Jan 25, 2017

Axios Vitals

By Caitlin Owens
Caitlin Owens

Morning, all. It's time for Republicans to huddle and decide how they want to replace Obamacare, Tom Price promised not to break the law before it's repealed, and one of the insurers that did best under Obamacare isn't ready to say they're going to play again next year.

Thanks, as always, for reading Vitals, and don't forget to check the Axios health care news stream throughout the day for the latest in health care politics and business.

Get ready for lots of Obamacare talk at GOP retreat

Can't decide how to repeal and replace Obamacare? Not to worry! That's what the Republican retreat is for. They'll be in Philadelphia today through Friday, and House Speaker Paul Ryan has already said there will be lots of Obamacare talk as GOP leaders try to get their members on the same page, or something close to it. Caitlin Owens will be there, and if there are actual decisions, she'll tell us.

Meantime, House and Senate GOP leaders met Tuesday to get their own act together pre-retreat, and Senate HELP Committee chairman Lamar Alexander said Republicans are "accelerating the replacement part of the package." Read Caitlin's story about the meeting. While in Philadelphia, they'll be treated to a barrage of scolding digital ads from the pro-Obamacare group Save Your Care, plus a protest on Thursday.

Tom Price sort of clears up that executive order

Bit of a missed opportunity in yesterday's Finance Committee confirmation hearing: They spent four hours with Health and Human Services nominee Tom Price and couldn't get him to give a clear picture of how he'll implement President Trump's executive order to ease the Obamacare rules. But Price did give this pledge to Democratic Sen. Mark Warner: Until Obamacare is repealed and a replacement is ready, "Our commitment is to carry out the law of the land."

What it means: Warner had asked Price if he'd use the executive order to bypass Obamacare, and Price said he wouldn't. But there are a whole lot of shades of gray there. Price may not be able to get rid of the individual mandate by himself, but he can grant so many exemptions that the mandate dies a slow, painful, bloody death. And as the Kaiser Family Foundation's Larry Levitt told Caitlin Owens, that doesn't say a lot about how Price would actually implement the executive order: "The real question is what, within the law, these agencies will end up doing."

What we didn't hear: Any Republican going wobbly on Price, despite all of the ethics questions that have been thrown at him. Read Caitlin's highlights of the hearing here.

The most awkward moment at the Price hearing

It was when Price gritted his teeth and hinted he wasn't having a ton of influence on Trump's Obamacare replacement plan. "I've had conversations with the president about health care, yes," Price said at one point. And when Democratic Sen. Claire McCaskill asked if he hoped to lead the Obamacare replacement effort, he answered: "I hope I have input, yes, ma'am."

The exchange suggests that CNN's M.J. Lee was right when she reported earlier this month that Trump's transition team had shut Price out of the writing of the plan — in part because they didn't want him to be able to answer questions about it.

The goal on drug marketing: Opinions as free speech

There's another wrinkle to the fight over marketing drugs for off-label uses. Our contributor Steve Brill reports that the drug industry wants to be able to express opinions about its drugs — to doctors and even consumers — and have them be protected as free speech. It's an argument that's being pushed mainly by lawyers, but it has broader implications than just being able to load up doctors with information about the potential benefits of off-label uses. Read Brill's piece here.

If you can't get Molina to stay in the exchanges ...

Bob Herman talked to J. Mario Molina, the CEO of Molina Healthcare, about how the insurer that's doing so well under Obamacare is reacting to the latest developments. No, he's not fazed by Trump's executive order. But he's not ready to commit to staying in the marketplaces next year: "There are just too many unknowns at this point to give a definitive answer."

That's not a no, but it's a lot less upbeat than when I talked to Molina shortly after Trump's election for a pre-launch edition of Vitals. At the time, Molina said insurers needed a clear signal by May of what the rules of the road will be. It's not May yet, so it may be too soon for Molina and other insurers to give an answer. But if Molina doesn't do it, that's bad news for getting other insurers to stay in — which Republicans really need to avoid a market collapse. Read Bob's story here.

But wait — the insurance industry has a plan

America's Health Insurance Plans, the main industry trade group, seems to be making peace with the idea that the individual mandate is going away. So it's proposing a form of "continuous coverage," an idea that's also in a lot of Republican replacement plans — where people would only be guaranteed coverage for pre-existing conditions if they keep themselves insured.

In a statement to the House Ways and Means oversight subcommittee, AHIP suggested designing the plan this way: Everyone would have a chance to sign up for insurance during 2018 open enrollment, and after that, they'd have to stay insured for 12 months. If they don't, they'd either pay higher premiums when they do sign up, or they'd have to wait six months to enroll — which is how it works with Medicare Part B and D.

Heritage Action to Congress: Don't stall repeal to death

To get an idea of the kind of pressure congressional Republicans are under, take a look at the survey Heritage Action circulated yesterday on Obamacare repeal. It was a Heritage Foundation survey that showed 70 percent agree with the statement: "The longer Congress waits to fulfill promises to repeal Obamacare, the less likely they are to be successful." (Note: it was an online survey, not a telephone one.)

That's an acknowledgment of a real tension: Many Republicans want to make sure they don't repeal Obamacare without a replacement, but conservatives want to make sure the GOP doesn't try to back out of its promise. Heritage Action's Michael Needham is trying to put the best face on the situation: "It is important to get Obamacare repeal on the books, and Leader McConnell and Speaker Ryan are moving quickly to ensure that happens," he said in a statement to Vitals.

Former Googlers are heading to health care startups

The Information has a good look at a bunch of Google and Alphabet alums who have headed to health care and biotech startups — 16 companies over the last five years. Why? Partly because Silicon Valley is sinking a lot of money into health care innovation — but also because, you know, they made a lot of money and now they want to do something else. Check out the piece here.

Caitlin Owens

What we're watching this week: Republican retreat in Philadelphia, today through Friday.

What we're watching next week: House Energy and Commerce subcommittee hearing on Medicaid expansion, Tuesday, Jan. 31.

Thanks for reading, and please keep the feedback and tips coming: david@axios.com.