with Paulina Firozi
Senior administration officials told me the president will draw a sharp distinction between his own approach to health insurance and high drug prices and the single-payer system advocated by many of the Democrats seeking to oust him next year.
“Right now we have the Democrats beating each other up over Medicare-for-all, so I think we’re going to take the opportunity to contrast with that vision,” one official said. “I think you’ll see in that speech a discussion of an alternative vision for health-care reform.”
The president had been scheduled to make the announcement in Florida in early August, but it was postponed after several mass shootings.
The executive order may call upon federal agencies to find ways to strengthen the private plans offered through Medicare Advantage, a popular alternative to traditional Medicare that covers about one-third of seniors. One way could be to let Medicare Advantage plans offer a wider array of medical benefits.
The president will also call for opening the door to drug imports from other countries to bring down the price of medicines purchased by Americans — a proposal Democrats have typically supported and might find difficult to criticize.
The administration seems to have shifted away from crafting a wholesale replacement of Obamacare. This speech would address several holes in the health-care system, but is not a holistic effort to overhaul it.
The Department of Health and Human Services recently outlined a plan to allow Americans to purchase lower-cost Canadian versions of some medicines. It would allow states, pharmacies and drug manufacturers to propose methods of safe importation and submit them for federal approval, as my Washington Post colleagues Yasmeen Abutaleb and Laurie McGinley reported in July.
Trump, in the upcoming address, may also criticize Obamacare — a law he frequently promises to repeal, even though Republicans failed to repeal and replace it two years ago.
Officials confirmed to me the White House has been working on a proposal to repeal and replace some parts of the health-care law. Former officials say the plan was heavily influenced by Centers for Medicare and Medicaid Services Administrator Seema Verma and doesn't propose cuts to Medicaid that tripped up Republicans two years ago in their repeal effort.
But the administration officials stressed that Obamacare will be only a side note of Trump's expected speech, not the focus.
They said Trump’s speech will be much broader, folding in things he’s already done to lower health-insurance costs and bring down drug prices, instead of recommending that Congress pass any one piece of legislation.
“This is a series of actions and proposals that, when pieced together, will be our plan for reforming health care,” one official said. “If you guys think we’re going to drop a bill overnight, that would be the wrong impression.”
Trump is striving to gain the upper hand on health care with voters as he looks ahead to his 2020 reelection effort. But he’s dogged by his own administration’s refusal to defend the ACA in a lawsuit from GOP-led states — a decision Democrats have seized upon.
The U.S. Court of Appeals for the 5th Circuit is expected to rule next month on the lawsuit, which argues the entire ACA is unconstitutional and should be struck down. Wherever the court lands, legal experts say the case is certain to be appealed to the Supreme Court and likely to be taken up in the high-stakes election year.
If the court rules against the ACA, Trump and Republicans will have to defend anew their opposition to the health-care law, particularly its popular provisions protecting people with preexisting conditions. Trump has insisted he supports such protections — despite his administration’s stance on the ACA — and is likely to stress that in his upcoming address.
He may also point to his administration’s efforts to reduce health-care costs.
HHS is working on a rule to link some drug payments covered by Medicare to lower prices in other countries. Over the summer, Trump signed an executive order to require hospitals to disclose negotiated prices with insurers. The administration also announced an effort to reform how Medicare pays for kidney dialysis.
AHH, OOF and OUCH
AHH: Drug companies asserted their final defenses in court filings ahead of a landmark opioid trial set to begin next month. The companies insist they should not be held responsible for the nation’s ongoing epidemic, our Washington Post colleague Lenny Bernstein reports.
“The long-awaited showdown over responsibility for the opioid epidemic pits two Ohio counties — Summit and Cuyahoga — against seven drug companies: manufacturers Johnson & Johnson and Teva Pharmaceuticals; distributors McKesson Corp., Cardinal Health, AmerisourceBergen and Henry Schein; and retailer Walgreens,” he writes. “Walgreens has been sued only over the conduct of its internal system of warehousing and distributing opioids to its retail stores — not for the way its pharmacists dispensed them.”
In the court filings, the plaintiffs and defendants had to file on Wednesday, lawyers for Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson, said: “Janssen’s medications did not cause or contribute to that crisis.” Similarly, Walgreens said the counties challenging the company “cannot show that any conduct by Walgreens resulted in the diversion of prescription opioid medications that could have caused the harms that plaintiffs allege.”
OOF: Monthly premiums and annual deductibles are still growing much faster than wages and inflation, according to the latest Kaiser Family Foundation’s annual survey of employer-sponsored coverage. Family premiums now average $20,576, with workers kicking in an average of $6,015 and employers covering the rest. More than eight in 10 covered workers have a deductible averaging $1,655.
A few other findings from the survey:
--Annual family premiums rose 5 percent this year. Since 2009, they’ve increased 54 percent and workers’ contributions have increased 71 percent. Over the same time frame, wages rose 26 percent and inflation rose 20 percent.
