Tagged Health Industry

Policy Thoughts: Much Is At Stake As The House Approaches A Vote On The GOP Health Bill

Editorial pages across the country are full of tough talk for the American Health Care Act and challenges for the Republican Party.

USA Today: The Republican Reckoning On Health Care
Ronald Reagan wanted to shrink the government and Bill Clinton said the era of big government was over. But their talk was premature. There was still one great task for the world’s wealthiest, most powerful nation to accomplish, and that was to make sure all Americans could get health care. The Affordable Care Act has put us closer to that goal than we’ve ever been, yet President Trump and many in the Republican Party appear determined to reverse these gains. Why? It sure seems like it’s because they’re wedded to ideological purity, the fantasy of a skeletal government, and a cruel political tactic (rip out “Obamacare” root and branch) that has outlived its purpose. (Jill Lawrence, 3/21)

The Wall Street Journal: A Defining Health Vote
The House health-care bill is gaining momentum, and on Monday night the GOP posted amendments meant to add fence-sitters to the coalition. Don’t discount the stakes: The vote scheduled for Thursday is a linchpin moment for this Congress, and a test of whether the GOP can deliver on its commitment to voters. (3/21)

The Wall Street Journal: The GOP Is Out Of Excuses On Health Care
Although this week got off to a crackling start with high-profile hearings on Judge Neil Gorsuch’s Supreme Court nomination and potential Russian interference in the 2016 presidential election, the event with the largest consequences for the Trump administration and the Republican congressional majority occurs on Thursday. That’s when the full House takes up legislation to repeal and replace the Affordable Care Act. (William A. Galston, 3/21)

San Francisco Chronicle: Trump’s Orgy Of Unnecessary Cruelty 
Next comes the House Republican plan, which Trump enthusiastically supports, to repeal the Affordable Care Act and replace it with a system that will cause 14 million Americans to lose their health insurance next year, and 24 million by 2026, according to the Congressional Budget Office. How does Trump justify this human hardship? The plan barely makes a dent in the national debt. It cuts the federal budget deficit by only $337 billion over the next 10 years — a small fraction of the national debt. (Robert Reich, 3/21)

Atlanta Journal-Constitution: Trumpcare, A Bullhorn Touting Its Scorn For The Poor
The poor can be safely ignored largely because they allow themselves to be split along tribal lines of creed and color and kept at one another’s throats. Then they are nickled and dimed and robbed damn near blind by monied interests and their political henchmen. The new health care bill is a prime example. (Leonard Pitts, 3/22)

USA Today: GOP Should Slow Down And Rethink Health Bill
Exactly seven years ago Thursday, after decades of effort to make health care available to all Americans, the Affordable Care Act was signed into law. Now, in what House Speaker Paul Ryan calls “an act of mercy,” the House is planning an anniversary vote to repeal it and, in addition, to radically alter the Medicaid program that has been a staple of the national safety net since the 1960s. For members of Congress, this is one of the most consequential votes they might ever face. (Andy Slavitt, 3/22)

Los Angeles Times: House Republicans Are Hoping The Senate Can Save Them From Their Own Ruinous Healthcare Bill
The House GOP leadership has aligned itself so closely with President Trump on healthcare, it’s borrowing his signature sales tactic as it tries to ram through a bill this week to “repeal and replace” Obamacare: the bold but empty promise. Specifically, it’s promising House Republicans a solution to their concerns about drastically increasing insurance premiums for millions of older Americans, but leaving the Senate to figure out how to deliver it. (Jon Healey, 3/21)

The Washington Post: Who Gets Blamed If The House Doesn’t Pass The AHCA
No great political acumen or psychology degree is necessary to conclude that President Trump is highly susceptible to flattery. It’s little wonder then that House Speaker Paul D. Ryan (R-Wis.), desperate to pass GOP health-care reform or at least not be blamed if it fails, keeps talking about what a terrific “closer” Trump is. (Jennifer Rubin, 3/21)

The New York Times: What’s At Stake In A Health Bill That Slashes The Safety Net
What do we lose when social insurance unravels? It is startling to realize just how much the social safety net expanded during Barack Obama’s presidency. In 2016, means-tested entitlements like Medicaid and food stamps absorbed 3.8 percent of the nation’s gross domestic product, almost a full percentage point more than in 2008. (Eduardo Porter, 3/21)

The New York Times: Fewer Americans Would Be Insured With G.O.P. Plan Than With Simple Repeal
The Congressional Budget Office recently said that around 24 million fewer Americans would have health insurance in 2026 under the Republican repeal plan than if the current law stayed in place. That loss was bigger than most experts anticipated, and led to a round of predictable laments from congressional Democrats — and less predictable ones from Republican senators, including Bill Cassidy of Louisiana and John Thune of South Dakota, who told reporters that the bill needed to be “more helpful” to low-income people who wanted insurance. (Margot Sanger-Katz, 3/21)

Axios: Why Deductibles Would Rise Under The GOP Health Care Plan
Health care is complicated, as the president has discovered. But here is one thing that is not so complicated: if people have modest means and limited tax credits, and coverage is expensive, they will mostly buy health plans with lower premiums — and high deductibles. This is what is likely to happen under the GOP health care bill, the American Health Care Act. Only people who need more health care will stretch for more generous coverage. If that happens, those health plans will draw too many sick people, causing insurance companies to stop offering them for fear of losing money. That would leave mostly the low-premium, high-deductible plans. (Drew Altman, 3/22)

The New York Times: A Republican Health Care Bill In Search Of A Problem
Republican leaders in the House have been huddling over the last few days in a frantic search for enough votes to win passage of their proposed revision of Obamacare, in the process making an already flawed bill even worse. One measure of their desperation was a cynical last-minute provision that would shift Medicaid costs from New York’s rural and suburban counties to the state government, pleasing upstate Republicans who represent those counties but reducing coverage provided by the state. (3/21)

The Charlotte Observer: What You Need To Know About Medicaid This Week
Per capita caps on Medicaid beneficiaries? Block-granting Medicaid? Do these wonky and innocuous-sounding proposals really make any difference? They do. The American Health Care Act – the Republicans replacement for Obamacare – is scheduled for a vote this week in the U.S. House. You will hear much discussion about the individual insurance marketplace, tax credits, and promotion of health savings accounts. However, the changes in Medicaid are the most profound in the AHCA. (Jessica Schorr Saxe, 3/21)

Bloomberg: Better Health Care for Less Money? It’s Not Easy
“America spends more on health care than other rich nations, but has lower life expectancy.” If I had a nickel for every time I have been informed this by an email, seen it in a headline, heard it in conversation, or watched it scroll across my social media feed, I would be able to personally fund a single-payer health-care system. (Megan McArdle, 3/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Perspectives: FDA Nominee’s Laissez-Faire Regulatory Posture Bad For Public Health

Read recent commentaries about drug-cost issues.

Stat: Scott Gottlieb’s Fervor For Deregulation Could Harm Patients
The Senate will soon begin the process of considering President Trump’s nomination of Dr. Scott Gottlieb, who has close professional and financial ties with the pharmaceutical and biotechnology industries, for commissioner of the Food and Drug Administration. A trial that began in a federal courtroom in Boston in January is a timely reminder of how the laissez-faire regulatory posture that Gottlieb is expected to promote can harm the public’s health. (Renee M. Landers, 3/16)

The Hill: Trump’s Nominee To Lead FDA Could Make Drug Prices Low Again
President Trump is neither a fan of regulation nor high drug prices. So it is no surprise that his nominee to head the Food and Drug Administration, Scott Gottlieb, is a candidate sent straight from central casting. Gottlieb, who is himself a doctor, American Enterprise Institute scholar, and former deputy commissioner of the FDA under President George W. Bush, has long been on record as a critic of the FDA’s overly risk-averse approach to approving new drugs and generic forms of existing ones. (Mytheos Holt, 3/17)

Stat: My Child Is Fighting A Rare Disease. A ‘Streamlined’ FDA Won’t Help Her
My 4-year-old daughter, Elle, is in the fight of her life. Her older sister, Milla, lost her fight last November. Their opponent? Batten disease, a rare, fast-moving, and fatal condition that destroys the central nervous system’s ability to function. Elle has a chance to help manage, or maybe even beat, her disease that Milla didn’t have: a clinical trial in which an investigational protein is infused directly into Elle’s brain every 14 days. (Frazer Gieselmann, 3/17)

Stat: Here’s One Drug Safety Rule The FDA Should Enact — Quickly
Next month, the Food and Drug Administration is likely to miss another target date for implementing a rule to improve generic drug safety. If that happens, the American public will lose. The rule is important because it addresses a maddening quirk in the law. Right now, brand-name drug makers can change product labels after learning about potentially harmful side effects. But generic companies cannot do the same thing — unless such a change has already been made to the corresponding brand-name drug. (Ed Silverman, 3/20)

Bloomberg: There’s A Middle Ground In Amgen’s Drug-Price Battle
The February news that Amgen Inc.’s cholesterol-lowering drug Repatha helped prevent heart attacks was one of the most exciting biotech events of the year, renewing faith in the drug’s blockbuster potential. But the full trial results behind that headline, which Amgen released on Friday, disappointed investors, sinking the company’s shares more than 6 percent.  (Max Nisen, 3/20)

Bloomberg: PTC Sticks Its Face In A Drug-Pricing Wasps’ Nest
It’s generally considered good sense to give wasps’ nests a wide berth. But PTC Therapeutics Inc. just paid $140 million in cash and stock for the pleasure of sticking its face in one.  PTC on Thursday bought the Duchenne Muscular Dystrophy (DMD) drug Emflaza from Marathon Pharmaceuticals. The drug is an old steroid widely and cheaply available in other countries. Marathon got FDA approval for it last month and proceeded to price it at a hefty $89,000 per year. (Max Nisen, 3/16)

The Philadelphia Inquirer: A Toehold On The Confusing World Of Pharma Pricing
I’m about to violate my own HIPAA protections to illustrate the illogical nature of health-care costs. I have toenail fungus on one toe. Right foot, middle toe. Gross, I know. I never did anything about it until a routine visit to the dermatologist last year. When she saw that nasty dawg, she told me there were meds that could fix it. (Michael Smerconish, 3/19)

Bloomberg: Eli Lilly Wants You To Know Its Price Hikes Don’t Work
The drug-pricing debate focuses too much on President Donald Trump’s Twitter account, and too little on the fact that price hikes don’t work that well any more. According to a report it released Monday, Eli Lilly & Co. had a 50-percent-off sale on its drugs in the U.S. in 2016, giving half the list price of its medicines back to insurers and pharmacy benefit managers, on average. It raised list prices by 14 percent, but only received 2.4 percent of that increase. (Max Nisen, 3/20)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Patient Groups Losing Faith In Pharma

News outlets report on stories related to pharmaceutical drug pricing.

Stat: Drug Makers Have A Bad Reputation Among Patient Groups
As far as many patient groups are concerned, the theme song for the pharmaceutical industry should be Joan Jett’s “Bad Reputation.” For all the criticism that drug makers have endured in recent years, a new survey finds that they are faring worse than ever. Just 38 percent of patient groups thought the pharmaceutical industry had an “excellent” or “good” reputation last year, down from almost 45 percent in 2015, according to PatientView, a research firm that canvassed more than 1,400 patient groups from 105 countries. (Silverman, 3/21)

Boston Globe: Biopharma Facing Stiffer Opposition 
Biopharma, a high-flying industry for most of the past decade, may be coming down to earth. The backlash against steep drug prices has become a rare subject of bipartisan agreement in Washington, D.C. Leading the charge is President Trump, who promised last week that his administration is “going to get drug prices so far lower than they are now your head will spin.” (Weisman, 3/19)

The Wall Street Journal: Sunlight Is The Best Medicine For Pharma
Scrutiny of high drug prices constitutes a major investment risk for big pharma. The industry’s transparency push can help. Eli Lilly released a report Monday that shows the growth of its gross and net prices across its U.S. drug portfolio. They are the third major drug company to release such data this year after Merck & Co. and Johnson & Johnson. The data show that Lilly has raised average gross prices by more than 11% in each of the past five calendar years. (Grant, 3/20)

Stat: Maryland Closer To Penalizing Generic Drug Makers On Prices
Abill that would allow the Maryland attorney general to take legal action against generic drug makers for price gouging cleared a significant hurdle on Monday night when the Maryland House of Delegates overwhelming voted to approve the measure. The legislation, which was approved by a vote of 137-to-4, now goes to the state Senate. Specifically, the bill would require the Maryland Medical Assistance Program to notify the attorney general when an “essential” generic drug rises in price by 50 percent or more within the preceding two-year period. (Silverman, 3/21)

Stat: Pricey Cholesterol Drug Cuts Cardiovascular Risk — But Will Insurers Pay?
Acholesterol-cutting drug from Amgen succeeded in lowering patients’ risk of cardiovascular trouble in a huge clinical trial — but the results, announced Friday, may not be good enough to prompt insurers to cover the expensive drug for millions of patients. Amgen’s treatment, called Repatha, met its goals in a two-year trial on more than 27,000 patients with heart disease who were already taking a maximum dose of statins like Lipitor and yet still had stubbornly high cholesterol. Those who got Amgen’s drug were 15 percent less likely to suffer a bad outcome, defined as heart attack, stroke, hospitalization for chest pain, placement of a stent, or death. (Garde, 3/17)

