ere’s the latest on what the Trump presidency means for health, hospitals, drug companies, and medical research.

Thursday, April 27

A vote this week?

Probably not, as Democrats hold funding the government over Republican heads. The question, as ever, though, is will the GOP have the votes? The changes offered to the bill essentially give states more leeway in how they broker health care.But, as with the last go-round, people aren’t pleased: this time, centrists, providers, and patient advocates  — if you’re healthy, you’ll do better, but if you’re not, you’ll likely pay more, for possibly less.


In the tweet of the moment

After postponing his vote, on Thursday, the Senate HELP committee voted in favor of FDA commissioner nominee Scott Gottlieb, sending the candidate to a full Senate vote sometime soon. But the vote came with a little drama — some of the Republicans needed to move Gottlieb along had to be hunted down.

He said this

“I think one of the biggest people to blame for the failure of the health care bill was me.”

— Budget director Mick Mulvaney, on the AHCA and his assertion that he misread the divide between GOP moderates and the far-right

Number of the day: 4,000

The number of health care jobs at the VA that may go unfilled, even as President Trump lifts the federal hiring freeze. The vacancies are all part of a plan to encourage veterans to seek private health care.

Read on

  • It looks like insurer subsidies, once a sticking point for insurers staying in the market, are safe for now
  • A long-shot proposal would bring universal, government-based coverage to Californians
  • President Trump said health care reform would be quick. Here’s why it hasn’t been

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Wednesday, April 26

Today in health care reform

You can’t please all of the people all of the time. As a new bill works it way off of congressional computers, what makes the Freedom Caucus happy (letting states opt out of some ACA guarantees) is bound to irritate the Tuesday Group. Even when a Tuesday Group co-chair is helping negotiate. A few no votes are turning to yes, but some Americans may bristle when they see that Congress’s mandated individual market health plans are exempt from some of the major cuts written into the new proposal.

Number of the day: 80

That’s the amount per premium dollar that the industry group representing health insurers says goes to paying for health care. But this analysis of the report, from JAMA Forum, raises red flags. The number is simplistic, and if the Affordable Care Act is repealed, that number will surely drop.

Today in confirmation hearings

The Senate HELP committee was supposed to vote today on FDA nominee Dr. Scott Gottlieb, but it’s been postponed until tomorrow. Criticism still swirls about his ties to industry, including this nugget about his role, while at the FDA, in helping a company being investigated for pushing opioid drugs get more fentanyl for a pain-relieving lollipop. Still, it is expected that he will get enough votes to head to the Senate floor for a full confirmation vote.

She said this

“I’m feeling optimistic, but I want to see it in writing.”

— West Virginia Senator Shelley Moore Capito, on efforts to shore up a health care fund that benefits coal miners. The president, who had the support of many voters in coal country, has remained silent on the issue.

Today in nominations

President Trump’s pick to run the nation’s mental health agency is causing a stir. Dr. Elinore McCance-Katz, former chief medical officer of SAMHSA, the Substance Abuse and Mental Health Services Administration, is President Trump’s nominee to run the agency as assistant secretary for mental health and substance use. The position was created under the 21st Century Cures Act by Pennsylvania Congressman Tim Murphy, who said (he had another candidate in mind) she’s a bad pick because she was at SAMHSA when it being investigated for wasteful spending. Advocates like her because, for one, she believes in medication-assisted treatment for addiction. After leaving SAMHSA in 2015, she was highly critical of the agency, saying it didn’t do enough to directly treat psychiatric illnesses.

Read on

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Tuesday, April 25

Today in health care reform

About half of Americans in one poll aren’t convinced that the GOP effort will make anything better, President Trump says we’re close, but Paul Ryan says we need to focus on the government shutdown first. And moderate Republicans are being rather quiet about a bill in the works that could end a lot of consumer protections afforded by Obamacare.

She said this

“Hi, my name is Dana from the University of Maryland. Would you take a quick survey on my tablet, please?”

