Here’s the latest on what the Trump presidency means for health, hospitals, drug companies, and medical research.
Friday, March 31
A generic drug downturn
Imports of generic drugs to the US fell 22 percent in the three months after the US election, compared with the three months before, notes the PharmaLetter. It’s a tricky intersection of policy: On the one hand, Trump’s election inspired hope to those who want to boost drug imports, but he’s also been highly critical of overseas manufacturing. Analysts blamed the downturn on wider health care uncertainty related to Trump’s promises of Obamacare repeal.
Ireland trade anxiety
President Trump is expected to sign two executive orders today meant to rectify trade deficits — and that has some in Ireland’s pharma industry nervous. Ireland ranks number five among nations with the highest trade surpluses with the US, driven largely by its pharmaceutical exports. The executive orders will encompass a study into unfair trade practices and a tax on countries selling products into the US at low prices.
Biotech’s big donor
Parker “Pete” Petit, CEO of biotech company MiMedx, has a new nickname: the Trump of Georgia. Petit was Trump’s 2016 Georgia finance chair, and his company has been a key donor to Republican candidates — in fact, ranking as the top contributor to now-HHS Secretary Tom Price for 2015-16. But some worry that those donations will influence a pending issue MiMedx is fighting with the Food and Drug Administration over the kind of licensing its wound-healing products — many of which are made from donated placenta and umbilical cords — need. Petit has now taken his case to members of Congress, arguing that the FDA overreached.
University overhead in the crosshairs
Medical research can’t be done in the dark. But should taxpayers be covering the light bills at university labs across the country? Price said this week that “indirect expenses” — which cover everything from buying lab equipment to paying the electric bills — covered by NIH were ripe for cuts. And such pronouncements are sending ripples of alarm through universities.
- How Trump could save himself — but screw the GOP (Vanity Fair)
- After Christie praises them, N.J. addiction doctors blast Trump budget cuts (NJ.com)
- The Freedom Caucus’s new health care demand: let insurers charge sick people more (Vox)
Thursday, March 30
Budget target: AHRQ
A little-known federal agency with the goal of making health care safer and more effective has a target on its back. AHRQ, the Agency for Healthcare Quality and Research, is a $334 million organization that examines things like whether back surgery is as effective as other therapies, or how rigor in hand-washing and protective dress can prevent infection control. On Wednesday, HHS Secretary Tom Price defended the plan to roll it into the NIH, calling some of the work it does duplicative. But its supporters say it’s an agency that helps keeps health care costs down, and needs to be saved.
He said this
“Do you pray for an iPhone? God forbid, I’ve had situations with my parents, my loved ones, my children, when they have a serious disease, that’s when we pray, and that’s why as a society, we have to make some decisions about what to invest in.”
— George Yancopoulos, cofounder of Regeneron Pharmaceuticals, on proposed cuts to the NIH budget under the Trump administration and the importance of basic biomedical science research.
Regulatory target: drug prices
With the failure of the American Health Care Act comes much conversation on other ways the Trump administration can attack health care reform, including relaxing or changing regulations and affecting the stability of the individual insurance market. Another way? Using drug prices to get Democrats to the table. President Trump has called Congressman Elijah Cummings multiple times on the issue. But it’s not a bull’s-eye: This analyst says that legislation may not overcome market forces and the influence of pharmacy benefit managers and bringing Democrats to the table, says House Speaker Paul Ryan, is not the GOP’s goal in reforming health care.
Staffing target: science advisors
It might be because the administration is moving slowly to fill slots created by previous presidencies, or it could be a dismissal of scientists-as-advisors for President Trump, but either way, there are a lot of empty offices in Washington once filled by scientists. Some, including a member of Trump’s transition team, say he will have plenty of access to science and scientists without official government agencies like the Office of Science and Technology Policy. But others say the optics of empty offices speak to a executive who has rolled back the Clean Power Plan and wants to cut the NIH budget as one who thinks little of scientific evidence as a basis for policy.
- A short-term plan to get health insurance to places where the market is in trouble
- These ACA programs for insurers are working as they are supposed to, a study says
- The EPA has said no to a petition to ban a pesticide that could affect children’s brains
- He wouldn’t say if the administration is still hoping for a repeal, but Tom Price did talk about undoing ACA this way
Wednesday, March 29
An HHS budget hearing
HHS Secretary Tom Price defended the president’s budget proposal, which includes large cuts to various programs within his department, in a hearing today with a House appropriations subcommittee. He referred to the scaled-down $69 billion budget (from $84 billion in 2017) as an effort to root out ineffective and duplicative programming. He defended nearly $6 billion in proposed cuts to the National Institutes of Health as an effort to reduce what he said was the 30 percent of grants that go to indirect costs in biomedical research. He also said that the NIH’s budget is about one-third of the HHS budget now, and that even with proposed cuts, it still would be the same share for 2018.
President Trump’s nominee to head the Food and Drug Administration, Dr. Scott Gottlieb, has promised he will resign from roles in banking, venture capitalism, and drug company consulting if he is confirmed. He’s also said that he will stay out of FDA deliberations on biotech and pharma companies in which he owns stock. He also said he would sell that stock.
Bipartisanship — at a price
Democrats penned a letter to President Trump saying they are willing to work with him on fixing issues with the Affordable Care Act, but in exchange, they want him to rescind an executive order that effectively softens regulatory power under the ACA. They also asked that he stop attacks on Obamacare, as Republicans said that repeal is back on the table.
She said this
“I will be the first one down lobbying against this if someone will sign me up for that.”
— Ann Romney, who has multiple sclerosis, on proposed cuts to NIH funding. The draft budget from the White House calls for a $5.8 billion cut for 2018. An additional $1.2 billion cut in 2017 has also been proposed.
He said this
“I’d much rather fight Ebola in West Africa than in West Dallas.”
— Oklahoma Representative Tom Cole, chair of the House appropriations health subcommittee, on proposed cuts to the Centers for Disease Control and Prevention, during a Wednesday hearing on the HHS budget featuring Price. Cole has previously said that the proposed $1.2 billion cut to the NIH for 2017 is “not going to happen.”
