The Senate is losing a health-care heavyweight at a point of unprecedented weakness, as it struggles to move forward on just about any kind of health policy.

Utah Republican Orrin Hatch — whose 40 years in office makes him the longest-serving GOP senator —  has announced his intention to retire at the end of this year. With Hatch’s exit, the Senate will lose one of its few remaining negotiators, one of the bipartisan-minded types who have become scarce in the halls of Congress.

“He represents a different time in the Senate and I think it’s kind of sad to see the era end,” a former Hatch staffer told me yesterday. “I don’t think they make senators like him anymore.”

Pick just about any major health-care bill enacted over the past several decades and Hatch probably had a hand in it. For the whole time I’ve covered Capitol Hill goings-on, Hatch has always been a reliable source of the latest news (as long as you stood close enough to hear his barely-above-a-whisper voice). He’s chairman of the Senate Finance Committee and has sat for years on the Senate’s No. 2 health-care panel, the Health, Education, Labor and Pensions Committee.

When Congress finally set out three years ago to replace a flawed Medicare formula that had annually threatened dramatic pay cuts for doctors, Hatch was in the middle of negotiations that eventually resulted in a new system that instead tries to reward doctors based on the quality of the care they provide.

Last September, Congress passed Hatch’s Chronic Care Act, a major victory for telehealth advocates because it allows Medicare accountable care organizations to expand virtual care for stroke and dialysis patients and builds broader telehealth benefits into Medicare Advantage plans.

But Hatch’s résumé extends way before The Health 202’s recollection. In the 1980s, he teamed up with Democratic Rep. Henry Waxman (Calif.) on major legislation that encouraged companies to manufacture generic drugs while establishing the modern system of regulating generic drugs (see yesterday's Health 202 for more on generics). Hatch was also co-sponsor of Waxman’s Orphan Drug Act, which gave drugmakers tax breaks for developing treatments for rare diseases.

In the 1990s he worked with his dear friend, Democratic Sen. Ted Kennedy (Mass.) to create what will be perhaps his best-remembered accomplishment: The Children’s Health Insurance Program, which has been very successful in covering many low-income children and pregnant women in the United States. Although support for the program remains bipartisan, it’s at a crucial moment as states start running out of funding and the parties remain gridlocked over how to fund the program for the long term.

Hatch and Kennedy, who were often described as “a legislative odd couple,” also worked together on bills involving biomedical research, AIDS, child care and civil rights for those with disabilities.

“I think they both were brilliant legislators,” said Pattie DeLoatche, who served as a health policy staffer to Hatch for more than a decade. “Both of them had a wonderful sense of humor and they both wanted to accomplish something.”

Of course, in recent years, Hatch has also lobbed his fair share of criticisms at the Affordable Care Act alongside his fellow Republicans. In February 2015, he introduced a bill with Sen. Richard Burr (R-N.C.) and Rep. Fred Upton (R-Mich.) to replace the ACA with a system that included revamped insurance subsidies and structural changes to Medicaid.

As the first senator to introduce legislation repealing the health-care law’s individual mandate to buy coverage and the employer mandate to offer it, Hatch appeared extremely gratified when the individual mandate was repealed in the GOP’s recent tax overhaul.

But through the years, Hatch has often criticized his follow senators for allowing their disagreements to escalate into bitter animosity, a state that seems more the norm than the exception in Congress these days. The old-school approach was for senators to disagree without being disagreeable — and Hatch has appeared increasingly dismayed that that’s not the modus operandi anymore.

“I’m concerned about this body and how it’s going,” Hatch told his colleagues from the Senate floor last February. “I’m hoping that we can still have our fights and still have our arguments and still have the enjoyable aspects around here of comradeship and working with each other.”

The partisan situation became even worse over the spring and summer, as the GOP worked to pass entirely one-sided health-care bills that ultimately folded in the Senate. Throughout the process, Hatch would often express skepticism to reporters, and even frustration, the process.

But clearly the soft-spoken senator loves being a senator. Former staffers say he’s not prone to working on impossible-to-pass legislation just to send a message, as many members do. Instead, he generally focuses on getting a Democratic co-sponsor for anything he truly hopes can get done.

