Dec 12, 2017

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning ... My sympathies to all the political operatives and reporters trying to focus on the Alabama special election today, only to see it lost in the shuffle of so much exciting health policy news. Or wait, do I have that backward?

CHIP likely to slip to next year

Congress probably won’t be able to restore federal funding for the Children’s Health Insurance Program by the end of the year, House GOP leadership aides told my colleague Caitlin Owens yesterday.

  • Federal CHIP funding expired Sept. 30. Lawmakers initially said they would have a deal before it expired; then, no more than a few weeks after it expired; then, by the end of the year; now, in January.
  • Virginia will begin notifying families today that CHIP coverage will end on Jan. 31 if Congress doesn’t act. It’s the third state to begin sending such notices, following Colorado and Utah.

Where it stands: The Centers for Medicare & Medicaid Services is providing states with stopgap funding, drawn from a reserve of leftover money from past years. That pot started off with roughly $3 billion; CMS has now paid out about $1.2 billion in grants to 21 states and territories.

  • Demand for that money will likely grow, as more states begin to run out of money in the first quarter of next year.

The other side: Even though House leadership aides said the bill will likely slip into January, Senate Finance chairman Orrin Hatch says he’s still optimistic about getting something done in the next three weeks.

  • “This continues to be a top priority for Chairman Hatch … The chairman is continuing to make progress in his discussions on how best to address this issue on the Senate floor and remains confident this will be resolved before the year’s end,” a committee spokeswoman said.
More Democrats are starting to like the ACA

The public is increasingly warming to the Affordable Care Act, according to a new survey from Pew Research.

  • 44% say the law has had a mostly positive effect on the country as a whole — a gain of more than 20 percentage points since 2013, when its central provisions hadn’t yet taken effect. Just 35% now say it’s had a mostly negative effect.
  • Overall, 56% of the public approves of the law while 38% disapproves.

Yes, but: The ACA’s favorability ratings are only rising because Democrats are getting behind the law.

  • The number of Democrats saying the ACA has had a positive effect on the country is up almost 30 points since 2013; the number of Republicans who say it’s been bad for the country has barely changed.

The bottom line: Like everything else in politics, the ACA’s public perceptions are driven mainly by hardcore partisanship. The law now enjoys majority support not because two sides have come together, but because Democrats are finally as dug in as Republicans.

Device manufacturers confident in tax delay

One thing Congress probably will be able to get done this year – prevent the ACA's tax on medical devices from kicking in. A freeze on the tax is set to expire at the end of the year, meaning a 2.3% fee on all U.S. device sales would snap back into effect. But industry sources tell my colleague Bob Herman they're confident Congress will keep the freeze in place a while longer.

What we're hearing: Congress likely will extend the moratorium for anywhere from two to five years and find a way to make up for the roughly $6 billion in lost revenue. There's also an outside shot the device tax could be fully repealed, since many Democrats in states with prominent medical device manufacturers also dislike the tax.

“Something will happen," a veteran medical device company lobbyist told Bob. “There's just universal agreement to get it done."

CDC director's finances raise Democratic eyebrows

Brenda Fitzgerald, the director of the Centers for Disease Control and Prevention, has recused herself from several big policy decisions due to financial conflicts. There's some concern, though, that there could be too many big policy areas affected.

The details: Fitzgerald and her husband have not been able to divest themselves from certain investments, including those in companies related to cancer detection and opioid monitoring. She has pledged not to participate in decisions that would affect her financial holdings.

Yes, but: Sen. Patty Murray, the top Democrat on the Senate HELP Committee, says those conflicts are sweeping and would require equally sweeping recusals.

“I am concerned that you cannot perform the role of CDC Director while being largely recused from matters pertaining to cancer and opioids, two of the most pervasive and urgent health challenges we face as a country," Murray said in a letter last week, which her office released yesterday.

Go deeper: The Washington Post has a more thorough look at these recusal issues (it's not exactly clear what Fitzgerald is recusing herself from), and some of the additional frustrations critics have voiced. She has sent more junior officials to testify in her place, and has generally made very few public appearances.

1 fun thing: The oral history of Viagra

A first generic version of Viagra hit the market yesterday, marking the end of a wild, 19-year ride in which Pfizer raked in more than $30 billion from a pill that also became a part of pop culture.

Bloomberg marked the occasion with an oral history of the drug, as told by the researchers, doctors and marketing executives who were there — all the way back when it started off as an unsuccessful attempt to come up with a new treatment for high blood pressure.

Two key quotes:

“I said, 'Look, I don't understand, what's the disease? You're saying you've got a drug but what are you treating?' And they said 'impotence,' and I said, 'Well, is that a medical condition?' And they said, 'Hmm, not so sure,' so they began to talk to doctors and experts, and that's where that whole idea of erectile dysfunction came up."— Art Caplan (medical ethicist)

“It was discussed quite robustly inside the [FDA]. Certain people felt the ads were over the top and inappropriate. Negative is in the eyes of the beholder, but when you see a guy looking at a sexy woman and little horns come up out of his head, I think you can imply that that is a drug for enhanced sexual behavior."— Peter Pitts (FDA official)

Caitlin Owens

What we're watching today: HELP hearing on the price of prescription drugs (10am; livestream).

Energy and Commerce oversight subcommittee hearing on fraudulent treatments for opioid addiction (10:15am; livestream).

What we're watching this week: HELP hearing Wednesday about the 21st Century Cures Act and mental health. Energy and Commerce health subcommittee hearing Wednesday on the drug supply chain.

What's going on in your world? Let me know: