Tagged U.S. Congress

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! This week was so busy that I am going to take the unprecedented step and highly recommend you check out our Morning Briefings for the past few days. So many compelling, interesting stories didn’t make the cut for the Breeze, but they’re worth reading.

On to what you may have missed!

Well, this one you probably didn’t miss unless you were in the middle of the woods sans cellphone service: Alabama Gov. Kay Ivey signed legislation that effectively bans all abortions and criminalizes the procedure. The uproar that followed was immediate and ferocious — especially from 2020 Democrats who all but tripped over each other to denounce it as “shameless” and “outrageous” — but is the bill actually the threat to Roe v. Wade that it so dearly wants to be?

The measure is destined for the courts, certainly, but that doesn’t mean it will make it to SCOTUS. One likely outcome: The justices can simply refuse to take it up, leaving in place the lower courts’ decision (which will probably be that the law is unconstitutional). Chief Justice John Roberts is known for favoring incrementalism over sweeping decisions that would overturn nearly 50 years of precedent on a hot-button social issue.

But you need only four votes to get a case on the docket, which has court-watchers eyeing newbie Justice Brett Kavanaugh. His appointment helped galvanize the anti-abortion movement in the first place, but in the past he’s talked seriously about needing a compelling reason to overturn precedent. So far, he has disagreed with the hard conservatives more than people expected. So, the future for Alabama’s law remains uncertain.

What seems more likely is that the high court will instead look to less extreme, but still restrictive state laws (such as bills dictating the disposal of fetal remains and an 18-hour waiting period after state-mandated ultrasound examinations) that are heading toward them even as we speak.

No matter how it plays out, you can pretty much guarantee this is going to be a Big Deal on the campaign trail.

The New York Times: Alabama Aims Squarely at Roe, but the Supreme Court May Prefer Glancing Blows

The Associated Press: Alabama Law Moves Abortion to the Center of 2020 Campaign

The Wall Street Journal: States’ Abortion Curbs Put Supreme Court to the Test

A smattering of the other (dozens and dozens) of thoughtful stories from the past few days:

• What is it like living in a liberal city in the Deep South during times like this?

The New York Times: Abortion and the Future of the New South

• Missouri wants in on the action this week.

KCUR: How Missouri’s Senate Passed a Restrictive Abortion Bill Overnight

• A vote in deep-blue (and very Catholic) Rhode Island was overshadowed by Alabama’s news, but it highlights how nuanced and complicated the issue can be.

Boston Globe: In Rhode Island, Vote on Abortion-Rights Bill Reveals a Complicated State

• A lot of Senate Republicans are trying their best to nope out of this conversation, like “no thank you, not touching that with a 10-foot pole.”

The Hill: Senate Republicans Running Away From Alabama Abortion Law

• And a really handy look at what’s going on at the state level.

The Washington Post: The Widening Gap in Abortion Laws in This Country


House Democrats took advantage of their newfound power by tying a vote on reining in high drug prices to legislation shoring up the health law. The bill is destined to die, of course, but the move forced their Republican colleagues to go on record voting against something that voters care very, very deeply about.

The New York Times: House Passes Legislation Aiming to Shore Up Health Law and Lower Drug Costs

They also foreshadowed a potential subpoena with letters to Attorney General William Barr. Five powerful committee chairmen said that they’ve been asking since April 8 for documents connected to the Justice Department’s decision to stop defending the health law but haven’t received a sufficient response. They’re giving DOJ two more weeks before they consider “alternative means of obtaining compliance.”

Politico: Dems Tee Up New Document Fight With DOJ Over Obamacare

Meanwhile, a new Sunlight Foundation report found that the Trump administration has been systematically altering and eliminating information on the health law that’s on government websites.

Wired: The Trump Admin Is Scrubbing Obamacare From Government Sites


Surprise medical billing is truly the darling of Capitol Hill recently with all the attention it’s getting. Multiple variations of bipartisan duos and groups are working on introducing legislation to combat the issue. The most recent bill unveiled would protect patients from the surprise costs, and let an outside arbitrator settle any disputes between hospitals and insurers. Other proposals have instead favored a rate-setting method to solve payment issues.

The Hill: Bipartisan Senators Unveil Measure to End Surprise Medical Bills

The Hill: Dem House Chairman, Top Republican Release Measure to End Surprise Medical Bills


Attorneys general from 44 states have filed suit against pharma companies over allegations that “the generic drug industry perpetrated a multibillion-dollar fraud on the American people.” The lawsuit implicates 20 pharma firms following an investigation into allegations that the companies sought not only to maintain their “fair share” of the generic drug market through agreements with one another but also to “significantly raise prices on as many drugs as possible.”

The Associated Press: States Bring Price Fixing Suit Against Generic Drug Makers


Washington state took a big step this week in approving the creation of a public option — which would essentially look like a state-sponsored health plan. But now comes the hard part: making it work.

And don’t call it a game changer quite yet, experts say. Even sponsors of the legislation acknowledge the state plans may save consumers only 5-10% on their premiums. Still, the rollout will likely be watched closely as the progressive universal health care push grows stronger.

