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The Health 202: Lame-duck health initiatives look unlikely in Congress

with Paulina Firozi


Republicans have a health-care checklist they would like to accomplish before losing their House majority early next year. But they’re well aware Democrats have little incentive to help them out — especially given the growing resistance top House Democrat Nancy Pelosi appears to be facing in her quest to assume the speakership.

Drug and medical device makers are lobbying hard for Congress to roll back legislation that cuts into their bottom lines. The pharmaceutical industry wants a reversal of a requirement passed in a budget deal earlier this year for companies to pay more into the so-called “doughnut hole” in Medicare’s prescription drug program. The medical device industry wants a sales tax imposed through the Affordable Care Act repealed.

There’s also talk of passing a bill with strong bipartisan support — notably from members on both the far right and the far left — that could move the needle toward lower drug prices by making it easier for drug companies to develop generic alternatives. (The Health 202 wrote about this CREATES Act in February).

Hypothetically, there could be room for Congress to advance these initiatives by lumping them into a must-pass bill to keep the government funded past Dec. 7. But lobbyists said they’re pessimistic anything substantial will happen, and aides told me a lot is up in the air.

For one thing, Democrats are already unenthusiastic about giving any ground to the health-care industry, particularly drugmakers. They’re on the cusp of taking charge of the House, a perch from which it will be much easier to advance their own priorities.

For another, Pelosi is unlikely to want to give any reason to incoming Democrats — some of whom vowed on the campaign trail to vote against her — to criticize her for surrendering to Republicans. She’s been furiously courting this new class of freshmen, as Politico detailed, hosting private dinners and receptions in preparation for a Nov. 28 vote inside the Democratic Caucus and a final Jan. 3 vote on the House floor. Rep. Marcia Fudge (D-Ohio), a member of the Congressional Black Caucus, emerged yesterday as a possible challenger to Pelosi, arguing there should be a minority woman in the top echelons of House leadership.

Republicans appear cognizant of these realities. Rep. Greg Walden (R-Ore.), who leads the Energy and Commerce Committee, told a private group yesterday that while he would like to get some of these priorities accomplished, it’s hard to imagine Democrats agreeing to any of them, a lobbyist at the meeting told me.

Still, lawmakers have just arrived back in Washington this week after the midterm elections, and negotiations are just at the beginning stages. Here are the things to be watching on the health policy front:

1. Reversing drugmakers' extra “doughnut hole” contributions.

The drug industry has been fighting tooth and nail to reverse part of a February spending bill requiring them to give deeper discounts to Medicare enrollees whose spending on drugs is high enough to reach a coverage gap known as the “doughnut hole.” The discount is currently 50 percent for brand-name drugs but is set to rise to 70 percent next year.

The aim of the provision was to reduce out-of-pocket spending for seniors — who are often on a fixed income and struggle to pay for their medications — but it also represented an unusual financial hit for the powerful pharmaceutical industry.

2. Passing the CREATES Act.

Legislators have floated passing this popular bill as a way to get Democrats on board with making the doughnut-hole fix that drugmakers want so badly. As I wrote in February, the CREATES Act tried to even the playing field for generic drug developers who often run up against blockades from branded pharmaceutical companies seeking to keep their competition at bay.

It would allow generic companies to sue branded companies for failing to provide them with samples needed for testing and has an unusually wide range of support from lawmakers, although the Pharmaceutical Research and Manufacturers of American predictably hates it.

3. Repealing the medical device tax.

This tax nearly always comes up in discussions about the ACA because the device industry has spent considerable energy trying to chip away at it. The 2.3 percent sales tax was included in the 2010 health-care law as a way to help pay for its insurance subsidies, but Congress has delayed its implementation until 2020. Because that's still a year away, the long timeline might remove a sense of urgency that could otherwise push Congress to repeal it.


AHH: New Jersey Republican Rep. Tom MacArthur has officially lost his reelection bid, according to the AP, more than a week after Election Day and days after his opponent, Democrat Andy Kim, declared victory in the race.