--Eight-two percent of covered workers have a plan with an annual deductible, compared with just 63 percent a decade ago. Back then, the average deductible for a single worker was $826.
--More than a quarter of all covered workers are in plans with a deductible of at least $2,000. That’s nearly four times the share in 2009. One in eight workers have a deductible of at least $3,000.
OUCH: It was a tumultuous day for Juul Labs. The major e-cigarette make said its chief executive is stepping down and will be replaced by a top official from tobacco giant Altria, which is a part-owner of Juul, our Post colleague Laurie McGinley reports.
Juul also announced it would suspend all its broadcast, print and digital product advertising in the United States and halt lobbying against proposed bans on most flavored vaping products.
Meanwhile, the staff shake-up at Juul coincided with the announcement from Altria and Philip Morris that the companies ended talks about a potential merger, another sign in the continuing fallout for the vaping industry.
"The sudden developments underscore the concerns prompted by continued increases in underage e-cigarette use and growing alarm over a mysterious lung ailment linked to vaping that has stricken at least 530 people, nine of whom have died," Laurie writes. "Officials said Tuesday that they still don’t know the cause."
Incoming Juul CEO K.C. Crosthwaite, Altria’s senior vice president and chief strategy and growth officer, will “continue a broad review of the company’s practices and policies to ensure alignment with its aim of responsible leadership within the industry,” Juul said.
HEALTH ON THE HILL
— The Food and Drug Administration’s acting commissioner Ned Sharpless told lawmakers the agency “should have acted sooner” to tackle e-cigarettes.
“In retrospect, the FDA should have acted sooner, we should have begun regulating these devices sooner,” he told members of the House Energy and Commerce’s Oversight Subcommittee. “But we’re going to catch up.”
Rep. Frank Pallone (D-N.J.), the chairman of the Energy and Commerce Committee said he, too, was “disappointed it’s taken so long to get to this point.”
Sharpless said the administration will finalize guidance soon that will crack down on flavored e-cigarettes. “The expected guidance will mark a pivot from the agency’s previous stance on e-cigarettes. The FDA has authority over cigarettes and smokeless tobacco under federal law,” Stat’s Megan Thielking reports. “In 2016, the agency determined that e-cigarettes also fell under that umbrella and asked companies to file applications to market their products by August 2018. But in 2017, former FDA Commissioner Scott Gottlieb rolled out a new plan to curb nicotine levels in traditional cigarettes — and noted that e-cigarettes could play an important role in that plan by giving adult smokers an alternative to conventional cigarettes.”
Gottlieb also weighed in on this issue on Twitter:
THREAD: The decision in 2017 to delay applications on e-cigs was made for two key reasons: 1. We were seeking to regulate nicotine in combustible cigarettes for the first time, and saw the e-cigs as one potentially less harmful alternative for currently addicted adult smokers.— Scott Gottlieb, MD (@ScottGottliebMD) September 25, 2019
We didn't want to sweep market of e-cigs at very moment we sought to regulate nicotine in cigarettes. We had to give adult smokers who still wanted to access nicotine some alternative. Our main goal was to transition adults off nicotine, or onto medicinal nicotine products.— Scott Gottlieb, MD (@ScottGottliebMD) September 25, 2019
— Senate Finance Committee Chairman Chuck Grassley (R-Iowa) suggested inaction on drug pricing legislation could be costly for Republicans in 2020. He suggested Senate Majority Leader Mitch McConnell (R-Ky.) should get on board with his proposed bill if he wants to keep the majority in the chamber.
“There’s 22 Republicans up for election next year, and if it’s like in my state and like it is in Maine … there’s a great deal of disgust with the rapidly increasing price of drugs, and every Republican up for reelection is going to have to have a place to land,” he said. “And this is the place to land because they’re surely not going to land with what Pelosi’s doing. And so if McConnell wants to keep the Republican majority, then this drug pricing bill is part of that plan.”
The remark, via our Post colleague Erica Werner:
In other news, at a pen&pad earlier Grassley basically threatened that McConnell will lose the Senate majority if he doesn't get behind Grassley's drug pricing bill: pic.twitter.com/InSYy2KrcS— Erica Werner (@ericawerner) September 25, 2019
— And here are a few more good reads:
Trump administration rule could end free school lunches for about 500,000 children (Moriah Balingit)
Human rights groups allege ICE, private detention companies, provide poor care to LGBTQ migrants and those with HIV (Robert Moore)
- The House Ways and Means Subcommittee on Oversight holds a hearing on the public health consequences and costs of gun violence.
- The House Judiciary Subcommittee on Crime, Terrorism and Homeland Security holds a hearing on community responses to gun violence.
- The House Education and Labor Subcommittee on Health, Employment, Labor and Pensions holds a hearing on lower drug prices and increasing transparency.
Mattel debuts a gender-neutral doll: