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Republicans worry Obamacare ruling will drag them down in the 2020 elections. Republicans fear that a federal judge's decision Friday striking down the Affordable Care Act will put them in a perilous political position and will hand Democrats a powerful line of attack for next Congress and the 2020 elections. While the law won’t be affected right away, as the case is set to go through the appeals process, it’s a boon to Democrats who are eager to campaign on healthcare and pre-existing illness protections, just as they did throughout the 2018 campaign. Throughout the cycle, Republicans were hammered in television ads for voting for bills that would have made coverage more expensive or out of reach for people with pre-existing conditions, such as cancer or diabetes. “Republicans now have to answer a set of questions that they wouldn't have otherwise had to answer,” said one GOP strategist on the political challenges of the ruling. “The ruling may have single-handedly galvanized Democrats on an issue where they play a lot of offense and put Republicans on defense for who knows how long.” In Congress, Senate Minority Leader Chuck Schumer, D-N.Y., is pressuring the Senate to bring a measure to the floor that would allow lawmakers to intervene.

Welcome to Philip Klein’s Daily on Healthcare, compiled by Washington Examiner Executive Editor Philip Klein (@philipaklein) and Senior Healthcare Writer Kimberly Leonard (@LeonardKL).  Email dailyonhealthcare@washingtonexaminer.com for tips, suggestions, calendar items, and anything else. If a friend sent this to you and you’d like to sign up, click here. If signing up doesn’t work, shoot us an email and we’ll add you to our list.

Democrats file to halt ruling striking down Obamacare. Seventeen Democratic attorneys general filed a motion Monday to challenge the Friday decision by a federal judge that ruled the Affordable Care Act unconstitutional. The motion, led by California Attorney General Xavier Becerra, asks the judge to grant a stay on his ruling until it is appealed to the U.S. Court of Appeals for the 5th Circuit in New Orleans. It also asks the judge, Reed O’Connor in the Northern District of Texas, for clarification on the ruling that said the law must be struck down because the fine on the uninsured, known as the "individual mandate," will be zeroed out in 2019. The filing asks O'Connor to make it clear that the Affordable Care Act, also known as Obamacare, is still the law of the land and should continue to be enforced by states and the federal government. “The District Court’s ruling poses a dangerous threat to the healthcare of millions of Americans," Becerra said in a statement. "We’re asking the court to make clear that the ACA is still the law and ensure that all Americans can continue to access affordable healthcare under it."

Elizabeth Warren wants to turn the federal government into a generic drugmaker. Sen. Elizabeth Warren has a novel idea for lowering drug costs: Let the federal government manufacture cheaper generic versions of brand-name prescription treatments. Legislation introduced on Tuesday by the Massachusetts Democrat and expected 2020 presidential candidate would establish an office at the Department of Health and Human Services that is "charged with lowering prices, increasing competition, and addressing shortages in the market for prescription drugs," according to a fact sheet on the measure. The office would be permitted to acquire manufacturing rights for generic drugs under specific conditions, including if only a select few companies are currently making the treatment or there is a shortage. The federal government would then mass-produce the drug — or, perhaps more likely, contract the production out to an outside entity — and set what the bill refers to as a "fair price" for the treatment, taking into account the cost to create and the impact of the price on market competition.

Trump-Democrats funding battle sidelines GOP. Senate Republicans failed on Monday to find a solution to the looming government shutdown, in part because they aren't sure what President Trump might agree to in talks with Democrats. Republicans have effectively been frozen out of the talks and are in a wait-and-see mode as Trump and Democrats battle it out in public. Without a deal by Friday, federal workers across seven agencies would face furloughs after spending authorization expires. On Monday evening, the No. 3 Republican, Sen. John Thune, R-S.D., told reporters lawmakers may have to return Christmas week to deal with unfinished spending if a deal cannot be hashed out by week’s end. Sen. John Cornyn said a holiday session is possible but “highly improbable.”

FDA funding set to run out on Friday, causing partial shutdown. The Food and Drug Administration’s funding will run out at midnight on Friday if Congress does not fund the government. If this were to happen, about 40 percent of staff at the agency wouldn’t need to show up for work, and most activities that would cease include routine inspections of food and drug plans. Work on prescription drugs, generics, biosimilars, medical devices, animal drugs, and tobacco products would continue, according to outlined contingency plans. Agency workers also would address emergencies including drug shortages, and outbreaks related to food poisoning and infectious diseases. Employees who are considered “essential workers” are paid retroactively when the government reopens, and in the past Congress has passed bills to pay furloughed employees as well. The other agencies within the Department of Health and Human Services are funded already. Lawmakers are running out of time to make a decision. The House won’t return until Wednesday, and Trump is still fighting with Democrats over border security funding. Congress may consider a continuing resolution, or CR, that would extend through Dec. 26 or through Jan. 3.

FDA cheers sign of reduced antibiotics use in farm animals. The amount of antibiotics purchased to treat animals that are raised for the meat, dairy, and egg supply fell by 33 percent from 2016 to 2017, according to a report released Tuesday by the Food and Drug Administration. FDA Commissioner Scott Gottlieb said in a statement accompanying the report that the decline suggested efforts by the agency to reduce improper use of the drugs were paying off. To combat drug-resistant bacteria, the Trump administration has been pressing farm workers to get an order from veterinarians when they use antibiotics, and to only use them when they are needed to treat or prevent disease. The tendency at agricultural facilities has been to mix antibiotics into food and water routinely, as a way to help animals grow or make up for unsanitary or crowded conditions. The report is only able to calculate sales from drug manufacturers to farms, so the FDA is not able to report how many antibiotics were actually given to the animals. It's possible that farmers and veterinarians buy the drugs but don't end up giving all of them to the animals. Proponents of further reducing antibiotics in the meat, egg, and milk supply have urged Congress to beef up reporting requirements.

Surgeon general singles out Juul in e-cigarette warning. Surgeon General Jerome Adams took aim at the popular e-cigarette Juul on Tuesday, warning the public that vaping could lead to lifelong addiction, harm brain development, and damage the lungs. “We need to protect our kids from all tobacco products, including all shapes and sizes of e-cigarettes,” Adams said in an advisory. “Everyone can play an important role in protecting our nation’s young people from the risks of e-cigarettes.” Juul, which controls 70 percent of the vaping market, is shaped to look like a USB flash drive and has become popular among teens. Adams said a typical cartridge, known as a "pod," has roughly the same amount of nicotine as a pack of cigarettes. The advisory came on the heels of a survey on teen use issued Monday that suggested 1.3 million more teens had tried e-cigarettes in 2018 compared with 2017. “In the data sets we use, we have never seen use of any substance by America’s young people rise as rapidly as e-cigarette use is rising,” Health and Human Services Secretary Alex Azar said in a statement.

Lamar Alexander to leave Senate after 2020. Sen. Lamar Alexander, R-Tenn., announced Monday that he will not run for re-election to the Senate in 2020, foregoing a likely fourth term in office. Alexander is the chairman of the Health, Education, Labor, and Pensions Committee, leading policies on Obamacare, drug pricing, medical research, and other areas. In a statement, Alexander, 78, said it is time for "someone else" to be able to represent Tennessee in the Senate. Alexander added that he intends to serve the final two years of his term. “I will not be a candidate for re-election to the United States Senate in 2020," Alexander said in a statement. "The people of Tennessee have been very generous, electing me to serve more combined years as Governor and Senator than anyone else from our state." Along with his three terms in the Senate, Alexander also served as governor of Tennessee and as secretary of education under President George H.W. Bush's administration.

Trump signs maternal health bill. Trump on Monday signed the Improving Access to Maternity Care Act, a bill that will allow the government to collect information on areas with maternity health shortages and allow for more workers to be distributed to those areas.

Senate to vote on Trump-backed federal pot legalization, but passage unlikely. The Senate is expected to vote Tuesday on an amendment that would federally legalize marijuana by allowing states to regulate their own medical and recreational pot markets. But even one senator can block a vote on the amendment, which would address a longstanding conflict between federal and state law. Sen. Cory Gardner, D-Colo., is seeking to attach the measure to the First Step Act, a bundle of prison, prisoner re-entry, and sentencing reforms that senators voted 81-12 to advance Monday. "While we are debating criminal justice reform, we need to address the threat of prosecution by the federal government for people in Colorado that are operating legal businesses under state law," Gardner said in a statement. But process issues could prevent a vote on Gardner's amendment, a rework of his STATES Act that Trump endorsed in principle earlier this year. "It will take unanimous consent — not Leader consent — for a vote to occur on this amendment," said David Popp, a spokesman for Senate Majority Leader Mitch McConnell, R-Ky. It's unclear how much support the amendment has, but it's doubtful that it's unanimous.

Nearly 17,000 lose Medicaid because of Arkansas work rule. Nearly 17,000 people have lost Medicaid in Arkansas after they failed to meet the state's new work requirements. State data show that 4,655 people were dropped from Medicaid in November after they failed to report to the state whether they had worked or trained for work for at least 80 hours a month, for three months in a row. That brings the total number of people dropped from Medicaid to nearly 17,000 people because of rules that began in June, which imposed requirements to work, volunteer, or take classes as a condition of staying enrolled in the program. People on Medicaid in Arkansas have to log their hours online, and if they fail to do so, they are taken out of the program and are not allowed to re-enroll until the following year. Arkansas officials announced last week that on Dec. 19 they will start letting people on Medicaid report their work requirements by phone, saying they wanted to see more people participate in the program. The number of people who reported their hours in November was lower than the number of people who did not. The report from the state shows that in November, 1,428 people reported their hours and 8,426 people did not.

Colorado sees 5 percent boost in Obamacare enrollment. More than 156,000 Coloradans picked a health insurance plan by Dec. 15, a rate 5 percent ahead of signups one year ago, Connect for Health Colorado said Monday. People who signed up by the first deadline with have coverage Jan. 1 and the state’s final deadline is Jan. 15 for coverage that would begin Feb. 1. “As a state-based health insurance marketplace, we are able to adjust our operations to best meet the needs of the residents of our state,” Connect for Health Colorado CEO Kevin Patterson said in a statement. “This year, that has meant introducing a streamlined process for obtaining financial help, improving our online tool for choosing a health plan and extending the enrollment period beyond the holidays.”

RUNDOWN

The Hill Incoming Dem chairman vows hearings on ObamaCare lawsuit 'right away'

The Associated Press Health insurance on demand? Some are betting on it

Stateline Lone Medicaid expansion defeat offers lessons for other states

Bloomberg FDA hires health technology executive for senior role at agency
STAT Welcome to the Church of Safe Injection: Clean syringes are salvation and membership may help skirt the law

Kaiser Health News Healthcare is where the jobs are. But what kind of jobs?

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Calendar

TUESDAY | Dec. 18

Senate in session.

3 p.m. U.S. District Court of the District of Columbia. Hearing on CVS-Aetna deal.

WEDNESDAY | Dec. 19

House in session.

2 p.m. HVC-210. Senate Veterans Affairs Committee meeting on “Tracking Transformation: VA MISSION Act Implementation.” Details.

FRIDAY | Dec. 21

Midnight. Deadline to avoid partial government shutdown.

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