Senate Republicans “Scrambling” To Overcome Unexpected Obstacle For Tax Reform Bill.
The New York Times (11/30, Subscription Publication) reports that GOP senators “are scrambling to figure out how to offset the deficit effects of” their tax reform “bill after the Senate parliamentarian rejected a trigger mechanism that would have automatically increased taxes if revenue growth projections were not met.” They are considering options such as “reinstating the alternative minimum tax…on C-corporations and some high net worth individuals.” The article says Sens. Bob Corker (R-TN) and Jeff Flake (R-AZ) “have said they want to raise another $500 billion given a new analysis by the Joint Committee on Taxation, which found that the bill will increase the deficit by $1 trillion over a decade.” Meanwhile, Sen. Susan Collins (R-ME) said she is still worried about the impact of repealing the ACA’s individual mandate as part of the tax bill.
The Washington Post (11/30, A1, Werner, Debonis, Paletta) reports there was a “standoff on the Senate floor, as Sens. Bob Corker (R-Tenn.), Jeff Flake (R-Ariz.), and Sen. Ron Johnson (R-Wis.) refused to vote with their colleagues until they had assurances that more changes could be made to the bill.”
McCain Says He Will Vote For Senate’s Tax Reform Bill. The Wall Street Journal (11/30, Rubin, Hughes, Peterson, Subscription Publication) reports that Sen. John McCain (R-AZ) has indicated he will vote for Senate Republicans’ $1.4 trillion tax reform bill. The article says McCain’s support propels the bill closer to passage, although some GOP senators remain undecided.
McConnell Vows Senate Tax Reform Bill Will Not Result In Medicare Cuts. The Hill (11/30, Bolton) reports that Senate Majority Leader Mitch McConnell (R-KY) has promised that “the GOP tax bill, which is projected to add $1.4 trillion to the deficit over the next decade, will not result in cuts to Medicare next year.” The article says he “offered the vow to Sen. Susan Collins (R-Maine), a key swing vote, during a Wednesday meeting in his office.”
House Conservatives Say They Will Not Vote For Funding Bill With Provisions To Shore Up ACA Marketplaces. The Hill (11/30, Hellmann) reports that conservative lawmakers in the House “said they won’t support a short-term spending bill to fund the government if it contains provisions to ‘bail out’ insurance companies.” Rep. Jim Jordan (R-OH) and others have said that they will not vote for such a bill.
Some GOP Senators Want IRS To Refund Penalties Paid As A Result Of ACA’s Individual Mandate. The Washington Times (11/30, Sherfinski) reports that Senate Republicans’ tax reform bill includes a provision to repeal the ACA’s individual mandate, but “a few GOP senators want to take things a step further by refunding some of the mandate-associated penalties people have already paid.” The article says Sen. Steve Daines (R-MT) “has offered an amendment to the bill that would direct the Treasury secretary to set up a refund program for mandate-associated penalties people paid in tax years 2014 and 2015.”
Repealing ACA’s Individual Mandate Could Result In More Consumers Purchasing Skimpy Health Plans. The New York Times (11/30, Abelson, Subscription Publication) reports that if the provision to repeal the Affordable Care Act’s individual mandate passes, millions of Americans could become uninsured, since they would no longer be required to have healthcare coverage. Since the ACA has already been “weakened by the Trump administration, big drops in enrollment would deal yet another body blow to the law and wreak more havoc in the individual insurance market.” The Times says this could result in many consumers turning “to the cheap, short-term policies that already skirt provisions of the law and may not cover pre-existing conditions or basic medical needs.”
Legislation and Policy
National Academy Of Sciences Calls For Changes In Marketing, Sales, And Prices Of Drugs.
The New York Times (11/30, Pear, Subscription Publication) reports the National Academy of Sciences “called…for sweeping changes in the pricing, sale and promotion of prescription drugs to make lifesaving treatments more affordable without discouraging the development of new medicines.” The academy said in a new report , “The federal government should consolidate and apply its purchasing power to directly negotiate prices with the producers and suppliers of medicines.”
Bloomberg News (11/30, Edney) reports the academy also recommended that the US discourage direct-to-consumer advertisements for prescription drugs. The report also said, “The United States biopharmaceutical enterprise…is rife with potential conflicts of interest.”
The Los Angeles Times (11/30, Levey) reports that the academy also said that the current drug market was failing millions of patients in need. Norman Augustine, the panel’s chairman, said, “Simply stated, the current system is not sustainable.” Additional coverage is provided by NBC News (11/30, Fox) and STAT (11/30, Silverman).
Public Health and Private Healthcare Systems
CVS, Aetna Negotiating Deal Possibly Worth Over $66 Billion.
The Wall Street Journal (11/30, Mattioli, Mathews, Subscription Publication) reports CVS Health Corp. is trying to buy Aetna Inc. for over $66 billion. The article reports that the two companies are negotiating a deal, which could be announced as soon as Monday.