Another former Hatch staffer recalled to me how the Utah Republican would often get lunch with Sens. Mark Warner (D-Va.) or Elizabeth Warren (D-Mass.). "He constantly worked across the aisle in ways the public rarely saw," the staffer said. "The Senate will be a much less civil place without him."

The Americans With Disabilities Act, a 1990 civil-rights law prohibiting discrimination based on disability, was among several bipartisan legislative accomplishments Hatch touted in a Deseret News op-ed published yesterday.

“During my time in the Senate, I’ve authored more bills that have become law than any other member of Congress,” Hatch wrote.

Many on Twitter offered their thoughts about Hatch and his career:

Democratic operative Hilary Rosen:

Kaiser Health News's Julie Rovner with some perspective:

PhRMA CEO Stephen Ubl:

Politico's Jennifer Haberkorn: 

CQ Roll Call's Mary Ellen McIntire: 


AHH: If you pay any attention to the health-care industry, you've probably noticed a lot of blame-shifting for steep medical costs. Insurers routinely blame drugmakers and providers blame insurers for the price tag of everything. And so on. Lately, pharmaceutical companies have been working hard to peg blame for rising drug costs on pharmacy benefit managers, our colleague Carolyn Y. Johnson writes. Pharmacy Benefit Managers, or PBMs, often serve as middlemen between the patient and drugmaker.

“Who decides what you pay for your medicines? Not who you might think,” warns a PhRMA-backed radio ad airing in D.C last month. “More than one-third of the list price of a medicine is rebated back to middlemen, like insurers and pharmacy benefit managers.”

"With national and state advertising campaigns, white papers and cartoon infographics, the powerful and well-funded drug-industry lobby spent 2017 working to redirect public anger about drug prices to pharmacy benefits managers: links in the supply chain that sits invisibly between the patient and the drugmaker — in the process bringing a long-simmering feud between two big health-industry players into the open," Carolyn writes.

Early last year, President Trump and Congress appeared ready to take on pharmaceutical prices. But drug companies' fight with PBMs and insurers has "helped thwart any real action — splintering the problem into a multi-industry echo chamber of accusations that's hard to comprehend, much less solve." "The intra-industry conflict has meant that 2017 — a year when it seemed as if concerns about the affordability of drugs might translate into action — was consumed with an effort to try to unravel what is happening in the supply chain," Carolyn writes.

OOF: This seems crazy, but the National Academy of Medicine has estimated the health-care system wastes around $765 billion a year -- which comprises about a quarter of what we spend. Why and how, you ask? Pro Publica's Marshall Allen explores some possible answers in a piece where he describes a warehouse in Maine filled to the brim with unused medical supplies and equipment.

“It’s hard to downplay what I found when I began investigating the issue. Hospitals throw out so many valuable supplies that a cottage industry of charities has sprung up to collect this stuff and ship it to the developing world — otherwise, all those goods in that Maine warehouse would be headed for a landfill,” Marshall writes. “Nobody tracks how much hospitals waste rather than donate, and I couldn’t track down where each item came from. But experts told me when hospitals change vendors for a type of supply, they often toss the old stuff. Or, if they take over a clinic or facility, they get rid of the items that come with it, even if they are unused and unexpired.”

Operating rooms are a major culprit. One hospital tracking the value of unused items that went to waste during neurosurgery procedures in a single year found a total of $2.9 million wasted for one type of surgery at just one hospital. Nursing homes also throw away hundreds of millions of dollars’ worth of valuable medication every year, Marshall writes.

Eliminating this waste would mean a lot more Americans could get covered. "The Kaiser Family Foundation says it costs an average of $6,690 to pay one person’s insurance premium in 2017. At that rate, the $10 billion saved could insure about 1.5 million people for a year,” Marshall writes. 

OUCH: A growing number of cancer survivors have powerful new immunotherapy treatments to thank, yet many are also suffering from a range of dangerous side effects including arthritis-like joint pain and lung and liver inflammation. These highly touted immunotherapy treatments have downsides that many doctors don't yet know about, The Post's Laurie McGinley writes.

"Called checkpoint inhibitors, the new therapies offer a tantalizing chance for survival for patients with advanced melanoma and hard-to-treat cancers of the bladder, kidney and lung," Laurie writes. "But the treatments, designed to unleash the immune system to attack malignancies, also can spur an assault on healthy organs, causing varied and bizarre side effects ranging from minor rashes and fevers to diabetes and deadly heart problems."

"Many doctors are not up to speed on how to spot and handle an immune system revved up by immunotherapy, with symptoms that can mimic those of the flu, infections or even food poisoning," she notes. "That lack of awareness can be dangerous, given that quick intervention is the key to preventing serious damage."

“Immunotherapy has a completely different side-effect profile than chemotherapy, and that has caught some physicians off guard,” said Drew Pardoll, director of the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University. Doctors — including emergency-room physicians, dermatologists and gastroenterologists — “need to go back to school” to learn about immunotherapy, he told Laurie.


--Maybe this is currently the best way to characterize Republicans' approach to repealing and replacing Obamacare: It's complicated. While it's nearly impossible to imagine how they'd manage to pass a health-care bill with an even narrower Senate margin and during an election year, House Majority Whip Steve Scalise (R-La.) said yesterday that repeal -- and entitlement reform -- is at the top of the GOP to-do list for the new year.

"We're going to have to work on health care again. I'm for repealing and replacing Obamacare," Scalise said in a Tuesday interview with “Fox and Friends.” He added that repealing the health care law’s individual mandate through the GOP tax overhaul was a good start.

"Now we need to go and fix the things wrong in health care that are jacking up the costs, so lets get back to work on some of those things, like what we passed in the House, that almost passed in the Senate, so that we can get our health-care system working and rebuild a private marketplace," Scalise said.

Reporters must wait a few more days to badger individual House members on this question, as that chamber doesn't return until next week. But today, we welcome back the Senate from its holiday break.

In the meantime, the ACA's tax on medical device manufacturers has gone into effect, despite earnest attempts by the industry to get it repealed or suspended in various health-care bills and the year-end spending bill. No such luck for the industry. The 2.3 percent excise tax went into effect Monday, after being suspended for 2016 and 2017, the AP reminds us.

But device makers aren't giving up their fight. "They still hold out hope of repealing or again suspending the tax," the AP writes. "Despite earlier failures, industry officials say congressional backing for repeal remains strong. The next attempt could come in connection with a spending bill needed by Jan. 19 to avert a government shutdown."

--A few more good reads from The Post and beyond:

Medicare is discouraging regional offices from levying fines for “one-time mistakes” or from using daily fines that seek to put pressure on nursing homes to make changes.
Kaiser Health News
President Trump's critics looking to seize on his medical records to undermine his presidency or take away his powers are likely to be dissatisfied by the information that will be made public in January.
Washington Examiner
Widespread screening for "scrutiny-dependent" cancers is misleading doctors and the public about what increases our risk of developing cancer.
Stat News
The research offers some insights, but it’s complicated.
Since 1999, the number of accidental gun deaths has declined nationwide. This decrease, according to data from the CDC, comes as the country has seen increases in gun deaths as a result of suicides and homicides. What’s led to the decline?
LA Times

Coming Up

  • The American Enterprise Institute holds a discussion on "Reconnecting Health Care Policy with Economics: Finding and Fixing Distortive Incentives” on Thursday.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the opioid crisis on Jan. 9.
  • The House Veterans’ Affairs Subcommittee on Economic Opportunity holds a hearing on "Home Loan Churning Practices and How Veteran Homebuyers are Being Affected” on Jan. 10.
  • The National Academy of Sciences holds a workshop on "The Promise of Genome Editing Tools to Advance Environmental Health Research” on Jan. 10-11.
  • The House Veterans’ Affairs Subcommittees on Health and on Economic Opportunity hold a joint hearing on addressing veteran homelessness on Jan. 18.

Here's what's on the GOP agenda this year: 

With Sen. Orrin Hatch’s retirement, President Trump is losing an ally, and might be gaining a foe:

White House press secretary Sarah Huckabee Sanders wouldn't say whether President Trump is open to supporting Mitt Romney for the Utah Senate seat vacated by Hatch:

Here's what you should know about Hoda Kotb, named co-anchor of NBC's "Today" show: