Subject: POLITICO Pulse, presented by PhRMA: Congress will leave, but Zika problem will stay unresolved — The next big issue could be drug costs — MACRA-more: What everyone's saying about physician-pay rule
From: POLITICO Pulse <[email-masked]>
To: <[email-masked]>
Date: Fri, 29 Apr 2016 08:02:56 -0600

By Dan Diamond | 04/29/2016 10:00 AM EDT

The number one health policy issue for the next administration could be drug costs, and another report alleges a link between Prince's death and opioids. But first: Congress bails on a Zika funding deal.

CONGRESS LEAVES, BUT ZIKA PROBLEM WILL STAY UNRESOLVED - The Senate's already gone. The House leaves for recess today. And that's why there's virtually no chance of a breakthrough on the long-awaited Zika funding package - more than two months after the White House's emergency $1.9 billion request, and a week after senators hinted that a bipartisan deal was close.

What happened? Democrats pushed for the full White House funding request, while Republicans said they wouldn't budge from $1.1 billion. And the brief moment of comity descended into partisan and even bicameral bickering, with Senate Republicans blasting their counterparts in the House for dragging their heels.

"It's clear that those Republicans interested in working with us have been beaten back by the extreme right wing, who don't want to do anything at all," Democratic Sen. Patty Murray told reporters this week.

- Rubio says state officials are 'freaked out' and demand action. The Florida senator warned his colleagues on Thursday that there's no time to waste by going through the usual appropriations process.

"There is no such thing as a Republican position on Zika or Democrat position on Zika because these mosquitoes bite everyone," Marco Rubio said on the Senate floor. "And they're not going to ask you what your party registration is or who you plan to vote for in November."

- 'On Zika Preparedness And Response, The US Gets A Failing Grade.' Georgetown University experts argue in Health Affairs that Congress is making a public health blunder and a "political mistake": http://go.politicoemail.com/?qs=b6598d84ddb86d98387c46965ad9b72da82f4470af7f8daeeebd7b681ceec1a5

- Where Zika virus could spread next. A new study from NASA researchers projects how temperature and climate could help mosquitoes spread the virus, suggesting that some parts of the southern United States will face year-round threats from the virus.

They also warned that several cities - including Washington, D.C. - would face a medium level of risk from Zika this summer. 

See the study: http://go.politicoemail.com/?qs=b6598d84ddb86d98dd5d1e1d9c819a8e24f2446134f012040594a134d59ca0f7

See the map: http://go.politicoemail.com/?qs=b6598d84ddb86d98388c803c44390a64213f11b2c30b0909badfa0a0bdef2d46

Meanwhile: Scientists say Zika virus is worse than expected. New scans and autopsies reveal that the virus eats away at fetal brain development by destroying lobes that control basic functions like thought and vision.

"These aren't just microcephaly, like a slightly small head," Jeanne Sheffield, an expert in fetal medicine at the Johns Hopkins School of Medicine, told the Wall Street Journal. "The brain structure is very abnormal."

THANK GOODNESS IT'S FRIDAY PULSE - And thank you for the wonderful reaction to our new "Pulse Check" podcast. Who would you like to hear from on upcoming episodes? Tips to [email-masked] or @ddiamond on Twitter.

THE NEXT BIG ISSUE COULD BE DRUG COSTS - That's according to CMS acting administrator Andy Slavitt, who told POLITICO's new "Pulse Check" podcast that the cost of drugs may well be the number one health policy challenge facing the next administration - of either party.

"If we don't address this problem in the next four or five years, and prescription drug costs grow as they've been growing," Slavitt warned, "this will be one of the top three issues for my successor, if not the No. 1 issue."

And that's one reason why CMS is contemplating new value-based pilots to address drug costs across the next nine months, he told our podcast. Because if not, he added, "my successor will say, 'What the heck was Slavitt thinking?'"

