Axios Vitals

A briefcase with a red cross on the front.

January 03, 2018

Good morning … All the best to Tim Jost, who has been a patient, accessible and indispensably smart expert on just about every twist and turn of the Affordable Care Act's entire life. Jost is stepping away from his regular contributions to the Health Affairs blog, which is a well-deserved break for him but a big loss for the rest of us.

I told you 2018 would be bad.

Congress has a full plate but a small appetite

All of the things that were on Congress' end-of-year to-do list are now on its January to-do list. But it's not clear how many of them will actually get done this month, my colleague Caitlin Owens reports this morning.

  • Congress passed short-term funding for the Children's Health Insurance Program before the holidays, taking away some of the urgency behind a longer-term reauthorization.
  • Once upon a time, it looked like Democrats would be able to use a government spending bill as a vehicle to help stabilize the Affordable Care Act. But they no longer support the once-bipartisan stabilization effort, saying it won't do enough in a world without the individual mandate. (Many experts agree with that assessment.)
  • Democrats now seem more inclined to prioritize immigration over health care ahead of the Jan. 19 deadline to avert a government shutdown.
  • Industry is also prodding Congress to pass a series of Medicare "extenders" and to delay some of the ACA's taxes, but both have already slipped this far.

Go deeper: Read Caitlin's full story in the Axios stream.

​Happy New Year! Now, here are some drug price hikes

A handful of drug companies rang in 2018 with price hikes that easily surpass inflation but stay conspicuously below double digits, my colleague Bob Herman reports. Investment banks Jefferies and Cowen highlighted some of the big ones:

  • AbbVie's blockbuster Humira: 9.7%
  • Amgen's arthritis medicine Enbrel: 9.7%
  • Allergan's dry eye drug Restasis: 9.5%
  • Insys Therapeutics' opioid spray Subsys: 9.5%
  • Biogen's multiple sclerosis drug Tecfidera: 8%

But wait, there's more: Cowen conducted a survey of large drug purchasers, and most said drug prices will continue to rise. More than three-quarters of respondents also said there's almost no chance U.S. drug price controls will occur in the next three years.

Get smart: Our reporting might sound like a broken record, but it's the truth: Despite public outcry, the pharmaceutical industry has no incentive to change its drug pricing tactics.

​Azar hearing set

Alex Azar — President Trump's nominee for HHS secretary — will get a hearing before the Senate Finance Committee on Jan. 9. (Trump technically needs to renominate him first, but that, presumably, will happen.)

Why it matters: HHS hasn't had a Senate-confirmed secretary since September, but the wait likely won't last much longer. Azar emerged largely unscathed from his hearing before the Senate HELP Committee last year; Finance is the committee that would actually move his nomination to the Senate floor.

Pharma vs. PBMs

Very few people outside the health care industry probably even know that there's a war going on between pharmaceutical companies and pharmacy benefit managers (PBMs), but inside Washington, it's raging.

The bigger picture: The Washington Post has a good breakdown of the feud, which has helped spread the finger-pointing over drug pricing. This, in turn, has stopped lawmakers from actually cracking down on either industry's profits.

Key quote: "It is so convoluted and so complicated," Gerard Anderson, a professor at Johns Hopkins, told the Post. "The PBMs have grown in power and profitability over the last 10 years, and are becoming a huge force. The drug companies, they're the ones that raise prices. It's definitely a synergistic relationship. We've got two bad actors, we don't have one."

​Hatch's health care legacy

The Senate — along with the Republican party — is losing one of its longest-serving leaders on health care policy, with Sen. Orrin Hatch's announcement yesterday that he won't run for reelection this year. Hatch's fingerprints are on some of the most significant health care laws of the past 30-plus years.

Some highlights:

  • He's the Hatch in "Hatch-Waxman," the 1984 law that established the FDA's approval process for generic drugs.
  • He and then-Sen. Ted Kennedy sponsored the bill that created the Children's Health Insurance Program. (And Hatch will have one more chance to renew that program before he leaves the Senate — its federal funding expired months ago.)
  • Hatch has been a staunch critic of the ACA. He was part of the bipartisan negotiations that dragged on and on (and on and on) through the summer of 2009, even though his support consistently seemed like a long shot. The sheer length of those talks, which stretched into the August recess after Hatch dropped out, almost killed the bill.

What's next: If Republicans still control the Senate after this year's midterms, Sen. Chuck Grassley would have the right of first refusal to take Hatch's place as the chairman of the Finance Committee.

  • Unless you've been lucky enough to repress all memory of the 2012 presidential campaign, you probably recall that Mitt Romney — the front-runner to take Hatch's seat — passed a health care law in Massachusetts that was an awful lot like the ACA.

Point of personal privilege: I'm pretty sure Orrin Hatch was the first elected official I ever interviewed. I was 16 and covering the 2000 Republican convention, but had no idea of how to go about doing that. I recognized Hatch from TV, at some reception I probably wasn't supposed to attend, and by the end of the week he was one of the only members of Congress who had been willing to take a few minutes for my extremely unsophisticated questions.

By now I've trailed him in the Senate hallways roughly one million times, enough to know he's almost always talkative with the press. That short interview wasn't access, though; it was charity. I, of course, take no position on Hatch's politics, but just as a person, it was very kind of him, and it meant a lot to an aspiring journalist — enough that I still remember it almost 20 years later.