Axios Vitals

A briefcase with a red cross on the front.

January 20, 2017

Good morning, and welcome to our Inauguration Day edition of Vitals. We'll have a new president in a few hours, and like you, we're all waiting to see what he'll say about health care — if it's part of his inaugural address. And then, watch for those executive orders that will start the repeal process.

Thanks for reading us this week. As you read Axios, don't forget that we have a separate news stream for health care — just click the "Health Care" tab at the top and you'll get all of our stories. Meantime, please tell everyone who wants to know more about health care politics and business to sign up for Vitals here.

The winners and losers of Obamacare repeal

One thing that Donald Trump is about to learn: Health care reform almost always has tradeoffs that create winners and losers, and the trick is to minimize the losers. I have a story up this morning with Caitlin Owens about who the winners and losers have been under Obamacare, and who they're likely to be under the leading Republican replacement plans.

Remember, President Obama and congressional Democrats tried to wrestle with all of this when the law was passed. They thought they had created a win-win situation for everyone: More people would get health insurance, and insurers, doctors and hospitals would all be winners because they'd have more paying customers. It didn't work out that way. Healthy people had to pay more to help cover sick people, younger people paid more so older people could pay less, etc.

It's just hard to rearrange the health care system without creating losers, and all of the Republican replacement plans so far would have them, too. The question is, how will they minimize the damage? Read our story here, and check out the cool graphic by Andrew Witherspoon and Alex Duner.

Will Trumpcare just be rebranded Obamacare?

I'm struck by how many people in D.C. health care circles are predicting the same outcome for the Obamacare repeal battles: Trump and congressional Republicans will end up with a program that's built on the framework of Obamacare, but modified to reflect Republican principles, like more choices of health coverage, an alternative to the individual mandate, and more flexibility for states to try different approaches.

In other words, the repeal will really be a rebranding of Obamacare, and Republicans will have to sell the hell out of it. Always Be Closing! That's not coming from hard intel from the Trump team, but it is the most popular prediction I'm hearing from experienced and politically savvy industry officials in D.C.. They're not Democrats, but others who have been through the political battles many times and usually have a pretty good idea how they're going to turn out.

Trump has proven them wrong many times before, and he could again. But the argument is, there are only so many ways to cover as many people as Obamacare has, and once Republicans work through that process, their version may not look as different as the Trump voters may have hoped. What's your prediction? Let me know.

Who's minding the store after today

When President Obama leaves the White House for the last time today, Health and Human Services Secretary Sylvia Burwell and other top health officials will leave with him. Here are the people who will be running the top health departments temporarily until Trump gets his nominees in place:

  • Acting HHS Secretary: Norris Cochran
  • Acting Centers for Medicare and Medicaid Services administrator: Patrick Conway
  • Acting Food and Drug Administration commissioner: Stephen Ostroff
  • Acting Centers for Disease Control and Prevention director: Anne Schuchat

Staying in place for now: National Institutes of Health director Francis Collins.

Tom Price's to-do list at HHS

The staff at the Department of Health and Human Services have put together a 118-page briefing book on all of the issues that will face the Trump administration's team, including HHS nominee Tom Price, as soon as the handoff takes place. The main ones:

  • Learn the emergency response procedures
  • Prepare a budget
  • Deal with outstanding policy issues, including Obamacare enrollment, a backlog of Medicare appeals, and Zika virus response
  • Remind Congress to reauthorize the Food and Drug Administration's user fees
  • Deal with the more than 7,400 lawsuits facing the agency

Not mentioned:

  • Repeal Obamacare

Cornyn makes a big Medicaid promise

Caitlin Owens reports that Senate Majority Whip John Cornyn made a pretty ironclad promise about Medicaid on Thursday: No one who gained coverage through Medicaid expansion will lose it after Obamacare is repealed. That pledge came after Republicans met with a group of GOP governors on Capitol Hill, including Ohio Gov. John Kasich, who expanded Medicaid and was worried about his constituents.

"We're all concerned, but it ain't gonna happen," Cornyn said after the meeting. He didn't say how Republicans could keep that promise, and Kasich wouldn't make the same pledge for his constituents.

Why it matters: Republicans now have a pattern of making promises about Obamacare repeal that they might not be able to keep, including House Speaker Paul Ryan's statement last month that repeal will leave "no one worse off." (He has stopped saying that.) Democrats are collecting all of these statements and are sure to remind the public about them.

One way Republicans might solve the Medicaid problem

Texas Gov. Greg Abbott told reporters the most likely outcome was per-capita caps, or limits on how much states would be reimbursed for each person on Medicaid. But the states would be able to set the income levels that would qualify for Medicaid, Abbott said, so some could still expand the program and the new system would be "very fair to all states." Read Caitlin's story here.

Why pharmacy benefit managers need to be worried

Sure, Washington loves to bash the drug companies. But now, it's the intermediaries that may be getting a close look, Bob Herman reports. Pharmacy benefit managers are the companies that create pharmacy networks and negotiate down prices from drug makers. But they get some of the money from drug sales, too, so they may be part of the chain that's leading to higher drug costs.

Now, some Democrats are getting interested in regulating them — and Republican Sen. Chuck Grassley might be interested, too. Read Bob's story here.

The company that's building a Medicaid data platform

Nuna, a health care data company headed by one of the people who rescued the Obamacare website, announced Thursday that it has raised more than $90 million in funding to build the first national data platform for Medicaid. They're going to collect information on eligibility, providers and managed care plans for Medicaid recipients throughout the country.

The funding comes from the venture capital firm Kleiner Perkins Caufield & Byers. The company is based in San Francisco and was founded by Jini Kim, who was part of the team that salvaged after the disastrous rollout in 2013.

What we're watching next week: Senate Finance Committee confirmation hearing for Price, Tuesday, Jan. 24; Republican retreat in Philadelphia, Jan. 25-27.

Thanks for reading, and as always, let me know what we missed: [email protected].