Trump in 30 Seconds: science and medicine in flux – Archive (April, May 2017)

STAT
Updated

Here’s the latest on what the Trump presidency means for health, hospitals, drug companies, and medical research.

Wednesday, May 31

Paris in springtime

President Trump is more than likely going to pull the U.S. out of the nearly 200-nation Paris climate change agreement, according to Politico. His reasoning? It’s bad for the U.S. economy. The D.C. reaction? Concern. Even Secretary of State Rex Tillerson thinks the country should stay in the agreement. The global reaction? Dismay. The U.S. is the second-largest producer of carbon emissions. Being part of the agreement puts pressure on other nations, especially developing ones, to curb their emissions as they further industrialize.

Number of the day: 3.6

That’s the percent of women (ages 15-44, on large employer health insurance) who paid out of pocket for birth control pills in 2014, after the enactment of the ACA’s contraception provision in 2012. In 2012, the percent of women who paid out of pocket for birth control was 20.9 percent. That provision, says Vox, is in danger under President Trump

In the tweet of the moment

He said this

“While the CBO was overly optimistic in 2010 about Obamacare, there’s a strong case that it is being overly pessimistic about the new House bill, the American Health Care Act.”

— Avik Roy, president of the Foundation for Research on Equal Opportunity, on the AHCA and how it can be fixed by taking into account its effect on poor Americans

Read on

Tuesday, May 30

Everyone’s pointing fingers

President Trump has talked frequently about reigning in drug prices, and in the halls of Congress, lobbyists on every side of the drug market conversation are blaming the other guys as part of a $78 million lobbying spending spree in the first quarter of 2017. As for legislators, they tell the New York Times that the onslaught is pretty constant, and that there’s plenty of blame to go around.

In the tweet(s) of the moment

It’s not clear what President Trump means, given his proposed budget and the AHCA call for cuts to different parts of the American health care system.

Again, it’s not clear what the president is referring to, since the Senate is more or less doing just that.

He said this

“The parliamentarian is a brilliant lawyer, a thorough and fair referee, and a walking encyclopedia of Senate precedent and procedure.”

— Don Stewart, Senate Majority Leader Mitch McConnell’s deputy chief of staff, on Elizabeth McDonough, the Senate parliamentarian, who will be tasked with examining the Senate version of the AHCA and its effect on the budget. See “Byrd bath.”

Read on

Friday, May 26

Trump and telemedicine

If President Trump’s proposed cuts to Medicaid happen, hospitals nationwide will have to figure out how to treat their lowest-income patients in a cost-effective way. At NewYork-Presbyterian, the CEO is thinking telemedicine may be part of the answer. Dr. Steven Corwin talks to STAT about telemedicine, how it’s already helping with long wait times for emergency psychiatry, and why the president’s proposed cuts to Medicaid (and the NIH) will hurt us in the long run.

The Senate has a plan for a plan

They’re crafting one. While the issues of cutting Medicaid and protecting preexisting condition coverage hang over them like dark clouds over the prairie, the Senate budget committee is taking a stab at the AHCA. Senate Majority Leader Mitch McConnell is worried, though. He needs 50 votes. He’s only got a couple to spare. How long will all this take? Who knows. But one man whose vote is crucial, both physically and philosophically, is Senator Bill Cassidy, who is touting a plan of his own.

He said this

“Republicans care about kids. Republicans care about the elderly. Just like many Democrats care about national defense. … We do one thing, which is very important, which is we are defending the taxpayer.”

— White House budget chief Mick Mulvaney, defending the Trump budget proposal from what even Republican legislators are calling “draconian, careless, and counterproductive” cuts.

She said this

“… policy changes affecting Medicaid beneficiaries will have implications for the individual market and vice-versa.”

— Marilyn Tavenner, CEO of America’s Health Insurance Plans, the industry group, in a letter to Senator Orrin Hatch, about what cuts to Medicaid will mean for private insurers, which, via CSRs and direct-to-consumer subsidies, help people get insurance when they are no longer eligible for Medicaid. (h/t Axios, David Nather)

Read on

  • FDA chief Scott Gottlieb thinks he can stop the next Martin Shkreli

  • The hiring freeze is over at the FDA. Here’s how Gottlieb wants to trim the ranks

  • How drug pricing talk (or lack thereof) could affect biotech trust trading

Thursday, May 25

Reporting on Trump

President Trump’s halting speech patterns: Maybe it’s cognitive decline, but maybe it’s completely deliberate. You told us how you felt about Sharon Begley’s wildly popular story about the president, the way he talks and what it says about the brain. Now, Sharon reveals how she went about reporting and writing it. Spoiler alert: She never thought she’d be writing about the president’s mind.