— Sociologist Dana Fisher, who conducts research on protests, at the March for Science last Saturday. She’s trying to understand if the March for Science, the Women’s March, and the upcoming climate march are indicators of a 1960s-style movement against President Trump or the work of seasoned protesters.

Number of the day: $2.3 billion

That’s the increase in federal costs for 2018 if cost-sharing subsidies, which insurers use to offer lower deductibles and copays to some people in the individual market, are taken away.

Read on

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Monday, April 24

A march in April

On Saturday, all over the world, people marched for science. The marches were political — organizers said they were by no means partisan, but anti-Trump messages were clear at some rallies. People marched for many reasons, including this woman, who said science saved her life. The president, for his part, said Saturday he would not forsake jobs in protecting the environment.

He said this

I would never willfully abandon my commitment to my Commissioned Corps officers, to the American people, and to all who have stood with me to build a healthier and more compassionate America.”

— Dr. Vivek Murthy, former surgeon general, on why he refused to resign his post. He was fired on Friday and replaced by Rear Admiral Sylvia Trent-Adams, a nurse.

A research summit in May

Vice President Mike Pence and a host of other Trump administration officials are meeting with biomedical research leaders from government, academia, and industry on May 8 to talk shop. The summit is presumably an effort to save federal funding for basic medical research — President Trump has called for cutting about $1.2 billion in funding this year and close to $6 billion in funding for 2018.

Number of the day: 35

That’s the percent of the nation’s job growth since 2007 that has come from health care. President Trump’s job creation platform would seem to be a good fit for the health care sector, which has benefited many American cities hit hard by the recession, but promises to repeal Obamacare are what some industry experts call “incompatible” with his job creation goals.

Read on

  • Kentucky’s Medicaid reform proposal includes a rewards program that would earn recipients their benefits
  • With a government shutdown looming, President Trump is lobbying hard to revive health care reform
  • With health care reform in limbo and deadlines approaching, states are looking to appease skittish insurers
  • Human civilization exists because of climate conditions. Changing those conditions could wreak havoc on human health

Friday, April 21

Today in health care reform

President Trump’s first 100 days in office are coming to a close, and the White House is pressuring Congress for another go at repealing Obamacare ASAP to get a win under its belt. But it’s not clear what’s going to be in the revamped bill or if any proposed changes — changes to community rating, invisible risk-sharing, etc. — will please the various GOP factions who were dissatisfied with the first go-round. All this is happening with the backdrop of a government shutdown.

Science in the White House

A White House official said the annual science fair, started during the Obama administration, will continue under President Trump. No date has been set, but the news comes a day before the March for Science in Washington, D.C., and satellite marches all over the country. It’s an interesting move for the White House, as Trump still has not appointed a director for the Office of Science and Technology Policy and has proposed cutting billions from the budget of the National Institutes of Health.

Tweet of the day

Number of the day: $44 billion

The total value of pharma and biotech acquisitions in the first quarter of 2017, a drop of 13 percent from the previous year. Bloomberg says President Trump’s drug pricing rhetoric is partly to blame.

Read on

  • Visa reform could affect the hiring of doctors (Kaiser Health News)
  • Some states are extending deadlines for insurers to submit 2018 rates (Modern Healthcare)
  • The FDA had plans to release 100 draft guidances this year, but has so far only released six (MassDevice)

Thursday, April 20

Today in health care reform

The bell is about to ring for the end of congressional recess, and health care reform looks to be back on the table. Politico reports that a new deal is in the works to give states more flexibility to opt out of different parts of Obamacare, while, at the same time, keeping provisions on preexisting conditions. It’s not clear if this plan will sway any Republican votes, but both centrist Republicans and tea party leaders have had their hand in it, and Vice President Pence believes the deal will be done.

He said this

“There’s a rumor that he is going to do something in that area. But maybe I and others will convince him that that’s not worthwhile.”

