Overnight Health Care: CEO of insurer lobby group stepping down | SEC charges Theranos founder with ‘massive fraud’ | Abortion fight holds up health deal

CEO of lobby group for insurers stepping down

Marilyn Tavenner is stepping down as head of the powerful insurance lobby America’s Health Insurance Plans (AHIP) after three years at the helm.

She will be replaced by Matt Eyles, the group’s chief operating officer. Her resignation will be effective June 1.

Eyles said in an interview Wednesday that Tavenner was “certainly the right leader at the right time and has helped improve the association.”

He said Tavenner made a “personal decision to step down at this time,” but expected an “orderly transition.”

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Tavenner was a former top official in the Obama administration who oversaw the passage and implementation of ObamaCare. She took over AHIP just as Republicans swept into power in both the House and Senate with a mandate to dismantle the law.

The group had suffered from some diminished resources, but Tavenner helped make it profitable. The organization turned a $1.2 million profit in 2016, compared to a $2.3 million loss in 2015.

AHIP counts large commercial insurers like Anthem and Cigna among its members, and the group gained 12 new members this year.

But Tavenner’s time at the organization has been turbulent, with President Trump’s unexpected victory plunging the industry into bitter fights to try and protect the law.

In addition, three of the country’s five largest insurance companies have left the group.

Asked about the high-profile departures of large insurers Humana, Aetna, and United Healthcare, Eyles indicated AHIP would work to bring them back.

“We want to represent everyone,” he said.

The insurance industry at large has had mixed results under the Trump administration.

Read more here.

 

SEC charges Theranos founder with ‘massive fraud’

Elizabeth Holmes, founder and CEO of the embattled blood-testing startup company Theranos, has been charged with “massive fraud,” the Securities and Exchange Commission announced Wednesday.

The SEC alleged that Holmes and the company’s former president, Ramesh “Sunny” Balwani, raised more than $700 million from investors through an “elaborate, years-long fraud in which they exaggerated or made false statements about the company’s technology, business, and financial performance.”

The agency said Theranos and Holmes have agreed to settle the fraud charges. Holmes will pay a $500,000 penalty, relinquish control of the company and be barred from serving as an officer or director of any public company for 10 years.

Theranos burst onto the scene by promising to revolutionize the blood testing industry. According to charging documents, “investors believed … that Theranos had successfully developed a proprietary analyzer that could conduct the full range of laboratory testing from a small sample of blood.”

But the reputation of the company and its CEO came crashing down after a series of Wall Street Journal reports in 2015 that Theranos may have significantly oversold its claims and failed to deliver on its promises.

In April 2016, federal investigators launched an investigation into Theranos. By July, Holmes had been banned from blood-testing for two years.

“They deceived investors by, among other things, making false and misleading statements to the media, hosting misleading technology demonstrations, and overstating the extent of Theranos’ relationships with commercial partners and government entities, to whom they had also made misrepresentations,” the SEC charged.

Read more here.

And click here to read the SEC complaint.

 

Abortion fight holds up health deal

A contentious dispute over abortion is standing in the way of a rare bipartisan deal to stabilize ObamaCare.

Republicans are insisting that a rule known as the Hyde Amendment, which restricts federal money from being used to fund abortion, be applied to new funds aimed at lowering ObamaCare premiums.

Democrats are pushing back, arguing this would represent an expansion of the Hyde Amendment to a new area of funding, preventing the government from offering money to any insurance plan that offered abortion coverage at all.

“Make no mistake: Republicans are saying they will only agree to lower Americans’ health costs if they can strip comprehensive health coverage away from millions of women at the same time,” Henry Connelly, a spokesman for House Democratic Leader Nancy Pelosi (Calif.), said in a statement Tuesday. “Republicans are not asking to reiterate Hyde, they are trying to radically expand it to control how private insurers use private dollars.”

Republicans are holding firm, saying that the new funds being provided to insurers, known as cost-sharing reductions (CSRs) and reinsurance, must be covered by the Hyde Amendment.

“While the decision for its inclusion has not been made, any appropriation for CSRs or reinsurance would need to be Hyde compliant,” AshLee Strong, a spokeswoman for Speaker Paul Ryan (R-Wis.), said last week. “That is not negotiable for House Republicans.”

Lawmakers are running out of time to reach a deal. Supporters of the ObamaCare payments want language attached to an omnibus funding bill. Congress faces a March 23 deadline to pass that bill.

Read more here.

 

House panel to examine 25 opioid bills next week

The House Energy and Commerce Committee plans to consider 25 bills aimed at combating the opioid crisis during a two-day legislative hearing next week.

The panel is working to hammer out a series of bipartisan bills with the goal of getting legislation to the House floor by Memorial Day.

The hearing next week focuses on an array of public health and prevention measures aimed at stemming an opioid crisis that shows no signs of abating.

Some of the bills focus on the Food and Drug Administration (FDA), such as one directing the agency to provide clearer data collection guidelines to help claims for products that could be used in place of an opioid.

Another would clarify the FDA’s authority to take into account misuse or abuse when approving an opioid.

On a call with reporters, a committee aide said FDA Commissioner Scott Gottlieb has been “highly engaged” in the process and met with panel Chairman Greg Walden (R-Ore.) and Health Subcommittee Chairman Michael Burgess (R-Texas).

Read more here.  

 

Exit poll shows health care a top issue in Pa. special election
The majority of voters in Tuesday’s special election in Pennsylvania considered health care to be an important issue in deciding who to vote for, according to an exit poll released Wednesday.

For 52 percent of voters, health care was ranked as a top issue when deciding who to vote for, while 19 percent said it wasn’t at all important to them, according to Public Policy Polling, a Democratic polling firm.

Voters who said health care was the most important issue to them favored Democrat Connor Lamb over his opponent Republican Rick Saccone 64-36 percent, according to the poll.

More voters also said Lamb was “more in step” with their views on health care than Saccone, 45 – 38 percent.

Read more here.

 

FDA chief becomes point man on drug prices

Scott Gottlieb, head of the Food and Drug Administration (FDA), has emerged as a key figure in the Trump administration’s push to lower the cost of prescription drugs.

Gottlieb has moved to the front lines of the drug pricing fight, criticizing brand-name drug manufacturers he says are trying to block competition from getting to market.

“We know that gaming goes on all the time,” Gottlieb told The Hill in a wide-ranging phone interview. “If [companies] have an opportunity to use the existing rules in ways to impede the public health goals we seek, we see them doing it. I don’t think that’s very public-health-minded. I think it’s corrosive to the overall system.”

President Trump has pledged to take action to lower drug costs. During his State of the Union speech, he said one of his top priorities is “fixing the injustice of high drug prices.”

Now in office, Trump has delegated most of the drug pricing efforts to Gottlieb’s FDA — and in a departure from traditional agency practice, the commissioner is tackling the issue head-on.

Read more here.

 

State by state

D.C. Council approves subpoenas for public hospital’s former consultants (The Washington Post)

Conor Lamb decisively won the health care vote in Pennsylvania (Vox)

California’s tax on millionaires yields big benefits for people with mental illness, study finds (Kaiser Health News) 

 

What we’re reading

Former Rep. Henry Waxman says lawmakers ‘derelict’ if they don’t address drug prices (Stat)

The CDC says its missing researcher wasn’t denied a promotion. Police say otherwise. (The Washington Post)

Opioid maker funds efforts to fight addiction: Is it ‘blood money’ or charity? (Kaiser Health News)