THE PROGNOSIS

House Republicans aren’t ruling out backing a potential deal between President Trump and Speaker Nancy Pelosi (D-Calif.) to let the government negotiate lower drug prices in the Medicare program, long a liberal aspiration.

But until a Trump/Pelosi deal actually happens — and that’s highly in doubt (check out our Monday Health 202 on the topic) — Republicans are fiercely opposing a bill Pelosi is pushing forward on her own this week, which would allow the government to directly negotiate with drug companies for lower prices for up to 250 drugs per year.

“It’s premature to speculate where the president will go on this,” Rep. Kevin Brady (Tex.), ranking Republican on the Ways and Means Committee, told reporters. “Right now he’s asking us to work on bipartisan legislation that lowers drug prices.”

Pelosi’s measure hasn’t garnered support from a single Republican — even though lowering drug prices was supposed to be a broad bipartisan effort this year. Instead, it represents the route Democrats would like to take if they could act unilaterally, without cooperation from the Trump White House and the GOP-majority Senate.

And Republicans are irate. 

“We’re serious about bringing down the high cost of drugs,” said Rep. Greg Walden (Ore.), ranking Republican on the Energy and Commerce Committee. “We were on a path to do this in a bipartisan way until the speaker’s office got in the middle of it and made this a partisan pothole.”

This morning, the Energy and Commerce Committee will mark up Pelosi's bill and vote on it while two other committees — the Ways and Means Committee and the Education and Labor Committee — hold hearings on the legislation. Walden said Republican members of the Energy and Commerce Committee will try to offer more than 200 amendments during the markup.

Pelosi, caught between the demands of liberals and moderates in her caucus, agreed to revise the legislation slightly by raising the floor of drugs the government must negotiate per year from 25 to 35. Those changes brought a few more progressives on board with the legislation, including Reps. Jan Schakowsky (D-Ill.) and Debbie Dingell (D-Mich.), but House passage may still not be guaranteed.

“The American people need bold action, and that’s what we are delivering today,” Pelosi said yesterday.

Yet Pelosi’s approach contrasts with that of the Senate, where the leaders of the Finance Committee have crafted a bipartisan bill that doesn’t include allowing the government to negotiate lower Medicare prices. Brady and Walden say they’re still reviewing that bill but stressed that they’re eager to replicate the bipartisan approach in the House.

“It doesn’t have to be this way,” Brady said. “Republicans were working in a bipartisan manner with Democrats in the House on lowering drug prices.”

The political machinations aside, here’s what would have to happen for any major legislation to lower drug prices. Trump and Pelosi would ultimately have to hash out an agreement that could pass both the Democratic-led House and the Republican-led Senate.

The biggest policy sticking point would be whether to allow direct drug price negotiations in Medicare. Trump has said he likes the idea, but he would face an uphill battle from conservatives and the pharmaceutical industry if he pushes for it. The White House notably hasn’t come out against Pelosi's measure — indicating that it’s trying to keep negotiations alive.

The whole effort underscores the deep difficulty in passing legislation shaking up the country’s pharmaceutical industry, which leads the world in developing new treatments and cures and yet also charges far more for medications than in any other advanced economy.

As if the Pelosi bill wasn’t already controversial enough, the Congressional Budget Office — which estimates the costs and savings of legislation — reached two major conclusions about the measure: that it would result in massive saving for the government but also harm the development of new drugs.

In a partial analysis released last week, the CBO estimated it would save a huge amount of money — $345 billion over a decade. To put that in perspective, it would reduce costs for Medicare’s prescription drug program by about a quarter.

Andy Slavitt, former administrator of the Centers for Medicare and Medicaid Services under President Barack Obama:

But the CBO’s other conclusion is fueling charges by Republicans, conservative activists and pharmaceutical companies that the Pelosi bill would stymie development of new drugs. The agency said there’s a consequence to the reduced spending: fewer new drugs coming on the market.

The agency estimates 8 to 15 fewer drugs would be approved over the next decade. That’s not a huge sum, considering the Food and Drug Administration is estimated to approve about 300 drugs in the same time frame.

Brady, Walden and other opponents of the Pelosi bill say it could have a chilling effect on developing untried treatments, causing manufacturers to instead focus on simply improving medications already on the market.

