Feb 9, 2017

Axios Vitals

Good morning. The Senate may finally vote on Tom Price's confirmation sometime in the middle of the night, or maybe even wait until Friday. Point is, he's going to be Health and Human Services secretary. Meantime, we're already moving on to Seema Verma, the Centers for Medicare and Medicaid Services nominee, who's going to have her turn under the microscope pretty soon.

Cheer up! The Tom Price debate may be over soon

Well, not soon, but we should have a Health and Human Services secretary by the weekend. The Senate started its debate last night, but Democrats are furious that Republicans are moving ahead, given the mountain of stories about questionable stock purchases by Price. So they're going to burn through as many of the 30 hours of "post-cloture" debate as they can. That could make it a late-night vote, but there was also talk that it could slip to Friday, during the daylight hours.

The outcome looks pretty clear, though, after the 51-48 procedural vote last night to end the debate. Sen. Joe Manchin, who was pretty much Price's last hope for getting a Democratic vote, was a no, as Caitlin Owens scooped yesterday. (Not helpful: the latest Price story yesterday, by USA Today, reported that he bought and sold so many health care stocks that he drew the attention of the House ethics committee and federal securities regulators.)

Remember Seema Verma? She's up next

The nominee for the Centers for Medicare and Medicaid Services has been waiting quietly while Price has been hogging the spotlight, but now she's going to get her turn. We're hearing that the Senate Finance Committee is likely to hold her confirmation hearing next week, possibly Thursday, assuming Price is confirmed. Verma won't face the same barrage of ethics questions that Price had to deal with, but that doesn't mean she'll have it easy.

Democrats are likely to question her approach to Medicaid reform, since she was one of the main authors of the Healthy Indiana Plan, which requires low-income people to make monthly payments to keep their coverage. They're also going to quiz her on how much she really knows about Medicare, which isn't part of her background. In the meantime, CQ-Roll Call's Kerry Dooley Young reports that the Office of Government Ethics may post an agreement with Verma that would address issues like her work as a Medicaid consultant.

Pharmacy benefit managers are ready to fight back

Bob Herman has a smart piece this morning about the middlemen in drug price negotiations, and how they're getting ready to fight back against their critics. Pretty important since there's growing talk of regulating them, including from Republicans in Congress, as Bob reported on Tuesday. But how easy is it going to be to explain their value to the public? It's a secretive business model — and besides, you try asking a normal, non-wonky person whether they have any idea what a pharmacy benefit manager is. Read Bob's story here.

Oh yeah, and Anthem doesn't get to merge with Cigna

We all knew this was coming, but a federal judge made it official yesterday: Anthem's proposed merger with Cigna isn't happening. Judge Amy Berman Jackson ruled that the merger would have been anticompetitive and would have caused higher prices. This ruling was pretty much inevitable after the Aetna-Humana merger was struck down, as Bob Herman wrote last month, since the Anthem-Cigna deal faced more antitrust hurdles and the two companies didn't seem to get along that well anyway. Read Bob's story on the ruling here.

The conservative wish list for Obamacare repeal

It's not going to make life any easier for Republican leaders, Caitlin Owens reports. The current and former leaders of the Freedom Caucus, along with Sen. Mike Lee, laid out their demands for reporters yesterday: They don't want to leave pieces of the 2015 Obamacare repeal bill out, and if anything, Rep. Jim Jordan — the former head of the Freedom Caucus — said he wants this year's to be even broader. And Lee doesn't want to include new tax credits in the repeal bill: "I think we need to repeal it first before deciding what comes next."

It's all about positioning and leverage, of course — would any of these conservative leaders really try to sink the repeal effort? Senate Majority Whip John Cornyn later said the repeal effort isn't going to fail, and that their concerns are "part of the normal consensus-building process." But it's also true that GOP leaders need their votes, so they'll try to use their leverage as much as they can. Read Caitlin's story here.

On the bright side: Insurers may get cost-sharing payments

It's going to be hard to keep insurers in the Obamacare markets if they don't get paid for their cost-sharing reduction subsidies, which go to low-income customers. Now, Rep. Mark Meadows, the chairman of the Freedom Caucus, says he'd be willing to go along with that as long as there's a longer-term plan to bring down health care costs, Caitlin reports. That suggests his group might not put up as much of a fight against that plan as they could have.

For more on why it's a big problem if Congress doesn't give them the money, check out my story about the "significant losses" a new industry study says the insurers could face without the payments.

Can machines detect tumors better than people?

A Deloitte University Press article on machine intelligence, including the ways it can be used in health care, has this nugget: One health care startup is already putting it to use in radiology. By using "deep learning" technology — which use neural networks that mimic the design of the human brain — its system has been able to diagnose malignant tumors as much as 50 percent better than human radiologists. (The startup is Enlitic, according to the Economist story cited in the Deloitte piece.)

What we're watching tonight, or maybe Friday: The Price confirmation vote in the Senate.

What we're watching next week: Senate Finance Committee confirmation hearing for Seema Verma.

All done! Let me know what else we should watch: david@axios.com.