Daily on Healthcare: Democrats haven’t rushed to reinstate parts of Obamacare they called essential

DEMOCRATS HAVEN’T RUSHED TO REINSTATE PARTS OF OBAMACARE THEY CALLED ESSENTIAL: Democrats have slammed the Trump administration and Republicans for working to undermine Obamacare, but two policies they have said were crucial to the healthcare law are missing from legislation they’re quickly advancing through the House.

House Democrats in the Energy and Commerce Committee worked late into the night Wednesday and into the early hours Thursday to advance six bills that they say will make coverage more affordable and “reverse the Trump administration’s sabotage” against the Affordable Care Act.

But two provisions were notably absent, and even have been missing from a larger bill that House Democrats unveiled recently to expand Obamacare: The reinstatement of the individual mandate, and the funding of cost-sharing reduction subsidies that help lower out-of-pocket medical costs for low-income people.

Republicans zeroed out the individual mandate as part of the 2018 tax law. Direct funding for cost-sharing reduction subsidies, or CSRs, were ended by Trump in 2017. Both moves were — and still are — widely criticized by Democrats in floor speeches and press conferences as catastrophic attacks on healthcare. Even so, they’ve been dropped from actual policymaking.

To be sure, there are new calculations that may go into Democrats’ decision not to address these provisions, and any bills they advance now have no chance at passage under divided government.

For instance, the repeal of the individual mandate has bucked predictions that its neutralization would throw millions of people off health insurance, with early numbers showing significantly more modest impact. And ending CSRs turned out to be helpful to a lot of consumers: Insurers shifted premium costs onto the federal government, resulting in a practice known as “silver loading” that allowed some Obamacare customers to pay $0 a month in premiums. Insurers also are suing to get the funds back.

But both provisions are in limbo. A lawsuit is underway by the Trump administration and GOP state officials that seeks to have all of Obamacare thrown out because the individual mandate has been zeroed out. The Trump administration also is asking for public comment on the practice of insurers stacking the subsidies and has proposed that every Obamacare customer be made to pay something in premiums. Further, the number of uninsured began ticking up during the end of former President Barack Obama’s second term and continued under President Trump.

The legislation that advanced out of the Energy and Commerce Committee in the early hours of Thursday to stabilize Obamacare adds a reinsurance fund, which would funnel billions of dollars to insurers to pay for high medical expenses that keep premiums down; helps to advertise awareness of Obamacare and fund navigators that help people sign up for coverage; and undoes certain policies the Trump administration has advanced to help people get health insurance that falls outside of Obamacare’s rules.

None of the bills had Republican support and many of the familiar disagreements emerged as Republicans pushed to add anti-abortion language to the bills and for states to have more flexiblity to experiment with their own ideas. In the end, Republican leaders released a statement accusing Democrats of “putting politics over people.”

The legislation is expected to pass the Democratic-controlled House but isn’t likely to get taken up by the Senate, where Republicans hold the majority.

The latest developments underscore how both parties are reshaping their views on Obamacare. Republicans have embraced the general concept of the government mandating protections for preexisting illnesses, even if critics say their alternatives fall short. At the same time, Democrats appear ready to part ways with policies that have played out differently than anticipated.

Good morning and welcome to the Washington Examiner’s Daily on Healthcare! This newsletter is written by senior healthcare reporter Kimberly Leonard (@LeonardKL) and healthcare reporter Cassidy Morrison (@CassMorrison94). You can reach us with tips, calendar items, or suggestions at [email protected]. If someone forwarded you this email and you’d like to receive it regularly, you can subscribe here.

ALASKA WANTS TO BE FIRST TO GET MEDICAID AS A BLOCK GRANT: Alaska’s Republican governor, Mike Dunleavy, is seeking federal authorization to turn the state’s Medicaid program into a block grant, a first-of-its-kind move to forgo some federal dollars in order to gain flexibility for managing the healthcare program.

“Your Medicaid administrator, Seema Verma, has urged us to be the first state to receive Medicaid dollars as a block grant,” Dunleavy wrote in a letter to President Trump. “We are eager to do this, but your support of her on this ‘first’ will keep the proper focus and speed on this application.” The letter, which was dated March 1, was obtained and first reported by Alaska Public Media.

SIX DRUG PRICING BILLS MAKE IT OUT OF COMMITTEE WITH BIPARTISAN SUPPORT: Six bills aimed at increasing generic competition advanced out of the Energy and Commerce Committee on Wednesday evening, largely without any issues as lawmakers found ways to move forward on a bipartisan basis. The legislation included the CREATES Act, a bill that blocks brand-name drugs from keeping less expensive generics from coming to market.

GOTTLIEB TO RETURN TO CONSERVATIVE THINK TANK: Food and Drug Administration Commissioner Scott Gottlieb will return to the conservative American Enterprise Institute think tank after leaving the government on Friday. In his role, he’ll be focused on drug pricing policy.

CHAMBER OF COMMERCE PRESSES FORWARD ON ASSOCIATION HEALTH PLANS DESPITE RULING: The U.S. Chamber of Commerce announced Thursday that it is rolling out a database for people who want to join association health plans, despite a judge’s decision to strike down the plans.

Katie Mahoney, the group’s vice president of health policy, said 20,000 current enrollees are going to be affected by the ruling, but that overall 300,000 people will be affected because they were likely to enroll in the plans that are still getting off the ground. The Chamber of Commerce said it was disappointed by the ruling and is urging a stay.

AFTER A YEAR-AND-A-HALF OF HURDLES, TRUMP ADMINISTRATION APPROVES MAINE MEDICAID EXPANSION: The Trump administration on Wednesday approved Maine’s plan to expand Medicaid to the poor under Obamacare after nearly 1.5 years of political and legal battles.

The approval from the Trump administration on Wednesday means that federal funds will start flowing to the state. The Centers for Medicare and Medicaid Services also approved allowing benefits to stretch back to July 2, 2018, when the plan would originally have taken effect.

HOUSE DEMOCRATS PASS CONDEMNATION OF TRUMP’S OBAMACARE LAWSUIT: House Democrats passed a resolution Wednesday condemning the Trump administration for asking an appeals court to throw out all of Obamacare.

The resolution, which passed 240-186, is symbolic and will not alter the outcome of the lawsuit but presented a tough vote for Republicans in swing districts. Eight Republicans voted alongside the majority of Democrats. Rep. Collin Peterson of Minnesota was the only Democrat to side against the resolution with Republicans.

ADVOCATES PUSH FOR KIDNEY DONATION BOOST: Advocates are meeting with lawmakers Wednesday and Thursday to ask for their support for the Living Donor Protection Act, which clarifies that living donors can take medical leave after recovering from the surgery. The bill would also direct the Department of Health and Human Services to educate people about live kidney donation and would ensure living donors aren’t charged higher premiums for life, disability, and long-term care insurance. Cassidy wrote about similar legislation in Maryland here.

LATEST TALLY FOR ‘BORN ALIVE’ ABORTION BILL: As of Thursday, 198 House members had signed onto the petition that would force a floor vote on the Born Alive Abortion Survivors Protection Act. It needs 218 supporters to force the vote.

DEMOCRATIC ATTORNEYS GENERAL SUE TRUMP ADMINISTRATION OVER SCHOOL NUTRITION STANDARDS: A group of attorneys general announced Wednesday that they are suing the Trump Administration for “illegally weakening” school nutrition standards championed by Michelle Obama. The suit was filed by New York, California, Illinois, Minnesota, New Mexico, Vermont, and the District of Columbia. The states argue the Department of Agriculture did not provide a legally required opportunity for comment on the rollback of federal nutrition standards for sodium and whole grains that were implemented in 2012.

HUMAN TESTING STARTS FOR UNIVERSAL FLU VACCINE: The NIH is undertaking the first clinical trial of a universal flu vaccine for human candidates.The trial will gradually enroll 53 healthy adults. Researchers at the National Institute of Allergy and Infectious Diseases will study its safety and immune response to the flu virus. The Vaccine Research Center expects the trial’s enrollment to be complete by the end of 2019 and to report results by early 2020.

FINANCE COMMITTEE LEADERS PROBE REPORTS OF GROUP HOME ABUSE: Sen. Chuck Grassley, R-Iowa, and Sen. Ron Wyden, D-Ore., have requested information on instances of abuse, neglect, and in one case, death in Iowa and Oregon group homes for adults and children with intellectual or developmental disabilities. The senators sent letters to REM Iowa and Mentor Oregon asking to provide information about their services and any previous or ongoing reports, investigations, performance reviews.

GRASSLEY SLAMS EXPRESS SCRIPTS OVER ITS DELAY TO TAKE ACTION ON INSULIN: Cigna announced Wednesday it would cap insulin prices for some patients, but Grassley asked why it took so long. While he said it was good Cigna has lowered the price, he said that it “shouldn’t take bad press and congressional scrutiny to get health plans…to arrive at a fair price.” Grassley added that lowering life-saving medication prices “shouldn’t be a one-time thing.” Grassley and Wyden sent letters to PBMs including Cigna on Tuesday asking for information about their relationships with insulin makers and why prices have skyrocketed.

FDA SUGGESTS THAT E-CIGARETTES ARE GIVING TEENS SEIZURES: Gottlieb said in a statement that he “can’t yet say for certain” that e-cigarette use is giving teen vapers seizures but that it is a “potential emerging safety issue.” He said that the seizures could be from nicotine toxicity, which is due in part to high concentrations of nicotine in e-cigarettes.

MURRAY PROBES TRUMP’S CONSOLIDATION OF HHS PROGRAMS: Sen. Patty Murray, D-Wash., requested further information Wednesday from HHS Secretary Alex Azar about the Trump administration’s plan to consolidate some HHS programs which help women, adolescents, low-income communities, and those with infectious diseases including HIV/AIDS. Murray said the Administration’s plan would further undermine Title X funding and the Teen Pregnancy Prevention Program.

KENTUCKY JUDGE RULES AGAINST UNVACCINATED STUDENT: A judge in Kentucky ruled against a high school student, Jerome Kunkel, 18, who sued after he wasn’t allowed to play basketball because he did not get a chickenpox vaccination for religious reasons. The judge sided with prosecutors who argued in favor of banning students from school and extracurriculars if they are not properly vaccinated.

The Rundown

Politico Health department suspends contracts with GOP-linked consultants

FierceHealthcare HRSA rolls out drug pricing site for 340B hospitals

Indianapolis Star Indiana abortion services bill that lets more healthcare workers opt out goes to Gov. Holcomb

The New York Times Risky stem-cell treatments come under F.D.A. scrutiny — again

Stat Digital health startups want to help Medicare prevent diabetes, if only it will let them

Calendar

THURSDAY | April 4

House and Senate in session.

10 a.m. 124 Dirksen. Health and Human Services Secretary Alex Azar to answer questions about President Trump’s budget request in the Senate Appropriations Committee. Details.

FRIDAY | APRIL 5

Scott Gottlieb’s final day as Food and Drug Administration commissioner.

SUNDAY | April 7

April 7-9. Marriott Marquis. American Hospital Association annual meeting. Agenda.

TUESDAY | April 9

10 a.m. Rayburn 2008. House Appropriation Committee’s Interior, Environment, and Related Agencies Subcommittee hearing on the Indian Health Services budget.

10:15 a.m. 215 Dirksen. Senate Finance Committee hearing with pharmacy benefit managers.

WEDNESDAY | April 10

10:30 a.m. 2322 Rayburn. House Energy and Commerce Committee’s Oversight and Investigations Subcommittee. Details.