The ACA

The New York Times [06-11-17, Reed Abelson] reports how repeal of the ACA would negatively impact a particular group that benefited from the ACA—those between jobs, or who for whatever reason lose their employer-provided coverage.  As the Times notes, the ACA gave many individuals greater flexibility by allowing them to purchase subsidized health insurance plans when out of work; under the House GOP plan, however, these plans may be risk-rated based on pre-existing conditions, and might be prohibitively expensive.

The Washington Post [06-12-17, Amy Goldstein] reports how Iowa is seeking to radically restructure its ACA marketplace in the face of the possible departure of all insurers from the state.  The Post states that the proposed plan would involve the abolition of Iowa’s marketplace, and would allow individuals to use subsidies to buy plans off the exchanges. It notes that the legality of this change outside the context of a 1332 waiver is unclear.

USA Today [06-12-17, Eliza Collins] describes how the drafting process of the Senate’s Obamacare repeal bill is cloaked in secrecy, with rank-and-file Republicans unaware of its contents.  The bill, USA Today notes, will be handed over to the Congressional Budget Office for scoring before it is made publicly available; it may include a somewhat slower phase-out of the Medicaid expansion as compared to the House bill.

Axios [06-12-17, Caitlin Owens] reports that the Senate Republicans are not planning to make a draft of their healthcare bill publicly available.  “We aren’t stupid,” a senior Senate Republican aide told Axios.  The outlet notes that the bill will be sent to the CBO, with a possible vote prior to the July 4 recess.

 Vox [06-14-17, Jeff Stein] reports on the left-wing groups leading the resistance to the Senate GOP’s healthcare law.  The article describes how town hall protests and a barrage of phone calls to lawmakers may have helped derail the House GOP’s initial attempt to pass the American Health Care Act in March.  It also notes a split between Democratic Senators and activist groups on a tactical issue. By withholding “consent,” activists contend that Senate Democrats could stop all Senate business and slow down passage of the law, buying more time to defeat it; some Senators, however, argue that this would have no sustained beneficial impact.

Medicaid

The Wall Street Journal [06-11-17, Arian Campo-Flores] describes how Kentucky—a state that had especially benefited from the Affordable Care Act, in particular through a robust Medicaid expansion—is looking to now retreat from those reforms.  As the Journal notes, Governor Matt Bevin is seeking a waiver from the Centers for Medicare and Medicaid Services that would allow—among other things—the state to require premiums from Medicaid participants, one of a number of changes that are expected to substantially shrink the program (head of CMS Seema Verma helped design this proposal, and has recused herself from the decision on its approval).

Modern Healthcare [06-12-17, Virgil Dickson] describes how Indiana’s approach to adding a work requirement for Medicaid participants—a change also being pursued by Maine, Kentucky, Arizona, and other states—may have skirted legal requirements for public comment.  Indiana’s Medicaid expansion, dubbed HIP 2.0, was designed by now CMS head Seema Verma, and represented a major departure from traditional Medicaid, requiring premiums from participants and kicking some out of the program for failure to pay.

Pharma

The New York Times [06-11-17, Abby Goodnough and Kate Zernike] reports how the maker of a  long-acting injectable opioid antagonist (trade name Vivitrol) has aggressively marketed its product as superior to less expensive agents that are used to treat those with opioid dependence—suboxone and methadone—without evidence to back up these claims. The Times note that the maker of the drug has put money into influencing legislators, policy makers, and judges to expand its use in supervised drug treatment programs, where it may be the only allowed option.

Bloomberg [06-12-17, Suzanne Woolley] reports that high healthcare costs are translating into booming business for crowdfunding platforms like GoFundMe, which may stand to benefit from a Republican Obamacare repeal that increases the number of uninsured. It notes that for one crowdfunding company, some 70% of campaigns were for healthcare fundraising.

Kaiser Health News [06-16-17, Emily Kopp] described how President Donald Trump’s “Drug Pricing and Innovation Working Group” has been heavily influenced by individuals and ideas straight from the pharmaceutical industry (the group is led by a former lobbyist for drug giant Gilead, for instance).  KHN obtained documents that demonstrate that the group has been focusing on a number of “principles” that would be highly favorable to industry and would be unlikely to do much about drug costs, including stricter enforcement of drug patents overseas, lower standards of evidence in clinical trials, reducing drug discounts for safety-net hospitals, and allowing drug companies to give information on off-label use of drugs to insurers before drugs are approved by the FDA.