Tagged Trump Administration

Trump’s Work-For-Medicaid Rule Puts Work On States’ Shoulders

The Trump administration’s watershed decision Thursday to allow states to test a work requirement for adult Medicaid enrollees sparked widespread criticism from doctors, advocates for the poor, and minority and disability rights groups.

Conservatives, however, hailed the change to the federal-state program for low-income people. Stephen Miller, the Medicaid commissioner for Kentucky, which received authority Friday to implement a work requirement, said the new policy will “allow states the flexibility to pursue innovative approaches to improve the health and well-being of Medicaid beneficiaries.”

Yet states considering whether to enact the controversial strategy face major hurdles. They will have to figure out how to define the work requirement and alternative options, such as going to school or volunteering in some organizations; how to enforce the new rules; how to pay for new administrative costs; and how to handle the millions of enrollees likely to seek exemptions.

Take Arizona, one of the 10 states that have applied for federal approval for a work requirement. The state must settle basic questions, including whether people would have to meet the new conditions at the time of enrollment, at the annual renewal of their Medicaid coverage or at another time.

Jami Snyder, deputy director of the Arizona Medicaid program, said a key goal for the state is to help people find jobs — not to reduce its Medicaid enrollment, which stands at 1.9 million.

“Infusing the requirement into our eligibility requirements acts as a nice incentive for enrollees in their effort to seek out employment and job training,” she said.

But the state today doesn’t know how many of its enrollees are already employed, said Snyder.

“We are still working through all the operational details,” she explained.

Seema Verma, administrator for the Centers for Medicare & Medicaid Services, said she hopes the new work requirement will improve enrollees’ health while reducing Medicaid rolls. The policy change should help people find jobs that offer health coverage or make enough money to afford private plans, she said.

Critics expressed skepticism. They say the work requirement proposal — which was repeatedly rejected by the Obama administration on the argument it would interfere with providing health coverage — is a more subtle way to reduce the number of non-disabled adults added to Medicaid under the Affordable Care Act. That Medicaid expansion was sharply criticized by conservatives, and Republicans in Congress tried to add work requirements in their unsuccessful bid last year to overturn the health law.

“This is an effort to walk back the Medicaid expansion,” said Judith Solomon, vice president of the Center on Budget and Policy Priorities, a Washington-based research organization. CMS said states would have to test whether the work requirement improves enrollees’ health — a point Solomon ridiculed. “What health outcome will be improved if we take away health care from those not able to work?” she asked.

Dr. Richard Pan, a California state senator and pediatrician in Sacramento who sees Medicaid patients, said the idea just “doesn’t make sense.” By making it harder for people to have health insurance, “you’re going to make it less likely for them to work,” he said.

Pan, a Democrat, said the proposal would create more bureaucracy and “feeds into a fiction” that Medicaid enrollees don’t work — or don’t want to work.

More than 4 in 10 non-disabled adults with Medicaid coverage already work full time.

Despite their concerns about the change in Medicaid policy, critics of the plan acknowledge that it will touch only a fraction of the nation’s total enrollment. Solomon estimates that fewer than 2 percent of the 74 million people covered would be directly affected by a work requirement.

In addition to the large group of enrollees already working, the federal guidelines excluded children — who make up nearly half of Medicaid enrollees. Also off the hook are the more than 10 million enrollees who have a disability. Many of those left either to go to school or take care of a relative or are too sick to work.

The CMS guidelines give states wide latitude in enacting work requirements, and state rules may differ on who gets exempted from the mandate. Arizona’s proposal has one of the longest lists of exemptions, including people 55 and over, victims of domestic violence, American Indians and individuals who have experienced a death of a family member living in the same household.

It is unclear how enrollees will prove they meet such criteria or if states will use the honor system.

In comparison, Kentucky seeks to exempt children; pregnant women; primary caregivers for children or a disabled relative; people who are medically frail; and full-time students.

Emily Beauregard, executive director for Kentucky Voices for Health, an advocacy group, said one of the key exemption issues states must work out is defining who is “medically frail”— a designation that CMS said would exempt enrollees from the requirement. The federal government, however, leaves the qualifying characteristics up to states.