Number of the day: 1/6

That’s the fraction of the US population whose individual market could crumble by 2020, based on the Congressional Budget Office report of the House version of the AHCA. CBO says this is because of waivers that could affect essential health benefits and community rating.

He said this

“Listen, I lost my sister to breast cancer. I lost my dad to lung cancer. If anybody is sensitive to preexisting conditions, it’s me. I’m not going to make a political decision today that affects somebody’s sister or father because I wouldn’t do it to myself.”

— Freedom Caucus chair Mark Meadows (R-N.C.), on the CBO score and what it says about the House version of the AHCA and people with preexisting conditions. He says he will make sure high-risk pools are well-funded.

Andy Slavitt: Health policy’s Mick Jagger?

“That’s him.” In a post-Obama world, former Centers for Medicare and Medicaid Services chief Andy Slavitt has become a bit of a health policy superstar, thanks to his Twitter account and a deep-ocean trench of understanding of health care in the US. And like a rock star, he’s gone on tour, holding town halls all over the US, in Trump-friendly territory, trying to get people to understand what’s at stake in the latest effort to reform health care. STAT went with him. Here’s what we found.

Read on

Wednesday, May 24

All the president’s words

His speech is halting. His sentences are sometimes incomplete. But it wasn’t always like this — on Wednesday, STAT went deeper into the science behind the president’s speech patterns in a Facebook chat with writer Sharon Begley, who wrote this story: STAT reviewed decades of President Trump talking, and found a change from a formerly articulate, sophisticated mogul to a leader who sometimes loses his train of thought mid-sentence. Experts say changes in speaking style can result from cognitive decline. But it may also say something about Trump’s brain health.

What’s the score?

The Congressional Budget Office is supposed to release its analysis of the House version of the AHCA sometime Wednesday afternoon, and no matter what it says, expect there to be hand-wringing over its fiscal impact and the number of people who might end up losing insurance. The big question is, how much of a difference did the MacArthur amendment make? The provision would allow states to waive some Obamacare insurance requirements. The GOP doesn’t want to vote again, but if the House bill doesn’t meet Senate budgeting rules, they may have no choice.

Dollars and sense

He said this

“You are taking the most vulnerable population and you’re putting an extra burden on them. I realize people want to reduce the cost of health care, but Medicaid affects 75 million Americans, and, in many ways, it is a middle-class subsidy. It’s going to be devastating.”

— Dr. Steven J. Corwin, CEO of NewYork-Presbyterian Hospital, on proposed Medicaid cuts in the Trump budget and in the AHCA, which combined are more than $1 trillion over 10 years. He spoke with STAT’s Casey Ross early Wednesday (@bycaseyross)

Read on

Tuesday, May 23

A skinny budget, fleshed out

The proposed budget for HHS leaked for a minute last night, and at first glance, it was like a scene from “Edward Scissorhands” — cuts all around. Among the hardest hit programs? Medicaid, with a $600 million cut planned on top of the $800 million written into the AHCA. Here’s where Medicaid dollars go. In addition, the CDC’s budget is slashed to what its former director calls “unsafe at any level of enactment,” and the National Cancer Institute loses funding as well. As for the NIH? The planned $5.7 billion cut comes with a 10 percent cap on indirect costs — stuff like electricity to keep labs running.

In the tweet of the moment

Bob Greenstein is the founder of the nonpartisan Center on Budget and Policy Priorities. The Trump budget is predicted to hurt the people who voted for him the most.

He said this

“If I had sort of a subtitle for this budget, it would be the ‘Taxpayer First’ budget. This is, I think, the first time in a long time that an administration has written a budget through the eyes of the people who are actually paying the taxes.”

