Subject: POLITICO Pulse, presented by Stop CMS Cuts: Who sets the health care agenda in a Trump White House? — Part B fight continues — National health costs up 6.5 percent in 2015
From: POLITICO Pulse <[email-masked]>
To: <[email-masked]>
Date: Mon, 9 May 2016 08:02:07 -0600

By Dan Diamond | 05/09/2016 10:00 AM EDT

Drug costs increased 15.8 percent in the commercial insurance market last year, and Democrats come out in support of Medicare's embattled Part B demo. But first: Who's setting policy if Donald Trump is president?

WHO SETS THE HEALTH CARE AGENDA IN A TRUMP ADMINISTRATION? - If Donald Trump ultimately becomes president, he would need to fill thousands of jobs with civil servants who understand how the massive government bureaucracy functions. But many policy experts who have served in past Republican administrations, and who would appear poised to rejoin the federal government if their party prevails in November, don't want anything to do with a Trump presidency - and that reticence extends to some health care wonks.

"I would never serve in a Trump administration," said James Capretta, who oversaw health care programs at the Office of Management and Budget under George W. Bush. "The person at the top is unfit for the presidency."

- The uphill climb to attract talent. Lanhee Chen, who served as Mitt Romney's 2012 policy director and advised Marco Rubio this year, declined comment when asked about his willingness to serve Trump. But he did admit the brash businessman faces an uphill climb attracting top-tier talent.

"My view is it would be very challenging for a lot of mainstream policy folks to envision working in an administration for somebody who has said some of the things Trump has said during the campaign," Chen said.

Much more from POLITICO's Paul Demko and colleagues on the troubles Trump might encounter in staffing a future administration: http://go.politicoemail.com/?qs=bdf445b9e76e0496664a0e699e23b5a842446c9ed138b3a425ee0e761b0382af

SCOOPLET: HOUSE DEMS BACK WHITE HOUSE ON DRUG PLAN - A group of House Democrats is defending the Obama administration's Part B demonstration project in the face of opposition to the project on the part of drug makers, doctors, Republicans and some patient groups.

"We believe this proposal will not only help to fix the current and flawed status quo but will also help combat the increasingly unaffordable prices that drug companies are charging for their products," the 19 Democrats wrote in a letter to CMS that was to be released later today.

Jen Haberkorn has more for Pros: http://go.politicoemail.com/?qs=bdf445b9e76e0496cc68d9f010dec293e62f903d30819a95575cbf035e0ebbf5
Read the letter: http://go.politicoemail.com/?qs=bdf445b9e76e0496e08971bb0acbbebedfdbddfcb37e84d101faed77ccff0d3b

FIRST IN PULSE: PATIENT GROUPS FOCUS COMPLAINTS ON PHASE 2 OF PART B DEMO - More than 40 groups, led by the Partnership to Improve Patient Care, are sending a letter to CMS acting administrator Andy Slavitt today with fresh concerns over the agency's planned Part B demonstration project.

While most criticism of the Part B demo has centered on Medicare's proposed changes to lower its add-on payment for drugs, the patient groups say that phase 2 of the proposal - which would introduce new payment pilots that draw on comparative-effectiveness research - would hurt patients, too.

For instance, the groups take issue with CMS's plan to draw on recommendations from ICER - which the groups contend is led by a governing board that "consists mainly of payers, with no representation from patients or people with disabilities."

"While no doubt a well-intentioned effort to advance value-driven health care, the approach it takes would represent a major step back for patients and people with disabilities," the organizations write.

Read the letter: http://go.politicoemail.com/?qs=bdf445b9e76e0496147e13435f7c197adf6fe7493aa31c10789f06934585a8dc 

WELCOME TO MONDAY PULSE - Where it's still Mother's Day. (Let's face it: moms deserve to be celebrated far more than one day per year.) Tips to [email-masked] or @ddiamond on Twitter.