— Microsoft cofounder Bill Gates, on President Trump and a possible vaccine safety inquiry, in an interview with STAT’s Helen Branswell (@helenbranswell).

Number of the day: 428,000

The number of veterans under the age of 65 who got health care coverage through the Affordable Care Act between 2013 and 2015 but who may not have been eligible for VA services. This represents a 40 percent drop in veterans being uninsured, from 9.6 percent to 5.9 percent. On Thursday, President Trump signed a bill extending some veterans’ ability to use private health care providers.

Paying to party

Drug makers Pfizer and Amgen and health insurers including Anthem and Aetna gave heavily to gain access to the Trump administration, Federal Election Commission documents show. Kaiser Health News reports that the money paid for the inauguration, candlelight dinners, and black-tie balls. Tobacco companies, interested in expanding their vaping footprint, also gave handily. These gifts come as the president has vowed to lower drug prices and his administration has been unclear whether cost-sharing reductions will be paid to insurers.

He said this

“I think that the march is a bad idea. It threatens to undermine the objective nature of scientific research that is so critical to its integrity.”

— Postdoctoral researcher Arthur W. Lambert, at the Whitehead Institute for Biomedical Research in Cambridge, Mass., on why he won’t participate in the March for Science on Saturday, seen by some as political action against anti-science decision-making out of the Trump administration

Read on

Wednesday, April 19

No assurances

Insurance executives met with CMS Administrator Seema Verma Tuesday, and left without knowing whether they’d be getting cost-sharing reductions for 2018. According to the Washington Post, Verma referred the conversation to Congress. CSRs, as we’ve noted before, are Obamacare subsidies paid to insurers to help offset the out-of-pocket costs for lower-income people on the exchanges. The payments are being argued about in court, and while some people say that without them, the individual market will collapse, we noted Tuesday that insurers may cautiously stay in the market.

She said this

“It’s become increasingly difficult over the past few decades for scientists to call themselves Republican as part of their core identity. The Republican party has been moving further and further away from recognizing the neutrality of science. Now it’s reached a peak.”

— Katharine Hayhoe, an evangelical Christian and atmospheric scientist at Texas Tech University in Lubbock, on being a conservative academic.

The pressure is on

During a speech Tuesday in Kenosha, Wis., President Trump urged his audience to talk to their members of Congress about health care reform and repealing the Affordable Care Act. He has previously said he wants to push through health care reform before tax reform, and believes, despite what his Treasury secretary says, it can be done by August.

Corporate cash

Pharma is second only to tech in the amount of money companies have stashed overseas. Both industries, and others, are waiting for promised tax relief to bring the dollars back stateside. But the money will likely do little to help job growth, CBS says. Instead, it will go toward mergers, stock buybacks, and higher dividends.

Read on

  • How the ankle replacement industry (and, some say, HHS head Tom Price) might benefit from a proposed Medicare payment rule
  • Consumer advocates want the Trump administration to make it easier to get a costly prostate cancer drug
  • President Trump signs an executive order to reform the H-1B visa program, which could impact life science hiring
  • Who are the different groups of people going to the March for Science? For one, journalists, including STAT. Talk to us

Tuesday, April 18

Tax reform vs. health care reform

Efforts to reform health care, which continue to start and stop under President Trump, will almost definitely push back tax reform, said Steven Mnuchin, the US Treasury secretary. The original goal was August, which was “aggressive,” Mnuchin said. Trump has said that health care reform will make tax reform easier, and is pushing ahead.

He said this

“We spend a lot of time looking at media and social media to see if we can glean any useful information.”

— Kirk Zimmer, executive vice president of Sanford Health Plan, which serves the Dakotas, on what role the federal government will play in the individual health insurance marketplace in 2018. Some companies have just a few weeks to decide whether to participate in the exchanges for the next year and to set prices for plans. While there are concerns that some companies will bow out because of uncertainty out of the White House, in general, insurers say they will stay in the market. The question is how much plans will cost consumers. Insurance executives are slated to meet with the Trump administration today.

Deregulating hospitals

A proposed rule that was released on Friday by the Trump administration is asking hospitals that are owned by doctors to comment on their role in health care and their thoughts on regulations that apply to them. Modern Healthcare says that for-profit and nonprofit hospital trade associations have lobbied against physician-owned hospitals because of what they call cherry-picking high-profit clientele, such as in orthopedics. Industry groups that support physician-owned hospitals see these requests as a way to prove their worth.

Number of the day: 3 million

The price tag on the ad campaign being run by Trump supporters America First Policies to garner support to repeal Obamacare.

Read on

  • President Trump is expected to sign legislation on Wednesday to extend a program that allows veterans to seek private health care
  • Wisconsin is looking to expand Medicaid, so long as some adult recipients can be drug tested
  • EPA chief Scott Pruitt’s predecessor outlines why cuts to EPA programs are cuts to public health

Monday, April 17

Concerns about opioid promises

During his campaign, President Trump said he would expand access to treatment for people suffering from opioid addiction, but experts are worried he’s opting instead for tough-on-crime policies. The president’s opioid commission is calling for more study — but people who treat addiction say the problem is pretty well-defined. They point to actions to curb National Institutes of Health funding and a lack of action on prescription opioid makers as further evidence the president is turning away from his campaign platform.

The March for Science: More than just Trump

Lydia Villa-Komaroff may not be a household name, but the research she did in the 1970s helped spawn an entire US industry — biotechnology. She’s an honorary co-chair of the March for Science and talks with STAT’s Pat Skerrett about the sentiments behind it. Lack of support for science and budget cuts existed long before President Trump, she said, even if he sparked the fire that led to the march. And while the march tends toward progressive participation, she knows many conservative scientists who support the march, and many liberals who aren’t sure the march will change anything.

Tomorrow is tax day: Do you have insurance?

Tax returns are due tomorrow, and with it, fines for not having insurance. It’s called the “shared responsibility payment” and not everyone who is uninsured has to pay it. Last year, the IRS says, about 6.5 million people paid an average of $470. Who leads the pack in paying the fine? Texas, with about 1 million returns filed in 2015 showing a fine.

Read on

  • Fact check: What members of Congress say about where their health care comes from and who pays for it
  • Health and taxes: The president’s renewed push on health care underlines the complicated relationship between it and tax reform
  • Market stabilization: A proposed rule that insurers like but consumer groups don’t could affect the individual insurance market in these ways

Friday, April 14

Mar-a-Lago is missing

Dana-Farber Cancer Institute holds a yearly fundraiser at Mar-a-Lago, President Trump’s resort in Florida, and this year was no different. Almost. For the first time, the cancer center’s newsletter, which has a write-up of the event, has no mention of Mar-a-Lago, no mention of the president, who attended this year, and no pictures including him. The decision might have to do with the president’s immigration orders, the effect such orders had on medical personnel traveling to the US immediately after, and backlash the institute received for not canceling the event. Dana-Farber has said it will avoid controversial venues in the future.

Ensuring insurer participation

With the president threatening to hold insurer payments hostage to bring Democrats to the table to negotiate health care reform comes a rule enacted on Thursday to try and stabilize the individual health insurance market. The rule shifts costs away from insurers and shortens the open enrollment period for 2018, satisfying some insurer demands, but causing worry for those that say people will buy fewer plans as a result.

He said this

“This action is another example of EPA implementing President Trump’s vision of being good stewards of our natural resources, while not developing regulations that hurt our economy and kill jobs.”

— EPA chief Scott Pruitt, on a decision Thursday to postpone compliance deadlines for an Obama-era rule regarding arsenic and mercury ending up in public waterways. The rule would affect power plants and coal producers, among others. Arsenic exposure can cause organ toxicity and mercury is a potent neurotoxin.

She said this

“Trump’s decision to attack our right to clean water on behalf of coal executives is just another indication of who this administration works for — and it isn’t American families.”

— Mary Anne Hitt of the Sierra Club, in response to Pruitt. Hitt said that more than one-third of coal-powered power plants discharge wastewater within five miles of drinking water intakes from downstream communities. She also said the administration was ignoring peer-reviewed research on the effects of heavy metal exposure.

Read on

  • Conservationists and politicians sue to stop the border wall until an environmental impact assessment is done on health and ecological impact
  • A new survey finds scientists are wary of FDA nominee Dr. Scott Gottlieb’s ties to industry and are concerned about the effect of budget cuts to the NIH

Thursday, April 13

You can never go home again

Especially if you’re a Republican on recess during a political fight over health care. Especially if you represent more purple places in the US. Especially if you decide to host a town hall. As Axios reports, siding with Trump over Trumpcare can get you booed, and not just from Democrats. It can earn you serious opposition in an upcoming election. It can earn you angry TV ads and put you on the spot on your commitment to sparing preexisting condition coverage. And, as we mentioned Wednesday, for this congressman, it can get one of your most famous moments as a politician thrown back at you.

She said this

“Carbon dioxide is not a pollutant, and carbon is certainly not a poison. Carbon is the chemical basis of all life on earth. Our bones and blood are made out of carbon.”

— Kathleen Hartnett White, director of the Texas Public Policy Foundation’s Armstrong Center for Energy & the Environment and former Texas state official, on whether carbon dioxide should be regulated as part of climate change. The climate change skeptic is in the running to lead the White House Council on Environmental Quality.

He said this

“Think of President Trump as the Martin Luther King of healthcare. ”

— CNN political commentator Jeffrey Lord, during a Thursday morning television appearance. He went on to say that the president’s effort to garner congressional support for the repeal of Obamacare was similar to the work of the civil rights leader in promoting equal rights legislation seen as unpopular during its time.

A sword over their heads

The battle over insurer subsidies continues, as President Trump has said he will stop paying them as a way to get Democrats to bargain on the Affordable Care Act. To be clear, these aren’t the subsidies people get to buy policies, but payments that the federal government gives insurers to offset losses from reduced copays and deductibles in some plans. Congress has sued to stop the payments, and a judge upheld its claim. In the meantime, though, the payments continue. For their part, however, top Democrats aren’t biting.

Read on

Wednesday, April 12

A new drug czar

Reports have surfaced that President Trump may be close to picking a drug czar. Tom Marino, a congressman that represents a chunk of northern Pennsylvania, appears to be getting the nod. Marino is a former prosecutor and author of an Obama-era law that was supposed to increase coordination between the Drug Enforcement Administration, pharmacies, and distributors regarding prescription drug abuse, but instead has been charged with limiting the DEA’s ability to shut violators down.

He said this

“We’re going to have a phenomenal tax reform, but I have to do health care first. I want to do it first to really do it right.”

— President Trump to Fox Business Network on Tuesday. This is a change of course for the president, who, after the failure of AHCA, said he would turn his attention to tax reform while waiting for Obamacare to fail.

Forensic junk science

When President Obama convened a panel of scientific advisers to investigate some of the different forensics techniques used as courthouse evidence, the goal was to identify best practices, says the Atlantic. There were multiple ways to analyze bite marks, blood spatter, and the like, and there were concerns that poor methods were putting the wrong people in jail. The findings were never acted upon, and with Attorney General Jeff Sessions disbanding the committee, it’s unclear what will happen to the burgeoning and sometimes troubled field of forensic science.

Read on

Tuesday, April 11

A long and winding road

Scientists are concerned about federal efforts to determine whether basic research is “in the national interest.” Some discoveries seem far removed from life-changing breakthroughs, but scientists argue you can’t know what early discoveries will save lives. Ike Swetlitz takes a look for STAT Plus at some basic research findings, and the medicine they helped spawn. One of the discoveries? An enzyme from geyser bacteria that allows researchers to copy DNA. Without it, we might not have some of the drugs and biologics we have now.

