Reporter

THE PROGNOSIS

The medical device tax in the Affordable Care Act has been a perennial target since the law's inception. Congress twice temporarily suspended it and last night the House once more voted to permanently repeal it. 

Officially killing off the 2.3 percent excise tax paid by medical device manufacturers is one of several health care-related measures aimed at further undermining Obamacare the House will take up before it goes on August recess next week. None of them are likely to be considered soon in the Senate, but House Republicans are intent on taking the votes to underscore their message before the midterms.

Unlike most attempts to chip away at the law, repealing the medical device tax is a rare bipartisan goal. 

When the ACA was written in 2009, lawmakers decided the various industries in the health-care sector that stood to benefit from the law's requirement that all Americans be insured should help offset the cost of the legislation. The multibillion-dollar medical device industry launched a full-throttled attack on the tax, and it became low-hanging fruit in the dozens of Republican attempts to repeal Obamacare. 

Pressure mounted on Democrats in states where device manufacturing is big business, and it wasn't long before they, too, sided with Republicans on repealing the tax. It garnered support from lawmakers spanning the ideological spectrum -- from liberals such as then-Sen. Al Franken (D-Minn.) to centrists such as Sen. Bob Casey (D-Pa.). Of the 18 co-sponsors on the Senate bill to repeal the tax, nine are Democrats. In the House, 45 Democrats added their names to the legislation.

The industry paid the tax, on its revenues, for three years before Congress stepped in to give manufacturers a two-year reprieve in December 2015. Then, as part of its deal to keep the government running this past January, it punted the tax again for another two years. But medical-device companies still cried foul, arguing these short-term moratoriums created too much uncertainty for businesses that need to be able to plan for the long haul. So, on Tuesday night, 57 Democrats joined 226 Republicans on a standalone bill to end the tax. 

While the repeal would likely sail through the Senate too, its future there is uncertain given the upper chamber's competing priorities. 

What's notable about the years-long push to end this tax is doing so wouldn't actually undermine the ACA as much as it would simply add to the deficit. The taxes included in the law were there to offset the costs of the new health care law. Without them in place, the government simply loses money. One source told me to think of it less as an Obamacare-measure and more as another tax cut bill. 

The House is also planning to take up another delay of an insurance tax paid for by insurers. It too has been delayed twice and the House will vote this week on legislation that includes putting off collection for another two years. Insurers warn premiums will go up if they have to pay the tax.

Each year the taxes are delayed, several billion dollars is added to the federal deficit because the government doesn't stop paying out ACA-created subsidies to help individuals afford purchasing insurance. 

Democrats who opposed ending the medical device tax took Republicans to task over its fiscal irresponsibility -- an interesting flip of the script for anyone who paid attention to GOP concerns during the Obama years.

"We devised the Affordable Care Act so that it could be paid for and we would not have to add to the deficit," said Bill Pascrell (D-N.J.), during floor debate. "We knew we had to pay for this. That's what health care is all about. And that's why you guys on the other side, you people, have not come up with an alternative because you don't know how to pay for anything."

Republicans, Democrats with companies in their backyards and the medical device industry argue it's a jobs issue, and the threat of the tax limits innovation and suppresses growth. 

"This is more than a dollars-and-cents line on a manufacturer’s ledger sheet," said Scott Whitaker, President and CEO of AdvaMed, which represents hundreds of device makers. "What’s being taxed are the technologies, treatments, diagnostics, and therapies that ensure better care and quality of life for patients. The downstream effects are real. The human impact is real. Congress has a chance to permanently repeal the tax, once and for all.”

Rodney Whitlock, a former Hill staffer now vice president at ML Strategies, told me AdvaMed deserved a place in the lobbying hall of fame for its success convincing lawmakers that the tax was enemy number one. It has spent millions on lobbying, campaign donations and ads. So far this year its PAC has given away $155,000 to lawmakers for their reelections, according to OpenSecrets. That money is well spent because every day the tax isn't collected is money its members get to keep. 