Politico: 5 Key Questions About the Country’s First Public Option

NPR: Washington State to Create ‘Public Option’ Health Care Plans

(If you feel like you need a refresher on all these terms — join the crowd, amiright? this one from NYT’s Margot Sanger-Katz is great.)


Rural hospitals, which sometimes fight literally hour by hour to afford to stay open, are in a crisis in this country, as evidenced by two amazing pieces this week on what happens to a town when one dies.

“If we aren’t open, where do these people go?” asked one hospital worker in The Washington Post’s coverage.

“They’ll go to the cemetery,” another employee answered. “If we’re not here, these people don’t have time. They’ll die along with this hospital.”

The Washington Post: ‘Who’s Going to Take Care of These People?’

Kaiser Health News: Dealing With Hospital Closure, Pioneer Kansas Town Asks: What Comes Next?

But I found a flicker of hope in a lovely story about how a one-room clinic in North Carolina just marked its 100th year.

North Carolina Health News: One Hundred Years in a Rural Clinic


Think this measles outbreak is big? (It is, by the way!) How about the one in 1990, which had more than 27,000 cases? In the past few months, I’ve read and written about the record 963 cases from 1994 more times than you can count but had no idea that just four years earlier it was that much higher. If you’re as intrigued as I was about how that changed, dive into NPR’s historical look at what exactly was going on at the time, and how public officials made so much progress so quickly.

NPR: How a Measles Outbreak Was Halted in the 1990s


In the miscellaneous file for the week:

• There’s a pretty serious debate going on right now about fair distribution of donated livers. A new rule that went into effect this week and then was immediately blocked by a judge would give the organ to the sickest patient within 500 nautical miles. But advocates in the Midwest and South say that’s unfair.

The Washington Post: Liver Transplant Rules Spark Open Conflict Among Transplant Centers

• The U.S. birth rate has fallen again to the lowest in three decades. Some say that means the sky is falling; others are unconcerned.

The Associated Press: US Births Lowest in 3 Decades Despite Improving Economy

• Despite there being thousands of children in the country with a terminal diagnosis, only three hospice facilities in the U.S. are designed specifically for them.

The New York Times: Where Should a Child Die? Hospice Homes Help Families With the Unimaginable

• Can we learn about trauma from an island of monkeys that was devastated by Hurricane Maria?

The New York Times: Primal Fear: Can Monkeys Help Unlock the Secrets of Trauma?

• Many of our gun safety discussions focus on buying the weapons, but teaching about proper storage can make a bigger difference than you’d necessarily expect.

The New York Times: The Potentially Lifesaving Difference in How a Gun Is Stored


Whew! You made it both through this hefty Breeze and the week itself. Take it easy this weekend as a reward!

Podcast: KHN’s ‘What The Health?’ States Race To Reverse ‘Roe’


Can’t see the audio player? Click here to listen on SoundCloud.


Alabama is the latest in a growing list of states passing bans on abortion in an attempt to get the Supreme Court to weaken or overturn Roe v. Wade, the 1973 ruling that legalized abortion nationwide. Unlike most of the other state laws that have passed this year, however, the Alabama law would completely ban abortion except when the woman’s life was in danger from the pregnancy.

On Capitol Hill, separate bipartisan groups in the House and Senate unveiled draft proposals to address “surprise” medical bills that patients get when they inadvertently receive care outside their insurance network. The bills take different approaches, however, so it’s not clear where a compromise might lie.

And in Washington state, the legislature has approved a new “public option” health insurance plan — to be run by private insurers — that will become available for consumers who purchase their own insurance.

This week’s panelists are Julie Rovner from Kaiser Health News, Margot Sanger-Katz of The New York Times, Anna Edney of Bloomberg News and Alice Miranda Ollstein of Politico.

Among the takeaways from this week’s podcast:

  • The high court’s justices can pick and choose which cases they take, and many observers think that they are more inclined to deal with abortion on an incremental basis rather than through a radical change like Alabama’s law. A law from Indiana that bans abortions for particular reasons, including gender selection and disability, has been before the court for months.
  • It’s not yet clear if the current spate of state bills will have an impact on the presidential election in 2020, but they could play a role in Senate races in Alabama, Georgia and Maine, among other states.
  • As the effort on surprise medical bills works its way forward, keep an eye on Sen. Lamar Alexander (R-Tenn.), who chairs the committee that handles these measures. He has suggested that he will have another bill to offer on the subject.
  • House Democrats have packed some popular bills to fight rising drug prices with measures to bolster the Affordable Care Act, and Republicans are crying foul. Once again, Sen. Alexander may be a critical player, because he is trying to pull together a measure that deals with drug pricing, surprise medical bills, the cost of health care and the Obamacare marketplaces.
  • Washington has become the first state to embrace a public option insurance plan for its ACA marketplace. But the plan will be run by insurance companies and it’s unclear how that would lead to lower premium prices for consumers.