- Access to health care doesn’t always equal better health
- The president’s rollback of climate protections is of concern to scientists who want to artificially cool the climate
- Some analysts think insurance premiums on the exchanges will go up again next year
Tuesday, March 28
Trump and biomedical research
On top of a budget proposal to cut $6 billion from the National Institutes of Health in 2018 comes this spending proposal for 2017: an additional $1.2 billion in cuts for the NIH that would predominantly affect research funding. The administration is also looking to cut about $314 million from the Centers for Disease Control and Prevention and $100 million from the Substance Abuse and Mental Health Services Administration. Cuts to research funding have been widely panned and tied to efforts to fund a border wall. There are many who say the proposals will not become reality.
She said this
“More clarity sooner rather than later would be tremendously helpful.”
— Kristine Grow of America’s Health Insurance Plans. The deadline is approaching for insurers to decide whether they will participate in the exchanges in 2018, and a lawsuit concerning about $10 billion in Obamacare payments to insurers is one way Republicans might try to destabilize the insurance market in an effort to undermine the Affordable Care Act.
Trump and opioids
Before he was elected, President Trump swore to end the American opioid epidemic, and now, an executive order is the works that would outline recommendations to address it. This order would be in addition to an opioids commission chaired by New Jersey Governor Chris Christie. But it’s not clear how the work would be funded. A proposed spending plan would cut funding from federal substance abuse coffers, and Republicans have wanted to roll back Medicaid coverage for addiction services.
He said this
“Clinging to a statement that has been shown to be false indicates that the person needs to be right, or believes that being wrong is a catastrophe.”
— Dr. Lance Dodes, a Beverly Hills psychiatrist, on conceding to an error, in a STAT story by Sharon Begley on the president’s psychological need to be right
Trump and health care reform
While the AHCA may no longer be in discussion, health care reform still very much is. Republican Senators Bill Cassidy (Louisiana) and Susan Collins (Maine) are expected to renew their push for their bill, and White House press secretary Sean Spicer said the president would be willing to work with Democrats on fixing problems with the Affordable Care Act. Even Paul Ryan says he’s going to stay the course, while working on other things.
- Remember the young woman at last month’s congressional address with Pompe disease? Her father has this to say about NIH cuts
- A controversial Bush-era HHS official in global health is now on President Trump’s State Department “beachhead team”
- In the wake of the AHCA failure, a whole bunch of states are looking to expand Medicaid, including Kansas and possibly Georgia
Monday, March 27
Monday morning quarterbacking
The GOP health care proposal failed to get to the House floor for a vote, and it seems, for now, President Trump is going to punt on efforts to repeal and replace the Affordable Care Act. His plan? Let the Obama health care legislation “explode.” The weekend saw lots of finger-pointing on the political front, but also a few promises that health care reform play clock hasn’t run out. HHS Secretary Tom Price can work within the department’s regulatory framework to affect health care policy, which he’s already doing with Medicare, and insurers themselves will also play a key role in keeping ACA afloat, or letting it go out of bounds.
He said this
“For every new opiate they want to bring on the market, there has to be something obsolete they should take off, and quit producing it. We talked about that.”
— West Virginia Senator Joe Manchin, in an interview with STAT, on opioids, regulation, and his request to President Trump. The president’s son-in-law, Jared Kushner, is expected to run a White House office on innovation that will potentially look at privatized solutions to opioid addiction and veterans care.
Markets are everywhere
The failure of the American Health Care Act has had disparate effects on the stock market. On Friday, hospital stocks did well, partially on the idea that they would not have to absorb higher levels of uncompensated care due to certain provisions in the act. But on Monday, markets opened lower, as investors potentially questioned whether the failure of AHCA would portend more trouble for a Trump presidency in enacting other legislation, in particular, tax reform.
- The president says things that aren’t true. His support doesn’t waver. Psychologists say “blue lies” might explain the paradox
- The president needed a Trumpcare win to ease into his tax reform plans. But he can still reform taxes and roll back climate regulation as his next big projects
- The New York Times ed board says the Trump administration’s “war on science” “sacrifices American innovation to small-bore politics”
- Canadian health care is often lambasted for long waits. But here are a few lessons American health care reform efforts can use
- Senator Bernie Sanders is pushing forth on efforts to lower drug prices. The question is, will he have support?
Friday, March 24
President Trump, who calls himself a deal-maker, gave the House an ultimatum last night: vote on Trumpcare, or be stuck with Obamacare. It worked, to a degree, but it’s still not clear if the GOP has the votes to move the bill along, despite a string of concessions designed to placate everyone from a handful of New York congressmen to more conservative holdouts. So, this morning, they debate. And at 3:30 p.m. EST, according to press secretary Sean Spicer, they are supposed to vote.
In the tweet of the moment
OMB Dir. Mulvaney on axing federal mandates for essential health benefits: "You can figure out a way to change the state you live in." (CBS) pic.twitter.com/xshIRxpCf3
— David Wright (@DavidWright_CNN) March 24, 2017
He said this
“We’ll have to see what happens.”
— President Trump, on what comes next if the AHCA fails to leave the House
She said this
“You may be a great negotiator; rookie’s error for bringing this up on a day you clearly are not ready.”
— Representative Nancy Pelosi (D-Calif.), on President Trump and the AHCA
It’s still a little amorphous, but a coalition has formed to try and stop the proposed 20 percent budget cut to the National Institutes of Health that the president outlined in his first budget draft. They are calling themselves the Coalition to Save NIH Funding, and they say that cuts to biomedical research funding will affect nearly every district in the country.
An unpaid bill
In the state with the largest amount of medical debt, STAT’s Max Blau finds out that Mississippi’s middle class is bearing the brunt of it. Mississippi is one of a handful of states that did not decide to expand Medicaid under the ACA, and many residents have high-deductible health plans, with little savings devoted to health care. It’s a gamble that pays off for some, but for others, including people with chronic conditions, it means bill after unpaid bill, piling up.
- Criminologists call for science to be part of Trump’s Justice Department
- If prescription drug coverage gets axed along with essential health benefits, pharma will feel it
- How will the provision to keep young people on parents’ insurance through age 26 fare in the reform fight?
Thursday, March 23
AHCA vote: Will they? Won’t they?
The House vote on the American Health Care Act is supposed to be today, but whether the vote will happen, or what the bill will look like by the time it gets to a vote, is all up in the air. At first, some Republicans said the bill didn’t go far enough, but as concessions have been suggested to please them, moderates are balking. President Trump is hoping OMB chief Mick Mulvaney and Vice President Mike Pence will help sway the roughly two dozen Republican holdouts in the House, but as of this afternoon, CNN says, “multiple meetings…have failed to produce a deal.”
One concession being demanded is an end to essential health benefits, a group of 10 things that the Affordable Care Act mandates be part of insurance plans. The list includes maternity care, prescription drugs, and mental health care. It’s part of the affordability argument — people are paying for coverage they don’t use, but in the long run, it could mess up the individual market. If EHBs get cut, the bill might stand a better chance of passing through the House, but the Senate could be another hurdle.
What Trumpcare finally does look like if it reaches the president’s desk is also up in the air. He said he would not cut Medicaid, but that doesn’t seem to be happening.
In the tweet of the moment
AHCA approval is underwater by 26 points among non-college whites; underwater by 46 points among voters age 50-64. This is Trump's base. pic.twitter.com/Z31jBVmeJN
— Sahil Kapur (@sahilkapur) March 23, 2017
- Population health, clinical quality, saving money: five things on the minds of hospital C-suiters in a Trump administration
- Stocks are up and down of late. Should the health care effort fail, they may fall again as investors view lost tax credits as a stall to economic growth
- Trump’s FDA nominee Dr. Scott Gottlieb has ties to pharma. Some people are concerned. Here are a few companies he’s associated with
- Both Republicans and Democrats are talking a lot about the repeal and replace effort. Here’s who is talking more
Wednesday, March 22
All bark, no bite on NIH budget cuts?
The Trump budget proposal includes a steep 20 percent cut to the National Institutes of Health budget, in what many scientists have said would be a devastating blow. But analysts at the Cowan Group are reading the tea leaves in a different way — they say a cut of that magnitude will never happen. Meantime, former NIH director Harold Varmus says there’s still plenty of reason for concern.
In the tweet of the moment
senior House aide tells me leadership intends to hold AHCA floor vote tomorrow even if bill lacks votes needed to pass
— John Harwood (@JohnJHarwood) March 22, 2017
Bumpy road for March for Science
Scientists and activists are trying to get together in April to march for science, but STAT’s Kate Sheridan and Lev Facher report there’s discord in the ranks of organizers. At the heart of the matter is what the march represents. On one hand, some want to march in support of issues related to the practice of scientific research: funding and evidence-based public policy. On the other, some want to march against inequities they see in science — the role of women and minorities, and the effect of immigration policy. The phrase being used to describe the principle behind the march? Scope creep.
He said this
“It used to be if you were a bright young person anywhere in the world, you would want to go to Harvard or Berkeley or Stanford, or what have you. Now I think you should give pause to that. We have pretty good universities here. We speak English. We’re a welcoming society for immigrants.”
— Alan Bernstein, president of the Canadian Institute for Advanced Research, on the US immigration climate under President Trump, and how Canada might benefit
- Buying drugs over the border could become standard as Trump talks about drug pricing controls
- Other countries use US science data. Here’s one worried about how budget cuts could impact their research
- How changes to health savings accounts under the GOP ACA replacement bill would benefit the wealthy
- Supreme Court nominee Neil Gorsuch gets questioned on abortion and contraception
Tuesday, March 21
Today in health care reform
The House bill is slated for a floor vote on Thursday. President Trump is telling members of the GOP that a lack of support could cost them their seats. The bill is being amended to end Medicaid expansions sooner and to impose work requirements on recipients, with the hope of getting more conservative conservatives to sign on. Then there’s this: a provision in the act that would effectively make it impossible for any private plan to cover abortion.
Today in pharma and biotech
Last night, President Trump went to Kentucky, a state quickly becoming the (non-Beltway) epicenter of repeal and replace stumping. Again, he lambasted the pharmaceutical industry — “You know why? Campaign contributions. Who knows. But somebody’s getting very rich.” And he talked about putting drug pricing controls into the current bill. Or maybe the one after. Investors are happy with the effort, and stocks, overall, seem to reflect that. But the question remains — what is the president actually going to do?
In the tweet of the moment
— NYT Science (@NYTScience) March 21, 2017
Today in Health and Human Services
Positions are starting to get filled at HHS. Seema Verma was confirmed last week to run Medicaid and Medicare. Louisiana Congressman John Fleming says he’s going to run health technology at the massive agency. And here are a few temporary appointees — the “beachhead” team — worth paying attention to at HHS. In the meantime, HHS Secretary Tom Price says that changes to the bill can continue to come — once it gets to the Senate.
- These psychology concepts describe the Trump era of politics. These psychologists talk Trump.
- Congressman Mark Meadows, who represents a deep-red swath North Carolina, is not a fan of AHCA
- Opinion: This pediatrician’s plea to save Medicaid
Monday, March 20
An Obama adviser, advising on AHCA
The man who engineered the Affordable Care Act is meeting with President Trump Monday, presumably to discuss issues with the American Health Care Act. This will be the third visit with Trump for Dr. Ezekiel Emanuel, who will be joined by Speaker of the House Paul Ryan and HHS Secretary Tom Price. Emanuel, who has said parts of ACA do need to be fixed, said he might be the only Democrat the GOP is willing to talk to when it comes to health care.
Conceding on some AHCA concessions
The House bill is coming to a vote on Thursday, and over the weekend, the Trump administration and the GOP were in a huddle, trying to figure out how to massage the act to keep it moving through Congress. Paul Ryan has signaled that work requirements to Medicaid could happen and that more help could come for older Americans, but some GOP leaders want more, including a faster phaseout of Medicaid expansions. The Trump administration says it agrees, in principle, but a move too far to the right means the bill will likely die in the Senate.
He said this
“The Trump plan — while perhaps good politics — will offer consumers little relief.”
— Dr. Scott Gottlieb, the nominee to run the Food and Drug Administration, on drug pricing in a March 2016 column. The Washington Examiner references that column in a look at five ways the nominee could affect drug policy if he is confirmed.
Averting adverse events
As talk swirls over how a Trump FDA might deregulate the drug approvals process, drug side effect reports have gone up fivefold in 12 years. The FDA’s adverse events reporting system is largely voluntary, so numbers are likely underreported, but in 2015, there were more than 1 million reports made. It’s not clear what will happen to the program, but some people are concerned that the FDA is allowing drugs to market before they are truly determined to be safe. And here’s this side effect to the side effects database: Pharma, insurance companies, and other groups are curious how they themselves might use the information to track drug performance.
- How the AHCA, as written, could cost pregnant women and people seeking mental health treatment more (STAT)
- How proposed budget cuts to scientific research will affect productivity (Bloomberg)
Friday, March 17
The budget rundown
STAT took a look at how cuts outlined in the Trump budget proposal would impact life science and public health. Here are some highlights:
- Pharma and biotech: While industry sources told STAT that cuts, which include a 20 percent cut to the NIH budget and reductions to the State Department, as well as hiked FDA user fees, are “horrifying” and “incredibly short-sighted,” there will be little immediate impact to industry. In the long run, however, budget cuts that affect basic science, startup funding, clinical trials, and the cost of FDA review could slow the drug development pipeline significantly.
- Public health: HUD oversees a bucket of federal funding on the chopping block called Community Development Block Grants, which are used for things like decontaminating lead-laden houses and training police officers in how to deal with mental health crises. But the CDBG program most discussed Thursday was Meals on Wheels, which budget chief Mick Mulvaney said wasn’t delivering on promises made to people. NIH-funded research shows that programs like Meals on Wheels reduce loneliness and increase drug adherence in seniors trying to maintain their independence at home.
- Basic research: The loss of $6 billion in NIH funding would be devastating to the scientific apparatus in the US, scientists told STAT. Research would stop, jobs would be lost or never created in the first place, and the American public would lose out on the foundational discoveries that eventually become therapies, medical devices, and pharmaceuticals.
AHCA and insurance
When the Congressional Budget Office delved into the American Health Care Act, it noticed that insurance premiums would eventually go down. But there’s more to it than that, Business Insider says. Premiums for some individuals will go up, because of things like relaxed age rating regulations. But they could also go down, plans could get more meager, so insurers will pay for less of your health care and potentially charge you less. It’s complicated, but worth noting that plans that cover a set of services comparable to what’s in the ACA will likely cost quite a bit.
They said this
“We stand ready to work with you to develop a proposal that is both fiscally sound and provides affordable coverage for our most vulnerable citizens.”
— Republican Governors John Kasich (Ohio), Rick Snyder (Michigan), Brian Sandoval (Nevada) and Asa Hutchinson (Arkansas) in a letter to House and Senate leaders Paul Ryan and Mitch McConnell about the AHCA and their inability to support it.
- Opinion: This father has a daughter with a rare disease in a clinical trial. He doesn’t want FDA regulations streamlined
- Opinion: Nearly everyone in the health care sphere is concerned about the AHCA. Except this insurance company’s CEO, after a meeting with President Trump
- Almost all of health and medicine would suffer cuts under the Trump budget. Except this public health effort, which seems to have presidential support
- These folks are too young for Medicare. But under the AHCA, they may have to postpone early retirement
Thursday, March 16
Trump’s federal budget: Steep cuts to science, health
Under the president’s current budget proposal, released today, the National Institutes of Health stands to lose close to 20 percent of its budget, Health and Human Services could lose about 18 percent of its budget, the Environmental Protection Agency’s cuts could cost 3,200 jobs, and other agencies could see 10 percent cuts across the board. Not touched? Medicare. Getting a boost? Services to combat opioid addiction. Here are how the NIH cuts could play out.
More budget: House Budget Committee advances AHCA
The vote was 19-17. Three Republicans from the House Freedom Caucus voted no on the bill, and all Democrats on the committee voted no. The White House has indicated that it is open to changes in the bill. Speaker of the House Paul Ryan has said he’s open to changes as well. A House vote is expected next week.
Not at all budget: Price defends cuts to Medicaid
In a CNN town hall event, HHS Secretary Tom Price, who has disputed the CBO’s findings on AHCA and the number of people who could lose coverage, ran into some trouble when trying to defend cuts to Medicaid expansions, one of the ways the ACA reduced the ranks of the uninsured. Price’s answer to a pointed question about Medicaid cuts? Doctors won’t see patients on the plan. When given a chance to support vaccine requirements, he also punted, saying it was up to states to require them.
In the tweet of the moment
Combine the administration's harsh climate toward pharma profits with a proposed 20% NIH budget cut…where will new drugs come from?
— David Kroll (@davidkroll) March 16, 2017
She said this
“Evaluating drugs is not the same as deciding whether one prefers Prego or Ragu.”
— Renée M. Landers, former general counsel at HHS, on Scott Gottlieb, the president’s pick to run the FDA and how deregulation of the FDA’s safety and efficacy standards might harm consumers when it comes to figuring out what treatments are best for them.
- What Trump’s budget means for health care investors
- What Trump’s budget means for FDA user fees
- What Trump’s budget means for space science
- What Trump’s budget means for global health
Wednesday, March 15
A letter to governors
One of Seema Verma’s first acts as the administrator of the Centers for Medicare and Medicaid Services was a letter from her and HHS Secretary Tom Price to US governors saying they want to collaborate on “more effective program management” and fast-tracking waiver applications. Among the ideas floated in the letter: premiums, designing emergency room copays to discourage non-emergency use, and ways to pay for opioid abuse treatment.
GOP governors on AHCA
Republican governors are voicing concerns about the Obamacare replacement plan, according to Politico. For some, the number of people in their states who could lose coverage is worrisome. For others, the plan isn’t conservative enough, or doesn’t give states the flexibility they want. Among those expressing concern is Vice President Mike Pence’s replacement, Indiana Governor Eric Holcomb, who says he wants to preserve the state’s Medicaid expansion.
Quote of the day
“I am astonished to hear people suggest that we can solve our heroin crisis by legalizing marijuana — so people can trade one life-wrecking dependency for another that’s only slightly less awful.”
— Attorney General Jeff Sessions, on marijuana as a gateway drug, in prepared remarks on violent crime and a section on opioid addiction and the need for “criminal enforcement, treatment, and prevention” to solve the problem.
Gottlieb and stem cells
FDA commissioner nominee Dr. Scott Gottlieb could have a huge impact on burgeoning fields of biological therapeutics, including the use of stem cells. In general, Gottlieb has spoken out about reducing the FDA’s ability to regulate, and there is some concern that he might apply this logic to biologics. The argument in favor of regulation? Stem cells and treatments therein are easily contaminated; the cells themselves grow and mutate, which could affect their treatment potential; and the stem cell clinic industry, whose products may not be all they are cracked up to be.
- Here’s a list of politicians to watch in the debate over the AHCA
- The “continuous coverage” provision of the AHCA may be headed to the chopping block
- President Trump’s defense secretary says that climate change is a national security issue
Trumpcare and innovation
Much of the talk of health care reform of late has involved “skin in the game,” with the assumption that consumers will make the best cost-related choices in seeking medical care. Forbes takes a look at how this phenomenon could lead to more consumer-based innovation in driving good decision-making, because some studies say that rather than price-shop, people forgo preventive care in the short-term that could lead to big expenses when sickness takes hold later.
- The Trump administration is releasing a budget today that will drastically cut the EPA budget
- Knowing they are under the microscope, drug makers tried to keep price hikes down in January
- Some Medicaid expansions are safe, for now, and some states who said “no thanks” before will now get to buy in
- Two Boston residents ask Tom Price to remember his safety-net hospital roots before dismantling Medicaid and the Affordable Care Act
‘Doing the healthcare’
In budget remarks on Wednesday, President Trump said that the administration would be offering a health care replacement for the Affordable Care Act in March. But his secretary of Health and Human Services, Tom Price, said the administration isn’t, but it’s happy to offer input to Congress as they sort this out. Why does it matter? Republicans have faced angry constituents in town halls, their seats may be up for grabs in 2018, and finding a common replacement that the president will also promote could be a challenge.
‘A pretty perennial topic’
The president has spoken out forcefully about America’s opioid epidemic, and he has cited the crisis as among the reasons he wants to build a wall between the US and Mexico. But at the same time, a recent report said his administration may try to do away with the White House Office of National Drug Control Policy, led by the so-called “drug czar.” Not everyone is worried, though. The office has been the subject of debate ever since it was established nearly 30 years ago.
- Dr. Scott Gottlieb, the leading candidate to run FDA, was once part of an academic-for-hire group that talked up high drug prices
- Rolling back FDA regulations could impact drug safety and approvals in other countries who follow the US lead
- As the March for Science nears, scientists are still debating on whether such an event can be anything but political
- Former Speaker of the House John Boehner says a wide-scale repeal and replace of Obamacare won’t happen
Wednesday, Feb. 22
PhRMA on FDA
President Trump has been vetting people to lead the Food and Drug Administration who could overhaul the way drugs are approved. But Stephen Ubl, CEO of PhRMA, the industry group that represents pharmaceutical companies, says don’t. The way drugs are approved now is the “gold standard.” Rebecca Robbins reports for STAT Plus on a meeting with an industry leader who is trying to revamp an image tarnished by high drug prices.
Medicaid and rehab
In various states, Medicaid expansion under the Affordable Care Act gave people with addictions access to inexpensive, or free, rehab for the first time. The Associated Press reports on a group of about 1.8 million beneficiaries and what they stand to lose should expansions be rolled back and block grants take the place of an entitlement. “I am scared to death to lose my coverage,” says one Pennsylvania woman. “It saves my life every day.”
Number of the day: 53
That’s the percent drop expected for vaccines given through public health programs funded by the Prevention and Public Health Fund, a component of the ACA that might be on the chopping block.
Republicans suing over Obamacare
As insurers debate over whether they will participate in the exchanges in 2018, Republicans are asking a judge for more time to let them decide. This all stems back to a lawsuit filed in the Obama era over how certain Obamacare subsidies to insurers were being paid out. As the Wall Street Journal (among others) reports, Republicans first filed the suit because they said Congress had never authorized the payouts, now about $7 billion, to insurers. In May, a court agreed. Now, Republicans are asking that the injunction be delayed indefinitely, to give them time to find a legislative way to manage the situation. Why does it matter? Insurers say without the the subsidies, they’ll walk, and millions of people could be left with few-to-no individual insurance options.
- Teaching hospitals on immigration policy: We’re unsure whether to accept residents from affected countries
- OPINION: Scientists who are afraid to speak up on anti-science, anti-medicine rhetoric: You owe it to your colleagues
- The CEO of Bayer on drug pricing: It’s all about innovation potential
Tuesday, Feb. 21
When Medicaid equals survival
Medicaid is often considered the safety net for poor Americans, but STAT’s Andrew Joseph heads to Missouri to meet a family for whom the health care program is a lifeline. Nathaniel Rankin, now 4, has a birth defect that has nearly killed him several times. His foster-to-adoptive parents have relied on Medicaid to pay his roughly $5,000 monthly medical bills. They worry what Medicaid reform might bring, and whether cuts to the program will mean Nathaniel will lose his hard-won and essential benefits.
When Obamacare equals innovation
Since the launch of the Affordable Care Act, the American technology sector has benefitted from venture capital for related products, flexibility for people in gig-economy startups, and the ability for entrepreneurs to leave employers and employer-based insurance to found startups. With the act in the crosshairs, tech buffs are wondering what will happen to their companies and the flexibility that allowed many of them to get off the ground. The Washington Post reports.
When an FDA pick equals agency overhaul
Dr. Scott Gottlieb has long been considered the most serious pick to run the Food and Drug Administration, but in an effort to let the nomination process ride out, he’s been shy to talk about what he might do to the agency. John Carroll at Endpoints scours what we know about the potential pick to predict how he might disrupt a regulatory agency responsible for everything from approving drugs to dealing with contaminated food. His first steps? Simplifying generics approvals. His later targets? The agency’s role in pushing health-related apps.
When a missing Treasury equals missing input
While at Mar-a-Lago this weekend, the Trump administration gathered to discuss Obamacare. Except, as Caitlin Owens reports for Axios, no one from the Treasury was at the table. Why does this matter? The Affordable Care Act lives and breathes off imposed taxes on some groups and tax credits on others. Any effort to reform the act would have to account for what would happen to those financial instruments.