— White House Office of Management and Budget Director Mick Mulvaney, on the revised budget and cuts to social welfare programs therein

Number of the day: 11

That’s the percent cut proposed for the National Science Foundation, which funds a broad range of scientific research and education projects. It’s among the many science- and health-related agencies facing steep cuts in the proposed budget

Read on

  • “Lead the government’s fight …” What the president’s backtracking on “drug czar” funding means for that office

  • “His tortured syntax …”: What the president’s speech patterns say about his mental acuity

  • “It sounds like a lot of money …”: What Chris Christie has to say about proposed Medicaid cuts

  • “We’re old and broken …” Why Thursday’s vote in Montana hinges on health care

Monday, May 22

CSRs: A powerful gambit

The White House is going to ask a judge for another 90-day extension in the court fight over whether insurer subsidies called cost-sharing revenues are legal. This could further put individual insurance in disarray, as CSRs have been a sticking point for companies trying to decide whether to participate in 2018. President Trump has said he’ll use them to get Democrats to the table. Centers for Medicare and Medicaid Services chief Seema Verma is in a bit of hot water after allegedly promising them to insurers in exchange for support of the GOP effort. Either way, CSRs won’t save the individual marketplace — some insurers are saying losses, whether actual or calculated, are too high for comfort.

In the tweet of the moment

Number of the day: $800 billion

That’s the amount of proposed cuts to Medicaid over 10 years, according to leaked information in the soon-to-be-released revised White House budget. The total proposed cuts to “mandatory” programs is about $1.7 trillion.

He said this

“We’re not there yet. As a matter of fact, we’re a long ways from there.”

— South Carolina Senator Lindsey Graham on the Senate version of the AHCA. The CBO score on the House version is expected on Wednesday.

Opinionated

  • PhRMA’s new membership rule — an off-mark save-face after Trump’s drug pricing criticism (STAT Plus)

  • Obamacare is a bad deal for millennials. Here’s why (The Heartland Institute)

  • Why more corporations should think like Warren Buffett about universal health care (The Nation)

  • HHS chief Tom Price is wrong about medication-assisted treatment. It works (Boston Globe)

Friday, May 19

A sweet deadline

More than 40 doctors and nutrition scientists are urging HHS Secretary Tom Price and FDA Commissioner Scott Gottlieb (both doctors) to stick to an upcoming deadline to include added sugar content to nutritional labels. Major food companies are supposed to add the information to their labels by July 2018 and smaller food companies are supposed to add the information by July 2019. The food industry has asked for a three-year delay.

She said this

“Every school child knows that when you pass a bill in the House, you send it to the Senate. You don’t hide it in a drawer somewhere for two weeks, while you wait for information that you should have had before you passed it.”

— New York Representative Louise Slaughter, a Democrat, in reference to the House having yet to send its version of the AHCA to the Senate, pending a CBO score. The House version may have to be revised and voted on again because of Senate budgetary rules, but health care reform might end up taking a back seat to White House drama.

Fact check: veterans and health care tax credits

House Minority Leader Nancy Pelosi said that 7 million veterans would lose their tax credit under the revised AHCA passed by the House. It’s not that concrete, says the Washington Post. The House Ways and Means Committee is trying to work the IRS to make the tax credit an actual law. The 7 million? It comes from reports, and includes veterans who aren’t in VA health care, but who could have Medicaid or employer insurance. Pelosi, they say, is playing a little too loose with the numbers.

Getting in on CSRs

Fifteen state attorneys general and the attorney general for Washington DC filed suit Thursday over the court battle on cost-sharing reductions, federal payments to insurers to cover copays and deductibles for lower-income subscribers. These payments have been a sticking point for insurers in deciding to stay in the individual markets and raise rates. Sure, Obamacare has issues, but insurers are blaming — in harsh terms — President Trump for the turmoil.

Read on

  • The Trump administration’s hiring freeze means 700 open positions at the CDC, including in emergency preparedness

  • Tom Price: Let’s cut FDA’s budget, and raise industry fees that drug companies and device makers pay

  • If the Trump presidency fails, here’s how pharma will pay the price

  • Budget leak: Some women and children’s programs get a boost; paid family leave becomes an option

  • Abortion foes may lose out when the AHCA goes through Senate budget reconciliation

Thursday, May 18

Out with the fake, in with the science

A group of Democrats on the House science committee wrote a letter to President Trump on Thursday, saying he needs to stop believing in fake news, and hire a science adviser. The Office of Science and Technology Policy has been mostly empty during Trump’s tenure, and the Dems on the letter, two of whom are scientists, try to tie the president’s belief in unfounded “research” to the lack of a chief scientist at the White House.

