Overnight Health Care: HHS chief refuses to testify on family separations | Grassley to test GOP on lowering drug prices | PhRMA spends record on lobbying in 2018

Overnight Health Care: HHS chief refuses to testify on family separations | Grassley to test GOP on lowering drug prices | PhRMA spends record on lobbying in 2018
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Welcome to Tuesday's Overnight Health Care.

It was a federal holiday yesterday, but the government shutdown is still ongoing and into Day 32.

On the health care front, PhRMA beat its own record for spending on lobbying, HHS Secretary Alex Azar is setting himself up for a fight with House Democrats, and Senate Finance Committee Chairman Chuck GrassleyCharles (Chuck) Ernest GrassleyState cites 38 people for violations in Clinton email review Lawmakers from both sides of the aisle mourn Cummings GOP cautions Graham against hauling Biden before Senate MORE is giving his fellow Republicans an early test on their commitment to lower drug prices.

We'll start with Azar:


HHS chief refuses to testify on child separation policy

The Department of Health and Human Services (HHS) is refusing to have secretary Alex Azar testify before the House Energy and Commerce Committee about the administration's child separation policy, according to the panel's chairman.


"[Azar's] denial to appear before the Committee in the coming weeks on the family separation policy is unacceptable, and we are going to get him here at some point one way or another," Rep. Frank Pallone Jr.Frank Joseph PalloneLawmakers set to host fundraisers focused on Nats' World Series trip CBO: Pelosi bill to lower drug prices saves Medicare 5 billion Trump official declines to testify on trade protections for tech platforms MORE (D-N.J.) said in a statement.

What's next: The move could set up a fight with House Democrats, who are focusing their new oversight power on the administration's border policy. Democrats have been putting pressure on the Trump administration, especially in the wake of a report from the HHS inspector general last week which found the administration separated thousands more migrant children from their parents than was previously known.

HHS pushes back: An HHS spokeswoman said Azar has spoken directly with Pallone "and is committed to the welfare of the children in HHS care."

She said Azar has been cooperating with information requests and is in regular contact with members of Congress to provide updates. He also hosts a weekly call with Capitol Hill.

HHS offered to have other officials testify, including Lynn Johnson, assistant secretary at the agency's Administration for Children and Families (ACF), Commander Jonathan White, the deputy director for children's services at ACF, and Jonathan Hayes, the acting director of HHS's refugee office.

However, a committee spokesperson said Pallone believes that Azar is "the appropriate person to testify." The hearing, which will be convened by Energy and Commerce's oversight subcommittee, has not been scheduled yet.

Trouble brewing between Trump officials, House Dems: Azar is the latest administration official to refuse a Democratic request to testify; Treasury Department Secretary Steven MnuchinSteven Terner MnuchinTop economic adviser warned Trump on reelection chances ahead of China truce: report The Hill's Morning Report - Tempers boil over at the White House Schumer seeks focus on health care amid impeachment fever MORE last week decline to testify at a hearing about the government shutdown's impact on his department.

More on the showdown here.


Health industry's big spenders

2018 was another expensive year for lobbying in the health care sector. Here's some of the year's biggest spenders, according to fourth-quarter disclosures released Tuesday.

  • PhRMA's spending on lobbying reached an all-time high in 2018 at $27.5 million. That tops the $25 million it spent in 2017. The next highest year for PhRMA in terms of spending was in 2009, when Congress was debating the Affordable Care Act. It spent $26 million that year.
  • Pfizer spent $11 million on lobbying in 2018, up slightly from the $10.5 million it spent in 2017.
  • The American Medical Association spent $20 million on lobbying last year, slightly down from the $21 million it spent in 2017.
  • AARP spent $8 million last year, a slight drop from 2017 when it spent $9.5 million.
  • America's Health Insurance Plans spent $7 million on lobbying last year, which is comparable to what it spent in 2017.


Grassley to test GOP on lowering drug prices

Sen. Chuck Grassley (R-Iowa) is giving Republicans an early test on their commitment to lowering drug prices.

Legislation sponsored by the Senate Finance Committee chairman and Democratic Sen. Amy KlobucharAmy Jean KlobucharDeVos calls Democratic presidential hopeful's education plans 'crazy' Senate Democrats want Warren to talk costs on 'Medicare for All' Biden struggles to reverse fall MORE (Minn.) would allow people to buy prescription drugs from approved pharmacies in Canada.

