Daily on Healthcare: Senate debates keeping community rating…Momentum grows in Senate for longer Medicaid phaseout

Senate debates keeping community rating. Sen. John Thune, R-S.D., said Wednesday that community rating is still under discussion. “There are still conversations about it,” he said. “What we are gonna do with this is try to find a consensus.” Some senators were reluctant to take a firm stance against letting states opt out of community rating. Sen. John Cornyn, R-Texas, the second-ranking GOP senator, said that was “a very good question and I haven’t given much thought to it.” When asked whether he supports giving states the option, Sen. Tim Scott, R-S.C. pivoted to ongoing negotiations. “I think the waiver conversation is going to be a meaningful conversation, one that we haven’t concluded on,” he said Wednesday. But some Republicans said they are unwilling to eliminate the community rating. Sen. Dean Heller, R-Nev., told reporters Thursday that he would “tend not to support” letting states opt out of community rating or the requirement that insurers cover 10 essential health benefits such as hospitalization. Sen. Bill Cassidy, R-La., also said that he supported continuing the community rating.

Momentum grows in Senate for longer Medicaid phaseout. Republicans are fervently trying to find a consensus on Medicaid so they can vote on healthcare reform before leaving for Congress’ August recess. A small but growing bloc is trying to persuade leadership to go with a seven-year phaseout of the Medicaid expansion compared with a three-year phaseout preferred by GOP leaders. Sen. Dean Heller of Nevada is the latest centrist Republican to say he supports a seven-year phaseout. Leadership needs centrist votes, but a GOP lawmaker told the Washington Examiner that Senate leaders want only a three-year phaseout as opposed to seven. Sen. Pat Toomey, R-Pa., pushed back when asked to comment on whether the talks are moving toward moderating the House bill. “I am not convinced that is an accurate characterization at this point,” he said. “I am not sure I would agree with the premise.”

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.

Problems with the parliamentarian? Republicans thought they got a good bill of health from the Senate parliamentarian on the American Health Care Act. However, Politico is reporting that the parliamentarian hasn’t given a clear ruling on anti-abortion restrictions in any tax credits for lowering insurance costs. The Senate parliamentarian declared there were no fatal flaws in the AHCA and that it can use reconciliation, which lets a budget bill be approved by 51 votes. But Democrats contend that the parliamentarian hasn’t ruled on the full bill, only on a portion affecting Native Americans. Republicans admitted in Politico there is no clear ruling on language that prevents tax credits from paying for abortion. The language, which conforms with the Hyde Amendment that prohibits federal funds from funding abortions, is important to anti-abortion groups.  

Trump blamed for insurer exits: Fewer insurers will be participating in Washington state’s 2018 exchange, called Washington HealthPlanFinder, leaving 3,346 residents in Grays Harbor and Klickitat without subsidized insurance options next year, according to the Washington commissioner’s office. Pam MacEwan, CEO for the exchange in the state, said the agency was disappointed with the filing proposals that were submitted this week. “While we are seeing a number of carriers returning this year, we also were dismayed by the role federal uncertainty played into the decision of others to discontinue offering products or scale back their existing service areas,” she said. The exchange in Washington, she said, was otherwise seen as stabilizing.

GOP senators urge Price to end restrictions on short-term insurance: In a letter to the HHS secretary, 14 senators have asked for short-term insurance plans to go back to being allowed to cover people for 364 days, rather than the 90-day limit placed on short-term insurance by the Obama administration. The regulation was put into effect under Obama because the administration feared that healthier enrollees would be targeted for such plans, which are cheaper and do not have comprehensive benefit requirements, leaving only sicker enrollees to buy insurance from the exchanges and resulting in an unbalanced risk pool. In their letter, senators said people needed more options for coverage because insurers are fleeing the exchanges. “As the Trump administration continues to work on repairing the damage caused by the Affordable Care Act, we must consider solutions that will increase consumer choice in the healthcare markets and, ultimately, decrease healthcare costs,” the senators wrote. “As health insurers continue to leave the Obamacare exchanges, consumers need more, not fewer, options for health insurance. Reversing this regulation will provide consumers with an important option for health coverage.”  

HHS asks for suggestions on changes to Obamacare: The agency said the regulations should offer consumers more choice, stabilize the exchanges, increase affordability and give more authority to states to regulate insurance. The public comment period will last 30 days.  The FDA asked a drug maker to remove opioid from the market, saying that its benefits no longer outweigh its risks. The medication, Endo Pharmaceutical’s reformulated Opana ER, has been abused by people who snort and inject it, a behavior that has been associated with a serious outbreak of HIV and hepatitis C, a liver disorder, as well as a blood disorder. “We are facing an opioid epidemic – a public health crisis, and we must take all necessary steps to reduce the scope of opioid misuse and abuse,” Dr. Scott Gottlieb, FDA commissioner, said in a statement about the agency’s decision on Endo. “We will continue to take regulatory steps when we see situations where an opioid product’s risks outweigh its benefits, not only for its intended patient population but also in regard to its potential for misuse and abuse.” In a statement, Endo said that it had received the request and was reviewing it. The company said it was committed to reducing misuse of its products and that the request was not indicative of the product’s safety or effectiveness when taken as prescribed.

