Overnight Health Care: Trump officials making changes to drug pricing proposal | House panel advances flavored e-cig ban | Senators press FDA tobacco chief on vaping ban

Overnight Health Care: Trump officials making changes to drug pricing proposal | House panel advances flavored e-cig ban | Senators press FDA tobacco chief on vaping ban

Welcome to Wednesday's Overnight Health Care.

There was news aside from impeachment today! Nancy PelosiNancy PelosiBriahna Joy Gray discusses Pelosi's 2022 re-election announcement The Hill's Morning Report - Who will replace Justice Breyer? House Republicans bash Democrats' China competition bill MORE isn't putting much stock into recent White House criticism of her drug pricing bill, Chuck SchumerChuck SchumerBreyer retirement throws curveball into midterms Schumer vows to vote on Biden Supreme Court pick with 'all deliberate speed' Voting rights failed in the Senate — where do we go from here? MORE doesn't believe in half-measures on drug pricing, and senators aren't happy with the administration's delay on the e-cigarette flavor ban. 

We'll start with drug pricing: 


Trump officials making changes to signature drug pricing proposal, Azar says

Remember the International Pricing Index? The Trump administration is still working on it. And is making some changes, HHS Secretary Alex Azar said Wednesday. 

Under the original proposal, prices would still have been lower than they are now but would still be a certain percentage higher than they are in other countries. Trump was not satisfied with that idea, Azar said Wednesday, and wanted the proposal changed so that prices in the United States are even lower than they are in other countries. 


"What we suggested was reducing that 180 percent premium [above other countries] by 30 percent," Azar said at an event hosted by Axios. "The president did not find that satisfactory. His view, which he has articulated publicly, is that America ought to be getting the best deal among developed countries. That was the terminology of 'most favored nation status.' And so that's the type of proposal we're working on."

What to watch: Azar still would not commit that this proposal will actually be finalized. Some observers think the administration is waiting to see what can happen in Congress on drug prices. 

Read more here


Schumer blocks drug pricing measure during Senate fight, seeking larger action

Meanwhile, there was some drama on the Senate floor on drug pricing. 

Sen. John CornynJohn CornynSenate Republicans press federal authorities for information on Texas synagogue hostage-taker Senators huddle on Russia sanctions as tensions escalate Momentum builds for new COVID-19 relief for businesses MORE (R-Texas) was seeking to pass by unanimous consent a bill he is co-sponsoring with Sen. Richard Blumenthal (D-Conn.), which would crack down on drug companies gaming the patent system to delay competition from makers of cheaper generic drugs. 

But Schumer objected to the request, blocking the move. The New York Democrat said that while he did not oppose the bill on substantive grounds, he opposed Cornyn playing a "little game" to try to move only his bill forward without larger action to lower drug prices, which he said Republicans are blocking. 

"We have a whole lot of legislative ideas, not just his," Schumer said on the floor. 

Cornyn responded that Schumer's move was "what people hate about Washington, D.C." 

Read more here


Pelosi aide hopeful White House will support drug-pricing bill despite criticism

Speaker Nancy Pelosi's (D-Calif.) top health care aide Wendell Primus made some newsy remarks at the University of Wisconsin.

"I still think at the end of the day we are going to get administration support, despite some recent comments they have made," Primus said last Friday. (Most other observers have a much more negative outlook on the Pelosi drug pricing bill's chances.)

"I also think when the I-word, the impeachment stuff, is completely behind us, whatever it turns out to be, that will also change the administration's opinion of some of this," Primus said.  

On the divide with House progressives, who are pushing for the bill to do more, Primus acknowledged they are frustrated with him but said he does not want the bill moving left. 

"Right now, my sense of this is we have this bill centered correctly," Primus said. "The bill cannot move to the left."

Context: Primus's comments get at the two main challenges for Pelosi's drug pricing bill: overcoming objections from House progressives and getting through the Senate. The first one is expected to be doable, the second one is much harder. 

Read more here


House panel advances flavored e-cigarette ban 

A proposal to ban flavored e-cigarette products advanced out of a House health panel on Wednesday.

Democrats, public health groups and some experts argue that flavors such as fruit and mint appeal to kids and have gotten a new generation addicted to nicotine.

"It's a very significant public health concern that these products are appealing to kids at unprecedented rates," said Rep. Frank Pallone Jr.Frank Joseph PalloneLawmakers discussing potential compromise to revive drug pricing measure House Democrats announce bill to rein in tech algorithms House Democrats ramp up probe of FDA approval of Alzheimer's drug MORE (D-N.J.), the chairman of the House Energy and Commerce Committee. 

In addition to banning manufacturers from adding nontobacco flavors to e-cigarette liquids, the bill, sponsored by Pallone and Rep. Donna ShalalaDonna Edna ShalalaHeadaches intensify for Democrats in Florida Democrats face bleak outlook in Florida 'Blue wave' Democrats eye comebacks after losing reelection MORE (D-Fla.), would raise the age to purchase tobacco to 21 and ban online sales of e-cigarettes and tobacco products.

There has been no announcement on when the Energy and Commerce committee will take up the bill. But if it passes, the next step would be a vote on the House floor. 

Read more here


On the other side of the Capitol, the administration's top tobacco official had no answers about the vaping ban.  


Senators press FDA tobacco chief on status of vaping ban

Lawmakers are running out of patience with the Trump administration on vaping.

