, but said that realistically, it isn’t going to happen in this Congress. Schedule-wise, only a few months are left before the August recess, and after that, lawmakers will be in campaign mode.

In 2018, Roskam says Ways and Means will focus on these two initiatives. Roskam said given the limited timeline for the remainder of this Congress, the health subcommittee would be focusing on two initiatives. One is to work on coming up with the healthcare equivalent of the Miscellaneous Tariff Bill, a bipartisan effort to make technical changes to clean up unnecessary or outmoded tariffs that are on the books. Translated to healthcare, it would mean looking at regulations or policies that drive up costs without improving care. The other initiative is to look at the “very mixed signals” that Medicare sends on opioids — by reimbursing for painkillers that are opiates. The committee is looking into ways Medicare could offer more flexibility to other forms of pain management.

Welcome to Philip Klein’s Daily on Healthcare, compiled by Washington Examiner Managing Editor Philip Klein (@philipaklein), Senior Healthcare Writer Kimberly Leonard (@LeonardKL) and Healthcare Reporter Robert King (@rking_19).  Email [email protected] for tips, suggestions, calendar items and anything else. If a friend sent this to you and you’d like to sign up, click here. If signing up doesn’t work, shoot us an email and we’ll add you to our list.

FDA chief criticizes insurers, drug plans for ‘shell games’ on pricing. Food and Drug Administration Commissioner Scott Gottlieb is accusing health insurers, drug plans and drug companies of collaborating on a “rigged payment scheme” that he said gets in the way of patients having access to cheaper medicines. “It’s time to stop the shell games over drug pricing, and start competing on delivering better health outcomes,” Gottlieb at the National Health Policy Conference for America’s Health Insurance Plans in Washington, which is a large conference with insurers. Gottlieb focused on patient access to biosimilars, which are generic versions of complex biologic drugs that have proteins or use byproducts of living cells. Biologics tend to treat rare genetic disorders, autoimmune diseases, and cancer. Gottlieb said the price of their generics hasn’t been as low as traditional generics because the field is newer, so insurers don’t tend to promote that doctors prescribe them. As a result, drug companies are reluctant to spend hundreds of millions of dollars in investment toward them. Gottlieb singled out the cause of high prices, as well, on deals that biologic developers have made with insurers and with pharmacy benefit managers in which they agree to cover a brand-name drug over its generic in exchange for discounts or rebates, a price saving that isn’t passed on to patients or to employers that pay for health insurance. “Everybody wins. The health plans get the big rebates. The PBMs get paid on these spreads. And branded sponsors hold onto market share,” Gottlieb said. “Everyone, that is, but the patients.”

Justice Department will use ‘all available tools’ to fight opioids. Deputy Attorney General Rod Rosenstein, also speaking before the AHIP conference, laid out the ways that his agency is working to combat the opioid epidemic, including by going after illegal drug distributors and pharmaceutical companies. The goal is to halt the increase of addiction and overdoses this year, he said. “We are confident that we can achieve that. We don’t need to accept the continued upward curve.” He pointed to over-prescription of painkillers by doctors. “The misuse contradicts the fundamental pledge of the medical professions: ‘First do no harm.’ Those drugs have caused a lot of collateral damage.” About a quarter of the treatment associated with opioid addictions will be paid for by insurers, Rosenstein said.

Idaho Blue Cross argues state Obamacare plans are legal. The lawyer representing Idaho Blue Cross told the Trump administration that Idaho’s plan to sell coverage that does not abide by Obamacare’s mandates is “entirely legal.” In a letter sent Tuesday to the Department of Health and Human Services, outside counsel Anthony Shelley wrote that Obamacare “did not contemplate [states] enforcing [the law] to a high degree or completely or rigidly,” arguing that states had some latitude to make changes to health insurance provisions. Shelley, from the law firm Miller & Chevalier, outlined various reasons that the firm believes Idaho’s proposal to overhaul the individual market fits Obamacare’s requirements. He said the state was enforcing Obamacare “substantially” with its proposal and that the deterioration of the exchanges had forced Idaho to act, arguing that doing so would help further Congress’ goal of getting more people insured.

