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The Health 202: Senators are pushing forward on measures to lower health-care costs

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with Paulina Firozi


Expanding health insurance to many more Americans isn’t happening anytime soon. That’s obvious from the endless clashes between Democrats and Republicans over Obamacare and Medicare-for-all.

But there might be an opening for legislation to help people afford the care they receive — a problem so common that more than 1 in 4 Americans say they skipped needed health-care services in the past two years because they felt they couldn’t afford them.

“If I go church and there is a Bernie Sanders supporter and a Donald Trump supporter yanking on different lapels but agreeing on the same thing, it’s the high cost of medications,” Sen. Bill Cassidy (R-La.) told reporters this week. “I think that’s why you see candidates across the spectrum speaking of it.”

On at least four separate occasions, President Trump has given addresses on the need to bring down health care and prescription drug costs, most recently calling for an end to the surprise medical bills patients receive all too often. His White House is reportedly in ongoing conversations with House Speaker Nancy Pelosi’s (D-Calif.) office over drug pricing legislation.

And two efforts are underway in the Senate to compile bipartisan packages aimed at lowering and bringing transparency to health-care costs, with the goal of merging them on the Senate floor this summer:

— Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and his Democratic counterpart, Ron Wyden (D-Ore.), are poised to release a drug pricing proposal by the end of the month.

— The other top health-care committee — Health, Education, Labor and Pensions — is preparing for a hearing on a health-care pricing package recently released by its leaders, Chairman Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) (although that won’t happen until Alexander is able to return to Capitol Hill after surgery for a benign leg tumor).

Neither package will include one singular big thing to lower health-care costs for consumers. Instead, they’ll be full of smaller proposals that legislators say together could help move the needle on prices.

“I believe we have a real opportunity this time,” Grassley said at an Axios event yesterday.

Alexander and Murray’s proposal would end surprise medical bills, which patients often receive through no fault of their own after unexpectedly receiving care from a provider or hospital outside their plan’s network. Their package would also require more transparency from drugmakers, insurers and providers, among other provisions. The Finance proposal is expected to include measures speeding the entry of competing generic drugs, capping out-of-pocket expenses for Medicare recipients and lowering drug spending in the Medicaid program.

Then there’s another bipartisan surprise medical billing proposal from Cassidy and five colleagues, who are pushing for their legislation to be included in whatever package the HELP committee assembles. Cassidy argues his measure offers the most effective method for insurers and doctors to negotiate the price when patients get out-of-network care — one that involves paying providers the median in-network rate for their services but allows for an independent arbitration process if it’s needed.

While the thought had been this approach would result in more government spending, the Congressional Budget Office is scoring the measure as saving $17 billion over its 10-year window, a GOP Senate aide confirmed to The Health 202.

Yet for all the optimism being expressed by the senators, there’s a lot stacked against them. For one thing, the policy changes would affect all the major health-care industry players — the pharmaceutical companies, the insurers, the hospitals and the doctors — who say publicly they’re behind the idea of lowering health-care costs but tend to mount major offensives against policies that would cut into their piece of the pie.

And while there’s a lot of momentum in the Republican-led Senate, that chamber isn’t where a deal would need to be struck. Any new measures would have to be passed by the Democratic-led House, so it’s the conversations between Pelosi and the White House that are most important at this juncture.

The road toward lower drug prices is a steeper climb than if lawmakers just pursued transparency and surprise billing reforms, said John Rother, president of the National Coalition on Health Care.

“Drug pricing is a lot messier and it’s hard to predict whether Congress will really do something significant there,” Rother said. “But the point is, there is a lot of activity.”


AHH: The Trump administration announced it will stop funding human fetal tissue research by government scientists. It also canceled a contract with a University of California at San Francisco laboratory to use fetal tissue to research new HIV therapies, our Post colleague Amy Goldstein reports. The decision to crack down on federal funding for the controversial medical research was determined by President Trump himself, Amy reports.

“The change represents a victory for antiabortion advocates, who immediately lauded the change, and a major disappointment to scientists who say the tissue collected from elective abortions has been instrumental to unlocking the secrets of diseases that range from AIDS to cancers to Zika, as well as to developing vaccines and treatments for illnesses such as Parkinson’s disease,” she adds.

The policy shift follows the administration’s move last year to launch a comprehensive review all of its federally funded research using fetal tissue.

OOF: The Trump administration is canceling a slew of resources for migrant children in federal custody at shelters across the country, including English classes, legal aid and recreational activities like soccer and table tennis.

The Department of Health and Human Service’s Office of Refugee Resettlement said it would end the funding for things that have been deemed “not directly necessary for the protection of life and safety, including education services, legal services, and recreation,” an HHS spokesman Mark Weber said, as our Post colleague Maria Sacchetti reports.

Weber indicated the program could run out of funds near the end of the month and is obligated to use funding for services that are essential. In April, there were an average of 12,500 minors held in federal shelters, and they stayed an average of 48 days at the facilities.

“The move to curtail services for unaccompanied minors — revealed in an email that an HHS official sent to licensed shelters last week, a message that has been obtained by The Washington Post — could run afoul of a federal court settlement and state-licensing requirements that mandate education and recreation for minors in federal custody,” Maria adds.

“We’ll see them in court if they go through with it,” lawyer Carlos Holguin said. “What’s next? Drinking water? Food? . . . Where are they going to stop?”

OUCH: For the second time in just weeks, anti-vaccine activists held a rally in Brooklyn to question the safety of vaccines, an event that comes as a measles outbreak has continued in parts of New York, including through the ultra-Orthodox communities there.

The city’s health commissioner denounced the rally ahead of the event, as our Post colleague Lena H. Sun and Ben Guarino report, stressing the danger of measles.

“To hold an anti-vaccination rally in the middle of an outbreak is beyond irresponsible; it is downright dangerous,” said Health Commissioner Oxiris Barbot. “New Yorkers are being put at risk by this spread of misinformation, including children who are too young to get vaccinated or those who have medical conditions that make vaccination impossible.”

The Tuesday night event banned the media and included conspiracy theorist Rabbi Hillel Handler and Del Bigtree. Outside the event, Bigtree told reporters: “They should be allowed to have the measles if they want the measles. It’s crazy that there’s this level of intensity around a trivial childhood illness.”

“As of Monday, there have been 566 cases in New York City since the outbreak began in October, with 42 hospitalizations and 12 admissions to intensive care units. Most of the cases have been in four Zip codes in Brooklyn,” Lena and Ben write.


— Insys Therapeutics, the maker of powerful fentanyl spray Subsys, has agreed to pay about $225 million in a settlement over allegations it bribed doctors to illegally prescribe the product, our Post colleague Eli Rosenberg reports.

The Justice Department announced the resolution yesterday. Insys will plead guilty to five counts of mail fraud, acknowledging it used a speaker program as a “‘vehicle to pay bribes and kickbacks to targeted practitioners,’ who were then willing to increase how much the prescribed the fentanyl spray, federal officials said.

After a trial last month, Insys founder John Kapoor and four other former executives of the opioid manufacturer were convicted of racketeering conspiracy related to marketing of the fentanyl spray, which was approved by the FDA to treat pain in terminal cancer patients.

“For years, Insys engaged in prolonged, illegal conduct that prioritized its profits over the health of the thousands of patients who relied on it,” U.S. Attorney for the District of Massachusetts Andrew E. Lelling said in a statement. “Today, the company is being held responsible for that and for its role in fueling the opioid epidemic.”


— Former vice president Joe Biden continues to support the Hyde Amendment, his campaign confirmed to NBC News. The longstanding amendment, added to numerous bipartisan congressional spending bills, bans the use of federal funds to pay for abortions except in cases of rape, incest or to save the life of the woman. 

The Democratic presidential contender is reportedly open to repealing the amendment “if abortion avenues currently protected under [Roe v. Wade] were threatened," NBC News’s Heidi Przybyla reports.

The report prompted an immediate backlash from other 2020 Democratic candidates who have called for ditching Hyde, signaling the party's shift to the left on the abortion issue. "Biden’s stance that he supports a law sharply limiting the use of federal funds for abortions created one of the clearest indications yet of a growing division among Democrats and a feistiness in the field, which on Wednesday displayed newfound willingness to criticize the front-runner," our colleagues Matt Viser, Michelle Ye Hee Lee and Jenna Johnson write. 

Yet nearly all the presidential candidates who are members of Congress -- including Sens. Elizabeth Warren (Mass.), Kirsten Gillibrand (N.Y.) and Kamala Harris (Calif.) -- have voted for measures that included the Hyde language.

Sen. Bernie Sanders (I-Vt.) tweeted there’s “#NoMiddleGround” on women’s rights, using a phrase recently used to criticize Biden’s proposal on climate action:

Sen. Kirsten Gillibrand (N.Y.) responded too:

Criticisms came from several other candidates in the growing Democratic field, as our Post collegaue Felicia Sonmez highlights. 

Abortion rights advocates also chimed in to slam Biden over his support for the amendment.

Ilyse Hogue, president of the abortion rights group NARAL, said in a statement that there’s “no political or ideological excuse” for such a stance. She said such a stance “translates into discrimination against poor women and women of color plain and simple.”

Kelley Robinson, executive director of the Planned Parenthood Action Fund said supporting the amendment "isn’t good policy or politics.”

“We hope that Vice President Biden will reconsider this position and what it means to millions of women,” said Stephanie Schriock, the president of Emily’s List.


— For the second time in a week, a medical testing company has disclosed a data breach. This time, LabCorp announced a breach at a third-party billing collection company affected 7.7 million customers whose personal and financial information were exposed, our Post colleague Rachel Siegel reports.

The same contractor, American Medical Collection Agency, notified medical testing company Quest Diagnostics about a breach affecting 11.9 million patients. “AMCA has indicated that it is continuing to investigate this incident and has taken steps to increase the security of its systems, processes, and data,” LabCorp said in a filing with the U.S. Securities and Exchange Commission. 

“LabCorp said the breach did not reveal information like tests ordered or lab results, the filing said. But the hacker was able to access names, birthdays, addresses, phone numbers, dates of service, account balances and other information from August 2018 to March,” Rachel writes. “The breach also exposed credit card and bank numbers attached to roughly 200,000 accounts, the filing said. AMCA told LabCorp that it was in the process of notifying those patients.”


— If you're a podcast enthusiast, check out “An Arm and a Leg,” which launched its second season this week. This podcast, co-produced by Kaiser Health News, tells revealing and surprising stories that help consumers learn more about the complicated world of health-care costs in the United States. While you're at it, make sure to subscribe to KHN's “What the Health,” an all-women podcast about health policy your Health 202 author regularly joins.

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

A nurse pushed patients to the brink of death for sport. He was just convicted of 85 murders. (Lindsey Bever)

Oakland decriminalizes ‘magic mushrooms’ and other natural psychedelics (Kayla Epstein)

An anguished Dutch teenager, who was raped as a child, dies after euthanasia request (Isaac Stanley-Becker)

Medicaid bought sex offenders' erectile dysfunction drugs (Associated Press)


A new law promised Maryland’s female inmates free tampons. They’re still paying. (Ann E. Marimow)


Coming Up

  • The House Veterans Affairs Subcommittee on Oversight and Investigations holds a hearing on the VA’s police force on June 11.
  • The House Veterans Affairs Subcommittee on Technology Modernization holds a hearing on electronic health record systems at Departments of Veterans Affairs and Defense on June 12.
  • The House Ways and Means Committee is scheduled to hold a hearing on universal health coverage on June 12.

Watch four moments from Trump's 'Good Morning Britain' interview with Piers Morgan:

President Trump’s interview with Piers Morgan on “Good Morning Britain” which aired June 5, touched on a wide range of topics. Here are four noteworthy moments. (Video: The Washington Post)