A direct cut to indirect costs

President Trump’s revised budget proposal isn’t going to end fears of large cuts to science. While the original proposal called for $5.8 billion to be removed from science budgets, the Atlantic is reporting that to stem costs, the administration will demand a 10 percent cap on indirect costs — things like electricity and IT. Paying for indirect costs takes up about 38 percent of the National Institutes of Health budget. But that subsidy, as it were, is a necessary cost of doing science, many scientists argue, including NIH Director Francis Collins, who was grilled on the topic Wednesday at a congressional hearing.

Number of the day: 1/3

That’s the fraction of all federal research dollars (about $35 billion) that went to states in 2014 that voted Trump in 2016. Why does this matter? A lot of proposed cuts to scientific programs will affect those states and the industries that depend on them.

He said this

“This president is very accessible to me. He has made it clear to both me and his staff that the issue of veterans and fixing the services for veterans is among his highest priorities.”

— David Shulkin, head of the VA, on the president and veterans health as a priority, in a recent visit with STAT.

Read on

  • Drug pricing talk and uncertainty surrounding the Obamacare repeal means there have been precious few health care IPOs so far this year

  • Is health care a right or a privilege? It depends what you mean, says this free-enterprise think tank

  • Folks can directly enroll in individual policies next year, without having to go through the marketplace

  • Can the Senate push through health care reform? Maybe not, says this CEO and former Senate GOP staffer

Wednesday, May 17

A seat at the table

Senator Bill Cassidy of Louisiana is a doctor. He’s pretty well-versed in reform. He knows a lot about health care. So why isn’t he part of the McConnell 13, the group that is working on the Senate version of the AHCA? STAT talked to Cassidy, who says, eh, it doesn’t matter. He has his own plan with Senator Susan Collins, and on Monday, the two met with other members of the Senate GOP, including Democrats. The consensus? It was a good, bipartisan conversation.

Number of the day: 6.3 million

That’s the number of people with preexisting conditions who might be charged higher premiums because of waivers that the House version of the AHCA would allow states to apply for to let them opt out of the requirement that insurers charge people with preexisting conditions the same as people without. This is the waiver that would allow states to set up high-risk pools, which Speaker Paul Ryan says will work, even as other people say that without a lot of money, they may not.

Fact check: Vets and non-VA health care

President Trump has recently said that 42 percent more veterans have been approved to get health care outside the VA system via the Choice Program. Turns out, it’s closer to 35 percent, says the Washington Post, but either way, it’s a significant jump and evidence that efforts to get vets off waiting lists as well as efforts to privatize veterans’ health care are progressing.

Setting the record straight

About 700 addiction experts sent a letter to HHS head Tom Price Monday, urging him to backtrack on statements that medication-assisted treatment for addiction implies that drugs like methadone do not aid in recovery; the experts say such medications help people recovering from addiction return to a more productive life. In addition, more than 70 members of the House signed a letter to budget chief Mick Mulvaney, urging him not to defund the Office of National Drug Control Policy, with one of its roles being an intermediary between the criminal and medical aspects of drug use in the US.

Read on

  • It makes sense for Obama’s FDA commissioner Robert Califf to join to Google’s Verily. Here’s why

  • Science advisory boards are falling by the wayside under President Trump. Here’s why it matters

  • The EPA asked the public which regulations needed to be rolled back. This is a sampling of what 55,000-plus people said

  • Tom Price urged states to apply for Obamacare “innovation” waivers several days ago. Now, CMS has provided a checklist for them to do so

Tuesday, May 16

Today in health care reform

President Trump seems to be supportive of the House version of the AHCA, even as the Senate wants to tweak the bill to alleviate concerns about people losing coverage. Sean Spicer, the White House press secretary, said that if the Senate’s efforts make the bill stronger, “then great.” And after being cut out of the conversation in the House, the health care lobby is pushing to be at the table as the Senate does its thing.

He said this

“Unquestionably, our greatest immediate challenge is the problem of opioid abuse.”

— FDA Commissioner Scott Gottlieb, in a wide-ranging first speech to staff, on what he thinks is the biggest drug-related issue facing the nation. He goes on to say that the FDA’s role in stemming the epidemic is to reduce the use of opioids and to help prescribers with their responsibilities.

Number of the day: $8.8 billion

This is the amount of money at stake as the Trump administration increases the reach of the so-called Mexico City Policy that prevents US funding from going to global family planning organizations that perform or promote abortion. The expansion means that organizations that do other health-care-related work that doesn’t necessarily apply to family planning, but who might discuss abortion, could also be affected.

ICYMI: A new face at USDA

The president’s supposed pick to oversee much of the USDA’s science is a radio talk show host with public administration credentials, but no apparent science background. Sam Clovis, from Iowa, is skeptical of climate change and, while campaigning on behalf of the president, spoke to changes in USDA policy to focus more on trade.

Read on

  • The small business health insurance exchange that was part of the ACA is closing. It wasn’t used as much as private brokers were

  • Senators from both parties came together to talk about health care reform. This is what they said

  • Despite protests from within, Cleveland Clinic says its Mar-a-Lago fundraiser for 2018 is most likely a “go”

Monday, May 15

Fact check: Medicaid isn’t broken

Drew Altman, the president of the nonpartisan Kaiser Family Foundation, takes Republicans to task on claims that Medicaid is a disaster that the AHCA will fix through steep cuts. Among his findings? More Medicaid beneficiaries have seen a doctor in the last year than people with private insurance. They are satisfied with their care. And costs for Medicaid are projected to grow more slowly than for private insurance. Bottom line? Medicaid is no more broken than private insurance.

He said this

“… the lack of choice in health insurance and in health-care providers, along with skyrocketing premium and out-of-pocket costs, are failing our citizens, our families, and, in particular, our women.”

— President Trump, in a prepared statement released on Mother’s Day, in recognition of Women’s Health Week

In the tweet of the moment

Hospitals in the US are surely trying to shore up their computer systems after an NSA cyberweapon was stolen and used to wreak havoc on multiple entities last week and over the weekend, including hospitals in the UK and Canada. There was evidence of the attack in the US, HHS said, but it’s not clear where or who was affected. And as of Monday morning, it appeared the attack was still ongoing.

Number of the day: 57

That’s the number of plans available to members of Congress and their staffs through the exchange in Washington, D.C. Congress is required to have health care through the ACA and, with few exceptions, use the federal or state health care exchanges.

Read on

Friday, May 12

Insurance: It’s going to get more expensive

As President Trump and his administration waffle on paying insurers subsidies, as insurers work to determine the nature of the risk of having large numbers of very sick patients outweigh the healthy ones, and as many have to deal with stockholder expectations, it appears, for now, that for Americans who get their insurance off the individual exchanges, the cost of their policies are going to go up.

He said this

“…in a short period of time I understood everything there was to know about health care…and actually it’s a very interesting subject.”

— President Trump to Time magazine in a broad-ranging interview.

Winding up to wind down Medicaid

Senate Majority Leader Mitch McConnell has tasked Pennsylvania Senator Pat Toomey and Ohio Senator Rob Portman to take on Medicaid reform, including slowing down Medicaid expansions and moving the program from an entitlement to block grants. Both Pennsylvania and Ohio have expanded the program, but the senators feel differently about their states’ efforts. Portman, for one, says Medicaid is important because it’s used to pay for opioid addiction treatment, which is a major issue in Ohio.

He said this

“If recent comments from the Administration indicate a shift away from an evidence-based, public health approach to the opioid crisis, I am concerned the negative impact on the health of Americans will be considerable.”

— Dr. Vivek Murthy, former surgeon general on comments made by HHS Secretary Tom Price on faith-based treatment for opioid addiction.

Read on

  • Scrapping the White House drug office is a bad idea, these members of Congress say

  • The president wants to reshape taxes. Here’s what might happen to health-based deductions

  • The intelligence community’s worldwide threat assessment cites climate change

  • The president told the Economist that health insurance should cost $15 per month

Thursday, May 11

America’s chief psychiatrist

Dr. Elinore McCance-Katz is a psychiatrist who specializes in addiction. She’s a proponent of aggressive treatment for mental illnesses, and strongly advocates for using meds to do this. She’s also the nominee to run SAMHSA, the agency within HHS that deals with mental health and addiction. Read more about her here.

Number of the day: 4

That’s the number of new appointees to President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis. The White House said on Wednesday that the president wants Republican Governor Charlie Baker of Massachusetts; Democratic Governor Roy Cooper of North Carolina; Patrick Kennedy, a former Rhode Island congressman and recovering addict; and Bertha Madras, a Harvard Medical School researcher, to join New Jersey Governor Chris Christie in tackling this national epidemic.

Border crossings

One of the few bipartisan issues in Congress is lower prescription drug prices. President Trump wants it. Bernie Sanders wants it. One way people are proposing to pay less is to get more meds from Canada. Here’s how that would work. If it would work.

He said this

“If we’re just substituting one opioid for another, we’re not moving the dial much. Folks need to be cured so they can be productive members of society and realize their dreams.”

— HHS Secretary Tom Price, in a visit to opioid-ravaged West Virginia on Tuesday. He voiced his preference for faith-based treatment for addiction over medication-assisted treatment for opioid addiction. This thinking may run counter to that of the SAMHSA nominee, Dr. Elinore McCance-Katz.

Read on

  • Firing FBI Director James Comey may have a ripple effect on the president’s push to repeal Obamacare

  • Everyone seems to want FDA to move faster to get drugs to market. It’s already happening. Here’s how

  • The author of the MacArthur amendment holds a town hall and hears about it, even as he talks about his daughter’s medical issues

Wednesday, May 10

The administration grows

On Tuesday, the Senate quickly confirmed Scott Gottlieb to run the FDA as many of us on the East Coast were starting our evening commutes. His ties to industry have been criticized, but for the most part, he has been praised. On his to-do list? Implementing the 21st Century Cures Act. But, how much will President Trump — given his interest in pharma, his desire for more rapid drug approvals, and his orders to slash two regulations for every one implemented — seek to control Gottlieb? Stay tuned.

In defense of checks and balances

Congressman Jason Chaffetz (Utah) and Senator Chuck Grassley (Iowa) sent a pretty stern letter to HHS Secretary Tom Price, a member of the Trump administration, a few days ago, warning him that an internal HHS memo telling employees that they couldn’t talk to Congress without first going through an HHS office on legislature was “potentially illegal and unconstitutional,” not to mention the effect on whistleblowing. It’s worth noting that both Chaffetz and Grassley are Republicans.

He said this

“We have skin in the game. The players across the board in the Senate want to get to yes. We recognize that we have an historic opportunity.”

— Texas Senator Ted Cruz, former opponent of President Trump, on efforts to repeal Obamacare. The AHCA is now in the Senate, where it is expected to be further amended. Cruz has been known for his role in opposing President Obama, calling him “imperial.” His Texas counterpart, Senator John Cornyn, said Tuesday that the repeal will happen in 2017.

In defense of (the amended) AHCA

When the AHCA first surfaced, many conservatives bashed it. But as it’s been amended, some of its toughest critics, including Avik Roy, have started to come around. Vox spoke to Roy, who runs a free-market think tank that focuses on lower-income Americans, about the amended AHCA, and what works. Among Roy’s praises? Reforming the individual market to reduce costs and allowing people to potentially opt out of coverage that doesn’t apply to them, like maternity care. His big concern? “How you provide financial assistance for poor people.”

She said this

“The most important thing is that we are leading with science. We know that people who are on medication-assisted treatment have better outcomes. We need to make sure more people have access to evidence-based treatment and recovery support.”

— Regina LaBelle, former chief of staff of the Office of National Drug Control Policy, on the need for the office. President Trump has proposed cutting the budget by 95 percent, effectively killing the office.

In the tweet of the moment

Blue Cross Blue Shield said Tuesday that it would re-enter the market in parts of Tennessee that, until Tuesday, had no other individual insurance option.

Read on

  • Seven states have health insurance “co-ops” under the ACA. Waivers proposed by the AHCA could kill them. Here’s how

  • These two governors are already considering applying for waivers proposed by the AHCA. What could go? Preexisting condition coverage

  • The Agency for Healthcare Research and Quality named Gopal Khanna as director, and his appointment stems some fears that the agency will be consolidated with the NIH

  • Medicaid expansions helped many adults get health coverage, including the parents of children already on the plan

Tuesday, May 9

Summing up the summit

At Monday’s biotech summit at the White House, many thought the proposed cuts to the NIH were going to be on the agenda. The meeting was hush-hush — the White House wouldn’t confirm it was happening and the NIH wouldn’t confirm that its director was going to be there. For his part, Francis Collins said funding cuts didn’t come up. But one attendee said they did, and posted her thoughts to Facebook.