The Wall Street Journal: Two Cheers For Biogen’s Court Victory
Biogen scored another intellectual property win for its investors Tuesday, but growth concerns remain. The U.S. Patent Trial and Appeal Board upheld a key piece of intellectual property on Biogen’s multiple sclerosis drug Tecfidera, following a hedge fund’s challenge to its validity. Biogen shares rose Tuesday morning, even as most biotech stocks sold off sharply. (Grant, 3/21)

Kaiser Health News: Trump’s Promise To Rein In Drug Prices Could Open Dam To Importation Laws
With prescription drug prices soaring and President Donald Trump vowing to take action, an old idea is gaining fresh traction: allowing Americans to buy medicines from foreign pharmacies at far lower prices. A new bill in Congress to allow the practice would modify previous safety standards and remove a barrier that proved insurmountable in past attempts to enable progress. (Bluth, 3/22)

NPR: U.S. Could Drive Down Drug Prices By Exercising Patent Rights
Rising drug prices are one of the biggest challenges in health care in the United States. More people are using prescription drugs on a regular basis, and the costs of specialty drugs are rising faster than inflation. President Donald Trump has promised over and over again to drive down drug prices. … But Trump already has a weapon he could deploy to cut the prices of at least some expensive medications. (Kodjak, 3/16)

The Associated Press: How Do Insurers Decide What Medicines To Pay For?
How do insurance companies decide what medicines to pay for and when to pay for them? Insurers and other payers look first at how well the drug works — not its cost — when they decide whether to cover the latest treatments, according to the nation’s largest pharmacy benefits manager, Express Scripts. The price patients eventually pay gets determined later, when an insurance company or pharmacy benefits manager decides where a drug fits on a list of covered treatments called a formulary. (Murphy, 3/17)

Kaiser Health News: Prescription Drug Costs Are On The Rise; So Are The TV Ads Promoting Them
Laura Ries was moved to action when she saw a TV commercial that portrayed a woman enjoying time with her grandchildren after taking Lyrica, a prescription medication for diabetic nerve pain. Ries’ elderly mother suffered from just that problem. “The ad showed someone who was enjoying life again,” said Ries, president of a marketing strategy firm in Atlanta, who then researched the drug and spoke with her mother’s doctor. “This … was very relatable to what my mom was experiencing.” (Horovitz and Appleby, 3/20)

The Wall Street Journal: Sanofi’s Prescription For Growth: Drug Sales In The Middle Kingdom
Sanofi SA expects its drug sales in China to grow at least 10% this year, helped by its push outside cities and efforts to tailor medicines to suit local needs, senior executives said. Sales in China last year exceeded €2 billion ($2.15 billion), making it the French company’s third-largest market after the U.S. and France. Drugs accounted for €1.8 billion, with the rest from vaccines and consumer health products. (Rana, 3/21)

Kaiser Health News: Low-Income AIDS Patients Fear Coverage Gains May Slip Away
When Tami Haught was diagnosed with HIV, she was one day shy of her 25th birthday. The diagnosis did not come as a shock since doctors had determined her fiancé was dying of AIDS several weeks earlier. In the two decades since, Haught, 48, has turned to expensive prescription drugs to keep the deadly infection in check. In 2005, she began receiving help purchasing her medications through the AIDS Drug Assistance Program (ADAP), a federally funded network of programs in each state that assist low-income HIV and AIDS patients. Since the Affordable Care Act was implemented, ADAP instead has helped her buy an insurance policy to cover a wide assortment of her health care needs. (Heredia Rodriguez, 3/21)

Stat: Pharma Convinces FDA To Delay Rule On Off-Label Marketing
In response to anger from drug makers, the Food and Drug Administration delayed implementing a final rule until next year that would give the agency greater leeway to police off-label marketing. The move comes three weeks after the pharmaceutical industry filed a petition urging the agency to postpone the rule over concerns it would harm public health and chill “valuable scientific speech.” As we noted previously, the rule says drug makers must update product labeling if there is evidence indicating a company intended its medicine to be used off-label, or for an unapproved use. (Silverman, 3/17)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Fla. House Committee OKs Hospice Measure; In Ariz., Bill Allowing Providers To Not Give End-Of-Life Instructions Gains Approval

Outlets report on news from Florida, Arizona, Georgia, Illinois, Missouri and California.

Health News Florida: House Panel Approves Hospice Care Expansion 
The House is advancing a measure making it easier for patients to access hospice care. Florida confines hospice services to the final six months of a person’s life.  But Rep. Gayle Harrell (R-Stuart) wants to ensure terminal patients can receive access to pain relief more quickly. (Evans, 3/21)

Georgia Health News: State Shows Improvement In Health System Scorecard
Georgia’s ranking on a health system scorecard has improved from 46th in the nation to 41st. The Commonwealth Fund’s 2017 scorecard ranked the 50 states and the District of Columbia on the most recent data available in five areas: health care access, quality, avoidable hospital use and costs, health outcomes, and health care equity. (Miller, 3/21)

Chicago Tribune: Advocate Children’s Hospital Takes On Rare Surgery To Help Baby Born With Four Legs 
Advocate Children’s Hospital surgeons have successfully operated on a baby from Africa born with two spines and an extra set of legs protruding from her neck. The Park Ridge hospital announced Tuesday that 10-month-old Dominique from Ivory Coast, or Cote d’Ivoire, in West Africa, is recovering well from the March 8 surgery. The baby already has started sitting up again, and doctors expect she’ll be able to live a normal, fully functional life. (Schencker, 3/21)

St. Louis Public Radio: More Farmers Claim That Monsanto’s Leading Weed Killer Product Caused Them Cancer 
Monsanto is facing more pressure to compensate farmers and farm workers who allege that its leading pesticide product caused them to develop cancer. A Los Angeles-based law firm on Friday filed 136 new cases against the company in St. Louis County Circuit Court. The lawsuits allege that exposure to glyphosate, the active ingredient in Roundup, caused the plaintiffs to develop non-Hodgkin’s lymphoma. (Chen, 3/21)

San Jose Mercury News: Walgreens’ “Disney” Animal Crackers Contain Cancerous Chemical, Group Says
“The Jungle Book” may be one of Disney’s most beloved animated movies, but a consumer health watchdog group is warning parents to lay-off feeding their kids Walgreens’ Disney Jungle Book whole grain animal crackers, featuring the storybook characters Mowgli and Baloo on the package. Turns out the bare necessities involved in making that version of the crackers requires higher baking temperatures, which produces excessive levels of a cancer-causing chemical called acrylamide, said Charles Margulis of the Oakland-based Center for Environmental Health. (Seipel, 3/21)

Tampa Bay Times: Senators Poised For First Major Medical Marijuana Hearing
Florida’s new medical marijuana market will start to take shape today as a panel of senators workshops five proposals to put the voter-approved constitutional amendment legalizing the drug into place. The Senate Health Policy committee, chaired by Tampa Republican Sen. Dana Young, will consider issues related to the five proposed bills and hear public comment, the first step toward passing legislation and the first time members of the public will hear what key senators think about how medical marijuana should be implemented. (Auslen, 3/22)

Health News Florida: Florida Legislature Starts To Tackle Medical Marijuana Bills 
Florida senators will begin hashing out possible medical marijuana laws this week. There are five competing bills just in the Florida Senate on how the state should implement a medical marijuana amendment. The Florida Senate’s Health Policy Committee under Senator Dana Young will start the medical marijuana debate. (Aboraya, 3/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

The Rules Have Changed: Exercise Is A Good Idea During Pregnancy

Despite the traditional advice that rest is important, a group of researches offer guidelines for pregnant women about how best to gain benefits from exercising while they are expecting. In other news, a study finds that prenatal vitamins with DHA supplements don’t boost a baby’s brains and news on the marketing of vasectomies.

The Washington Post: In New Report, Doctors Urge More Exercise For Pregnant Women
Old health advice often dies hard. This is particularly true — perhaps dangerously so — of historic advice for pregnant women, according to a new Viewpoint published Tuesday in the Journal of the American Medical Association. Most adults remember the traditional guidelines for expectant mothers. Get as much rest as possible during your pregnancy, even prolonged bed rest if complications arise. At the same time, “eat for two” — you and your developing child. According to the new report, however, “these misguided recommendations” have “evolved into a major contributor to the worldwide obesity epidemic.” (Burfoot, 3/21)

NPR: Exercising While Pregnant Is Almost Always A Good Idea
A group of researchers want women to know that when it comes to exercise, there is a strong consensus of benefit for both the mother and developing fetus. “Within reason, with adequate cautions, it’s important for [everyone] to get over this fear,” says Alejandro Lucia, a professor of exercise physiology at the European University of Madrid, an author of the viewpoint published Tuesday in JAMA, the journal of the American Medical Association. (Hobson, 3/21)

KQED: Ignored By Obamacare, Vasectomies Find A Champion In ‘March Madness’ Marketing
Procrastination can be so common with the “Big V” that it takes a panel of sports jocks offering a free procedure for some guys to finally let a doctor take a scalpel to their nether regions. That may be one reason vasectomy rates are low: Five percent of women rely on their partner’s vasectomy for contraception, unchanged from a decade ago. The CDC’s National Survey of Family Growth compares that to 20 percent of women who have had a sterilization procedure, even though women’s surgery is more invasive and more expensive. (Dembosky, 3/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

GAO To Launch Investigation Of FDA’s Orphan Drug Program

Acting on a request from three influential U.S. senators, the government’s accountability arm confirmed that it will investigate potential abuses of the Orphan Drug Act.

The Government Accountability Office still must determine the full scope of what it will look into and the methodology to be used. Determining the scope will take some months, said Chuck Young, GAO’s managing director for public affairs.

Earlier this month, Sens. Orrin Hatch (R-Utah), Chuck Grassley (R-Iowa) and Tom Cotton (R-Ark.) sent a letter to the GAO and raised the possibility that regulatory or legislative changes might be needed “to preserve the intent of this vital law” that gives drugmakers lucrative incentives to develop drugs for rare diseases.

Grassley’s office said Tuesday they expected the GAO to begin its work in about nine months. The delay is typical as the agency has a queue of requests it is pursuing.

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The senators have asked the GAO to “investigate whether the ODA is still incentivizing product development for diseases with fewer than 200,000 affected individuals, as intended.”

Congress overwhelmingly passed the 1983 Orphan Drug Act to motivate pharmaceutical companies to develop drugs for people whose rare diseases had been ignored. Drugs approved as orphans are granted tax incentives and seven years of exclusive rights to market drugs that are needed by fewer than 200,000 patients in the U.S.

In recent months, reports of five- and six-figure annual price tags for orphan drugs have amplified long-simmering concerns about abuse of the law. The senators’ call for a GAO investigation reflects that sentiment.

“While few will argue against the importance of the development of these drugs, several recent press reports suggest that some pharmaceutical manufacturers might be taking advantage of the multiple designation allowance in the orphan drug approval process,” the letter states.

In January, Kaiser Health News published an investigation that found the orphan drug program is being manipulated by drugmakers to maximize profits and to protect niche markets for medicines being taken by millions.

That investigation, which also was published and aired by NPR, found that many drugs that now have orphan status aren’t entirely new. More than 70 were drugs first approved by the Food and Drug Administration for mass-market use. Those include cholesterol blockbuster Crestor, Abilify for psychiatric disorders and the rheumatoid arthritis drug Humira, the world’s best-selling drug.

Others are drugs that have received multiple exclusivity periods for two or more rare conditions.

The senators asked the GAO for a list of drugs approved or denied orphan status by the FDA. It also asked if resources at the FDA, which oversees the law, have “kept up with the number of requests” from drugmakers and whether there is consistency in the department’s reviews.

And they said it would be important to include patient experiences in the GAO review. The GAO does not provide updates on ongoing work but rather reports its findings once they complete an assignment.

The rare-disease drugs have become increasingly popular with pharmaceutical and biotech companies and are expected to comprise 21.4 percent of worldwide prescription sales by 2022, not including generics, according to consulting firm EvaluatePharma’s 2017 orphan drug report.

That’s in part because of the exorbitant prices that can be charged. Of the top 100 drugs in the U.S., the average cost per patient per year for an orphan drug was $140,443 in 2016, compared with $27,756 for a non-orphan, EvaluatePharma said.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

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Viewpoints: Planned Parenthood’s Popularity; FDA’s Retreating Oversight Of Supplements

A selection of opinions on health care from around the nation.

