With help from Rachel Roubein, Renuka Rayasam and Alice Miranda Ollstein
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â€” A Senate working group is releasing legislation to deal with surprise medical bills that would encourage the use of arbitration to settle disputes.
â€” More lawsuits are expected in a generic drug-price fixing probe, Connecticut’s attorney general told POLITICO.
â€”Â Uwe Reinhardt’s final book was motivated by his desire to correct health care misinformation, the famed economist’s widow said on POLITICO’s “Pulse Check” podcast.
** A message from PhRMA: Some in Washington want to upend Medicare Part B, threatening access to medicines just to save the government money. They want the Administration to go around Congress to force these changes on seniors. Shouldnâ€™t the Administration be prioritizing what patients need? Basing prices on foreign governments is the wrong prescription for Medicare. **
THIS IS THURSDAY PULSE â€” Where your author is curious what New York City Mayor Bill de Blasio, who’s expected to announce his presidential campaign today, will pledge about health care in his early remarks. Health care for all, as he vowed in January? A push for better mental health care, a top priority for his wife? A cure for the ailing Knicks, who seem beyond recovery?
To quote Joe Biden, fixing the Knicks would truly be a BFD. Tips to firstname.lastname@example.org.
SENATE WORKING GROUP RELEASES SURPRISE MEDICAL BILL LEGISLATION â€” A new draft bill released this morning sets up a so-called â€śbaseball-styleâ€ť arbitration process for providers and plans as an option to settle payment disputes, POLITICO’s Rachel Roubein writes. Today’s draft comes after Sens. Bill Cassidy (R-La.), Michael Bennet (D-Colo.) and four others spent eight months refining legislation first introduced in September. More for Pros.
â€” Today’s legislation prohibits balance billing in three instances, Rachel writes. (1) For emergency care, (2) during elective care at an in-network facility but when a service is performed by an out-of-network provider and (3) when a patient needs additional medical care after an emergency at an out-of-network facility but canâ€™t travel elsewhere.
â€” The most contentious part of addressing surprise medical bills: the payment. Under the new bill, providers would automatically be paid the median in-network rate. But they can dispute that, initiating a so-called â€śbaseball-styleâ€ť arbitration process, where mediators will base decisions on â€ścommercially reasonable ratesâ€ť (the in-network rates for that area and not actual charges).
â€” But Congress may not go with an arbitration approach. House Energy and Commerce Committee leaders are seeking feedback on a different bipartisan discussion draft they released this week. Senior administration officials have called arbitration â€śdisruptive,â€ť and Senate HELP Committee Chairman Lamar Alexander (R-Tenn.) has concerns with that approach, a Senate GOP aide told POLITICO last week.
This all comes as President Donald Trump is exerting pressure on Congress to tackle the issue, and major health industry players are jockeying to ensure they donâ€™t pick up a bulk of the tab.
MORE LAWSUITS EXPECTED IN GENERIC DRUG PRICE FIXING PROBE â€” That’s what Connecticut Attorney General William Tong, who led last week’s multistate filing, told POLITICO on Wednesday.
The state attorneys general charged Teva, Mylan and 18 other generic drug manufacturers with engaging in a massive conspiracy, drawing on thousands of phone calls, emails, text exchanges and other communications about setting prices in tandem.
“What really broke the case wide open were the phone records,” Tong said, describing a flurry of calls and messages between different manufacturers each time a product price would be raised.
The unredacted Teva complaint could be unsealed within the next few weeks and will be “explosive,” he added. The companies are also accused on colluding on dividing up the market share for the medicines. More for Pros.
“PULSE CHECK”: UWE REINHARDT’s NEW BOOK AND LASTING LEGACY â€”Â The Princeton economist’s final book, “Priced Out,” was published this week after Reinhardt passed away in late 2017. The book’s title is a reference to a famous paper â€”Â “It’s the Prices, Stupid” â€”Â written by Reinhardt and colleagues, arguing that the U.S. health care cost-crisis could be explained by inflated prices set by hospitals, doctors and others.
… Tsung-Mei (May) Cheng â€”Â Reinhardt’s widow and frequent collaborator â€”Â joined POLITICO’s podcast to discuss her husband’s work and his thoughts on ideas like Medicare for All.
Cheng said that Reinhardt was inspired to write the book in 2017, during Republicans’ push to repeal the Affordable Care Act and amid rampant misinformation about health care. “Uwe, being a teacher at heart … he wanted to bring the facts, tell the truth about our health care system,” she said.
… On the podcast, Cheng said that she and her husband carried on a never-ending conversation about fixing health care’s many problems. “Breakfast, lunch, dinner… there’s so much to talk about,” Cheng said. “We both want health care for everyone.” Listen to the podcast.
