Health Policy Reporter

THE PROGNOSIS

Two weeks from now, Congress has yet another shot at helping stabilize the Obamacare marketplaces for 2019. But the political barriers appear even higher than before.

At play are dual, bipartisan bills to lower monthly premiums paid by shoppers on the Affordable Care Act’s marketplaces. Viewed with suspicion by more conservative Republicans, they’ve been stuck in limbo since last fall -- and it’s looking more likely than not they’ll stay that way instead of getting rolled into a $1.3 trillion catchall spending bill lawmakers must pass by March 23.

House Speaker Paul Ryan (Wis.) told his GOP conference at a Tuesday meeting that he wouldn’t bring the measures to the floor without accompanying language known as the Hyde Amendment, ensuring taxpayer dollars can’t go toward plans that cover abortions.

“The speaker yesterday in conference made it very clear without the Hyde Amendment he’s not bringing it up,” Rep. Phil Roe (R-Tenn.) told me yesterday. Rep. Tom MacArthur (R-N.J.) also said there has been commitment by leadership to ensure Hyde language would be included in a stabilization measure.

But this insistence on Hyde is a no-go for Sen. Patty Murray of Washington state, the lead Democrat trying to hammer out an agreement with Sen. Lamar Alexander (R-Tenn.) to get the measures added to the spending bill. From Murray’s perspective, Republicans are reneging on the original deal she’d agreed to with Alexander by laying out extra demands.

“We’re not going to give them an expansion of Hyde and say that’s a goal we all agree to,” Murray told me. “They’re moving further and further away from their original goal, which was to make sure people have lower costs and access.”

The Hyde issue, which I explained in more detail in this Health 202, is just one thorn in a whole prickly bed of disagreements sprouting up between Republicans and Democrats around an issue they’d once seemed able to unite.

Insurers are already preparing their plan rates for the 2019 ACA enrollment season, which will take place later this year. Many Republicans, particularly the more centrist ones, feel it’s important to do everything possible to help them offer lower-priced plans and even encourage more to enter the marketplaces now that Congress has failed to repeal the ACA.

Democrats feel that way, too. But they’re not willing to give Republicans their way considering all the holes they and Trump's administration have tried to punch in the ACA lately.

Murray — deeply frustrated by the GOP’s repeal of the health-care law’s individual mandate to buy coverage and Trump’s expansion of short-term and association health plans exempt from ACA rules — is sticking by a new list of demands she says Republicans should acquiesce to because they’ve changed the playing field.

She wants her legislation with Alexander — which funds extra payments to marketplace insurers for the cost-sharing discounts they must offer the lowest-income consumers — to also expand premium subsidies, restore outreach dollars the administration had slashed and block the expansion of ACA-exempt plans, which she and other Democrats term “junk” insurance.

And the White House appears to be circulating its own list of demands. According to a list provided by a congressional aide, officials want any marketplace stabilization bill to allow renewals of short-term health plans, expand tax-free health savings accounts and allow insurers to charge older people five times more for premiums than younger people, instead of just three times more as allowed under the ACA.

No. 4 Senate Republican John Barrasso (Wyo.) introduced legislation yesterday aiming at that first goal. His bill would make permanently legal for short-term plans to last a year instead of just three months and would guarantee they could be renewed.

Speaking from the Senate floor yesterday, he commended the Trump administration for halting the cost-sharing reduction payments last fall and said that if Congress is to fund them again, it should also consider other “fixes” to the ACA too.

“We should discuss finding a real solution to rising health-care costs,” Barrasso said. “One that doesn’t just continue the unworkable and frankly unfair system Obamacare created.”

But to Senate Democrats, whose support is essential for any marketplace stabilization measures, all these Republican-led changes to the ACA and new demands make them more resistant than ever to passing anything at all.

“They keep throwing obstacles in,” Murray told me. “If we would just go back to the basic premise here and do what we all agreed to do, we’d be able to get this done.”

