The megabill's health care ripple effects

Politico

4 days ago

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Driving the Day
HEALTH INDUSTRY IMPACTS — The Senate passed its version of the GOP megabill on Tuesday, and big players across the health care industry — from insurers to providers — have been quick to warn of the widespread impacts of the bill's massive Medicaid cuts.
The Senate's version of the bill goes farther than the House-passed legislation, cracking down on sources of revenue for state Medicaid programs — which could lead to less funding for providers and cuts to benefits. If either version of the bill passes, millions of people would lose health insurance, according to the Congressional Budget Office.
To discuss the legislation's potential trickle-down, industrywide impacts, Kelly caught up with Karen Ignagni, the executive board chair of nonprofit insurer EmblemHealth and the former longtime president and CEO of health insurance trade group AHIP. Ignagni, once the nation's top health insurance lobbyist, helped shepherd the Affordable Care Act's passage in 2010. Today, she worries about reversing massive progress in lowering the uninsured rate since Obamacare was implemented.
Here's some of our conversation, edited for length and clarity:
If the Senate's version of the bill is enacted, what would be the impact of those changes across the health industry?
The health of the population is very important to the country's productivity, and that's important for economic growth. Measures that, according to CBO, would lead to large numbers of people no longer having eligibility — that means that chronic illnesses don't get attended to, which means they get worse. That means that prevention goes by the wayside. Health suffers.
Not having coverage means that you postpone care, there is no early intervention, and the only place you can receive care, when the situation is most extreme, is through the hospital emergency room. And that has not only significant health consequences, but it also has significant economic consequences across the country.
How will health insurers react to these cuts if they go through?
Health insurers will be very focused on what we as an industry can do to help people with requirements, significant increases in paperwork. Insurers will need to begin to seriously consider what are the strategies that we can use to better support our population, the populations we serve in those areas that heretofore have not been front and center but now will be, depending upon what is done between the House and the Senate.
Provisions in the bill crack down on ACA eligibility, which CBO has estimated could lead to millions becoming uninsured. How might that affect the Obamacare market?
It's very early, because we don't know exactly how the House and Senate will reconcile these two pieces of legislation, but the fundamental goal back in 2008, 2009, 2010, was to provide coverage for people who were left out of the system. To the extent you cut back coverage — we're back to the same thing that we were just talking about on the impact of not having coverage. Essentially, you're reducing coverage for a significant number of people, whether it's through subsidies, whether it's through other provisions on the ACA side.
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Industry Intel
PHARMA WINS IN THE MEGABILL — Drugmakers are celebrating the absence of President Donald Trump's 'most-favored nations' policy in the Senate-passed version of the GOP's massive spending bill, POLITICO's David Lim reports.
The pharmaceutical industry also notched two other key wins in the bill: a measure that would exempt more drugs from Medicare drug-price negotiations — specifically medicines that treat multiple rare diseases — as well as a sought-after tax break for research and development costs.
Most-favored nations out: Republicans' decision not to codify the most-favored-nation policy Trump proposed — requiring drugmakers to charge no more than the lowest price paid in other wealthy nations — is the number one win 'by a mile' for drugmakers, said one pharmaceutical industry lobbyist granted anonymity to discuss the bill. Sen. Bill Cassidy (R-La.), chair of the Senate Health, Education, Labor and Pensions Committee, circulated a most-favored-nation-like proposal in early June, but it didn't make the cut.
The Pharmaceutical Research and Manufacturers of America, the trade group for brand-name drugmakers, repeatedly lambasted the idea of a most-favored nation policy in the days leading up to the Senate vote.
'It makes no sense to adopt foreign pricing as a benchmark when the administration itself has noted those prices are held artificially low,' PhRMA CEO Steve Ubl wrote in a June 26 op-ed in STAT.
Pharma losses: The Senate didn't include a provision that would have aligned the number of years that small-molecule and large-molecule drugs are exempt from Medicare negotiations that drugmakers describe as a pill penalty. It also doesn't address another top priority for drugmakers: reform of the 340B program that allows hospitals to buy discounted medicines to serve low-income individuals. Drugmakers say hospitals abuse the program to make more money.
Senators also dropped a slate of measures included in the House-passed version of the megabill that targeted industry middlemen known as pharmacy benefit managers that negotiate drug prices on behalf of insurers and large companies.
In the courts
HHS LAYOFFS INTERCEPTED — A federal judge today temporarily blocked much of the mass layoffs that plagued Department of Health and Human Services staffers in March — ordering the Trump administration to cease plans to overhaul the department's workforce.
U.S. District Judge Melissa DuBose in Rhode Island granted the preliminary injunction sought by a group of 19 attorneys general in a lawsuit filed in early May.
Her order bars the Trump administration from finalizing the layoffs or rolling out any further firings. It also directs HHS to provide a status report by July 11.
'The executive branch does not have the authority to order, organize, or implement wholesale changes to the structure and function of the agencies created by Congress,' DuBose wrote in her order.
Key context: Health Secretary Robert F. Kennedy Jr. purged the agency of more than 10,000 employees in late March, announcing the department would be consolidated and transformed into the Administration for a Healthy America.
HHS response: 'HHS remains committed to modernizing a health workforce that for too long prioritized institutional preservation over meaningful public health impact,' said HHS spokesperson Andrew Nixon in a statement. 'We are reviewing the decision and considering next steps.'
DATA-SHARING CHALLENGE — Twenty state attorneys general are suing the Trump administration for sharing personal information with immigration officials about people who receive public health insurance, POLITICO's Tyler Katzenberger reports.
The unprecedented data grab, first reported by The Associated Press last month, targeted residents of California, Illinois, Washington state and Washington, D.C., which all offer public health insurance benefits for undocumented immigrants. It sparked outrage from Democratic leaders from other states and data-privacy advocates, who blasted the action as invasive and potentially illegal.
The Trump administration has argued the data-sharing maneuver is legal and would ensure Medicaid benefits are reserved for U.S. citizens. The White House did not immediately respond to a request for comment.
HEALTHLINE SETTLEMENT — Healthline, a popular health information website, will pay $1.55 million to California to resolve allegations that it improperly shared consumers' personal data, Tyler reports.
According to California Attorney General Rob Bonta's office, Healthline violated the state's landmark 2018 Consumer Privacy Act by sharing personal data collected by online trackers with third parties even when consumers opted out.
'Healthline shared data that could uniquely identify the consumer, in addition to the title of the article they were reading,' a statement from Bonta's office, released Tuesday, alleges. 'Some titles indicated that the reader may have already been diagnosed with a serious illness, such as 'You've Been Newly Diagnosed with MS. What's Next?''
Healthline did not respond to a request for comment.
The San Francisco-based company doesn't admit wrongdoing under the terms of the settlement, but agreed to strengthen its privacy protections and to stop sharing articles with titles suggesting an existing medical diagnosis, according to Bonta's office.
Names in the News
Jonathan Blum has joined Noridian Healthcare Solutions' board of directors. Blum, a senior scholar at the USC Schaeffer Institute, was formerly the principal deputy administrator and chief operating officer at the Centers for Medicare and Medicaid Services.
The Reproductive Freedom Alliance is adding Sydney Etheredge as director of operations and strategic initiatives and Izzy Nathanson as director of state partnerships. Etheredge previously was president and CEO of Planned Parenthood of Western Pennsylvania. Nathanson most recently was a health policy adviser in Colorado's Office of Saving People Money on Health Care.
WHAT WE'RE READING
POLITICO's Maya Kaufman reports on New York raising the threshold for Medicaid enrollees to qualify for in-home personal care services.
STAT's Meghana Keshavan reports that an experimental psychedelic therapy showed some effectiveness against treatment-resistant depression in a midstage trial.