FIRST IN PULSE: Home health workers sue over Trump rule on union dues. The lawsuit was filed in the Northern District of California by seven members of the Service Employees International Union and one member of the United Domestic Workers, POLITICO’s Alice Miranda Ollstein scoops. It seeks to stop a rule that would bar workers from paying union dues out of their paychecks.
The new lawsuit follows an earlier challenge filed by five Democratic attorneys general this week. If the rule isn’t blocked, it will take effect in July.
â€” What the workers argue: That the new federal rule violates their First Amendment right to free association as well as the Constitution’s Equal Protection Clause.
“This rule tries to prevent us from using payroll deduction for any purpose, even to contribute to our healthcare or for transportation costs or to support our union,” said plaintiff Camille Christian, a home care worker from Alameda, California. “How would you feel if the government told you how to spend your wages?”
House scheduled to vote on ACA outreach bill. H.R. 987 (116), introduced by Rep. Lisa Blunt Rochester (D-Del.), would reverse the Trump administration’s cuts to Obamacare marketing and navigators, among other provisions.
PHILLIP SWAGEL to be next CBO director. Swagel, a University of Maryland professor and former George W. Bush administration official, will start a 3.5-year term next month, Congressional Republicans announced. Swagel will replace Keith Hall, who’s been in the seat since 2015.
â€” Swagel on the Affordable Care Act in 2013. Writing in The New York Times, Swagel said he supported the law’s goals to expand coverage, boost quality and lower cost â€” especially because it was a “moral affront” that millions of Americans were uninsured or underinsured.
“But achieving [the goals] will require an honest assessment of both successes and problems, and a willingness to make adjustments going forward,” Swagel wrote, warning that the ACA could ultimately hurt the nation’s fiscal situation.
Altarum’s latest look at the health care economy. The institute is out with its monthly economic indicators, and here are two takeaways that grabbed your PULSE author:
â€” Health care prices continue to grow at “amazingly low” rates. Year-over-year health care price growth was 1.5 percent, lagging the Consumer Price Index (which grew 2.0 percent).
That’s been driven by low drug price growth, Altarum researchers found, and it’s a positive sign for efforts to bend the health care cost curve.
â€” 403,000 jobs. That’s how many health care jobs the private sector added in the last year, up 2.5 percent. Expect all those jobs â€” many at hospitals and physicians’ offices â€” to become a sticking point as Democrats push plans like “Medicare for All,” which could lead to industrywide pay cuts and possible layoffs.
Texas: Hemp bill one step away from governor’s desk. TX HB1325 (19R), which would create a state-regulated hemp industry, cleared the state Senate on Wednesday, POLITICO’s Renuka Rayasam reports. The bill would bring Texas in line with new federal farm bill legislation.
The Senate bill would allow farmers to grow hemp and for retailers to sell CBD oil as long as they contain less than 0.3 percent THC. Stores that want to sell products containing CBD would be required to get a permit and be subjected to random testing of their products. Law enforcement officials could also seize any crops or products that they believe are marijuana.
The state House already passed a separate version of the bill and the two chambers must hammer out the differences before it heads to Gov. Greg Abbottâ€™s desk.
de Beaumont Foundation recognizes “40 under 40” in public health. The members of the inaugural list include Jeffrey Howard, commissioner of Kentucky’s public health department; Carolyn Mullen, the government affairs chief at Association of State and Territorial Health Officials; and Lauren Powell, director of Virginia’s office of health equity.
Lorri Unumb has been named CEO of the Council of Autism Service Providers. She previously was VP of state government affairs at Autism Speaks.
By Dan Goldberg
The Washington Post reports that a federal judge on Wednesday temporarily blocked a new policy for distributing livers for transplant, after declining to intervene on Monday. More.
The Associated Press reports that the Utah prosecutor responsible for the county with the stateâ€™s only two abortion clinics said he wonâ€™t enforce the stateâ€™s new abortion law, which bans the procedure after 18 weeks. More.
Kaiser Health News explains why Walmart, a company that covers 1.1. million employees and their dependents, is encouraging workers to use one of 800 imaging centers that have been deemed to provide high-quality care. More.
** A message from PhRMA: The United States has the only health system in the world that relies on market competition, saving the government and seniors a total of $132 billion from 2005 to 2017 in Part B medicine spending. Thatâ€™s because Part Bâ€™s market-based reimbursement system, which was implemented in 2005, incorporates discounts, rebates and price concessions negotiated across the U.S. market, providing millions of seniors with access to medicines that are used to treat some of the most complex diseases like cancer and autoimmune conditions. Some in Washington want to end this and instead set payment based on the prices mandated by foreign governments that seriously restrict patient access to medicines. Why would we take that risk here in the United States? Any changes to Medicare should help patients, not hurt them. Limiting seniorsâ€™ access to lifesaving treatments based on the choices of foreign countries is the wrong prescription for Medicare. Learn more. **