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

Julie Rovner: The Atlantic’s “Why the Government Pays Billions to People Who Claim Injury by Vaccines,” by James Hamblin

Margot Sanger-Katz: Journal of the American Medical Association’s “Association of a Beverage Tax on Sugar-Sweetened and Artificially Sweetened Beverages With Changes in Beverage Prices and Sales at Chain Retailers in a Large Urban Setting,” by Christina A. Roberto, Hannah G. Lawman, Michael T. LeVasseur and others

Alice Miranda Ollstein: The New York Times’ “Why Politics Should Be Kept Out of Miscarriages,” by Aaron E. Carroll

Anna Edney: Kaiser Health News’ “No Mercy: Dealing With Hospital Closure, Pioneer Kansas Town Asks: What Comes Next?” by Sarah Jane Tribble

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle Play or Spotify.

Listen: A Blitz Of Health Care Bills

Julie Rovner, Kaiser Health News’ chief Washington correspondent, talks with Robin Young on “Here and Now” about Democrats’ plans to push a package of health care bills through the House this week. The measure will give lawmakers a talking point about their efforts to bolster the Affordable Care Act after the Trump administration has sought to weaken it. The package, however, includes several bills with bipartisan support to get generics on the market sooner. So, voting against the package will prove tough for Republicans. Rovner and Young also discuss bipartisan efforts on Capitol Hill to eliminate surprise medical bills that patients get when their doctors or hospitals are outside their insurance network and the administration’s new requirement for drugmakers to add medications’ list prices in TV ads. You can listen to the discussion here.

Eric Swalwell’s Tweet About Georgia’s New Abortion Restriction Only Slightly Off-Key

Georgia Gov. Brian Kemp signed into law Tuesday the state’s latest abortion restriction. Political reaction to the measure, which prohibits the procedure once a doctor can detect a fetal heartbeat — usually at about the six-week mark — was swift.

Abortion opponents applauded the measure, which puts Georgia in the company of Ohio, Kentucky, Mississippi, North Dakota and Iowa. (Courts have blocked the Iowa and North Dakota laws.) Reproductive rights activists are widely expected to challenge the Georgia law, which many legal experts say violates the abortion standard set by the Supreme Court in its landmark Roe v. Wade decision.

Rep. Eric Swalwell (D-Calif.), a 2020 Democratic presidential candidate, was among the critics who weighed in.

“The so-called ‘heartbeat’ law outlaws abortion before most women even know that they’re pregnant,” Swalwell posted on Twitter. “This is one of the most restrictive anti-abortion laws in our country.”

Swalwell’s claim is an argument we’ve heard often about the six-week abortion ban. We emailed his press team, who redirected us to an article in The Atlanta Journal-Constitution, describing the law’s passage. But we wanted to dig deeper.

‘Most Women’?

Swalwell’s claim has two components: First, he said the law bans abortion “before most women even know that they’re pregnant.”

This is a tricky one. We contacted four reproductive-law experts, along with the American College of Obstetricians and Gynecologists. We also looked at information from the Guttmacher Institute, a reproductive health research and policy organization that supports abortion rights but whose research is widely cited.

None of those sources could point us to data showing when “most women” know they’re pregnant.

Maggie McEvoy, an ACOG spokeswoman, said the organization doesn’t track that information, and it isn’t clear anyone does.

And about Swalwell’s statement:

“Is it empirically true? I don’t know that the medical literature supports that,” said Katherine Kraschel, who runs the Solomon Center for Health Law and Policy at Yale Law School.

Rep. Eric Swalwell (D-Calif.)

But even without that data, experts said, it is abundantly clear that women who are not trying to conceive are much less likely to be aware of a pregnancy until well after six weeks.

That’s because “six weeks” really means “six weeks after a woman’s last menstrual cycle.” Typically, a cycle is about 28 days, or four weeks, long. But many women are accustomed to having irregular periods, and delays can be exacerbated by everyday factors such as stress and fatigue, which could stretch a cycle to 30 or 40 days. At this point, though a woman may not yet be aware that she is pregnant or be experiencing any symptoms, a physician may be able to discern a fetal heartbeat.

Most women don’t realize they’re pregnant until missing at least one period, said Dr. Kristyn Brandi, an OB-GYN at Rutgers Medical School. Often, it takes two.

Generally, medical experts say, women who are actively trying to conceive tend to track their cycles very closely and know much sooner if they are pregnant. But for women whose pregnancies are unintended, and who may be more likely to contemplate an abortion, Swalwell’s statement is more accurate.

About two-thirds of women seeking abortions usually come in around eight weeks since their last menstrual period, per the most recent Guttmacher statistics.

In other words, the six-week restriction would cut off access to abortion at a point in the pregnancy when “there’s a high level of women who might not know,” Kraschel said.

‘One Of The Most Restrictive’

The second half of Swalwell’s claim is easier to verify.

He said this is “one of the most restrictive anti-abortion laws” in the country, a characterization experts say is certainly accurate. The phrase “one of” is a crucial distinction. The Georgia ban is no more stringent than those approved in the five other states that have passed heartbeat laws.

In Alabama, lawmakers are considering a bill that would effectively criminalize all abortions — treating physicians who perform the procedures as felons. If it were to become law, Alabama’s would be the most stringent in the nation. But voting in the state Senate on that legislation was postponed after a debate erupted over whether to include an exemption for rape or incest.