In the tweet of the moment

Number of the day: 50

That’s the number of votes needed in the Senate to pass its version of the American Health Care Act. But that’s assuming that the bill will survive being tested by the Byrd rule and the Senate parliamentarian (see Monday’s Trump in 30 Seconds for more).

She said this

“You just torched the health benefits of 200,000 West Virginians, and in the middle of an [opioid] epidemic.”

— Mary Aldred-Crouch, an addiction counselor in West Virginia, on AHCA passing the House, to the three congressmen from her state who voted for it. The bill has been framed as giving more choice to people in buying insurance. But it also comes with steep cuts to Medicaid, a key vehicle for covering addiction treatment, and the possibility that the state may opt out of mandatory mental health coverage, putting addiction treatment out of reach for many in the state.

The Jimmy Kimmel test

After his monologue on his show last week about his son’s heart condition, Jimmy Kimmel has become a celebrity voice for access to affordable health care. On Monday night, he had Louisiana Senator Bill Cassidy on his show to talk about the “Jimmy Kimmel test,” the phrase Cassidy coined to determine whether a plan would provide care without spending caps. Cassidy, along with Maine Senator Susan Collins, has proposed an alternative health care plan that prohibits caps.

Read on

  • A loophole in President Trump’s website is allowing people to post URLs that voice their opinions about health care reform

  • OPINION: Is cigarette smoking a disease or a behavior? It matters, as FDA commissioner candidate Scott Gottlieb might soon find out

  • Pharma is a great fan of Gottlieb, whose confirmation vote could come as early as Wednesday

  • A user-friendly way to keep track of the various changes and tweaks to the health care bill

Monday, May 8

A congregating of biotechies

A slew of biotech leaders are descending on the White House today to meet with President Trump. On the agenda, presumably, is funding for basic biomedical research. But here are five things STAT will be watching out of this meeting, including whether or not drug pricing will come up, or if indirect expenses will have to be defended, or, if tax breaks to repatriate overseas cash stashes will be a topic on the table.

Remember this term: Byrd Bath

A Senate phrase for what’s about to happen as Mitch McConnell and crew determine what parts of the House health care bill might be able to stay in the Senate version based on their effect on the budget (the Byrd Rule). One aspect of the House bill that may be affected are the waivers proposed for states to get out of covering essential health benefits. The person who helps decide? The Senate parliamentarian.

Number of the day: 7

As in, here are seven ways your taxes might be affected by AHCA, as passed by the House. Warren Buffett pointed out that his taxes would drop by about 17 percent, and he called it a “huge tax cut for guys like me.” Some of the taxes in play? Medicare, the individual mandate and contributions to FSAs and HSAs. Of course, some of these will not end up in the Senate version, but it’s safe to say some will.

All eyes on states

As the Senate puts together their own health care plan, the question is, how will all this play out in the states? There’s politics: Repealing Obamacare is likely to settle heavily on upcoming elections, as Democrats use the repeal effort to try and swing voters back their way. And there’s policy: How would states handle opting in (or out) of essential health benefits? And will these provisions survive? Stay tuned.

He said this

“I’ve now become one of the statistics I’ve talked about for a long time.”

— Illinois Senator Dick Durbin, who said he now has a preexisting condition after being treated for an irregular heartbeat last week. He spoke to reporters on Sunday, referencing a plan released several weeks ago by Senators Susan Collins and Bill Cassidy to keep preexisting condition coverage.

She said this

“The Senate is starting from scratch. We’re going to draft our own bill, and I’m convinced that we’re going to take the time to do it right.”

— Maine Senator Susan Collins, on the Senate effort to repeal Obamacare, which will likely keep some of the more popular provisions of the act. She also commented on the House plan to give states a lot of leeway in determining essential coverage, saying it was “without any guardrails.”

Another number of the day: 0

As in, the committee working on the Senate version of the health care plan has zero women on it. The Rose Garden celebration after the House passed their version featured zero women in some photos. Some people are not amused. Others are defending the moves.

