Health Update (February 11)
|President Donald Trump delivered his State of the Union Address this past Tuesday, and two health issues earned mentions. The president announced a plan to direct $500 million in funding for pediatric cancer research, a number Speaker Nancy Pelosi (D-CA) wrote off as not enough, seeing as the National Cancer Institute’s yearly budget is roughly $6 billion. President Trump also announced a plan to end new HIV transmissions by 2030. While little is known about the specific plan, the president’s annual budget will direct members of Congress to make “needed commitments” to eliminate transmissions over the next decade.
All seven drug companies invited to testify before the Senate Finance Committee will send representatives to the hearing “Drug Pricing in America: A Prescription for Change, Part II” on February 26th. After none of the companies invited to speak showed up for Part I in January, some senators hinted at the threat of subpoena. Ranking Member Ron Wyden (D-OR) said that participation in this hearing “wasn’t entirely voluntary.” Confirmations of attendance slowly rolled in this week after the committee sent letters to the seven drug companies (AbbVie, AstraZeneca, Bristol-Myers Squibb, Johnson & Johnson, Merck, Pfizer, and Sanofi) requesting their presence later this month.
In remarks to the Association for Accessible Medicines (AAM), Department of Health and Human Services (HHS) Secretary Alex Azar said that the Food and Drug Administration (FDA) is looking at international collaboration to create competition for generic drugs. “In some cases, the U.S. market for a generic drug may not be big enough to attract a second or third manufacturer to keep prices low, but the combined market of the United States and other wealthy nations certainly would be.” Secretary Azar also said that a harmonization effort could bring low-volume generic drugs to other peer nations that do not yet have access. To read his full remarks to AAM, click here.
Affordable Care Act
The Utah state legislature is considering two bills that would accept a more narrow Medicaid expansion plan, offering coverage to residents earning up to 100% of the poverty level as opposed to 138% under the Affordable Care Act. If passed into law, the Centers for Medicare and Medicaid Services (CMS) would have to approve the partial Medicaid expansion. If CMS doesn’t grant approval of the partial expansion, the state will have to pay more for the cost of coverage or abandon Medicaid expansion altogether. The Utah Senate bill would cancel expansion entirely, while the Utah House bill would force the state to pay for the increased costs of expansion. As the state legislature considers both bills, the state health department is preparing to implement full expansion of Medicaid, which was approved by voters in November, by April 1st.
Democrats are working on legislation to incentivize states who have not expanded Medicaid to do so. Senators Doug Jones (D-AL) and Mark Warner (D-VA) are planning to introduce legislation that will allow holdout states to receive the full federal match that was guaranteed in the first three years after passage of the ACA. Reps. Terri Sewell (D-AL) and Marc Veasey (D-TX) are working on companion legislation in the House. Additionally, Senator Jones has reintroduced legislation in tandem with Rep. Stephanie Murphy (D-FL) that would provide an annual report to non-expansion states on the benefits of expanding Medicaid. The text of that bill can be found here.
The Idaho Supreme Court rejected a lawsuit against Medicaid expansion, which was approved by voters this past November. The challenge, brought by the Idaho Freedom Foundation, argued that expansion ceded too much authority to the federal government. Conservative advocates in many expansion states have raised concerns about what would happen to state health departments if the federal government does not uphold its funding for Medicaid. The court’s opinion determined that the lawsuit was “unpersuasive” because “many Idaho statutes reference federal law.”
Three Democratic members of Congress introduced a bill this week to protect Americans from junk health plans. Reps. Annie Kuster (D-NH), Don Beyer (D-VA), and Joe Courtney (D-CT) introduced the Protecting Americans with Pre-existing Conditions Act, legislation that would revoke Section 1332 guidance from HHS that weakened protections for people with pre-existing conditions. The guidance was among the many actions taken by the Trump administration that Democrats have criticized in recent ACA hearings.