With help from Paul Demko (@PaulDemko) and Jennifer Haberkorn (@jenhab)

DRIVING THE DAY: HEALTH DATAPALOOZA - The annual conference gets underway at Washington's Grand Hyatt, with a slew of federal officials to speak on the connection between data and outcomes. 

. HHS Secretary Sylvia Mathews Burwell is scheduled to address the conference at 8:40 a.m.
. National Coordinator for Health IT Karen DeSalvo is scheduled to speak at 9:50 a.m.
. Vice President Joe Biden is scheduled to speak at 1:30 p.m.

Today's agenda: http://go.politicoemail.com/?qs=bdf445b9e76e04968f8987888acd3fd8f43ab3088e2a4621fff90e0c8f959547 

CONGRESS IS BACK THIS WEEK - And lawmakers return to a packed agenda that includes ongoing negotiations over funding the National Institutes of Health and the White House's $1.9 billion request to fight Zika virus. 

 - House to vote on opioid bills. The House Rules Committee will start the process Tuesday afternoon and roll several of the bills together into a few floor votes, potentially under suspension. As of now, they're all expected to be approved overwhelmingly. Expect to see the legislation quickly move into a conference with the Senate.

Also on tap:

. The House Ways & Means Committee holds a Wednesday hearing on implementation of Medicare's physician payment law
. The House Energy & Commerce Committee holds a Wednesday hearing on alternatives to Obamacare

FIRST IN PULSE: NATIONAL HEALTH COSTS INCREASED 6.5 PERCENT IN 2015 - That's according to the S&P Healthcare Claims Index Monthly Report, which tracks spending in the commercial insurance market and is scheduled to be released Monday morning. (The report's data is drawn from commercial health insurance plans' payments to providers.)

It's also a faster pace than the 4.3 percent cost increase that S&P found in 2014.

Overall, S&P says that in the commercial market in 2015:

. Medical services costs increased by 4.3 percent
. Drug costs increased by 15.8 percent, although there was a significant split between the increases in brand-name drug costs (19.2 percent) and generic drug costs (6.6 percent).

Read the report: http://go.politicoemail.com/?qs=bdf445b9e76e04960ab0cc9fda76e95c57b19bfee399240093a442c3a6d0927c 

POLITICO EVENT - COCKTAILS AND CONVERSATION. Health care and technology leaders discuss the cost of keeping our data safe at "Outside, In: Unhealthy Hacking: Medical Privacy in the Age of Cyber Attacks." Right after Health Datapalooza. Tuesday, May 10 - Doors at 5:15pm; District Architecture Center - 421 7th St. NW. RSVP: http://go.politicoemail.com/?qs=bdf445b9e76e04960a2ab1f396e7c5e7a4f0b989b088505278d496b08df798a9

** 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 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. **

STATE WEEK: MOVEMENT ON KENTUCKY MEDICAID? - As Gov. Matt Bevin's administration works on a proposal to change the state's Medicaid expansion, the Foundation for a Healthy Kentucky will convene a closed-door meeting this week for various health care groups to provide input and shape its development, Pro's Rachana Pradhan reports. More in State Week: http://go.politicoemail.com/?qs=bdf445b9e76e04967d7a1dd7ebb92850f0f8eb5c5912bc07d30e54ef0deab90e

ICYMI: CMS ANNOUNCES CHANGES TO MARKETPLACES - The agency on Friday said it's making a series of requested changes intended to stabilize the Obamacare exchanges and strengthen competition.

Under Friday's rule, CMS says it's ... 

. Helping the co-ops get new funding. CMS is revising some of the governance rules in order to allow the 11 remaining co-op plans to attract additional investors. More for Pros.

. Tightening special enrollment periods. Individuals who want to sign up outside of the standard enrollment window because of a "permanent move" will need to show they've had coverage for at least one day in the previous two months in order to qualify.

