Subject: POLITICO Pulse, presented by Stop CMS Cuts: The Senate's scramble on mental health — House passes first opioid bills on way to larger package — What we learned at 'Outside, In'
From: POLITICO Pulse <[email-masked]>
To: <[email-masked]>
Date: Wed, 11 May 2016 08:03:37 -0600

By Dan Diamond | 05/11/2016 10:00 AM EDT

Donald Trump takes aim at Roe v. Wade, and Cigna is named the top-performing health plan in one annual ranking. But first: The Senate's latest move on mental health legislation.

MENTAL HEALTH SCRAMBLE IN THE SENATE - The Senate's mental health effort may have a fighting chance after all, POLITICO's Brianna Ehley reports. Leadership asked Republicans on Tuesday whether they would support using a fast-track measure to approve a mental health reform bill that's been idle since it was approved by the Senate HELP Committee in March, POLITICO first learned. 

The decision to "hotline" the bill signals that Senate leadership might want to move the legislation soon, despite remaining struggles over funding and gun politics. The move comes as leaders are trying to approve appropriations bills. If those don't move - or get delayed - this could be an alternative to fill floor time.

- Gun fight looming. Sen. John Cornyn, the Senate's No. 2 Republican, almost immediately submitted his own mental health reform bill as an amendment to the HELP measure being fast-tracked. 

Although the majority of Cornyn's measure contains bipartisan provisions dealing with the law enforcement, it also includes language dealing with gun background checks that is a nonstarter for Democrats who want to keep the issues separate. That provision alone threatens to sink the effort. 

Pro's Brianna Ehley has the details on the hurdles the bill still faces: http://go.politicoemail.com/?qs=82b91f9492adb3f1d9ab0440dc7852ad53eaa880c30b00068459b86ca4badd99

- Separately, Sens. Chris Murphy and Bill Cassidy announced they will hold a Senate mental health summit on May 26, to continue pushing their bill. 

TRUMP: I'LL APPOINT JUDGES WHO COULD OVERTURN ROE v. WADE - The Republican front-runner defended his anti-abortion stance and vowed to "protect" life in a Fox News interview on Tuesday. 

"The biggest way you can protect it is through the Supreme Court and putting people on the court," Donald Trump told host Bill O'Reilly. "Actually the biggest way you can protect it, I guess, is by electing me president."

But Trump hedged a bit when directly asked if he would appoint justices specifically to strike down Roe v. Wade; "we'll see about overturning" the landmark law, he added.

A CLOSER LOOK AT CLINTON'S 'MEDICARE FOR MORE' PLAN - The Democratic front-runner this week floated the idea of letting younger Americans buy into the Medicare program, as reported in yesterday's PULSE. The New York Times has a front-page story today that explores the history of the concept, which also was proposed during President Bill Clinton's administration and has sporadically popped up since then: http://go.politicoemail.com/?qs=82b91f9492adb3f133068f6f45fc1ee190df5531f513ac1d636b922eab85eb2e

WELCOME TO WEDNESDAY PULSE - Where we hope you handle life's surprises as well as this guy. Tips to [email-masked] or @ddiamond on Twitter.

With help from Brianna Ehley (@BriannaEhley) and Brett Norman (@BrettNorman)

HOUSE PASSES FIRST OPIOID BILLS ON WAY TO LARGER PACKAGE - The chamber last night cleared the first few of 18 opioid bills slated for votes this week. And the Rules Committee made a total of 26 amendments in order on the two main pieces of legislation that will be on the floor today and Thursday, Pro's Brett Norman reports.

- What was missing: The Democrats' sought-after measure to include $600 million in emergency funding for the epidemic. 

 - What's next: After the voting concludes, the bills will be packaged together and likely conferenced with the Senate-passed Comprehensive Addiction and Recovery Act, with the goal of final approval this summer.

"Get it done, get it to the president's desk and let's appropriate some money to fund these programs," said Becky Vaughn of the National Council for Behavioral Health. "We've got people dying every day."

ANTI-ADDICTION ADVOCATES DISAPPOINTED IN WATERED DOWN MAT BILL - One bill that's up for a vote tomorrow has been dramatically scaled back from the version that passed the Energy and Commerce Committee last month, and medication-assisted treatment advocates aren't pleased. 

The E&C bill would have raised the number of patients doctors can treat with buprenorphine from 100 to 250 - a measure badly needed to fill the "treatment gap" between those addicted to opioids and those who have access to care, advocates say. That was scrapped after the CBO said it would be costly, according to lobbyists. Now the bill instead includes a "sense of the House" recommendation that the HHS Secretary consider raising the cap, which doesn't cost anything ... but it doesn't do anything, either.

"[W]e are deeply concerned that [the bill] ... will not raise the patient caps ... and overall is an inadequate response to the opioid epidemic," reads a Tuesday letter to House leadership from the American Society of Addiction Medicine.