More: http://go.politicoemail.com/?qs=b6598d84ddb86d98a2549c0a74c47aaa6430b3eb9c01599bed072468ae751a64 

ICYMI: How the man in charge of Medicare plans to win back doctors' hearts and minds. In an exclusive interview for POLITICO's new 'Pulse Check' podcast, CMS acting head Andy Slavitt dishes on his top priorities. To listen to the full interview and ensure you don't miss upcoming episodes, subscribe to the podcast on iTunes. http://go.politicoemail.com/?qs=b6598d84ddb86d98763af45a79e91c6ec502f6802d9763c9dbd2ef7da331fc98 

MACRA-MORE: WHAT EVERYONE'S SAYING ABOUT PHYSICIAN PAYMENT RULE. Yesterday's PULSE featured immediate reactions to Medicare's proposed new physician payment system - with the American Medical Association applauding the rule and the American Hospital Association blasting it - and here's a quick roundup of other voices.

On the Hill

. House W&M Chair Kevin Brady: "I'm pleased to see the Administration move forward with implementing this important law, and urge them to work with doctors, patients, and health care providers as they finalize the proposed rule." More.

Specialty groups

. The American College of Rheumatology: "Initial review of the proposed rule suggests that CMS has been listening to the rheumatology community's concerns."

. The American Medical Group Association: "We remain concerned that qualifying as an APM remains challenging at best, even for AMGA members, many of whom are very experienced with risk-based payment models.

. The American Osteopathic Association: "These changes respect the kind of quality care osteopathic physicians provide to their patients and give DOs flexibility to pick the payment system and quality measures that actually reflect how they practice."

Other analysis

. The Advisory Board Company: "The significant incentives to move towards downside-risk models as well as the amount of payment at stake for providers participating in MIPS reminds physicians that the development of care management and quality reporting strategies is no longer optional." More.

. The National Committee for Quality Assurance: "We are particularly pleased that the proposed rule supports independent validation that clinicians are providing patient-centered care in Patient-Centered Medical Homes and Patient-Centered Specialty Practices." More.

CNN: PRINCE HAD OPIOIDS ON HIM WHEN HE DIED - Prescription opioid medication was found on the deceased music legend and in his home, a source told CNN. http://go.politicoemail.com/?qs=b6598d84ddb86d98ee5063210ba5eb5b3cbdeaa5c124bb4da993c54aee39df24

It's still early in the investigation into Prince's sudden death at age 57, but several reports have now linked the artist's recent health problems with a potential opioid overdose. And if that turns out to be true, that could make Prince the most visible symbol of America's growing opioid crisis.

- Stars, they're sadly just like us. "Prince's alleged story [is] like many of my VA patients," primary care doctor Jeremy Sussman tweets. "A pious man [with] work-related pain who was prescribed medicine."

"Why the opioid crisis is so insidious," Sussman added, is that it sweeps up people with no addiction history and severe pain who are just "doing the 'right' thing, initially."

MEET THE NEW HEAD OF AHRQ: ANDREW BINDMAN - Bindman is a primary care physician and health policy researcher at the University of California at San Francisco, and he'll become the new director of AHRQ on May 2. More on Bindman's background for Pros.

** A message from PhRMA: Biopharmaceutical intellectual property (IP) protections, such as patents, provide the incentives that spur research and development and lead to lifesaving treatments and cures. Learn more here about the outcome of strong IP policies. **

TEEN PREGNANCY RATES HIT HISTORIC LOWS - That's according to new CDC data, which found that the teenage birth rate plunged 60 percent between 1991 and 2014. Births among Hispanic and black teens alone have fallen by nearly half since 2006.

See the CDC report: http://go.politicoemail.com/?qs=b6598d84ddb86d988e6e8db41cb3e92301b68edecc343ac82ab2a9d030bf52aa 

 - Meanwhile: The United States still lags its peers. Despite recent improvements, the U.S. teenage birth rate is still much higher than peer nations and essentially on par with Moldova and Rwanda, according to World Bank data.

Birth rate per 1,000 teenagers:

Canada: 10 births
Denmark: 4 births
France: 9 births
Germany: 7 births
United Kingdom: 15 births
United States: 24 births

CORNYN SAYS LACK OF COORDINATION HAMPERING MENTAL HEALTH FIGHT - Sen. John Cornyn on Thursday said a lack of coordination among Senate committees may be setting back legislation to reform the mental health care system, Pro's Brianna Ehley reports.

After a Senate Finance Committee hearing on mental health, Cornyn expressed frustration with the upper chamber's efforts to combine legislation from three committees into a larger package expected to reach the Senate floor this year. More for Pros.

