Subject: POLITICO Pulse, presented by Stop CMS Cuts: What's next after House GOP's Obamacare win? — Senate to vote on Zika deal — House passes major opioids legislation
From: POLITICO Pulse <[email-masked]>
To: <[email-masked]>
Date: Fri, 13 May 2016 08:03:03 -0600

By Dan Diamond | 05/13/2016 10:00 AM EDT

WHAT'S NEXT AFTER HOUSE GOP'S OBAMACARE WIN? - House Republicans scored a major victory in their Obamacare lawsuit Thursday, when a federal judge ruled that the Obama administration has been improperly funding the law's cost-sharing subsidies. 
 
The insurance industry's response: Let's wait-and-see.
 
"There is a long judicial process ahead before a final decision is made," Marilyn Tavenner, CEO of America's Health Insurance Plans, said in a statement. Namely, the ruling is stayed pending appeal, so there's no immediate fallout for health plans (or beneficiaries.) And industry watchers point out that it could be years until the case is resolved and more important short-term battles are looming - including this fall's election.
 
 - What's at risk for insurers: $175 billion in subsidies over a decade. The industry's sanguine response shouldn't disguise the stakes. The dollars are big, and so are the consequences for millions of potentially affected patients. More from Paul Demko for Pros.
 
 - What the experts are saying. Policy analysts were split on what Thursday's ruling from a judge appointed by President George W. Bush foreshadows - and whether it'll ultimately amount to much.
 
For insurers, "the timing couldn't be worse, coming one day after the deadline to submit 2017 bids for healthcare.gov offerings," conservative policy consultant Chris Jacobs concludes. "If Judge Collyer's ruling is upheld on appeal, the policy landscape facing insurers could prove far different than they envisioned when submitting their plans for next year."
 
"My hunch ... is that the Supreme Court will either not intervene or uphold the D.C. Circuit's eventual dismissal of the case," Michigan law professor Nick Bagley predicts. "This opinion will attract a lot of attention - and it should - but it's not an existential threat to the ACA."
 
AND WHAT'S NEXT ON REPLACEMENT PLAN - The House Republican health care task force met again Thursday to get member feedback to the very preliminary replacement plan in the works, Pro's Jen Haberkorn and Brianna Ehley report.
 
The blueprint is expected to be released in the coming weeks, according to people familiar with the draft plan. And so far, it includes several Republican go-to measures: 
 
. Establish HSAs, association health plans and high-risk pools
. Allow insurers to sell across state lines and reform Medicare and Medicaid
. Change the employer tax benefit for providing health coverage
 
Energy and Commerce Chairman Fred Upton told reporters, "we're getting close ... we will have a document in the next couple weeks."
 
THANK GOODNESS IT'S FRIDAY - Especially after that frantic Thursday in health care. Tips to [email-masked] or @ddiamond on Twitter.
 
With help from Brianna Ehley (@briannaehley), Jen Haberkorn (@jenhab) and Brett Norman (@BrettNorman).
 
SENATE TO VOTE ON ZIKA FUNDING DEAL - The chamber will vote next week on a long-awaited $1.1 billion package to combat the Zika virus, a compromise plan struck between Democratic Sen. Patty Murray and Republican Sen. Roy Blunt. The package is less than the $1.9 billion the White House requested three months ago.
 
More from POLITICO's Burgess Everett and Jen Haberkorn.
 
HOUSE PASSES MAJOR OPIOIDS LEGISLATION - The House on Thursday passed a sweeping array of bills to address the nation's opioid epidemic, a rare legislative accomplishment on an issue of popular concern that lawmakers can tout on the campaign trail this fall, Pro's Brett Norman writes.
 
Lawmakers approved the final pieces after three days of bipartisan cheerleading and overwhelming votes on more than 15 bills involved and about two dozen amendments. The main elements would set up a new federal task force to update best practices for pain management and establish a program at the Department of Justice to fund substance abuse programs in the states. More for Pros.
 
 - Just one problem: Where are the dollars? HHS Secretary Sylvia Mathews Burwell said opioid legislation passed by the House this week lacks the "significant investment" needed to fight the epidemic.
 
"[W]hile we appreciate the attention Congress is paying to the issue, the legislation being voted on today in the House lacks the funding necessary to help every American with an opioid use disorder who wants treatment get the help they need," Burwell said in a statement shortly after the House finished three days of votes on bills - none of which appropriate new funding.
 
LEAVING HHS: SCHULTZ AND FRANK - HHS Chief Counsel Bill Schultz and Assistant Secretary for Planning and Evaluation Richard Frank will be departing the agency shortly, according to an internal email from Secretary Sylvia Mathews Burwell first obtained by POLITICO. 
 
Schultz will depart May 26 and Frank on June 6. Peggy Dotzel will become Acting General Counsel. She previously served as Schultz's deputy. No replacement was named for Frank. More details for Pros.
 
"My favorite part of Burwell announcement re: Frank departure," Pro's Sarah Karlin-Smith tweets. "She has ASPE pocket protector thanks to him."
 
'HARRY AND LOUISE' - AND HILLARY. Who should Hillary Clinton blame for the infamous ad campaign that killed her 1993 health reform plan?
 
Hillary Clinton.
 
That's according to Chip Kahn - a top D.C. health lobbyist and the brains behind the infamous "Harry and Louise" ad campaign - who was the featured guest on this week's "PULSE CHECK" podcast. He says that Clinton's scathing attack on the insurance industry's ads backfired in ways she never could have predicted, and there are lessons for the 2016 election, too.
 
Listen to the episode: http://go.politicoemail.com/?qs=046db0672b6ba3de3a9e3a5685e928a73a8cc3e214541af204ad6630dc25855a 
Read the story: http://go.politicoemail.com/?qs=046db0672b6ba3de8d4c0306c06c598ee31645f5f6519785b467bc36bccb46f2 
 
Check out recent episodes of PULSE CHECK 
. Andy Slavitt on why CMS lost the "hearts and minds" of doctors - and how it's going to win them back. Listen.
. Farzad Mostashari on how government really works, and what meaningful use got wrong. Listen.
 
Subscribe on iTunes
 
HEALTH INSURER WATCH: BIG RATE REQUESTS IN IOWA - "Wellmark Blue Cross & Blue Shield is sending letters this week telling about 30,000 customers it plans to raise their premiums by 38 percent to 43 percent next year," Tony Leys writes in the Des Moines Register. 
 
Two key caveats: The rate requests are only for the customers who buy Wellmark plans through the state's insurance exchange, and these are just proposals, which still need approval. But Wellmark warns that it's taking a bath on Obamacare: The insurer says it's lost $99 million on exchange customers the past two years.
 
One pricey patient is responsible for a 10 percentage point rate increase. That's according to a Wellmark executive, who says the insurer is covering "a single, extremely complicated patient who is receiving $1 million per month worth of care for a severe genetic disorder."
 
 - Meanwhile, in Kansas. The state's exchange is losing United but gaining Medica and Aetna (Coventry), according to the latest filings.
 
** 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. **

NOW AVAILABLE: CMS FACT SHEET ON FLEXIBILITY FOR PRATICES UNDER MACRA - The fact sheet reviews flexible measurement under the new Merit-based Incentive Payment System (MIPS) and flexibility for practices under Advanced Alternative Payment Models. http://go.politicoemail.com/?qs=046db0672b6ba3deb6d3fa180460520f5cbe559904409dfad0486464cbc8e789 
 
FIRST IN PULSE: BOXER WANTS FTC TO STEP UP STUDY OF E-CIGS - The California senator is sending a letter today that urges FTC to expedite its study into how e-cigarette makers market their products.
 
Sen. Barbara Boxer wants FTC to "specifically solicit information about marketing tactics that target youth, including online advertising, advertising on social media, behavioral targeting, mobile marketing, and viral videos," she writes chair Edith Ramirez. And she's urging FTC to take immediate action to stop the practices, too. 
 
Read the letter: http://go.politicoemail.com/?qs=046db0672b6ba3deefd0ac6025c31819bce2002e8547d5d340846aa844d36c5b
 
E-cigarette use among high school students
 
2011: 1.5 percent
2014: 13.4 percent
2016: 16.0 percent
 
ON THE HILL TODAY: E&C SUBCOMMITTEE LOOKS AT CONCUSSIONS - The oversight subcommittee's 9:30 a.m. hearing examines the risks of permanent brain injury for athletes participating in youth sports. Today's event is part of Chair Tim Murphy's ongoing focus on concussions; he convened the March roundtable where the NFL first admitted that concussions lead to brain disease.
 
 - Playing in the NFL doesn't appear to lead to elevated suicide risk. That's according to a study in the current issue of the American Journal of Sports Medicine that bucks the conventional wisdom. In fact, researchers concluded that "suicide among [the studied] cohort of professional football players was significantly less than would be expected in comparison with the United States population." 
 
