Jan 11, 2017

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning, and we're back with Vitals. The Senate is about to take an easy Obamacare repeal vote, President-elect Trump is about to learn that Congress is slow, and Johnson & Johnson is about to take a step toward drug price transparency. Also: a look at what those Obamacare enrollment numbers really mean.

Thanks to everyone who's been giving us feedback over the past couple of days — please keep it up. And if you know anyone who hasn't subscribed and really should, please ask them to sign up here.

They can start Obamacare repeal, but can they finish it?

Senate Republicans think they're probably safe on the budget resolution vote that starts the Obamacare repeal process. It's happening after a long series of amendment votes that could start Wednesday night. The bigger danger: Republicans still aren't any closer to uniting around a replacement plan afterwards, much less a timetable for passing one.

Sen. Lamar Alexander, the moderate chairman of the Senate Health, Education, Labor and Pensions Committee, is talking up his own plan to move to a new system, Caitlin Owens reports. It's unique in that it takes a few steps, including:

  • Give states way more flexibility through waivers, pass legislation letting people use subsidies outside of Obamacare marketplaces
  • Congress passes a broader replacement
  • Then repeals the rest of Obamacare
The Obamacare repeal state of play, in two quotes
Long to me would be weeks.— President-elect Trump to the New York Times, on how quickly Congress should pass an Obamacare replacement after repealing itGiven the fact you have 535 members of Congress, it may take us a little while longer.— Senate Majority Whip John Cornyn to reporters, responding to Trump
How Trump broke health care Twitter on Tuesday

President-elect Trump didn't exactly win the confidence of the medical science community after vaccine skeptic Robert F. Kennedy Jr. claimed Trump had asked him to head a commission on vaccine safety. They were already nervous about him during the presidential campaign when he seemed to support the widely discredited theories about links between vaccines and autism.

Here's what two public health experts told me:

  • Sandro Galea, dean of the Boston University School of Public Health: "A drop in vaccine uptake endangers all of us. Having leading figures cast doubt on vaccines takes us many steps backwards."
  • Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia: "Awful news. Hard to believe. I'm speechless."

For the record: the Trump team later walked the idea back, with spokeswoman Hope Hicks insisting Trump was only considering a commission on autism and "no decisions have been made at this time."

And what will Scott Gottlieb do?

He's still very much in the running to head the Food and Drug Administration, and was starting to look like the front-runner. But Gottlieb has also been outspoken about the scientific consensus that there's really no danger in the vaccines. "We don't need more research. At some point, enough is enough," he told CNBC in 2015.

Does he still want to be FDA commissioner in an administration where he'd have to deal with a commission headed by a vaccine skeptic? And how would he handle the conflict if he takes the job? Gottlieb wouldn't comment for the record when I asked him — which isn't surprising, but still leaves him in an awkward position. Keep your eye on this one.

Johnson & Johnson's move into price transparency

The company is getting a lot of attention after promising to reveal its average prescription drug price increases next month. The catch? It's only going to be average list and net price increases — not the prices of individual drugs, reports Linda Johnson of the Associated Press.

The upside: Other drug makers could follow Johnson & Johnson's lead, especially since members of Congress have been calling on the pharmaceutical industry to show more transparency.

The downside: The move really won't shed light on individual drug prices, AP notes, because J&J doesn't want to disclose the discounts it gives to middlemen.

The Obamacare age mix hasn't changed — at all

Obamacare signups are definitely outpacing last year, according to the latest enrollment report — 11.5 million signups so far. But if you look at the age mix, it's a different story. Compared to last year's report at this time, the share of customers in each age group is almost exactly the same.

That could be a problem for the Obama administration, which has been trying to goose the young adult signups so insurers will have more healthy customers. Key points from two members of the Axios board of experts, a group of outside analysts who will contribute insights to help deepen our coverage:

  • "That underscores that the individual market remains unbalanced," said Chris Condeluci, a consultant and former Senate Finance Committee Republican aide.
  • But it's not necessarily bad news for insurers, Condeluci said, because they have more experience now: "They understand that the risk pool is not improving and is not likely to improve.
  • Yvette Fontenot, a former Democratic Senate aide and Health and Human Services official, said the bottom line is that enrollment is higher than ever: "Just goes to show that few things are quite as motivating as threatening to take away a family's health insurance."
Liquid biopsies and other health care tech to watch

The nonprofit ECRI Institute has released its list of the top 10 advances in health care technology that will have the biggest impact this year, according to Healthcare IT News. A few of the highlights:

  • Liquid biopsies (genetic tests that use bodily fluids instead of biopsied tissue)
  • Genetic testing and biosensors to see who's at risk for opioid addiction
  • Web-based tools and coaching that can help patients recover from abdominal surgery
Obama's challenge: Come up with something better
"If anyone can put together a plan that is demonstrably better than the improvements we've made to our health care system – that covers as many people at less cost – I will publicly support it."— President Obama, in farewell address Tuesday night

Reality check: Obama has been saying things like this for years: If you have better ideas, Republicans, send 'em my way. Now that they're on the road to repeal, it's his parting challenge, and it's easy to make — because he and most Democrats are sure that Republicans won't be able to do it. They're about to have their chance to prove him wrong.

Caitlin Owens

What we're watching today: Trump press conference, 11 a.m. Eastern; Senate "vote-a-rama" on budget resolution leading to Obamacare repeal, starting around 6 p.m. Eastern.

That's it, and thanks for reading. Keep sending your feedback, tips and especially leaks: david@axios.com.