THE PROGNOSIS

Obamacare plans remain too expensive for some Americans — particularly those who are older and earn moderate income. But don’t expect Congress to do much about it.

For all the lip service lawmakers still pay to improving the Affordable Care Act, there’s little path forward this year for any bipartisan legislation to improve the affordability of plans offered through a law that remains sharply divisive nearly a decade after Congress passed it.

Moderate House Democrats trying to counter the Medicare-for-all push from liberals say they’re focusing on ACA fixes as a pragmatic, bipartisan way forward. But so far they’ve not advanced any such measures that have GOP buy-in, even as they prepare for another ACA-themed hearing tomorrow morning in the House Energy and Commerce Committee’s Health subcommittee.

As for congressional Republicans, they’re publicly admitting they’ve pretty much moved on from Obamacare and any effort to improve, weaken or otherwise change it.

“I think there’s a little bit of once burned, why are we going at it again?" Sen. Bill Cassidy (R-La.) told reporters Thursday.

“I think as a Republican legislator, I look for where can I get a result — where can I get something that Patty Murray and I and Frank Pallone and Greg Walden all can agree on?” Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.) said at an Atlantic event the day prior, referring to the leaders of the top health committees in the House and the Senate.

“We’ve proved over eight years that’s hard to do on Obamacare so I’d rather work on this other set of issues for the next couple of years,” Alexander continued, pointing to broader efforts underway to rein in drug prices and increase transparency.

Alexander, speaking at the Atlantic event:

It’s a striking admission from the senator, who poured energy into advancing a bipartisan measure he co-wrote in late 2017 with Sen. Patty Murray (D-Wash.) to infuse more funding into the Obamacare marketplaces. The effort showed a rare GOP openness to improving the health-care law, but it all collapsed under fights over federal funding for abortion (as I detailed at the time).

That same disagreement would almost certainly derail one of three bills Democrats are teeing up for consideration at tomorrow’s hearing. The measure, sponsored by Reps. Angie Craig (D-Minn.) and Scott Peters (D-Calif.), would give states money to either set up “reinsurance” programs to boost insurers with sicker patients or reduce out-of-pocket costs for poorer enrollees.

Those are ideas Republicans have broadly supported in the past, but the Craig-Peters bill doesn’t include longstanding federal restrictions on when federal funding may be used for abortions. In a memo sent to GOP committee members last night, committee staff noted that omission and added that the bill isn’t paid for.

The other two bills being considered by the subcommittee would supply new funding for navigators — a not-so-subtle dig at the Trump administration for mostly canceling grants for groups that enroll people in marketplace plans. It would also restore now-expired funds for states to run their own marketplaces instead of relying on Healthcare.gov.

“These bills either miss the mark or squander a real opportunity to advance solutions that have had bipartisan consensus,” a Republican committee aide told Health 202.

Rep. Mike Burgess (R-Tex.), the Health subcommittee's ranking member, said he's "concerned that they do not adequately address the affordability of health insurance."

A spokesman for Energy and Commerce Democrats said the bills “were chosen because they’re commonsense solutions to lower consumers’ health care costs right away.”

—It’s like Democrats and Republicans are still residing on totally different planets when it comes to the ACA. Shortly after Alexander made his comments at the Atlantic event, top Energy and Commerce Democrat Frank Pallone (N.J.) mounted the stage and said he’s focusing on ACA fixes precisely because he thinks they can move through a divided Congress.

“I’m trying to focus in Energy and Commerce mostly on things we think we can get done in this two-year session,” Pallone said. “Most of our focus is stabilizing the Affordable Care Act because of all the sabotage by the Trump administration.”

But so far, Democrats have spent the bulk of their time lambasting Republicans over various ways they’ve undermined protections for patients with preexisting conditions or pushed what Democrats term “junk” insurance plans — topics that helped Democrats win the House majority last year. Over the past two months, Democratse have held a half-dozen hearings framed along these lines.

—All the while, older, middle-class people are struggling to afford coverage, particularly in rural areas. According to a Kaiser Family Foundation study released this morning, 60-year-olds with a $50,000 income must pay at least one-fifth of what they earn for the least expensive premiums for health plans in ACA marketplaces across a broad swath of the Midwest, my colleague Amy Goldstein reports. In much of the country, those premiums require at least one-sixth of such people’s income.

"The new analysis documents county by county that even as average ACA premiums for the most popular level of coverage dipped slightly for this year — the first time that has happened since the marketplaces opened in 2014 — there is wide geographic variation in how affordable rates are," Amy writes.

Two features of the ACA make middle-class and older adults especially vulnerable to high insurance costs. There's a “cliff” in which premium subsidies end at 400 percent of the federal poverty line and a rule allowing ACA health plans to charge three times as much to older adults as younger ones.

"The combined effects of these rules are especially stark in rural areas, where health plans tend to be more expensive," Amy explains. "The analysis shows that in almost all of Nebraska, a 60-year-old with a $50,000 income would pay between 30 percent and 50 percent of that income in premiums for the least expensive ACA health plan."