- An explainer on the good and bad of Medicaid block grants
- Why a formerly bouncy biotech might now be a great investment
- The president’s doubts on vaccines are fueling an anti-vaccine fire in Texas
- Ten things that might be lost in GOP plans to overhaul Obamacare
Monday, Feb. 20
Rural hospitals and Trump
Rural hospitals are in the very areas that put President Trump in office, but they stand to lose a lot, depending on how the repeal and replacement of Obamacare goes down. Yet, rural hospital administrators and staff seem to be quiet on the issue, according to the Washington Examiner. Not so, say their lobbyists. The folks that provide medical care to much of America are quietly waging their own battle to make sure their voices are heard in the war over health care coverage.
A new EPA chief who doesn’t like the EPA
On Friday, despite a judge’s ruling on releasing his emails with oil and gas companies, and efforts to slow down the confirmation, Scott Pruitt, the attorney general of Oklahoma, became the head of the Environmental Protection Agency. While concerns abound about how he will deal with the regulatory agency regarding fossil fuels, there are also concerns about how he will manage the clean air, water and land use issues that could affect Americans’ health.
The repeal/replace fervor dying down
After the past few weeks of vocal town halls, where Republican lawmakers were taken to task for their role in pushing an Obamacare repeal and replacement, the fervor to repeal quickly seems to have died down. Several lawmakers tell the New York Times that Obamacare has become a bit of a minefield — repeal without a good replacement and constituents who stand to lose coverage will not remember them fondly. In the meantime, efforts to craft a replacement are starting to involve the very insurance companies whose market shares and profits could rise or fall.
Quote of the day
“It’s uncomfortable for me as a scientist, but it’s necessary.”
— Brittany Goods, a postdoctoral student in biomedical sciences at MIT, protesting at a rally for science this weekend in Boston that coincided with a major annual scientific research meeting. Trump has been a constant topic of conversation at the American Association for the Advancement of Science conference, which ends today.
Testing presidents for dementia
Heated language has been used to describe President Trump’s mental health, but what about his neurological health? As presidents get older — Trump is 70, and the oldest president to date — should we be testing them for cognitive decline? Trump’s father, says this NPR story, had Alzheimer’s disease in his 80s, and there has been much speculation that President Reagan developed dementia while in office.
The president steps out for cancer research
Dana-Farber Cancer Institute went ahead with its Mar-a-Lago fundraiser Saturday, despite protests from within the medical profession and the Boston cancer center itself. President Trump made an appearance at the event, which raised more than $2 million. Protests have centered on Trump’s immigration policy but also on the general idea that the cancer institute should not align itself politically by hosting the party at the president’s resort. It’s the third weekend in a row that the president has been at what he’s called the “winter White House.”
- Some of the GOP’s replacement plans for Obamacare could result in higher taxes for people with employer-based insurance plans
- Changing the Affordable Care Act could significantly impact access to health care. Here are some ways this could play out
- The “repeal and replace” movement often pits the role of the federal government against that of the states in providing health care. This report dissects everyone’s roles
- Hospitals are investing in legal expertise on immigration as Trump mulls a new executive order
- India is a major supplier of US generics. Here’s how their companies are thinking about Trump
- With repealed regulation and a pharma fervor to acquire, biotech could have a fantastic financial year
Friday, Feb. 17
STAT is at the AAAS Annual Meeting, the largest gathering of scientists, science policy experts, and science communicators in the US. On the agenda today? Everything from gene editing to robotics to information and public policy. But no matter where STAT has gone at the conference, the role of science in sound policymaking is front of mind.
For more on AAAS sessions, which go through Monday, see #aaasmtg or #aaas2017 on Twitter. Here are a few highlights of the Friday morning sessions.
Draining the swamp
During a session called “Science Policy in Transition: What to expect in 2017 and beyond,” Dr. Robert Cook-Deegan, a noted genetics ethicist and former federal scientist, said this about Trump’s claim that he would “drain the swamp” in Washington.
Government agencies and scientific ethics
In another session on gene editing and ethics, Gary Marchant of Arizona State University addressed the issue of ethics, science, and the role of government: He suggested bringing Congress into the ethics debate (people laughed nervously), using presidential bioethics commissions to discuss the morals and consequences of new technologies, bringing back the now-defunct Office of Technology Assessment, and even creating a whole new agency on new technology and ethics.
Why we need science advisers
In a session about scientific evidence and its role in public policy in Canada, noted bad health claim debunker Tim Caulfield said this afterward about Trump and science: “He’s really bought into this idea that we can’t trust science, full stop — that we should be suspicious of the voices of science, and I think that, on the broader scale, is probably more damaging.”
Caulfield talked about vaccine safety and the role of the FDA in the US in giving people safety and efficacy information. “It’s all about trusted sources passing along good science,” he said. Other panelists, including Rémi Quirion, chief scientist of Quebec, stressed the importance of chief scientists in promoting evidence-based policy. Trump has yet to name a science adviser.
- We may have an ACA replacement by sometime in March
- At a press conference Thursday, the president said Congressman Elijah Cummings skipped a meeting to talk drug prices. Here’s how Cummings responded
- Tom Price was criticized for stock purchases in an Australian biotech, but what about the congressman who was said to have introduced him to the stock?
Thursday, Feb. 16
A new chief for Medicaid and Medicare?
Seema Verma, a consultant who helped Indiana, among other states, revamp its Medicaid program under the Affordable Care Act, is in the middle of a Senate confirmation hearing to be the new chief of CMS. While being questioned by Senator Debbie Stabenow of Michigan, STAT reporter Lev Facher said Verma voiced support for women to be able to buy insurance plans that do not include maternity care. Before the ACA, maternity coverage was often a policy add-on that some critics said unfairly added to women’s health insurance expenses. Verma has been praised and criticized for her role in privatizing parts of Medicaid in several states. Here’s STAT’s story on Verma’s work in Indiana, and a First Opinion about whether her state programs can translate to national ones.
Fact-checking Trump on vaccines and autism
The Associated Press takes a look at President Trump’s statement this week on the prevalence of autism. On Tuesday, he said that it was “really a horrible thing to watch the tremendous amount of increase.” Have diagnoses increased? Yes, but for nuanced reasons. Why should you care? The president has tweeted about “doctor-inflicted autism,” and has linked vaccines to autism in another tweet. He’s also met with noted anti-vaccine advocate Robert F. Kennedy, Jr., who has said more than once that the president is putting together a vaccine safety committee.