Los Angeles Times: Why Is Planned Parenthood Popular? And If It’s Defunded, Could Any Other Organization Fill The Gap?
Congressional Republicans, President Trump and Vice President Mike Pence are united in support of “defunding” Planned Parenthood. Indeed, a provision in the GOP’s American Health Care Act would end its eligibility as a Medicaid provider, meaning patients covered by the low-income insurance program could no longer choose Planned Parenthood clinics for care. … Before unraveling Planned Parenthood, though, Republicans should look at why it’s so popular among Medicaid recipients — and whether any other organization is well-positioned to fill the gap. (Elizabeth Nolan Brown, 3/21)

Los Angeles Times: Bitter Pill To Swallow: Less FDA Oversight Of Supplements Seems Likely
The Food and Drug Administration last week shut shut down several Colorado dietary-supplement companies that it said were selling “misbranded and adulterated” products that wrongly purported to treat “high cholesterol, hypertension, diabetes, depression and muscle pain. ”The agency said violations such as these “put consumers’ health in jeopardy.” If President Trump has his way with the federal budget, it’s almost a sure thing that people increasingly will be at greater risk when it comes to the safety and effectiveness of over-the-counter supplements. (David Lazarus, 3/21)

The Des Moines Register: Right-To-Try Gives Little Hope To Sick Iowans
Every so often, a bill comes before the Iowa Legislature that no single lawmaker would dare vote against. Enter Senate File 404. The legislation gives terminally ill Iowans the “right to try” drugs and devices not yet approved by the U.S. Food and Drug Administration by permitting manufacturers to legally provide them. … “This gives patients hope,” said Sen. Rick Bertrand, R-Sioux City, who proposed the legislation in response to a friend’s battle with a degenerative illness. But that hope may be false. (3/20)

St. Louis Post-Dispatch: Missourians Deserve Affordable In-Home Care
Home care workers provide valuable care for Missouri families, but it often goes unnoticed, behind closed doors. I take care of Ms. Linda, who has been in my care for five years. I prepare her food and medications, dress and help her get to doctor’s visits — everything she needs to stay happy and healthy in her own house, instead of a nursing home. I love my job because it gives me the opportunity to work with my clients one-on-one, which provides an unmatched quality of care that you don’t get in a nursing home. The work is hard but rewarding. … But right now, the proposed $113 million budget cut from Gov. Eric Greitens threatens the care of Missourians like Ms. Linda. (Elinor Simmons, 3/21)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Ga. House Panel Approves Bill To Reduce ‘Surprise’ Medical Bills; Two Anti-Abortion Measures Clear The Texas Senate

Outlets report on news from Georgia, Texas, Colorado, New Jersey, Connecticut, Massachusetts and Ohio.

Georgia Health News: House Panel OKs New Plan To Halt ‘Surprise’ Bills; Doctors Voice Opposition 
The House Insurance Committee on Monday passed revamped legislation to reduce “surprise billing,’’ in which patients using hospitals in their insurance network may still get unexpected bills from doctors who are not in the network. Consumers who have procedures or visit ERs at hospitals in their networks often get separate bills for hundreds or even thousands of dollars from non-network doctors who were involved. These bills can come from ER doctors, anesthesiologists and radiologists, among others. (Miller, 3/20)

Texas Tribune: Texas Senate Passes Two Anti-Abortion Bills
Two GOP-backed anti-abortion bills passed the Texas Senate on Monday — one that would prevent parents from suing doctors if their baby is born with a birth defect and another that would require doctors to make sure a fetus is deceased before performing a certain type of abortion. Sen. Brandon Creighton’s Senate Bill 25, a “wrongful births” bill designed to prevent doctors from encouraging abortions to avoid lawsuits, passed 21-9. Creighton said without it, doctors have “an invitation to be sued for just practicing medicine” and might not want to work in the state. (Evans, 3/20)

Denver Post: Fingerprint-Based Criminal Background Check Legislation For Colorado Health Care Professionals Passes Key Hurdles
Spurred on by concerns that dangerous criminals are getting hired to care for ill, disabled and frail patients, legislation that would require fingerprint-based criminal background checks for health care professionals in Colorado passed key hurdles this month. House Bill 17-1121, sponsored by Rep. Janet Buckner, D-Aurora, recently cleared two key House committees and appears headed to the Senate for final consideration. (Osher, 3/20)

Houston Chronicle: Health Agency Investigating Its Privatization Of Medicaid Transport Program 
The Texas Health and Human Services Commission has opened an internal investigation into the bungled privatization of a program that transports poor Texans to medical appointments. The probe by the commission’s inspector general, Stuart Bowen, will examine why officials gave lucrative contracts for administration of the program to companies and nonprofit organizations that did not provide cost information and, in some cases, scored poorly on the state’s own rating system. (Rosenthal, 3/20)

Houston Chronicle: One Health Care Disparity Appears To Widen In Houston Area 
It takes less time for a new patient to see a doctor in Houston than the national average, but a health care study also finds the percentage of physicians who accept Medicaid and Medicare remains much lower than in other major cities. Taken together, the two measurements could signal a widening disparity in access to health care based on income and insurance availability in Houston, said Phillip Miller, vice president of communications for Merritt Hawkins, a leading national physician search and health care consulting firm. (Deam, 3/20)

The Philadelphia Inquirer: 31 New Jersey Patients Infected After Injections For Knee Pain
New Jersey health officials have identified 31 patients who became infected after receiving injections to treat knee pain at a clinic in Wall Township, Monmouth County. State and local investigators identified “infection control issues” during an inspection of the clinic on March 13, said Donna Leusner, a spokeswoman for the state Department of Health. At least 20 of the patients at Osteo Relief Institute Jersey Shore have needed surgery to treat their infections, said David A. Henry, health officer for the Monmouth County Regional Health Commission. The investigation is ongoing, he said. (Avril, 3/20)

The CT Mirror: The Health Care That Happens Outside The Doctor’s Office 
[Nadia] Lugo was working as a community health worker, a role many people involved in health care in Connecticut see as a key way to improve care for high-need patients. The job involves bridging the medical and social service systems and the many other factors in people’s lives that can have as much or more impact on their health than medical care – things like housing, transportation and food. (Levin Becker, 3/21)

Boston Globe: Lawmakers Wrestle With Changes To Marijuana Law
State revenue officials predicted taxes on marijuana could eventually bring in more than $100 million each year. The attorney general’s office encouraged lawmakers to clarify how cities and towns can prohibit pot stores. And a long bearded man argued that bills to adjust the state’s new marijuana law are “essentially shredding the will of the people.” (Miller, 3/21)

Columbus Dispatch: Should Only Ohio Residents Be Allowed To Grow Medical Marijuana In State?
People who want to grow medical marijuana in Ohio are certain about one thing: they don’t want outsiders coming in to take over. The vast majority of more than two-dozens speakers at a public hearing today on marijuana cultivation rules said there should be a residency requirement for those granted licenses to grow pot legally under a new state law. (Johnson, 3/20)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Congress May Delete Requirement That Businesses Track Worker Injuries

Also in public health news, the traditionally high U.S. infant death rate is making a promising decline and a new study highlights a connection between global warming and diabetes rates. Media outlets also report on a range of other developments, including ketamine being used to treat severely depressed patients and insurers weighing a simple treatment for artery disease.

NPR: Congress May Undo A Key Worker Safety Rule
Safety advocates are worried that lawmakers are getting ready to make it harder to penalize companies that don’t keep track of workers’ injuries. Since 1971, the Occupational Safety and Health Administration has required many employers to keep careful records of any worker injuries or illnesses. (Greenfieldboyce, 3/20)

Stat: Infant Deaths, Stubbornly High In The US, Continue A Promising Decline
In the US, a rising number of babies are living to see their first birthday, according to a study released Tuesday by the Centers for Disease Control and Prevention. The data show that infant mortality has declined by 15 percent over the last decade, with the biggest gains concentrated in the south and east of the country. That’s good news given that the US has persistently had a higher rate of infant deaths than other wealthy nations. (Swetlitz, 3/21)

NPR: Ketamine For Severe Depression Gains Popularity Among Doctors
Gerard Sanacora, a professor of psychiatry at Yale University, has treated hundreds of severely depressed patients with low doses of ketamine, an anesthetic and popular club drug that isn’t approved for depression. This sort of “off-label” prescribing is legal. But Sanacora says other doctors sometimes ask him, “How can you be offering this to patients based on the limited amount of information that’s out there and not knowing the potential long-term risk?” Sanacora has a simple answer. (Hamilton, 3/20)

Stat: Insurers Weigh A Simpler Treatment For Artery Disease: Supervised Workouts
When Char Zinda’s doctors discovered that she had had a couple of small, undiagnosed heart attacks, their instructions were to start walking. She was game. She tried going to the local university’s indoor walking track near her house. But she couldn’t even walk two-tenths of a mile. “The bottoms of my feet just felt like somebody had taken a sharp pencil and was poking it in,” said the 64-year-old, who lives in Morris, Minn. The pain was so bad it made her cry. (Boodman, 3/20)

Stateline: With A Daily Dial, Police Reach Out To Seniors
Living alone can be tough for seniors. Some don’t have family nearby to check on them, and they worry that if they fall or suffer a medical emergency and can’t get to the phone to seek help, no one will know. That’s why hundreds of police agencies in small towns, suburbs and rural areas across the country are checking in on seniors who live alone by offering them a free automated phone call every day. (Bergal, 3/21)

The New York Times: Popular Prostate Cancer Therapy Is Short, Intense And Unproven
After learning he had early stage prostate cancer, Paul Kolnik knew he wanted that cancer destroyed immediately and with as little disruption as possible to his busy life as the New York City Ballet’s photographer. So Mr. Kolnik, 65, chose a type of radiation treatment that is raising some eyebrows in the prostate cancer field. It is more intense than standard radiation and takes much less time — five sessions over two weeks instead of 40 sessions over about two months or 28 sessions over five to six weeks. (Kolata, 3/20)

The Washington Post: This Woman’s Labored Breathing Alarmed Her Friends. Doctors Were Startled To Find The Cause.
“What’s wrong with you?” Dianne Hull remembered her friend Vicky Weinstein asking, alarm evident in her voice. The two women had just finished lunch in December 2012, and Hull breathed heavily as she walked across the kitchen of her friend’s home. Hull’s audible breathing — and increasing breathlessness — had been shoved aside in her constellation of pressing concerns. For months, Hull had been focused on a medical crisis affecting her young son. But now Weinstein — a nurse — was delivering a forceful reminder: It was past time for Hull, then 38, to pay attention to her own health. (Boodman, 3/20)

Stat: Craig Venter Wants $1,400 To Sequence A Genome. Is It Worth It?
The genomics pioneer who sequenced the human genome carved out a new niche just over a year ago, selling exhaustive $25,000 medical workups to apparently healthy people. Now Craig Venter’s trying to take one small piece of that business to a much wider audience — and to prove it’s worthwhile. (Robbins, 3/21)

Sacramento Bee: How To Wean Yourself From Your Gadget Addiction 
Many people find the constant dings, rings, buzzes and beeps that come from their computers and cell phones impossible to ignore. Experts say its a sign of our dependency on technology, which validates and entertains us while also cutting into our productivity and altering our attention span for the worse. (Caiola, 3/20)

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Republican Replacement Plan Would Result In 1.8M Fewer Jobs, Analysis Projects

The left-leaning Center for American Progress report is the first to look at the job market impact of the American Health Care Act. Meanwhile, vulnerable rural hospitals are increasingly worried about their fate under the Republicans’ plan.

McClatchy: GOP Health Care Bill Would Kill 1.8 Million Jobs In 2022
The U.S. economy would produce 1.8 million fewer jobs in 2022 if the Republican legislation to repeal the Affordable Care Act became law, according to a new analysis by the Center for American Progress. Two provisions in the legislation accounted for most of the projected job losses: repealing expanded eligibility for Medicaid coverage and cutting federal financial assistance for marketplace health coverage. Both measures were expected to eliminate 2.2 million jobs in 2022, according to the study by the left-leaning think tank. (Pugh, 3/20)

The Associated Press: Already In Peril, Rural Hospitals Unsure On Health Care Bill
Talmadge Yarbrough had just sat down at his desk and opened a box of pecans when he let out a gasp that could have been his last breath. He’d gone into cardiac arrest in his office, a co-worker called 911, and an ambulance drove him two miles to the small hospital that serves this rural community in southeast Georgia. “I would have never lasted to get to Savannah or Statesboro,” Yarbrough said of the biggest cities near Claxton — each 30 to 60 miles away. “I firmly believe if that hospital wasn’t here, I wouldn’t be here.” (Bynum, Santana and Foody, 3/20)

And in other news —

CNBC: How The Trump Administration Can Undermine Obamacare If Repeal Fails 
As chairman of the House Budget Committee, Tom Price spent the last seven years trying to muscle through a repeal of Obamacare. Now, as Health and Human Services Secretary, that health-reform law, the Affordable Care Act, may give Price a lot of the leeway he needs to roll back its regulations… Health policy analysts say the ACA gives the secretary the most discretion when it comes to enforcing reporting regulations for insurers, hospitals and physicians, in particular. (Coombs, 3/20)

Kaiser Health News: GOP Scraps Individual Mandate But Sets Up New Penalty For Those Skipping Coverage
The Affordable Care Act’s tax penalty for people who opt out of health insurance is one of the most loathed parts of the law, so it is no surprise that Republicans are keen to abolish it. But the penalty, called the individual mandate, plays a vital function: nudging healthy people into the insurance markets where their premiums help pay for the cost of care for the sick. That has required Republican lawmakers to come up with an alternative. The GOP approach is called a “continuous coverage” penalty. It increases premiums for people who buy insurance if they have gone 63 consecutive days without a policy during the past 12 months. Their premiums would rise by 30 percent and that surcharge would last for a year. While the ACA assesses a fine for each year people don’t buy insurance, the GOP plan would punish those who decide to purchase it after not being in the market. (Rau and Gorman, 3/21)

Atlanta Journal-Constitution: Trump Voters In South Georgia Come To Terms With GOP Health Plan
Kenneth Peek had a rough year. The South Georgia farm where he and his wife grow corn, wheat and soybeans faced a drought and lost money in 2016. So he’s working construction jobs to make ends meet. The 64-year-old hoped to catch a break on his health care costs. He has insurance through the Affordable Care Act, better known as Obamacare, but the premiums and bills keep going up and up. That’s one reason he voted for Donald Trump. … But like many older Americans and people with limited means, Peek is learning that the Republican plan to replace Obamacare doesn’t give him a break. It gives him a thumping. (Schneider and Williams, 3/20)

Kaiser Health News: KHN On Call: Answers To Questions On Tax Credits, Penalties And Age Ratings
For years, Republicans in Congress have promised to repeal and replace the Affordable Care Act, claiming that its requirement for nearly everyone to buy insurance or pay a fine is burdensome and costly, and that it doesn’t give people enough flexibility to get the coverage they need.Now that they’re in charge, the bill they’ve released as an alternative (the American Health Care Act) would effectively eliminate the requirement to buy coverage and might open up more health care choices. (Kodjak and Rovner, 3/20)

Kaiser Health News: I Do … Take You To Be My Lawfully Covered Health Care Dependent
[Don] Boyer and [Ann] Justi were getting married. Never mind the blizzard-like conditions that kept one set of friends home, and a bad cold that waylaid another. They were determined to tie the knot that afternoon. So they recruited their landlord from downstairs and a public radio reporter to be witnesses. Why the rush? Boyer and Justi had been listening to the news. They were planning to get married in the fall, but it occurred to them that there’s no knowing what could happen to health insurance if the Trump administration and congressional Republicans dismantle the Affordable Care Act. (Mogul, 3/21)

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GOP Recycles Controversial 2003 Bill To Boost Small-Business Insurance

In a bid to improve the health insurance purchasing clout of small businesses, Republicans have dusted off a piece of controversial legislation more than a decade old and reintroduced it as part of their effort to remake the market after they throw out the Affordable Care Act.

The earlier bill, which passed the House in 2003 but didn’t advance, was widely panned by groups representing consumers, providers, the health insurance industry and state officials. At the time, they argued that it would do little to enhance the coverage options or control costs of many small businesses, especially those that employ older, sicker workers, while at the same time weakening consumer protections against plan insolvency and fraud.

Health policy experts say there’s no reason to change that assessment now.

“It was a bad idea in 2003, and it’s a worse idea today,” said Timothy Jost, an emeritus professor at Washington and Lee University School of Law in Virginia who is an expert on the health law.

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The bill would allow the establishment of nationwide “association health plans” that could be offered by professional or trade groups, chambers of commerce and the like. Small businesses could buy coverage through these associations, in theory gaining strength in numbers to enhance their bargaining leverage with insurers, leading to cheaper, better coverage and lower administrative costs.

The Small Business Health Fairness Act of 2017 is slated to head to the House floor this week. Speaker Paul Ryan (R-Wis.) has expressed enthusiasm for association health plans and said he intends to move the legislation in tandem with the reconciliation bill that would unwind budget-related provisions of Obamacare, another name for the ACA.

Several business groups, including the National Retail Federation and the U.S. Chamber of Commerce, support the bill, hoping that it will encourage more small businesses to offer their employees coverage.

“We don’t think it’s going to be the panacea to solve all our members’ issues, but we view it as a valuable option,” said Kevin Kuhlman, director of government relations for the National Federation of Independent Business, a trade group and supporter of the bill. NFIB members, he said, “want a little more ability to design their own options and less responsibility to conform to federal requirements.”

The idea isn’t new. Association health plans have existed for decades. But they often escaped close supervision because neither states nor the federal government had clear regulatory authority over them. In the 1970s and ’80s, there were cases of fraud and insolvency that raised concerns about the model. Some multiple-employer purchasing groups went belly up and left consumers and providers with millions in unpaid claims.

So Congress amended federal law to allow states to regulate these plans. When the ACA passed in 2010, the Obama administration required that association health plans meet the new small-group standards: They had to cover the 10 essential health benefits, for example, and couldn’t charge older people premiums that were more than three times higher than those of younger people.

The new bill would change all that. It would eliminate most state regulation of association health plans and put oversight in the hands of the federal Department of Labor, which would certify them.

The ACA requirements that apply to all plans, like the prohibition on lifetime and annual coverage limits, would apply to association health plans as well, said Kevin Lucia, a research professor at Georgetown University’s Center on Health Insurance Reforms. But the ACA’s small-group requirements would not. Plans could offer stripped-down coverage and would have more latitude in setting premiums than regular plans in the small-group market. They could operate in multiple states and generally avoid state-mandated benefits and other state insurance rules.

Under the Republican bill, association health plans still couldn’t discriminate against individuals based on their health, but they could charge higher premiums to companies with sicker workers. So association health plans would likely appeal to employers with younger, healthier workers who would qualify for lower rates and not be troubled by skimpier coverage. That could draw those businesses away from state-regulated health plans, which would be left with sicker, costlier enrollees, creating an uneven playing field and a segmented market.

“If you’re a healthy small employer and you’re allowed to escape all these rules, you may be able to have lower premiums, until someone in your group gets sick,” said Lucia.

Solvency is a real concern as well, say experts, since the federal standards in the bill are generally less rigorous than state rules.

The flexibility that GOP lawmakers see in the bill might not serve workers well, said Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities.

“Right now there’s a fairly consistent set of rules of what a small group or individual plan has to look like in terms of benefits, costs and coverage,” she said. “If we’re talking about a world where none of that exists anymore or an association health plan is outside of those standards, then as a consumer you’re dealing with a very confusing situation.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Health Industry, Insurance, Insuring Your Health, Repeal And Replace Watch, The Health Law

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In Deep-Red Western N.C., Revered Congressman Leads Charge Against GOP Bill

HIGHLANDS, N.C. — In this corner of Appalachia, poverty takes a back seat to art galleries, country clubs, golf course communities, five-star restaurants and multimillion-dollar houses.

From this perch, Rep. Mark Meadows, a real estate entrepreneur who capitalized on the area’s transformation into a prosperous retirement and vacation community, rose to political power quickly. Now the conservative Republican leads the House Freedom Caucus, controlling between 30 and 40 votes in Congress and showing few qualms about endangering his party’s best chance to repeal the Affordable Care Act.

“I am willing to invest the political capital to get it right,” Meadows, who has called the GOP replacement “Obamacare Lite,” said Thursday on MSNBC. “The next week is critical.”

And on Saturday, Meadows went to President Donald Trump’s Mar-a-Lago Club in Florida to negotiate over the bill with Trump aides, along with with Sen. Ted Cruz (R-Texas) and Sen. Mike Lee (R-Utah).

Meadows’ confidence is warranted.

His gerrymandered district covers 17 counties, spanning 150 miles across western North Carolina. The populous liberal bastion of Asheville is mostly carved out of his district like a bite from a cookie. What’s left is a retiree-rich constituency of 750,000 people that is heavily Republican, mostly white and lives mainly in small, rural towns amid pockets of extreme wealth. Its survival could hinge on a Supreme Court ruling expected this year in a case alleging racial bias in the state Legislature’s 2011 redrawing of North Carolina’s congressional map.

Elected in 2012, Meadows, 57, has rebelled against the establishment Republican Party — helping shut down the government in 2013 and ousting Speaker John Boehner in 2015.

While Democrats and even moderate Republicans decry House Speaker Paul Ryan for cutting federal aid to help get people insured in the GOP bill, Meadows says the cuts don’t go deep enough. He vows to oppose any ACA replacement that does not bring down health costs for people and government. No such plan that actually controls costs is on the table, however.

Meadows wants to cut off all 10 million Americans who today get federal subsidies to buy health coverage, which he says the country can ill afford. With enough support, Meadows could either block the House leadership from passing its plan or force it to approve a more conservative replacement that would face little chance of getting through the more moderate Senate.

Meadows’ potential role as “Trumpcare” spoiler — is stirring concern in the White House and Congress. By Thursday, Meadows seemed to have gotten that message.

“The last thing I want is for the president to be mad at me,” Meadows told Politico. “He asked me to negotiate in good faith, so I have been working around the clock.”

A lake in Highlands, N.C., is pictured. (Phil Galewitz/KHN)

Meadows was absent, though, from a Friday meeting in the Oval Office with members of the Republican Study Committee, another group of conservative representatives, where Trump said he had secured enough votes to pass the House bill.

Meadows’ hard line doesn’t bother most folks back in western North Carolina, where Obamacare is unpopular. Only about 5 percent of those in his district receive government-subsidized health plans made available by the law.

Meadows, who now lives in West Asheville, moved to North Carolina from Tampa to raise a family in the 1980s. The proprietor of a small sandwich shop here in Highlands before he shifted to real estate, Meadows is revered by his constituents.

Even the local hospital industry — which typically opposes any effort to scale back the health law — remains firmly in Meadow’s corner.

“We are big fans of Mark. He’s a man of integrity and he has the heart,” said Jimm Bunch, CEO of Park Ridge Health, a 103-bed hospital in Hendersonville, N.C. He heaps praise on Meadows even as the congressman fights to eviscerate the law that helped the hospital achieve one of its best financial years ever. As more patients got insurance, Park Ridge gained $600,000 a year in funding it used to provide free care to other patients.

Jimm Bunch, CEO of Park Ridge Hospital in Fletcher, N.C. says the hospital made more money as a result of Obamacare subsidies but won’t bash the Meadows plan to take them away. (Phil Galewitz/KHN)

Because North Carolina did not expand Medicaid under Obamacare, many poor adults remained uninsured. The state’s uninsured rate fell from 20.4 percent in 2013 to 13.6 percent in 2016, 2.5 points higher than the national average, according to Gallup.

Small-business owners, who provide most jobs in the district, are reluctant to take on Meadows., who is seeking to eliminate their government assistance to get health coverage.

At Sanctuary Brewing in Hendersonville, co-owner Joe Dinan said the Obamacare coverage he bought this year helped him get skin cancer surgery on his head. “I don’t want to see the subsidy end,” Dinan said. He won’t say anything critical about Meadows though, demurring that Hendersonville is a small town.

Meadows insists no one will get left behind.

He wants to allow people to buy less-expensive policies with fewer benefits than now required under the ACA. His tax help would be in the form of deductions people take at the end of the year or a break on their payroll taxes — different than both the current law and the Trumpcare plan working its way through Congress now.

It worries Rachel Lewicki, 30, who works at the local tea and spice shop on Main Street in Highlands.

Lewicki recently had surgery for a uterine tumor, paid for by a subsidized health plan she bought under Obamacare that costs her less than $100 a month. Now she fears her good fortune will end. “It’s not fair,” she said. “The way things are going, I’m scared and so are a lot of people who need this help.”

Kent Loy, a volunteer at a thrift store in Hendersonville, speaks of Meadows in harsher, personal terms.

“It’s an attack on the poor and how someone who claims to be a Christian can take this behavior is beyond me,” said Loy, 71. “This should disqualify him from office.”

Joe Dinan, co-owner of Sanctuary Brewing in Hendersonville, used Obamacare subsidies to get coverage and deal with skin cancer this year. (Phil Galewitz/KHN)

But it won’t, said Chris Cooper, professor of political science at Western Carolina University. Meadows has little to worry about in his heavily Republican district where he took 65 percent of the vote in November. “Taking out Asheville turned the district from being the most competitive district in the state to the most conservative,” Cooper said.

The political climate is challenging for cultivating grass-roots opposition, according to Susan Kimball, of Waynesville, N.C., who is part of Progressive Nation WNC, a group pushing to retain the ACA.

She said she has sought to meet Meadows in his district office several times to complain about his Obamacare stance, but to no avail.

Critics like her have recently pushed Meadows to hold a town hall meeting to hear their views, as many members of Congress did in the past month. His office said Meadows arranges such meetings only in August.

“I just feel like he doesn’t care,” Kimball said.

A cancer survivor, Kimball, 62, has benefited from Obamacare’s mandate that insurers provide coverage to people with preexisting health conditions. For $237 a month, Kimball has a subsidized Blue Cross plan that pays for visits to doctors and tests when she needs them.

She moved to Waynesville from South Florida four years ago, and the area’s conservatism has been an eye-opener.

“We were just moving to the mountains, and we didn’t know the region would become Tea Party central,” Kimball said.

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GOP Bill’s Unheralded Changes In Rules Could Undermine Health Of Neediest

An under-the-radar provision in the Republican proposal to replace the Affordable Care Act would require the millions of Medicaid enrollees who signed up under the Obamacare expansion to renew their coverage every six months — twice as often as under current law.

That change would inevitably push many people out of coverage, at least temporarily, experts say, and help GOP leaders phase out Medicaid expansion — a key goal of the pending legislation.

“That’s designed to move people off those rolls as soon as possible,” said Ken Jacobs, chairman of the University of California, Berkeley, Center for Labor Research and Education.

The proposal to cut renewal time in half is among other changes that seem only procedural but could have a profound effect on Medicaid enrollees’ health, pocketbooks and ability to get — and keep — coverage.

Another proposal would eliminate the ability of new Medicaid enrollees to request retroactive coverage for up to three months before the month they apply, which they can do under the current law — assuming they were eligible during that previous period.

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Health care experts and advocates fear that could potentially saddle people on Medicaid with unaffordable medical bills, shortchange providers and raise costs throughout the health care system.

“These are changes to fundamental pieces of the Medicaid program,” said Cathy Senderling-McDonald, deputy executive director of the County Welfare Directors Association of California in Sacramento, which represents human services directors from the state’s 58 counties.

“They could result in people delaying their health care or having to pay out-of-pocket and not having any hope for reimbursement at all,” she said.