The bill is reigniting a long-simmering debate about drug importation, a proposal strongly opposed by the powerful pharmaceutical lobby.

Despite Grassley's support, the measure faces an uphill battle in the Senate, where the Iowa Republican has long fought to make inroads with skeptical Republicans.

What's new this time: This isn't a new idea. Grassley has championed it in the past, along with the late Sen. John McCainJohn Sidney McCainCummings to lie in state at the Capitol Elizabeth Warren should concern Donald Trump 'bigly' Lawmakers toast Greta Van Susteren's new show MORE (R-Ariz.). But intense public pressure on drug companies over escalating prices and support from the Trump administration could tip the scales. Grassley's new role as the chairman of the Finance Committee, which has some jurisdiction over health care, could also give him more sway with his colleagues on drug pricing issues.

Has the administration endorsed the bill? Not quite. The Food and Drug Administration last summer formed a working group to examine ways to safely import drugs in cases in which there is a dramatic price increase for a drug produced by one manufacturer and not protected by patents or exclusivities. HHS Secretary Azar has predominantly been using the idea of importation as a threat to industry to get them to lower the list prices of prescription drugs, but that doesn't mean they wouldn't support the bill.

More on Grassley here


Dem chairman schedules hearing on pre-existing conditions

Mark your calendars: A Ways & Means hearing about pre-existing condition protections will take place next Tuesday, the committee announced today.

It will be one of the committee's first hearings since Democrats regained the majority.

No other information about the hearing, including who will testify, has been announced yet.

Maintaining ObamaCare's protections for people with pre-existing conditions was a central message for Democrats in the midterm elections and helped propel them to take control of the House.

Expect to see a lot more hearings along those lines in the coming months as Democrats look to fulfill their promise-- especially with the GOP lawsuit over ObamaCare continuing to hang over everyone's heads. A Texas judge recently sided with the GOP attorneys general, but that ruling is being appealed by Democratic-led states. 

More on the hearing here.


Insulin costs double over five-year period

Per-person spending on insulin doubled in a recent five-year period, according to a report released Tuesday.

Individuals with type 1 diabetes spent an average of $5,705 on insulin in 2016, compared with $2,864 in 2012, according to a study from the Health Care Cost Institute.

The dollar amount represents the combined amount paid by a patient and their insurer — and it doesn't include discounts given later.

The spending jump is largely driven by price increases, the authors wrote, and not because more people are using insulin.

Why it matters: Lawmakers have told stories of constituents rationing insulin because they can't afford it. Such measures are not recommended by the medical community and could be life threatening.

What's next: Several Democratic chairmen in the House have vowed to investigate high drug prices, and that's expected to include insulin costs.

More on the study here.


New government affairs firm: Mason Street Consulting

Susan Zook, a former health care advisor to Sen. Mike CrapoMichael (Mike) Dean CrapoGOP requests update on criminal referrals prompted by 2018 Kavanaugh probe Nearing finish line, fight for cannabis banking bill shifts to the Senate On The Money: Trump strikes trade deal with Japan on farm goods | GOP senator to meet Trump amid spending stalemate | House passes cannabis banking bill | Judge issues one-day pause on subpoena for Trump's tax returns MORE (R-Idaho) is launching her own firm, Mason Street Consulting. Zook is also a former lobbyist for Aetna, helping them navigate the changes from ObamaCare.


What we're reading

Democrats' plan to neuter Medicare for All irks liberals (Politico)

Trump proposals could increase health costs for consumers (The New York Times)


Drug makers still raising prices, but seeking fewer hikes (Axios)   

Rural hospitals in greater jeopardy in non-Medicaid expansion states (Stateline)


State by state

Work requirements knock thousands off Medicaid in Arkansas. Will that happen here? (Indianapolis Star)

It took a nearly 3-month special session for Mississippi to pass Medicaid. Could history repeat? (Mississippi Today)

Illinois governor's executive order demands abortion, reproductive services be included for public employees (WQAD)  


From The Hill's opinion page

Breast cancer is not a partisan issue -- we need to work together to address it