He said this
“Trump should start a drug company. I would be proud to help implement this.”
— Martin Shkreli, during a controversial talk Wednesday night at Harvard University, as a proposed solution for high drug prices
Trump and Netanyahu meet
President Trump met with Israel Prime Minister Benjamin Netanyahu Wednesday. The US and Israeli economies are tightly linked, including in the biomedical sphere. Israel’s Teva Pharmaceuticals, for instance, is one of the largest generic drug companies in the world and trades on the New York Stock Exchange. It’s valued at more than $1 billion US. Here are some other numbers:
- 6.7 billion: total estimated import value of pharmaceuticals and medical instruments from Israel.
- 1,380: the number of life sciences businesses registered by the Israeli government.
- OPINION: The IRS’ quiet rule change on reporting for the ACA mandate is a first step in fulfilling Trump’s regulatory burden order
- GOP leadership meets with House Republicans to talk replacing Obamacare
- The leadership of the largest science organization in the US on scientists and Trump: ‘Do not retreat to the microscope’
- Think you know your ACA? Take this quiz
Wednesday, Feb. 15
The vaccine safety committee: Still on?
According to Robert F. Kennedy, Jr., yes. He announced his participation in a yet-to-be formed panel a few weeks ago, but the Trump administration said the panel wasn’t certain to happen. On Wednesday, alongside Robert De Niro, Kennedy talked about vaccine safety. De Niro has a son with autism. The actor had this to say about Trump.
Cleveland Clinic CEO — and Trump adviser — speaks
Breaking his silence about his role as a presidential adviser, Cleveland Clinic CEO Dr. Toby Cosgrove talks to STAT’s Casey Ross about the immigration ban, the clinic’s upcoming fundraiser at Mar-a-Lago, and his thoughts on the effort to “repeal and replace” the Affordable Care Act. Spoiler alert: He (among others) doesn’t think a full repeal and replacement will happen.
Number of the day: 50,000
The approximate number of people in Tennessee who will be left with zero options for the insurance exchange after Humana announced Tuesday it would be pulling out of the program.
Changes to ACA open enrollment
In another sign of the complexity of repealing and replacing the ACA, the Trump administration wants to cut the open enrollment period by about six weeks, and make it harder to enroll in the event of a life change. A proposed rule is meant to alleviate insurer fears, CNBC says, and the current acting head of CMS thinks the rule is fair, but the former head of CMS, Andy Slavitt, strongly disagrees. Public comment is open until March 7. Seema Verma, Trump’s nominee to lead CMS, will appear for her confirmation hearing on Thursday.
- Pharma worries that if FDA approvals stringency is relaxed, insurers won’t cover new drugs (Reuters)
- More psychiatrists are debating President Trump’s mental health (Scientific American)
- Trump may not be able to do much about drug prices (National Review)
Tuesday, Feb. 14
The VA’s new leader
The Senate voted 100-0 to confirm Dr. David Shulkin to be the new secretary of Veterans Affairs. The question is, how will he fix the system that President Trump has vowed to repair? He’s said no to full privatization, and has praised the VA in the past; Trump on the other hand has said the agency is “the most corrupt.” Shulkin is the first non-veteran to get this role, and has been earnest in his call to be fired if he can’t do the job.
A global health message
The Gates Foundation released its annual report this Valentine’s Day as a letter to major contributor Warren Buffet. As STAT’s Helen Branswell (@helenbranswell) reports, the letter talks about successes in vaccine and family planning work. Trump has voiced his concerns about vaccine safety andrecently ended US contributions to international aid agencies that discuss abortion. The letter could be seen as a subtle message to the Trump administration about the importance of global health and international aid.
Number of the day: 67
The percent of people polled by the Kaiser Family Foundation who said their top health priority is lower individual costs for health care. Kaiser Health News takes a look at four talking points the GOP is using in its efforts to repeal and replace.
Town halls and Obamacare
In fiery speeches reminiscent of Tea Party protests against the Affordable Care Act, several Republican legislators found themselves the target of angry constituents during town halls that ended up as referenda on Obamacare. The New York Times delves into recent meetings, shouts of “do your job,” and a Republican Party that has few answers for myriad questions about Americans and their health care coverage.
In the meantime, a group of progressive health care professionals is planning protests on Feb. 25 at the offices of local GOP politicians.
- These doctors talk about Dana-Farber Cancer Institute, its relationship with President Trump and Mar-a-Lago, and becoming politically active
- With two big insurance mergers failing, how will the Trump administration approach antitrust work?
- As efforts to repeal and replace Obamacare slow down, universal health care may find its way back into conversation
- Insurers weigh in what they want during repeal and replace: keep the mandate and the subsidies, lose the taxes
Monday, Feb. 13
My funny #healthpolicyvalentines
Just in time for Valentine’s Day, health policy experts, analysts, and yes, journalists, have taken to Twitter to link our national day of love to our national interest in health care. Some of our favorites? Here. Here. And here. Many are using the hashtag to talk about the ACA repeal, but also things that new HHS leader Tom Price will have a say in, like value-based care and cutting health care spending. As the famous song says (sort of)…#healthpolicyvalentines ? ? ?…you make us smile.
Tom Price in charge
Now that he’s been sworn in as Secretary of HHS, Tom Price has wide latitude to go after parts of the Affordable Care Act. The Wall Street Journal asks, though, how quickly will he act? Administrative rules are apparently in the works to shore up the federal health insurance exchange, and in his first memo to staff, Price talked about working to ensure “affordability, accessibility, quality, and responsiveness” in changes to come.
She said this
“Hiding information and making it more difficult for consumers to learn about the Affordable Care Act and what it means in their lives is just the latest in a string of efforts by the Trump Administration to sabotage the health-care law.”
— Lori Lodes, former communications director for the Centers for Medicare and Medicaid Services, on efforts to remove positive language about Obamacare from hhs.gov and healthcare.gov
Insurance in a Trump era
The GOP is gunning hard to dismantle the Affordable Care Act, but first, they are trying to shore it up, says the New York Times. Their primary target is the health insurance exchanges. Many pundits and politicians have pointed out that without a mandate, insurers have little incentive to stay in the exchanges. Should constituents lose their insurance, Republicans fear they themselves will be excoriated, and both the administration and House Republicans appear to be willing to address this.