Read ASAM's letter to House leadership: http://go.politicoemail.com/?qs=82b91f9492adb3f1047f2d66e35c46765cb893073fa6e13b294686c20f21b3c0 

 ... The Senate HELP Committee has already passed the TREAT Act which would let doctors treat up to 500 patients. It was not included as part of CARA, but ASAM and others are lobbying lawmakers to include an increase when they conference the House and Senate versions of CARA.

FIRST IN PULSE: DURBIN CALLS ON MEDICAL ASSOCIATIONS TO RAMP UP PRESCRIBER TRAINING - The Senate's No. 2 Democrat will send letters today to the American Medical Association, the American College of Emergency Physicians, the American Dental Association and the American Academy of Family Physicians, urging them to endorse evidence-based interventions and new continuing medical education requirements for opioid prescribers.

"When it comes to the opioid and heroin crisis, each stakeholder needs to do their part," Sen. Dick Durbin writes. The letters come amid officials' broader push to change prescriber patterns, and Durbin last month appealed to PhRMA to ramp up its own efforts to curb opioid addiction.

Read Durbin's letter to the AMA: http://go.politicoemail.com/?qs=82b91f9492adb3f1e6664f7e3d16bbc1e9c221177e396bb2cf34300914b407b8

LOPERAMIDE - It's the active ingredient in Imodium and other antidiarrheals. And it provides a cheap high if consumed in massive amounts, which is why some opioid addicts are misusing it at dangerous levels. http://go.politicoemail.com/?qs=82b91f9492adb3f17c8f9eb151c98faf2ff7ddcb452e18c7829d6622b1747048

** A message from Stop CMS Cuts: Medicare has proposed a payment "model" that will take clinical decision making out of the hands of physicians by allowing the government to influence decisions for seniors. A patient's care should be determined by physicians in collaboration with patients, not government regulators. Stop Medicare's experiment on seniors. Visit StopCMSCuts.com. **

WHAT WE LEARNED AT 'OUTSIDE, IN' - POLITICO's annual health IT series kicked off last night with two panels that tackled why health care's cybersecurity problem has gotten so bad, and how to fix it.

Five takeaways:

1. Cyber-attacks are becoming big business for bad guys. The rising awareness of health care's vulnerabilities has led to a growing number of attacks, of all kinds, CHIME's Leslie Krigstein said. She noted that one large East Coast hospital turned away 1 million ransom-mail emails in March alone.

2. There needs to be a baseline of accountability. "It's important for patients to be able to trust that their data is safeguarded," said HHS's Deven McGraw. "I'm not suggesting that we have a right to demand perfection in accountability, but we do expect entities to devote resources to security."

3. The onus falls on providers. "If you're relying on the government to defend yourself, you're going to have a much larger problem," said Rep. Will Hurd.

4. High-profile attacks are kicking security efforts into gear. "These recent ransomware attacks were the best thing that could have happened to health care security," Brookings' Niam Yaraghi said. "Health care providers [now] have much more business incentives to invest in cybersecurity." 

5. The industry's also getting better as it's maturing. "We're not perfect in health care, but we at least have a model to say, how do we ensure that these threat vectors aren't shared?" said Hunch Analytics' Aneesh Chopra.

- What the experts say: The best thing that government can do to help with cybersecurity problems? Simplify regulations, according to the "Outside, In" health IT advisory panel. Read the story: http://go.politicoemail.com/?qs=82b91f9492adb3f1f6a8ec2574ab2efa508a8959de0cbb2635158d9b746153d4 

STILL NO DEAL ON ZIKA - Lawmakers still don't appear to be getting any closer on a deal to approve emergency funding for Zika. Democratic leaders in the House and Senate continued blasting their Republican colleagues on Tuesday for not supporting the Obama administration's $1.9 billion funding request. 

But Republicans still say they won't approve that money until they get more details from the administration. Sen. John Cornyn called the request a "blank check." And Sen. Roy Blunt, a chairman of the appropriations committee that oversees the CDC, said he was trying to find savings elsewhere, our colleagues report. 

SENATE DEMS: FDA DEEMING RULE IS 'CRITICAL' PUBLIC HEALTH STEP - That's according to a letter that 17 Senate Democrats will send to FDA and HHS today, first obtained by POLITICO.

"The deeming rule is a much-needed step to give the FDA crucial tools to prevent manufacturers and retailers of currently unregulated tobacco products from targeting our children and teens," Sen. Patty Murray and 16 other Democrats write. "We urge your agencies to remain diligent in working quickly to further limit the effect and reach of these products on our nation's youth."

- But they say it doesn't go far enough. The Democrats flagged several areas that weren't addressed by the deeming rule and offer two recommendations for regulators.

. Restrict e-cigarette advertisements that may be targeted to reach middle and high school students. 

. Rein in tobacco companies' practice of producing e-cigarettes and other products in fruit and candy flavors

Read the letter: http://go.politicoemail.com/?qs=82b91f9492adb3f1d9ac1f16f7009e4778225a21037188123a2e7d347b5aca23 

HOW PARTISANSHIP COLORS OBAMACARE - An upcoming Kaiser Family Foundation survey finds that among ACA marketplace shoppers, there's a major divide in how they view the law based solely on their politics.

Researchers asked exchange customers if they're benefiting from the broader health law.

According to.. 
. Democrats: 75 percent said they've benefited
. Republicans: 29 percent said they've benefited

What explains the striking difference? "There is no reason to believe that there are demographic differences between these Republican or Democratic marketplace enrollees that would explain this large of a difference in their responses," the Kaiser Family Foundation's Drew Altman writes. "They are all purchasing coverage in the ACA marketplaces, and most members of each group are receiving premium subsidies under the law." 

Read Altman's column: http://go.politicoemail.com/?qs=82b91f9492adb3f1dc2125a4f4b5ac85051fa5ac30bdcfc735ece0f142f3d3d4 

SLAVITT'S LATEST MACRA PITCH: IT'S TRANSFORMATIVE LIKE ACA - The CMS acting administrator used his Tuesday keynote speech at Health Datapalooza to stump for Medicare's new physician payment law, framing it as the latest necessary reform to the nation's health system.

"I have seen how much technology can radically improve health care and how fast," Andy Slavitt said. "MACRA is the burning platform for progress in care delivery, just as the ACA was in health care coverage. Together, we can make the system radically better." Read the speech: http://go.politicoemail.com/?qs=82b91f9492adb3f19bcbe1c71275a0308a936f32b826dd460344f8f741e0543c 

 - Speaking of MACRA. Slavitt will be testifying on the law's implementation at 2 p.m. in front of the House Ways & Means Committee. More.

CIGNA NAMED TOP-PERFORMING HEALTH PLAN - That's according to athenahealth's annual payer rankings, which assess health plans based on their administrative, financial and transactional performance. (For instance, Blues plans typically pay providers for their services within 26 days, compared to 35 days for all payers.) See the rankings: http://go.politicoemail.com/?qs=82b91f9492adb3f129a227bfbb8f6af21ee1a6886dd7da9f0dd370bacb5f4062 

PEGGY GIRSHMAN'S LAST WORD - The well-regarded health journalist passed away earlier this year, but left behind her own eulogy, which was read at a memorial service this weekend. With her family's permission, NPR published portions of it that reflected Peggy's philosophy about health care, science, evidence, vegetables ... and cookies. We're sharing it - and recommend you read it too. http://go.politicoemail.com/?qs=82b91f9492adb3f189548ee0cc8bf0925d80a82ca5d984af956d874fd0a5bb6e

WHAT WE'RE READING by Brett Norman

The New York Times hosts dueling posts on whether the FDA's new regulations on e-cigarettes will cause fewer smokers to quit. http://go.politicoemail.com/?qs=82b91f9492adb3f1acbcd7421d5e70bcd25165a8271c5fc0c5148a03021b4f3d

The Washington Post editorial board argues the agency's new tobacco rules don't overreach and "are long overdue." http://go.politicoemail.com/?qs=82b91f9492adb3f18069e17485f81dd23e70e32ac164859f0ead96ff1df3ecc9

A Minnesota doctor saw Prince the day before he died and prescribed drugs, according to a search warrant reported by the Associated Press. http://go.politicoemail.com/?qs=82b91f9492adb3f1c670862c672448a8f071aa037d1e695134425e34214dfeef

Cigna has negotiated extra price discounts for a costly new class of cholesterol drugs if they don't produce the outcomes they're expected to, according to a Wall Street Journal story. http://go.politicoemail.com/?qs=82b91f9492adb3f16be6806f5087819fe42e09971a54eed9ba8ab98716001afe

A post at NORC's Sparks blog digs into the fact that hepatitis C continues to kill Americans in record numbers despite the costly new cures now available.http://bit.ly/1TPZhwI

** A message from Stop CMS Cuts: Medicare has proposed a new payment "model" for Part B drugs that is really an experiment that will take clinical decision making out of the hands of physicians by allowing government bureaucrats to influence decisions for seniors. In a cookie-cutter approach, Medicare wants to sway treatment options based solely on cost and not on the patient's individual clinical needs. Rather than testing payment changes in a limited, controlled model, this is a mandatory, national experiment without patient safeguards and disclosures. Decisions about a patient's care should be made by physicians in collaboration with patients, not government regulators. 

Bipartisan lawmakers, patient advocates and providers agree: We must stop Medicare's experiment on seniors. Visit StopCMSCuts.com to learn more. **

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