SPOTTED: DR. PHIL AND HIS CAMERA CREW - The well-known TV host was seen on Thursday in discussion with House E&C Chairman Fred Upton and Rep. Diana DeGette. The topic of conversation? 21st Century Cures.
 
PATIENTS ARE DOCTOR-SHOPPING USING PROPUBLICA - The investigative journalism outlet had posted its Prescriber Checkup tool as a way for patients to identify doctors with dangerous prescribing habits and steer clear of them. But editor-in-chief Stephen Engelberg warns of an unintended consequence: "Some readers are using the data ... to search for doctors likely to prescribe them some widely abused drugs, many of them opioids." 
 
It's a conundrum for ProPublica, which doesn't want to enable addicts but is committed to relentless transparency. So Engleberg says that ProPublica's adding a warning to all relevant web pages. 
 
"On the whole, we do NOT believe the answer to drug-seeking behavior is to pull the app, but we do believe it is responsible to discuss," reporter Charlie Ornstein tweeted.
 
JOHNS HOPKINS HOSPITAL GETS FIRST FEMALE PRESIDENT - The 127-year-old hospital has named Redonda Miller, who first came to Hopkins as a medical student and now serves as vice president of medical affairs, as its next leader. Miller takes over on July 1. http://go.politicoemail.com/?qs=046db0672b6ba3dea31d3e3feda48f7bc9b74533dbbcbc0487bb229a1a401c33 
 
BELATED HAPPY NURSES DAY - Yesterday was the annual event, and health care luminaries marked the occasion in a manner befitting 2016: Kind and pithy messages on social media. 
 
"I'm the doctor I am today because of the nurses who have helped train me along the way," Surgeon General Vivek Murthy tweeted. "Thank you all for all that you do."
 
ICYMI: POLITICO'S EVENT ON HEALTH AND CYBERSECURITY - Two panels of experts weighed in this week on whether cybersecurity is getting worse in health care, and what the government could - and should - do about it. The C-SPAN video is here. 
 
- Stay connected. Our ongoing "Outside In" series has a splashy new homepage, complete with video, top tweets and more on health IT challenges.
 
POLITICO Pro Health Care Report - Reaching the Tipping Point: Health Care Delivery Reform: A conversation about regional variation in health care delivery system reform. How are different parts of the country responding to the push for value-based payment in the public and private sectors? Why do delivery and payment reforms take root in some markets but not others? Thursday, May 19 - Doors at 8:00 a.m. W Hotel - 515 15th St NW. RSVP: http://go.politicoemail.com/?qs=046db0672b6ba3de4263a7ef47e7e030f0927e0f1a27593f5aaa5daec2373e1e
 
SHOULD YOU WORRY ON FRIDAY THE 13th? - Based on the evidence ... maybe! Some researchers have found a higher risk of car accidents and greater frequency of hospital admissions. But given limited research, the picture's as clear as a cracked mirror. http://go.politicoemail.com/?qs=046db0672b6ba3dea6bc703323147f9fa90e37b905ab66f0a894063773e4e60d 
 
WHAT WE'RE READING by Jennifer Haberkorn
 
The Wall Street Journal editorial board says John Boehner deserves an apology from conservatives after the House won the lawsuit against Obamacare that he authorized. http://go.politicoemail.com/?qs=046db0672b6ba3de845813e93f2a9b6cf96e730395fd2a382fd15f44f06340c8
 
The government should be able to use a type of "eminent domain" to lower prices on rare and valuable drugs, a group of physicians write in the Washington Post. http://go.politicoemail.com/?qs=046db0672b6ba3de16ebedbece8d7d805d136fcf367ca7ca3ca2c00cbca723a3
 
The New York Times magazine's health issue includes a story of a young child whose parents moved him to hospice - only to see him slowly recover. http://go.politicoemail.com/?qs=046db0672b6ba3de28cd8c79ce251f08c87f154fe2f83ac0e8985b794f990efd
 
The New York Times magazine also profiles the Catholic nuns who help people as they die. http://go.politicoemail.com/?qs=046db0672b6ba3de2e362294a1680a04aef314c1bde023829c7f5275158729e3
 
Attempts in Congress to link new medical research funding to new standards for drug and medical-device approvals are troubling some public health experts, the WSJ reports. http://go.politicoemail.com/?qs=046db0672b6ba3dedf618679fc92c7f1f1ebdcef305fb16f60175c21d7db8f26

The lawyers behind the House v. Burwell lawsuit celebrate the district court win. http://go.politicoemail.com/?qs=046db0672b6ba3dee220672a19aba7ae1c6da7d70c387a5dbd540961f02f3282

** 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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