Health Policy Updates: July 29 2017

As of Tuesday, the Senate voted to open debate on a bill which, 24 hours prior, its members did not know the contents of.

“…there are at least four different draft health care bills floating around right now…The lack of clarity is part of a larger lack of direction for Senate Republicans’ six-month health care effort…Throughout this process, Republicans have struggled to articulate what exactly they want to achieve — aside from delivering on a seven-year campaign promise to repeal and replace Obamacare.”

Votes on the BCRA and then “full” Obamacare repeal followed shortly thereafter, and were both defeated by slim margins. Attention then turned to the so-called “skinny repeal,” which would leave the ACA/Obamacare’s Medicaid expansion intact and get rid of only the individual and employer mandates to have health insurance. Finally, even skinny repeal went down in a vote early Friday morning, with John McCain breaking party ranks (and joining Sens. Collins and Murkowski) to become the decisive “no” vote, in a dramatic fashion on the Senate floor – video here.

It remains to be seen whether the ACA repeal effort is truly dead this time, or will continue to rise from its own ashes.

To try to turn away from the media circus surrounding the Congressional circus, the world of actual health policy research has continued to move forward.

In Health Affairs recently, a recent paper showing that the ACA has resulted in reduced socioeconomic disparities in health care access. This makes sense, if you think about the architecture of the bill in both expanding Medicaid and targeting subsidies to lower-SES groups.

“Health care access for people in lower socioeconomic strata improved in both states that did expand eligibility for Medicaid under the ACA and states that did not. However, gains were larger in expansion states.”

Also in Health Affairs, a brief on the “pay for delay” tactics used by pharmaceutical companies to avoid having to compete with lower-cost generic drugs.

In some cases, the innovator (brand-name) company can settle patent litigation with a single generic drug firm by negotiating a payment to the challenger in exchange for agreement on a set, future date for generic entry–and, in the process, blocking all other generic launches of the same drug.

Interesting thought piece on how to improve the effectiveness of new cancer drugs.

Several prominent voices have called on the field to “raise the bar” and aim higher in research efforts, to measurably and meaningfully lengthen and improve patients’ lives. The American Society of Clinical Oncology (ASCO), for example, has defined minimum thresholds for “clinically meaningful outcomes,” such as three-months additional survival for patients diagnosed with advanced non-small-cell lung cancer. The crucial question, though, is how to achieve these gains.”

In my view, however, the author omits two critical steps: requiring that clinical trials rely on “hard” outcomes such as overall survival rather than surrogate endpoints, and broadening eligibility criteria to include “real world” patients rather than only the healthiest.

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