But Michael Cannon, director of Health Policy Studies at the libertarian Cato Institute, said some of these changes would prevent fraud and keep ineligible people from obtaining benefits, thus saving taxpayer money.

“It’s so hard to eliminate fraud in Medicaid, because someone always benefits from it,” he said. “They don’t want to give that up.”

The expansion of Medicaid — the federal-state health care program for people with low incomes, known as Medi-Cal in California — would be phased out under the Republicans’ plan starting in 2020.

The expansion, adopted by 31 states and the District of Columbia, added more than 11 million people to the rolls, including about 3.7 million in Medi-Cal. The federal government picks up a much higher proportion of the cost for this population than for traditional Medicaid enrollees.

In the GOP plan, people already covered under the expansion would continue to be funded by the federal government after Jan. 1, 2020, but if states opted to sign up new enrollees under the expansion criteria after that date, they wouldn’t receive the more generous federal funding for them.

And those who remained in the program after 2020 but later lost eligibility would not draw the more generous federal funding for expansion enrollees if they became eligible again and re-enrolled at a later date.

In California, the potential loss of federal dollars caused by the rollback of the expansion would be massive. The state Legislative Analyst’s Office estimated last month that the Golden State is slated to receive more than $17 billion from the federal government for the Medi-Cal expansion in 2017-18.

“We’re talking about a big shift in costs to the state of California and potentially a major loss in coverage,” said UC Berkeley’s Jacobs.

The GOP legislation, which is scheduled for a vote on the House floor on Thursday, would impose the new renewal requirement on expansion enrollees starting Oct. 1.

“They’re saying to states that do the expansion, ‘We’ll cover people who are continuously in the program, but we’ll make it really hard for people to be continuously in the program,’” Jacobs said.

Wolf Faulkins, a resident of Mariposa, Calif., who enrolled in Medi-Cal in 2014 as a result of the expansion, said the proposed rule change regarding renewal would add one more layer to Medi-Cal’s already considerable bureaucratic requirements, none of them logical or simple.

“If I were more of a senior citizen than I am now, I would be overwhelmed” by it, Faulkins, 61, said. “I would not be a happy camper.” But he would complete the extra paperwork, he added, because his Medi-Cal coverage keeps him alive: Among other things, he has a heart condition and high blood pressure as well as knee and hand ailments.

Senderling-McDonald said the new paperwork will lead some enrollees to drop out for two reasons: Either they’re no longer eligible, or they’re eligible but the new bureaucratic hurdle stops them.

Faulkins agreed. Even though he would jump through the necessary hoops to keep his coverage, some others probably wouldn’t, he guessed. “There are people who are just going to say, ‘It’s important, but it’s too overwhelming. There’s no one to advocate for me. There’s no one to help me figure this out, ” he said. “People are just going to get frustrated and say no.”

The new renewal time frame has a precedent in California, which adopted a semiannual reporting requirement in 2003 for some enrollees that lasted about a decade. Though it was less cumbersome than the regular annual renewals, it nonetheless resulted in people dropping from the rolls, Senderling-McDonald said.

But the Cato Institute’s Cannon believes six-month renewals are reasonable. “The savings from removing ineligible people would justify the paperwork involved,” he said.

The paperwork imposed by these changes could be the least of the headaches for Medicaid beneficiaries.

Retroactive benefits, for example, are extremely valuable for new Medicaid enrollees who face medical bills during a gap in coverage, and losing them could cause financial pain.

“If they have had health expenses, like having to pay for a prescription out-of-pocket or a doctor’s visit, or a woman goes into labor uninsured, they can say to the county, ‘I had medical bills. Can you see if I was eligible during that time?’” said Senderling-McDonald.

Pregnant women are among the most frequent beneficiaries because they often don’t know that they’re pregnant right away, she added.

The GOP bill would end this, and would allow coverage to begin only the month in which enrollees apply. This provision would affect all Medicaid applicants and, like the change in renewal time, would begin Oct. 1.

Some experts believe the proposed change would increase medical debt for consumers hit with massive bills, and for providers who ultimately won’t get paid for their services.

The three-month retroactive rule is “a big deal for hospitals as well as people, because it keeps them from being saddled with medical debt,” said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities in Washington, D.C.

Senderling-McDonald warned that as more consumers racked up medical debt, the cost of it would shift to other people. “If someone has to declare bankruptcy when they are hit with bills they can’t pay, everybody else takes the hit for it,” she said. “They’re going to raise insurance rates or costs of care for everybody. People who have coverage through employers or the private market could see their rates go up.”

Cannon agreed that providers will get hit with more unpaid bills, but said that this provision would save the federal government money. “States have taxing authority and can fund these benefits themselves if they want to,” he said. “If they don’t, that should tell us something — that they don’t value these benefits that much.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Categories: California Healthline, Cost and Quality, Health Industry, Insurance, Medicaid, Repeal And Replace Watch, The Health Law

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Perspectives: Where Purists And Politicians Intersect In The Health Care Debate

Editorial pages nationwide take on the politics of the Republican efforts to dismantle Obamacare.

Richmond Times-Dispatch: Republicans Purists Could Doom Obamacare Repeal – And Their Party
Purity, apparently, is what some conservative Republicans are demanding in a health insurance bill, which likely will be voted on this week, unless it is held back because Speaker Paul Ryan doesn’t think it has enough votes to pass. Supporters of the evolving House bill emphasize that this is a three-step process designed to get what virtually all conservatives want, a more cost-effective health plan, only they can’t muster enough votes, especially in the Senate. Some conservatives are taking an all-or-nothing approach, which is likely to guarantee they will get nothing. (Cal Thomas, 3/19)

Cleveland Plain Dealer: Why Stop With 24 Million? Let’s Dump Everyone With Last Names “L” To “Z” Off Health Care. Think Of The Savings!
Last fall when he was winning hearts and minds in the Midwest, Mr. Red Cap promised to remove the curse of Obamacare from the nation and replace it with something beautiful that would cover everybody. Now that Trumpcare is out for previews, he is still upbeat and says he is in a “beautiful negotiation” and will wind up with a “beautiful picture,” but it’s no longer about everybody. And the picture seems more like a watercolor than a photo. (Garrison Keillor, 3/18)

Arizona Republic: The Stealth Attack On Health Care Through Obamacare Repeal Efforts
Health care should be a right for every American. That was an applause line for Sen. Bernie Sanders at a recent town hall in the very deep Trump territory of West Virginia. Sanders is in sync with a decades-long national trend of increasing access to health care. But the party in power is doing something completely different. (Linda Valdez, 3/18)

The Washington Post: Medicaid Is Out Of Control. Here’s How To Fix It.
It’s time to take control of Medicaid before it takes control of us. Unless we act — and there is little evidence that we will — Medicaid increasingly becomes another mechanism by which government skews spending toward the old and away from the young. In the raging debate over the Affordable Care Act (Obamacare), this is a subject that neither Republicans nor Democrats dare touch. It’s an ominous omission that obscures the overhaul Medicaid really needs. (Robert J. Samuelson, 3/19)

Richmond Times Dispatch: Medicaid Provides A Critical Foundation For Children’s Success 
The largest threat to children’s health in the new proposal is that it dismantles the Medicaid program, a primary source of health insurance coverage for children. In Virginia, more than 488,000 children and more than 15,000 pregnant women are covered by Medicaid. One in three births are covered by Medicaid. Roughly 30 percent of children with disabilities or special health care needs are insured through Medicaid, as are all children in foster care. (Margaret Nimmo Holland, 3/19)

The New York Times: Gripes About Obamacare Aside, Health Insurers Are In A Profit Spiral
Over the last few years, big managed care companies like UnitedHealth Group have contributed to the furor over the fate of the Affordable Care Act by saying that important parts of it are fundamentally flawed. But Obamacare hasn’t been a curse for the managed care companies. Over all, based on their share performance, it has been something of a blessing. (Jeff Sommer, 3/18)

Austin Statesman: Google ‘Universal Health Care’ For Startling News
The people in our government who oppose universal health care try to scare us by talking about how we’ll lose the personal connection we have with our doctor. Ha. I like my doctor fine, but if we were in an elevator together, I know he’d be trying to place me. “She looks familiar,” he’d be thinking, “but …” If I’m feeling sick, can I reach for the phone and call my doctor? I’d be lucky if I could get an actual person instead of a recording. And as for being seen, well, my doctor is booked for weeks in advance. If I’m sick, it’s Urgent Care where I go. (Carolyn Banks, 3/18)

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State Highlights: Va.’s Immunization Rates Plateau; Ga. Senate OKs Family Sick Leave Bill

Outlets report on news from Virginia, Georgia, Pennsylvania, Missouri and Connecticut.

WABE: Georgia Senate Passes Family Sick Leave Legislation
The Georgia Senate passed SB 201 that would require employers to let workers use their sick days to take care of a child, parent, or any dependent listed on tax returns. State Rep. Brian Strickland (R-McDonough) is sponsoring the bill in the House. (Bandlamudi, 3/17)

Kansas City Star: Ill Missouri Woman Turns Destitute While Fighting For Social Security Disability | The Kansas City Star
[Barbara] Sales’ situation goes to the heart of problems that have plagued the Social Security Administration for years: Underfunded and overwhelmed, it operates with a workforce that has remained all but flat for more than 20 years in the face of a rising population and an explosion of disability applications… Some good news came this month when union officials representing federal workers were told that despite a federal hiring freeze, the Social Security Administration would be allowed to hire 100 extra workers to authorize benefits. (Adler, 3/19)

The CT Mirror: Unspeakable Horrors Gave Theanvy Kuoch Incredible Strength And Compassion 
The organization [Khmer Health Advocates] provides health care and counseling, and runs a treatment program for torture survivors. It has used a variety of innovative techniques to provide care, including a videoconferencing program that allowed people across the state to communicate with – and receive care from – those in the West Hartford office without having to travel. Another program paired the organization’s community health worker with a pharmacist who helped patients manage their medications. (Levin Becker, 3/19)

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Number Of Patients Experiencing Side Effects Skyrockets

Experts say the surge in reports could indicate a growing number of harmed patients or more vigilant reporting of adverse events. In other public health news: childbirth, chronic diseases, telehealth and a rare version of strep throat.

Stateline: Childbirth For Women In Their 30s At 50-Year High
Women in their 30s are having babies at the highest rate since the 1960s, providing a rare bright spot in what’s an otherwise stagnating U.S. population. For women in their early 30s, the birthrate in 2015 was the highest it’s been since 1964, according to a Centers for Disease Control and Prevention report this year. And the rate for women age 35 to 39 was the highest since 1962, when families were larger and births hit near all-time highs in the baby-boom years. (Henderson, 3/20)

NPR: Common Blood Tests Can Help Predict Disease Risk
A score based on common blood tests may someday help people gauge their risk of developing a chronic disease like diabetes or dementia within three years of taking the test. The Intermountain Chronic Disease Risk Score was 77 to 78 percent accurate in predicting whether someone would be diagnosed with diabetes, kidney failure, coronary artery disease and dementia, among other illnesses. It’s based on the results of a comprehensive metabolic panel, which includes tests for blood glucose and liver function, and complete blood count, which measures the quantity of different types of blood cells. (Hobson, 3/17)

Modern Healthcare: Tapping Telehealth For Complex Cases 
Intermountain, whose telehealth system is among the most advanced in the country, is using the technology to extend its specialists’ skills into the smaller community hospitals and rural locations in its network. These medical outposts rarely have the clinical expertise necessary to handle the more-complex cases that come through their front doors. The system has installed videoconferencing setups in 1,000 rooms across its 22 hospitals. Intermountain’s 35 telemedicine programs include specialists providing consultations on stroke, newborn critical care, behavioral health, wound care and cancer care. Intermountain is also using remote monitoring for chronic disease patients with conditions such as hypertension and heart failure. (Livingston, 3/18)

The Washington Post: A Father Went To The Hospital With Stomach Pain. He Left Without His Hands And Feet.
When Kevin Breen first complained about feeling achy and tired, his wife couldn’t help but wonder whether he was trying to wiggle out of a busy day of family responsibilities. It was Christmas Day, and Breen — an active 44-year-old whose idea of relaxing is going water skiing on Lake Michigan or playing pickup basketball — is rarely short on energy. But the Grand Rapids, Mich., resident insisted he really was feeling ill. And two days after his vague, flulike symptoms had begun, they’d taken on a strange new form: a razor-sharp stomach pain so powerful that Breen could no longer walk. (Holley, 3/18)

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Mayo Clinic Head Backpedals After Saying Hospital Should Prioritize Patients With Private Insurance

“In an internal discussion I used the word ‘prioritized’ and I regret this has caused concerns that Mayo Clinic will not serve patients with government insurance. Nothing could be further from the truth,” Dr. John Noseworthy said.

Stat: Mayo Clinic CEO ‘Regrets’ Statement On Prioritizing Private Insurance Patients
Facing a possible civil rights investigation, Mayo Clinic’s chief executive is backpedaling from statements he made to employees about prioritizing the care of privately insured patients over those on Medicare and Medicaid. Dr. John Noseworthy issued a press release late Friday saying that he regrets that the wording he used caused confusion about the hospital’s commitment to serving patients with government insurance. He sought to correct the record after Minnesota regulators said they are looking into potential legal violations based on his comments. (Ross, 3/17)

The Associated Press: Mayo Clinic Faces Questions After CEO Comments On Insurance
John Noseworthy’s comments were made late last year in a videotaped speech to staff but surfaced only this week after a transcript of his speech was obtained by the Star Tribune newspaper. The Mayo Clinic has verified the transcript is accurate. Noseworthy said in a statement Friday that medical need will always be the top factor in scheduling an appointment. (Forliti, 3/17)

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Medical Research, Cancer ‘Moonshot’ Would Be Hit Hard By Trump Budget Blueprint

From the FDA and NIH to Meals on Wheels, news outlets cover the impact that the proposed Trump administration budget cuts would have on a range of health care organizations and initiatives.

The Washington Post: Proposed Federal Budget Would Devastate Cancer Research, Advocates Say
Cancer researchers and advocacy groups are denouncing President Trump’s proposed budget, warning that its 19 percent cut for the National Institutes of Health could cripple or kill former vice president Joe Biden’s cancer “moonshot” initiative and other important biomedical efforts. “Forget about the moonshot. What about everything on the ground?” said George Demetri, an oncologist at Dana-Farber Cancer Institute in Boston. “Fundamentally, this is so extreme that all I can think is that it’s pushing two orders of magnitude off the grid so that when people come back to less extreme positions it looks normal.” (McGinley, 3/17)

The New York Times: Trump Plan Eliminates A Global Sentinel Against Disease, Experts Warn
Nobody in the United States has ever died from an intercontinental missile strike. Over the past 50 years, hundreds of billions of dollars have been spent on silos, submarines, bombers and satellites to ensure that does not happen. During the same period, nearly 2 million Americans have died from intercontinental virus strikes. The toll includes one American dead of Ebola, 2,000 dead of West Nile virus, 700,000 dead of AIDS, and 1.2 million dead of flu — a virus that returns from abroad each winter. (McNeil, 3/17)

CQ Roll Call: FDA And NIH Budget Proposals Startle Health Research Community
President Donald Trump’s budget proposal deeply rattled the nation’s biomedical research enterprise, which was not only dismayed by massive cuts to the National Institutes of Health but also caught off guard by major changes to the Food and Drug Administration’s budget. The administration did not specify a topline number for the FDA budget, which was around $4.7 billion in recent years. Normally $2.7 billion comes from discretionary appropriations and the rest from fees paid by regulated industries. The administration seems to want to flip that. The budget plan said it would “recalibrate” medical user fees and increase them by $1 billion in order to “replace the need for new budget authority.” (Siddons, 3/17)

Kaiser Health News: Researchers Call Trump’s Proposed NIH Cuts ‘Shocking’
An estimated $5.8 billion in cuts to the National Institutes of Health in President Donald Trump’s proposed budget has California’s top universities and medical institutions sounding the alarm. Trump’s spending plan — running into opposition from Republicans and Democrats alike — would cut about 20 percent of the roughly $30 billion budget of the nation’s medical research agency that supports research on cancer, Alzheimer’s disease, Zika and other conditions. Research institutions nationwide decried the cuts as potentially devastating to their work. (Korry, 3/17)

Cleveland Plain Dealer: Trump’s Budget Puts Local Public Health, Medical Research And Jobs At Risk
President Donald Trump’s proposed budget includes cuts in public health and medical research funding that would both eliminate jobs and essential services in Northeast Ohio, according to local health and policy experts. Combined with the proposed public health funding cuts in the Republican Obamacare replacement plan, the impact on Ohio state and local health department infrastructure and ability to deliver basic preventive health services would be enormous, said Cuyahoga County Health Commissioner Terry Allan. (Zeltner, 3/17)

Houston Chronicle: Houston Could Lose Big If Trump Cuts Medical Research Funding 
President Trump’s proposal to slash federal support of medical research would undercut Houston’s burgeoning health care and medical technology industries, which are becoming an increasingly important segment of the region’s economy. Health care employs more than 560,000 people in the Houston area, a steadily expanding sector that has added about 170,000 jobs over the past 10 years and helped stabilize the local economy during the recent oil bust. Those figures don’t include an emerging industry of biotechnology and medical device firms that are growing around Houston’s medical complex. (DePillis, 3/17)

Bloomberg: Trump’s Cuts To Meals On Wheels Could Hurt Veterans, Raise Health-Care Costs 
One of the casualties of President Donald Trump’s proposed budget may be Meals on Wheels, the familiar food delivery program for homebound Americans. The aim is to decrease federal spending, but cuts to the service could backfire by raising health-care costs, the program warned. The spending plan calls for reductions to two grants that Meals on Wheels relies on in some locations, as well as to federal departments that help fund the program, spokeswoman Jenny Bertolette said in a statement. “With a stated 17.9 percent cut to the U.S. Department of Health and Human Services budget,” Bertolette said, “it is difficult to imagine a scenario in which these critical services would not be significantly and negatively impacted if enacted into law.” (Mosendz, 3/17)

Public health officials also brace for the fallout of the administration’s visa policy and push to deregulate  —

The New York Times: Rural Areas Brace For A Shortage Of Doctors Due To Visa Policy
Small-town America relies on a steady flow of doctors from around the world to deliver babies, treat heart ailments and address its residents’ medical needs. But a recent, little-publicized decision by the government to alter the timetable for some visa applications is likely to delay the arrival of new foreign doctors, and is causing concern in the places that depend on them. (Jordan, 3/18)

KQED: Bay Area Lawmakers Outraged Over Trump’s Push To Eliminate Federal Refinery Regulator
Local leaders and health officials in Contra Costa County, home to four oil refineries, are blasting a part of President Trump’s budget that calls for cutting all money for the federal agency that investigates chemical accidents. Trump’s spending plan aims to eliminate funding for the U.S. Chemical Safety Board (CSB), which has conducted hundreds of probes, including one into the 2010 Deepwater Horizon oil spill. (Goldberg, 3/17)

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With Analysis Of GOP Bill, States And Localities Begin To Confront Possible Funding Cuts

Local officials worry about the effects on older residents, people enrolled in Medicaid, hospitals and mental health coverage.

Atlanta Journal Constitution: How The Republican Health Care Plan Will Affect Georgia Counties
One-size-fits-all was one of the chief criticisms of the Affordable Care Act, also known as Obamacare. It seems the alternative proposed by the Trump administration has taken the same route — only this time, affecting the poorest and oldest Americans. An AJC analysis of Kaiser Family Foundation data on the proposed American Health Care Act revealed that older Americans with the lowest incomes would be hit the hardest by the Republican replacement plan. (Datar, 3/17)

Politico Pro: Could ACA Repeal Push Massachusetts Back To Romneycare? 
Massachusetts Republican Gov. Charlie Baker has a way to deal with the uncertainty surrounding his party’s efforts to scrap Obamacare: Shift back to the pre-ACA days, when Romneycare reigned supreme. At its core, the system established in 2006 under former Gov. Mitt Romney was proto-Obamacare, mandating free health insurance for residents earning less than 150 percent of the federal poverty level while requiring employers with more than 10 full time workers to offer coverage. The 2010 federal health law superceded the state system, which by then had reduced the uninsured rate in the Bay State to 3 percent without raising health spending. (Dezenski, 3/17)

Chicago Tribune: Illinois Experts Say Republican Health Care Plan Could Cost State $40 Billion 
Illinois stands to lose an estimated $40 billion in federal money over the next decade under the Republican health care proposal being considered in Congress, experts told state lawmakers Thursday. … The $40 billion projection is based on a report released this week by the Congressional Budget Office that said 24 million Americans would lose coverage by 2026 under the Republican plan, David Gross, senior vice president of government relations for the Illinois Health and Hospital Association, told lawmakers. The report said states could lose out on a possible $880 billion in federal funding over that same period. (BeMiller, 3/17)

Providence Journal: Medicaid Coverage Under Republican Health Plan Could Cost RI Up To $70 Million By 2021
Rhode Island may need to spend another $25 million to $30 million to keep 70,000 low-income adults from losing their Medicaid coverage under the House Republicans’ plan to replace the Affordable Care Act in 2020, according [to] a preliminary analysis performed by health experts for The Providence Journal. And that’s just in the first year. In 2021, the additional cost is projected to run between $65 million and $70 million — an expense, some experts say, the state would likely be unable or unwilling to absorb. (Arditi, 3/17)

The Associated Press: Analysis: Medicaid Changes Could Have Sweeping Impact In La.
Despite a national focus on the individual insurance markets, the Republican health plan being debated in Washington could have far more sweeping impact in Louisiana for other provisions that curb federal spending on Medicaid. That redesign is estimated to come with deep spending cuts. The implications would be major for Louisiana, where more than one-third of residents get health services through the Medicaid program, financed jointly by the state and federal government. (Deslatte, 3/19)

Detroit News: Medicaid Cuts Would Force Tough Choices
Detroit mother Vanessa Raices, 42, said she doesn’t know the ins and outs of what is happening with health care in Washington, D.C., but she knows enough to be worried. Health care for Raices and one of her four children is covered under Michigan’s Medicaid program. That coverage could change dramatically under the GOP health plan under debate by Congress. … The program has deep roots in Michigan, where Medicaid provides health coverage for nearly 2.5 million people. The proposed changes would touch every community in the state, from urban centers in the southeast to the rural counties of northern lower Michigan and the Upper Peninsula. (Bouffard, 3/20)

Denver Post: Denver Health Could Lose $85 Million In Medicaid Dollars If American Health Care Act Passes 
Half of Denver Health’s patients are on Medicaid, meaning government dollars play a major role in the safety-net hospital’s budget. Already this year, Denver Health is trying to trim $48 million from its budget because of expected cuts to the hospital provider fee, a complicated mechanism to pay back hospitals for taking in poor and low-income patients that has also become embroiled in state Capitol budget fights. But the bigger threat, Denver Health leaders say, could come if Congress passes the American Health Care Act, the Republican-backed plan to replace Obamacare and overhaul how Medicaid works. Peg Burnette, Denver Health’s chief financial officer, said the bill could mean a revenue hit in 2020 — when the bill’s more significant Medicaid provisions kick in — of between $50 million and $85 million. (Ingold, 3/18)

Tampa Bay Times: AARP Report: Obamacare Replacement Would Hurt Older Floridians 
How many older Floridians with Affordable Care Act coverage would see their premiums rise under the Republican replacement plan? About 454,000, according to a new analysis by AARP. Low-income people in their 60s would be hardest hit, the analysis found. For some, the proposal under consideration in Congress could mean an annual tax credit reduction of nearly $6,000. (McGrory, 3/17)

Houston Chronicle: A Half Million Texans Could Be Without Insurance Under GOP Health Care Plan
As many as a half-million Texans could become uninsured under the Republican plan to replace the Affordable Care Act, wiping out at least half the gains the state has made in reducing the number of uninsured residents in recent years, according to health care analysts. Texas still has the nation’s highest percentage of people without health insurance, but that uninsured rate has dropped significantly, falling to about 19 percent from 26 percent over the past four years. About 1 million more Texans gained coverage under the health care overhaul known as Obamacare, which became law in 2010. (Deam, 3/18)

Roll Call: ‘What Does It Mean?’ West Virginians Weigh GOP Health Care Plan
[Diane] Hughes was among the West Virginia residents gathered at the Robert C. Byrd Health Science Center here on Thursday for a town hall meeting on the Republican plan to overhaul the 2010 health care law. … She credited the health care law with allowing her to participate in a behavioral health program that has helped her recover [from addiction to pain medication]. … The Republican plan, which is scheduled for a House floor vote on Thursday, would eliminate a requirement relating to mental health and substance abuse services. Plans offered through the 2010 law’s Medicaid expansion were required to provide those services. (Bowman, 3/20)

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Prescription Drug Costs Are On The Rise; So Are The TV Ads Promoting Them

Laura Ries was moved to action when she saw a TV commercial that portrayed a woman enjoying time with her grandchildren after taking Lyrica, a prescription medication for diabetic nerve pain. Ries’ elderly mother suffered from just that problem.

“The ad showed someone who was enjoying life again,” said Ries, president of a marketing strategy firm in Atlanta, who then researched the drug and spoke with her mother’s doctor. “This … was very relatable to what my mom was experiencing.”

Her reaction was precisely the aim of direct-to-consumer (DTC) advertising: getting patients or their family members to remember a drug’s name and ask by name for a prescription.

Spending on such commercials grew 62 percent since 2012, even as ad spending for most other product types was flat.

“Pharmaceutical advertising has grown more in the past four years than any other leading ad category,” said Jon Swallen, chief research officer at Kantar Media, a consulting firm that tracks multimedia advertising. It exceeded $6 billion last year, with television picking up the lion’s share, according to Kantar data. Shows such as the major network’s evening news programs, the CBS comedy “Mike & Molly” and ABC’s daytime drama “General Hospital” are heavy with drug ads, Kantar data show.

But the proliferation of drug advertisements has generated new controversy, in part because the ads inevitably promote high-priced drugs, some of which doctors say have limited practical utility for the average patient-viewer. The cost of Lyrica, the drug Ries was asked about for her mom, is about $400 for 60 capsules, for example. Critics say the ads encourage patients to ask their doctors for expensive, often marginal — and sometimes inappropriate — drugs that are fueling spiraling health care spending.

The American Medical Association took a hard-line position on these ads in 2015 by calling for a ban, saying “direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate.”

Such a prohibition is unlikely. Previous efforts to push such an outcome have stalled, generally on free-speech arguments by the powerful drug lobby and assertions that such ads provide valuable information to patients about treatment options.

Spending Zooms

One thing is certain: DTC advertising is big. And, as nearly everyone who watches TV knows, it’s getting bigger.

A screenshot from an ad by Pfizer, the maker of Lyrica. (YouTube)

Some programs — the nightly news and sitcoms aimed at older Americans — get most of their advertising from drugmakers. A Kantar analysis shows 72 percent of commercial breaks on the “CBS Evening News” have at least one pharmaceutical advertisement. Commonly, the ads target a range of conditions that generally affect this demographic, such as dry eyes, erectile dysfunction, pain and constipation. Sixty-two percent of commercial breaks during “General Hospital” include a drug ad.

“A lot of these ads target the caregivers and the children of older folks,” said consultant Tom Lom, a former managing partner of Saatchi & Saatchi Consumer Healthcare, which has created ads for pharmaceutical giants from Pfizer to Merck.

Drugmakers were on track to spend an estimated $6.4 billion on DTC advertising in the U.S. last year, up 5 percent from 2015, according to Kantar. In 2012, spending for pharmaceutical TV ads was the 12th-largest category. By last year, drug ads were sixth. While substantial, the spending was less than the amount spent by automakers, retail and restaurants. Networks — ABC, CBS, NBC — along with cable channels like CNN — draw a lot of the pharmaceutical advertising. According to Swallen, the effect of the ban on networks would be a daunting, 8 percent loss of total ad revenue, and its impact would be most evident for programming popular with viewers older than 60 ­— for instance, evening news shows. Similarly, cable networks such as the Hallmark Channel, which draw viewers from this demographic, would feel the pinch because they “have more skin in the game,” he said.

Why Some Drugs Are Advertised

For years, the DTC industry was mostly focused on drugs that relieved chronic, typically non-fatal afflictions like heartburn (Nexium), allergies (Claritin) and high cholesterol (Lipitor).

More recently, Lom said, advertising has focused on cancer and illnesses affecting seniors, such as Alzheimer’s disease. Ads for drugs that target constipation caused by other drugs — opioids — hit the scene last year, reflecting the large numbers of people taking painkillers.

For years, the DTC industry was mostly focused on drugs that relieved non-fatal afflictions like allergies. Advertising has more recently focused on cancer and illnesses affecting seniors. (Screenshot)

In 2016, the top three ads based on total spending were Lyrica, with $313 million in spending; rheumatoid arthritis drug Humira at $303 million; and Eliquis, a treatment for a type of heart arrhythmia, at $186 million, according to Kantar.

Reasons why some drugs are advertised more than others vary, with drugmakers evaluating which products are most likely to bring them the most revenue.

Drugmakers don’t care “whether it’s a rare, expensive drug or a popular cheap drug,” said Amanda Starc, associate professor of strategy at Northwestern’s Kellogg School of Management. “They’re looking at the marginal return on advertising. A small number of customers spending a lot or a big number spending a little.”

How Advertising Plays To Consumers

The United States is one of two countries — the other is New Zealand — that allows DTC advertising, a long-standing practice that became more common in the mid-1980s after the FDA issued new rules. Most advertising was in print. But more television advertising began appearing when some of the rules were relaxed a decade later.

Lom said the ads give consumers a “head start” on knowing about drugs that might be available for their ailments, speeding up the consumer education process.

But, surprisingly, 62 percent of physicians, for instance, said they would or might prescribe an innocuous, even placebo treatment to a patient who didn’t need it but demanded it, according to a 2016 poll conducted by Medscape, an online physician education website.

Current rules require that if a drug is named in an ad, information must be included about side effects and adverse reactions. That makes it even more important that drug advertising be visually captivating — if not surprising, say consultants.

The ad for Spiriva, a drug for people with lung diseases that can make it hard to breathe, shows an elephant sitting on actress Jeanette O’Connor’s chest. During the 2016 Super Bowl, viewers saw a man emerging from a restroom with a pleased look on his face in an advertisement about opioid-induced constipation. Cialis, which treats erectile dysfunction, uses images of couples in side-by-side bathtubs, which sticks in consumers’ minds.

Meanwhile, the side effects are glossed over. “They describe the risks at the same time they play pleasant music — or show pleasant pictures — which helps to distract people from getting the message,” says Dr. Aaron Kesselheim, associate professor of medicine at Harvard Medical School.

And while President Donald Trump said he wants to reduce the high costs of prescription medicines, he is also likely to encourage fewer government restrictions on the development and marketing of drugs.

But whether the advertising empowers patients or leaves them vulnerable is debatable.

Those that do advertise, however, appear to have a leg up. Ries, the brand consultant, says it wasn’t just the ad that helped her to remember Lyrica, but the name, too, which was easy to spell and pronounce.

Reis said her mother did take the Lyrica “and it’s helped.” That’s a good thing, says the brand guru who takes pride in looking out for her mom. “The ad spurred the conversation.”

Categories: Cost and Quality, Health Industry, Pharmaceuticals

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Travel Ban Adds Stress To ‘Match Week’ For Some Doctors

Dr. Amin Rabiei knew he wanted to work in medicine from an early age. While growing up in Iran, he watched his dad experience seizures and his mom struggle to help. Rabiei went on to medical school in Iran, then practiced at a rural clinic there, all the while working toward an important career point that culminated Friday: getting matched to a medical residency training program in the United States.

“I decided to come here to have better opportunities for research and clinical education,” said Rabiei, who is already in Philadelphia on a research visa doing postdoctoral research at Thomas Jefferson University. His ultimate aim? “Hopefully, to share this information and these skills for the people who need this in the undeveloped countries.”

Rabiei hopes to train in neurology with a focus on epilepsy. For international medical graduates like Rabiei, becoming eligible for residency training in the U.S. is a rigorous process that can take years of planning, financing and work. In general, landing one of these coveted spots, a requirement for anyone aspiring to train and practice medicine in the U.S., is already competitive; about 32,000 slots are available to an applicant pool of 42,000. Last year, about half the applicants from outside the U.S. were successful in getting a match.

But this year, in the run-up to Match Day, Rabiei and others worried that the recent White House executive orders on immigration had further diminished their chances of getting a match.

“It becomes like double stress,” Rabiei said.

“It is a valid concern,” said Dr. William Pinsky, president of the Educational Commission for Foreign Medical Graduates. And that valid concern continued, even though the most recent executive order on travel was blocked nationwide, at least temporarily, last week.

Here’s why: Pinsky says President Trump’s executive orders have created new unknowns in the visa process for foreign medical graduates — and the ambiguity puts the residency programs, as well as the applicants, in a bind. Though the training programs rank applicants according to their merits and qualifications, the matching system hinges on these young doctors being available and ready to start caring for patients in July. Many residency programs can’t risk having an empty seat because of visa processing delays.

“Program directors have to weigh various factors of applicants, from their medical knowledge, ability to communicate, their observed level of empathy, their leadership capabilities — and their ability to be available when July 1 comes,” Pinsky said.

He estimates that roughly 300 to 400 applicants this year from the countries covered by the White House executive orders would now need to apply for a visa — or change or renew the one they have — to train in the U.S.

About 1,800 people from these countries are already in medical residencies in the United States.

Further complicating this year’s “match week,” most residency programs ranked their preferences of applicants on Feb. 22 — in between the issuing of the first and second executive orders on travel restrictions. Those match decisions were released Friday.

“The timing and uncertainty of the executive order could not have come at a worse time,” Pinsky said.

The first White House executive order restricting travel came out in January and applied to seven Muslim majority countries: Iran, Iraq, Libya, Somalia, Sudan, Syria and Yemen. The more recent version, announced in early March, removed Iraq from the list. It bans new visas from the remaining six countries for 90 days, but also includes some exceptions that allow U.S. entry — such as for lawful permanent residents of the U.S. and those with other valid documents.

The Educational Commission for Foreign Medical Graduates, which is based in Philadelphia, is responsible for certifying all international graduates who wish to apply for residency and practice medicine in the U.S. This involves administering qualifying exams and overseeing other background checks. ECFMG is also closely involved in the visa process, as a main sponsor of J-1 clinical visas for international graduates — the most common type of visa granted for training and practicing medicine in the United States. A smaller number of institutions may directly sponsor residents through an H-1B visa.

“If someone has a visa, as I understand, even though they’re from one of these six countries, it’s not an issue,” Pinsky said.

Even so, it’s still unclear who is eligible to get a visa or how long it will take. His organization is awaiting clarification from the federal government on that process and whether, as before, the process can be expedited in order to be completed by the start of a medical residency.

Dr. Atul Grover, vice president of the Association of American Medical Colleges, said large residency programs may be less affected by the executive orders than small ones.

“I think our bigger institutions, like Penn and CHOP [Children’s Hospital of Philadelphia], have very much said, ‘Just on principle we’re going to rank these people if we think these are the best people,’” Grover said.

“You know, if I’m Penn and I’ve got an internal medicine class of, like, 45 residents, maybe I can take more of a chance. If one resident doesn’t come maybe I can figure it out.” (Indeed, a spokesperson from Penn said they don’t think the executive order will impact the institution’s ability to train residents who match there.)

But waiting for somebody’s visa to come through can be a greater risk for smaller programs, Grover said. “You can’t afford to lose 10 or 25 percent of your class. It’d be a big gamble for them.”

Dr. Robert Wimmer heads a small pediatric residency program at Einstein Medical Center in North Philadelphia, and said about half the residents there are medical graduates from another country. The program can’t afford to accept someone in their new class of 10 if there’s a chance they might not be able to start in July because of visa issues.

“It’s unfortunate,” Wimmer said. “Many work their tails off to get to the U.S. We might be losing a lot of talent.”

While the United States has long been known as an epicenter for top medical research and care, Pinsky worries that reputation and the whole system could suffer if an uncertain immigration climate discourages young doctors from trying to train and practice in the United States.

“There could be an issue of access to health care as well as a quality situation,” he said.

Rabiei said he and his Iranian peers are trying to stay positive.

They feel encouraged by the support they’ve received from colleagues and their universities.

“When you try so hard to get to your dream, and all of a sudden you feel that there are some issues — unexpected problems — it’s a really bad feeling,” he said.

Rabei was thrilled to learn Monday that he has been offered a position by at least one institution. He knows other Iranians who were not so lucky. And on Friday, he got very good news: He matched with Drexel University College of Medicine. He will be able to stay in the United States — and even in Philadelphia.

This story is part of a partnership that includes WHYY’s The Pulse, NPR and Kaiser Health News.

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Report: Fired U.S. Attorney Was Probing Tom Price’s Stock Trades

Preet Bharara, a former top federal prosecutor in Manhattan, was investigating stock trades by Health and Human Services Secretary Tom Price prior to Bharara’s ouster last week by President Donald Trump,  ProPublica reported Friday.

The report, attributed to an unnamed person familiar with the U.S. Attorney’s Office of the Southern District of New York, revived questions about the propriety of Price’s investments in numerous health care companies that stood to benefit from legislation he voted for and sponsored as a Georgia congressman. Those concerns have dogged the former congressman since Trump nominated him to head HHS last November.

Preet Bharara

Preet Bharara was asked to step down as U.S. attorney for the Southern District of New York by the Trump Administration. (Peter Foley/Bloomberg via Getty Images)

It also brought fresh dramatic flair to the little that is known about how one of the nation’s most prominent U.S. attorneys lost his job. Bharara, whose jurisdiction included Wall Street, gained fame prosecuting financial corruption cases over eight years on the job.

When the Trump administration asked 46 U.S. attorneys, including Bharara, to step down, he refused the request.  Afterward, Bharara tweeted that he had been fired.

The U.S. attorney’s office declined to comment on ProPublica’s report.

Price, previously a member of the House Ways and Means Committee, came under fire during his confirmation hearings for his health industry stock trades and promised to divest himself of holdings within 90 days of taking office. An HHS spokesman said Friday that Price met that requirement but declined to release details.

Among Price’s stock purchases that garnered the most scrutiny: his investment in Innate Immunotherapeutics.

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While Price sat on the Ways and Means health subcommittee, he bought shares of the Australian biotech in a private placement at a discounted rate — $0.18 cents per share. A new private placement announced Friday will offer shares for $0.72 per share. Innate’s trading on the Australian Stock Exchange was suspended while the company raises capital.

Four other Republican congressmen invested too, even as scrutiny surrounding the company increased. A report from ethics watchdog CREW (Citizens for Responsibility and Ethics in Washington) Friday found that Reps. Mike Conaway (R-Texas), Doug Lamborn (R-Colo.), Billy Long (R-Mo.) and Markwayne Mullin (R-Okla.) all bought shares of Innate in January 2017. Mullin and Long both sit on the health subcommittee with Collins.

“Congressman Long did not learn of Innate Immunotherapeutics through a colleague, but rather through the news in January when the company became a daily topic in the news,” Long’s press secretary Hannah Smith said in an email.

Democrats in January called for an investigation into the extent of Price’s holdings and asked the Securities and Exchange Commission to determine whether he used insider information. Earlier that month Public Citizen, a nonprofit watchdog group, submitted a letter of inquiry to the Office of Congressional Ethics requesting closer scrutiny of investments by Price and Collins in the foreign company.

The offices of Mullin, Conaway and Lamborn did not immediately return requests for comment.

Categories: Health Industry, Repeal And Replace Watch

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Viewpoints: Pharma Execs Embrace Trump’s Pick To Head FDA As One Of Their Own; What About ‘Good Eugenics’?