Before coming to Washington last year, Verma was a health consultant who worked with Indiana and Kentucky to expand Medicaid under the ACA. But in a speech to the nation’s Medicaid directors in November, Verma said adding non-disabled adults to Medicaid was a mistake for a program designed to help children, the disabled and pregnant women.

“The thought that a program designed for our most vulnerable citizens should be used as a vehicle to serve working-age, able-bodied adults does not make sense,” she said at the time.

Some Democratic-leaning states are not expected to make the change. California health care leaders dismissed the idea of imposing a work requirement on the state’s Medicaid enrollees, saying it would never come to pass.

Kevin de León, a Democrat and the leader of California’s Senate, wouldn’t comment on the proposal because he said it’s a non-starter.

“This is not an option we are considering,” said Jennifer Kent, director of the state Department of Health Care Services, which administers Medi-Cal, the state’s Medicaid program that covers about 13.5 million Californians.

Most states contract with private health insurers to run much of their Medicaid operations. Those insurers said they remain concerned that as the work mandate unfolds, their jobs might become harder because of increased churn in enrollment and administrative work. About 52 million of the 74 million Medicaid enrollees rely on managed-care companies for their coverage.

“With this guidance from CMS, it will be essential for states and stakeholders in the states — including insurance providers — to understand the details of who will be impacted by work requirements, how these requirements will be defined and administered, and how people who are impacted will be directed to new pathways for coverage and care,” said Kristine Grow, a spokeswoman for America’s Health Insurance Plans, a national trade group.

Jeff Myers, president and CEO of the Medicaid Health Plans of America, another trade group, noted that most people on Medicaid already work. He said his group is concerned work requirements could affect how the health plans operate. They will need to “see all of details from states,” he said.

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

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Insurance Medicaid States

Trump’s Work-For-Medicaid Rule Puts Work On States’ Shoulders

The Trump administration’s watershed decision Thursday to allow states to test a work requirement for adult Medicaid enrollees sparked widespread criticism from doctors, advocates for the poor, and minority and disability rights groups.

Conservatives, however, hailed the change to the federal-state program for low-income people. Stephen Miller, the Medicaid commissioner for Kentucky, which received authority Friday to implement a work requirement, said the new policy will “allow states the flexibility to pursue innovative approaches to improve the health and well-being of Medicaid beneficiaries.”

Yet states considering whether to enact the controversial strategy face major hurdles. They will have to figure out how to define the work requirement and alternative options, such as going to school or volunteering in some organizations; how to enforce the new rules; how to pay for new administrative costs; and how to handle the millions of enrollees likely to seek exemptions.

Take Arizona, one of the 10 states that have applied for federal approval for a work requirement. The state must settle basic questions, including whether people would have to meet the new conditions at the time of enrollment, at the annual renewal of their Medicaid coverage or at another time.

Jami Snyder, deputy director of the Arizona Medicaid program, said a key goal for the state is to help people find jobs — not to reduce its Medicaid enrollment, which stands at 1.9 million.

“Infusing the requirement into our eligibility requirements acts as a nice incentive for enrollees in their effort to seek out employment and job training,” she said.

But the state today doesn’t know how many of its enrollees are already employed, said Snyder.

“We are still working through all the operational details,” she explained.

Seema Verma, administrator for the Centers for Medicare & Medicaid Services, said she hopes the new work requirement will improve enrollees’ health while reducing Medicaid rolls. The policy change should help people find jobs that offer health coverage or make enough money to afford private plans, she said.

Critics expressed skepticism. They say the work requirement proposal — which was repeatedly rejected by the Obama administration on the argument it would interfere with providing health coverage — is a more subtle way to reduce the number of non-disabled adults added to Medicaid under the Affordable Care Act. That Medicaid expansion was sharply criticized by conservatives, and Republicans in Congress tried to add work requirements in their unsuccessful bid last year to overturn the health law.

“This is an effort to walk back the Medicaid expansion,” said Judith Solomon, vice president of the Center on Budget and Policy Priorities, a Washington-based research organization. CMS said states would have to test whether the work requirement improves enrollees’ health — a point Solomon ridiculed. “What health outcome will be improved if we take away health care from those not able to work?” she asked.

Dr. Richard Pan, a California state senator and pediatrician in Sacramento who sees Medicaid patients, said the idea just “doesn’t make sense.” By making it harder for people to have health insurance, “you’re going to make it less likely for them to work,” he said.

Pan, a Democrat, said the proposal would create more bureaucracy and “feeds into a fiction” that Medicaid enrollees don’t work — or don’t want to work.

More than 4 in 10 non-disabled adults with Medicaid coverage already work full time.

Despite their concerns about the change in Medicaid policy, critics of the plan acknowledge that it will touch only a fraction of the nation’s total enrollment. Solomon estimates that fewer than 2 percent of the 74 million people covered would be directly affected by a work requirement.

In addition to the large group of enrollees already working, the federal guidelines excluded children — who make up nearly half of Medicaid enrollees. Also off the hook are the more than 10 million enrollees who have a disability. Many of those left either to go to school or take care of a relative or are too sick to work.

The CMS guidelines give states wide latitude in enacting work requirements, and state rules may differ on who gets exempted from the mandate. Arizona’s proposal has one of the longest lists of exemptions, including people 55 and over, victims of domestic violence, American Indians and individuals who have experienced a death of a family member living in the same household.

It is unclear how enrollees will prove they meet such criteria or if states will use the honor system.

In comparison, Kentucky seeks to exempt children; pregnant women; primary caregivers for children or a disabled relative; people who are medically frail; and full-time students.

Emily Beauregard, executive director for Kentucky Voices for Health, an advocacy group, said one of the key exemption issues states must work out is defining who is “medically frail”— a designation that CMS said would exempt enrollees from the requirement. The federal government, however, leaves the qualifying characteristics up to states.

Before coming to Washington last year, Verma was a health consultant who worked with Indiana and Kentucky to expand Medicaid under the ACA. But in a speech to the nation’s Medicaid directors in November, Verma said adding non-disabled adults to Medicaid was a mistake for a program designed to help children, the disabled and pregnant women.

“The thought that a program designed for our most vulnerable citizens should be used as a vehicle to serve working-age, able-bodied adults does not make sense,” she said at the time.

Some Democratic-leaning states are not expected to make the change. California health care leaders dismissed the idea of imposing a work requirement on the state’s Medicaid enrollees, saying it would never come to pass.

Kevin de León, a Democrat and the leader of California’s Senate, wouldn’t comment on the proposal because he said it’s a non-starter.

“This is not an option we are considering,” said Jennifer Kent, director of the state Department of Health Care Services, which administers Medi-Cal, the state’s Medicaid program that covers about 13.5 million Californians.

Most states contract with private health insurers to run much of their Medicaid operations. Those insurers said they remain concerned that as the work mandate unfolds, their jobs might become harder because of increased churn in enrollment and administrative work. About 52 million of the 74 million Medicaid enrollees rely on managed-care companies for their coverage.

“With this guidance from CMS, it will be essential for states and stakeholders in the states — including insurance providers — to understand the details of who will be impacted by work requirements, how these requirements will be defined and administered, and how people who are impacted will be directed to new pathways for coverage and care,” said Kristine Grow, a spokeswoman for America’s Health Insurance Plans, a national trade group.

Jeff Myers, president and CEO of the Medicaid Health Plans of America, another trade group, noted that most people on Medicaid already work. He said his group is concerned work requirements could affect how the health plans operate. They will need to “see all of details from states,” he said.

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

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Insurance Medicaid States

Podcast: ‘What The Health?’ Should You Work For Your Medicaid Coverage?

The Trump administration this week told states they will be allowed to require some beneficiaries of the Medicaid program to work or perform community service in order to keep their health insurance — a break with long-standing policies of both Democratic and Republican administrations.

Meanwhile, the Congressional Budget Office said that renewing the Children’s Health Insurance Program (CHIP) for 10 years would actually save the federal government money, because alternative arrangements for the 9 million children now covered would be more expensive.

Plus, Paul Starr, Princeton professor and co-editor of The American Prospect, talks about his about ideas for expanding the Medicare program, if and when the political winds shift in that direction.

