Overnight Health Care — Presented by That’s Medicaid — Deal on surprise medical bills faces obstacles | House GOP unveils rival drug pricing measure ahead of Pelosi vote | Justices to hear case over billions in ObamaCare payments

Welcome to Monday’s Overnight Health Care.

Key lawmakers said they have an agreement on solving surprise medical bills, but it’s no sure thing. The Supreme Court is letting Kentucky’s ultrasound abortion law stand, House Republicans have an alternative drug pricing bill, and the fight against vaping is going local.

We’ll start with surprise billing…

 

Deal on surprise medical bills faces tough path ahead

Lawmakers are touting a bipartisan deal on protecting patients from surprise medical bills, but the effort still faces some tough questions before it can reach President Trump’s desk. 

While the deal, announced Sunday, was a boost to efforts to address the complicated issue, supporters still face opposition from powerful industry groups and need to secure the backing of congressional leaders, who have yet to sign on.

And the clock is ticking. Backers of the deal between House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.), Rep. Greg Walden (R-Ore.), and Senate Health Committee Chairman Lamar Alexander (R-Tenn.), are trying to include the measure in a year-end government funding package, which must pass before a Dec. 20 deadline. 

The American Hospital Association, an influential group in Washington, is also opposed, worried the measure would result in damaging cuts to payments to hospitals. Doctors and hospitals have been lobbying hard on the measure and that work is likely to ramp up as the year draws to a close. 

Key question marks: Sen. Patty Murray (D-Wash.) and Senate Minority Leader Charles Schumer (D-N.Y.). 

Murray is the top Democrat on the Senate health committee. From a Murray spokesperson: “Senator Murray is working through members’ concerns and is very hopeful a final agreement can be reached that’s consistent with the goal she’s had throughout this process: ending surprise billing in a way that doesn’t shift costs back onto patients in other ways.” 

Schumer is facing pressure from a major hospital group in his state. From a Schumer spokesperson: “Senator Schumer absolutely believes patients should be protected from surprise medical billing. This is one piece of many health care related proposals that are being considered by various committees in both chambers of Congress. Senator Schumer believes you’ve got to look at all of them together as a whole to get the best deal for working Americans.”

Read more here.  

 

House GOP unveils alternative drug pricing measure ahead of Pelosi vote

There’s a big vote on the Democratic drug pricing bill this week, but Republicans are putting forward their own alternative.  

Republicans said they designed their measure to include only policies that both parties can agree to, saying Congress could pass their bipartisan bill rather than the Democratic legislation, which is expected to pass on a largely party-line vote. 

The Republican legislation is significantly smaller-scale than the Democratic bill. It does not include anything that Republicans deem “price controls” for drugs, which the GOP argues would hinder the development of new treatments. 

The Democratic bill, in contrast, would limit drug prices based on the prices paid in other countries and allow for the government to negotiate lower prices, both ideas opposed by House Republicans. 

Key provisions: Capping out-of-pocket drug costs for seniors on Medicare, cracking down on tactics drug companies use to delay competition from cheaper generic drugs and requiring drug companies to submit justifications to the government for large price hikes. 

While the pharmaceutical industry is far more opposed to the Democratic bill, there are some provisions in the Republican bill that the industry opposes as well, such as a provision requiring drug prices to be listed in TV advertisements for drugs. 

Read more here. 

 

Dem lawmaker calls for Seema Verma’s resignation

Rep. Joe Kennedy (D-Mass.) on Monday appeared to be the first lawmaker to call for the resignation of Centers for Medicare and Medicaid Services Administrator Seema Verma. 

Verma, who is reportedly feuding with Health and Human Service Secretary Alex Azar, has come under fire after a report by Politico found she was seeking tens of thousands in taxpayer dollars to reimburse her for the cost of stolen jewelry and other items. She is also facing lawmaker criticisms for spending more than $2 million on public relations consultants, some of which worked to boost her own personal brand. 

“While spearheading efforts to take health care away from low-income Americans, Administrator Seema Verma has shown a troubling willingness to disregard concerns about taxpayer funding when it comes to her own personal profile,” Kennedy said in a statement to The Hill. “Whether paying millions to political consultants for flattering profiles or asking taxpayers for a bailout for stolen goods she chose not to insure, she has proven unwilling to place the interests of the American people above her own. She must resign immediately.” 

Kennedy, who is running to unseat incumbent Democratic Sen. Edward Markey (Mass.), has been a vocal critic of Verma’s. During a hearing earlier this year, Kennedy pressed Verma to try to defend her commitment to Medicaid work requirements. During the same hearing, he also questioned Verma about her use of PR contractors. 

 

Supreme Court declines to hear appeal of Kentucky ultrasound law

The Supreme Court on Monday left in place a Kentucky law that obligates doctors to show and describe ultrasounds to women who seek abortions, even if patients object.

A federal appeals court upheld the law against a First Amendment challenge from the American Civil Liberties Union (ACLU) that claimed the measure abridged doctors’ freedom of speech. The Supreme Court declined to hear an appeal. The ACLU argued the law interfered with the doctor-patient relationship, and was meant to coerce women into opting out of having an abortion. 

The decision not to hear the appeal was made without comment. 

The law requires physicians, prior to an abortion, to perform an ultrasound, describe and display its images to the patient, and make the fetal heartbeat audible. It was passed in 2017, and signed by Gov. Matt Bevin (R), an ardent opponent of abortion who lost his bid for re-election last month.

More on the decision here.

 

Justices to hear ObamaCare case with billions at stake

ObamaCare is back at the Supreme Court on Tuesday. This time, the arguments center on $12 billion dispute over payments insurers say they are owed by the federal government.