A selection of opinions on health care from around the nation.

Los Angeles Times: Farewell To Drug Regulation? Trump Nominates A ‘Bona-Fide Pharma Shill’ To Head The FDA
Lots of people in the healthcare field heaved a sigh of relief last week when President Trump nominated Scott Gottlieb, a physician, venture investor and former official of the Food and Drug Administration, to be the FDA’s next commissioner. Some healthcare experts were relieved that, whatever Gottlieb’s particular qualities, at least he wasn’t someone from the camp of “we-have-to-destroy-the-agency-to-save-it” species of Trump appointee like, say, Environmental Protection Agency boss Scott Pruitt. (Michael Hiltzik, 3/16)

Los Angeles Times: Is There Such A Thing As Good Eugenics?
We entered a new phase as a species when Chinese scientists altered a human embryo to remove a potentially fatal blood disorder — not only from the baby, but all of its descendants. Researchers call this process “germline modification.” The media likes the phrase “designer babies.” But we should call it what it is, “eugenics.” And we, the human race, need to decide whether or not we want to use it. (Adam Cohen, 3/17)

Boston Globe: Trump NIH Cuts Threaten Mass. 
Lawmakers need a stark reminder that advances in medicine and cures for human disease often come only after decades of painstaking scientific research — much of it funded by government grants. That’s why the $5.8 billion cut proposed for the National Institutes of Health on Thursday is as short-sighted as it is devastating for the nation’s researchers, doctors, and patients. (3/16)

The New England Journal Of Medicine: Out Of Sight, Out Of Mind — Behavioral And Developmental Care For Rural Children
The Centers for Disease Control and Prevention (CDC) has just offered further evidence that American children — and rural children in particular — are in trouble. Previously, the CDC had noted that poor U.S. children 2 to 8 years of age have higher rates of parent-reported mental, behavioral, and developmental disorders (MBDDs) than their wealthier counterparts. Now, in the latest of a series of reports, the agency documents the finding that rural children from small communities are more likely to have MBDDs than those living in cities and suburbs. (Kelly J. Kelleher and William Gardner, 3/16)

WBUR: Doctor: Boston Evictions Tantamount To A Public Health Crisis 
Evictions can lead to many health problems. According to a nationally representative study published by Harvard and Rice University researchers, evicted mothers are more likely to have depression and report worse health for themselves and their children. Disruptive life events like eviction and homelessness at a young age may have lifelong health impacts for developing children. (Lara Jirmanus, 3/16)

The Des Moines Register: Profit-Seeking Medicaid Insurers Vs. Iowans
Iowa has been victimized by Gov. Terry Branstad’s Medicaid privatization for nearly a year. Handing over a $4 billion government health insurance program to profit-seeking companies did not make sense in theory, and in practice, it has been a nightmare for health providers and low-income Iowans. Enough is enough. It is time to return to the state-managed Medicaid system that had low administrative expenses, timely reimbursement for providers and consistency in coverage for patients. (3/16)

San Jose Mercury News: Too Many Health Plan Choices Mean Worse Care
I appreciate that the healthcare system within which I work accepts most insurance plans, but when my patients change jobs, move, become eligible for Medicare, or their insurance plan switches networks, they are forced to get new doctors and establish care within a new system. Many critics of universal healthcare argue that it limits patient choice. However, in my experience there are overlooked negative consequences of having too many health insurance options. (Tenessa Mackenzie, 3/16)

The New England Journal Of Medicine: Clarifying Stem-Cell Therapy’s Benefits And Risks
The current excitement over the potential for stem-cell therapy to improve patient outcomes or even cure diseases is understandable. We at the Food and Drug Administration (FDA) share this excitement. However, to ensure that this emerging field fulfills its promise to patients, we must first understand its risks and benefits and develop therapeutic approaches based on sound science. Without a commitment to the principles of adequate evidence generation that have led to so much medical progress, we may never see stem-cell therapy reach its full potential. (Peter W. Marks, Celia M. Witten and Robert M. Califf, 3/16)

Arizona Republic: Trust These Folks To Apply Anesthesia To Patients
There is – Senate Bill 1336.This simple, commonsense measure benefits Arizona patients and health-care professionals. We write as surgeons who recognize the critical service provided by our nursing colleagues, Certified Registered Nurse Anesthetists (CRNAs). In many facilities, especially in rural or underserved communities, it is a CRNA – not an anesthesiologist – who is in charge of making sure the patient is asleep and comfortable for their procedure. (Eric Nelson, Robert Schuster and Steven Washburn, 3/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Different Takes: Attacking And Defending The GOP Health Plan

Editorial pages feature arguments from all sides of the current congressional debate about health policy.

The New York Times: Trumpcare’s Lonely, And Seedy, Supporter
The Republican health bill doesn’t have many outside supporters. Groups representing doctors, nurses, hospitals, retirees, patients of various diseases and even insurers have all criticized it. Some of the only outside praise has come from the chief executive of Anthem, the country’s second largest insurer. And therein lies another tale of the Trump administration’s conflicts of interest. (David Leonhardt, 3/17)

The Wall Street Journal: Offending ObamaCare
Have you heard the news? Democrats are going “on offense” to promote ObamaCare as Republicans consider the best way to replace it. Just one week ago NBC News reported that Democrats were “revving up” their “offensive” on health care. Now apparently the offensive is no longer merely idling in the political driveway but cruising around Capitol Hill. The progressive activists at Buzzfeed dutifully relay that the Democratic Senatorial Campaign Committee “is now posturing itself as on offense on the issue.” (James Freeman, 3/16)

The Wall Street Journal: How To Repair ObamaCare’s Fiscal Damage
Most of the debate about the Affordable Care Act has centered on how it affects health care. It’s time to pay attention to how ObamaCare has damaged federal finances. Lawmakers must bear in mind, even as they balance other important value judgments affecting the health and income security of millions of Americans, that the current repeal-and-replace effort represents a unique, fleeting opportunity to accomplish essential fiscal corrections. (Charles Blahous, 3/16)

The Washington Post: How To Save The GOP Health-Care Plan
The American Health Care Act is in trouble, with House Speaker Paul D. Ryan (R-Wis.) admitting Wednesday that the bill must change to make it through Congress. The reason? The Republican right and the Republican center want different things, and the rules under which the proposed Obamacare replacement can pass the Senate by a simple majority make it extremely hard to satisfy both sides. But the apparently difficult problems of policy reforms are just that: “apparent.” With some outside-the-box thinking, some dealmaking and a little humility, the AHCA can be saved. (Hugh Hewitt, 3/16)

The New York Times: The G.O.P. Health Care Plan’s Fatal Flaw
Reconciliation is a fast-track process that allows budget-related legislation to pass the Senate without the prospect of a filibuster. The Byrd rule prevents reconciliation from being used to pass any measure for which the budgetary effects — “changes in outlays or revenues” — are “merely incidental to the non-budgetary components.” Republicans know they lack the 60 votes to break a filibuster in the Senate, so they designed their repeal-and-replace bill to satisfy the Byrd rule’s requirements. Yet there is a surprising flaw in their design — one that has so far drawn little notice, but that Senate Democrats will surely seize on. (Daniel Hemel and David Herzig, 3/16)

The New York Times: Why Republicans Keep Talking About Health Care ‘Prongs’
When faced with a tough question about nearly any aspect of the health bill moving through Congress, Republican officials like to mention their plan’s other “prongs.” In a briefing Tuesday, the White House press secretary, Sean Spicer, cited the prongs again and again. Paul D. Ryan, the House Speaker, is fond of mentioning them. So is Tom Price, the secretary of Health and Human Services. They say the bill needs to be understood as part of a larger strategy of reforming the health care system, not a piece of legislation that, alone, can achieve their goals. (Margot Sanger-Katz, 3/16)

Sacramento Bee: Insurance Companies’ Deafening Silence On Destructive GOP Health Plan
Doctors, nurses and hospital executives have taken a stand to protect patients against the House Republicans’ American Health Care Act, the bill to eviscerate Obamacare. The potent voice of most health insurers so far is silent. Worse, some seem supportive. If major insurers support the Republican proposal, they would be making a tragic mistake, reinforcing their status as one of the country’s most reviled industries. (Tom Epstein, 3/16)

Bloomberg: Obamacare Isn’t Going To Fix Itself
As the exciting saga of the American Health Care Act staggers forward, it’s easy to forget that new chapters of our old health care drama are still being written. On Wednesday, the department of Health and Human Services released its final estimate of the enrollment figures for Obamacare. … If you’re not following health care policy closely, the significance of these changes may not be clear. But they are significant, and they matter, because they tell us how Obamacare is going — and that matters not just for where we are now, but for the fate of any future Republican replacement. (Megan McArdle, 3/16)

The Wall Street Journal: Repeal And Replace: What Would Reagan Do?
As a conservative, I’d also like to see work requirements for able-bodied adults on Medicaid. Right now, 70 million Americans are enrolled in Medicaid, roughly nine million of whom are able-bodied adults with no children at home, But should we, in Reagan’s words, ”jump off the cliff,” or should we celebrate that this legislation includes the most transformational reform to Medicaid since its inception 50 years ago? (Rep. Robert Pittenger, (R-N.C.) 3/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Cholesterol Drug Prevents Heart Attacks — But It Doesn’t Come Cheap

WASHINGTON — For the first time, research shows that a pricey new medication called Repatha not only dramatically lowers LDL cholesterol, the “bad cholesterol,” it also reduces patients’ risk of dying or being hospitalized.

Repatha, a man-made antibody also known as evolocumab, cut the combined risk of heart attack, stroke and cardiovascular-related death in patients with heart disease by 20 percent, a finding that could lead more people to take the drug, according to a study presented Friday at a meeting of the American College of Cardiology.

Some doctors hailed the results as major progress against heart disease. In an editorial in The New England Journal of Medicine, Dr. Robin Dullaart, a researcher at the University of Groningen in the Netherlands, called it a landmark study.

Others said they expected more from the $14,000-a-year drug. It was approved in 2015 without evidence that it prevents heart attacks, simply because its cholesterol reductions were so dramatic and promising.

Doctors often recommend that people keep their LDL levels under 100 milligrams per deciliter, and that people at very high risk reduce their LDL under 70.

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In the new study, patients with heart disease who combined Repatha with a statin, the most commonly used cholesterol medication, decreased their LDL from 92 milligrams per deciliter to 30. Doctors have rarely seen cholesterol levels that low. Many doctors wondered if such low levels would be dangerous, causing memory problems or dementia due to a lack of cholesterol, said Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic, who was not involved in the new research but has led clinical trials of PCSK9 inhibitors in the past.

The new study, which followed 27,000 patients for two years, found no safety risks.

While doctors said they were relieved that Repatha is safe, doctors such as David Rind said they had hoped the study would show that the injectable medication reduces heart attacks and other serious complications by 30 percent or more, given its success in early studies.

“This [result] is probably a little less than we had been hoping for,” said Rind, chief medical officer at the Boston-based Institute for Clinical and Economic Review, which evaluates drugs’ cost effectiveness. Rind also was not involved in the study.

The study’s author, Dr. Marc Sabatine, said the “compelling reductions” in heart attacks, strokes and death suggest doctors should treat cholesterol much more aggressively, aiming to lower LDL levels as much as possible. His study focused on patients with underlying heart disease, most of whom had already had a heart attack.

The standard treatment for cholesterol, other than diet and exercise, is a generic statin, which costs $250 a year. Statins can cut LDL levels by up to half and reduce heart attack risk by 25 percent, Nissen said.

Some doctors are less impressed with the new study, which was funded by Amgen, Repatha’s manufacturer.

(Courtesy of Amgen)

In the study, also published in The New England Journal of Medicine, 5.9 percent of patients who combined Repatha with a statin had a heart attack, stroke or died, compared with 7.4 percent of patients who took a statin plus a placebo.

“It’s a small reduction for a super expensive drug,” said Dr. John Mandrola, a cardiologist at Baptist Health in Louisville, Ky., and chief cardiology correspondent for Medscape, who wasn’t involved in the study.

Yet Repatha’s high cost could burden the U.S. health system, said Dr. Steve Miller, senior vice president and chief medical officer at Express Scripts, a pharmacy benefit manager. A similar drug to Repatha, called Praluent, costs about as much. Doctors don’t know whether Praluent would also prevent heart attacks, Rind said.

Repatha and Praluent, which belong to a class called PCSK9 inhibitors, are especially expensive because they would be taken for such a long time. Unlike an antibiotic, which patients take for a few days or weeks, those prescribed Repatha would take it for the rest of their lives.

Given its price, doctors aren’t likely to give Repatha to everyone with high cholesterol, said cardiologist Cam Patterson, chief operating officer at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, who wasn’t involved in the study.

About 11 million Americans could be eligible for Repatha, according to Amgen. Repatha was approved for people with an inherited condition that causes high LDL levels or who have underlying heart disease but haven’t been able to adequately lower their LDL with statins alone. About 70 million Americans have high cholesterol and 25 million take statins, Nissen said.

Repatha could be an important drug for some high-risk patients, in spite of the cost, he said.

“It would be hard for me to look a patient in the eye, if they’ve had a couple of heart attacks and is scared to death, and say it’s not worth you taking this medication,” Nissen said.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Categories: Cost and Quality, Health Industry, Pharmaceuticals

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