Legal experts also suspect that, as conservatives pursue new abortion legislation, heartbeat restrictions are among the likeliest to end up in front of the Supreme Court. Conservatives believe the judicial makeup favors a ruling that could overturn or scale back the abortion protections outlined in Roe v. Wade.

Our Ruling

Swalwell runs into data obstacles with the first half of his claim. He says a six-week ban prohibits abortion before “most women” know that they are pregnant, but there isn’t any research that conclusively says that’s correct.

Some clarification would help him here.

Most women who aren’t trying to conceive are less likely to know this early that they are pregnant. They probably aren’t taking pregnancy tests or closely monitoring their periods. And women seeking abortions are generally coming in after six weeks.

To be fair to Swalwell, his broader point here is true: The women more likely to seek abortions are, six weeks from their last period, less likely to realize they are pregnant.

The second half of this claim is unequivocally correct. Georgia’s law is indeed among the nation’s strictest.

This claim is correct but could use more context and clarification. We rate it Mostly True.

How Obamacare, Medicare And ‘Medicare For All’ Muddy The Campaign Trail

The health care debate has Democrats on Capitol Hill and the presidential campaign trail facing renewed pressure to make clear where they stand: Are they for “Medicare for All”? Or will they take up the push to protect the Affordable Care Act?

Obamacare advocates have found a powerful ally in House Speaker Nancy Pelosi, who in a recent “60 Minutes” appearance said that concentrating on the health law is preferable to Medicare for All. She argued that since the ACA’s “benefits are better” than those of the existing Medicare program, implementing Medicare for All would mean changing major provisions of current Medicare, which covers people 65 and up as well as those with disabilities.

This talking point — one Pelosi has used before — seems tailor-made for the party’s establishment. It’s politically palatable among moderates who believe that defending the ACA’s popular provisions, such as protecting coverage for those with preexisting conditions, fueled the Democrats’ House takeover in 2018.

Progressive Democrats argue that the time has come to advance a far more disruptive policy, one that guarantees health care to all Americans. Those dynamics were on full display on Capitol Hill, as recently as an April 30 Medicare for All hearing.

But this binary view — Medicare (and, for argument’s sake, Medicare for All) versus Obamacare — oversimplifies the issues and distracts from the policy proposals.

“It’s sort of a silly argument,” said Robert Berenson, a health policy analyst at the Urban Institute, of Pelosi’s talking point. “She’s trying to argue the Affordable Care Act needs to be defended, and Medicare for All is a diversion.”

As the debate continues, one point should be clear: Medicare for All would not look like the ACA or like Medicare today. Instead, it — or any other single-payer system — would drastically change how Americans get health care.

 

Analyzing Medicare Isn’t That Helpful In Understanding ‘Medicare For All’ Proposals.

Medicare for All is complicated, analysts noted, and the phrase is often deployed to mean different things, depending on who is speaking.

What’s clear is that the “Medicare” described in Sen. Bernie Sanders’ (I-Vt.) legislation — the flagship Medicare for All proposal — would create a health program far more generous than traditional Medicare’s current benefit, or even the vast majority of health plans made available through the ACA.

Sanders relied heavily on this concept during his 2016 Democratic presidential primary run and recently introduced an updated version in the Senate.

To be fair, though, Sanders also sometimes blurs the lines between the programs. In a May 5 appearance on ABC’s “This Week with George Stephanopoulos,” he used existing Medicare as part of his sales pitch: “Medicare right now is the most popular health insurance program in the country,” he said. “But it only applies to people 65 years of age or older. All that I want to do is expand Medicare over a four-year period to cover every man, woman and child in this country.”

As counterintuitive as it sounds, understanding Medicare as it works today isn’t helpful in envisioning a Medicare for All plan. Unlike with existing Medicare, the proposed health plan would cover things like nursing home care, vision care and dental services. It would get rid of cost sharing — meaning no premiums, deductibles or copays. (Sanders has acknowledged that financing the program would mean raising taxes.)

“It’s not Medicare. It’s something different,” said Ellen Meara, a health economist at the Dartmouth Institute for Health Policy and Clinical Practice.

But voters may not grasp the differences between the existing Medicare program for seniors and the hypothetical one being discussed. Pelosi’s comments may add to that confusion. Pelosi’s office did not respond to a request for comment.

Prioritizing efforts to bolster the ACA based on Medicare’s current benefit package “is convenient and not necessarily compelling,” Berenson said, adding: “No one is proposing the Medicare benefit package would be taken and applied nationally.”

That said, many of the presidential candidates have advanced far less sweeping health care options that would lower the Medicare age to 55 or allow people to buy in to the current Medicare program — an approach often referred to as a “public option.” Those would keep the program essentially structured as it is today.

The Democratic Health Care Debate Is More Complicated Than These Familiar Words Suggest.

Every analyst interviewed for this story floated some kind of concern regarding a Medicare for All system. There’s the issue of how people would respond to losing the option of private insurance — a likely consequence of Sanders’ proposal — and the question of what level of tax hikes would be necessary to finance such a system, particularly if it covers a big-ticket item such as long-term care. There are also concerns about the financial impact for hospitals, often large employers in a community, or for the private insurance industry jobs that would likely disappear.