 

The slew of health-care bills on the floor this week is an attempt by the GOP to notch health-care related victories in order to stave off a concentrated effort by Democrats to make health care a cornerstone of the midterm elections. Democrats have been campaigning on the issue following Republicans' failed effort to repeal and replace the ACA last summer.

To that end, also this week, the House will vote to make low premium, high-deductible catastrophic health plans available to anyone who wants them. Currently only those under 30 years old who don't have access to an affordable plan in their area can buy the so-called cooper plans from the ACA insurance exchanges.

AHH, OOF and OUCH

AHH: The Ebola outbreak in the Democratic Republic of Congo is officially over, the World Health Organization said yesterday. During the outbreak, which was declared on May 8, there were 54 cases of the virus including 33 deaths, CNN’s Jacqueline Howard reports.

The availability of vaccines was a critical element in fighting the outbreak, in addition to traditional approaches.

At least 3,330 people were vaccinated with an experimental vaccine developed by U.S.-based pharmaceutical giant Merck.

“We had a vaccine — and that I think is going to be extremely important for the future of Ebola control,” said Peter Salama, a medical epidemiologist and WHO's deputy director-general of emergency preparedness and response, according to Jacqueline. Salama also noted: “It's not enough to do traditional public health containment measures. We really feel that the same kinds of vaccines and drugs that we would offer to patients in the West should be offered to people in developing countries as well.”

OOF: The Trump administration is on track to reunite most of the migrant families separated at the border by its looming Thursday deadline, government attorneys said yesterday. But they noted they are still determining whether hundreds of parents were deported without their children.

Out of the 2,551 parents who were separated from their children, 1,012 parents have been reunited with their children, government attorneys told U.S. District Court Judge Dana M. Sabraw, our Post colleague Nick Miroff reports. And still, hundreds more families are set to be reunited by tomorrow.

“But the judge was less pleased with the government’s inability to say how many migrant parents have already been deported, or released from custody by Immigration and Customs Enforcement into the interior of the United States,” Nick writes. “Sabraw ordered the government to provide those lists to the court by noon Wednesday, and suggested the administration has not been transparent about the whereabouts of 463 parents whose files indicate they are no longer in the United States.”

“It appears there’s a large number of parents who are unaccounted for or who may have been removed without their child, and that is a deeply troubling reality,” Sabraw said yesterday.

— Meanwhile, our colleague Michael E. Miller details in this extensive read what’s ahead for families who have separated and then reunited. He writes that after being reunited with their children, families were taken to nonprofit groups who had helped them, and they were told they were free.

“But the parents wondered: Free for how long?,” Michael writes. “Some had been given GPS ankle monitors just an hour or two earlier. All of them were required to check in with Immigration and Customs Enforcement — the agency that had just released them. For now, they were here, in a place that was part emotional respite, part logistical staging ground.”

OUCH: Pharmaceutical giant Purdue Pharma appears to have changed the language in a print ad published in The Washington Post, after first warning that taking opioids “even when taken as prescribed” can be dangerous, Kaiser Health News’s Fred Schulte reports.

“We are acutely aware of the public health risks opioid analgesics can create, even when taken as prescribed,” a full-page advertisement read in the July 19 issue of The Post. Days later, an identical ad appeared in the July 24 issue, except the words “even when taken as prescribed” were removed from the ad.

Andrew Kolodny, director of advocacy group Physicians for Responsible Opioid Prescribing, told Fred it was “interesting” that Purdue Pharma seemed to initially acknowledge the risk of opioid prescriptions. “I’ve never seen them state that publicly before,” Kolodny said. “It’s disappointing that they may have backtracked.”

In a statement, Purdue Pharma spokesman Robert Josephson said risks related to “addiction, abuse, misuse and diversion of opioids, even when taken as prescribed, is well-known and clearly spelled out” in warnings that come with medications, Fred reports.

AGENCY ALERT

— The Trump administration said yesterday it will resume the billions of dollars of risk-adjustment payments to health insurers under Obamacare, after announcing earlier this month it would suspend the program. The administration said it would continue the program "because otherwise health plans could become insolvent or withdraw from the market, causing chaos for consumers,” the New York Times’s Robert Pear reports.

Critics said stopping the program, which is meant to even out insurer costs for sicker patients, would destabilize insurance markets. Centers for Medicare and Medicaid Services Administrator Seema Verma said some health plans that “expressed concerns about having to withdraw from markets or becoming insolvent should be assured by our actions today.”

“Taking immediate action to allow for the continued operation of the risk adjustment program is imperative to maintain stability and predictability in the individual and small group health insurance markets,” CMS said, according to Robert. The payments are set to resume on Oct. 22. 

— Good news for burger enthusiasts. The Food and Drug Administration has approved the use of soy leghemoglobin, the key ingredient in the Impossible Burger, the meat substitute that has a distinctive blood-like color and taste.

Last year, the New York Times’s Stephanie Strom had reported that the key substance had “raised regulatory questions” because it had never been consumed by people. But the agency said in a letter to the Impossible Foods start-up that it determined “soy leghemoglobin GRAS, or generally recognized as safe, in its most recent review,” CNBC’s Ariel Shapiro reports.

“Getting a no-questions letter goes above and beyond our strict compliance to all federal food-safety regulations,” Impossible Foods founder and CEO Patrick O. Brown said in a statement, per the report. “We have prioritized safety and transparency from day one, and they will always be core elements of our company culture.”

HEALTH ON THE HILL

— A group of Republican senators is looking to block an effort by the District of Columbia to establish its own individual mandate even after the Republican overhaul repealed the federal mandate at the end of last year.

Sen. Ted Cruz (Tex.), introduced an amendment yesterday to an appropriations bill alongside Sens. Tom Cotton (Ark.), Mike Lee (Utah), Ron Johnson (Wis.), Cindy Hyde-Smith (Miss.) and Marco Rubio (Fla.) to prevent federal funds from being used to reestablish the mandate’s financial penalty in Washington, the Washington Examiner’s Robert King reports. “We need to finish the job on Obamacare, not prop it up with a broken system,” Cruz said.

STATE SCAN

— Add another prominent candidate to Democrats endorsing single-payer health care. New York Democratic gubernatorial candidate Cynthia Nixon released a video yesterday endorsing a single-payer system for the state.

Nixon, who is running against Gov. Andrew Cuomo (D), cites the New York Health Act, a bill that blocked by a Republican-controlled state Senate even after passing the state assembly four years in a row, the Albany Times Union reports.

“Health care should be a human right, not a privilege for those who can afford it,” she says in the video. “When I'm governor we'll pass the New York Health Act and create a single-payer, Medicare-for-all system that covers every New Yorker.”

Nixon said when she was 13, her mother found a lump in her breast, but was unemployed and uninsured and had to find a job that offered health coverage. “And then she waited a month because she was afraid if she got it checked out right away, the health insurance company would say it was a preexisting condition and refuse to pay for her treatment,” Nixon explains. “We shouldn’t have to depend on our employers for health insurance and we certainly shouldn’t have to lie to our doctors to get the treatment we need.”

— As part of ongoing efforts to legalize marijuana, New Jersey’s top lawyer issued a statewide order to delay marijuana-related prosecutions for a month while the state comes up with guidelines to downgrade or dismiss some of the current offenses, Bloomberg News’s Elise Young reports.

“Starting today, New Jersey courts must suspend all marijuana prosecutions while [Attorney General Gurbir Grewal], prosecutors and other law-enforcement officials develop guidelines on how they should be handled,” Elise writes. “Pending cases will be postponed until after Sept. 4, and Grewal expects to issue a long-term policy directive by the end of August.”

Elise notes that N.J. lawmakers have not yet passed a legalization bill, an effort that Gov. Phil Murphy (D) campaigned on, pushing to join the handful of states that have legalized pot for recreational use. Democratic Senate President Steve Sweeney told reporters he is planning to send such a bill to the governor’s desk by September, Elise reports.

REPRODUCTIVE WARS

— The FDA yesterday approved a new drug to treat pain related to endometriosis, a common condition that involves abnormal uterine tissue and can cause severe pain and infertility.

