Jan 27, 2017

Axios Vitals

By Caitlin Owens
Caitlin Owens

Happy Friday, Vitals readers! Can you believe it's already been a month since President Trump was inaugurated? Wait, it just feels that way? Lots of changes already in the works, but we still have a couple of big, unresolved plot lines: We still don't have an Obamacare repeal/replacement plan, and we still don't have a new Health and Human Services secretary. The old one has a new gig already.

Thanks for reading, have a great weekend, and don't forget to check out the Axios health care news stream and sign up for our health care alerts.

The Obamacare enrollment outreach shutdown

On Wednesday, the Obamacare outreach machine was still humming along, pumping out reminder emails to potential customers like the one in yesterday's Vitals. By noon Thursday, I'm told, the White House had shut it down. The decision, first reported by Politico, was like a call to arms to former Obama administration officials, since it came in the critical final days before open enrollment ends on Tuesday:

  • Kevin Counihan, the former CEO of HealthCare.gov, called it "sabotage."
  • Andy Slavitt, the former head of the Centers for Medicare and Medicaid Services, tweeted: "Get the coverage you're entitled to by law. RT so this isn't the only notice of this."
  • Other former administration officials wondered whether the Trump team will allow HealthCare.gov and the enrollment call center to keep running.

Even if it's not a total surprise that the Trump administration wouldn't keep advertising a law it hates, there's no doubt that this will hurt the final Obamacare enrollment totals. And will we still get the final enrollment report? One former Obama official's advice: "You might have to FOIA it."

About the HHS "gag order" ...

It's worth a check-in with people who have worked in high-ranking Health and Human Services positions in past administrations, now that House Democrats have released the text of the order that has gotten so much coverage. Here's what I found in talking to some of them:

  • Former Obama administration HHS officials do think it's worse than what other new administrations have done.
  • Former Bush administration HHS officials think it's not — and that other Trump administration actions, especially on climate change, are making this memo seem more ominous than it actually is.

So we just have another unhelpful partisan disagreement, right? Hear them out first. Tevi Troy, a former deputy HHS secretary under President George W. Bush, notes that every new administration tries to take control of communications. When Bush took over, Troy recalls, the order was, "secure the fax machines." Another former Bush HHS official tells me that new administration officials sometimes overreact, but that the HHS order itself "does not seem extreme."

But two former Obama HHS officials were more alarmed. "I've never seen an order this broad-sweeping before," said one, who wondered whether HHS will still be able to do things that need to be done in the next few weeks, like releasing new Medicare Advantage payment rates.

What the HHS order says

Here's the key language:

No correspondence to public officials (e.g., Members of Congress, Governors) or containing interpretations or statements of Department regulations or policy, unless specifically authorized by me or my designee, shall be sent between now and February 3, during which time you will have the opportunity to brief President Trump's appointees and designees on any such correspondence which might be issued.

Read the rest here.

Retreat Day Two: So where are we on Obamacare repeal?

Not very far along, Caitlin Owens reports from Philadelphia, and certainly not far enough for anyone who thought a concrete plan was going to come out of the Republican retreat. It does appear that Republicans want to include expanded health savings accounts in the budget "reconciliation" bill that will be used for repeal. And House Energy and Commerce Committee chairman Greg Walden told CNN he'll introduce a bill next week that will "provide and reaffirm" the commitment to keep covering pre-existing conditions.

Beyond that, not so clear. One senator, James Risch, even fudged what the ultimate goal is: "There's definitely going to be changes to Obamacare, very substantial changes and outright repeal, possibly."

Good luck with that: Conservative hardliners will push to repeal as much in the next round as they possibly can. Rep. Mark Meadows, the chairman of the conservative Freedom Caucus, told reporters that in addition to the individual mandate and the employer mandate — which requires most employers to offer coverage — he's pushing for Obamacare's insurance regulations to be repealed in the reconciliation bill as well. Just one problem: Aides who worked on the last reconciliation bill say it can't be done.

The trouble with selling insurance across state lines

One Obamacare replacement idea that resurfaced in Philadelphia Thursday: House Budget Committee chairwoman Diane Black said the "reconciliation" bill could include a provision to let health insurance be sold across state lines. That's not surprising since it's been on the Republican agenda for years, but state insurance commissioners hate the idea — and they spoke out against it just earlier this week.

In a letter to top Republicans and Democrats on the two House health committees, the National Association of Insurance Commissioners said the state lines idea would be imposed "by federal edict ... Such federal actions would strip states of the ability to protect consumers and create competitive markets and should be rejected." That's a political fight the Republicans may not have had to face before, but they will now.

And there's another Obamacare lawsuit

This one is from Molina Healthcare, which is suing for $52 million in unpaid risk corridor payments, Bob Herman reports. And Molina is one of the insurers that has done well in the program — but not well enough that it's willing to overlook all of that money. The company says it didn't want to sue, but noted that it participated in the program "with the understanding that the United States would honor its commitments." Read Bob's story here.

Here's how you send a signal about Medicare Advantage

Insurance industry officials are pleased with a letter that a bipartisan group of senators, led by Republican Mike Crapo and Democrat Bill Nelson, sent to acting Centers for Medicare and Medicaid Services administrator Patrick Conway earlier this week. It doesn't sound remarkable: it just expresses their "strong support for Medicare Advantage," the private plans that cover one out of three Medicare beneficiaries.

But here are the messages the letter is really trying to send, according to an insurance industry official:

  • There's no partisan fight over this program — 65 senators signed the letter.
  • They'll be watching closely when the new payment rates come out.
  • And if Congress tries to take any money out of the program to pay for an Obamacare replacement, watch out.
Caitlin Owens

What we're watching next week: The end of Obamacare open enrollment, Tuesday, Jan. 31; Senate HELP Committee hearing on stabilizing the individual market, Wednesday, Feb. 1; House Energy and Commerce health subcommittee hearing on pre-existing condition coverage and other insurance reforms, Thursday, Feb. 2; Centers for Medicare and Medicaid Services expected to release 2018 payment rates and policies for Medicare Advantage plans, Thursday, Feb. 2.

Thanks for reading, and don't forget the feedback, tips and leaks: david@axios.com.