Sen. Susan Collins (R-Maine), who is sponsoring the other stabilization bill that would compensate insurers for their highest-cost patients through what’s known as “reinsurance,” shrugged off the building controversies. She questioned whether the new demands were actually from the White House.

“I remain optimistic that we’ll have it,” Collins told reporters yesterday. “I think the negotiations are going well.”

AHH, OOF and OUCH

AHH: The 24-year-old Trump appointee recently ousted from leading the White House Office of National Drug Control Policy will join another government agency as a lower-ranking employee, Politico reports. Taylor Weyeneth will serve as a mid-level official focusing on opioid policy in the office of Community Planning and Development, according to HUD spokesman Raphael Williams.

Weyeneth, a former Trump aide during the campaign, stepped down in January after The Post reported on inconsistencies and inaccuracies on three résumés he submitted to the government. His high-ranking position, which he'd achieved in part because of staff turnovers and vacancies, had also raised eyebrows. The office, known as ONDCP, is responsible for coordinating anti-drug initiatives at 16 federal agencies and supporting President Trump’s efforts to confront the opioid epidemic.

OOF: Suicides among black children under age 18 have spiked 71 percent nationwide in the last decade, rising 114 percent for children age 13 and younger. During that same time period, 2006 to 2016, the suicide rate among all children also increased 64 percent, our colleague Justin Wm. Moyer writes.

"Researchers aren’t sure what has fueled the slightly larger rise for black children," Justin writes. "Some speculate that those affected by racism might be at greater risk. Another factor could be the notion that suicide isn’t a problem in the black community, hindering prevention efforts."

Rheeda Walker, a psychology professor at the University of Houston, said her research into African American mental health shows possible links between perceived racism and suicide among black youths. And the perception that suicide isn’t a black problem makes it difficult for parents, teachers and others to spot warning signs. “If there is a belief that black children do not kill themselves, there’s no reason to use tools to talk about suicide prevention,” Walker said.

OUCH: Yesterday, VA Secretary David Shulkin announced an overhaul of senior leadership overseeing almost two dozen troubled hospitals across the country. His move follows the release of a searing investigation by the agency's watchdog into management failures that put patients at VA’s flagship medical center in Washington at risk, The Washington Post's Lisa Rein and Emily Wax-Thibodeaux report.

Shulkin said he has appointed 24 new facility directors in the past year, including in Maryland and Virginia, after outside teams identified low-performing hospitals. "The personnel moves came as Shulkin tries to reassert control over the second-largest federal agency in the aftermath of a separate, critical report by Inspector General Michael J. Missal on a trip Shulkin took to Europe last summer," Lisa and Emily write. "That report exposed deep factions in the agency’s senior leadership ranks, with Shulkin claiming that political appointees on his staff are trying to oust him.

“It is time for this organization to do business differently,” Shulkin said at a news conference at the Washington Medical Center. “These are urgent issues, and many of these issues are unacceptable.”

HEALTH ON THE HILL

--As Washinton GOP leaders move past the possibility of any significant gun-control legislation in the wake of the Parkland, Fla. shooting, they're focusing instead on measures that would beef up school security. The House plans to vote next week on the STOP School Violence Act, a measure authorizing $50 million annually for safety improvements, including training teachers and students in how to prevent violence and developing anonymous reporting systems for threats of violence, the New York Times reports.

"The bill, drafted by Representative John Rutherford, a Republican and former sheriff from Jacksonville, Fla., is one of a flurry of bipartisan measures introduced in the House and the Senate devoted to school safety — without curbs on guns. In the Senate, a companion bill would also give schools money for physical improvements, such as installing metal detectors or bulletproof doors," Sheryl Gay Stolberg and Erica L. Green write.

