Trump selects Tom Price as HHS Secretary – Politico
TRUMP TAPS TOM PRICE AS HHS SECRETARY — The Georgia Republican, an orthopedic surgeon, is a fierce Obamacare foe. The announcement is likely today. More for Pros.
— Where Price stands on replacing Obamacare. He has called for moving quickly to strike down key components of the law through budget reconciliation in January. However, Price has his own plan to replace the ACA — the “Empowering Patients First” act — and it differs from House Speaker Paul Ryan’s “Better Way” proposal, Pro’s Rachana Pradhan writes. More here.
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“This pick would suggest that Trump is serious about dismantling Obamacare and replacing it with a market-based alternative,” tweeted Stanford scholar Lanhee Chen.
See Price’s proposal: More.
— Price also wants to see Medicare premium support. Earlier this month, the House Budget Committee chair told reporters that he’d expect Republicans to push for Medicare changes after in a second budget reconciliation for FY 2018, presumably in the second half of 2017.
— Price would be rare physician to lead HHS. The orthopedic surgeon would be the first doctor to steer the agency since Louis Sullivan, who led HHS between 1989 and 1993.
— And he’s a fan of balance billing. Price has spent years arguing that physicians should be allowed to contract with Medicare patients on a fee and then bill them for additional charges that go beyond Medicare’s allowable limits. The proposal has alarmed patient advocates, who say it would lead to surprise out-of-pocket bills for seniors. Price says it’s necessary to keep doctors participating in Medicare, which typically pays lower rates than private insurance.
— Conservative critics of Trump like Price for HHS. Among them: Amanda Carpenter, a former Ted Cruz campaign staffer who emerged as a vocal critic of Trump, but applauded the Price selection as a “solid pick.”
— But LGBTQ groups are worried about losing key protections. Price has opposed same-sex marriage and gay rights legislation, and he’s said that engaging in LGBTQ behaviors can lead to “real” health impacts. That’s alarmed groups like GLAAD, which are worried about losing the nondiscrimination protections offered through the ACA.
— Abortion-rights groups also are concerned. “Price could take women back decades,” Planned Parenthood’s Cecile Richards warned, adding that Price’s plan to repeal the ACA would take away no-copay birth control from 55 million women.
— Who wins and loses under Price’s ACA repeal-and-replace plan. The health insurance analyst who blogs under the pseudonym Richard Mayhew breaks down Price’s proposal. More.
REPORT: TRUMP PICKS SEEMA VERMA TO HEAD CMS — Verma, an Indiana health policy consultant, will be announced alongside Price as part of Trump’s health care “dream team,” Reuters reported.
— If chosen to be CMS administrator, Verma would bring experience implementing the Affordable Care Act, working across the aisle and working with Vice President-elect Mike Pence. She was the architect of the Healthy Indiana Plan, the state’s coverage expansion for low-income individuals enacted under former Gov. Mitch Daniels and supported by Democrats.
— Pence later retained Verma to help design an alternate approach to Obamacare’s Medicaid expansion, called the Healthy Indiana Plan 2.0.
GOP AIMS TO DEFUND PLANNED PARENTHOOD — Congressional Republicans are aiming to cut off federal funding for Planned Parenthood early next year, according to GOP sources on and off the Hill, as social conservatives press for a milestone win under Donald Trump’s presidency after years of thwarted attempts to defund the health care group, Pro’s Jen Haberkorn and Burgess Everett report.
“The entire movement is poised for a victory,” said Marjorie Dannenfelser, president of the Susan B. Anthony List, an advocacy group that opposes abortion. “We have every assurance [from congressional leaders] that it’s going to happen. Nobody is saying ‘whether,’ the question is ‘when.’”
Keep reading: More here.
THIS IS TUESDAY PULSE — Where the rumors were true: For Trump, the Price was right. (I’ll now see myself out of the building.) Throw your tips and rotten tomatoes toward email@example.com or @ddiamond on Twitter.
Pro’s Paul Demko continues his updates from the DOJ’s court challenge of Anthem and Cigna’s planned $54 billion merger.
DOJ expert: Anthem-Cigna merger would be big blow to competition. That’s according to Northwestern economist David Dranove, the government’s key economics expert who testified on Monday. For instance, Blue Cross Blue Shield plans currently account for roughly 40 percent of the market for employers with at least 5,000 workers; Anthem’s acquisition of Cigna would push that closer to 50 percent, Dranove argued.
“It’s just a remarkably large, unprecedented acquisition,” Dranove added, warning that it would squelch innovation in an already concentrated market. More for Pros.
Humana official says the company couldn’t compete in national market. Humana stopped trying to win new national employer accounts in 2013 because it was losing money on that business and couldn’t compete with other national carriers, a company official testified on Monday morning.
By compelling Humana to testify, the Justice Department was trying to establish that the market for national accounts is already dominated by a quartet of powerful players that includes Anthem and Cigna. More for Pros.
** A message from PhRMA: Medicare Part D has been providing seniors and individuals with disabilities access to affordable prescription drug coverage since its implementation 10 years ago. As Medicare open enrollment comes to an end next week, find tips and checklists here. **
21ST CENTURY CURES
Hot doc: CBO scores the bill. See the CBO score.
Bill gives boost to hospitals. Hospital groups are cheering the legislative package, which served as the vehicle for at least a few items that the industry lobbied hard to get a vote before the year’s end. Pro’s Adam Cancryn has a quick rundown:
1) Progress on site-neutral payments. Hospital-owned outpatient facilities under development before Nov. 2, 2015, will dodge new Medicare reimbursement cuts, thanks to a grandfathering measure included in Cures. The provision shields those facilities from CMS’s site-neutral payment rule, which is set to lower payment rates for outpatient departments and close the gap between what hospitals and doctors are paid for providing outpatient services. Cures would also similarly exempt cancer hospitals from the site-neutral rule.