“The president has never told me he wants a solution that actually discourages new cures,” Brady said.

— Rep. Elijah E. Cummings, a Democratic congressman from Maryland, died early Thursday morning at Gilchrist Hospice Care, a Johns Hopkins affiliate in Baltimore. He was 68.

“After undergoing an unspecified medical procedure, the Democratic leader did not return to his office this week, the Baltimore Sun reported. A statement from his office said that he had passed away due to ‘complications concerning longstanding health challenges,’” our colleagues Jenna Portnoy and Antonia Noori Farzan report.

Born to a family of Southern sharecroppers and Baptist preachers, Cummings became one of the most powerful Democrats in Congress. During the Trump presidency, he made efforts to work with the Trump administration, but they mostly proved fruitless, Jenna and Antonia write. “In a bipartisan gesture, he attended Trump’s inauguration and, at the luncheon afterward, raised an issue on which he felt they could find common ground, lowering prescription drug prices. In that and in future encounters, he urged the president to pursue policies that could unite the country and burnish his legacy. The congressman said that after a few promising meetings, he never heard from Trump again.”

AHH, OOF and OUCH

AHH: Trump floated issuing an executive order to shutter parts of the Veterans Affairs health system, according to a description by former VA secretary David Shulkin in an upcoming book, as the Associated Press’s Hope Yen reports.

Shulkin details a March 2017 White House meeting during which Trump discussed ways to make the changes at what he described as “the most corrupt” and “probably the most incompetently run” department. He asked whether “we should begin to close the VAs.” When Shulkin told the president that the agency was working with lawmakers on a review process to address underperforming VA facilities, the president responded: “So, let’s just do an executive order!”

“Shulkin told the AP that ultimately he dissuaded Trump from pursuing that route, persuading him to sign executive orders for changes with wider support, such as expanded telehealth options for veterans,” Hope writes. “The 2017 Oval Office conversation is illustrative of Trump’s early intentions toward the VA and remains significant as he pushes for reelection, citing in part his accomplishments in expanding Choice and boosting mental health care for veterans. Veterans as a group have largely backed Trump throughout his presidency, despite lingering questions about his intentions about preserving the VA.”

OOF: A top federal health official warned lawmakers that the number of vaping-related lung illnesses is expected to “considerably” rise, with more cases being reported every day.

The Centers for Disease Control and Prevention’s most recent update reported that more than 1,200 people have been sickened and at least 26 people have been killed by the mysterious disease that the agency is tentatively calling EVALI, or “e-cigarette, or vaping, product use associated lung injury.” But CDC Principal Deputy Director Anne Schuchat told lawmakers on a House Appropriations subcommittee that more cases are being reported every day, CNBC’s Angelica LaVito reports.

It was Schuchat’s third appearance before lawmakers in the past month. “This is extremely complicated and difficult. It’s fatal or potentially fatal, with half of the cases requiring intensive care,” she said.

OUCH: The nation’s three largest drug distributors and two manufacturers are in talks to settle thousands of opioid cases with a $50 billion agreement before the landmark trial is set to begin next week, the New York Times’s Jan Hoffman reports. But details are still being ironed out, and the agreement could falter before opening statements on Monday.

The drug giants have agreed on a framework of a deal, and “cities and counties across the country are tentatively supporting the broad parameters of the deal but are negotiating over its total value as well as attorneys’ fees.”

Another detail to finalize would be the timeline for how the settlement funds would be paid. Whom the money goes to — and how much of it will go toward attorney’s fees — is also still wrapped up in negotiation.

“The agreement would release AmerisourceBergen, Cardinal Health and McKesson, which together distribute about 90 percent of the country’s medicines, along with Johnson & Johnson and Teva, the Israeli-based manufacturer of generic medicines, from a rapidly growing list of more than 2,300 lawsuits that they face in federal and state courts,” Jan writes. “… Whether the amount will be considered sufficient by all the plaintiffs remains to be seen.”

SECOND OPINION

—Sen. Elizabeth Warren (D-Mass.) didn't want to acknowledge at this week's debate that Medicare-for-all would require people to pay higher taxes. But Americans already pay a major hidden “tax” to fund health care, a pair of economists argue in their new book.