MacArthur was instrumental in helping House Republicans negotiate a way to push through their bill last summer to repeal the Affordable Care Act. He was the co-author of an amendment with Freedom Caucus Chairman Mark Meadows (R-N.C.) that would have allowed states to apply for waivers from Obamacare’s ban on higher premiums for people with preexisting conditions. In effect, some Americans with these illnesses would have seen their premiums go up as a result of the waiver, as Paige noted in The Health 202 this week.

The effort to repeal the ACA died in the Senate, but it became a flashpoint in the campaign. Both sides repeatedly insisted they would maintain protections for preexisting conditions. But MacArthur faced ire from his constituents over the bill, and Democrats said Republicans’ vote to repeal the ACA contradicted some of their promises.

For his part, Kim told the Associated Press  that MacArthur's vote to repeal the ACA helped push him to run. “The moment that was most important in this district over the last two years was the health-care vote and the town hall that MacArthur did,” Kim said. “That was what got me into the race, that’s what just turned this district on its head and why people got so fired up.”

OOF: A group from the American College of Surgeons has weighed in on the debated role of medical professionals surrounding gun control, releasing a new set of gun-safety recommendations. What’s particularly notable about the list of surgeons who authored the report is that a majority of them are “passionate firearms owners,” our Post colleague Frances Stead Sellers reports.

The list “aims to bridge the political divide,” Sellers writes, and follows a debate that broke out over social media when the National Rifle Association chided doctors, telling them to “stay in their lane,” rather than weigh in on gun safety.

“The recommendations, which include robust background checks, enhanced gun-safety training, mandatory reporting requirements for people considered a threat to themselves or others, and the use of innovative technologies to prevent accidental firearms discharge, are striking not so much for their content as their authorship,” Sellers writes.

Jeremy Faust, an emergency physician at the Brigham and Women’s Hospital in Boston who was not involved in the report, told Sellers the list represents two key perspectives: “As surgeons, they know firsthand the havoc that guns can impart. As gun owners, they understand the issues that non-gun owners might not fully appreciate.”

OUCH: A norovirus outbreak has occurred at a shelter where evacuees of the Camp Fire in Northern California are staying.

An unknown number of people staying at a shelter in Chico, Calif. have been sickened by the virus, which is highly contagious and causes diarrhea and vomiting. “Norovirus is not uncommon, especially this time of year, and it’s especially not uncommon for a shelter situation where you have hundreds of people living in very close quarters,” Butte County Public Health Department spokeswoman Lisa Almaguer told reporters,The Mercury News’s Jason Green reports.

Almaguer said those who are ill have “separate restroom facilities and they are being cared for by public health nurses.”

As of Wednesday, the death toll from the Camp Fire, which is the deadliest in the state’s history, had risen to 56. That number is expected to increase as authorities continue to search for the hundreds of people still missing. Butte County made public a list of hundreds of names of people still unaccounted for.  


— Data from the Centers for Medicare and Medicaid Services shows Obamacare enrollment is down somewhat compared with the same time last year.

More than 804,000 people have enrolled in ACA health plans so far in the second week of open enrollment, CMS announced, and a total of nearly 1.2 million people signed up in the first 10 days of the sign-up period, which started on Nov. 1. 

“The numbers are lower than during a similar period a year ago, but higher than the year before that,” Bloomberg’s John Tozzi reports. But enrollment lasts through Dec. 15 and there could still be a spike. Tozzi reports there is “typically a surge of people who come in at the end of the six-week enrollment period.”

— Meanwhile, America’s Health Insurance Plans (AHIP), the trade group that represents health insurers, released a dozen recommendations for federal and state officials that it says will help lower individual market premiums.

The group says its three “core” recommendations include addressing rising health-care and prescription drug costs, offering premium savings for families who make more than 400 percent of the federal poverty level and increasing the number of individuals who buy coverage plans, which it says will balance risk and bring down costs for all.


— Because of worsening security concerns, the United States has no plans to send personnel to help fight the growing Ebola outbreak in Congo, our Post colleague Lena H. Sun reports. And whether or not to send personnel has been a growing debate within the administration.

“The outbreak in northeastern Congo is taking place in an active war zone and has now become the country’s largest in more than four decades,” Lena writes. “Attacks on government outposts and civilians by dozens of armed militias have complicated the work of Ebola response teams, who have often had to suspend crucial work tracking cases and isolating people infected with the deadly virus. Violence has escalated in recent weeks, including attacks by armed groups this weekend near the operations center in Beni, the urban epicenter in North Kivu province.”

Staff from the Centers for Disease Control and Prevention and the U.S. Agency for International Development are deployed in Kinshasa, a capital about 1,000 miles away, but there are no U.S. citizens in the outbreak zone.

“Securing the safety of our staff is our highest priority,” one administration official told reporters adding, it’s right now “simply too dangerous.” Lena added the official “declined to say whether sending CDC experts under the protection of U.S. military personnel is under consideration.”


— Contrary to what the name may suggest, Extra Strength Tylenol “Rapid Release gels” actually take more time to dissolve than cheaper tablets from Tylenol, according to a new study.

The rapid release gels take about 30 seconds longer to dissolve than a tablet with the same dose, our Post colleague Carolyn Y. Johnson reports.

“The researchers from Valisure, a start-up pharmacy that screens medicines, found a similar effect when they compared rapid-release gelcaps to regular tablets of generic acetaminophen from Walgreens, Rite Aid and Walmart Equate,” Johnson writes. “Several outside experts said the laboratory tests don’t raise health or safety concerns.

“But the finding highlights how difficult it can be for consumers to decipher the claims of over-the-counter drugs — in this case potentially opting to pay more for a form of medicine that’s called ‘rapid release’ but is no faster to dissolve than a tablet.”

—  A new start-up, Virta Health, has a novel business plan: It will only get paid if the service is successful. The company conducts virtual coaching for helping patients control and reverse their Type 2 diabetes and it "defines type 2 diabetes reversal as reaching an A1C level below 6.5 percent and eliminating all diabetes medications,” Stat’s Rebecca Robbins reports.

Here’s how the payment structure works: “[A] health plan or employer will pay Virta a fee only if the patient is sufficiently engaged with its program after one month,” Robbins writes. “The second payment comes after a year, only if patients lower their A1C, a measure of glucose in the blood, to a certain level determined on a case-by-case basis.

“With its new business model, Virta joins a number of other medical companies that are experimenting with payment structures tied to how well patients fare,” she continues. “These outcomes-based contracts between payers and manufacturers, as they’re called, are increasingly being pitched to try to persuade a reluctant insurer to take the plunge on covering a pricey new therapy, device, or service.”

“If we don’t deliver results, and make our patients healthier and in most cases reverse their type 2 diabetes, we don’t get paid,” Virta CEO and co-founder Sami Inkinen told Robbins. “Literally, we can enroll a patient, and get paid $0, on an individual patient level.”

— And here are a few more good reads from The Post and beyond: 

Heat waves caused by climate change could impair male fertility across generations, scientists warn (Isaac Stanley-Becker)

Big Tobacco Warns It May Fight FDA Over a Menthol Ban (Wall Street Journal )

A giant insurer is offering free Apple Watches to customers who meet walking goals (CNBC)

What to Know About Getting a Flu Shot This Year, No Matter Who’s Paying (The New York Times)

20 Americans Die Each Day Waiting for Organs. Can Pigs Save Them? (The New York Times)

Jury clears J&J of liability in California talc cancer case (Reuters )


When ‘hell moved in,’ a California nurse drove through fire to save lives (Amy Wang)

California’s deadliest wildfire is also a massive air quality problem (Ben Guarino, Zara Stone and Sawsan Morrar)

Billions are now spent to protect kids from school shootings. Has it made them safer? (John Woodrow Cox, Steven Rich)


Democratic lawmakers warn Pompeo against possible ban on sex health terminology (Politico)



  • The House Veterans Affairs Subcommittees on Disability Assistance and Memorial Affairs hold a hearing on oversight of contract disability examinations.

Trump endorses bipartisan criminal-justice reform bill:

President Trump announced his support for the bipartisan bill H.R. 5682, known as the "First Step Act," on Nov. 14. (Video: The Washington Post)