Axios Vitals

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March 13, 2018

Good morning ... You are not alone.

House votes today on “right to try”

Photo: Debbie Egan-Chin /NY Daily News via Getty Images

The House is set to vote today on a “right to try” bill — a proposal to let terminally ill patients access drugs that are still being reviewed by the Food and Drug Administration. It’s a more complicated issue than it might seem at first blush:

  • There’s an obvious moral argument for letting patients who have already tried everything else take their chances with a drug that might not work.
  • But there’s also a strong interest in making sure those uses don’t undermine the clinical trials the FDA relies on when it decides whether to approve these products for the general public.

Republicans think they’ve found that balance. Axios’ Caitlin Owens dug through some changes Republicans unveiled over this past weekend, most of which seem designed to make sure that “right to try” uses won’t get in the way of clinical trials.

  • The new bill would give the FDA more authority to decide how to use the data from these patients, tighten the definition of who’s eligible for this pathway, and impose more rigorous reporting requirements for side effects.
  • It incorporates all of the consumer protections recommended by FDA commissioner Scott Gottlieb.

Yes, but: Democrats are still expected to oppose the measure. "This legislation simply is not needed," said Rep. Frank Pallone, the top Democrat on the House Energy and Commerce Committee.

Go deeper: Caitlin has more details.

Murky outlook for ACA stabilization efforts

Sens. Susan Collins and Lamar Alexander support ACA stabilization. Photo: Alex Wong/Getty Images

The once-bipartisan effort to stabilize the Affordable Care Act’s insurance markets “is faltering amid escalating demands by each party and erratic positions by President Donald Trump,” AP reports.

  • Democrats have proposed an ambitious ACA expansion they won’t get, while conservative Republicans are pushing for new abortion restrictions that could sink the entire bill.
  • A stalemate would leave premiums on track to skyrocket just before the midterms.

The other side: Senators backing the stabilization effort released a new analysis from Oliver Wyman that says their proposal would work, lowering premiums by as much as 40%.

  • Funding the ACA’s cost-sharing subsidies would reduce premiums by about 10%, compared with what they’d be next year if the payments aren’t funded. Creating a new reinsurance program would lower premiums another 10%, the analysis found.
  • States would also be able to obtain federal waivers that would use those savings to help provide additional reinsurance money. That could add another 20% reduction.

The clock is ticking: If Congress is going to work something out, it probably needs to happen before the next deadline to fund the federal government — which is to say, in the next 10 days.

The case for high deductibles

High-deductible insurance plans can end up being cheaper even for people who use a lot of health care, according to a new working paper published by the National Bureau of Economic Research.

The researchers looked at workplaces where employees have a choice between plans with higher premiums and lower deductibles or higher deductibles and lower premiums.

The findings: Choosing the high-deductible plan typically saves employees about $500 per year. And roughly two-thirds of the time, employees’ maximum total health care spending in a year would be lower with the high-deductible plan.

  • Although high-deductible plans obviously require employees to pay more out of their own pockets, employers will usually make a bigger contribution to help cover the premiums for those plans.
  • That money, plus contributions to health savings accounts, is usually enough to offset a higher deductible, the authors found.

Why it matters: High-deductible plans are increasingly common, although consumers don’t love them.

More lofty health care CEO pay ratios

My colleague Bob Herman is still tracking executive compensation and the new mandate to disclose how CEOs' pay stacks up against the average employee.

We wrote about the first tranche of documents here, and Bob has found more noteworthy company filings. Here are the latest total CEO compensation and pay ratios from 2017, based on the actual realized gains of stock:


  • CEO Richard Gonzalez: $41.6 million
  • Pay ratio: 264:1 (median employee made $157,347)


  • CEO Joe Swedish (now executive chairman): $26.4 million
  • Pay ratio: 373:1 (median employee made $70,867)


  • CEO Michael Neidorff: $24.9 million
  • Pay ratio: 374:1 (median employee made $66,600)

Molina Healthcare

  • CEO J. Mario Molina (fired last year, includes severance): $31.1 million
  • Pay ratio: 671:1 (median employee made $46,397)

Republicans’ “arranged marriage” with ACA

Peter Suderman, the managing editor of Reason, has a very good op-ed in The New York Times about Republicans’ relationship with the ACA and the mark they’ve been able to make on its basic structure.

Key quote: “Republicans are now in something of an arranged marriage with the health care law. These alterations are being made in a predictably haphazard fashion, with little in the way of guiding theory, but the cumulative effect is to turn Obamacare into a law that they can, if not love, at least learn to live with.”

What’s next: Republicans have started working within the framework of the ACA just as Democrats are moving on to embrace some form of a single-payer system.

  • Suderman described that as “a dynamic that deprives the nation of a real debate about how health care should be financed, regulated and provisioned, because it assumes that one party is largely disinterested in reforms that go beyond tweaking the status quo and opposing whatever further interventions its opponents have in mind.”

What we're watching this week: HHS secretary Alex Azar testifies Thursday at a House Appropriations subcommittee hearing on HHS' budget request (details). VA secretary David Shulkin will also appear before House appropriators on Thursday.

Senate HELP Committee hearing Thursday on the 340B drug discount program.

What's on your radar? Let me know: [email protected].