January 31, 2017

Welcome back to Vitals. Busy day ahead: a Senate Finance Committee confirmation vote for Tom Price, a meeting between President Trump and leaders of the Pharmaceutical Research and Manufacturers of America, the first Aetna earnings call since a federal judge knocked down its proposed merger with Humana, and the season finale of Obamacare open enrollment. Oh, and we'll get a Supreme Court nominee tonight, too. And those are just the things we know about.

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How the regulations executive order could backfire

The goal of President Trump's latest executive order is clear enough: Fewer rules. But the way he's going about it — making agencies withdraw two old regulations every time they issue a new one — is a bit sloppy and probably will cause more problems than it solves, former Health and Human Services officials tell me.

That's mainly from Obama administration alums, so take it for what it's worth. But they weren't really hostile to the idea — they just don't think it will end well. Here's what the Trump team will probably find out as they implement the order:

  • It takes time to figure out which regulations to withdraw. That "just adds a layer of work that may not be very productive," said Kathleen Sebelius, the former Health and Human Services secretary under President Barack Obama.
  • If Republicans really want to repeal or even rewrite Obamacare, it's going to take a whole new set of rules to implement that, and the executive order is "more likely to slow things down rather than speed them up," said Sebelius.
  • It also takes a lengthy process just to get rid of a rule, said former HHS official Rima Cohen.
  • There are also plenty of regulations that are routine, and that everyone wants — like updating payment rates for doctors.

Tom Scully, who ran the Centers for Medicare and Medicaid Services under President George W. Bush, said the order would be "a little clumsy, but I don't think it's undoable" — as long as the Office of Management and Budget doesn't apply the order too literally. More from Caitlin Owens and me here.

One big impact: 21st Century Cures

The executive order could have an especially big impact on implementing the 21st Century Cures law, which just passed in the last Congress. Rachel Sachs, a health care legal expert at Washington University in St. Louis, explains why in this blog post that was making the rounds yesterday: the law has all kinds of provisions that will require new regulations, such as one to make sure health IT companies don't do anything that gets in the way of exchanging electronic health information.

Those regulations, Sachs points out, "are not ones the agency in its own judgment has decided are necessary. They are ones that Congress and the President have deemed are necessary."

Obamacare open enrollment could end quietly

Tonight is the deadline for people to sign up for Obamacare for 2017 coverage, but there's going to be a big difference between this year and previous years. Every time open enrollment ended under the Obama administration, they'd eagerly give us real-time updates. "Look how many people signed up by noon! It's going gangbusters!" This year, there's no guarantee that we'll get any updates at all. I've been asking HHS officials from President Trump's team, and haven't gotten an answer yet.

Of course they don't have the same level of enthusiasm for the law as the Obama team did, but we're also still in that transitional period where the old HHS team isn't allowed to talk publicly and the new team is still getting its act together. So maybe we'll get some updates out of the blue — but it's also possible we'll end the day with no idea what happened.

How hospitals are being rattled by Obamacare uncertainty

Bob Herman has a story this morning about why hospital executives are so worried about what comes after Obamacare, if the repeal goes through. It's actually not the loss of patients with private insurance that concerns them the most, Bob writes — it's losing patients with Medicaid coverage. But they're also worried about patients who won't be able to pay their bills because of high deductibles.

The bottom line: Hospitals were just starting to make progress against the uncompensated care costs they used to face — and they don't want to go back. Read Bob's story here.

PhRMA leaders to get face time with Trump

Well, that didn't take long: Trump and Vice President Mike Pence are going to meet this morning with PhRMA president and CEO Stephen Ubl, along with several of the group's board members. What ever will they talk about? Yes, you can be pretty sure drug prices will come up. But Ubl has talked about other issues on the group's agenda where they're more likely to find common ground, especially on reforming the Food and Drug Administration to give more encouragement to medical innovation.

So yes, it'll be awkward, but it probably won't be awkward the whole time.

That drip-drip-drip isn't stopping the Tom Price vote

Trump's Health and Human Services nominee is up for a Senate Finance Committee confirmation vote this morning, and at the moment, he looks safe even though the ethics stories haven't stopped. The latest came yesterday from the Wall Street Journal, which reported that Price got a privileged offer to buy stock in Innate Immunotherapeutics Ltd., an Australian medical biotechnology company, at a discount — which is not what he said in his confirmation hearings.

So far, none of the stories about Price's stock trades have made enough of an impact to peel Republicans away, so he'll probably have the votes even if some or all Democrats oppose him. The Finance Committee will vote on Price as well as Steven Mnuchin, the Treasury nominee, whose confirmation vote got delayed yesterday by a Democratic procedural maneuver.

New lawsuit targets drug companies over insulin prices

Eli Lilly, Novo Nordisk and Sanofi are grappling with a new class-action lawsuit that accuses them of colluding with pharmacy benefit managers to jack up the prices of their insulin products, Bob Herman reports. The lawsuit says each drug company raised prices at the same times even though there was no change in demand or research costs. Yale endocrinologist Dr. Kasia Lipska called the rise of insulin prices a "racket" in a popular New York Times op-ed last February.

Why this matters: Drug companies will continue to face heat over what many have said are unjustified price hikes. Several generic drug makers are facing similar legal probes over price-fixing. But this latest lawsuit also shows an appetite to drag pharmacy benefit managers out of the shadows. You can view the full lawsuit here.

What we're watching today: Aetna quarterly earnings report, to be released before the markets open; Trump meeting with PhRMA leaders, 9 a.m. Eastern; Senate Finance Committee confirmation vote on Tom Price, executive session starts at 10 a.m. Eastern; Trump announces Supreme Court nominee, 8 p.m. Eastern; the end of Obamacare open enrollment, midnight.

What we're watching this week: Senate HELP Committee hearing on stabilizing the individual market, Wednesday; House Energy and Commerce health subcommittee hearing on pre-existing condition coverage and other insurance reforms, Thursday; 2018 payment rates and policies for Medicare Advantage plans, Thursday.

OK, get on with your day. Thanks, and keep me posted on other stuff we should be covering: [email protected].