Jan 17, 2017

Axios Vitals

Good morning and welcome back to Vitals. President-elect Trump has stirred up the health care world, but everyone is still waiting to see his plan. Will it really do what he says it will? "Insurance for everybody?" Even Obamacare didn't do that — but all the more reason to look forward to the actual plan.

We are one day away from the launch of Axios, and I hope you'll check it out to see what we've been working on all this time. Take a look at Axios.com tomorrow morning and let us know what you think. We're aiming for "cool and different and doesn't waste your time." Meantime, thanks for reading Vitals, and if you know other smart people, please tell them to sign up here.

Trumpcare is still a mystery, even to the Hill

So what, exactly, is Trump's plan to provide "insurance for everybody," with cheaper health plans and lower deductibles, as he described it to The Washington Post? We're hearing that even key Republican staffers on Capitol Hill are a bit mystified. The transition team is keeping details so tight that the Hill aides who should be consulted often aren't. "No one knows what he will do," one Senate aide told Caitlin Owens. "It's like a day at the roulette wheel."

Between the lines: Regardless of how Trump talks about it, it's not likely to be that different from past plans by members of the House GOP Doctors Caucus. That's the best read I'm getting from plugged-in health care wonks. Even incoming White House press secretary Sean Spicer clarified Monday that it will be based on "marketplace solutions," to make sure it doesn't sound too lefty.

Because Trump's biggest influences at this point will be his health care nominees, it may add more state flexibility through special Obamacare waivers — called "Section 1332 waivers" — that are favored by people like Seema Verma, Trump's pick to run the Centers for Medicare and Medicaid Services.

Walden isn't waiting for Trump

Greg Walden, the new chairman of the House Energy and Commerce Committee, tells Caitlin Owens he doesn't feel a need to wait for Trump's plan before Congress can start working on its own — especially since he and other House Republicans already know how Health and Human Services nominee Tom Price thinks about health care. "I think that we have a pretty good idea of what President-elect Trump would like to see in a plan," he said in an interview Friday. "We certainly know what the Health and Human Services secretary wants to be done."

Why it matters: Walden is the chairman of one of the health care committees that would have to write an Obamacare replacement. So it's a bit of a statement of congressional independence from Trump — and a reminder to the president-elect that Congress doesn't have a ton of time to work on this.

And: Walden also said House Speaker Paul Ryan's "A Better Way" plan is "a great starting point," but won't necessarily be the bill. Check out more from the interview after the Axios launch.

Your speed-read guide to the Price plan

Even if it's not exactly what Trump will propose, Price's Obamacare replacement plan is a good guide to how the HHS nominee thinks about health care — and the advice he's likely to give to the Trump team. Here are the highlights:

  • Tax credits based on age (not income, like Obamacare)
  • Limits the tax exclusion for employer-sponsored health coverage ($8,000 for individual, $20,000 for family)
  • Encourages health savings accounts
  • Employers can give a set amount of money to employees — they can stay with the company's health plan or go to a different one
  • Small businesses can use auto enrollment to sign up their workers for their cheapest health plan
  • People with pre-existing conditions would be covered if they'd stayed insured for 18 months
  • High-risk pools would cover the rest
  • Insurance could be sold across state lines

How it compares to other replacement plans: It's cheaper. Price's tax credits, for example, would be way smaller than the ones in Senate Finance Committee Chairman Orrin Hatch's most recent replacement plan. (For the 50-and-older crowd, who are sure to have health needs, Hatch would give them a $4,690 credit. Price would give them $3,000.)

Meantime, Price's ethical questions aren't going away

The latest damaging ethics story came from CNN's Manu Raju, who reported Monday that Price introduced a bill to help a medical device company days after buying stock in it. Not the best timing, since Price is supposed to have his "courtesy hearing" before the Senate HELP Committee on Wednesday (the Finance Committee is the one that votes on his nomination.) He was already a big target for Democrats after a series of stories on his investments and stock trades in other health care companies.

Yes, but: The Trump transition team says the latest story is bogus, because the stock purchase was directed by a broker and Price didn't know about it until long after the bill was filed. "Any effort to connect the introduction of bipartisan legislation by Dr. Price to any campaign contribution is demonstrably false," transition spokesman Phil Blando said in statement Monday night.

Why it matters: None of these stories will actually derail Price's nomination unless they peel Republican votes away from him. But the more stories there are, the better the odds that some Republicans might have second thoughts. And at the very least, they'll make it easier for Democrats to stall his nomination — leaving HHS without a permanent leader at a critical time.

Medicare Advantage provider directories are terrible

That's according to a new report quietly released by the Centers for Medicare and Medicaid Services last Friday. My colleague Bob Herman reports that it probed the online listings of doctors for 54 insurers in Medicare Advantage — which offers Medicare coverage through private plans — or about a third of all the program's companies.

Bad phone numbers and dead doctors: The report found that nearly half of the sampled doctors' locations and other information had at least one error. Incorrect phone numbers, provider locations and other basic information were common. In some cases, the doctor had been retired or dead for years, or wasn't accepting new patients.

Why this matters: The roughly 18 million Medicare Advantage members rely on provider directories to find in-network physicians. These kinds of "significant errors," according to the agency, could pose serious barriers for people to get the affordable care they need. America's Health Insurance Plans, which has heavily backed the politically popular Medicare Advantage program, said last year it would address lousy provider directories through a new project.

While you were holiday weekending ...
  • Vice President-elect Mike Pence said an Obamacare replacement plan will be passed in the first 100 days.
  • Sen. Bernie Sanders spoke at a rally in Michigan to encourage people to fight Obamacare repeal.
  • Balaji Srinivasan isn't up for Food and Drug Administration commissioner after all, per POLITICO's Tony Romm.
  • Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention, will become acting director after Tom Frieden leaves office on Friday, the Washington Post's Lena Sun reports.
  • Cleveland Clinic chief executive officer Toby Cosgrove disavowed a piece by a top clinic official that questioned the safety of vaccines.
What you need to read from Atul Gawande's latest

His new piece for the New Yorker is about how our health care system undervalues "incremental" care — from doctors who improve people's health over years, sometimes lifetimes — compared to "rescue" care. The highest-paid specialists, Gawande points out, are in rescue care: orthopedics, cardiology, dermatology, gastroenterology, and radiology. The lowest-paid ones: pediatricians, internists, family medicine doctors and other incrementalists.

The priorities need to shift, Gawande writes — because "life is a pre-existing condition waiting to happen," and when people get them, their conditions need to be managed. The most moving part: Gawande writes about his son, Walker — who was born with a heart condition and would be uninsurable without Obamacare.

What we're watching this week: Senate HELP Committee holds hearing on Tom Price, Wednesday, 10 a.m. Eastern; Senate Finance Committee roundtable on Medicaid, Thursday.

That's it for today. Please keep the feedback coming: david@axios.com.