Emmanuel Saez and Gabriel Zucman, a pair of economists from the University of California at Berkeley, argue private health insurance costs are “taxes in everything but name,” our Post colleague Christopher Ingraham writes. The difference is those “taxes” are paid to private insurance companies instead of to the federal government, the economists argue in their book “The Triumph of Injustice.”

“They are automatically deducted from workers’ paychecks. And they are essentially mandatory for families who don’t want to be crippled by long-term health-care costs or unexpected illnesses,” Christopher writes. “… Saez and Zucman have produced an estimate of just how much we’re already paying for health insurance and find it’s a little north of $1 trillion per year: ‘close to 6% of national income in 2019 — the equivalent of one-third of all federal income tax payments!’ Health insurance costs raise the average effective tax rate on American labor from 29 percent to 37 percent, they said.”

— Leana Wen, an emergency physician and the ousted former chief executive of Planned Parenthood Federation of America, panned the fourth Democratic presidential debate for being largely focused on Medicare-for-all instead of other pressing health issues.

“The controversial idea of abolishing private insurance in favor of a single, government-run program certainly deserves some rigorous back-and-forth,” she wrote in an op-ed for The Post. “But not at the expense of issues with a much greater impact on our health.”

She wrote that closure of rural hospitals, the loss of services — including obstetrics — at these hospitals, reproductive health-care deserts, the cost of prescription drugs and the opioid crisis are other critical topics that deserve airtime.

“To be fair, multiple candidates have proposals for stabilizing rural hospitals, funding community health centers, protecting women’s health care and incentivizing health professionals to work in underserved areas. But you wouldn’t know it from the substance of the campaign so far,” she wrote. “The American people need to hear more about these ideas on how — literally — to access care, which is a prerequisite to discussion of how to pay for it.”

MEDICAL MISSIVES

— Youth suicide rates have increased by 56 percent in the decade between 2007 and 2017. And in 2019, the suicide rate for adolescents and young adults surpassed the homicide death rate.

According to a CDC report, people ages 10 to 24 saw a decreased suicide rate from 2007 to 2017, but the rate climbed again through 2017, the Wall Street Journal’s Brianna Abbott reports.

“Despite concern over the rising suicide rates, researchers aren’t sure of the exact causes. A rise in depression among adolescents, drug use, stress and access to firearms might all be contributing factors, experts say,” she writes. “Some mental-health experts suggest that social-media use among teens might be fueling the increase in mental-health conditions and leading to greater suicide risk, and some early studies have linked smartphone use to anxiety, depression and sleep deprivation among adolescents.”

Suicide became in 2017 the second-leading cause of death for that age group, behind unintentional injuries including drug overdoses.

Benjamin Shain, a child and adolescent psychiatrist at NorthShore Medical Group in Illinois, told Brianna he is seeing a growing number of young patients who pose a suicide risk. “Unfortunately, it’s not surprising, but it is highly disturbing,” he said. “To see it statistically across the country hits me in a different way.”

HEALTH ON THE HILL

— And here are a few more good reads: 

Politics
The endorsements of Sanders by Ocasio-Cortez and Omar suggest that despite Warren’s rise, the battle for the allegiance of the Democratic Party’s liberal wing is far from over.
Sean Sullivan and Chelsea Janes
The Fix
The former housing secretary isn't doing well in the polls but is leading the conversation on police violence.
Eugene Scott
South Bend, Ind., Mayor Pete Buttigieg (D) wrote in a tweet last year that he supported "Medicare for All," a contrast to his attacks on the proposal at Tuesday night's debate. 
The Hill

INDUSTRY RX

In what experts call an “epidemic of immobility,” older hospital patients remain stuck in bed, their movements tracked by loud and ineffective bed alarms, losing muscle mass that’…
Kaiser Health News
California has already seen several flu-related deaths. “It does make me a little bit more nervous” about flu season, one expert says.
Wall Street Journal

STATE SCAN

The Florida Division of Emergency Management is hiring Darcy Abbott, a longtime health official, as its first mental health coordinator for recovery efforts after hurricanes and other disasters.
Miami Herald
Morning Mix
Natalie D. Simms alleges that her constitutional rights were violated when she was subjected to a public vaginal cavity search by a San Antonio police officer in 2016.
Allyson Chiu

DAYBOOK

Today

  • The Washington Post hosts its latest "Chasing Cancer" live event. Watch a livestream of the event here

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