Subject: POLITICO Pulse, presented by PhRMA: Obamacare's November surprise — What's next after first U.S. Zika death? — Obamacare's 'knotty' economic legacy
From: POLITICO Pulse <[email-masked]>
To: <[email-masked]>
Date: Mon, 2 May 2016 08:03:14 -0600

By Dan Diamond | 05/02/2016 10:00 AM EDT

Warren Buffett blasts two health care companies, and CDC reports the first U.S. death from Zika virus. But first: How the Affordable Care Act could cause problems for Democrats on the ballot this fall.

OBAMACARE'S NOVEMBER SURPRISE - The recent stories about high premiums and insurers' struggles on Obamacare are just the beginning, Pro's Paul Demko reports. A more concerning series of headlines for Democrats are likely to hit, right up until Election Day.

Many insurers are signaling that they'll raise plan prices to stay viable on the ACA marketplaces, which have turned out to be less profitable and more risky than those insurers expected. That could mean double-digit rate hikes, and "many consumers won't see actual rates until the insurance marketplaces open Nov. 1 - a week before they go to the polls," Paul writes.

Paul's story: http://go.politicoemail.com/?qs=db12ef29fba0aff9a3351fc03844a08c02c1a3692ac29d706d3a4b9b6218e161 

WELCOME TO MONDAY PULSE - Where only one ICD-10 code can capture last night's wild episode of Game of Thrones. Tips to [email-masked] or @ddiamond on Twitter.

AFTER FIRST U.S. ZIKA DEATH, WHAT'S NEXT? - CDC on Friday reported that a 70-year-old Puerto Rican man died in February from complications from the virus. 

Several other Zika patients have died from the virus in South America - but it's an exceedingly rare outcome, CDC officials stressed. They reiterated their guidance that they expect relatively small clusters of Zika outbreaks in the United States this summer.

The CDC report: http://go.politicoemail.com/?qs=db12ef29fba0aff99b7e100556d02a7773921e29ca6b29ff6c97eab8e8289250 

The virus already is pervasive in Puerto Rico: More than 6,150 people have been tested for infection, with 683 confirmed cases. Sixty-five of those cases of Zika are in pregnant women.

- Democrats starting to frame Zika as women's issue. It's a new twist on the Zika funding battle, and part of Democrats' broader narrative heading into the fall elections about what they call the Republicans' war on women, Pro's Nancy Cook reports. One senior Democratic congressional aide even called Zika the "sleeper issue of the summer." More for Pros.

- Zika birth defects may be just the 'tip of the iceberg.' That's according to researchers at an annual meeting of pediatricians in Baltimore, who note that some nearly normal newborns have ended up showing signs of brain damage in subsequent months. More.

- ICYMI: Thune pushes bill to reduce pesticide regulation. The South Dakota senator's bill would waive some of the Clean Water Act's requirements to make it easier to spray mosquito-killing pesticides. More.

MEDICAID ENROLLMENT RISES TO 72.4 MILLION - That's a new all-time high, according to Friday's enrollment report, and it's about 14 million people more than in October 2013, before the Affordable Care Act's coverage expansion began to take effect. (h/t Emma Sandoe)

How Americans get covered
Medicaid: 72.4 million
Medicare: 55.2 million
UnitedHealth: 47.7 million
Anthem: 39.6 million

(There's some double-counting in the above list, which includes dual-eligibles and insurers' Medicare Advantage business.)

WHY OBAMACARE HAS A 'KNOTTY' ECONOMIC LEGACY - The positive side: The health law reduced Americans' financial insecurity by expanding health coverage and forced insurers to cover patients with pre-existing conditions.

But those new protections also meant that some Americans would opt out of the workforce, no longer needing their employer-sponsored health insurance, Andrew Ross Sorkin writes in a retrospective on President Obama's economic policies in Sunday's New York Times Magazine. And the ACA further took aim at slowing the growth of the health care sector, a major engine of the U.S. economy.

- Meanwhile, the president's decision to focus on health reform meant that he picked that legislation over other high-priority items, including a possible infrastructure stimulus that could have immediately boosted the 2009-2010 fledgling economic recovery.

"You might say, 'Well, he should've focused even more on pushing through a bigger fiscal stimulus, which he could have if he wasn't going for the Affordable Care Act,' ... That was a trade-off he made, and it cost him," Harvard economist Ken Rogoff said.

Read the story: http://go.politicoemail.com/?qs=db12ef29fba0aff9ce4e70e08e8b88690ef22ca0a337942fb9a1846961b84bef 

** A message from PhRMA: Developing innovative medicines is not possible without the people who volunteer to participate in clinical trials. During Clinical Trials Awareness Week, we celebrate clinical trial study volunteers who help inform the drug discovery process. Watch here how clinical trials are playing an important role in making new treatments a reality. **

WARREN BUFFETT ON VALEANT AND THERANOS - The legendary fund manager addressed both troubled companies at Berkshire Hathaway's annual meeting this weekend.

"The business model of Valeant was enormously flawed," Buffett said, defending his repeated decisions never to purchase stock in the drug company, which has been brought low by scrutiny over its price hikes. He added that the company was a "Wall Street scheme."