Senators from both parties pressed the Trump administration's top tobacco official on Wednesday for information about the administration's efforts to remove e-cigarette flavors from the market.

Mitch Zeller, the head of the Food and Drug Administration's (FDA) Center for Tobacco Products, told members of the Senate Health Committee that the agency is working on an e-cigarette policy, but declined to give more information about when it will be released, what the policy will be, or even if the administration still intends to remove flavors from the marketplace.

For example: Sen. Tim KaineTimothy (Tim) Michael KaineDemocrats call on Biden administration to ease entry to US for at-risk Afghans Manchin, Sinema join GOP to sink filibuster change for voting bill Desperate Dems signal support for cutting Biden bill down in size MORE (D-Va.) asked if the administration still intends to follow through on its initial promise of clearing the market of unapproved flavors.

"There is no final answer as of now," Zeller said.

Sen. Lisa Murkwoski (R-Alaska) said she was disappointed that the administration seems to be moving towards exempting mint and menthol from the ban.

"I don't think we need to nuance the message here, and I'm just frustrated that we are still arguing over whether or not menthol or mint as a flavor is an attractant to kids. If it makes it taste that much better, they're going to be attracted to it," Murkowski said. 

How we got here: On Sept. 11, Trump and the administration's top health officials sat in the Oval Office and announced their intent to clear the market of every flavor of e-cigarettes except for tobacco.

But ever since, the message has been muddled. Officials like White House counselor Kellyanne ConwayKellyanne ConwayKellyanne Conway memoir set for May release Pennsylvania Republican David McCormick launches Senate campaign McCormick drawing support from Trump alumni ahead of Pennsylvania Senate bid MORE as well as Azar, and even Trump himself, have been increasingly trying to draw a distinction between "e-cigarettes" and "vaping." Meanwhile, the status of FDA's rule remains a mystery.

Get the full rundown here.


GOP senator urges Trump to back down from vaping ban

Sen. Ron JohnsonRonald (Ron) Harold JohnsonJewish groups sound the alarm as anti-vaccine mandate movement invokes Holocaust  Former Senate candidate launches bid for governor in Wisconsin Wisconsin Democratic Senate candidate Sarah Godlewski rolls out rural policy plan MORE (R-Wis.) is using economics to try to convince President TrumpDonald TrumpMark Walker to stay in North Carolina Senate race Judge lays out schedule for Eastman to speed up records processing for Jan. 6 panel Michael Avenatti cross-examines Stormy Daniels in his own fraud trial MORE to back down from restricting e-cigarette flavors.

Such a move "could have a devastating effect on the e-cigarette industry and force many small businesses to shut down," Johnson wrote Wednesday in a letter to Trump. 

"Many stakeholders in the e-cigarette industry are small businesses ... so an outright ban on the most popular flavors purchased by adults will likely force them to close," Johnson wrote, adding that the estimated $9 billion industry could be completely destroyed.  

Johnson's arguments are similar to the ones being raised by other vaping advocates and conservative groups. 

Democrats and public health groups are concerned Trump may be listening.


More than 750,000 enroll in ObamaCare plans 

More than 750,000 people enrolled in ObamaCare plans on healthcare.gov during week two of open enrollment, which spanned from Nov. 3-10. 

That compares to the 804,000 people who enrolled during week two of open enrollment last year -- a 6 percent decrease. 

Still, the exchanges appear to be starting off strong. Cumulatively, 932,049 people signed up for plans between Nov. 1 and 9. 

Advocates are somewhat encouraged by the numbers, as Week 2 is the first full week of enrollment this year but note that it's still too early to draw conclusions.

Joshua Peck, who helped run healthcare.gov under President Obama: 

"Cumulative sign-ups are down 21%, but this should largely be explained by one fewer days in the reporting period this year and tech problems on the first day of OE that prevented 100,000 people from signing-up."

-- Joshua Peck (@JoshuaFAPeck) November 13, 2019


Drug-resistant bacteria and fungi kill 35,000 people a year: CDC

More people are dying from drug-resistant bacteria and fungi infections than previously estimated, according to a new report from the Centers for Disease Control and Prevention (CDC). 

These bacteria and fungi that are resistant to antibiotics cause more than 2.8 million infections and 35,000 deaths in the U.S. each year, the CDC said. 

The CDC estimated someone in the U.S. gets an antibiotic resistant infection every 11 seconds and every 15 minutes someone dies.

The report lists 18 germs resistant to antibiotics, with five considered to be an "urgent threat." 

Still, the report says there has been "significant progress" in preventing infections in hospitals. But infections caught elsewhere have increased. 

"Antibiotics save lives, but any time antibiotics are used--in people, animals, or crops--they can cause side effects and can contribute to the development of antibiotic resistance," the report reads. 

The report notes that antibiotic resistance can affect any person, but people at health care facilities or those with weakened immune systems are at higher risk. 


What we're reading 

Verma attacks critics of Medicaid work requirement, pushes for tighter eligibility (Kaiser Health News)

The sexist double standard behind the Medicare for All fight (Daily Beast)


State by state

Medicaid Tweak Might Offer Means To Improve U.S. Maternal Health (Kaiser Health News)

Wyoming committee advances Medicaid expansion bill (Associated Press

Idaho seeing bigger jump in uninsured children than most states (Post Register)

Dialysis patients panic as financial 'life raft' becomes unmoored (California Healthline)