The Trump administration says it's trying to improve affordability by expanding access to certain types of leaner, cheaper plans, but Democrats have characterized those plans as "junk" insurance and there's been little evidence on Capitol Hill of bipartisanship on the issue of health-care costs.

AHH, OOF and OUCH

AHH: Pharmaceutical giant Eli Lilly announced it will start selling a generic version of its popular insulin product, Humalog, at 50 percent of the current price.

The company said it would offer a so-called authorized generic of the product, Humalog 100, for $137.35 per vial, which is half the current list price, the New York Times’s Katie Thomas reports. This new product will be called Insulin Lispro. Such an “authorized generic” means that, besides the label, “it is identical to the brand-name drug and manufactured in the same facilities,” Katie writes.

The change comes amid escalating criticism over the skyrocketing cost of prescription drugs, and as lawmakers have focused some of the criticism on rising insulin costs specifically. “The move offers a compromise to critics who have called on drugmakers to lower their list prices,” Katie writes. “Lilly will continue selling Humalog at its regular price to the insurers and employers who want to keep pocketing the large discounts, or rebates, they receive for purchasing brand-name drugs, while also making available a cheaper version to patients who pay for their insulin out of pocket.”

The move also comes after the Senate Finance Committee sent a letter to the top insulin manufacturer asking for information about how it sets prices for its products.

"While this change is a step in the right direction, all of us in the health care community must do more to fix the problem of high out-of-pocket costs for Americans living with chronic conditions," the company’s chief executive, David A. Ricks, said in a statement. "We hope our announcement is a catalyst for positive change across the U.S. health care system."

OOF: A group of 20 states and California Attorney General Xavier Becerra (D) separately announced lawsuits to stop the Trump administration’s rule that could shift tens of millions of dollars away from organizations such as Planned Parenthood and toward faith-based and antiabortion clinics.

The lawsuits seek a court injunction to halt the implementation of the rule in 60 days, our Post colleague Ariana Eunjung Cha reports, and they’re the first in an expected wave of legal challenges to the administration’s changes to the Title X family-planning program.

The administration’s rule means federally funded family planning clinics can no longer refer patients for abortions and have to maintain a “clear physical and financial separation” between abortion services and services funded by the government.

Becerra’s suit was filed yesterday in U.S. District Court in San Francisco, while the multistate suit from the group of mostly Democratic-controlled states is expected to be filed Tuesday in U.S. District Court in Eugene, Ore., Ariana reports.

Becerra said the rule would deny “patients access to critical health care services and prevents doctors from providing comprehensive and accurate information about medical care.” In a statement, officials from Oregon, one of the states in the other suit, said the changes “would require health clinics to open another location, or create a separate entrance for patients, have separate examination rooms, hire separate personnel to work at separate workstations, maintain a separate phone number and website, and have separate electronic medical systems in order to continue to accept Title X funds.”

“The 21 states are just some of the parties — including the American Civil Liberties Union and the Center for Reproductive Rights — that have vowed to sue over the rule, which was published Monday in the Federal Register,” Ariana reports.

OUCH: A top official in Washington state, which is dealing with the worst measles outbreak in two decades, wants the federal government’s help in tackling the anti-vaccination movement, our Post colleague Lena H. Sun reports.

Washington state’s health secretary John Wiesman is calling for a national campaign, similar to the government’s efforts to stop smoking, to combat the false information coming from parents and others regarding immunizations to prevent a variety of childhood diseases. At least 75 people have been sickened by the measles outbreak in the Pacific Northwest, and most of those are unvaccinated children under age 10. The region is home to some of the most vocal and organized anti-vaccination activists, Lena writes.

Wiesman, who will testify today before the Senate HELP Committee, lamented a lack of strategy. He wants the federal government to provide funding for the Centers for Disease Control and Prevention to launch a campaign to examine why people are worried about vaccine safety and come up with a public health response, Lena reports.

“We don’t have anything to counter the media of a very well-organized and connected group of a small number of folks who are having a huge impact” in spreading misinformation about vaccines, he told The Post. “We’re really lacking that.”

INDUSTRY RX

— OxyContin maker Purdue Pharma filed a motion to try to throw out a lawsuit from Massachusetts Attorney General Maura Healey. In the motion, Purdue says the suit amounts to “oversimplified scapegoating,” which creates a “sensationalist and distorted narrative that ignores facts," our Post colleague Katie Zezima reports.

Healey’s suit alleges Purdue disregarded addiction risks, misleading patients and doctors as they prescribed and took high doses of the opioid, even as opioid-related overdoses spiked.

“Purdue alleges that some claims made by Healey are contradicted by the Massachusetts Department of Health and the FDA, which approved the medication and its labeling,” Katie adds. “Purdue argues that Healey is putting forward a ‘misleading narrative’ about OxyContin.”

Healey’s office is planning to oppose the motion.

— Meanwhile, the company is reportedly considering filing for bankruptcy amid potential liabilities in more than 1,600 lawsuits against the manufacturer, alleging it contributed to the opioid crisis. 

