Mar 30, 2017

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning ... Should we talk about something besides Obamacare and Trumpcare for a change? Great! Drug prices are back — and it sounds like President Trump may be ready to buy into a huge chunk of the Democratic agenda.

Cummings: Trump wants to do something big on drug prices

How serious is President Trump about drug prices? Democratic Rep. Elijah Cummings tells Caitlin Owens that Trump has called him three times to follow up on their conversation at the White House earlier this month. And Trump's not just talking about letting Medicare negotiate drug prices, Cummings says. It's even worse for Republicans — because Trump is also talking about importing cheaper drugs from other countries.

Why it matters: Trump has said many times he wants to do something about drug prices, and has terrified both the pharmaceutical industry and free-market Republicans with his talk of doing more price negotiations. They assume that means allowing the government, through Medicare, to directly negotiate prices. But if price negotiations are Enemy #1 of prescription drug policy for Republicans, Enemy #2 is allowing importation of drugs from abroad — which Trump also wants to do.

"We came in talking about Medicare, being able to negotiate. And he was saying he wants something even broader," Cummings said. "Then the other thing that we weren't even talking about, was...importation. And then he brought that up, and how ridiculous it was to go to Canada and buy something for $100 and come in the United States and buy it for $900. I think he just sees it as a principle, you know, the idea that, as he said, they're getting away with murder."

Bottom line: "He understands the policy, he gets it," Cummings said. (Democrats introduced a new bill yesterday with those policies and others.)

Trumpcare sightings have become the new Elvis sightings

They want us to believe Trumpcare is dead — but if that's true, why do we keep hearing talk about a bill that BEARS AN UNCANNY RESEMBLANCE TO TRUMPCARE????

  • Bloomberg got the Twitters all worked up yesterday with a report that the House could try to vote on the bill again next week. It cited two Republican lawmakers, but House Ways and Means Committee chairman Kevin Brady said: "I don't think there's any truth to that. None." AshLee Strong, a spokeswoman for House Speaker Paul Ryan, tweeted: "Now seems like an appropriate time to remind folks to be careful what they read."
  • There's also a members-only meeting among Energy and Commerce Committee Republicans, but I'm told it's not anything to get too excited about.

Bottom line:

Maybe we will find out sometime soon that there's been a breakthrough and Trumpcare is alive again, because either conservatives or moderates caved or both. But now is not the time to freak out, because nothing has changed. We'll tell you when it's time to freak out.

Watch the smaller bills: Now Sen. Lamar Alexander is pushing a bill to let people buy any state-approved health insurance if all of the Obamacare insurers left.

Sorry, Trumpcare, the public doesn't miss you

From a CBS News poll released last night — on how the public felt about the Republican health care bill not passing Congress:

  • Glad: 58 percent
  • Frustrated: 32 percent

But look at the Republican responses, and you see why we keep having those Trumpcare sightings:

  • Glad: 31 percent
  • Frustrated: 59 percent
Tom Price's mixed messages on Obamacare

Health and Human Services secretary Tom Price revealed himself to be a conflicted man yesterday. Over and over, he told a House subcommittee he's going to "uphold the law of the land" as long as Obamacare is the law. But it was clear that he really wants to move toward something more like Trumpcare, with lots of different health insurance choices and cheaper prices. How will he do both? Watch the regulations he writes.

The other things we learned from the hearing on the HHS budget (you can read my highlights here):

  • You won't pin him down. Price dodged questions on what he'd do about Obamacare's cost-sharing subsidies, whether he'd advertise the next Obamacare enrollment season, and whether he'd enforce the contraception coverage mandate: "This is one of those areas where we think individuals should have access to the kind of coverage that they want, not what the government tells them to buy."
  • It's not just the medical research cuts that Republicans oppose. The subcommittee chairman, Rep. Tom Cole, doesn't like the proposed 19 percent cut for the National Institutes of Health — but he's also worried about the Centers for Disease Control and Prevention. "You're far more likely to die from a pandemic than from a terrorist attack," Cole told Price.
  • Cole was play fighting with him. Their friendship from Price's House days was clear when Price walked in, sounding a bit weary. "If anyone can handle it, the former chairman of the Budget Committee can," Cole told him.
  • Rosa DeLauro was real fighting with him. The ranking Democrat on the subcommittee harangued Price with a series of "yes or no" questions, finally accusing him of "deconstructing" HHS.
  • Price almost got angry. He's always cheerful and stayed cheerful through most of the hearing, but he finally raised his voice toward the end when Rep. Barbara Lee asked him how he felt about Trump cutting his department to pay for defense spending: "Deconstructing the department is not a goal."
NIH will still face questions about high overhead

Even though Cole is clearly a defender of NIH — and wants to bring its officials to the Hill in May to defend their budget — he's sympathetic to Price's argument, echoed by Rep. Andy Harris, that too much of its grant money is eaten up by administrative expenses. They'll probably get questions about that when they testify, Cole told reporters after the hearing.

On the bright side: Cole said he's going to push to make sure NIH gets its funding increase in the budget for the rest of this fiscal year, which could give the agency another $2 billion. "They'll be very happy" with the funding agreement as it stands now, Cole said.

Don’t forget delivery system reform!

Obamacare's projects to change how hospitals and doctors deliver care to people are some of the most overlooked components of the law. And most of those delivery system reforms aren't going away regardless of what happens in Congress, Dr. Benjamin Chu, the CEO of Memorial Hermann Health System in Houston, told Bob Herman at the annual meeting of the American College of Healthcare Executives.

There's legitimate debate over whether accountable care organizations — networks of hospitals and doctors that are paid based on their clinical quality instead of the volume of services — have saved enough money. But health care providers have invested too much time and money for those projects to disappear. Memorial Hermann is a high-profile participant in Medicare's ACO program, so here's how Chu sees it:

  • On the shift away from filling hospital beds: "It's not about drumming up volume just for the sake of drumming up volume…if you could really demonstrate better quality overall, then you hopefully can capture greater market share."
  • Why ACOs can still struggle: "The challenge is to try to figure out how to tighten the in-network utilization and to convince people that in-network utilization is better care."
About that opioid commission ...

Trump made a big deal yesterday of his new opioid commission, to be headed by Chris Christie. But Vox's Julia Belluz was unimpressed, and makes a good case for why we should be unimpressed too. Her point: It's not like the opioid problem hasn't been talked about. It's been talked about quite a lot, including by the surgeon general's office last year. Also, Trump's budget cuts would probably affect some of the services that fund addiction treatment.

Key quote, from Stanford University's Keith Humphreys: "It's bizarre to create a new entity outside of government to dig into things that have already been dug into, to not use the expertise you have, and not have the commission report to the president."

Caitlin Owens

What we're watching today: Senate takes up a resolution overturning an Obama administration rule requiring states to provide Title X family planning grants to abortion providers; Trump legislative affairs lunch on opioid and drug abuse, noon Eastern.

What we're watching next week: Centers for Medicare and Medicaid Services releases final Medicare Advantage payment rates and policies, Monday, April 3; House Energy and Commerce oversight subcommittee hearing on health care cybersecurity, Tuesday, April 4; Senate HELP Committee confirmation hearing for Food and Drug Administration nominee Scott Gottlieb, Wednesday, April 5.

If you see Elvis, let me know: david@axios.com.