This week’s “What The Health?” panelist are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Sarah Kliff of Vox.com and Margot Sanger-Katz of The New York Times.

They discuss these topics as well as the prospects for quick confirmation of former Health and Human Services Deputy Secretary Alex Azar to head the department. And Rovner interviews Paul Starr.

Among the takeaways from this week’s podcast:

  • The new work policy follows efforts to add a work requirement to Medicaid eligibility. But that change came through congressional action. The Trump administration’s decision to shift policy through the executive branch could complicate its legal arguments when advocates file their promised lawsuits.
  • Despite concerns about the historic nature of the change in Medicaid requirements, many people — including many Medicaid enrollees — say they support a work mandate.
  • The Congressional Budget Office’s revisions to estimates about the cost of the Children’s Health Insurance Program appear to be breaking the logjam on funding on Capitol Hill.
  • Alex Azar, the nominee to be secretary of the Department of Health and Human Services, appears on the glide path for confirmation, with at least two Democratic senators, Heidi Heitkamp of North Dakota and Joe Manchin of West Virginia, having already announced they will vote for him.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner:  Mother Jones’ “Go Fund Yourself,” by Stephen Marche

ALSO: The New York Times’ “You’re Sick. Whose Fault Is That?” by Dhruv Khullar.

Joanne Kenen: The New York Times’ “Baltimore Hospital Patient Discharged at Bus Stop, Stumbling and Cold,” by Jacey Fortin

Sarah Kliff: Marketplace’s “The Uncertain Hour, Episode 1: The Magic Bureaucrat,” by Krissy Clark

Margot Sanger-Katz: The Wall Street Journal’s “Trump Nominee to Lead Indian Health Services Faces Claims of Misrepresentation,” by Christopher Weaver and Dan Frosch.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Related Topics

Insurance Medicaid Multimedia States

Podcast: ‘What The Health?’ Should You Work For Your Medicaid Coverage?

The Trump administration this week told states they will be allowed to require some beneficiaries of the Medicaid program to work or perform community service in order to keep their health insurance — a break with long-standing policies of both Democratic and Republican administrations.

Meanwhile, the Congressional Budget Office said that renewing the Children’s Health Insurance Program (CHIP) for 10 years would actually save the federal government money, because alternative arrangements for the 9 million children now covered would be more expensive.

Plus, Paul Starr, Princeton professor and co-editor of The American Prospect, talks about his about ideas for expanding the Medicare program, if and when the political winds shift in that direction.

This week’s “What The Health?” panelist are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Sarah Kliff of Vox.com and Margot Sanger-Katz of The New York Times.

They discuss these topics as well as the prospects for quick confirmation of former Health and Human Services Deputy Secretary Alex Azar to head the department. And Rovner interviews Paul Starr.

Among the takeaways from this week’s podcast:

  • The new work policy follows efforts to add a work requirement to Medicaid eligibility. But that change came through congressional action. The Trump administration’s decision to shift policy through the executive branch could complicate its legal arguments when advocates file their promised lawsuits.
  • Despite concerns about the historic nature of the change in Medicaid requirements, many people — including many Medicaid enrollees — say they support a work mandate.
  • The Congressional Budget Office’s revisions to estimates about the cost of the Children’s Health Insurance Program appear to be breaking the logjam on funding on Capitol Hill.
  • Alex Azar, the nominee to be secretary of the Department of Health and Human Services, appears on the glide path for confirmation, with at least two Democratic senators, Heidi Heitkamp of North Dakota and Joe Manchin of West Virginia, having already announced they will vote for him.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner:  Mother Jones’ “Go Fund Yourself,” by Stephen Marche

ALSO: The New York Times’ “You’re Sick. Whose Fault Is That?” by Dhruv Khullar.