. Giving states more flexibility. CMS is encouraging states to develop their own solutions for helping small health plans that have been hit with significant risk adjustment assessments. More for Pros.

Read the rule: http://go.politicoemail.com/?qs=bdf445b9e76e049654dd5d49de147da3f3e0271277cc30eb44b626a6eeceefb5 

 - What insurers are saying: Necessary fix. Payers specifically hailed the changes to the special enrollment period as a necessary fix, citing their ongoing concern that the rules around special enrollments have been too lax and allowed for too many free riders.

"Linking special enrollment periods for a permanent move to prior coverage is an important step towards helping stabilize the market and will also encourage people to stay continuously covered, so they can get the coordinated care and preventive services they need," Alissa Fox of Blue Cross Blue Shield Association said in a statement. "We will continue to work on additional measures to stabilize the marketplace."

"This is progress," AHIP added in a statement. "Having clear guidelines around special enrollment periods is critical to delivering affordable coverage for all consumers."

BLACKS SEE MAJOR GAINS IN LIFE EXPECTANCY - "Blacks are still at a major health disadvantage compared with whites," Sabrina Tavernese writes in a front-page New York Times story today. "But evidence of black gains has been building and has helped push up the ultimate measure - life expectancy."

Tavernese rounds up a series of recent federal reports and shows how the gap is closing - partly because of improvements in care, and partly because life expectancy for whites has fallen in the wake of the opioid crisis and other problems.

Read the story: http://go.politicoemail.com/?qs=bdf445b9e76e0496ebb53dd095e8a7749f3c0b7e36e82dddc52298bb7e5d5e99

CONFESSIONS OF AN EX-REGULATOR ON HOW GOVERNMENT SHOULD WORK - When crafting major reforms like meaningful use, "regulators really, really, really want to get it right," Farzad Mostashari said on POLITICO's "Pulse Check" podcast last week, but they end up being too cautious and conciliatory. And that's bad for health care, he argues, because it protects underperformers and lets them stick around. The story for Pros.

MAJOR LEAGUE BASEBALL SCRAPS PUERTO RICO SERIES OVER ZIKA CONCERNS - A two-game series on the island had been scheduled for later this month to honor Hall of Famer Roberto Clemente, who was from Puerto Rico. But players objected after receiving a CDC briefing on the risks of the virus, and the games will be relocated to Miami. More from NPR: http://go.politicoemail.com/?qs=bdf445b9e76e04966b5d3abe422fa518b4d4af2c29face91f0b342ab0af6d537 

 - Rapid Zika test introduced. Meanwhile, researchers on Friday unveiled an inexpensive, paper-based test that can gauge presence of Zika within just a few hours, as opposed to days or weeks. It's based on a similar test developed to detect Ebola. http://go.politicoemail.com/?qs=bdf445b9e76e0496411e4a64695bd428b3166aa25f08910d3d3e1daa1f6ba883 

WHAT WE'RE READING

Florida is a swamp of fraud, Modern Healthcare's Lisa Schencker writes. Since January, HHS has flagged about a dozen cases of alleged Medicare or Medicaid fraud in the state, and the DOJ has announced more than 15: http://go.politicoemail.com/?qs=bdf445b9e76e0496eeaeac77c7eca019722350ff9ed7c2efb6f7df33eb16ad31 

Ge Bai and Gerard Anderson clarify a few points about their study on hospital profitability: http://go.politicoemail.com/?qs=bdf445b9e76e04969ba6eaa4c17e7820b93a8aa0ff997d18300591c0817143b8

Pop star Prince may have died from opioids - and in his age group, the risk of opioid overdose climbs. Why? A closer look from NPR:http://bit.ly/1rC3YRJ 

Janet Weiner offers more context on a recent JAMA study that found the benefits of price transparency might be overplayed: http://go.politicoemail.com/?qs=bdf445b9e76e049620122ab2bd3c7cd85e1d8d2fdda5e7305ec0b27519b1d9b0

** 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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