Dems Warn California Voters in New Health Care Ad: “Just Like a Zombie, Repeal Keeps Coming Back”

Image result for Dems Warn California Voters imagesSource: Los Angeles Times

Republicans may have abandoned their latest effort to repeal parts of the Affordable Care Act, but some advocacy groups aren’t letting the issue go so easily.

A couple of groups started running ads in the districts of GOP members of Congress this week, encouraging voters to call their representatives and demand that they reject the concept of a healthcare repeal altogether.

Save My Care, a left-leaning healthcare advocacy group in Washington, began running a series of digital ads this week taking aim at California Reps. David Valadao (R-Hanford), Jeff Denham (R-Turlock) and Darrell Issa (R-Vista).

“Just like a zombie, repeal keeps coming back,” the ads warn. They’re part of a “five-figure” national media buy, said Marcos Rodriguez Maciel, a spokesman for the group. He declined to disclose the group’s major funding sources.

The Democratic Congressional Campaign Committee also began running its first California TV ad of the year this week. The ad, titled “Never Stop,” features Republican House Speaker Paul Ryan and warns that “They’ll never stop…coming after your healthcare.”

The ads are running on MSNBC and CNN in Denham and Valadao’s districts, and are being paired with radio ads that specifically target each member. In Valadao’s Central Valley district, constituents will also hear Spanish-language versions on the radio.

The ads are part of a “sizeable, six-figure” campaign running nationwide, according to the DCCC.

In a statement, spokesman Drew Godinich said it should be “no cause for comfort” that House Republicans have faltered in their attempts to repeal Obamacare and noted that several GOP members have already suggested they’d try again in the coming months.

Every House Republican from California voted in favor of a previous failed effort to repeal Obamacare, stoking Democratic hopes that it could become a galvanizing campaign issue in the 2018 elections.

But for that to happen, left-leaning groups will have to keep healthcare top of mind for many voters, even as more time passes since the latest repeal effort.

Overlooked By ACA: Many People Paying Full Price For Insurance “Getting Slammed”

Image result for paying full price for health insurance imagesSource: California Healthline

Paul Melquist of St. Paul, Minn., has a message for the people who wrote the Affordable Care Act: “Quit wrecking my health care.”

Teri Goodrich, of Raleigh, N.C., has the same complaint. “We’re getting slammed. We didn’t budget for this,” she said.

Millions of people have gained health insurance because of the federal health law. Millions more have seen their existing coverage improved.

But one small slice of the population — including Melquist and Goodrich — are unquestionably worse off. They are healthy people who buy their own coverage but earn too much to qualify for help paying their premiums. And the premium hikes that are being announced as enrollment looms for next year — in some states, increases topping 50 percent — will make their situations more miserable.

Exactly how big is this group? According to Mark Farrah Associates, a health care analysis firm, as of 2017 there were 17.6 million people in the individual market, 5.4 million of whom bought policies outside the health exchanges, where premium help is not available. Combine that with the percentage of people who bought insurance on the exchanges but earned too much (more than four times the federal poverty level, or about $48,000 for an individual) to get premium subsidies, and the estimate is 7.5 million, or 43 percent of the total individual market purchasers, according to insurance industry consultant Robert Laszewski.

And who are these people?

“They’re early retirees,” said Laszewski. “They’re people working part time who have substantial outside income. They’re people who are self-employed of any age, people who are small employers.”

Melquist is one of those early retirees. He and his wife are both 59. He worked in the defense industry and retired at the end of 2016.

He said he always planned to retire at age 55, but ended up working longer in part because he knew health insurance costs were rising. When he did retire and sought to purchase coverage for himself and his wife, “I was shocked to find out how bad it actually was.”

For a bronze-level plan with a health savings account, Melquist said, “we pay $15,000 a year” in premiums “and the first $6,550 [for health care expenses] for each of us comes out of our pocket. So basically you could be looking at $30,000 out-of-pocket before anything gets covered.”

Insurance is important, Melquist said, particularly if a catastrophic health issue were to hit either of them. In the meantime, he can still pay the bills. But he’s frustrated. “I’m not eating dog food, but I’m also not able to do stuff for my grandchildren,” he said, like help with college costs. “It’s not that my life is falling apart, but the [Affordable Care Act] has ruined a lot of things I’d like to have done.”

The good news, if there is any, for Melquist is that premiums in Minnesota are going up by only small amounts for 2018, and in some cases going down, due to a reinsurance program passed by the state legislature that will help cover the costs for some of the state’s sickest patients in the individual market. That helps keep premiums from spiking even more.

But that won’t be the case in Raleigh, where Goodrich and her husband, John Kistle, work as private consultants in the energy industry.

Goodrich, 59, and Kistle, 57, bought insurance through the ACA exchange in their state for three years. When premiums reached $1,600 per month with deductibles of $7,500 each, however, “it was just unbelievable. We decided just not to get insurance,” Goodrich said.

Eventually, they bought short-term plans that cover only catastrophic illness or injury. That insurance is not considered adequate under the ACA, so the couple could be liable for a tax penalty as well.

Goodrich, who volunteers to help people with their taxes in her spare time, said she has run the numbers and thinks that insurance is so expensive where she lives that the couple will be exempt from the penalty. That’s because the cheapest insurance would cost the couple more than 8.16 percent of their income. Under the health law’s provisions, the penalty does not apply above that because insurance is considered unaffordable.

“We try to be good citizens and do the right thing,” she said. “Next year, we’re trying to figure out how to make less than $64,000 so we can get subsidies.” That amount is equal to 400 percent of the federal poverty line for two people, the cutoff for premium assistance because Congress assumed those who earned more could afford to buy affordable coverage.

Sabrina Corlette, a research professor at Georgetown University who specializes in health insurance, agreed that this is a population “that faced big hikes” in premiums when the health law took effect.

But, she said, in many cases people in the individual market were previously paying artificially low premiums. Some of those old policies had substandard coverage. For others, however, the higher prices are the result of one of the fundamental changes enacted by the health law. “These are folks who were benefiting from a system that was affordable solely because insurers were able to keep sick people out,” Corlette said, adding that they are now being asked “to pay more of the true cost of health care.”

This is a population that is also more likely to vote Republican, said Laszewski, “which is one of the grand ironies now.”

Republicans in Congress and President Donald Trump have not been able to “repeal and replace” the health law. But some of their efforts are undermining it — primarily the administration’s threat to stop paying billions of dollars to insurers in subsidies help some lower-income people pay their out-of-pocket costs. The uncertainty surrounding those subsidies has led insurers to boost premiums next year by an estimated 20 percent. Those who get premium help from the government won’t have to pay more. But those who are paying the full freight will.

Also driving up premiums for next year, said Corlette, are the administration’s threats not to enforce the individual requirement for insurance and its decision to cancel most advertising and outreach for the year’s open-enrollment period that begins Nov. 1. Both of those provisions bring more healthy people into the insurance pool to help spread costs.

“One could argue that the 2014 premium increases were painful, but it was about getting us to a system that was more fundamentally fair and just,” Corlette said. “Now, it’s completely unnecessary price increases for unsubsidized folks that could so easily be avoided by a rational political system.”

House GOP Budget Sets Up Next Healthcare Battle

Image result for house gop budget images

Source: Associated Press

The House on Thursday passed a $4.1 trillion budget plan that promises deep cuts to social programs while paving the way for Republicans to rewrite the tax code later this year.

The 2018 House GOP budget reprises a controversial plan to turn Medicare into a voucher-like program for future retirees as well as the party’s efforts to repeal the “Obamacare” health law. Republicans controlling Congress have no plans to actually implement those cuts while they pursue their tax overhaul.

That’s especially so in the Senate, where the Budget Committee on Thursday gave party-line approval to a companion plan.

Instead, the nonbinding budget’s chief purpose is to set the stage for a tax overhaul plan that is the party’s top political priority as well as a longtime policy dream of key leaders like Speaker Paul Ryan.

The White House issued a statement saying the House plan is a key step toward “Making America Great Again.”

The House measure, passed by a near party-line vote of 219-206, calls for more than $5 trillion in spending cuts over the coming decade, promising to slash Medicaid by about $1 trillion over the next 10 years, cutting other health care costs, and forcing huge cuts to domestic programs funded in future years by Congress.

“It’s a budget that will help grow our economy, and it’s a budget that will help rein in our debt,” said Ryan, R-Wis. “It reforms Medicaid. It strengthens Medicare.”

But Republicans are not actually planning to impose any of those cuts with follow-up legislation that would be required under Washington’s Byzantine budget rules. Instead, those GOP proposals for spending cuts are limited to nonbinding promises, and even a token 10-year, $200 billion spending cut package demanded by tea party House Republicans appears likely to be scrapped in upcoming talks with the Senate.

Instead, the motivating force behind the budget measures is the Republicans’ party-defining drive to cut corporate and individual tax rates and rid the tax code of loopholes. They promise this tax “reform” measure will put the economy in overdrive, driving economic growth to the 3 percent range, and adding a surge of new tax revenues.

“In order to pay for these huge tax breaks for millionaires and billionaires, this Republican budget makes savage cuts to the life and death programs that mean so much to ordinary Americans,” said Sen. Bernie Sanders, I-Vt.

Passing the measure in the House and Senate would provide key procedural help for the tax measure because it sets the stage for follow-on legislation that can’t be filibustered by Senate Democrats. Republicans used the same so-called reconciliation procedure in their failed attempt to kill “Obamacare,” including its tax surcharges on wealthy people.

“Through reconciliation, our budget specifically paves the way for pro-growth tax reform that will reduce taxes for middle-class Americans and free up American businesses to grow and hire,” said Rep. Diane Black, R-Tenn., who chairs the House Budget Committee.

Eighteen Republicans opposed the measure, including several from high-tax states like New York and New Jersey who are concerned that the upcoming tax effort would repeal the deductions for state and local taxes.

Democrats blasted the sweeping spending cuts proposed by Republicans — more than $5 trillion over 10 years in the House plan and somewhat less in the Senate GOP measure — as an assault on middle-class families and the poor.

“Is it a statement of our values to take a half-trillion dollars out of Medicare to give a tax cut to the wealthiest people in our country?” said House Minority Leader Nancy Pelosi, D-Calif.

The Senate Budget Committee’s companion plan approved Thursday differs in key details — but would still result in a deficit of $424 billion in 2027, according to the Congressional Budget Office.

The House measure assumes the upcoming tax bill won’t add to the deficit; the Senate version, however, would permit the measure to add $1.5 trillion to the $20 trillion-plus national debt over the coming 10 years. The final version is likely to stick closely to the Senate measure in key respects. A final House-Senate agreement won’t come until November, Black said, but she anticipated conflict over the Senate plans.

“That is certainly going to be a very lively discussion,” Black said of House-Senate talks. “Our members are concerned about (budget) balance and they’re also concerned about the debt and deficits.”

The real-world trajectory of Washington, however, is for higher deficits as Republicans focus on tax cuts, a huge hike in the defense budget, and a growing disaster aid tally that is about to hit $45 billion.

“The train’s left the station, and if you’re a budget hawk, you were left at the station,” said Rep. Mark Sanford, R-S.C.

California to Require Advanced Notice on Hikes in Drug Costs

Image result for drug cost hikes images

Source: ABC News

Drug companies doing business in California will soon have to notify the public two months in advance of dramatic price spikes under legislation signed Monday by Gov. Jerry Brown.

California’s legislation marks one of the strictest drug-price transparency laws in the country, as states move to shine a spotlight on rapidly rising costs in the hopes of enticing drugmakers to keep them down.

One in four Americans have trouble affording prescription drugs, according to the Kaiser Family Foundation. Price spikes in EpiPen and other critical drugs in recent years sparked outrage from consumers and lawmakers.

“This measure is a step at bringing transparency, truth, exposure to a very important part of our lives — that is the cost of prescription drugs,” Brown said during a signing ceremony at the Capitol.

The pharmaceutical industry, though, has vociferously fought drug-price transparency laws in California and across the country and helped kill similar legislation last year. Drugmakers argue such bills will not do anything to meaningfully reduce costs and could hinder their ability to spend money on research and development.

“It’s time to move beyond creating new, costly bureaucratic programs that don’t make a dent in patients’ costs for medicines,” Priscilla VanderVeer, deputy vice president of the Pharmaceutical Research and Manufacturers of America, said in a statement.

Several states, including Vermont and Nevada, have passed transparency laws that require drugmakers to disclose costs and the reasoning behind them. But California’s bill is poised to have a significant impact because of the size of the state’s market and its strict requirements.

California’s law applies to any prescription drugs that sell for a wholesale cost of more than $40, including drugs purchased by the state for Medi-Cal and Medicare.

Drug companies must notify the state, health plans, insurers and pharmacy benefit managers 60 days in advance if a drug’s price increases more than 16 percent over a two-year period. The manufacturer must specify if the price increase will improve the drug’s effectiveness.

The legislation also ramps up annual disclosure requirements on overall pricing.

Democratic state Sen. Ed Hernandez, the bill’s prime sponsor, said Congress should take a cue from California in taking similar steps to fight drug cost increases.

“We have to make this a priority not just in California but in the country,” he said.

Bill to Rescue Children’s Health Program Hits Snag in House

Image result for Children's Health Insurance Program bill imagesSource: New York Times

Legislation to rescue the Children’s Health Insurance Program sailed through a Senate committee on Wednesday, but touched off a partisan conflict in the House, diminishing hopes that the popular program would be quickly refinanced.

Funding for the program expired on Sunday, and state officials said they would soon start notifying families that children could lose coverage if Congress did not provide additional money. It was impossible to say when Congress might pass a bill and send it to President Trump.

By voice vote, the Senate Finance Committee approved a bill on Wednesday that would provide more than $100 billion over five years for the program, which insures nearly nine million children.

The committee chairman, Senator Orrin G. Hatch, Republican of Utah, hailed the bill as “a prime example of what government can accomplish when both parties work together.” Mr. Hatch wrote the bill with the senior Democrat on the committee, Ron Wyden of Oregon, just as Mr. Hatch helped create the program in 1997 with Senator Edward M. Kennedy, Democrat of Massachusetts.

But in the House Energy and Commerce Committee, lawmakers brawled Wednesday over a similar bill to provide money for the children’s health program. Democrats strongly support the program, but complained that Republicans would take money from Medicare and the Affordable Care Act to offset the cost.

The House committee eventually approved the bill, by a vote of 28 to 23, with all of the opposition coming from Democrats.

One provision of the House Republican bill would require older Americans with income of more than $500,000 a year to pay higher Medicare premiums.

“Folks that earn a half-million dollars a year and are over 65, they can pay a little bit more for Medicare,” said Representative Fred Upton, Republican of Michigan. “And you know what? If they don’t want to pay, they don’t have to enroll. That’s a choice they will have.”

The House bill would also make it easier for states to eliminate Medicaid coverage for some low-income people who hit the jackpot in lotteries. Under current Medicaid rules, income received as a lump sum, such as lottery winnings, is counted as income only in the month when it is received.

This forces taxpayers to bear the cost of providing health care benefits for people who no longer need assistance, Republicans said.

But Democrats said it was outrageous for Republicans to demand such offsets for CHIP while pushing huge tax cuts that could add hundreds of billions of dollars to federal budget deficits.

The Republican CHIP proposals “will likely mean more delay and possibly no action in Congress until the end of the year as part of an omnibus appropriations bill,” said Representative Frank Pallone Jr. of New Jersey, the senior Democrat on the Energy and Commerce Committee.

Time is running short.

Minnesota received an emergency infusion of $3.6 million of federal cash on Monday, and Utah has filed an amendment to its CHIP plan that would allow the state to restrict eligibility or benefits if it runs out of cash. Minnesota and two other states are expected to exhaust their CHIP funds by the end of December, and 27 additional states expect to run out of money by March.

“People are scared, and they have every right to be,” said Representative Joseph P. Kennedy III, Democrat of Massachusetts.

Instead of providing money for CHIP, Mr. Kennedy said, “Republicans have focused solely for months on taking health care from millions of Americans” by trying to repeal the Affordable Care Act.

Representative Ryan A. Costello, Republican of Pennsylvania, said he had heard from constituents fearing that children would lose coverage. But in fact, he said, “every child who was eligible for this program as of a week ago is still in that program today.”

The Senate bill does not specify how the government would pay for extending the children’s health program. Republicans and Democrats are working together and expect to agree on financing before the bill goes to the Senate floor.

High-income Medicare beneficiaries already pay premiums of more than $400 a month. Representative Greg Walden, Republican of Oregon and the chairman of the Energy and Commerce Committee, said the House bill would increase premiums by perhaps $135 a month for people with annual incomes over $500,000.

Representative Jan Schakowsky, Democrat of Illinois, said the proposal was “a first step in eroding a social insurance program, Medicare, that has for many years been in the cross-hairs of the Republican Party.” It would, she said, be much better to save money for Medicare by attacking the “price gouging” of some pharmaceutical companies.

Senator Patrick J. Toomey, Republican of Pennsylvania, was the only senator who criticized the Senate bill, saying it provided more money than states could reasonably be expected to use — “a number that’s wildly in excess of what anyone thinks could plausibly happen.” Some of the money, he said, will be available as “a slush fund” for activities unrelated to health care for children.

“It is completely dishonest budgeting,” Mr. Toomey said. “It is unaccountable. It is meant to circumvent any caps” on spending.

But senators of both parties said that Congress could not wait.

“If you don’t get this addressed in a timely way, you put children at risk,” Mr. Wyden said. “These enrollment freezes and belt tightening and other emergency measures that states have talked to us about — they are not abstractions. They represent very real problems for kids and parents and families that are walking on an economic tightrope.”

Clock Is Ticking On Covered California 25% Increase Decision

Image result for clock is ticking imagesSource: Capital Public Radio

Covered California has been holding out on setting its premium rate increases, but time is wearing thin.

It’s still unclear whether the federal government will continue cost-sharing reductions to subsidize public health exchanges. The subsidies help keep premium rates down for Covered California shoppers.

If Congress doesn’t make a decision by Oct. 11, Covered California will move forward with its contigency plan. They’ll assume federal contributions are finished, and add a surcharge to silver tier plans on the exchange.

The exchange’s executive director, Peter V. Lee, says the goal is “to be the least confusing possible, to protect consumers that have subsidies, and protect consumers that get no subsidy from having an unwarranted increase in their prices. We believe that the policy we have in place will do that, and it is not ideal. The ideal thing is for the federal government to act.”

Premium rates for silver tier enrollees could jump 12.4 percent for next year. That’s on top of a previously announced 12.5 percent average increase for all shoppers. Some people will get a higher federal tax credit to make up for the increase, but others will have to choose whether they want to take on the extra out-of-pocket costs.

Covered California enrollees will be able to view their options on an online “Shop and Compare” tool available Oct. 11.

Charles Bacchi of the California Association of Health Plans says making decisions about rates so close to enrollment is unusual. Typically, plans provide information to consumers as far in advance as possible. There are also forms and packets to be mailed out ahead of time.

“We need to be able to get them their notices on time, to give them the ability to decide what their choices are going to be when open enrollment actually opens up,” he says “So yeah we are running out of time.”

The silver tier plans are the only plans in the exchange that were benefiting from the federal cost-sharing reductions, so they’ll be the only plans affected if funds are pulled.

About 1.4 million Californians buy insurance on the public marketplace.

Trump Says Health Care Executive Order Will Allow Coverage to be Sold Across State Lines

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Source: Politico

President Donald Trump plans to sign an executive order this week aimed at expanding access to loosely regulated health insurance plans — a move that could give consumers more coverage options but also destabilize Obamacare markets.

The order is expected to direct a trio of agencies to rewrite federal rules to allow trade associations and other groups offer their own health plans. Those so-called association health plans would be exempt from some of Obamacare’s strict regulations and could be sold across state lines.

“They will be able to buy, they’ll be able to cross state lines and they will get great competitive health care and it will cost the United States nothing,” Trump said today. “With Congress the way it is, I decided to take it upon myself.”

Trump is planning to sign the directive on Thursday, a source briefed on the plans said, in a move that would follow through on his repeated calls to open up the sale of health insurance across state lines. Republicans including Sens. Rand Paul and Mike Enzi have long championed association health plans as a way to lower insurance costs and give people more options.

The order likely won’t contain many specifics on how the administration would pave the way for those alternative offerings. Instead, it’s likely to leave it to the Labor, Treasury and Health and Human Services departments to reinterpret a sweeping employee health benefits regulation with an eye toward expanding coverage options for consumers.

It remains unclear how far the Trump administration will go in circumventing Obamacare’s regulations to encourage sales of looser-regulated plans — and exactly which rules association health plans would be exempt from.

The Labor Department has already met with business trade groups about the planned executive order and begun work on reinterpreting federal regulations, two sources familiar with the matter said.

The Trump administration is separately looking into easing rules on short-term insurance policies, two sources familiar with the plans said. The Obama administration last year limited the length of those policies — which also don’t comply with Obamacare’s rules — to three months.

The rule change being explored now would restore insurers’ ability to sell short-term policies that provide up to a year of coverage, effectively reestablishing them as a competitor to more robust Obamacare plans.

But already, insurers and policy experts have warned that allowing cheap, loosely regulated association health plans to flood the market would upset the Obamacare market’s delicate balance and open the door to undermining key protections for people with pre-existing conditions.

Association health plans are already sold in some states but have to meet Obamacare’s regulations. If the administration were to free them from those rules, those plans could charge far lower premiums for a skimpier set of benefits — aiming to attract the healthiest and cheapest enrollees while potentially leaving Obamacare plans with higher-cost customers.

“It would deteriorate the risk pool, lead to increased premiums, more instability and potentially make insurers have to make decisions on whether they’re going to continue to participate,” said Cori Uccello, a senior health fellow at the American Academy of Actuaries.

Concerns about undermining Obamacare’s patient protections — including a ban on charging people more based on their health status — helped sink multiple Republican efforts to repeal and replace the law.

But conservative Republicans including Paul have continued to insist that rolling back Obamacare’s regulations are the only path to lowering premiums and increasing competition. And business groups are largely expected to back an attempt to expand the health coverage that trade associations can over to their members.

“Any effort to jump start this issue and provide more competition in the states, in the individual and small group market, is welcome,” said Neil Trautwein, the vice president for health policy at the National Retail Federation.

Since congressional Republicans admitted defeat on repeal, Trump has been vocal about his frustration with the failure to deliver on a key campaign promise.

In an interview with Forbes published Tuesday morning, Trump reiterated his position that Obamacare is “a total mess” and insisted that while the healthcare law is now his responsibility, blame for its struggles fall entirely at the feet of his predecessor. “Obamacare is Obama’s fault. It’s never going to be our fault,” Trump said.

“What we’re doing is trying to keep it afloat, because it’s failing,” the president said. “I mean the insurance companies are fleeing and have fled. They fled before I got here. But with that being said, no, Obamacare is Obama’s fault. It’s nobody else’s fault.”

FDA Chief Says Agency Will Take Action To Lower Drug Prices

Image result for Scott Gottlieb imagesSource: The Hill

The Food and Drug Administration (FDA) will take action to deal with the rising cost of prescription drugs, the agency’s head said on Monday.

FDA Commissioner Scott Gottlieb said high drug prices are “a public health concern that FDA should address.”

Gottlieb said the agency will take steps to speed up the regulatory approvals of certain kinds of generic alternatives to pricey “complex” drugs. The goal is to increase competition, which could help to slow the growth or even lower the price of prescription drugs.

“[A]ny steps we can take to encourage the development of generic competitors to complex drugs will have an outsized impact on access, and prices,” Gottlieb said in a blog post.

“If consumers are priced out of the drugs they need, that’s a public health concern that FDA should address,” he said.

Gottlieb’s actions are largely unprecedented as the FDA has mostly stayed out of the drug pricing debate. The agency has historically focused on making sure products are “safe and effective,” leaving the pricing issues to Congress.

Congressional outrage over rising prescription drug costs has been a bipartisan concern, but the parties are divided over whom to blame and solutions.

Democrats want greater price controls and want to allow certain drugs to be imported from overseas. Republicans want to increase competition in the marketplace and encourage the development of generic alternatives.

So far, no bills have passed.

During his presidential campaign, Trump railed against the pharmaceutical industry and its prices, saying they are “getting away with murder.”

In June, the Trump administration floated a draft executive order that would have cut regulations in order to speed up drug approvals or lower the price of expensive prescription drugs.

The order was never published, but experts said the policies were considered to be friendly toward the pharmaceutical industry.

Price Resignation Sets Off Frenzy of Speculation Over Replacement

Image result for price resignation imagesSource: The Hill

The resignation of embattled Health and Human Services Secretary Tom Price for using private jets for government travel is setting off a frenzy of speculation about who will replace him.

While it’s still early, health policy insiders see two current officials as perhaps the most likely candidates: Centers for Medicare and Medicaid Services Administrator Seema Verma and Food and Drug Administration (FDA) Commissioner Scott Gottlieb.

Hard-line conservatives, meanwhile, have floated national figures like former Louisiana Gov. Bobby Jindal (R) and former Pennsylvania Sen. Rick Santorum (R).

But before the race even started, two potential names took themselves out of the running.

Sen. Ron Johnson (R-Wis.) was suggested by Heritage Action, but he told reporters late Monday that he was not interested in the job.

And one name that surfaced over the weekend, Sen. John Barrasso (R-Wyo.), has taken himself out of consideration.

The pick could provide a window into President Trump’s approach to ObamaCare going forward, after the GOP failed to repeal the law in dramatic fashion in recent months.

Will he pick another strident opponent of the health-care law, like Price, which would indicate that the battle will continue, or a more pragmatic choice that could indicate a new phase in ObamaCare politics?

The nomination of Verma could signal that Trump wants to keep up the intense battle against ObamaCare. The former health-care consultant was a key figure in efforts to repeal the law this year, making frequent trips to Capitol Hill to try to win over wavering lawmakers.

She is also close to Vice President Pence. Verma worked on putting a conservative twist on Indiana’s Medicaid program while Pence was governor.

Gottlieb would be seen as a more pragmatic choice, signaling that fighting ObamaCare might not be front and center.

A doctor, Gottlieb is best known for his work on drug policy. He worked at the FDA under President George W. Bush and also was a scholar at the right-leaning American Enterprise Institute.

He has steered clear of partisan controversies so far at the FDA and has been relatively press friendly, with frequent tweets and speeches.

Another name floated, Veterans Affairs Secretary David Shulkin, would also be a less partisan choice.

A holdover from the Obama administration, he was confirmed as VA secretary by a 100-0 vote earlier this year. But he is now facing his own controversy over taxpayer-funded flights after The Washington Post reported the government paid for a flight to Europe for him and his wife, where he combined business meetings with sightseeing.

The conservative group FreedomWorks, meanwhile, is pushing for Jindal. A former presidential candidate, Jindal has a long background in health care, serving in the Department of Health and Human Services (HHS) in the George W. Bush administration, and is a strong opponent of ObamaCare.

As a candidate, he touted his plan for replacing the health-care law.

But one hurdle is his past disparagement of Trump. In 2015, Jindal called Trump an “unstable narcissist.”

Any nominee is sure to face a tough confirmation process.

Senate Democrats have been warning about the “sabotage” of ObamaCare at HHS so far, including a 90 percent cut to the advertising and outreach budget that encourages people to enroll in the health insurance marketplace.

Democrats plan to seek commitments from a nominee about how they would carry out ObamaCare, according to a Senate Democratic aide.

It is possible that Trump might not even nominate a replacement anytime soon. The president has not nominated a new Homeland Security secretary since the post became vacant in July.

A delay would leave acting Secretary Don Wright, who vaulted from obscurity into the position with Price’s resignation, in place for the near future.

Wright, a doctor, was a career official in the department, serving under both Bush and President Obama. His background is in public health, a less partisan area in contrast to the battles over ObamaCare.

Joseph Antos, a health-care expert at the American Enterprise Institute, said the failure of GOP efforts to repeal ObamaCare has taken some of the luster out of the HHS position.

“The job is not the same job that one might have imagined in February,” Antos said. “There’s not going to be legislation.”

Instead, the job will be more focused on regulations, which Antos said can be “really tedious stuff.”

Antos said that reality might scare off more high-profile contenders.

Florida Gov. Rick Scott (R) is often mentioned as a possible nominee. He is the former CEO of a hospital company.

But he is a considering a run for Senate in 2018. And a spokesman said Monday that Scott “has no plans to pursue” the HHS position.

Housing and Urban Development Secretary Ben Carson, famous for his work as a neurosurgeon, is also a possibility, but he told Trump in November that he was not interested in the HHS job.

Michael Leavitt, a former HHS secretary under Bush, wrote in an email that the next secretary has the opportunity to use administrative actions to shift ObamaCare in a rightward direction.

“This is a powerful tool, and while not providing the political victory the President and Congress promised, it could, nonetheless, make constructive changes consistent with Republican ideology,” he wrote. “The selection may provide insight on whether the President sees that opportunity.”

Other States Closely Watching Fate of California’s Drug Price Transparency Bill

Image result for drug price transparency imagesSource: KQED

Insurers, hospitals and health advocates are waiting for Gov. Jerry Brown to deal the drug lobby a rare defeat, by signing legislation that would force pharmaceutical companies to justify big price hikes on drugs in California.

Drugmakers have spent $16.8 million since January 2015 lobbying to kill drug legislation in California, according to data from the Secretary of State’s Office, and have hired 45 lobbyists or firms to fight Senate Bill 17, the drug price transparency bill. Against the backdrop of this opposition campaign, Brown must decide by Oct.15 whether to sign or veto the bill.

“If it gets signed by this governor, it’s going to send shock waves throughout the country,” said state Sen. Ed Hernandez (D-West Covina), the bill’s author and an optometrist. “A lot of other states have the same concerns we have, and you’re going to see other states try to emulate what we did.”

The bill would require drug companies to give California 60 days notice anytime they plan to raise the price of a drug by 16 percent or more over two years. They’d also have to explain why the increases are necessary. In addition, health insurers would have to report what percentage of premium increases are caused by drug spending.

This is the second go-round for this drug price bill. Last summer, the same legislation crashed and burned. Its intended regulations were gutted so extensively that Hernandez decided to pull it. But two key things happened after that, he said, which set the stage for a successful second attempt.

First, in August 2016, less than a week after Hernandez pulled the bill, a firestorm of controversy erupted nationally over the price of EpiPens spiking nearly 500 percent. The increase inspired a chorus of outrage from parents who carry the auto-injectors to save their children from life-threatening allergic reactions.

Momentum grew among federal lawmakers last September to do something. They called for hearings. Several proposed bills aimed to reign in drug prices across the country.

But then, the election of November 2016 disrupted all order of health care business in Washington. After Donald Trump was elected and Republicans took control of Congress, the number one health policy priority became repealing and replacing the Affordable Care Act.

As federal lawmakers focused on taking away health coverage from millions of Americans, Hernandez said he saw another opportunity for state lawmakers to act on drug prices. He reintroduced his bill in early 2017, and this time political support grew quickly, beyond the usual suspects.

“It wasn’t just labor,” he recalled. “It was consumer groups, it was health plans. It was the Chambers of Commerce, it was the Hospital Association.”

Hernandez is optimistic the governor will sign SB 17 into law. But he knows nothing’s certain. That’s because of what happened on Sept. 11, the day the bill came up for a key vote in the state Assembly — the same place it went down the year before. Hernandez thought he’d secured all the votes he needed, but at the last minute the votes started slipping away.

The bill needed 41 votes to pass the Assembly. During the roll call, the tally stalled around 35. Hernandez said he had plenty of colleagues willing to cast the 42nd vote, but with drug lobbyists swarming the Capitol, no legislators wanted to be the one to cast the deciding vote.

“If the bill fails and you’re stuck out there, then you’re the person that’s attacking the industry,” Hernandez said.

On the second round of voting, the bill crossed the 41-vote threshold quickly, and the remaining lawmakers glommed on. In the end, the bill passed with 66 votes. All the Democrats and half the Republicans in the state Assembly voted for it.

This was much to the dismay of drug companies, which lobbied hard and issued a blitz of advertising in the last weeks before the vote.

The Pharmaceutical Research and Manufacturers of America, or PhRMA, the industry’s trade group, argued that SB 17 was full of “false promises” that wouldn’t help consumers pay for their medicines, and would instead stifle innovation with cumbersome regulatory compliance.

“That takes up a lot of resources and will take up a lot of time,” said Priscilla VanderVeer, deputy vice president of public affairs for PhRMA. “And that could mean pulling resources from research and development and having to put it into the reporting structure.”

Experts say the drug industry doesn’t want a large influential state like California forcing them to share their data.

“When they have to justify in California, de facto, they have to justify it to the other 49 states,” said  Gerard Anderson, a public health professor at Johns Hopkins University. “So other states essentially get to piggyback on the good efforts of California, and hopefully, because they might have difficulty justifying the price increases, everybody’s prices around the country will be lower.”

Other states, like Maryland, Vermont, Nevada and New York, have passed similar laws aimed at bringing more transparency to prices and curbing price gouging. But the pharmaceutical industry has fought the hardest in California. If drug companies don’t like the disclosure laws in smaller states, they could decide not to sell their drugs there, Anderson said, but the market in California is just too big to ignore.

“States like Maryland are just not as powerful,” he said. “It just doesn’t have the clout that a state like California has.”

But drugmakers are likely already devising ways to work around the California bill, Anderson warned. They’ve filed lawsuits to try to slow or stop laws from being implemented in other states, or to weaken the rules if and when they go into effect. Policy experts are watching to see what kinds of legal challenges the California law might be vulnerable to, and if it can withstand them.

“We learn from the mistakes of other states,” Anderson said. “Legislation is an iterative process. We have 50 states and hopefully, by some time, we’ll get it right. We’re looking for California to take the lead on this.”

Last Updated 10/4/2017

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