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Hemophilia groups file civil rights complaint against Wellmark. The advocacy groups say that Wellmark, part of Blue Cross Blue Shield, is leaving Iowa’s Obamacare exchange to avoid paying the medical bills of patients with the disorder, including one patient whose medical bills amounted to $1 million a month. The complaint, filed with the Office for Civil Rights at the Department of Health and Human Servicess, says Wellmark violated Obamacare by preventing people with hemophilia from accessing coverage, first by selling plans only in certain counties in Iowa and then by declaring it wouldn’t sell these plans in the entire state for 2018. The complaint also accuses Wellmark of violating medical privacy laws by publicly disclosing information about the $1 million-a-month patient, because they identified him as a 17-year-old male. The National Hemophilia Foundation, the Hemophilia Federation of America and Hemophilia of Iowa, all of which filed the complaint, are asking the agency to “take all necessary steps to remedy Wellmark’s unlawful conduct.” The complaint does not specify what those remedies would be, but a HIPAA violation would result in fines.
A reminder about what happened to the patient in Iowa. A Wellmark official cited the example of the patient during a presentation in Des Moines to demonstrate an example of rising medical costs. The company, which has lost $99 million through the exchange, raised premiums by between 38 percent and 43 percent for this year. Minnesota-based Medica is the only insurer that has committed to selling plans on the exchange in Iowa for 2018, and it has asked for premium rates that are 45 percent higher than what customers paid this year.
One caveat: Wellmark has said it is open to re-entering the exchange in Iowa. But that’s only if the state approves a short-term solution it has proposed, which would include a federally funded reinsurance program. It’s not clear if the program will be approved by the Trump administration because it needs to fulfill several regulatory requirements first.
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Expected today: CBO report on impact if Trump cuts off insurer payments. The report, which is being prepared with staff from the Joint Committee on Taxation, will include projections about how cutting off the cost-sharing reduction subsidies would affect the federal budget, the stability of Obamacare exchanges and premiums, and whether it would increase the number of people who no longer have health insurance, according to a blog post on the nonpartisan budget scorekeeper’s website. A specific time for the report was not provided. Trump has not said if he will stop making the payments, but he has said he would consider the option as a way to bring Democrats and Republicans together to negotiate a healthcare deal. After failing to pass a bill that would repeal and replace portions of Obamacare, a handful of senators said they believed the funds should be appropriated through Congress and that they should move to do so when they return from their August recess.
A backup plan for CSRs: Have states pay them. If the Trump administration fails to commit to making the payments, states do have some options. Chief among them is making the payments themselves. States also could apply for a waiver from the federal government to fund and potentially profit from giving out the CSRs, according to a recent blog post in the journal Health Affairs. Under a 1332 innovation waiver, a state can modify or waive certain provisions of Obamacare. If the modifications result in any savings from cost-sharing reduction payments or tax credits to pay down premiums, then the state gets to keep those savings. Health Affairs pointed to a study from Covered California, the state-run Obamacare exchange. The study found that the federal government paid $750 million in CSR payments in 2016, but if it were to defund the CSRs then spending on tax credits would rise by $976 million since tax credits increase to meet any premium hikes. So if California were to set up its own CSR system, it would pay out $750 million but would receive $967 million from the federal government in saved tax credit payments. If the payments were ended, states would “have a viable, and potentially profitable, means of administering CSR payments to stabilize their insurance markets.”
Number of Obamacare’s ‘empty counties’ down to 16, for now. Centene moved to fill an empty county in Indiana on Monday, so for now people who live in 16 counties face the prospect of having no insurer to buy tax-subsidized coverage from next year, according to data from the Kaiser Family Foundation. This number could change if Trump ends cost-sharing reduction payments, or if Congress injects additional funding into the exchanges in a way that would make insurers confident that they would not suffer massive losses. According to the data, 8,429 people in the “empty counties” buy coverage from the exchange, compared to the roughly 11 million people who are in the exchange overall. What also stands out is that 14 of the “empty counties” are in Nevada, and are rural. State officials blamed federal instability, but also acknowledged that lack of access to providers and of contractual agreements has always been a problem for insurance carriers in Nevada’s rural areas. “It is challenging in these rural counties to achieve rates that are both adequate to the carrier and affordable to the consumer because of the higher provider cost in rural Nevada counties,” said Yeraldin Deavila, public information officer for the Nevada Department of Insurance. Staff officials are trying to encourage insurers to do business in these counties, and Deavila said they were “extremely hopeful.” Gov. Brian Sandoval is expected to hold a press conference Tuesday to address the issue.
More CEOs quit manufacturing council, and another healthcare CEO speaks out. Kenneth Frazier, CEO of pharmaceutical giant Merck, said Monday that he was leaving Trump’s American Manufacturing Council because of how the president failed to immediately single out white supremacist groups after Saturday’s violence in Charlottesville, Va. Though Trump on Monday afternoon delivered a statement in which he said “racism is evil” and specifically singled out the KKK, neo-Nazis and white supremacists, two other CEOs announced they also would be leaving the council. The first was Under Armour CEO Kevin Plank, who said on Twitter: “I joined the American Manufacturing Council because I believed it was important for Under Armour to have an active seat at the table and represent our industry. However, Under Armour engages in innovation and sports, not politics.” The second was Intel CEO Brian Krzanich, who said in a blog post that, “politics and political agendas have sidelined the important mission of rebuilding America’s manufacturing base.” Scott Paul, president of the Alliance for American Manufacturing, said Tuesday morning he also is resigning. The other healthcare executive on the council is Johnson & Johnson CEO Alex Gorsky, who hasn’t said anything about the incident. The CEO of Kaiser Permanente, Bernard Tyson, who is not on the council, made his views known. “The president should consistently demonstrate zero tolerance for white supremacy, neo-Nazi groups. We must be unwavering,” he tweeted Monday.
Martin Shkreli: I was targeted for being ‘flamboyant and personable.’ Shkreli, the drug CEO who was found guilty on two counts of securities fraud and one count of conspiracy to commit securities fraud, said Tuesday that he was told that he was targeted by government authorities because he was too “flamboyant.” “In fact, the SEC told me so, which is really remarkable,” Shkreli said on Fox Business. “There was one very senior person at the SEC who has now left, he’s at a big law firm, and he said to my lawyer that if I kept my mouth shut none of this would have happened,” he said. “I think it’s a sad day in this country where just being a flamboyant and personable figure results in somebody saying, ‘Oh, let’s look at that guy’s records and let’s see what we have on him,'” Shkreli said.
Experts: FDA may not be able to clear generic drugs faster. A new report from the Pew Charitable Trusts casts doubt on the feasibility of the Food and Drug Administration being able to approve generics within six months, as some bills in Congress are calling for. Already, a new law requires the FDA to approve a generic drug within eight months as opposed to the usual 10 months if the drug can compete with a high-priced version. FDA officials have said that it may be hard to review generics in less than eight months because of the time to takes to inspect manufacturing facilities, many of which are overseas, Pew said. “If the agency is required to act on some applications in less than eight months, FDA may not have adequate time to conduct any necessary facility inspections and communicate with sponsors to request clarifications or changes to the application,” according to a fact sheet from Pew. “This could increase the share of applications requiring multiple review cycles, which would lengthen the overall time to approval and delay access to generics.”
Police arrest man related to burglary of Dean Heller’s office. The Las Vegas Metropolitan Police Department arrested a 62-year-old man Monday in relation to a burglary at Republican Sen. Dean Heller’s Las Vegas office last month, where a threatening note was left behind about the senator’s position on Obamacare repeal. Richard Holley was arrested and booked in the Clark County Detention Center without bail, the police department said. He faces charges of extortion, burglary and intimidating a public officer, according to the Las Vegas Metropolitan Police Department. Heller voted against a bill to repeal and replace Obamacare as well as a bill to repeal Obamacare immediately and replace it later. But he did vote for a “skinny” repeal bill aimed at kickstarting talks with the House.
Trump appoints health expert to economic council. Dr. Tomas Philipson, who was appointed to the Council of Economic Advisers, is the Daniel Levin Public Policy chairman at the University of Chicago and director of the Health Economics Program of the Becker Friedman Institute. He was previously senior economic adviser to the commissioner of the FDA and the administrator of the Centers for Medicare and Medicaid Services. He received the Kenneth Arrow Award of the International Health Economics Association twice and was a co-founder of the consulting firm Precision Health Economics LLC.
South Carolina latest state to sue opioid maker South Carolina is suing the maker of popular painkiller Oxycontin for deceptively marketing the addictive opioid. The state is the sixth to sue an opioid maker for deceptive marketing, joining several counties and cities across the nation. South Carolina charges that Oxycontin maker Purdue Pharma from 2007 onward “significantly downplayed how addictive its opioids are and also overstated the benefits of opioids compared to other forms of pain management in order to increase its market share and profits,” according to Attorney General Alan Wilson.
