Jun 1, 2017

Axios Vitals

Good morning ... There's more of a variety of health care opinions in Mark Meadows' district than you might think, but only because his constituents are living in two different worlds of news. And online brokers are looking forward to a bigger role in Affordable Care Act signups.

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Freedom Caucus chairman's district chooses its news

Caitlin Owens has been driving around Freedom Caucus chairman Mark Meadows' North Carolina district this week, finding out what people think of the health care bill he helped pass. One thing she found that kind of surprised us: There are liberals in his district? And even a Democrat who's running against him (with a bumper sticker)? It's so un-Freedom Caucus.

But don't get the wrong impression: Meadows is still strong in his district, and his supporters aren't worried about the criticisms of the House bill. They either don't believe the worst things they've heard, or they're not really tuning in because they figure the Senate is just going to rewrite everything anyway. Meadows may come from a conservative district, but it doesn't all speak with one voice — and his constituents are living in two different worlds of news about his work on health care. Read Caitlin's story here.

Online brokers will get a piece of the ACA action

Online insurance brokers will have a bigger role to play in the ACA's next open-enrollment period. Shoppers will be able to sign up for coverage directly from web brokers like eHealth, instead of getting redirected to HealthCare.gov.

Why it matters: As Bob Herman explains, the changes make it clear that if the Trump administration has to carry out the law, it will put more control into the hands of the private sector. More people could ultimately sign up for ACA plans if they don't have to bounce around different websites, but there are concerns that web brokers might direct people toward health plans that aren't the best fit.

Cornyn's pledge: Health care vote by end of July

Senate Majority Whip John Cornyn didn't sound worried yesterday when he phoned in to a Lubbock radio station to talk about the Senate's health care efforts. "We'll get it done by the end of July at the latest," he told The Chad Hasty Show.

But settle down, Republicans: Cornyn also sent a signal that some Republicans may have to lower their expectations. "We've only been debating this for seven years now, and there are all sorts of great ideas from Republicans on repealing and replacing Obamacare, but we can't vote on all of them. We need to come up with a consensus bill."

What the medical device makers told Tom Price

A group of medical device industry officials made the rounds yesterday with Health and Human Services secretary Tom Price and Commerce secretary Wilbur Ross, and while their interests lined up on some big things, it wasn't a complete match. The high points, via AdvaMed spokesman Greg Crist:

  • Made the case against the Affordable Care Act's medical device tax: "harms our competitiveness and stalls innovation cycles."
  • Asked for policies at the Food and Drug Administration and the Centers for Medicare and Medicaid Services that promote innovation.
  • A warning on the FDA's medical device user fees: "We support our agreement as negotiated and would not support re-opening the agreements at this late stage."

Between the lines: The first two are easy sells with the Trump administration. The last one was a pretty blunt message about President Trump's budget proposal, which would make the industry pay the full cost of medical product reviews. Price has been trying to push that idea on members of Congress, but the user fees have already been negotiated with the industry and no one is interested in starting over.

Why Molina matters

The Wall Street Journal has a good behind-the-scenes look at the most interesting soap opera in health care: Molina Healthcare, which went all in on the ACA — 34% of its revenue comes from the exchanges or the Medicaid expansion — before its CEO and CFO were fired.

The company blamed its poor financial performance last year on higher-than-expected ACA enrollment. It also blamed the ACA's risk-adjustment program, saying it owed more than it expected. Investors didn't accept that explanation. Among other complaints about the company's former leaders, one investor "said he also wanted reassurances that Molina would completely leave the ACA marketplaces."

Between the lines: Molina is just one company, with its own quirks and internal dramas. But the fundamental tensions at play here — trying to make some money in a new market, despite that market's volatility and pressure from risk-averse investors — are hardly unique. It's not hard to understand why bigger insurers are so wary of the exchanges, or how much the political climate is exacerbating that wariness.

Why the Senate moderates might not kill health care

We've all spent a lot of time tracking the concerns of Senate Republicans like Bill Cassidy, Shelley Moore Capito, Lisa Murkowski and Rob Portman, who all have serious critiques of the House health care bill. But FiveThirtyEight's Perry Bacon has a smart, skeptical look at whether they'd really stand in the way if the Senate version is similar to the House bill.

Why they might not: Some of them come from states that Trump carried by big margins. Trump won West Virginia, Capito's state, by 42 percentage points. He won Cassidy's state of Louisiana by 20 percentage points, and Murkowski's state of Alaska by 15. And as Bacon points out, no Republican wants to be blamed for derailing the repeal of the ACA, which their party has been promising for seven years.

Yes, but: They have to consider all of that — but they also have to answer to voters who might lose Medicaid or ACA insurance, or pay higher premiums if the new tax credit doesn't give enough help to low-income people or the elderly. The possible consequences don't become irrelevant just because of the political winds.

What to expect from Trump's plan for drug prices

The White House is expected to release a plan sometime soon to bring down the price of prescription drugs, and Novartis CEO Joe Jimenez told Bloomberg he's anticipating "a solution that will preserve the business model of how we innovate and discover and develop and launch into the U.S., as opposed to some of the bigger and more draconian elements that were discussed earlier."

Between the lines: Sounds like the drug industry thinks it will be pretty happy with the president's plan to bring down their prices—a far cry from Trump's past rhetoric about pharmaceutical companies "getting away with murder" and his endorsement of Medicare price negotiations, which the industry strongly opposes.

What we're watching this week: Senate Republican leaders and staff write the first draft of the health care bill over the recess.

What we're watching next week: The Senate comes back, holds more meetings, tells reporters they're making progress. Also, the investment bank Jefferies holds its global health care conference in New York City, June 6-9. And Facebook is reportedly holding a health summit on June 6 for pharmaceutical marketers, per CNBC.

What else do you want to know? Give us a shout: david@axios.com, baker@axios.com.