Berkshire Vice Chair Charlie Munger went further. "Valeant, of course, was a sewer," Munger said. "Those who created it deserve all the opprobrium that they got."

Buffett also invoked Theranos as a company that had a board filled with "great" names, but who failed at day-to-day management.

- How to talk 'Theranos.' Buffett puts the stress on the company's second syllable.

"You say THERAnos. Warren Buffett says TherANOS," CNN Money's Paul La Monica tweeted. "Let's call the whole thing off."

WHY 'CJ' TOOK THE WHITE HOUSE PODIUM ON FRIDAY - A viral clip of "C.J. Cregg" - really, actress Allison Janney reprising her famous "West Wing" character - addressing the White House press corps swept across the Internet this weekend. 

But why Janney was at the White House: To help the administration promote its efforts to fight opioid abuse.

The White House's latest opioid actions
Counting Friday's announcement, at least

. 191 nursing schools
. 61 medical schools
. 54 pharmacy schools

have now committed to requiring their students to take advanced prescriber education, in line with the latest CDC guidelines on opioids, before they graduate.

COMING TO TERMS WITH ALZHEIMER'S - A special standalone section in Sunday's New York Times follows how a nurse turned health care executive turned Alzheimer's patient struggled to understand what the disease would mean for herself and her family.

The story's written by N.R. Kleinfeld, who also authored the memorable front-page story, "The Lonely Death of George Bell," six months ago.

Read the story: http://go.politicoemail.com/?qs=db12ef29fba0aff9ebdb03df8656dc1f7872bf3badd8fd02ab5386a399239da6 

 - The toll of Alzheimer's. "Every 67 seconds, with monotonous cruelty, Alzheimer's takes up residence in another American. Degenerative and incurable, it is democratic in its reach. People live with it about eight to 10 years on average, though some people last for 20 years. More than five million Americans are believed to have it, two-thirds of them women."

STATE WEEK: HOW MUCH WILL MEDICAID EXPANSION SAVE HOSPITALS, REALLY? - Two Louisiana hospitals are raising doubts that Medicaid expansion will save the state as much money as Gov. John Bel Edwards' administration says, Rachana Pradhan writes. 

More from Louisiana, Oregon, South Dakota, Hawaii and Pennsylvania in State Week: http://go.politicoemail.com/?qs=db12ef29fba0aff9f6f846023d26d162cf892a0ac5f0b8a4a3f29b0dd0a1b17e

'HEALTH CARE COMPETITION SAVES LIVES' - That's the takeaway from a paper that won one of the American Economic Journal Best Paper Prizes on Friday. Researchers tracked how England's NHS piloted a model where patients could choose between multiple hospitals for care, and how the resulting competitive pressures led to improved care quality and outcomes.

WHEN PRICE TRANSPARENCY GETS THE 'BLUES' - Last week's Health Care Cost Institute's report on the dramatic variation in state-by-state health prices was notably incomplete. Why? Researchers couldn't report prices for eight states - Alabama, Hawaii, Idaho, Michigan, Montana, South Dakota, Vermont and Wyoming - because of the states' dominant Blue Cross Blue Shield plans, Columbia's Daniel Barth-Jones points out. 

The lesson: In America's balkanized health care system, even efforts to be transparent about health costs aren't always fully transparent.

WHAT WE'RE READING

The ongoing boom in health care ventures has led to a wave of doctors now advising start-ups, Chrissy Farr writes: http://go.politicoemail.com/?qs=db12ef29fba0aff9e270282ab8776fbfeb5bebb539e29a9968d241935949aec6

"60 Minutes" investigates accusations that medical gear sold to protect physicians during the Ebola crisis had major quality problems: http://go.politicoemail.com/?qs=db12ef29fba0aff923c13a6c3e77c8acc92fcc4bde1e2f05adc8c5c49ab5a970

A source tells the Guardian that investigators are "99 percent sure" that Prince's death was from an accidental opioid overdose: http://go.politicoemail.com/?qs=db12ef29fba0aff962ad5a3c7e1724fdd74881e252bdd50a1af7cb4e2cfa6607

Valeant's new CEO: Not that different from the old CEO? http://go.politicoemail.com/?qs=db12ef29fba0aff9bb58fa282402d48580ea48052b3972d90a328873cb4354fd

Omnia's new tiered health plan was intended to reward top-performing providers. Instead, it's sparked lawsuits and a legislative battle in New Jersey: http://go.politicoemail.com/?qs=db12ef29fba0aff9e8705696f04327ecd8b2e25cc92d09a26aba7566cf967835

** A message from PhRMA: A dynamic and collaborative health care ecosystem is crucial to conducting efficient and effective clinical trials, but 2/3 of trials fail to enroll enough participants. Misconceptions and a lack of awareness about this important research often keep people from participating. During Clinical Trials Awareness Week, get the facts about how America's biopharmaceutical companies are designing new ways to conduct clinical trials to increase efficiency and bring medicines to patients faster. Learn more here. **

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