Drug manufacturer AbbVie has developed what it says is the first new drug in a decade to treat endometriosis, the Associated Press’s Linda A. Johnson reports, a condition that affects about one in 10 women of reproductive age. The drug Orilissa, which can be used to treat discomfort during menstruation and sex, treats pain by reducing the production of estrogen. “In testing, it significantly reduced menstrual pain in about 45 percent of women given a low dose and 75 percent given a high dose, compared to about 20 percent of women given dummy pills,” Linda writes. “Reduction of pain outside menstruation was slightly lower.”

The pill will cost $845 every four weeks without insurance, Linda reports.

INDUSTRY RX

 — Eli Lilly CEO David Ricks denounced the Trump administration’s proposal to find ways to import prescription drugs into the United States, saying it was “the wrong road to go down,” the Hill’s Nathaniel Weixel reports.

Health and Human Services Secretary Alex Azar, a former top Eli Lilly executive, last week called on the FDA to form a working group to examine how it can safely import drugs in certain circumstances.

During an earnings call, Ricks said he believes the issue of drug pricing should be handled through regulatory reforms.

“This is really a regulatory failure from our perspective,” Ricks said, per The Hill. “We agree it should be solved, [it’s] the method we disagree with.”

MEDICAL MISSIVES

— Check your pantries. Here are some of the latest reports about potential food-borne outbreaks:

  • Pepperidge Farm has voluntarily recalled four types of its Goldfish Crackers over concerns about potential salmonella contamination. The recall includes Flavor Blasted Xtra Cheddar, Flavor Blasted Sour Cream & Onion, Goldfish Baked with Whole Grain Xtra Cheddar and Goldfish Mix Xtra Cheddar Pretzel, our Post colleague Lindsey Bever reports. No illnesses have been reported yet. The recall was declared after a supplier said whey powder used in the crackers was potentially contaminated.
     
  • Mondelez International has also recalled some of its Ritz cracker products over a potential contamination of salmonella in whey powder. The recall includes Ritz Bits Cheese, Ritz cheese cracker sandwiches and Ritz bacon cracker sandwiches, the New York Times's Daniel Victor reports, and is limited to the United States including Puerto Rico and the U.S. Virgin Islands. No illnesses had been reported as of Monday.

— And here are a few more good reads: 

Limited by federal law, the veterans’ health system can’t study the benefits of cannabis or prescribe it to patients. Nearly a million veterans may be using it anyway.
The New York Times
Paul Mango, a former health-care consultant who ran unsuccessfully this year for governor of Pennsylvania, is joining the Trump administration.
Philadelphia Inquirer
Though voters approved a binding resolution last fall to expand the program, Gov. Paul LePage has refused to do it, saying he’d rather go to jail.
The New York Times
New research shows more promise for using AIDS treatment drugs as a prevention tool, to help keep uninfected people from catching HIV during sex with a partner who has the virus. There were no infections among gay men who used a two-drug combo pill either daily or just before and after sex...
Associated Press
Voraciously
Some worry a negative health-inspection score could remain online long after a restaurant has fixed any problems.
Tim Carman
To Your Health
Bioethicists call for a federal investigation into experiments using ketamine on agitated patients.
Carolyn Y. Johnson
OPIOID OPTICS
‘Pragmatic trials’ differ from most research studies by focusing on effects in the real world.
The New York Times
MALPRACTICE
Fact Checker
An attack ad by an abortion-rights group cites HHS Secretary's Alex Azar's quote out of context.
Glenn Kessler
DAYBOOK

Today

  • The Senate Energy and Commerce Subcommittee on Health holds a hearing on the 21st Century Cures.
  • The Senate Health Education Labor and Pensions Committee holds an executive session.
  • The Bipartisan Policy Center holds an event on the future of health care.

Coming Up

  • The Food and Drug Administration Antimicrobial Drugs Advisory Committee holds a meeting on Thursday.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on “An Update on the Merit-based Incentive Payment System” on Thursday.
SUGAR RUSH
Houston police said surveillance footage shows a suspect in the July 20 killing of Mark Hausknecht, a cardiologist who treated former President George H.W. Bush