Yesterday, Sen. Lamar Alexander (R-Tenn.) and a dozen other Republican senators introduced a school safety measure allowing 100,000 public schools to use federal dollars for school counselors, alarm systems, security cameras and crisis intervention training. “We have drafted this legislation to help states and communities keep schools safe. Safe schools are for the most part a local responsibility, but in this case, the federal government can and should help," Alexander said in a statement.

(Meanwhile, the Florida legislation approved significant gun-control restrictions yesterday).

--Rep. Keith Ellison (D-Minn.) has taken over as sponsor of House Democrats’ universal health-care bill, replacing former congressman John Conyers Jr. (D-Mich.)  Ellison, the deputy chairman of the Democratic National Committee, asked for and received unanimous consent to take over the Expanded & Improved Medicare for All Act, our colleague Dave Weigel reports. Conyers stepped down in December after a growing number of his former female aids accused him of sexual misconduct.

Ellison could have his own set of problems as he faces questions about his previous support of Louis Farrakhan and the Nation of Islam. But Ellison told Dave he's not worried. He said none of his fellow lawmakers raised concerns about Farrakhan while he was campaigning to sponsor the single-payer health care bill.

“I am telling you — no one cares. I’ve been all over Minnesota, all over Alabama, all over Missouri, all over Pennsylvania and Connecticut, and nobody ever asked me about this,” he said.

Meanwhile, he insists it’s “time for us to organize around” a universal health care plan. “It’s a better policy, at a better price. People in labor, people all over the country, they’re going to be driving the public conversation, raising the dialogue about this,” he told Dave. 

AGENCY ALERT

--Yesterday, FDA chief Scott Gottlieb blamed high drug prices on pharmacy benefit managers, health insurers and drugmakers alike, calling them out for “Kabuki drug-pricing constructs," per Reuters.

“Patients shouldn’t face exorbitant out-of-pocket costs, and pay money where the primary purpose is to help subsidize rebates paid to a long list of supply chain intermediaries,” Gottlieb said at the national health policy conference for America’s Health Insurance Plans, the major insurers lobby. “Sick people aren’t supposed to be subsidizing the healthy.”

Gottlieb specifically called out the health industry for not promoting access to biosimilar versions of drugs -- copies of original drugs that are meant to be less expensive but just as effective. The FDA commissioner has prioritized approving such generic drugs while in office, and he noted the FDA approved 1,000 copycat drugs to enter the market last year. Only three of the nine approved biosimilar therapies have reached the market, however.

Today we'll be watching the AHIP conference for an early address by HHS Secretary Alex Azar, who's expected to include discussion of pricing and transparency reforms in his remarks.

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

TRUMP TEMPERATURE
After the Florida school shooting, President Donald Trump is reviving an old debate over whether violent video games can trigger violent behavior.
AP
MEDICAL MISSIVES
WorldViews
Quebec physicians insist they already make too much money, according to a petition to cancel the pay raises and redistribute the money throughout the province's health-care system.
Amy B Wang
INDUSTRY RX
The move, offering memberships for $5.99 a month instead of $12.99, expands an effort to attract more shoppers with low incomes, who favor Walmart.
New York Times
On Small Business
The decline is most noticeable in states that have legalized marijuana.
Gene Marks
CEO Bruce Broussard made $34 million in 2017.
Axios
REPRODUCTIVE WARS
Democrats are vowing to block the slew of long-sought conservative priorities.
Politico
DAYBOOK

Today

  • HHS Secretary Alex Azar speaks at the AHIP National Health Policy Conference.
  • The Senate Health, Education, Labor and Pensions committee holds a hearing on the opioid crisis.
  • George Washington University hosts an event on the seate of the health care system in the EU.

Coming Up

  • The National Coalition on Health Care holds an event on alternative payment models on March 16.
SUGAR RUSH

White House press secretary Sarah Sanders says there is no issue at White House, despite record turnover:

The latest twists and turns in the Stormy Daniels saga:

Watch Miami Heat star Dwyane Wade surprise students at Marjory Stoneman Douglas High School in Parkland, Fla.: