Axios Vitals

A briefcase with a red cross on the front.
November 03, 2017

Good morning ... Wait a minute, did Congress just successfully pivot to another piece of domestic policy, without getting immediately drawn back into a debate over the Affordable Care Act? Who knew that was actually possible?

GOP plan would ax two health care tax breaks

House Republicans' Tax Cuts and Job Act would repeal two tax breaks related to health care: one that allows patients to deduct some particularly expensive health care bills, and another designed to spur the development of new drugs to treat rare diseases.

The bottom line: Both of these changes would affect relatively small — but also especially vulnerable — groups of people. Although Republicans spared the most widely used and most expensive health care-related tax provisions, don't be surprised if Democrats seize on the deduction for medical expenses as a key point in their criticism of the bill.

How it works: Current law allows you to deduct certain health care expenses, if those expenses add up to more than 10% of your income. The GOP bill would repeal that deduction.

  • This is an especially big deal for people with chronic diseases or who need long-term care, according to the Kaiser Family Foundation's Larry Levitt. It would also affect families who pay for a relative's care, particularly for expensive conditions like Alzheimer's.
  • The deduction costs the government roughly $10 billion per year, according to figures from the Joint Committee on Taxation.
  • Existing law also provides a tax credit to drug companies that develop "orphan drugs" — new products to treat rare diseases. The House bill would eliminate that credit, for a savings of roughly $54 billion over a decade.

What they're saying: The Biotechnology Industry Organization yesterday praised the larger attempt at a tax overhaul but said Congress should retain the credit for orphan drugs "to ensure that our nation's tax code most effectively encourages innovation."

What they're not saying: For all the anticipation, the bill ended up treading pretty lightly in the health care world. It wouldn't touch any of the ACA's taxes or penalties, nor would it change the tax exclusions for employer-provided insurance — one of the most expensive tax breaks in the entire code.

Hospital CEOs could face new taxes

The Republican tax overhaul bill also includes a small section that would levy a 20% excise tax on any wages of more $1 million for executives who work at tax-exempt organizations. Guess who's not thrilled about that? Hospitals.

What they're saying: The American Hospital Association said it was "concerned" about that provision because "there is already a rigorous process prescribed by the Internal Revenue Service for setting up executive compensation."

Go deeper: As Axios' Bob Herman has reported, hospital and health system CEOs command some of the highest salaries in the not-for-profit world.

​Trump's executive order takes a step forward

The IRS has taken its first steps toward implementing President Trump's executive order on health care, issuing a guidance document that lays out some of the parameters for new options Trump would extend to employers.

Where it stands: Trump's executive order called for greater use of health reimbursement accounts, or HRAs, under which employers would be able to give their workers cash to go buy health insurance, rather than actually sponsoring a health care plan.

Buzz: The IRS guidance delves deep into the weeds on HRAs, and there are still some big questions to be answered. But the guidance won praise from at least one Trump skeptic: Tim Jost, a Washington and Lee University law professor who has defended the ACA.

  • "[Trump's] executive order provoked concerns that the departments subject to the order might promulgate rules or guidance that would seriously undermine ACA requirements," Jost wrote at the Health Affairs blog. "This first guidance under the executive order, however, hews closely to existing IRS guidance on HRAs and provides reasonable interpretations of the new law. We will see what follows."

CMS scraps pay model for home health

The stocks of publicly traded home health companies soared Thursday after the Centers for Medicare & Medicaid Services tossed out a controversial new payment system that would have cut Medicare payments to home health providers by $1 billion in 2019.

Between the lines: As Bob outlines this morning, this is yet another example of health care's lobbying power. The home health industry hated Medicare's proposed pay system, talked with the right people, and consequently got what it wanted.

​EpiPen failures seem to be mounting

At the same time the price of the EpiPen has soared, so have reports of malfunctions, according to a Bloomberg News analysis of data from the Food and Drug Administration.

The details:

  • The FDA has received 228 reports of EpiPen failures so far this year — up from 105 last year, up from just four in 2012.
  • Of those 228 reported failures this year, 35 people were hospitalized and seven were tied to patients' deaths, according to Bloomberg.
  • The product's design has changed recently. Mylan, the company that sells the EpiPen, said those changes were important for patient safety. They also extended Mylan's patent protections.

Why it matters: "This is a lifesaving product," Diana Zuckerman, president of the National Center for Health Research, told Bloomberg. "If it fails 105 times, that's significant."

​Study: Stents may not work

New research from the U.K. threatens to upend one of the most widely accepted pieces of conventional wisdom in medicine: that stents help alleviate chest pain in patients with heart problems.

The details:

  • Per The New York Times' coverage of the study, researchers found 200 patients with badly blocked arteries and severe chest pain. All of them took blood thinners. Half got stents, and half had a placebo procedure.
  • Patients who received stents didn't report any more improvement in their chest pain than those who had a fake procedure.

Why you'll hear about this again: Stents — small, tube-like cages inserted into blocked arteries — are incredibly common. Hundreds of thousands of people receive them each year. If they're not as effective as we thought, cardiologists will have to rethink an awful lot about how they practice medicine.

Go deeper: Read the study, published in The Lancet.

What we're watching today: The House is expected to pass a bill funding the Children's Health Insurance Program. Brookings is hosting an event on policy solutions to the opioid crisis (details here). National Press Club luncheon with FDA commissioner Scott Gottlieb.

Keep your reports coming: Many thanks to the readers who shared their experiences with the enrollment process today. If you've tried to use this week, I'd love to hear from you, too, about how it went and what you thought of your options. Get in touch at [email protected].