If the company filed for bankruptcy protection, the move would halt the lawsuits so Purdue Pharma could negotiate legal claims with plaintiffs under the direction of a bankruptcy judge, Reuters’s Mike Spector, Jessica DiNapoli and Nate Raymond report.

“The potential move shows how Purdue and its wealthy owners, the Sackler family, are under pressure to respond to mounting litigation accusing the drugmaker of misleading doctors and patients about risks associated with prolonged use of its prescription opioids,” they write.

The company hasn’t made a final decision about the bankruptcy filing, per the report.

“As a privately-held company, it has been Purdue Pharma’s longstanding policy not to comment on our financial or legal strategy,” the company told Reuters in a statement. “We are, however, committed to ensuring that our business remains strong and sustainable. We have ample liquidity and remain committed to meeting our obligations to the patients who benefit from our medicines, our suppliers and other business partners.”

— A new analysis from Kaiser Health News found the pharmaceutical industry gave money to various patient advocacy groups that have expressed opposition to a Trump administration proposal to change what drugs are covered by Medicare Part D’s “protected” classes.

Of the dozens of patient advocacy groups that have recently been part of national advertising campaigns pushing back against the Trump administration's proposed Medicare changes, about half of the groups received money from drugmakers.  More than $58 million went to the groups in 2015, Kaiser Health News’s Sydney Lupkin, Elizabeth Lucas and Victoria Knight report, citing data from financial disclosures in its “Pre$cription for Power” database.

“As patient organizations gain ground lobbying Congress and the administration, experts have begun to question whether their financial ties could push them to put drugmakers’ interests ahead of the patients they represent,” they write.

Matthew McCoy, a University of Pennsylvania medical ethics and health policy assistant professor, told the Kaiser reporters that even though there are circumstances in which “what’s best for patients is the same as what’s best for drugmakers, people should consider patient advocacy group statements with a ‘skeptical eye’ if groups have financial ties to the pharmaceutical industry."

MEDICAL MISSIVES

— A decade after the first person was cured of HIV, a London man could be the second. He has been in remission from the disease for a year and a half, without drug treatment, after receiving a stem cell transplant of virus-resistant cells.

It’s still “premature” to be declared a cure, according to the report of the patient’s case in the journal Nature, our Post colleague Carolyn Y. Johnson reports.

Timothy Brown, known as the "Berlin patient," was cured a decade ago after he received a similar stem cell transplant.

“The London patient, infected with HIV and suffering from Hodgkin’s lymphoma, received bone marrow cells from a donor who had a malfunctioning CCR5 gene as part of his cancer treatment,” Carolyn writes. “The gene is known to create a protein that is crucial for HIV to invade blood cells. Brown had also received a transplant without functioning CCR5 genes.”

She adds researchers have failed for a decade to reproduce the results of the Berlin case, in part because these transplants are rare and only performed when there’s a clinical reason, like cancer, to do them. It’s also rare to find the needed donors who are genetic matches and carry two copies of the disabled CCR5 gene.

“These new findings reaffirm our belief that there exists a proof of concept that HIV is curable,” International AIDS Society president Anton Pozniak said in a statement. “The hope is that this will eventually lead to a safe, cost-effective and easy strategy to achieve these results using gene technology or antibody techniques.”

— And here are a few more good reads: 

Morning Mix
The findings, published in the Annals of Internal Medicine, further discredit warnings about the two-dose course for the highly contagious virus.
Isaac Stanley-Becker
Inspired Life
When a college student had to bring his baby to class, this professor helped out so he could take notes.
Deanna Paul
Doctors are worried that when used by millions, atrial fibrillation warnings could lead to unnecessary or even harmful medical care.
Politico
AGENCY ALERT
The Food and Drug Administration called out 15 retailers on Monday for allegedly selling tobacco products to minors.
CNBC
The Food and Drug Administration warned against the use of robotically assisted devices for mastectomies and other cancer surgeries.
Stat
HEALTH ON THE HILL
Former Rep. Beto O'Rourke called for the legalization of marijuana nationwide Monday in an email to supporters that comes ahead of an expected bid for the 2020 Democratic presidential nomination.
CNN
Sanders said that he supports decriminalizing the drug even though his personal experience with it is limited.
Politico
DAYBOOK

Today

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on vaccines and what’s driving preventable disease outbreaks.

Coming Up

  • The House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies holds a hearing on electronic health record modernization on Wednesday.
  • The Food and Drug Administration holds a vaccines and related biological products advisory committee meeting Wednesday and Thursday.
  • The Senate Special Committee on Aging holds a hearing on prescription drug prices on Thursday.
  • The House Judiciary Subcommittee on Antitrust, Commercial and Administrative Law holds a hearing on the effects of consolidation and anticompetitive conduct in health care markets on Thursday.  
SUGAR RUSH
Alabama Gov. Kay Ivey (R) detailed President Trump’s expressions of support from the federal government in the wake of deadly storms that rocked the state