May 12, 2017

Axios Vitals

By Caitlin Owens
Caitlin Owens

Happy Friday ... Looks like the Senate's health care discussions are going to be more industry-friendly than the House's. And Office of Management and Budget director Mick Mulvaney says the Trump administration is looking at some big executive actions on drug prices.

In other important Senate news, I missed Sen. Bill Cassidy on the Senate floor with his "#KimmelTest" chart yesterday, but I did witness the pathos of former vice presidential candidate Tim Kaine speaking to an empty Senate chamber.

The Senate isn't shutting out industry like the House did

Hospitals, doctors, insurers and other industry policymakers were pretty grouchy when the Trump administration and House Republicans excluded them from the GOP bill talks. But now that the more moderate Senate is handling the potential Affordable Care Act repeal effort, health care groups are finding a seat back at the table, Bob Herman reports.

What does the industry want changed? A lot. Repealing the taxes and allowing insurers to medically underwrite again were industry winners. But the key issue to watch is the giant Medicaid cuts, which have been opposed by almost everyone. One industry lobbyist told Bob: "I don't think the House approach to Medicaid will survive in the Senate." Read his story here.

But wait: Why do we want the Senate talking to a bunch of industry lobbyists, anyway? It may sound uncool, but remember, one of the biggest criticisms of the House was that they wrote their bill without talking to anyone who would actually be affected by it. As one insurance company official memorably put it to the Los Angeles Times last month: "They're not interested in how health policy actually works."

Mulvaney says Trump wants executive action on drug prices

Office of Management and Budget director Mick Mulvaney says the Trump administration is looking for executive actions it can take to lower drug prices — and one idea that has been floated, he said at a panel discussion at the LIGHT Forum at Stanford University yesterday, is to require rebates in Medicare Part D that would be similar to Medicaid.

  • Medicare Part D was "a tremendous giveaway to the pharmaceutical companies" because it didn't require drug companies to give rebates to the government the way Medicaid does, Mulvaney said.
  • "We are looking at things we can do internally ... without Congress," he said. "The president keeps asking me again and again and again, 'What are we doing to fix this?'"

Why it matters: If the idea moves ahead — and Mulvaney didn't make it clear how seriously they're considering it — it would be a huge change for the drug industry. OMB spokeswoman Meghan Burris said only that "there are a number of ideas that have been, and are being discussed" to lower drug prices and encourage innovation.

The Medicaid rebates are calculated by a formula that's set in federal law, as opposed to Medicare Part D, where the only rebates are negotiated between drug companies and the private Part D plan sponsors. (The government isn't allowed to participate in those negotiations.) So the Medicaid rebates are bigger than the Medicare ones.

PhRMA's response: "Any type of government price setting in Medicare Part D would limit access to needed medicines and increase costs for beneficiaries. It also would destabilize a successful, market-based program ... The risks of these proposals clearly outweigh the benefits."

The big Senate goal: Just lower the premiums

Senate Republicans have spent a lot of time this week discussing their health care options. But they've come to agreement on very little, except that they need to lower premiums, Caitlin Owens reports.

The more well-known and well-understood way to do this is to undo or reform some of the Affordable Care Act's consumer protections, like the essential health benefits or the pre-existing conditions protections. But, as the House found out, doing so is extremely controversial and can have big political consequences.

However, there's another idea floating around: automatically insuring people in a basic health plan. Aides have been discussing this idea for months now, but it appears to be getting more legs. Senate Majority Whip John Cornyn spoke on it in the working group meeting on Thursday, and Sen. Bill Cassidy is also a big fan. More here.

About the right to health care ...

Mulvaney also took issue with the argument that everyone has a right to health care — which is an article of faith among Democrats, and pretty much the whole point of the Affordable Care Act. He expressed a view that's shared by at least some Republicans — that some of people's health problems happen because they don't take care of themselves.

  • "We have plenty of money to deal with that safety net so if you get cancer, you don't go broke. The question is, who's responsible for your ordinary health care — you or someone else?"
  • "If you have a right to health care, as a fundamental human right, that creates a burden on someone else to provide it to you."
  • If a child is born with a severe health condition like Jimmy Kimmel's newborn son, Mulvaney said, "we will come together as a community and take care of them. That doesn't mean we should do the same thing for someone who sits home, drinks Coca Cola … drinks sugary drinks and doesn't exercise."

Why it matters: If the Trump administration and Democrats don't agree on the basic goal of health care, then of course the GOP rewrite of the Affordable Care Act isn't going to get the same result.

But hey, approval is up to 21 percent

In the glass-half-full department: the new Quinnipiac poll out yesterday showed that 21 percent of Americans approve of the House-passed health care bill, while 56 percent oppose it. Why is that good news for Republicans? Because that's up from the 17 percent approval rating from the last Quinnipiac poll.

'People will die': overheated, but not made up

We heard a lot of this from Democrats after the House Republican bill passed last week — usually in a general way, but sometimes more specific, like when Sen. Bernie Sanders told CNN that "thousands of Americans will die." So I dived into that for a new Facts Matter piece to see if that was even checkable.

The bottom line:

  • You won't get any agreement on numbers, so Democrats are probably better off staying away from those. There are too many other factors that determine people's health.
  • Republicans think the argument is ridiculous on its face: Why not say the same thing about people who lose coverage because insurers are pulling out of the Affordable Care Act?
  • But there is a study that suggested deaths decreased in states that expanded Medicaid — where people gained health coverage.
  • So the safest way to say it is: If people lose health coverage, yes, they are at greater risk of death.

The back story: Sanders got his numbers from two founders of a pro-single payer group, Physicians for a National Health Program — who based their estimates on the Medicaid research.

A peace offering from a freshman senator

Republican Sen. Todd Young was elected to the Senate last year, and he just joined the HELP Committee, but he's trying to start things out on a bipartisan note. He sent a letter to every Democratic senator yesterday offering to sit down over a cup of coffee and hear their views on health care: "As the Senate begins drafting legislation from a blank piece of paper...I hope you will share your individual analysis on current ACA policies that you believe are working, policies that you believe should be repealed, and policies that should be adjusted."

Reality check: If he gets any takers, he's going to hear the same line that Democrats have been saying publicly: Sure, but take repeal off the table. But better to let them have that conversation and see if they can work through it, rather than talking past each other all the time, right?

Caitlin Owens

What we're watching next week: More Senate health care working group meetings. Also, House Ways and Means health subcommittee holds hearing on Medicare payment policies, Thursday, May 18.

What we're watching in two weeks: The Congressional Budget Office releases the cost estimate for the House-passed version of the American Health Care Act — "early in the week of May 22," per the announcement.

Thanks, have a great weekend, and let us know what else is on your radar: david@axios.com.