Here's the Alexander-Murray bill - Axios
Health Care

Here's the Alexander-Murray bill

Sens. Lamar Alexander and Patty Murray have reached a bipartisan health care deal. Photo: Alex Brandon/AP

Here's the draft text of the deal struck by Sens. Lamar Alexander and Patty Murray, obtained from a senior GOP aide. The plan can now be seriously evaluated, especially regarding changes made to Affordable Care Act state innovation waivers.

Items of note:

  • Revised waiver language requires states to "provide coverage and cost sharing protections against excessive out-of-pocket spending that are of comparable affordability, including for low-income people, people with serious health needs, and other vulnerable populations."
  • State insurance regulators must submit a certification to the Department of Health and Human Services that the state will make sure plans receiving cost sharing reduction subsidies in 2018 pass those benefits on to enrollees or the federal government, and a plan for doing so. This is intended to prevent insurers that charged higher premiums in 2018 in anticipation of not receiving the payments don't just keep the payments once they're appropriated.
  • Requires HHS to release guidance on model state plans that meet waiver approval requirements. This could include, for example, a state plan to create a reinsurance program or invisible high risk pool.

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Medicare relaxes heart device policy

Medicare made it easier for hospitals and doctors to implant certain heart devices. Photo: Patrick Semansky / AP

The Centers for Medicare & Medicaid Services will not reduce coverage requirements for implantable cardioverter defibrillators, Modern Healthcare reports. Instead, Medicare "cut regulatory burden" for hospitals and surgeons looking to implant the heart devices.

Why it matters: The government's decision to relax the coverage policies comes two years after more than 500 hospitals had to pay $280 million to settle allegations they billed Medicare for the heart devices even though they violated Medicare's rules.


Amazon to partner with Cerner on health care data

Amazon and Cerner will analyze health care data together. Photo: Ted S. Warren / AP

Amazon's cloud-computing division is expected to partner with health care technology giant Cerner to mine patient health care data, CNBC reports. Amazon would work with Cerner, a major developer of electronic health records, to analyze clinical data and predict what treatments are valuable.

Why it matters: Amazon is expected to make a bigger jump into health care. Pharmacies and drug distributors are worried the conglomerate will overhaul prescription drug delivery. But the partnership with Cerner would get at the lower-hanging fruit of health care data analysis, which is attracting gobs of money in the hope of reducing the country's health care spending.


2.3 million have signed up for ACA coverage

ACA sign-ups lag behind last year's pace. Photo: Andrew Harnik / AP

Roughly 2.3 million people have signed up for Affordable Care Act coverage through, the Centers for Medicare & Medicaid Services said today.

Between the lines: We're halfway through the six-week open enrollment window. Halfway through the last open enrollment window, which was twice as long, more than 4 million people had signed up for coverage.

The bottom line: It's hard to draw an apples-to-apples comparison because of differences in deadlines and the overall length of the enrollment period, but enrollment does seem likely to drop this year, in part due to the Trump administration's decision to eliminate almost all promotion and outreach.


How activists are blocking states from getting execution drugs

Illustration: Rebecca Zisser / Axios

Arkansas is set to execute its fourth death row prisoner in a week today, with four more executions on hold. But activists who oppose the death penalty have made these executions more difficult by cutting off states' access to drugs needed for lethal injections.

Popularity: Approval of the death penalty is at the lowest it's been since the 70s, according to Gallup's poll.

The drugs: Traditionally, a cocktail of three drugs has been used in lethal injection: 1. An anesthetic so the prisoner is unconscious. 2. A paralytic, which freezes up the lungs and other muscles. 3. Potassium chloride, which stops the heart.

The problem: The anesthetic. Anti-death penalty activists have managed to block one powerful anesthetic after another, which has resulted in experiments with different drugs and ultimately, several seemingly-botched executions.

The timeline:

  • Sodium thiopental was the anesthetic of choice for years, and Hospira was the only American, FDA-approved pharmaceutical for the drug.
  • Hospira stopped production of sodium thiopental after the FDA discovered several cases of drug contamination in 2010. This left states with a shortage of drugs, according to the Atlantic.
  • State prisons turned to Europe, Dubai and even a salesman in India to illegally import the sodium thiopental.
  • Maya Foa, an anti-death penalty activist, first convinced British government and eventually the European Commission to ban the exporting of drugs intended for lethal injection, the Atlantic reports. The activist organization she worked for also managed to stop other countries from exporting sodium thiopental by informing the pharmaceutical companies what the drug was being used for.
  • The Drug Enforcement Administration then went on raids taking the states' supplies after reports came out about states importing drugs for lethal injections.
  • In 2010, pentobarbital was first used as the anesthetic in a three-drug lethal cocktail in Oklahoma, according to the Death Penalty Information Center.
  • 7 months later, the pharmaceutical company Lundbeck used distribution controls to prevent the U.S. government from using their pentobarbital for executions, according to the Atlantic.
  • In the 2010s, several states passed secrecy laws which maintained anonymity for the doctors and pharmacists who supplied drugs to state prisons, in an effort to encourage cooperation. Only in Missouri did the court demand that the prison's reveal their sources of the lethal drugs.
  • In 2013, Midazolam was first used in a three-drug, lethal cocktail in Florida, according to the Death Penalty Information Center.
  • In April 2014, Clayton Locket's execution, which lasted two hours, Midazolam was used and resulted in Locket gagging and gasping for breath.
  • In 2015, the Supreme Court ruled that there was not enough evidence that the use of Midazolam falls under "cruel and unusual punishment," in a case brought by death row prisoners. Activists had engaged "in what amounts to a guerrilla war against the death penalty," wrote Justice Samuel A. Alito.
  • Earlier this year, the large pharmaceutical company, McKesson Corporation, sued Arkansas for using its drugs for executions deceitfully, Reuters reported. Arkansas then scheduled eight executions in 11 days, after no execution since 2005. Several of the inmates' executions were delayed after lawyers made the argument that the use of Midazolam could violate the 8th Amendment. However, the first execution was carried out last week, a double execution was performed on Monday and a fourth execution is scheduled for tomorrow.
  • Why the rush? The state's supply of Midazolam expires at the end of the month and they don't know when they could get more.

Higher premiums would cancel out some tax cuts

Some people's tax cuts under the GOP Senate bill would be canceled out by the increased premiums they would face due to the repeal of the Affordable Care Act's individual mandate, according to an analysis by The Commonwealth Fund. And, for those roughly 7 million people who buy insurance on their own but don't get premium subsidies, high health care costs would endure even after the bill's tax cuts expire.

Data: The Commonwealth Fund; Chart: Lazaro Gamio / Axios

Why this matters: This is the downside of repealing the individual mandate in the tax bill. Although doing so provides savings to help pay for the bill's tax cuts, on balance, the bill would leave millions of middle-income Americans worse off financially.


The biggest health issue we aren’t debating

Thanksgiving is always a time to think about those in need. How about, then, a group we don't worry about enough: the many lower and moderate income Americans who can't cover their cost sharing if they get sick? It raises the question: How much cost sharing is too much?

Reproduced from Kaiser Family Foundation analysis of the 2016 Survey of Consumer Finance; Note: Liquid assets include the sum of checking and saving accounts, money market accounts, certificates of deposit, savings bonds, non-retirement mutual funds, stocks and bonds. Chart: Axios Visuals

The bottom line: High deductible plans, which require people to pay large amounts out of pocket before their medical bills are covered, are a good deal for some middle and upper income people. But many lower and moderate income Americans simply don't have $1,500 to $3,000 to pay for the colonoscopy that might save their life, or a stress test that might reveal the heart disease which is the cause of their chest discomfort.

The details: The chart, drawn from a new study, tells the tale: More than four in in 10 households with private coverage and incomes between 150% and 400% of the federal poverty line do not have enough liquid assets to cover a deductible of $1,500 for single people and $3,000 for families.

  • That's not a high deductible plan, but about the average in an employer-provided insurance plan.
  • Sixty percent couldn't cover deductibles double those amounts, which are not uncommon, especially in the individual insurance market.
  • Ninety percent of insured households with incomes of 400% of poverty or more could meet a typical employer insurance deductible, but just 37% of lower income household with incomes under 150% of the poverty level could.

For many families, even if they have insurance, any significant illness could wipe out all their savings, making impossible to fix a broken car to get to work, or pay for school, or make a rent or mortgage payment.

Congress has passed no law declaring that the country will go with high deductible coverage as its main approach to health insurance. There has been no meaningful debate about its pros and cons. But as deductibles and other forms of cost sharing have inched up year by year, the nature of insurance has changed.

The people to worry about most are the ones who are least equipped to deal with that change. There may be someone who fits that bill around your Thanksgiving table.


Murkowski backs ACA individual mandate repeal

Photo: Jose Luis Magana / AP

Sen. Lisa Murkowski, a moderate Republican who broke ranks over the summer to vote against GOP plans to repeal the Affordable Care Act, has written an op-ed declaring her support for a repeal of the ACA's individual mandate. She writes, "I believe that the federal government should not force anyone to buy something they do not wish to buy in order to avoid being taxed."

Why it matters: The Senate tax plan includes a repeal of the mandate, which helps stabilize insurance markets by incentivizing healthy people to buy coverage. This may be a signal Murkowski intends to vote yes on the plan.


Tobacco companies will start running anti-tobacco ads

After a protracted legal battle, tobacco companies will begin running court-ordered ads next week about the health risks of smoking. The campaign of "corrective statements," mandated by a federal judge in 2006, includes a year of TV spots and roughly four months of full-page ads in 50 newspapers.

Why now? These ads have been the subject of litigation for nearly 20 years. They're the product of a lawsuit the Justice Department filed in 1999, which was decided in 2006, then appealed, before the ads themselves were finalized earlier this year. And though the spots will run widely, both TV and newspaper advertising have lost a lot of their reach since this all began.

The details: The "corrective statements" tobacco companies must make cover five topics:

  • The U.S. death toll of cigarettes and the diseases they cause
  • The addictiveness of nicotine
  • The fact that "light" and "low tar" cigarettes are not safer
  • That cigarettes are designed to be addictive
  • The adverse health effects of secondhand smoke

Beginning next week, print ads will run in the Sunday editions of 50 daily newspapers. The television spots must run for 52 weeks, in prime time, on the major networks.


AmerisourceBergen eyes $815 million buyout of H.D. Smith

AmerisourceBergen is acquiring a competitor for $815 million. Photo: George Widman / AP

AmerisourceBergen said Monday it will acquire H.D. Smith, a smaller, independent drug wholesaler, for $815 million in cash. It would further consolidate the drug distribution industry, as AmerisourceBergen, McKesson and Cardinal Health control about 85% of the market.

Looking ahead: The Federal Trade Commission might scrutinize the deal closely, considering H.D. Smith is the second-largest drug wholesaler outside of the big three. AmerisourceBergen has struggled to hold a profit due to declining generic drug prices, and several cities and municipalities have accused the company and others of making the opioid epidemic worse by not properly monitoring where painkillers were going.


Alex Azar made millions in the drug industry

Alex Azar (left) made millions from his drug industry stint. Photo: Katsumi Kasahara / AP

Alex Azar, President Trump's nominee to replace Tom Price as Health and Human Services secretary, is worth as much as $20.6 million, according to new federal disclosures analyzed by the Associated Press. Most of that fortune was made while Azar was at pharmaceutical giant Eli Lilly & Co.

Go deeper: Congress still needs to confirm Azar. The biggest questions surrounding him involve his history with the drug industry and what he'd do to change the U.S. drug pricing system.