Axios Vitals

A briefcase with a red cross on the front.

March 27, 2017

Good morning ... It was a slow, slow day yesterday as the health care world caught its breath. But there are still big decisions the GOP has to make after Trumpcare, including whether to give insurers the payments they want to prevent an Obamacare market collapse. Oh, and maybe Trumpcare isn't totally dead. It's pretty dead, though.

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Decision time for Obamacare cost-sharing payments

One big bit of unfinished business after Trumpcare's collapse: What to do about the money insurers want for Obamacare's cost-sharing reduction subsidies? Caitlin Owens reports that Republicans will have to decide whether to drop the House GOP lawsuit against them — which was filed when Barack Obama was still president — and just give the insurers their money. If they do that, maybe the Obamacare marketplaces won't collapse.

Problem is, their next chance to do it is in the spending bill to keep the government funded after the end of April — which is probably going to get bogged down in fights over Planned Parenthood and President Trump's border wall. But it would give Republicans a chance to clean up the mess they brought on themselves. Read Caitlin's story here.

Ryan: "Not giving up" on health care

We ignored White House press secretary Sean Spicer when he said yesterday that "I don't think we've seen the end of health care." But now, the Washington Post reports that House Speaker Paul Ryan is saying the same thing. He told GOP donors that he's going to work "two tracks," moving on to the rest of the GOP agenda "while we work the health care problem." Ryan suggested that he'd brief donors on a plan at a retreat in Florida Thursday and Friday: "We are not giving up."

Why it matters: Hard to tell if it does. What else was Ryan going to say to donors? He doesn't want them to stop giving money. But there's no sign that he's any closer to getting enough votes to pass an Obamacare repeal. Let's see what he tells the donors and see how serious it sounds.

Know who else isn't letting it go?

That's what Trump tweeted last night. He also trolled the Democrats one more time: "The Democrats will make a deal with me on healthcare as soon as ObamaCare folds - not long. Do not worry, we are in very good shape!"

The states are throwing a big Medicaid expansion party

And it looks like the collapse of Trumpcare is encouraging some states to move ahead on Medicaid expansion (in different ways). Here's what they're up to:

  • Virginia: Democratic Gov. Terry McAuliffe is amending his budget to move ahead with Medicaid expansion. (He's always wanted to, but he held off while the Obamacare repeal was a real possibility.)
  • Kansas: The state Senate voted to expand Medicaid yesterday, the Wichita Eagle reports, with one Democratic state senator telling the Kansas City Star that the failure of the Obamacare repeal "takes away a huge argument" against it. (Republican Gov. Sam Brownback probably won't sign it, though, and supporters are just shy of the votes they'd need to override his veto.)
  • Georgia: Even Republican Gov. Nathan Deal is looking for ways to expand Medicaid coverage — although he'd probably do it differently. He's thinking of applying for a federal waiver that would relax the minimum coverage requirements, per the Atlanta Journal-Constitution. "The governor is exploring a variety of solutions that bring Georgians greater flexibility and access to care," but hasn't decided on a specific proposal, spokeswoman Jen Talaber Ryan told me.

Other states to watch: North Carolina, Idaho, Nebraska, and South Dakota, per Forbes.

Anthem, Trump and the Justice Department

The Trump administration could have a conflict-of-interest problem on its hands. Trump announced last night that he's nominating Makan Delrahim as the top antitrust official at the Justice Department. Bob Herman reports that Delrahim was a lobbyist at Brownstein Hyatt Farber Schreck, specifically lobbying lawmakers on antitrust issues tied to Anthem's acquisition of Cigna.

Anthem is still fighting the Justice Department to have its deal approved (even though Cigna wants it dead) and argued last week that the appeals court erred in blocking the deal. Hiring a paid advocate of the health insurance merger isn't going to look good to the "drain the swamp" crowd.

Yes, but: Trump's Justice Department already filed a legal brief a couple weeks ago telling the appeals court not to overturn the decision that blocked the merger. If Delrahim reverses the Trump's support to stop the merger, it could create a political bomb — not to mention appeals court judges would raise their eyebrows at an administration contradicting itself in a matter of weeks. And hospitals, doctors and consumer groups who oppose the Anthem-Cigna deal would flip out if Delrahim backed off the Justice Department's current position.

"Enormous amounts of human suffering"

When Trump proposed a 19 percent cut in the National Institutes of Health budget, it had a deeply personal meaning for biotech entrepreneur John Crowley. That's because his daughter Megan, who's battling a rare disorder called Pompe disease, had just been a guest at Trump's speech to Congress, where the president talked about the importance of encouraging medical innovation. My colleague Dan Primack has a story up this morning about his conversation with Crowley.

Key quote: "We could say right now: 'No new drugs.' Then all current drugs would go generic and cost less, but I don't think that's acceptable. And if you have a kid with a rare disease or a parent with Alzheimer's it's obviously not acceptable. So if we don't invest massively in this effort, which includes NIH funding, it's going to lead to enormous amounts of human suffering."

Controversial health care CEO gets a new national role

Bob Herman is reporting from the annual meeting of the American College of Healthcare Executives in Chicago, where a bunch of top health care leaders get together and talk shop for a week. To kick things off, ACHE put out a press release announcing four new people are on its board of governors. Pretty run-of-the-mill, except that one of those new board members caught his eye: Anthony Armada, the CEO of the western Washington region of Providence St. Joseph Health.

The problem: Armada resigned as CEO of Providence's Swedish Health Services last month after a Seattle Times investigation found patient-care lapses and volume-driven motives at Swedish's neurosurgery institute. Armada reportedly ignored staff members' concerns — not exactly a badge of honor for a new board member representing health care executives. ACHE didn't acknowledge this issue in the release, nor did it respond to inquiries.

What we're watching today: House Energy and Commerce health subcommittee hearing on the FDA's medical device user fee program, 10:15 a.m. Eastern. Livestream here.

What we're watching this week: House Appropriations Committee hearing on the HHS budget, featuring testimony from HHS secretary Tom Price, Wednesday; Senate Aging Committee hearing on Alzheimer's disease, Wednesday.

Thanks for reading, and let me know what other health care news we missed while we were chasing Trumpcare: [email protected].