In the meantime, NASDAQ takes a look at what the health insurance industry faces under a Trump administration, with merger efforts, waiting for a replacement for ACA, the pending end of some regulations, and what will happen to Medicaid and Medicare. The bottom line? Sure, there will be hurdles, but things aren’t as dire as some people say they are.
- This man may be our new drug czar
- Dentists deal with a lot of mercury in cavity fillings. A regulation controlling its disposal was just rolled back
- Eli Lilly was looking to upgrade its facility in Ireland. That’s been stalled, and Irish politicians are blaming Trump’s protectionism
- Changes to Medicaid could affect education funding
Friday, Feb. 10
Tom Price squeaks through
In what Axios reports was the narrowest margin of approval for any recent HHS nominee, Congressman Tom Price became the head of Health and Human Services overnight. Price was an orthopedic surgeon and ran a successful practice in metro Atlanta before entering politics. Many expect his first prominent battles will likely have to do with Obamacare and changes to Medicare, but HHS also oversees child welfare and numerous public health programs, including the CDC, health care and quality research, and a disease and toxics registry. What might happen to those programs is less clear.
The travel ban and humanitarian medicine
While the federal court system debates the validity of President Trump’s travel ban, the Houston Chronicle reports on this US doctor, an Iranian national who goes home to perform fetal surgeries that no doctor there can do, and how by Skype, he had to cancel his latest mission for fear his team would not be able to come back.
How Gorsuch might affect health care
What is the Administrative Procedures Act and what does it have to do with Trump’s SCOTUS pick? Legal and policy types take a look at different ways Judge Neil Gorsuch might affect health care if sworn in, including how he might rule on health agencies’ rule-making, how he might interpret the relationship between the courts and federal agencies, and more.
Pharma’s potential shopping spree
Trump has told drug makers that they’ll get a tax cut if they “repatriate” money that was stashed overseas. So what would companies do with those billions? STAT’s Damian Garde says acquisitions. Lots and lots of acquisitions. He also reviewed what happened last time the industry got a tax holiday. What he found: laid-off workers.
- This family fled Syria and sought care for their child’s rare disease in the US. They worry that presidential orders may send them home
- This insurer took part in Obamacare. Now a court has ruled the government owes them millions
Correction: An item in Wednesday’s Trump in 30 Seconds referred to AARP’s threat to sue incorrectly. The agency threatened to sue if the administration made certain changes to Obamacare, not Medicare.
- Employers worry about what an ACA replacement will do for job-based insurance plans
- The first jobs report under the Trump administration was released today. Here’s what’s happening with health care
- OPINION: There are protections in the ACA for people with crippling diseases. We need to keep them
Thursday, Feb. 2
Private care for veterans?
Despite President Trump’s call to privatize veterans health care, and the support of Republicans in Congress, Trump’s pick for Veterans Affairs secretary says no, that’s not going to happen. Dr. David Shulkin, the current undersecretary of the veterans health care system, has promised to reform an agency embroiled in scandal. If he can’t do it, he told the Senate Committee on Veterans’ Affairs during his confirmation hearing on Wednesday, “you should replace me.”
He said this
“No one wins in a trade war. Period. We’re selling airplanes and software. We’re buying fruit and shoes.”
—Chart Westcott, a biotech investor from Dallas, on President Trump’s trade talk at a Koch-sponsored retreat.
America’s medical future
Trump’s immigration ban, imposed last Friday, is making medical students nervous. Match Day is just around the corner, and every year, hundreds of foreign medical graduates apply for coveted opportunities to train and serve patients in the US. For those coming from the seven countries included in the executive order, there is fear that medical schools will bypass them, not because they aren’t qualified, but because their ability to get here and stay here is up in the air. The ban is also predicted to have a chilling effect on biomedical science — one of the visas quietly revoked on Friday was that of Samira Asgari, a tuberculosis researcher from Iran who was supposed to work in Boston. In the meantime, President Trump is hanging onto President Obama’s doctor — Dr. Ronny Jackson, a rear admiral in the US Navy.
- Don’t know what you’ve got till it’s gone — Obamacare, on the brink of repeal, is more popular than ever
- US health care and international doctors: often, foreign doctors go where American-born doctors won’t
- Here are all the health-related organizations planning soirees (and possibly dealing with protests) at Trump’s Mar-a-Lago resort in Florida
Correction: An item in Monday’s Trump in 30 Seconds about hospitals and foreign-born staff had a tweet from a health IT executive linked to the word “insurance.” The URL should have been attached to “health IT.”
Wednesday, Feb. 1
Price is on his way
The Senate Finance Committee confirmed Tom Price to lead HHS today, bypassing a rule requiring at least one Democrat be present for a vote. But will he stick to what he said during his confirmation hearing last week about adhering to science in decision-making? ProPublica writes today about Price’s objections to a US Preventive Task Force recommendation on reducing certain cancer screenings. Price disagreed. Why it matters? The task force’s recommendations typically guide insurance coverage, and fewer screens means fewer payments for doctors, a group Price has typically looked out for.
Scientists on immigration
President Trump’s immigration ban has scientists marching, but also refusing to peer-review articles in US-based journals and go to conferences in the US. Will it have any impact? STAT’s Watchdogs, Ivan Oransky and Adam Marcus, take a look at the petitions and letters and callouts from a world that does not often take a political stand.
He said this
“I don’t care what they want at this point.”
— Utah Senator Orrin Hatch, chair of the Senate Finance Committee, on the Price vote and Democrats’ request for more information on Price and Treasury nominee Steve Mnuchin
Blowing up the FDA
President Trump has repeatedly said that the FDA needs to be overhauled. He’s talked about speeding up drug approvals and reducing regulations — he’s vetted possible FDA heads who want to put drugs to market before we know they are effective. But, outside the White House and Capitol Hill, is there anyone who agrees with this? STAT’s Damian Garde takes a look.
- Pharma execs talk about adding jobs — but only after several years of cuts (Endpoints)
- Trump’s SCOTUS nominee has strong views on assisted suicide. He’s shot down the contraception mandate. But what about abortion? (STAT and Slate)
- Trump’s immigration ban will hurt hospitals and the country’s doctor shortage (Scientific American)