HHS TAKING ACTION ON GENDER BIAS - The agency will conduct Title IX compliance reviews to ensure that universities it funds are addressing gender-based discrimination within their research programs, Reps. Rosa DeLauro, Louise Slaughter and Eddie Bernice Johnson announced. More.

ICYMI: WHAT WE LEARNED FROM THE EARNINGS REPORTS THIS WEEK - Collectively, three insurers painted a very different picture of their Obamacare exchange performance than UnitedHealthcare, which announced last week that it was losing money on the ACA exchanges and would soon exit most of them.

Aetna: On track to break even on its ACA business
- CEO Mark Bertollini on Thursday: "We see [the exchanges] as a good investment, hoping that we have an administration and a Congress that will allow us to change the product like we change Medicare every year and we change Medicaid every year."

Anthem: Hopes to earn a profit on its ACA business
- CEO Joe Swedish on Wednesday: "We believe we have taken a conservative posture in the first quarter regarding our expectations for the profitability of this book of business for 2016... We do believe we're well positioned for continued growth in the exchange marketplace if the market stabilizes to a more sustainable level."

Centene: Already turning a profit
- CEO Michael Neidorff on Tuesday: "Centene's exchange experience continues to be favorable and we are achieving margins at the higher end of our targeted range." 

GPhA UNHAPPY ABOUT POSSIBLE PENALTY FOR HIKING GENERIC DRUG PRICES - The generic drug trade association is unhappy about efforts to amend the Medicaid Drug Rebate Program to impose a possible penalty on its members for price increases. 

Congress's efforts reflect a failure to recognize the "different dynamics associated with brand and generic markets," GPhA writes to Senate Finance Committee and House E&C Committee leaders.

"This new generic Medicaid rebate provision ... fundamentally serves to impede the natural market dynamics that allow generic drugs to be low priced, and could lead to potentially irreversible and unintended negative consequences for patient access to affordable medicines," the letter warns.

Read the letter.

A BEGINNER's GUIDE TO OLD AGE - The quick-witted Michael Kinsley speaks at Politics & Prose tonight at 7 p.m. on the aging of the Boomer generation and what he's learned as someone who developed Parkinson's at an early age. He'll be interviewed by POLITICO's own Timothy Noah.

THIS. IS. JEOPARDY! - One of the so-called hardest questions on the quiz show this week was probably one of the all-time easiest riddles for health wonks.

. The category: GOVERNMENTAL LAST NAME'S THE SAME
. The $2,000 answer: "A late Tennessee senator/Hollywood actor & the Secretary of Health & Human Services from 2001 to 2005"
. So what's the question? Click here and scroll down. (H/t Jen Haberkorn and Jason Millman)

WHAT WE'RE READING by Nancy Cook

Healthcare companies see scale as the only way to compete: http://go.politicoemail.com/?qs=b6598d84ddb86d98318db4c55f1b10866d968d5461bcca98d5d601122d6ae446 

Drugmakers place big bets on cancer medicines they expect will command premium prices: http://go.politicoemail.com/?qs=b6598d84ddb86d984f7ffbe7891b5014ec074464095e9ee8a9a2ff8fd0477acb 

Senators want to halt change to Medicare Part B drug pay: http://go.politicoemail.com/?qs=b6598d84ddb86d9837b635a52dc2cfbbc9515f010b70ff958f9280937bfc644b 

Op-Ed in Bloomberg View: Congress has no reason to delay Zika funding: http://go.politicoemail.com/?qs=b6598d84ddb86d985224ae0df370003a16cad960a79241c207a7342fb02fdd38 

Studies document risks of assault for health care workers: http://go.politicoemail.com/?qs=b6598d84ddb86d9828d16e393c35fc8643d91d23f9f7846ab3a722d80fe9ca5d

** A message from PhRMA: Take a moment to consider the impact that strong and robust IP policies have on our daily lives and on the country. Due to the complexity of developing a medicine, strong IP protections are necessary to ensure that innovative biopharmaceutical companies are able to secure resources for future investments in research, giving hope to patients who await tomorrow's medicines. Learn more here about the outcome of strong IP policies. **

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