Focusing on current Medicare benefits misses the point, suggested Sherry Glied, a health economist and dean at New York University. When debating the merits of the ACA versus Medicare for All, Medicare’s current generosity is kind of a red herring, she said.

Plus, making Obamacare or Medicare for All an either-or debate ignores a sizable political bloc: Democrats who say they support the ACA and see single-payer as a next step. That tension is at play with presidential candidates like Kamala Harris, who frame Medicare for All as an ultimate goal, while also backing incremental reforms.

Comparing Medicare To Obamacare Is Difficult Since Each Offers Different Benefits To Different People.

The problem is that both Medicare and Obamacare are vast programs. Depending on your income, health needs and the version you sign up for, either one could prove the better choice.

“It’s impossible to say the ACA as a concept has more or less generous benefits,” Berenson said.

Broadly, the ACA has protections in place that traditional Medicare doesn’t. It caps how much patients pay out-of-pocket, and it has more generous coverage of mental health care and substance abuse treatment. But, in practice, those benefits have proved elusive for many since Medicare generally has a more robust network of participating physicians than many of the ACA’s cheaper plans, which restrict patients to a narrower coverage network.

Also, most beneficiaries don’t solely have traditional Medicare.

About a third use Medicare Advantage, in which private insurance companies construct Medicare plans with benefits and protections based on factors like company, tier and geography. They, too, are often restricted to narrower networks.

More than 1 in 5 traditional Medicare beneficiaries also receive Medicaid coverage, according to figures kept by the Kaiser Family Foundation, and about a third of them buy so-called Medigap plans, which are sold by private insurance and are meant to supplement gaps in coverage.

The ACA also encompasses an array of coverage options. Which plans are available in an area and whether earnings qualify a consumer for a government subsidy— a tax break meant to make an ACA plan more affordable — make a significant difference in evaluating whether Medicare or an ACA plan offers better benefits for a particular person or family.

Suggesting that one is clearly better than the other, Meara said, is a “gross oversimplification.”

But that kind of oversimplification may be hard to avoid, especially in a primary season where health care is a top issue.

“The Affordable Care Act is also not one thing, the way Medicare is not one thing,” said Katherine Baicker, dean of the Harris School of Public Policy at the University of Chicago. “So much of health care is more complicated than we can explain in a sound bite.”

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! As if those sky-high medical bills weren’t bad enough, apparently California teachers also must pay substitutes to cover for them — even while undergoing treatment for breast cancer.

Which is the perfect segue into what you may have missed this week (almost like I planned it).

President Donald Trump waded into the turf wars among doctors, hospitals and insurers Thursday when he called for an end to surprise medical bills. The issue has been gaining attention across the country as stories about $48,512 cat bites and $109,000 heart attacks resonate with voters who are sick of paying an arm, a leg and a mortgage for health care even when they have insurance.

It’s not exactly a controversial issue — it’s listed as a top concern among voters, and lawmakers are lining up in droves to sign their names to any potential legislation. But, as is often the case with health care costs, the devil’s in the details. The costs don’t just disappear because the president doesn’t want patients to have to pay them. Physician groups tend to favor arbitration, while insurers argue that method is flawed because it still relies on bill charges. Instead, the industry wants set prices, with rates in line with what they would consider reasonable for the procedures. Each side hates the other’s opinion. So … good luck to the lawmakers who have to balance those two big interest groups!

The New York Times: Trump Said He Wanted to Work With Democrats on Surprise Medical Bills. Then He Attacked Democrats.

(FWIW: Two stories of the patients who were featured at the White House event were previously highlighted in KHN and NPR’s “Bill of the Month” series. Check them out here.)


Kicking off a veritable blitz of bills, House Democrats voted on legislation that would ban the Trump administration from granting states waivers for health law regulations. Over the next couple of weeks, Dems are expected to go hard on their campaign promises to shore up the bruised and battered health law. Some of the topics of those bills: short-term “junk insurance” plans, outreach funding, “reinsurance” payments, drug rebates and more.

The New York Times: With Insurance Bill Passage, House Democrats Begin Health Care Blitz

Speaking of waivers, Tennessee is set to ask for one to shift its Medicaid program into a block grant model. Block grants — aka Republicans’ longtime dream system — as an idea have a long history riddled with controversy and criticism, and the request, if granted, is all but certain to draw a court challenge. Now the question is: How far is CMS ready to go in pushing the envelope on Medicaid changes? Especially when other waivers are getting knocked down left and right in court?

Modern Healthcare: Tennessee Will Test CMS’ Willingness to Block-Grant Medicaid

Meanwhile, the Trump administration is proposing a change to the formula to calculate poverty. That may seem fairly dry, but since government assistance (like Medicaid and food stamps) is tied to that line, millions could lose health care coverage and/or have to go hungry.

The New York Times: Trump Administration Seeks to Redefine Formula for Calculating Poverty


Pharma companies are going to start to have to include list prices in their TV ads under a new rule that’s central to the Trump administration’s war on high drug costs. While most people think, in general, it’s a good step, many doubt it will accomplish much. It’s not as if sick consumers can then go negotiate a different price, as they would with cars.