The House Appropriations Subcommittee on Labor, Health and Human Services, and Education held a hearing this week on the impact of the Trump administration on the ACA. Witnesses gave testimonies that highlighted the Trump Administration’s effects on ACA plan marketing, the effects of extending short-term plans and adding the choice of Association Health Plans (AHP), and how the new and proposed rules affect pre-existing conditions. The witnesses chosen by the Democrats emphasized the following issues: cutting the ACA marketing budget was detrimental to enrollments, short-term plans and AHPs cause rising premiums for people left on the exchange, and short-term plans offer substandard coverage. The Republican-chosen witness made the case that the ACA marketing budget was unnecessary, and short-term and AHP plans were beneficial choices for the American consumer. For full coverage of this hearing, click here.
Senator Bill Cassidy (R-LA) led a letter this week to health providers requesting information on out-of-network care and the issue of surprise billing (also known as balance billing). The letter requests data and feedback from states that have balance billing laws compared with states that do not. This letter, viewable here, is part of a “bipartisan effort to lower health care costs and improve price transparency.”
Meanwhile, Senate HELP Committee Chairman Lamar Alexander (R-TN) is also convening groups to discuss the issue of surprise medical bills. While no hearings have been announced, Chairman Alexander has recently indicated that he expects to see legislation “in the next several months.” On the Senate floor today, he announced that he is requesting specific recommendations for legislative, regulatory, and sub-regulatory solution to reduce health care costs. A press release from December, linked here, mentions specifically the need to “make available more information on the cost and quality of care.” Stakeholders are invited to share comments with Chairman Alexander and the committee by March 1, 2019.
 Adam Cancryn. “Pelosi rips Trump’s childhood cancer research boost as inadequate.” POLITICO, 6 Feb 2019. https://www.politico.com/story/2019/02/06/pelosi-trump-childhood-cancer-research-1152287
 E.J. Mundell. “President Trump Unveils Plan to Stop U.S. HIV Transmissions by 2030.” U.S. News & World Report, 6 Feb 2019. https://www.usnews.com/news/health-news/articles/2019-02-06/president-trump-unveils-plan-to-stop-us-hiv-transmissions-by-2030
 Berkeley Lovelace Jr. and Angelica LaVito. “Congress invites 7 drugmakers to testify at potentially hostile hearing on drug price. Here’s what they’re saying.” CNBC, 6 Feb 2019. https://www.cnbc.com/2019/02/06/7-drugmakers-asked-to-testify-before-congress—-heres-their-response.html
 Alex Azar. “Remarks to the Association for Accessible Medicines.” Department of Health and Human Services, 6 Feb 2019. https://www.hhs.gov/about/news/2019/02/06/remarks-to-the-association-for-accessible-medicines.html
 Paige Winfield Cunningham. “The Health 202: Utah is trying to roll back Medicaid expansion plans on a shaky assumption.” The Washington Post, 8 Feb 2019. https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2019/02/08/the-health-202-utah-is-trying-to-roll-back-medicaid-expansion-plans-on-a-shaky-assumption/5c5c5e341b326b66eb098653/
 Alice Miranda Ollstein. “Democrats see opening to push holdout states to expand Medicaid.” POLITICO, 5 Feb 2019. https://subscriber.politicopro.com/health-care/whiteboard/2019/02/democrats-see-opening-to-push-holdout-states-to-expand-medicaid-2624652
 Audrey Dutton. “Idaho Supreme Court upholds Medicaid expansion, rejects Idaho Freedom Foundation suit.” Idaho Statesman, 5 Feb 2019. https://www.idahostatesman.com/news/politics-government/state-politics/article225578040.html
 “Kuster, Beyer, Courtney introduce bill to protect Americans from junk health plans.” Augusta Free Press, 8 Feb 2019. https://augustafreepress.com/kuster-beyer-courtney-introduce-bill-to-protect-americans-from-junk-health-plans/
 Bill Cassidy. “Information Request Surprise Medical Billing Letter.” United States Senate, 5 Feb 2019. https://www.cassidy.senate.gov/imo/media/doc/Information%20Request%20Surprise%20Medical%20Billing%20Letter.pdf
 Shefali Luthra and Emmarie Huetteman. “Bipartisan Support Builds for Limits on Surprise Medical Bills.” NPR, 5 Feb 2019. https://www.npr.org/sections/health-shots/2019/02/05/691374149/bipartisan-support-builds-for-limits-on-surprise-medical-bills