Feb 6, 2017

Axios Vitals

Morning, all. Conservative groups are getting antsy about when we're going to see some actual Obamacare repeal legislation, and the Hill doesn't seem to be ready to give it to them. Meantime, we've got a brand new look at those sky-high hospital CEO salaries you may have heard about.

Is it repeal o'clock yet?

So far, most of the conservative groups that have been pushing Obamacare repeal the hardest — like Americans for Prosperity and Heritage Action — have pulled some punches as the effort has slowed. Even as Republicans' internal disagreements have become more obvious, they haven't hit hard against statements like Sen. Lamar Alexander's talk of "repair" rather than repeal. Now, they're going to start pushing Congress to get on with it.

"It's time for Congress to put out language — actual, specific language" for repeal and replacement bills, Americans for Prosperity president Tim Phillips told me. He didn't sound worried about President Trump's comments to Bill O'Reilly Sunday about the repeal work possibly continuing into next year: "We're more focused on getting language."

Top Republicans insist they're still on the case, and that they're still united in their goal of repealing and replacing the law, as Senate Finance Committee chairman Orrin Hatch said in a floor speech yesterday. But the lack of movement in the committees has become pretty obvious. Here's the evidence House Speaker Paul Ryan's office cited yesterday to prove that Congress is doing things on repeal:

  • The House Energy and Commerce health subcommittee is working on two Medicaid bills this morning: one to make it harder for wealthy couples to get Medicaid, the other to make sure it's not spending money on lottery winners.
  • The House Small Business Committee is holding a hearing.
  • Tom Price may be confirmed later this week.
A new way to look at hospital CEO salaries

Our contributor Steve Brill, who has spent several years reporting on the money in the health care system, has a deep dive on hospital CEO salaries this morning with a unique new way of looking at them. He gives us the first look at how much they earn for every night a patient stays in their hospital. It's one thing to just count the zeroes in their salaries — it's another to figure out how much they're actually costing their patients.

The winner was Norman Roth, the CEO of Greenwich Hospital in southern Connecticut — who earned $56 for each night a patient stayed in his hospital in 2015. That's the most extreme case Brill says he's seen, but there are plenty of others. Read his story here.

Obamacare rule might increase premiums for older people

A lot of health care wonks were talking about this story by the Huffington Post's Jonathan Cohn yesterday. He's hearing that the Trump administration's first big Obamacare rule, which is likely to tighten the enrollment rules, may also let insurers charge higher premiums to older customers than they do now.

  • Current Obamacare rule: older customers can only be charged three times as much as young adults.
  • The new rule: might increase that to 3.49 times as much.
  • Why 3.49? Because it rounds down to three — which is what's written in the law.

Why it matters: This might not happen — it's just something that has been discussed. Insurers would rather increase the range even more, to five times as much for older adults as for younger ones, because they say that's closer to the true cost of their care. But that would require a change in the law, and AARP has already been warning members of Congress not to try it. If the Trump administration tries to do it through rulemaking, they're sure to hear from the seniors' lobby, too.

Local media starting to focus on repeal impact

Here's one development that could make the repeal effort harder: Newspapers are starting to report on the funding states could lose, and other ways that Obamacare repeal could have a local impact.

  • The Richmond Times Dispatch reports that Virginia could lose $20 million in public health funds.
  • The Charlotte Observer reports that North Carolina could suffer a similar loss.
  • The Des Moines Register notes that Iowa hospitals' charity care costs have dropped by $127 million since Obamacare was passed.
Express Scripts: We really are keeping drug costs down

The pharmacy benefit manager had a goal in mind for the drug prices report it released yesterday: It was trying to show that its negotiations with drug makers really do bring down prices, Bob Herman reports. Express Scripts reported that drug spending increased by just 3.8% for the employers and health insurers it works with. It was a way of pushing back against the drug industry, which has been trying to blame pharmacy benefit managers for some of the huge price increases we've seen lately. Read Bob's story here.

Key quote: From Dr. Glen Stettin, chief innovation officer at Express Scripts: "We don't do anything to set prices for the drug manufacturers. They do."

Scott Gottlieb is accepting speaking gigs

A tipster spotted this announcement of an interesting conference speaker: Scott Gottlieb, one of the leading candidates to run the Food and Drug Administration under President Trump, has been booked as the keynote speaker at a Pharmacy Benefit Management Institute conference in Orlando next month. It's not unusual for conference speakers to be booked months in advance, of course, and he can always cancel if he gets the FDA gig. It's just a bit surprising since he was supposed to be a lock to run the agency soon.

Gottlieb didn't respond to a request for comment. Trump promised last week that he'd name an FDA commissioner "fairly soon," but we're still waiting on that.

What we're watching today: Vice President Mike Pence attends the weekly Senate Republican lunch, 12:30 p.m. Eastern; Pence meets with advocates of the "right to try" experimental drugs, 4 p.m. Eastern.

What we're watching this week: Senate confirmation vote on Tom Price, possibly late Thursday (depending on how much debate time Democrats use on him and other nominees).

What we're skipping: Ted Cruz, Bernie Sanders debate future of Obamacare on CNN, 9 p.m. Eastern.

And you're done. Keep me in the loop: david@axios.com.