The power of uncertainty

One of the ways that the Trump administration can hasten the fall of Obamacare is through uncertainty. Insurers have a few more weeks to decide whether they want to participate in the individual marketplace for 2018, but it may not be clear that they will get what they want in return — payments from the government that the Trump administration and House Speaker Paul Ryan say will happen, but whose existence is being battled over in court.

Housing as health care

Health care providers across the nation are trying their hand as housing developers, with the idea that giving people who are homeless and chronically ill a place to live might give them the stability to manage their diseases. But many of these housing developments rely on government subsidies and tax credits through the Department of Housing and Urban Development. Patients and providers both fear the loss of health-related gains should deep cuts proposed for housing programs happen.

He said this

“The only effective way of addressing climate change is to make the price of fossil fuels include their cost to society.”

— Climate scientist James Hansen, on the demise of the Clean Power Plan and what he thinks (as do some Republicans) would reduce carbon emissions — a fee that fossil fuel companies pay that is repaid to the public as a dividend.

Read on

Monday, April 10

Behind the hearing, Gottlieb edition

Many people are praising Dr. Scott Gottlieb’s performance on Wednesday during his confirmation hearing with the Senate HELP committee. In his responses, says Endpoints News, are a few less obvious things that Gottlieb would do as head of FDA. Gottlieb is likely to promote different ways to do clinical trials, but still with an eye toward safety and efficacy. He’ll also likely look at complex generic drugs and drugs for rare diseases.

He said this

“Asking the NSF to certify that what they do is in the national interest is like asking the Defense Department to certify that what they do is in the national interest.”

—  Jonathan Moreno, a professor of medical ethics and health policy at the University of Pennsylvania, on calls by Republicans, including Representative Lamar Smith, to verify that what the National Science Foundation funds is in “the national interest.” The language was written into the law that created the agency, but has been recently brought back up in efforts to examine the agency’s spending.

Trump effect, Kansas and Georgia edition

Outside of Washington, some elections are raising eyebrows as possible rebukes for Trumpcare. The Tuesday special election for the House seat representing the 4th District of Kansas could be the first test of GOP popularity in the US after the failure of the AHCA. The Democratic candidate seems popular, and the GOP governor vetoed efforts to expand Medicaid, so key Republicans have descended to stump for the Republican candidate. The Democrat running to take over HHS Secretary Tom Price’s seat in Congress in Georgia has raised large sums of money and appears to be doing well in early voting.

Read on

Friday, April 7

Fallout in the GOP over the failure of health care bill

Congress has left town for its spring recess. Before lawmakers scooted, House Republicans proposed setting up a federal insurance pool for those with serious and expensive medical conditions. But there is reportedly growing tension between the White House and GOP lawmakers, and administration aides are under pressure to help the House deliver another bill soon.

Protecting US leadership in medicine

The Trump administration has proposed cuts to the budget of the National Institutes of Health, and Tom Price, the secretary of health and human services, has argued that there are plenty of savings to be had. But in a new op-ed, a former president of MD Anderson Cancer Center says that failing to invest in NIH “will have long-term consequences for America’s leadership in biomedical research in the 21st century.”

A matter of time

Dr. Tony Fauci, director of the National Institute of Allergy and Infectious Diseases, said it’s only a matter of time before the Trump administration has to confront a major disease outbreak. “Absolutely something is going to happen,” he said. Why? According to Fauci, every administration in modern history has had an outbreak on its watch.

Quote of the day

“I will admit that was somewhat gratifying.”

— Hillary Clinton on the GOP’s failure to pass a health care bill

Read on

  • Trump eyes combining infrastructure with health care, tax reform
  • Republicans are trying to save their health plan with more money to cover sick people
  • A modest proposal for the march for science

Thursday, April 6

A congressman marching

There is but one PhD-level scientist in Congress, and he’s decided to join the March for Science on April 22. Representative Bill Foster of Illinois is a former Fermilab physicist who tells STAT’s Lev Facher he’s not marching as a politician, but as a researcher. He says that being a scientist allows him to be political without some of the partisan side effects: When he sees policymaking that ignores evidence, he says he criticizes the policy, not the politicians who proposed it.

He said this

“We want to do a great infrastructure plan, and on that side I will say that we’re going to have, I believe, tremendous Democrat support. We are also going to have some good Republican support, and I think it’s going to be one of the very bipartisan bills and it’s going to happen. I may put it in with health care.”

— President Trump in an interview with the New York Times, suggesting that he might tie infrastructure legislation to efforts to repeal and replace Obamacare.

Repeal efforts march on

Congress is about to go on recess, but before it does, Trump wants more action on repealing Obamacare. Bloomberg reports that the White House wants any new replacement bill to protect seriously ill patients, and the House is expected to propose a high-risk pool amendment for people with grave illnesses. The Washington Post reports that Trump needs a win on health care, in part because of fears that in-party rancor will grow, but it’s unclear whether a high-risk pool amendment will get to the House floor by the end of the week.

Insurance brokers marching away

Politico says the White House may be looking to cut certain insurance subsidies in an effort to destabilize the individual market, and insurers have until June to decide whether to stay in the market, but Modern Healthcare says that insurance brokers are bowing out now, and have been for a while. Why? Insurance companies aren’t paying brokers commissions on higher-tier plans or special plans that they sell to consumers. Between 2015 and 2017, nearly 35 percent of healthcare.gov brokers have left the system.

Read on

Wednesday, April 5

A White House science advisor

What is a science advisor and why do we need one? John P. Holdren, President Obama’s science advisor and the director of the Office of Science and Technology Policy, addresses this in a column for STAT. His key points? A science advisor helps plan the nation’s science and technology budget, he says, but more broadly, the office provides the science and technology data needed to inform policy in many areas, from economics to urban affairs to agriculture.

In the tweet of the moment

Dr. Scott Gottlieb was grilled today in a confirmation hearing to become the head of the FDA. He answered several questions about potential conflicts of interest and his well-known views about the FDA approvals process, but also about opioids.

Trump and GMOs

While one arm of the biotech industry waits to see what Trump will do to drug prices, supporters of another arm are hoping he’ll start enforcing an Obama-era decree that USDA, EPA, and FDA update their regulatory framework to account for GMOs, agriculture made by biotechnology. Among the recommendations that the nonpartisan Information Technology & Innovation Foundation makes? Enforce food labeling laws, and open up national lands for planting biotech seeds.

Read on

  • Some insurers may be pulling out of the individual market because of losses, but this company is reaping huge profits from Obamacare
  • Democrats write a letter to Trump, telling him the legal framework already exists to lower drug prices and to fulfill his promise quickly
  • As Republicans continue efforts to repeal it, for the first time, a majority of Americans approve of the Affordable Care Act
  • Health care in Alaska is expensive, so its residents are watching to see what happens to the Affordable Care Act

Tuesday, April 4

More family planning cuts

The Trump administration has pulled about $32 million in US funding to the United Nations Population Fund under a contested claim that the organization promotes abortion and sterilization in China. The cuts affect the organization’s 2017 budget and keep in line with Trump’s call to reduce US financial involvement in the United Nations. The money will instead go into the US Agency for International Development’s coffers for its family planning work.

More work on repeal and replace

The White House circled the wagons Monday with both moderate and conservative Republicans in an effort to revive the Obamacare repeal effort. Vice President Mike Pence led the effort, including meeting with the Freedom Caucus, whose resistance to the American Health Care Act derailed its progress. The president is anxious to continue the repeal effort — the bill could materialize as early as today, and the White House wants a vote before spring recess.

He said this

“This is no time to undercut progress, for God’s sake. It’s time to double down.”

— Former Vice President Joe Biden, on Trump’s proposed cuts to the National Institutes of Health.

She said this

“Half of our present GDP is due to investments in science and technology and much of that investment has been by the federal government.”

— France Córdova, director of the National Science Foundation, on proposed cuts to federal research spending. Dr. Robert Califf, former FDA commissioner, also spoke out against cuts to research.

More insurers bowing out

The Trump administration will continue to subsidize insurers in the marketplace while the subsidies get debated in court, but for some companies, it may not matter. Wellmark Blue Cross and Blue Shield announced Monday that it would pull out of the Iowa individual market for 2018, even as an insurance stabilization measure gets finalized. Wellmark, which has also pulled out of the South Dakota market, said it’s lost $90 million over the past three years. Wellmark isn’t alone. Insurers in Minnesota have announced a $687 million loss for 2016, an announcement that could portend massive rate hikes in the future, Minnesota Public Radio says.

Read on

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Monday, April 3

A Medicaid vote

The state Legislature in Kansas has just narrowly failed to override the governor’s veto of a Medicaid expansion in the state. The bill would have allowed up to 180,000 more people in the state to receive health insurance. The governor, Sam Brownback, vetoed the bill, over what he said would be “unrestrainable” costs to the state. The vote was 81-44 in the state house; they needed 84 votes to override the veto.

Up in smoke

The president’s perspective on some aspects of the pharma industry is well-known (lower drug prices, faster approvals), but what about drugs like nicotine and marijuana, and the small businesses they’ve seeded? The pro-business president has talked about leaving medical marijuana machinations to states, but at the same time, his administration has talked about stricter enforcement of drug laws. Experts hope he’ll stick to his states-first thinking. As for e-cigarettes and vaping, there is hope that he will back off regulations that affect this estimated $10 billion industry.

Revealing disclosures

Financial disclosures released late last week by the White House revealed some interesting health- and science-related connections. The president’s senior counselor, Kellyanne Conway, was once paid as a consultant for the American Association for the Advancement of Science, one of the groups behind the upcoming March for Science. Deputy White House counsel Makan Delrahim counts Bayer Healthcare, Ardent Healthcare, and the Medical Device Manufacturers Association as larger sources of income. The president’s top economic advisor, Gary Cohn, owns stock in Samumed, an anti-aging company valued at $12 billion, even though one of its founders said the company couldn’t deliver returns to investors right away if it went public.

He said this

“Yeah, I don’t lose. I don’t like to lose.”

— President Trump, on the failure of GOP health care reform, in an interview with Financial Times. He follows up with promises to work with Democrats, even if the end result isn’t “as good a form of healthcare” as he wants.

She said this

“Just a single health condition could drain a state’s entire high-risk pool, with no money remaining for those with cancer, heart attacks, diabetes, or other medical conditions.”

— Houston writer Melanie Ormand, on the cost of care following her brain aneurysm, and how high-risk pools wouldn’t affect just her if she needs more treatment post-ACA, but everyone in Texas who might end up in such a system.

Read on

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.

Read on

  • 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.

Read on

  • 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.

Untangling ties

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.”

Read on

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.

Read on

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.

Read on

  • 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

An ultimatum

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

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

A coalition

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.

Read on

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

Read on

  • 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

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

Read more

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

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.

Read on

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.

Read on

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

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.

Read on

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.

Read on

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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.

Read on

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‘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.

Read on

Wednesday, Feb. 22


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.

Read on

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.

Read on

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.”

Read on

  • 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.

We spoke with the leaders of AAAS earlier this week. Here’s what they had to say about scientists and politics and the future of science-based initiatives under President Trump.

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.

Read on:

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.

Read on

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.

Read on

  • 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.

Read on:

  • 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.

Read on

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.

Read on

  • 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.

Read on:

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.

Read on

  • 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.

Read on

  • 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)

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