As Ben Wakana, the executive director of Patients for Affordable Drug Prices, told NPR: “Drug companies have been shamed about their price increases for years. They appear to be completely comfortable with the shame as long as it is bringing them in the billions of dollars a year that they make from their outrageous prices.”

NPR: New Rule for Drugmakers: Disclose Drugs’ List Prices in TV Ads

Drug prices were a hot topic this week (and most weeks, amiright?), with the Senate Finance Committee holding a hearing on the idea of setting an international price index. Other countries set lower prices and “we look like chumps,” said Sen. John Kennedy (R-La.).

Modern Healthcare: GOP Senators Warn Drug Price Controls Could Come

And, yup, there’s still more news: Despite HHS Secretary Alex Azar’s concerns about safety, Trump backed Florida’s plan to import drugs from other countries. The kicker here: Florida will surely be a battleground state in the 2020 election, and drug prices routinely top voters’ list of concerns. The potential for a winning talking point is huge.

The Associated Press: Trump Backs Fla. Plan to Import Lower-Cost Meds From Abroad


In somewhat tangential news, Gilead announced it will donate its drug that reduces the risk of HIV transmission for up to 200,000 people a year. The price of the life-changing medication has long been a barrier to the goal of ending HIV transmissions, and many advocates were thrilled with the decision. Still, others were disappointed, saying that will cover only a fifth of what the country needs.

The Associated Press: Drugmaker Will Donate Meds for US Push to End HIV Epidemic

But everyone was cheering a new study out of Europe. Out of nearly 1,000 gay male couples where one partner had HIV and was taking antiretroviral drugs, there were zero cases of HIV transmission even without the use of condoms.

Reuters: AIDS Drugs Prevent Sexual Transmission of HIV in Gay Men


Fed up with the strategy to slowly chip away at abortion rights, Alabama lawmakers are poised to go all in. The legislation (which was almost up for a vote this week, but was delayed because of a ruckus over rape and incest amendments) would effectively ban all abortions and criminalize the act of performing the procedure. The supporters of the bill aren’t being coy at all about their intention: They want to challenge Roe v. Wade with a simple, “clean bill” on the legality of abortions.

The New York Times: As States Race to Limit Abortions, Alabama Goes Further, Seeking to Outlaw Most of Them

And over in Georgia, abortion rights advocates have one message to Republican Gov. Brian Kemp, who just signed a heartbeat bill: “We will see you, sir, in court.”

The Associated Press: Opponents of Georgia Abortion Ban Promise Court Challenge


On a sad note: Legendary New York Times reporter Robert Pear passed away this week from complications of a stroke. Although I did not have the pleasure of meeting or working with him, his byline became a familiar friend of mine. He has shaped my world for the past several years with the stories he continuously broke. It is a loss for journalism, for health care and for the people he helped through the light he shined on Washington.

His last story is a perfect example of that: looking at legislation that carried promises of helping people with preexisting conditions but failed to live up to them.

The New York Times: Robert Pear, Who Covered Washington for 45 Years, Dies at 69

The New York Times: Republicans Offer Health Care Bills to Protect Patients (and Themselves)


In the miscellaneous files of the week:

• Traditionally, HHS has received, on average, one complaint related to “conscience” violations from health care workers per year. Last year, that rose to 343. What on earth happened? (Hint: It does not mean the problem actually worsened.)

NPR: Why Are Health Care Workers’ Religious and Moral Conscience Complaints Rising?

• It might seem like the anti-vaccination movement is a new phenomenon spurred on by social media, but there’s a long history of resistance in the country. And it’s not as random as it might appear at first. Usually, it’s tied to time periods that are marked by great resentment toward government.

Los Angeles Times: Why the Measles Outbreak Has Roots in Today’s Political Polarization

• Stories about student heroes stopping mass shooters and dying in the process highlight just how grim our reality has become as young people find themselves thrust into violence.

The New York Times: Colorado School Shooting Victim Died Trying to Stop the Gunman

• Not only is the United States’ maternal mortality rate abysmal, a new study finds that many of those deaths — 60%! — are preventable. What’s more, African American and American Indian/Alaska Native women are three times more likely to die from pregnancy and childbirth than white women.

USA Today: Pregnancy and Childbirth Deaths Are Largely Preventable, CDC Says

• Beneath the bright, tantalizing promises of the stem cell industry (targeted at the most desperate patients) festers a dark underbelly of greed and profit.

ProPublica: The Birth-Tissue Profiteers


Have a great weekend, and remember, as National Nurses Week wraps up, to hug (or otherwise appropriately thank) the nurses in your life. Their job can be quite tough.

Podcast: KHN’s ‘What The Health?’ ‘Conscience’ Rules, Rx Prices and Still More Medicare


Can’t see the audio player? Click here to listen on SoundCloud.


In a new set of rules, the Trump administration wants to let not just doctors but almost any health care worker or organization decline to provide, participate in or refer patients for any health service that violates their conscience or religion.

Also this week, the Trump administration is ordering prescription drugmakers to include list prices in their television ads for nearly all products.

And there’s yet another entry in the growing group of bills aimed at overhauling the nation’s health system. This one is “Medicare for America.”

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Jen Haberkorn of the Los Angeles Times and Alice Miranda Ollstein of Politico.

Also, Rovner interviews Joan Biskupic, author of “The Chief: The Life and Turbulent Times of Chief Justice John Roberts.” Biskupic talks about the behind-the-scenes negotiations that led to the 2012 decision upholding the constitutionality of the Affordable Care Act.

Among the takeaways from this week’s podcast:

  • Robert Pear, who died this week, was the dean of health policy reporters and will be remembered not just for the many front-page stories he produced for The New York Times, but also as a generous and kind colleague who helped mentor many reporters new to the beat.
  • The Trump administration’s announcement last week of new regulations to protect health care workers from having to do anything they believe violates their religious beliefs is a stronger policy than past Republicans have adopted. But it follows other efforts to expand past conservative policies, such as the current administration’s more stringent Title X family planning rules.
  • The administration’s new rule requiring drugmakers to add list prices to their TV ads could confuse some consumers, since few of them actually pay that price. Their insurers often negotiate better prices, and other factors, such as geography and type of pharmacy, affect the consumer’s bottom line.
  • President Donald Trump this week told Health and Human Services officials to work with Florida on its plan to import drugs from Canada to take advantage of lower prices there. HHS Secretary Alex Azar said he would see if it can be done without jeopardizing the safety of the drugs. That is the rub that his predecessors have used to stop importation efforts, dating to the 1990s.
  • The increasing interest in Democratic proposals such as “Medicare for All,” which would set up a government-run health care system, and “Medicare for America,” which would offer a government-run option for consumers and businesses, suggests that a public option is not the political hot potato it was during the debate setting up the ACA. It’s also not clear whether consumers are ready to give up their current insurance.
  • Tennessee is getting ready to ask federal officials for a major change in its Medicaid system. The state wants to switch to a block grant, in which its federal funding would be limited but would come with much more flexibility for spending. The proposal is likely to end up in court because advocates for the poor argue the change would cut off services to some people and would violate laws that have defined Medicaid.

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

Julie Rovner: CNBC’s “Insiders Describe Aggressive Growth Tactics at uBiome, the Health Start-Up Raided by the FBI Last Week,” by Christina Farr, and “Health Tech Start-Up uBiome Suspends Clinical Operations Following FBI Raid,” by Christina Farr and Angelica LaVito

Joanne Kenen: ProPublica and the New Yorker’s “The Birth-Tissue Profiteers,” by Caroline Chen

Jen Haberkorn: The Los Angeles Times’ “Health Insurance Deductibles Soar, Leaving Americans With Unaffordable Bills,” by Noam N. Levey

Alice Miranda Ollstein: Bloomberg News’ “Trump May Redefine Poverty, Cutting Americans From Welfare Rolls,” by Justin Sink

To hear all our podcasts, click here.

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Drug Industry Patents Go Under Senate Judiciary Committee’s Microscope

Congress isn’t making much headway in finding a solution to the problem of soaring prescription drug prices, but lawmakers from both parties are tinkering on the edges with legislation that aims to increase competition among drugmakers.

A comprehensive piece of drug-pricing legislation is a high priority for Senate Finance Committee Chairman Chuck Grassley, (R-Iowa) and Sen. Ron Wyden (D-Ore.). And it could be introduced by mid-June, according to congressional staff.

But while that is hashed out, a slate of options to reform drug patents is working its way through the Senate Judiciary Committee, which had a hearing Tuesday featuring academics, patient advocates and a representative from the pharmaceutical industry. Their mission: to increase competition without decreasing innovation in the industry.

“I think we’re dangerously close to building a bipartisanship consensus around change,” Sen. Dick Durbin (D-Ill.), said during the hearing.

The four proposed bills share a common goal: avoiding some of the thorny issues around drug pricing, like whether the government will set drug prices or negotiate with manufacturers on what federal programs will pay. Instead, the patent reform proposals get at the ways branded drug manufacturers use patents, and the legal monopolies that are granted with patents, to keep lower-priced generic competitors from reaching patients.

“A package of patent reforms are important because they fix systemic problems that allow prices to go up and keep them high,” testified David Mitchell, the president of Patients for Affordable Drugs, a Washington, D.C.-based advocacy group focused on lowering prescription drug prices.

Sen. John Cornyn (R-Texas) offered specific examples of drugs that have benefited from  system issues, including Humira, an expensive drug for arthritis and psoriasis that is protected by 136 patents.

That’s called a “patent thicket,” because it prevents a generic alternative from entering the market for more years — in this case, until 2023 for a drug first approved for use in the United States in 2002. “Is there anyone on the panel who’d like to defend the status quo?” he asked.

“There is no way a biosimilar can deal with a hundred patents,” testified Michael Carrier, a professor at Rutgers Law School. “This is an abuse of the system.”

Among the proposed bills, the Stop STALLING (“Stop Significant and Time-wasting Abuse Limiting Legitimate Innovation of New Generics”) Act, is the bipartisan brainchild of Sen. Amy Klobuchar (D-Minn.) and Grassley. The bill is supposed to put a stop to “sham” citizen petitions to the FDA. Critics say these petitions are often introduced by drugmakers under the guise of patient advocacy to slow FDA approval of new generic medicines. “Nearly every one of these citizen petitions is brought by a brand company. None are filed by individuals. I love the legislation. I would go even stronger,” Carrier said.