The case has mostly flown under the public’s radar, as the lawsuit is not a partisan attack on the law, and future of the law does not ride on the outcome. 

The case still has high stakes for insurers and for the Trump administration, which could find itself in the awkward position of having to pay out billions even as it fights to end the law.

At issue is a temporary financial carrot that Congress dangled before insurers to encourage their participation in the early years of the Affordable Care Act’s (ACA) health care marketplaces. The funding program in question, known as risk corridors, sought to mitigate risk by protecting insurers against unforeseeable losses in the new markets.

The Republican-controlled Congress in late 2014 stripped most of the money as part of a government funding bill, and legal challenges soon followed. Led by Sen. Marco Rubio (R-Fla.), Republicans called the program a slush fund, and a “taxpayer-funded bailout” of insurers. 

Court watchers were somewhat surprised that the case was taken up; the government has had mixed success among the lower courts. 

Read more on the case here.

 

Fight against flavored e-cigarettes goes local 

State and local governments are moving to ban flavored e-cigarette products in response to the Trump administration’s lack of action on rising youth vaping rates. 

The bans are being pushed by influential anti-tobacco advocates and public health groups, who argue flavors like mint and fruit have helped create a youth vaping epidemic. 

While Massachusetts recently became the first state to ban all flavored tobacco products, more states could follow in 2020 when legislatures reconvene.

“I think we will see an unprecedented level of action in the state legislatures,” said Matt Myers, president of the Campaign for Tobacco-Free Kids, one of the groups lobbying for flavor bans. 

“As Washington capitulates to the [tobacco] industry, more and more states are deciding they can’t wait and they need to act.” 

Why it matters: Public health advocates note that they have greater success at the state and local level. Myers said he expects debates in eight to 12 state legislatures next year, including in Hawaii, Illinois, California, Minnesota and Delaware.

More than 230 municipalities have already passed laws restricting flavored tobacco sales — and more are likely to do so in 2020.

But they’ll face strong opposition from the tobacco industry, which is lobbying against flavor bans at the federal, state and local level. 

“We think [the U.S. Food and Drug Administration] is in the best position to determine restrictions of e-vapor flavors and agree that action by FDA is needed,” an Altria spokesman said to The Hill.  “We also think raising the legal age of purchase to 21 is an important step and support state legislation and bipartisan legislation in Congress that does that.”

Read more here.

 

Speaking of e-cigarettes… Surprise billing compromise includes tobacco 21 provision 

The bipartisan, bicameral proposal on surprise medical bills would also raise the minimum age of sale of tobacco products from 18 to 21, similar to the measure introduced earlier this year by Senate Majority Leader Mitch McConnell (R-Ky.) and Sen. Tim Kaine (D-Va.).

The bill would also require age verification for purchase and delivery of e-cigarette products purchased online, mirroring a bill by Rep. Rosa DeLauro (D-Conn.) that was passed by the House in October.

Fines would also be increased for those who sell tobacco products to people under the age of 21.

It also requires the FDA issue regulations requiring labels on e-cigarette products stating that they contain nicotine.

But: Anti-tobacco advocates, who have long supported increasing the purchasing age to 21, argue that measure alone is not enough to curb youth vaping rates. 

“To reverse this epidemic, Congress needs to take strong action and not be limited by what the tobacco industry says is acceptable,” said Matt Myers, president of the Campaign for Tobacco-Free Kids. 

“While raising the tobacco age to 21 would be a positive step, it is not a substitute for prohibiting the flavored e-cigarettes that are luring and addicting our kids.” 

A bill sponsored by Energy & Commerce Chairman Frank Pallone (D-N.J.) and Rep. Donna Shalala (D-Fla.), which is favored by public health groups because it would ban flavored tobacco products, will not get a vote until next year given this month’s crowded legislative calendar. 

 

Coming up tomorrow: the Medicare for All, et. al. hearing in the House 

Medicare for All supports will score a big win tomorrow when the House Energy and Commerce Committee — which has primary jurisdiction over health care — holds a hearing on the proposal from Rep. Pramila Jayapal (D-Wash.) and Sen. Bernie Sanders (I-Vt.).

But the spotlight won’t just be on the single-payer health care proposal. The committee will also hear from witnesses, mostly lawmakers, about eight other bills that aim to achieve “universal” coverage. 

The hearing will be divided into two panels, with five lawmakers testifying in the first and five experts and activists testifying in the second. 

Progressives were ecstatic Monday when it was announced that the president of National Nurses United (NNU) — a nurses union that supports Medicare for All — will testify. 

“In my professional judgment as a nurse, the only way nurses can put our patients first–as we are ethically and morally bound to do–and the only way we can truly heal America is through Medicare for All,” NNU President Jean Ross will say, according to her prepared testimony. 

 

What we’re reading

Bad Medicine: critics say powerful pediatrician too quick to diagnose child abuse, traumatizing families. (Gatehouse News)

Facebook ads push misinformation about HIV prevention drugs, LGBT activists say, ‘harming public health’ (The Washington Post)

J&J CEO Gorsky spurns U.S. congressional hearing on carcinogens in talc products (Reuters)

Who gets hit with surprise hospital bills (Axios)

 

State by state

Hospital chain pledges to cut opioid prescriptions 40 percent by 2018 in face of painkiller epidemic (CNBC)

Lawmakers rip last-minute, $8 billion Medicaid contract awarded by Bevin administration (Courier Journal)

Medicaid changes hit mental health services in state; payment cuts cited as providers shut (Arkansas Democrat Gazette)