Joanne Kenen: The New York Times’ “Baltimore Hospital Patient Discharged at Bus Stop, Stumbling and Cold,” by Jacey Fortin

Sarah Kliff: Marketplace’s “The Uncertain Hour, Episode 1: The Magic Bureaucrat,” by Krissy Clark

Margot Sanger-Katz: The Wall Street Journal’s “Trump Nominee to Lead Indian Health Services Faces Claims of Misrepresentation,” by Christopher Weaver and Dan Frosch.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Related Topics

Insurance Medicaid Multimedia States

Fallout From ‘Nuclear Button’ Tweets: Sales Of Anti-Radiation Drug Skyrocket

A Twitter battle over the size of each “nuclear button” possessed by President Donald Trump and North Korea’s Kim Jong-un has spiked sales of a drug that protects against radiation poisoning.

Troy Jones, who runs the website www.nukepills.com, said demand for potassium iodide soared last week, after Trump tweeted that he had a “much bigger & more powerful” button than Kim — a statement that raised new fears about an escalating threat of nuclear war.

“On Jan. 2, I basically got in a month’s supply of potassium iodide and I sold out in 48 hours,” said Jones, 53, who is a top distributor of the drug in the United States. His Mooresville, N.C., firm sells all three types of the product approved by the Food and Drug Administration. No prescription is required.

In that two-day period, Jones said, he shipped about 140,000 doses of potassium iodide, also known as KI, which blocks the thyroid from absorbing radioactive iodine and protects against the risk of cancer. Without the tweet, he typically would have sent out about 8,400 doses to private individuals, he said.

Jones also sells to government agencies, hospitals and universities, which aren’t included in that count.

Alan Morris, president of the Williamsburg, Va.-based pharmaceutical firm Anbex Inc., which distributes potassium iodide, said he’s seen a bump in demand, too.

“We are a wonderful barometer of the level of anxiety in the country,” said Morris.

A spokeswoman for a third firm, Recipharm AB, which sells low-dose KI tablets, declined to comment on recent sales.

Jones said this is not the first time in recent months that jitters over growing nuclear tensions have boosted sales of potassium iodide, which comes in tablet and liquid form and should be taken within hours of exposure to radiation.

It’s the same substance often added to table salt to provide trace amounts of iodine that ensure proper thyroid function. Jones sells his tablets for about 65 cents each, though they’re cheaper in bulk. Morris said he sells the pills to the federal government for about 1 penny apiece.

Yet, neither the FDA nor the Centers for Disease Control and Prevention recommends that families stockpile potassium iodide as an antidote against nuclear emergency.

“KI (potassium iodide) cannot protect the body from radioactive elements other than radioactive iodine — if radioactive iodine is not present, taking KI is not protective and could cause harm,” the CDC’s website states.

The drug, which has a shelf life of up to seven years, protects against absorption of radioactive iodine into the thyroid. But that means that it protects only the thyroid, not other organs or body systems, said Dr. Anupam Kotwal, an endocrinologist speaking for the Endocrine Society.

“This is kind of mostly to protect children, people ages less than 18 and pregnant women,” Kotwal said.

States with nuclear reactors and populations within a 10-mile radius of the reactors stockpile potassium iodide to distribute in case of an emergency, according to the Nuclear Regulatory Commission. An accident involving one of those reactors is far more likely than any nuclear threat from Kim Jong-un, Anbex’s Morris said.

Still, the escalating war of words between the U.S. and North Korea has unsettled many people, Jones said. Although some of his buyers may hold what could be regarded as fringe views, many others do not.

“It’s moms and dads,” he said. “They’re worried and they find that these products exist.”

Such concern was underscored last week, when the CDC announced a briefing on the “Public Health Response to a Nuclear Detonation.” One of the planned sessions is titled “Preparing for the Unthinkable.”

Hundreds of people shared the announcement on social media, with varying degrees of alarm that it could have been inspired by the presidential tweet.

A CDC spokeswoman, however, said the briefing had been “in the works” since last spring. The agency held a similar session on nuclear disaster preparedness in 2010.

“CDC has been active in this area for several years, including back in 2011, when the Fukushima nuclear power plant was damaged during a major earthquake,” the agency’s Kathy Harben said in an email.

Indeed, Jones saw big spikes in potassium iodide sales after the Fukushima Daichii disaster, after North Korea started launching missiles — and after Trump was elected.

“I now follow his Twitter feed just to gauge the day’s sales and determine how much to stock and how many radiation emergency kits to prep for the coming week,” Jones said, adding later:

“I don’t think he intended to have this kind of effect.”