Grassley is also the lead sponsor on the bipartisan Prescription Pricing for the People Act of 2019. It directs the Federal Trade Commission to investigate mergers of pharmacy benefit managers, the middlemen that negotiate between drugmakers and health plans.

Klobuchar and Grassley teamed up again on another measure, the Preserve Access to Affordable Generics and Biosimilars Act, which they  say would end “anti-competitive behavior” — specifically, deals struck between branded companies and generic companies to keep a generic, or a biosimilar, off the market. Klobuchar,  a Democratic presidential candidate, has frequently discussed her opposition to this practice on the campaign trail.

James Stansel — the executive vice president and general counsel of the Pharmaceutical Research and Manufacturers of America, a drug industry trade group, and the lone voice of the pharmaceutical industry on the panel — cautioned against moving too aggressively on this point. “We want to make sure we don’t do something that’s anti-competitive in the hopes it would be pro-competitive,” he said.

There’s also the CREATES (“Creating and Restoring Equal Access to Equivalent Samples”) Act, introduced by Sen. Patrick Leahy (D-Vt.) with 31 bipartisan co-sponsors and endorsed by nearly every witness on Tuesday’s panel. It’s supposed to crack down on branded companies that refuse to sell samples of their drugs to generic companies, a necessary step to increasing the number of generics on the market.

Versions of all four of those bills have also been introduced in the House and advanced out of the House Judiciary Committee.

“The American people are being played for chumps,” said Sen. John Kennedy (R-La.). “Just chumps. And it’s got to stop.”

Feds Want To Show Health Care Costs On Your Phone, But That Could Take Years

Federal officials are proposing new regulations that for the first time could allow patients to compare prices charged by various hospitals and other health care providers using data sent to their smartphones.

Donald Rucker, who coordinates health information technology policy for the Department of Health and Human Services, said he expects that the rules, first proposed in March, will give patients new power to shop for care based on price and quality.

Consumers have long sought more knowledge about health care prices, but administration officials cautioned it could take two years or more for it to appear in a user-friendly form on a phone app. Many specifics, including how patients would make sense of complex pricing policies for purchasing health care and insurance and assessing quality via an app, remain unclear.

Rucker said in remarks prepared for a Senate Health, Education, Labor & Pensions Committee hearing Tuesday that patients “have few ways if any to anticipate or plan for costs, lower or compare costs, and, importantly, measure their quality of care or coverage relative to the price they pay.”

The Trump administration proposal comes amid growing outrage from patients hit with seemingly exorbitant “surprise” medical bills. One study found that these bills — which are for amounts far more than the patient anticipated or for care not covered by insurance — have bedeviled more than half of American adults.

The Senate committee is reviewing regulations proposed under the 21st Century Cures Act, a law passed in 2016 to promote innovation in health care.

Dr. Kate Goodrich, the chief medical officer for the federal government’s Centers for Medicare & Medicare Services, said the agency wants every American to have an electronic health record (EHR) that will follow them as they move through the health care system, “giving them the data they need to make the best decisions for themselves and their families.”

Everyone, Goodrich said in her prepared statement to the committee, “should be able, without special effort or advanced technical skills, to see, obtain, and use all electronically available information that is relevant to their health care, and choices — of plans, providers, and specific treatment options.”

Meeting these goals could prove to be a tall order. For well over a decade, federal officials have struggled to set up a digital records network capable of widespread sharing of medical data and patient records. In 2004, President George W. Bush said he hoped to have a digital record for most Americans within five years. In early 2009, the Obama administration picked up the challenge and funneled billions of dollars in economic stimulus money into a campaign to help doctors and hospitals buy the software needed to replace paper medical files.

Critics argue that poor oversight over the stimulus spending and objectives has saddled many doctors and hospitals with flawed software that typically cannot share information across health networks as promised. It has also caused new types of errors that compromise the safety of patients.

Botched Operation,” a recent investigation published by Kaiser Health News and Fortune, found that the federal government has spent more than $36 billion on the EHR initiative. Thousands of reports of deaths, injuries and near misses linked to digital systems have piled up in databases over the past decade — while many patients have reported difficulties getting copies of their complete electronic files, the investigation found.

Despite the slow progress, federal officials remain optimistic that digital records will save the nation billions of dollars while reducing medical errors, unnecessary medical testing and other waste — and encouraging more Americans to take a bigger role in managing their health care by comparing prices.

But Sen. Lamar Alexander, R-Tenn., the committee’s chairman, said the results would have been better had officials not rushed out the stimulus plan. “I am especially interested in getting where we want to go with input from doctors, hospitals, vendors, and insurers, so we have less confusion, make the fewest possible mistakes, and make sure we don’t set some kind of unrealistic timeline,” he said in a statement.

Anger over the lack of easy access to health care has dominated public comments on the proposed regulation posted on a government website.

“The proposed policy to mandate disclosure of health care pricing by hospitals, insurance companies, etc. is one of the most important in American history. That is not hyperbolic,” one anonymous commenter wrote, adding: “The only way to save money on healthcare in America is to never receive it.”