Bloomberg News (11/30, Langreth, Tracer) reports that such a deal “could upend the health insurance, pharmacy and drug benefit sectors.”
Reuters (11/30, O’Donnell) adds that after the Wall Street Journal broke the story, CVS shares increased 2.7% and Aetna shares increased .7% in early morning trading.
Under the deal, the Washington Examiner (11/30, Leonard) reports that Aetna may be valued at between $200 and $205 per share.
CMS Administrator Exploring New Methods For Drug Payments.
Reuters (11/30, Humer) reports Centers for Medicare and Medicaid Services Administrator Seema Verma is exploring new payment methods for high-price breakthrough medical treatments, such as Novartis’ blood cancer drug Kymriah with a list price of $475,000 and Gilead Science’s CAR-T treatment which costs $373,000. Verma said, “We are trying to do whatever we can within the regulatory structure.” According to the article, one model may be to pay “different prices for a single drug based on its success treating a particular condition” and another under consideration is to “to extend the payment of an extremely expensive medicine over a longer time-frame.”
CMS Releases List Of Possible Medicare Quality Measures.
Modern Healthcare (11/30, Castellucci, Subscription Publication) reports that CMS released a list of 32 measures Thursday that are “under consideration for Medicare’s quality reporting and value-based purchasing programs.” Last year, CMS considered almost 100 measures. The smaller number of measures is “in line with CMS Administrator Seema Verma’s focus on reducing regulatory burden for providers” and the agency’s Meaningful Measures initiative. The list was culled from a pool of 184 submitted by stakeholders.
Enrollment In New York ACA Exchange Up 13 Percent Over Last Year.
The New York Daily News (11/30, Blain) reports New York State of Health Executive Director Donna Frescatore announced Thursday that more than 140,000 residents have renewed or signed up for health insurance on the state’s exchange so far, outpacing last year’s figures by 13 percent. Frescatore observed, “NY State of Health is off to a busy start.” The Daily News adds that enrollment in the Essential Plan, “a state-run and federally funded coverage plan for people making up to twice the federal poverty level,” is around 700,000.
The AP (12/1) reports that of the enrollees, nearly 46,000 of them are new to the state marketplace. Enrollment continues through January 31 in New York.
Idaho Health Exchange Reports Steady Enrollment. The Idaho Statesman (11/30, Dutton) reports Executive Director of Your Health Idaho, the state’s ACA health exchange, Pat Kelly, announced that more than 87,000 customers have signed up for plans for 2018 so far. Kelly said, “That number has grown every day in the last several weeks.” Last year, there were more than 100,000 enrolled during open enrollment, while around 90,000 were signed up at any given time last year, as people enrolled or canceled during the year.
Arizona Preparing Waiver Request For Medicaid Work Requirement.
The AP (11/30, Christie) reports Arizona Gov. Doug Ducey’s (R) Administration outlined plans Thursday to request a waiver from federal Medicaid rules that would add a work requirement for some “able-bodied adults in the state’s Medicaid program.” Ducey’s health policy adviser Christina Corieri added that the waiver would also “include limits on non-emergency medical transportation in urban areas, cuts to retroactive coverage and limiting access to some drugs,” plus “a five-year lifetime limit on coverage for those who fail to meet the work requirements.” The proposed waiver follows a letter signed by CMS Administrator Seema Verma and then-HHS Secretary Tom Price in March urging states to consider such changes.
The Arizona Daily Star (11/30, Fischer) reports that Gov. Ducey previously proposed adding a work requirement last year, but the Obama Administration rejected it. The Daily Star says that “his new proposal, to be submitted later this month, will be scaled back from the one federal officials rejected” because it offers “new exceptions and a limit on how much time someone needs to spend on a job or in training each week to keep receiving benefits.”
Lawsuit Seeks To Block Expansion Of Illinois Abortion Coverage.
Reuters (11/30, Kenning) reports that abortion opponents filed a lawsuit “to block a recently approved law expanding state-funded coverage of abortions for low-income Medicaid recipients and state workers.” The lawsuit aims to block state funding for the law, “arguing that the state failed to set aside up to $30 million in the budget to pay for abortions.” The lawsuit “also argued that the law could not take effect until June 2018, instead of January, because of when it was approved.”
Virginia’s Governor-Elect Optimistic On Medicaid Expansion.
The AP (11/30, Suderman) reports Virginia Governor-Elect Ralph Northam said Thursday, “My agenda this year, and I anticipate over the next four years, will be a bipartisan effort.” The AP said that “he’s optimistic about the chances of passing Medicaid expansion in Virginia.” Northam said of his Medicaid expansion plans, “I will design a system that I think Republicans and Democrats will be satisfied with.”