Axios Vitals

A briefcase with a red cross on the front.

October 09, 2017

Good morning ... The newsletter is a bit shorter today for the government holiday, but we'll have plenty to look forward to as the week unfolds.

​Trump's call with Schumer

My colleagues Mike Allen and Jonathan Swan broke the news Friday night that President Trump had called Senate Democratic leader Chuck Schumer to talk about a bipartisan health care deal.

My thought bubble: Skeptical confusion.

  • Trump has done nothing — nothing — to make any bipartisan moves whatsoever on health care. It's not just about his support for repeal and replace, which is a GOP imperative. Everything he's done on his own has pointed toward destabilizing the ACA.
  • That includes: keeping insurers in limbo about cost-sharing subsidies; an executive order he's expected to release this week (read more below); cuts to enrollment outreach; and, reportedly opposing even Republican governors' attempts to stabilize their states' markets.
  • There's a bipartisan effort under way already, between Sens. Lamar Alexander and Patty Murray. They do not have a deal, and they're nowhere near as far apart as Trump and Schumer.

What they're saying: No one else seems especially bullish on this compromise, either.

  • "The administration has to stop sabotaging the law before anything real can happen," a Democratic aide told Jonathan and Mike.

​New executive order coming this week

Trump will issue a new executive order this week rolling back a handful of Obama-era health care policies and expanding access to cheaper, less comprehensive insurance plans, the Wall Street Journal reports.

The details: According to the WSJ, the order will:

  • Direct federal agencies to expand access to association health plans, which would be exempt from many of the Affordable Care Act's coverage requirements.
  • Expand access to short-term health plans, which also cover a more limited set of benefits, with a lower premium. President Obama limited those plans to 90 days; Trump will likely allow people to buy them for up to a year.
  • Allow consumers to use tax-preferred health savings accounts to pay their premiums.

What it means: Association health plans and short-term insurance function similarly: They create lower-cost, less comprehensive options that are most likely to appeal to healthy people.

The fear — among Democrats as well as insurance companies — is that those healthier consumers would choose these new plans and leave only sicker, more expensive consumers buying comprehensive coverage through the ACA's exchanges. If that happens, expect insurers to raise their rates or look for the exit.

The AMA’s Medicare influence remains opaque

Axios' Bob Herman has reported before about the growing power of the American Medical Association group known as the RUC, which makes recommendations to Medicare about physicians' payments. Medicare has been accepting more and more of the RUC's recommendations, meaning doctors have a lot of sway over their own Medicare payments.

So Bob tried to attend a RUC meeting last week in Chicago, in order to tell our readers what it was recommending and how it was arriving at those decisions. Turns out, although those meetings are ostensibly open to the public, attendees have to sign confidentiality agreements that prohibit them from discussing the panel's deliberations. Which sort of defeats the purpose.

  • "Given that [the Centers for Medicare and Medicaid Services] has said they are going to accept everything from the RUC, they really should not be tolerating a secret process," said Paul Ginsburg, a senior fellow at the Brookings Institution and expert in Medicare payment policies.

Go deeper: Read Bob's full assessment of the AMA's closed-door policy and why it matters for public policy.

​While you were weekending...

  • On CNN's "State of the Union," Sen. Ron Johnson said he still supports a bipartisan ACA fix — funding its cost-sharing subsidies in exchange for regulatory flexibility along the lines of what Alexander has been seeking.
  • White House budget director Mick Mulvaney, appearing on "Meet the Press," offered this interpretation of Trump's call with Schumer: "If the question is, is the president interested in working with Democrats to repeal and replace? That would be our language. The answer is yes. The Democrats may use a different word for that."
  • Women who use contraception for medical reasons which may or may not include birth control are worried about Trump's changes to the ACA's contraception mandate, CNN reported.
  • A new plague outbreak, similar to the onset of the 2014 Ebola epidemic in its virulent transmission, has struck Madagascar, per The New York Times.

What we're watching this week: Trump's executive order.

House Energy and Commerce oversight subcommittee holds a hearing Wednesday on the 340B drug discount program.

Get in touch: As always, I'd love to hear your feedback, questions and tips: [email protected]