Overnight Health Care — Sponsored by PCMA — ObamaCare premium wars are back

Overnight Health Care — Sponsored by PCMA — ObamaCare premium wars are back
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Welcome to Overnight Health Care, sponsored by the Pharmaceutical Care Management Association.


It's Wednesday and we're asking for the rain to stop, please. Where are our May flowers? But in the meantime, we've got lots of ObamaCare and drug news to bring you today.


First... the ObamaCare premium wars are back.

But they're looking different than in years past.

During the Obama administration, Republicans railed against ObamaCare premium hikes while pledging to repeal and replace the law. But that repeal push ended in failure last year, and Democrats say the political winds have shifted in their favor.

Key quote: "Thus far, Democrats have been on the defensive about premium increases," said Cynthia Cox, a health insurance expert with the Kaiser Family Foundation.

"Now they're starting to play offense, and from our polling we've seen that a lot of the public now feels that the Trump administration and Congress are responsible for any problems with the [Affordable Care Act] going forward, so it may be that the politics of premium increases has changed."

On the other side: Republicans counter that it was Democrats who passed the law, enacted in 2010, in the first place and without any GOP votes. And they blame Democrats for the failure to pass a bill that was aimed at shoring up ObamaCare's exchanges.

Democrats counter that moves from the Republican-controlled Congress and administration have resulted in ObamaCare "sabotage."

Context: Only a handful of states have released proposed premiums for next year, as insurers are largely still hammering out what their preliminary rates are going to be.

  • In Maryland, the average proposed increase among insurers and plans was 30 percent. CareFirst BlueCross BlueShield, for example, requested an 18.5 percent hike for its HMO plans and 91.4 percent for its PPO plans.
  • In Virginia, proposed rate hikes varied widely, from 15 percent to 64 percent.
  • Vermont's proposed premium increases were more modest.

We take you inside the fight here.


Lindsey GrahamLindsey Olin GrahamSaudi mystery drives wedge between Trump, GOP Suspects in journalist's disappearance linked to Saudi crown prince: report Overnight Defense: Trump worries Saudi Arabia treated as 'guilty until proven innocent' | McConnell opens door to sanctions | Joint Chiefs chair to meet Saudi counterpart | Mattis says Trump backs him '100 percent' MORE working on a new ObamaCare repeal bill.

Sen. Lindsey Graham (R-S.C.) is talking to other senators about bringing back an ObamaCare repeal bill, but it's probably not going anywhere.

Reason for the heavy skepticism: Senate Republicans only have 50 votes now, even fewer than they had last year when they couldn't get the votes for a repeal bill. Any number of senators, from Rand PaulRandal (Rand) Howard PaulSaudi mystery drives wedge between Trump, GOP Noisy democracy, or rude people behaving like children? Lawmakers, Wall Street shrug off Trump's escalating Fed attacks MORE to Susan CollinsSusan Margaret CollinsGraham: I hope Dems 'get their ass kicked' for conduct around Kavanaugh St. Lawrence alumni, faculty want honorary degree for Collins revoked 'Suspicious letter' mailed to Maine home of Susan Collins MORE to Lisa MurkowskiLisa Ann MurkowskiEx-Florida lawmaker leaves Republican Party Murkowski not worried about a Palin challenge Flake on Kavanaugh confirmation: To see GOP 'spiking the ball in the end zone' doesn't seem right MORE, would be extremely tough votes to get. Losing just one would kill the effort. And leadership has shown no interest.

But, here's a draft bill we obtained (though it's slightly old) if you're interested in getting a sense of what they're working on.

Key quote: "I haven't given up," Graham said. "Will there be another effort to replace ObamaCare with a state-centric plan? I hope so."

Read more on Graham's effort here.



Sponsored content - Pharmaceutical Care Management Association

Drugmakers set and raise prices unrelated to the rebates they negotiate with pharmacy benefit managers (PBMs).  The most direct way for drugmakers to reduce costs and improve access is to simply cut their own prices.



Meanwhile, Democratic attorneys general were granted the right to defend ObamaCare in a lawsuit brought by Republicans.

Republican attorneys general argue in their lawsuit that the ACA is no longer constitutional because Congress eliminated the fine for not having insurance, but not the requirement itself.

The Republican AGs argue that the Supreme Court in 2012 upheld the fine, not the mandate, and now the law is illegal.

The latest twist: A federal judge now says Dem AGs can intervene in the case and fight to defend the law.

Why it matters: The GOP lawsuit itself is probably a longshot, but Democrats will likely put up a stronger defense of the ACA than the Trump administration, given its opposition to the law.

Read more here.


Short-term plans could end up costing a lot more than the administration thinks.

A new report found that the Trump administration's proposal to allow insurers to sell more limited, short-term plans would cost the federal government more money and affect more people than the administration previously estimated.

The report's conclusions echo the arguments made by Democrats and the insurance industry: short-term plans will siphon healthy people away from ObamaCare exchanges. That will result in higher premiums for those people who remain on the exchanges.

Let's see the numbers:  

  • An estimated 1.4 million people are expected to sign up for short-term plans in 2019 and 1.9 million are expected to sign up by 2022.
  • Federal spending would increase by $1.2 billion in 2019 and $38.7 billion over the next 10 years.

The administration's estimates:

  • At most, 200,000 people would buy short-term plans.
  • Federal spending would increase $96 million to $168 million a year.

Click here for our breakdown of the report.



The Trump administration is facing pressure from conservative groups and congressional Republicans to restore Reagan-era abortion restrictions on federal family planning funding.

These restrictions, described as a "gag rule" by Democrats, would ban Title X grant recipients from promoting abortions, or giving patients referrals for abortions. It would also require recipients have a physical and financial separation from abortion providers.

Why it matters: Both sides say this is an attempt to cut away at federal funding to Planned Parenthood. The organization and its affiliates serve about 40 percent of patients who get services through Title X. These restrictions would make it harder for Planned Parenthood to participate in the program, or disqualify some clinics altogether.

Looking ahead: The administration routinely takes it cues from anti-abortion groups (which say they're optimistic about this happening) so watch for HHS to issue regulations in the near future. Notably, Republicans in Congress are also calling for these changes.

We've got more on what is coming up here.


Vermont has become the first state to allow drug wholesalers to import some medicines from Canada.

Gov. Phil Scott (R) signed legislation Wednesday allowing the imports.

But the move puts the state at odds with the Trump administration. HHS Secretary Alex Azar on Monday called the idea of importing drugs from another country a "gimmick."

Context: The bill was based off model legislation from the National Academy for State Health Policy (NASHP). Eight states proposed similar legislation this year, but Vermont's is the first to be signed into law.

The opposition: The nation's top drug lobby, Pharmaceutical Research and Manufacturers of America (PhRMA), was quick to criticize the proposal.

"Lawmakers cannot guarantee the authenticity and safety of prescription medicines when they bypass the FDA-approval process, and the Canadian government does not inspect or take responsibility for the legitimacy of prescription medicines shipped to the U.S.," PhRMA said in a statement.

The other side: NASHP argues that requiring wholesalers to import the drugs is a key distinction that provides assurances the drugs coming into the state would be safe.

Read more here.


Do you want copies of your medical records? That might cost you.

Rep. Bill FosterGeorge (Bill) William FosterCongress and Trump are out of step on intellectual property Overnight Defense: House passes 5B defense spending bill | Pentagon moving forward on Trump military parade | Mattis vows 'ironclad' support for South Korea's defense House passes 5B Pentagon spending bill MORE (D-Ill.), though, wants to change that. He's sent a Dear Colleague letter around asking if lawmakers want to become cosponsors on a bill that would require providers to give patients free access to their medical records once a year.

HIPAA, the relevant law, "requires providers to give patients access to their medical records and allows them to charge the patients a 'reasonable, cost-based fee' intended to cover the cost of copying pages, procuring USB drives, postage, etc.," Foster wrote in the letter.

But he warned that, "For patients with chronic diseases or complex medical histories, fees could easily reach hundreds if not thousands of dollars to access a complete copy of their own medical records."

A recent report from the Government Accountability Office noted that at least two patients interviewed have been charged more than $500 for a single medical record request -- and that one patient paid $148 for a pdf of her medical record.



Sponsored content - Pharmaceutical Care Management Association

A drug company’s decision to increase the price of a forty-year-old drug by 1400% – despite no change in the supply chain – undermines drugmakers’ attempt to blame their prices on the insurers, pharmacies, PBMs, and wholesalers through which patients access medicines. 



Wednesday roundup:

A California judge overturned the state's assisted suicide law, arguing that it was passed unconstitutionally.

The top lawyer for Switzerland-based drugmaker Novartis is leaving over payments his company made in a consulting contract with President TrumpDonald John TrumpFive takeaways from Cruz, O'Rourke's debate showdown Arpaio files libel suit against New York Times IMF's Christine Lagarde delays trip to Middle East MORE's personal attorney, Michael Cohen.

A group of current and former nurses are fighting to have the name of Facebook founder Mark Zuckerberg taken off a general hospital in San Francisco.

Opioid manufacturers are being hit with another lawsuit. New York's acting attorney general said Wednesday the state is preparing to sue Purdue Pharma, the manufacturer of the painkiller OxyContin.

And a patient is doing well, thanks to the surgeon general, after suffering a medical emergency on a plane.


What we're reading

At Houston hospital, patients suffer as renowned heart transplant program loses its luster (Propublica & the Houston Chronicle)

Alex Azar calls Democratic reforms to lower drug prices 'gimmicks' and ineffective (Washington Examiner)

As Ebola flares once again, a rapid global response invites cautious hope (Stat)

Which poor people shouldn't have to work for aid? A look at proposed Medicaid work requirements in Michigan. (The New York Times)


State by state

California hospital giant Sutter Health faces heavy backlash on prices (California Healthline)

Ohio Medicaid overhauling how it pays for addiction, mental health care (Dayton Daily News)

ACLU, Maine spar in court over paying for abortions with Medicaid funds (Press Herald)