Health Policy Updates: September 30 2017

Another frantic news week in health care policy, with the demise of both the Graham-Cassidy Obamacare repeal bill, and of Tom Price’s tenure as HHS secretary.

With passage of Graham-Cassidy looking doubtful, a revised draft of the bill was crafted over last the weekend. This version not-so-subtly moved additional funds to those states with “hold out” GOP senators; this move suggesting something of a vote-buying effort:

“The favoring of certain states over others in the new version of the bill, presumably to please Senators representing the favored states and obtain their votes, raises serious constitutional issues. Law Professor Brian Galle has argued that it would violate the Constitution’s Uniformity Clause, which prohibits laws specifically favoring particular states.”

The overall structure of the bill, including steep Medicaid cuts and a return of pre-existing condition exclusion, remained intact:

“Like the earlier version, the latest draft allows states that obtain block grants to waive certain consumer protections contained in the ACA…As with the earlier draft, however, the consumer protections that the bill does allow states to permit insurers to waive makes protection for people with preexisting conditions very tenuous.”

After an insurmountable number of GOP senators expressed their intent to vote against the bill (including Collins, McCain, and Paul), the Graham-Cassidy bill was effectively dead by mid-week.

The white house is already falling back on its quick-and-easy fix for all problems in US health care: allowing states to sell insurance across state lines.

“Experts said it’s not clear what an executive order on selling insurance plans across state lines would do. Under ObamaCare, states are already allowed to let insurers sell plans outside their borders. No states have chosen to do so.”  

The Atlantic takes a look back on the short, unhappy career of Tom Price as HHS Secretary:

“Price’s departure caps a stormy and unusually short tenure. A physician from Georgia who previously served in Congress, Price was subject to withering attacks during his confirmation hearings from Democrats, who said that his trading of health-care stocks that were affected by his work in Congress was dubious at best and insider trading at worst. Once confirmed in February, he found himself in the midst of the frantic, shambling effort to repeal the Affordable Care Act. “

It is hard to have a productive debate about a problem, when there still exists a large amount of disagreement over what the problem actually is. This is remarkably true for US health care – it is quite impossible to fix the system when there is still a fundamental disagreement over whether the government should be in the business of providing health care. One person’s “fix” may be to provide health care to more people, while another person’s might be to provide it to fewer.

Atul Guwande takes on this problem in his latest piece for the New Yorker, exploring Americans’ opinions on whether health care should be considered a right.

“Before I entered the field of public health, where it’s a given that health care is a right and not a privilege, I had grown up steeped in a set of core Midwestern beliefs: that you can’t get something for nothing, and that you should be reluctant to impose on others and, likewise, to be imposed upon. Here self-reliance is a totemic value.”

Austin Frakt on the popular “drug coupon” shenanigan that drug companies use to promote brand-name use over generic alternatives.

If everyone wants lower drug prices, then why is lowering them so hard?

“In response to the new threats, the Pharmaceutical Research and Manufacturers of America, already one of Washington’s biggest-spending trade groups, reportedly increased member dues 50 percent last year as they prepared for battle. The pharmaceutical and health products industries spent $145 million on lobbying for the first half of 2017, according to the Center for Responsive Politics.”


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