KHN’s coverage of these topics is supported by Laura and John Arnold Foundation and Gordon and Betty Moore Foundation

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Pharmaceuticals Public Health

HHS Nominee Vows To Tackle High Drug Costs, Despite His Ties To Industry

Senate Democrats on Tuesday pressed President Donald Trump’s nominee for the top health post to explain how he would fight skyrocketing drug prices — demanding to know why they should trust him to lower costs since he did not do so while running a major pharmaceutical company.

Alex M. Azar II, the former president of the U.S. division of Eli Lilly and Trump’s pick to run the Department of Health and Human Services, presented himself as a “problem solver” eager to fix a poorly structured health care system during his confirmation hearing before the Senate Finance Committee. Azar said addressing drug costs would be among his top priorities.

But armed with charts showing how some of Eli Lilly’s drug prices had doubled on Azar’s watch, Democrats argued Azar was part of the problem. Sen. Ron Wyden of Oregon, the committee’s top Democrat, said Azar had never authorized a decrease in a drug price as a pharmaceutical executive.

“The system is broken,” Wyden said. “Mr. Azar was a part of that system.”

Azar countered that the nation’s pharmaceutical drug system is structured to encourage companies to raise prices, a problem he said he would work to fix as head of HHS.

“I don’t know that there is any drug price of a brand-new product that has ever gone down from any company on any drug in the United States, because every incentive in this system is towards higher prices, and that is where we can do things together, working as the government to get at this,” he said. “No one company is going to fix that system.”

Azar’s confirmation hearing Tuesday was his second appearance before senators as the nominee to lead HHS. In November, he faced similar questions from the Senate Health, Education, Labor and Pensions Committee during a courtesy hearing.

If confirmed, Azar would succeed Tom Price, Trump’s first health secretary, who resigned in September amid criticism over his frequent use of taxpayer-paid charter flights. A former Republican congressman who was a dedicated opponent of President Barack Obama’s signature health care law, Price had a frosty relationship with Democrats in Congress as he worked with Republicans to try to undo the law.

Price and the Trump administration often turned to regulations and executive orders to undermine the Affordable Care Act, since Republicans in Congress repeatedly failed to enact a repeal. “Repeal and replace” has been the president’s mantra.

But at the hearing, Azar was circumspect about his approach, noting that his job would be to work under existing law. “The Affordable Care Act is there,” he said, adding that it would fall to him to make it work “as best as it possibly can.”

Senate Republicans touted Azar’s nearly six years working for the department under President George W. Bush, including two years as a deputy secretary. Committee Chairman Orrin Hatch (R-Utah) praised Azar’s “extraordinary résumé,” adding that, among HHS nominees, he was “probably the most qualified I’ve seen in my whole term in the United States Senate.” Hatch, who is the longest-serving Republican senator in history, has been a senator for more than 40 years.

In addition to drug costs, Azar vowed to focus on the nation’s growing opioid crisis, calling for “aggressive prevention, education, regulatory and enforcement efforts to stop overprescribing and overuse,” as well as “compassionate treatment” for those suffering from addiction.

Pressed about Republican plans to cut entitlement spending to compensate for budget shortfalls, Azar said he was “not aware” of support within the Trump administration for such cuts.

“The president has stated his opposition to cuts to Medicaid, Medicare or Social Security,” Azar said. “He said that in the campaign, and I believe he has remained steadfast in his views on that.”

But Democrats pushed back, pointing out that Trump had proposed Medicaid cuts in his budget request last year. Sen. Sherrod Brown (D-Ohio) said such cuts would hurt those receiving treatment for opioid addiction.

“What happens to these people?” he said.

Despite such Democratic criticism, Azar is likely to be confirmed when the full Senate votes on his nomination. An HHS spokesman Tuesday pointed reporters to an editorial in STAT supporting Azar, written by former Senate majority leaders Bill Frist and Tom Daschle — a Republican and a Democrat. “We need a person of integrity and competence at the helm of the Department of Health and Human Services,” they wrote. “The good news is that President Trump has nominated just such a person, Alex Azar.”

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Cost and Quality Pharmaceuticals The Health Law