Healthcare groups press for Obamacare stabilization bills. Major groups representing doctors, hospitals, insurers and businesses are urging Congress to pass two Obamacare stabilization bills. The groups sent a letter to congressional leaders Tuesday supporting a bill that would hand out Obamacare insurer payments and give states $10 billion over two years to help prop up Obamacare insurers. The letter comes as congressional appropriators are deciding what to put in a two-year spending bill that lawmakers are expected to vote on this month. “Immediate action is necessary to reduce premiums for individuals and families that purchase coverage on their own,” the letter said. Insurance lobby America’s Health Insurance Plans, American Academy of Family Physicians, American Benefits Council, American Hospital Association, American Medical Association, Blue Cross Blue Shield Association, Federation of American Hospitals and the U.S. Chamber of Commerce signed on to the letter.

Dirty needles and wasteful spending: Watchdog finds massive failures at DC VA hospital. Department of Veterans Affairs officials mismanaged a Washington medical center so badly over “many years” that providing safe care to veterans became a “challenge,” the agency’s inspector general wrote in a scathing report made public Wednesday. The dysfunction spread from wasteful spending and shoddy record-keeping to unsterile surgical conditions that put patients at risk, according to the VA watchdog. Dirty medical tools caused “avoidable hospitalizations” for some veterans and forced others to remain under anesthesia for “prolonged” periods of time while VA employees scrambled to find usable surgical supplies.

Oklahoma governor directs health agency to write work requirements for Medicaid. Arizona Gov. Mary Fallin on Tuesday issued an executive order directing the Oklahoma Health Care Authority to develop a work requirement for Medicaid. The order specifies that the department must file a waiver within six months to the governor and to the legislature. “We in Oklahoma should require people who receive Medicaid assistance to work, if they are able,” Fallin said. “A core objective of the Medicaid program is to help low-income families and individuals attain capability for independence. Work requirements in other welfare programs have helped move individuals from welfare to work.” Fallin proposed exemptions for people who are physically unfit for employment, for pregnant women, caregivers, parents with a dependent child under the age of 6, and people receiving treatment for addiction.

CDC: Opioid epidemic worsens. New data on emergency room visits shows that the opioid crisis is worsening. From July 2016 to September 2017, emergency room visits for suspected opioid overdoses increased by 30 percent, according to data from the Centers for Disease Control and Prevention. “Long before we receive data from death certificates, emergency department data can point to alarming increases in opioid overdoses,” said CDC Acting Director Anne Schuchat. The data comes from 52 jurisdictions in 45 states, and CDC reported significant variations among states. For instance, emergency room visits in Delaware increased by 105 percent and in Pennsylvania by 81 percent over the same period. However, states such as Massachusetts, New Hampshire and Rhode Island saw slight decreases. In North Carolina, there was a 31 percent increase in emergency room visits, while Kentucky had a decrease of 15 percent. “The sharp increases and variation across states and counties indicate the need for better coordination to address overdose outbreaks spreading across county and state borders,” the CDC said.

Trump administration outlines new moves to boost access to electronic health records. The Trump administration started a government-wide initiative aimed to give patients more power over electronic health data in a move to make it easier to share records with doctors. Centers for Medicare and Medicaid Services Administrator Seema Verma announced a new tool as part of the initiative, which is called MyHealthEData, during a speech at the Health Information and Management Systems Society annual conference in Las Vegas. The tool, called Medicare’s Blue Button 2.0, is a secure way for Medicare beneficiaries to share medical information with a new doctor. “More than 100 organizations, including some of the most notable names in technological innovation, have signed on to use Medicare’s Blue Button 2.0 to develop applications that will provide innovative new tools to help those with patients manage their health,” CMS said.

Amazon to expand Prime membership to Medicaid beneficiaries. Amazon will offer discounted memberships for Amazon Prime to people on Medicaid, according to a report in Reuters. Amazon Prime costs $12.99 per month but customers that have a valid Medicaid card or Electronic Benefits Transfer would receive a discount of $5.99 a month. Amazon Prime offers free two-day shipping and a variety of other discounts. The company said this year it planned to expand discounted Prime memberships to people on government aid.

RUNDOWN

The Hill Opioid crisis spurs Medicaid funds push

Politico HHS official who spread conspiracy theories allowed back on job

Associated Press Prescription opioids fail rigorous new test for chronic pain

NJ.com As Trump ends Obamacare individual mandate, New Jersey is stepping in to reinstate it

Wall Street Journal CVS bets big with $40 billion bond sale

Kaiser Health News Crowded shelters and the vicious flu brew perfect storm for the homeless

CNN Mississippi could be the first state with 15-week abortion ban