Axios Vitals

A briefcase with a red cross on the front.
October 02, 2017

Good morning ... The short list to replace Tom Price is going to get longer before it gets shorter. If you're hearing any interesting names floating around, or have reason to be skeptical about any of the ones you've heard, let me know: [email protected]

Who will replace Tom Price?

The hunt for a new Health and Human Services secretary is on, and so far the speculation is heavily focused around one name: Seema Verma. At least in these early days, many people in the health care world think the job is hers to lose.

  • Verma is a close ally of Vice President Mike Pence. When Pence was governor of Indiana, Verma helped him design the waiver he used to accept the Affordable Care Act's Medicaid expansion.
  • Her work with Pence and other red-state governors gave her experience pulling the ACA to the right — and with repeal-and-replace off the table, that's the best conservatives can hope for.
  • She was a fixture on Capitol Hill during the repeal-and-replace debate, trying to persuade wavering Republicans the various bills would be good for their states. It didn't work, obviously, but she gets more credit for her effort than Price did.

Yes, but: It's still incredibly early. Verma is the early front-runner, not a lock. The short list will likely grow. Other names we've already heard circulated include:

  • Scott Gottlieb, the commissioner of the Food and Drug Administration, is a reliable conservative with health care experience. He's also taken some aggressive public postures at the FDA on combatting the opioid epidemic and speeding the approvals of generic drugs, as a way to lower costs through more competition.
  • Bobby Jindal, former Louisiana governor, has been seen for a while as a potential HHS secretary in any Republican administration. But his statements about President Trump during last year's primary could doom him.
  • Veterans Affairs secretary David Shulkin is also in the mix, according to The New York Times, due to his experience overseeing the turnaround at the VA.
  • Another dark-horse candidate, per my colleague Jonathan Swan: Sen. John Barrasso, who is a doctor.

Some cold water: There are big reasons to be skeptical about a couple of other names you might have seen in the mix:

  • Rep. Fred Upton used to chair the Energy and Commerce Committee, so he knows health care, but diverting him to HHS would cost Republicans one of their strongest potential challengers to Sen. Debbie Stabenow.
  • A similar dynamic applies for Rep. Marsha Blackburn, who's a logical choice but is also said to be considering a run for Sen. Bob Corker's soon-to-be-former seat.
  • I've only heard people mention Dr. Oz as a joke. Calm down about that one.
  • Before anyone starts floating Sen. Bill Cassidy, remember that Louisiana's Democratic governor would get to appoint his replacement in the Senate.

Congress gets serious about CHIP

Federal funding for the Children's Health Insurance Program has expired. (It ended at the close of the fiscal year, which happened over the weekend.) Most states have enough extra cash on hand to carry them for a while, but Congress will buckle down on reauthorization efforts this week.

  • Republican and Democratic leaders on the Senate Finance Committee have already reached an agreement to extend the program for five years while gradually phasing out a funding bump that was part of the ACA. The committee will mark up its bill on Wednesday.
  • In the House, the Energy and Commerce Committee is also scheduled to mark up CHIP legislation, along with bills to fund community health centers, this week.

Why association health plans may not work

Trump could release an executive order as early as this week on "association health plans," which would allow groups of small employers to band together and purchase their health care coverage as a collective — and to buy that insurance from across state lines.

There's considerable concern among nonpartisan health care experts that broader association health plans would weaken insurance markets by peeling healthy consumers away from the rest of the market. But there's another, potentially stronger possibility: that they wouldn't accomplish much at all.

The reason: Networks. Insurance isn't just a local product because of regulatory tradition. It's because people buy insurance so they can use some health care service, and they usually want to use those services reasonably close to the places they live.

Buying insurance from another, less regulated state might sound like an effective cost-saver in economic theory, but who's going to buy a plan from another state when you need to see doctors and hospitals in your area?

Go deeper: If you want to bone up on association health plans before Trump releases his executive order, here's a good primer from the American Academy of Actuaries.

Puerto Rico’s health care crisis

The devastation that followed Hurricane Maria has left Puerto Rico's health care system in a crisis. Similar to the situations following Harvey and Irma, loss of electricity and a lack of clean water are among the biggest problems. But Maria's severity, and the slower response, have made things even worse.

  • "If you're someone who is in need of emergency medical care or urgent medical care, it's a very difficult situation," one relief agency told USA Today. "People are being turned away from health facilities. There are long waits. Or it's just very difficult to get to health facilities because of debris or damage or lack of fuel."
  • One region of Puerto Rico saw 100 elderly patients die in the days after the storm — triple its usual mortality rate, according to the L.A. Times.

While you were weekending

  • The Trump administration has again delayed new rules for the 340B drug discount program, Mic reports.
  • The Daily Beast looks to Michigan as an example of the administration's efforts to undermine ACA enrollment.
  • In the absence of federal action, states are taking steps on their own to control drug prices, Kaiser Health News reports.
  • On "Fox News Sunday," Heritage Action CEO Michael Needham floated Sen. Ron Johnson as a potential HHS secretary.

What we're watching this week: Movement toward a bipartisan agreement on ACA fixes between Sens. Lamar Alexander and Patty Murray. Plus, Energy and Commerce Committee marks up bills to renew funding for the Children's Health Insurance Program and community health centers.

Tuesday: Energy and Commerce health subcommittee hearing on access to investigational drugs.

Wednesday: Finance Committee's CHIP markup

What's on your radar? I'd love to hear your tips, feedback and questions: [email protected]