Welcome to Wednesday’s edition of Overnight Health Care. President Trump was driving much of the health care conversation today, but for once it was not because of a tweet.
In Congress, Democrats gave a glimpse of what the next term will be like if they win control of at least one chamber, and the Justice Department gave the green light to a health care mega-merger.
But tonight, we’ll start in Florida.
HHS declares public emergency for Florida
We hope readers in the Florida panhandle are staying safe from the effects of Hurricane Michael. The Department of Health and Human Services has declared a public health emergency, giving beneficiaries, providers and suppliers greater flexibility in meeting emergency health needs.
HHS said it has positioned about 125 personnel from the National Disaster Medical System, an incident management team and medical equipment to respond quickly to community medical needs, with another 100 or so ready to assist after the storm if needed.
Senate defeats measure to overturn Trump’s expansion of short-term health plans
The Senate narrowly defeated the Democratic measure, as expected, but Democrats were still able to use the vote to put the issue of pre-existing conditions front and center ahead of next month’s election.
The politics: Democrats said Republicans voting to keep in place these “junk” insurance plans that do not have to cover pre-existing conditions was another example they can use to paint the GOP as wrong on health care. Democrats have made pre-existing conditions the centerpiece of the campaign.
Republican pushback: Sen. Lamar Alexander (R-Tenn.) went to the Senate floor Wednesday to forcefully push back, saying Republicans just want to expand choices.
Alexander said the message is “you can pay less with less coverage and at least you will have some insurance.”
“But our Democratic friends will say, ‘Oh no, we don’t want to do anything that will lower the cost of insurance,'” Alexander added.
A taste of how it’s playing out in campaigns: Rep. Jacky Rosen (D-Nev.), running against Sen. Dean Heller (R-Nev.), was quick out of the gate with a statement attacking Heller for his vote. “Heller Casts Deciding Vote to Continue Trump’s Expansion of Junk Health Insurance Plans That Attack Pre-Existing Conditions Protections,” her press release read.
Department of Justice approves Aetna-CVS merger
The Department of Justice (DOJ) on Wednesday approved the $69 billion proposed merger between health insurer Aetna and CVS Health.
The DOJ said its approval is contingent on Aetna selling its Medicare Part D prescription drug business.
Aetna said it reached an agreement last week to sell the plan to WellCare Health Plans.
That sale, once finalized, would “fully resolve the Department’s competition concerns,” the DOJ said.
“Today’s settlement resolves competition concerns posed by this transaction and preserves competition in the sale of Medicare Part D prescription drug plans for individuals,” said Assistant Attorney General Makan Delrahim of the Justice Department’s Antitrust Division.
Why it matters: The merger means that there will no longer be any independent pharmacy benefit managers in the U.S.
These drug-pricing middlemen negotiate prices between drug companies and insurers.
Pharmacy benefit managers have been absorbed by insurers in recent years. The Justice Department last month also approved a merger between Cigna and Express Scripts, a pharmacy benefit manager.
Juul boosts lobbying amid FDA scrutiny
E-cigarette maker Juul is ramping up its Washington lobbying operation as it tries to head off potential regulatory threats from the Trump administration and Congress.
The company has been under scrutiny from Food and Drug Administration (FDA) regulators and lawmakers from both parties amid a massive surge in popularity for its products among teens.
FDA Commissioner Scott Gottlieb in recent months announced a major crackdown on e-cigarette sales to minors, accusing manufacturers and retailers of contributing to an “epidemic” of use among kids and teenagers.
In late September, the FDA conducted a surprise inspection of Juul’s corporate headquarters and collected more than a thousand pages of documents.
What can FDA do? The agency has pretty broad authority. Gottlieb is weighing a possible ban on flavored e-liquids if five of the largest manufacturers can’t come up with adequate plans to help keep e-cigarettes out of the hands of those under the age of 18. He could also further restrict the sales of the devices themselves. Anyone under age 18 is banned from purchasing an e-cigarette, but that hasn’t stopped the proliferation of teen users.
What is Juul doing? The company opened a Washington, D.C. office in February. Since then, they’ve been hiring several well-connected former administration officials from both parties to lead both the compliance and in-house lobbying teams. They’ve also cranked up the spending: According to lobbying records, the company has hired three lobbying firms and spent $330,000 so far in 2018, compared to $120,000 on two firms in 2017.
Read more on their efforts here.
Trump signs bills banning gag clauses in drug pricing
President Trump on Wednesday signed two bills banning “gag clauses” that keep patients in the dark about how to save money on prescription drugs.
The clauses are sometimes included in the contracts insurers have with pharmacies — preventing pharmacies from telling customers they can save money on a drug if they pay with cash instead of using their health insurance.
“This is very strong legislation to end these unjust gag clauses once and for all,” Trump said during a signing ceremony at the White House.
Context: The bills are bipartisan, and were a part of Trump’s blueprint to lower drug pricing. Trump said he thinks drug-pricing reform might actually be an issue Democrats and Republicans can work on.
“If there’s anything bipartisan, it’s lowering drug prices,” he said.
But it’s a relatively small bill in the grand scheme of things. It will help consumers make better financial decisions when purchasing prescription drugs. But the bill doesn’t do anything to actually lower the cost of drugs.
Trump’s op-ed on Medicare for all gets strong blowback
President Trump attacked “Medicare for all” in a new USA Today op-ed.
“In practice, the Democratic Party’s so-called Medicare for all would really be Medicare for None,” Trump writes. “Under the Democrats’ plan, today’s Medicare would be forced to die.”
The op-ed drew a swift rebuttal from supporters of Medicare for all who noted that far from proposing to end traditional Medicare, they actually want to add extra benefits to it.
From Sen. Bernie Sanders (I-Vt.): “Bottom line is he’s trying to frighten seniors and suggest that Medicare for all would cut back the benefits they have. The truth is it would expand the benefits that they have.”
From Senate Democratic Leader Charles Schumer (N.Y.): “The American people deserve better than smears and sabotage,” Schumer said in a statement. “All of the false and misleading words in the world can’t cover up the truth: President Trump and Republicans in Congress are forcing millions of Americans to pay more for health insurance and trying to rip away protections for people with pre-existing conditions.”
The claims Trump made were also widely debunked by various fact-checkers, including Politifact, and the Washington Post, which found that “almost every sentence contained a misleading statement or a falsehood.”
The implications: Trump is far from the first Republican to attack “Medicare for all.” He’s not even the first this week. House Speaker Paul Ryan (R-Wis.) took that honor on Monday. But by arguing that Democrats want to end traditional Medicare as we know it, Trump and the Republicans are trying to flip the script on Democrats. Instead of running on traditional GOP fiscal austerity like entitlement reform and cuts to Medicare spending, Republicans are signaling a new message; they will protect Medicare, Democrats will end it.
Read more on the Trump op-ed here, and the responses from Schumer here and Sanders here.
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Comments open for public charge rule
The Department of Homeland Security officially published its new “public charge” proposal Wednesday, opening up a 60-day public comment period. Expect public health groups and doctors to weigh in and push back on the proposal.
In fact, doctor and hospital groups like the American Medical Association and American Hospital Association have already issued statements urging the administration to rescind the proposal.
The proposed rule would allow immigration officials to refuse admission and deny extensions to those who might become “public charges.” The list of benefits that would be considered include Medicaid, the Medicare Part D Low-Income Subsidy Program, the Supplemental Nutrition Assistance Program (SNAP) and several housing programs.
The fear among advocates is that immigrants will be too afraid to use the services necessary to keep them healthy. If patients don’t get treated, it can exacerbate medical conditions, leading to them being sicker and a higher reliance on hospital emergency departments.
What we’re reading
AP fact Cceck: Trump’s dark portrait of Dem health plans (Associated Press)
With Kavanaugh confirmed, both sides of abortion debate gear up for battle (NPR)
Centene expands offerings in health insurance marketplaces (The Wall Street Journal)
State by state
Illinois ObamaCare exchange rates to decrease next year for many popular plans (Chicago Tribune)
Poll: Ohioans of all political stripes like Medicaid, by large majorities (Cincinnati Enquirer)
Massachusetts officials set new conditions on Beth Israel-Lahey merger (Boston Globe)
From The Hill’s opinion page
World Mental Health Day — let’s remember our veterans
Cure for cancer would become more likely if FDA streamlined the drug approval process