A sign of things to come? It is not clear if the FDA is going to call on more opioid makers to remove products due to abuse issues. It is pretty rare for the FDA to remove a drug for safety or effectiveness reasons. Zachary Brennan with the Regulatory Affairs Professionals Society noted that a review of drugs from 2006 to 2015, there were 149 withdrawals, nine of which due to safety or effectiveness issues. Another important piece of context is that the FDA is still approving opioids. It approved the drug RoxyBond back in April.

Democrats seek drug prices hearing: Democrats are asking for a House hearing on high drug prices as their legislative efforts have fell on deaf ears in Congress. Every Democrat on the House Energy and Commerce Committee sent a letter to Chairman Greg Walden, R-Ore., to hold a hearing on drug prices. The panel pointed to a hearing scheduled next week in the Senate Health, Education, Labor and Pensions Committee on drug prices. The request comes as Democrats have had little progress on legislative reforms such as letting Americans buy cheaper drugs from Canada and giving Medicare the power to negotiate for lower drug prices. Drug prices are likely to be addressed somewhat in the upcoming user fee reauthorization legislation for the Food and Drug Administration. Amendments to speed up the generic drug approval process seem likely to make it into the final version.

FDA approves first generic of drug that prevents from HIV infection: Gilead’s Truvada, a form of pre-exposure prophylaxis, received approval for the generic version of its drug Friday. Its brand-name drug was first approved in 2012.

Zika caused serious birth defects in 120 babies in US territories. According to a CDC report released Thursday, data show that in the U.S. territories women infected during early pregnancy have a roughly 8 percent chance of having a baby with birth defects. Scientists reviewed 2,549 women who were possibly infected with Zika who had completed pregnancies; 2,464 resulted in live births while the others resulted in miscarriage, stillbirth or abortion. Of the total number of pregnancies, 1,508, or about 60 percent, had confirmed Zika infection. Of pregnancies affected in the second trimester, 5 percent resulted in birth defects and 4 percent were affected in the third trimester. The findings, published in the CDC’s Morbidity and Mortality Weekly Report, reviewed cases from American Samoa, Puerto Rico, Micronesia, the Marshall Islands and the U.S. Virgin Islands, from Jan. 1, 2016, to April 25, 2017.

RUNDOWN

Axios The big business of health savings accounts

The Hill Insurers exit Obamacare in two Washington counties

Washington Post Why Mitch McConnell wants to pass a healthcare overhaul

Kaiser Health News Quantity over quality? Minorities shown to get an excess of ineffective care

New York Times A key Republican demands subsidies to calm insurance markets

Politico Senate GOP finds a new problem for every one resolved on Obamacare repeal

CNN Even amid Comey probe, Democrats see healthcare as their big winner

STAT News Expert panels that develop depression treatment guidelines had industry ties

Calendar

SATURDAY | JUNE 10

June 10-June 14. Hyatt Regency Chicago. American Medical Association Annual Meeting. Agenda.

TUESDAY | JUNE 13

June 13-15. Rancho Palos Verdes, California. Goldman Sachs Global Healthcare Conference. Details.

8:30 a.m. State Room. Boston. The Atlantic conference on “Pulse: On the Front Lines of Health Care,” will explore topics ranging from policy and the economy to global public health and the future of biotechnology. Details.

8 a.m. 1777 F St. NW. Event hosted by The Hill on “Prioritizing Patients: A Discussion on Outcomes-Based Care,” with Sen. Bill Cassidy, R-La., and Rep. Doris Matsui, D-Calif. Details.

10 a.m. Dirksen 430. Senate HELP committee meeting on “The Cost of Prescription Drugs: How the Drug Delivery System Affects What Patients Pay. Details.

2:30 p.m. Dirksen 628. Senate Indian Affairs Committee will review bills involving the Indian Health Service and housing for Veterans Affairs. Details.

WEDNESDAY | JUNE 14

9 a.m. 1775 Massachusetts Ave. NW. Brookings Institution. Fostering competition in the pharmaceutical distribution chain. Details.

10:14 a.m. 2322 Rayburn. House Energy and Commerce hearing on CHIP reauthorization. Details.

2:30 p.m. Dirksen 106. Special Committee on Aging Hearing on “Military Caregivers: Families Serving for the Long Run.” Details.