Axios Vitals

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January 18, 2017

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Trump on insurance for everybody: Never mind

Our own Jim VandeHei and Mike Allen asked President-elect Trump about his "insurance for everybody" comments in an exclusive interview yesterday — and this time, Trump was back to talking about Obamacare replacement the same way he did in the campaign. "We want people taken care of," Trump said. "There will be nobody dying on the streets in a Trump administration."

And where Trump was starting to sound like he was drifting to the left a few days ago, now he's back to talking about Medicaid block grants: "Whether it's Medicaid block grants or whatever it may be, we have to make sure that people are taken care of and it's going to be a very important part to me."

Between the lines: Trump's latest comments should help settle the big question Republicans, and many health care wonks, had after Trump's Washington Post interview: Is he talking about a different plan than he laid out in the campaign? The answer, it now appears, is no. Read the full story here, and check out the Axios news stream for other things Trump said.

Ryan translates Trump: It's about access

Mike Allen passes on a telling quote from his interview with House Speaker Paul Ryan earlier this week, which seems to back up Trump's current tone. When Mike asked about the "insurance for everybody" comment, Ryan said it meant access for everyone, which is more consistent with the way most Republicans think about health reform. "What that means is we want to make sure that everyone has access to affordable health care coverage regardless of their health condition," Ryan said.

And when Mike asked how many people Republicans want to cover, Ryan answered: "You're asking the wrong question." By focusing only on coverage numbers, Ryan said, the authors of Obamacare "forgot to think about the quality of the health care system, the viability of the health care system, and the affordability of health coverage in America."

The big difference with Trump: It's about negotiating drug prices, as Trump wants. If Medicare does "one singular negotiation," Ryan said, "you'll have to have a much more restrictive formulary that doesn't compensate for all of the various different needs that seniors have." If you haven't signed up for Mike's Axios AM, please fix that by signing up here.

Price faces first round of grilling on ethics, Obamacare

Health and Human Services nominee Tom Price goes to make his case before the Senate HELP Committee this morning, and it's likely to be heavy on questions about his financial investments in health care companies, thanks to a series of news stories about them. The latest: Time reports that Price made big investments in six pharmaceutical companies just before fighting a Medicare payment reform rule that those companies opposed. (The transition team says a broker made those trades.)

But there's probably going to be plenty of questions from Democrats on his policies, too — especially from Bernie Sanders and Elizabeth Warren, who are both on the committee. Sanders met with Price on Tuesday and concluded that Price would move health care in "exactly the wrong direction," Caitlin Owens reports. Warren sent him a 20-page letter full of questions about Obamacare repeal, Medicare and Medicaid, medical research, and opioids. And Patty Murray, the ranking Democrat, is planning to ask Price why he doesn't want to let Medicare negotiate drug prices and Trump does.

Why it matters: Guess Price isn't going to get their votes. That's not going to sink him, but any answers they get could shed valuable light on how he'd do his job — and that does matter. The bigger event is still the Senate Finance Committee confirmation hearing, now scheduled for Jan. 24. That's the panel that votes on his nomination.

The other side of the Price record: health care costs

It's getting lost in all the coverage of Price's ethics questions and Obamacare repeal, but Price has a record of opposing the Obama administration's cost-saving initiatives — and he'd be able to cancel them easily. Our contributor Steven Brill takes a close look at Price's record in the House in a story this morning, and concludes that "he can bring a swift end to the cost-cutting ideas that health care reformers have been eyeing for years."

Check out the full story in the Axios news stream. We're all about smart brevity, but when a story deserves a deeper dive — as Price's record does — we run it because it's worth your time.

This venture capitalist is still defending Theranos

My colleague Dan Primack has an interview up this morning with Tim Draper, a venture capitalist who's a family friend of Theranos founder and CEO Elizabeth Holmes. The blood-testing company is still facing plenty of troubles — it failed a second federal inspection of its lab facilities, the Wall Street Journal reports this morning. But Draper is still loyal to Theranos, and thinks Holmes was "the victim of a witch hunt" and her competitors were "hugely threatened." And about the errors in violation of its own standards? "I like that they're self-policing." Read the full interview here.

The takeaways from CBO's scary Obamacare repeal report

We're going to be hearing about this Congressional Budget Office report on Obamacare repeal for quite a while, so here's what you need to know:

  • It shows what would happen if Congress repeals Obamacare and doesn't pass a replacement right away — even if the repeal is phased in.
  • It's mainly about what happens if the individual mandate is repealed but insurers still have to cover sick people.
  • It says 18 million people would lose their health insurance in the first year.
  • Two years later, that number would rise to 27 million as Medicaid expansion and Obamacare subsidies go away.
  • Individual insurance premiums would rise by 20 to 25 percent in the first year, and 50 percent two years later.
  • The report is based on the "reconciliation" bill Congress passed last year, which is likely to change this year.
  • Republicans are correct when they say the report doesn't look at the impact of any replacement for Obamacare.
  • But CBO wasn't asked to analyze a replacement bill — and there isn't one yet with enough detail for them to look at.

Why pricing could make this drug company go bankrupt

Famous short-seller Andrew Left of Citron Research published a report Tuesday that predicted Lannett, a generic drug company that's one of the targets of a price-fixing investigation and other lawsuits, will be "the first pharma company to go bankrupt amid continuing drug pricing scrutiny," Bob Herman reports.

If Lannett has to roll back its drug prices to where they were a few years ago, Left wrote, the drug maker will go belly up quickly because it will not generate enough cash to pay off its large debt load. Lannett is reliant on only a handful of its drugs, like thyroid medicine levothyroxine, for most of its business. (When Bob asked a Lannett spokesman if the company wanted to comment, the answer was short and to the point: "No.")

Why it matters: Other drug companies that took on major debt to make deals, with the expectation of raising prices later, could find themselves in a similar situation. But this, of course, assumes Trump and Congress both agree to take on the drug industry.

How fighty will this Medicaid roundtable get?

Senate Finance Committee Republicans are having a roundtable with GOP governors on Thursday to talk about the future of Medicaid, but this one is shaping up to be more than the predictable "give us block grants" affair. Most of the 10 states didn't expand Medicaid under Obamacare, but the group is going to include Ohio Gov. John Kasich and Michigan Gov. Rick Snyder — who not only expanded the program, but are likely to push Senate Republicans on what happens to their states if Obamacare goes way.

What we're watching today: Senate HELP Committee holds hearing on Tom Price, 10 a.m. Eastern. Livestream here.

What we're watching this week: Senate Finance Committee roundtable on Medicaid, Thursday.

What we're watching next week: Senate Finance Committee confirmation hearing for Price, Tuesday, Jan. 24.

And we're out of here, but please let me know what we missed and what else should be on our radar: [email protected].