Hospitals pushed for the carve-out on the basis that they’d made construction decisions in anticipation of receiving the higher reimbursement rate, and had rallied broad support for it in both the House and Senate.
“The under-development provision, that gives us a little more leeway in terms of paying hospital outpatient departments that were affected by the recent legislation,” Federation of American Hospitals President and CEO Chip Kahn said.
2) Adjusting payments for socioeconomic factors. Cures also changes Medicare’s Hospital Readmissions Reduction Program to better consider socioeconomic factors when measuring hospitals’ performance. The risk adjustment provision was a top priority for America’s Essential Hospitals, which contends that hospitals serving the most vulnerable face more difficulties in improving health outcomes.
“Hospitals that care for our nation’s most vulnerable people face disproportionate penalties under the HRRP for socioeconomic factors beyond their control. Risk adjustment, as this provision would require, can help level the playing field for these hospitals and their patients,” said Beth Feldpush, senior vice president of policy and advocacy at America’s Essential Hospitals.
3) A delay for the 25 Percent Rule. Long-term acute care hospitals would get temporary relief from a new rule penalizing hospitals that receive 25 percent or more of their referrals from the same source.
Currently, long-term acute care hospitals can get up to half their referrals from one hospital before their Medicare reimbursement rate is cut. The 25 percent threshold was originally set to take effect for reimbursements starting July 1, but Cures would delay implementation until Oct. 1, 2017.
IN THE COURTS
SCOTUS gets new Obamacare case. The state of West Virginia on Monday asked the Supreme Court to reverse a lower court that ruled the state cannot sue the Obama administration over its changes to the health care law. West Virginia filed the suit in response to the White House’s 2014 decision to allow states to let people stay on plans that would otherwise have been canceled under the ACA, Pro’s Jen Haberkorn reports. The state argued that the executive branch was illegally punting a politically sensitive decision to the states.
— The American Freedom Law Center filed a very similar suit against Obamacare and, earlier this month, also sent a petition to the Supreme Court. That suit alleges that the White House did not faithfully execute the law when it allowed people to stay on plans that should have been canceled.
Both suits are long shots at the Supreme Court, especially because the lower courts ruled that neither party had the right to bring the suits in the first place.
ON THE HILL
Liberal groups push for Flint funding. It’s still not clear whether or how Congress will provide funds to address the drinking water crisis in Flint, Mich., and a coalition of labor, faith and environmental groups sent a letter Monday urging lawmakers to get aid to Flint in the lame duck.
EYE ON SILICON VALLEY
More shareholders seeking class-action lawsuits against Theranos. Robert Colman and Hilary Taubman-Dye say that founder and CEO Elizabeth Holmes knew that her company’s technology didn’t work, but pitched it to investors anyway. More.
Big-name investors stand to lose big on Theranos. Among them: Rupert Murdoch, who invested about $100 million in the blood-testing startup. Murdoch owns the Wall Street Journal, which led the investigations into Theranos that sparked regulatory reviews and prompted Forbes to downgrade the company’s value from $9 billion to $0. More.
FIRST IN PULSE: Rock Health strikes partnership with DaVita. The venture fund and research hub says partnering with the kidney care giant reflects both organizations’ commitment to innovation. “DaVita will be a valuable resource for our entrepreneurs as they strive to improve care management across the board,” Rock Health said in a statement. More.
AROUND THE NATION
STATE WEEK: Alaska preps Obamacare waiver. The state has posted a draft waiver proposal that asks the federal government to cover a significant share of the cost of its ACA reinsurance program. Alaska appropriated $55 million for reinsurance in 2017 to shore up the state’s individual market, which had been at risk of collapsing because of rising costs and insurer exits. More in State Week.
Texas announces first case of local Zika transmission. The patient — whose illness was confirmed by a lab test last week — is a resident of Cameron County, which borders Mexico and is the southernmost county in Texas. The officials said the patient is not pregnant and reported no recent travel to countries with ongoing Zika virus transmission.
The announcement makes Texas the second state to report local transmission of the Zika virus, Pro’s Rachana Pradhan notes. In Florida, state health officials say two areas of Miami still have local transmission.
WHAT WE’RE READING by Jen Haberkorn
In a Bloomberg View piece, Ramesh Ponnuru of National Review is pessimistic that a quick repeal of Obamacare is a good idea — or easy to implement. More.
The expansion of Medicaid has brought health coverage to tens of thousands of previously uninsured gunshot victims, who in the past had often missed out on follow-up health care after the emergency room. More.
Arizona Gov. Jan Brewer speculated — in an interview with the AP — that the ACA’s Medicaid expansion may not be repealed. More.
Young adults don’t need to be on their parents’ health care plans through age 26, writes Christian Schneider, a Milwaukee Journal Sentinel columnist and USA Today contributor. More.
A Tennessee woman accused of using a coat hanger to end a pregnancy entered a not-guilty plea Monday to a charge of attempted criminal abortion, according to USA Today. More.
** A message from PhRMA: In the 10 years since its implementation, Medicare Part D has successfully provided affordable prescription drug coverage to seniors and individuals with disabilities, helping them live longer, healthier lives. In fact, since 2006, nearly 200,000 Medicare beneficiaries have lived at least one year longer thanks to Part D coverage. And today, more than 40 million people benefit from the program. With Medicare open enrollment ending next week, learn more about Part D and how it benefits patients here. **