Good morning ... The House and Senate have now both passed bills to end the second government shutdown of 2018. If you slept through the whole thing, I’m jealous.
The pharmaceutical industry is livid about a surprise change to Medicare drug policy that was slipped into the Senate budget deal, my colleagues Caitlin Owens and Bob Herman report this morning.
The details: The bill would close the Medicare Part D "donut hole" in 2019, a year earlier than previously scheduled, and force drug companies to shoulder more of the cost.
What they’re saying: "They were completely blindsided,” one lobbyist says of the drug industry.
The big picture: Pharma usually gets everything it wants. But of all the options that were on the table to squeeze a little more money out of drugmakers, this was probably the most palatable.
The Trump administration is considering regulatory changes that would make it harder for immigrants to gain permanent U.S. residency if they rely on public assistance, Reuters reported last night.
The gritty details, per Reuters:
The Trump administration is approving new limits on Medicaid coverage. Photo: Wally Skalij / Los Angeles Times via Getty Images
Congressional Republicans weren’t able to pass their proposals for a sweeping Medicaid overhaul, but sweeping changes are happening anyway — at the hands of the Trump administration and Republican governors, relying on a system of regulatory waivers that has never been used quite this way before.
What’s next: Robin Rudowitz, a Medicaid expert at the Kaiser Family Foundation, told me the next two big things to watch are: states’ efforts to receive full federal funding for only a partial expansion and the attempt to impose lifetime limits on Medicaid coverage.
Go deeper: Read more about the administration’s quiet Medicaid overhaul in the Axios stream.
David Mitchell, a patient advocate we wrote about when he launched the group Patients for Affordable Drugs, has been critical of the pricing for Novartis' new CAR-T drug, Kymriah. (It’s $475,000 for a one-time infusion). So he accepted a challenge to say what he thought the right price should be.
His answer, per Forbes: $160,000. Still kind of expensive, right? But it’s a third of the price that Novartis is charging for the blood cancer treatment. Mitchell and a team of health care researchers published an analysis in Health Affairs to explain how they arrived at that conclusion.
The other side:
Our thought bubble: Drug companies are never going to win the PR battle over drug prices until there’s more transparency — but the rest of us will have to accept that certain drugs are just never going to be cheap.
The American Hospital Association took issue with Bob’s report about Medicare hospital audits in Wednesday's Vitals. The lobbying group’s top lawyer wrote Thursday the report “is misleading and only tells one side of the story.” So, Bob has more:
The bottom line: Hospitals often are able to lower their penalties by showing mistakes in audits. But the government’s broader findings that hospitals have poor oversight of their billing and medical claims still stand — and hospitals often admit as much when responding to the audits.
Here’s a quick dose of health care merger news for you: Carolinas HealthCare, which is attempting to merge with UNC Health Care, is absorbing a smaller hospital system in Georgia called Navicent Health. Carolinas also rebranded itself as Atrium Health as it looks to grow into a bigger force in the South.
Between the lines: It’s a more significant deal locally than it is nationally. But these are the types of mergers that academics and policymakers have warned raise prices (and therefore insurance premiums) for local residents.
Mark your calendars: HHS secretary Alex Azar will be on Capitol Hill next week defending the administration's budget request for his department. He'll be at the Ways & Means Committee on Wednesday, and on Thursday will appear before both the Finance and the Energy and Commerce panels.
What else is going on? Let me know: email@example.com.