Opinion: Congress needs to kill the medical device tax. The Senate’s inability to move forward on healthcare reform left behind one key provision that made sense both as sound economic policy and good health policy – repeal of the innovation-crushing and jobs-killing medical device excise tax. On behalf of American patients, their families, and manufacturers, it’s time to pivot and move this forward now. While Republicans’ years-long effort to reform the U.S healthcare system lingers, this issue is too urgent for us to wait. Time is running out for America’s device manufacturers, and the reality is that thousands of companies across the country will face an enormous tax increase at the end of the year if Congress doesn’t act – to the tune of $20 billion.
RUNDOWN
Modern Healthcare The switcheroo that could give McConnell enough votes to repeal Obamacare
Bloomberg What’s harder than making copycat biological drugs? Selling them
Talking Points Memo Trump’s HHS shrugs off question on future of Obamacare outreach
Atlanta Journal-Constitution Isakson faces frustrated voters at Kennesaw town hall
The Hill GOP senator meeting with White House on a new Obamacare repeal plan
Associated Press Bernie Sanders to offer Medicare-for-all plan soon
Politico Cecile Richards to Democrats: Stand firm on abortion
USA Today Poisonous drinking water putting millions in U.S. at risk
Calendar
TUESDAY | Aug. 15
Congressional Budget Office expected to release an estimate of the effect of ending cost-sharing reduction payments.
Aug. 15-16. Crowne Plaza Atlanta Perimeter at Ravinia, Atlanta. Centers for Disease Control and Prevention National Conference. Details.
Aug. 15-16. Washington Plaza Hotel, 10 Thomas Circle NW. Office of the National Coordinator for Health Information Technology holds forum on “Beyond Boundaries: ONC’s 2017 Technical Interoperability.” Details.
Aug. 15-17. Hyatt Regency Atlanta Hotel. National Conference on Health Communication, Marketing and Media. Details.
2 p.m. EST. Nevada Gov. Brian Sandoval to issue an announcement about empty counties in the state’s Obamacare exchange.
Noon MDT/2 p.m. EST. University School Auditorium. 6519 W. 18th St., Greeley, Colo. Sen. Cory Gardner, R-Colo., to hold town hall. Details.
12:30 p.m. CST/1:30 p.m. EST. Washington High School Auditorium. 1111 S. B Ave, Washington, Iowa. Sen. Joni Ernst, R-Iowa, to hold town hall. Details.
12:30 p.m. HST. Kualapuu Community Center. 1 Uwao St, Ho’olehua, Hawaii. Sen. Brian Schatz, D-Hawaii, to hold town hall. Details.
3:30 p.m. MDT/5:30 p.m. EST. Colorado Christian University. 8787 W. Alameda Ave., Lakewood, Colo. Sen. Cory Gardner, R-Colo., to hold town hall. Details.
7 p.m. Chase Elementary School. 40 Woodtick Rd. Waterbury, Ct. Sen. Chris Murphy, D-Ct., to hold town hall. Details.
6 p.m. PST/9 p.m. EST. Gonzaga University. Sen Maria Cantwell, D-Wash., to hold town hall. Details.
WEDNESDAY | Aug. 16
9:30 a.m. CST/10:30 a.m. EST. 1903 N. Walnut St., Cameron, Mo. Cameron Regional YMCA. Sen. Claire McCaskill, D-Mo., to hold town hall. Details.
1:30 p.m. CST/2:30 p.m. EST. Chillicothe Municipal Utilities. 920 Washington St. Chillicothe, Mo. Sen. Claire McCaskill to hold a town hall. Details.
3 p.m. CST/4 p.m. EST. Colby Community College. 1255 Range Ave. Colby, Ks. Sen. Jerry Moran, R-Ks., to hold a listening tour. Details.
3:30 p.m. CST/4:30 p.m. EST. Grundy County Public Library. 1331 Main St. Trenton, Mo. Sen. Claire McCaskill, D-Mo., to hold town hall. Details.
6:30 p.m. Edmund Town Hall. 45 Main St. Newtown, Ct. Sen. Chris Murphy, D-Ct., to hold town hall. Details.
THURSDAY | Aug. 17
9 a.m. PST/Noon EST. USC Caruso Center. Los Angeles. National Hispanic Medical Association leadership summit on “Cardiovascular Disease and Hispanics.” Details.
MONDAY | Aug. 21
9 p.m. House Speaker Paul Ryan to appear in CNN town hall. Details.