Read on

  • The EPA fired scientists from an advisory board, to possibly be replaced by industry scientists

  • Older Americans: The Senate works on their version of health care reform with an eye toward protecting one of their most reliable voting blocs

  • A vote on reauthorizing funding for the Children’s Health Insurance Program was postponed as Dems said they didn’t want health care reform to overshadow it

  • HHS Secretary Tom Price took to television to defend the House plan, saying that people would not lose Medicaid coverage, despite CBO projections

Friday, May 5

Celebrating, but then back to business

President Trump watched the vote with close advisers, including his daughter, and was phoning members of the House up to the very moment the voting began. A short while later, the American Health Care Act was passed along party lines, and lawmakers praised the commander in chief’s effort in getting the bill through on the thinnest of margins. But now, a bigger test awaits. The Senate has been working on their own bill — members have voiced concerns over Medicaid and preexisting conditions. The margin to pass the Senate is even tighter, and if the bill ends up back at the House considerably different than before, various factions may balk, sending the process right back to the drawing board.

Freedom, and all its definitions

The House GOP sold the AHCA to its constituents (and to each other) as a way to preserve freedom — less government interference in health and more choices for consumers to get the coverage they want. STAT took to the purple suburbs of Atlanta and Cleveland to see whether voters, for Trump or otherwise, bought the argument.

He said this

“You could say all of us have a preexisting condition of import, and it’s just a matter of when we’re going to manifest it. Very few of us are genetically bulletproof.”

— Dr. Eric Topol, a genomicist at the Scripps Research Institute, on the idea that our genetic information, protected by GINA and Obamacare, is a compendium of preexisting condition information that could be used if the law is repealed.

In the tweet of the moment

Read on

  • Insurers selling plans in Virginia and Maryland are already asking for higher premiums for next year

  • About $1 billion could be lost from public health funding with the House passage of AHCA

  • Despite the president’s promises on funding addiction treatment, AHCA, as it stands now, could do the opposite

  • The Trump administration is interested in a “public forum” to talk climate change, but environmentalists say there’s nothing to debate

Thursday, May 4

They voted …

The American Health Care Act, amended to give states more flexibility in defining coverage and offer funding to help people with preexisting conditions, passed the House with a 217-213 vote down party lines.

The bill, which heads to the Senate, will likely be reworked, but in the meantime, the flexibility we talked about above doesn’t just affect people who are in the individual market, but also the 156 million Americans who get health insurance through their employer.

… without the CBO

But the House voted without input on the amendments from the Congressional Budget Office. Some estimates say the high-risk pools that are supposed to help people with preexisting conditions would fall $20 billion short each year, covering only about 5 percent of the estimated 52 million people who have preexisting conditions.

…. with no wiggle room

The Republicans needed 216 votes. They got 217. For a minute, two Democrats appeared to vote in favor of the bill. But they switched votes. Almost immediately, health advocacy groups voiced their disappointment, some in emailed statements:

… with support from President Trump

… and Democrats responded

In song. Several people report seeing House Dems singing “Na Na Hey Hey Kiss Him Goodbye,” as if to warn their Republican colleagues that their seats may be in jeopardy, come 2018.

Read on

  • The health care debate has been endlessly quotable. Can you guess who said these things and why? (STAT)

  • Lost in the AHCA talk: special education programs that rely on Medicaid to help students with disabilities (New York Times)

  • These 11 states all voted for President Trump. They stand to lose big if preexisiting condition coverage goes (CNN)

  • Tom Marino withdraws from consideration to be drug czar “due to a critical illness in my family” (Philly.com)

Wednesday, May 3

Trump and Vivek Murthy

A group of Democrats sent a letter to President Trump Wednesday, wanting to know why former Surgeon General Vivek Murthy was fired in late April. As surgeon general, Murthy spoke out about gun control and the dangers of e-cigarette use, and in the letter, the senators asked whether those positions fed into the decision to fire him. Murthy had only been in office for slightly more than two years, and the letter noted that it is common for surgeon general appointees to serve across party lines.

Trump and the GOP

With the current pass at health care reform lacking necessary votes, and some flip-flopping and waffling making it hard to get a clear count, President Trump is scheduled to meet today with lawmakers who have crafted a plan they think can salvage the effort. The plan calls for an $8 billion infusion to help offset premiums for people with preexisting conditions, but moderates say this opens the door for insurers to charge people more.

In the tweet of the moment

Number of the day: 5

As in, here are five ways that Kaiser Health News says health care reform could play out, from piecemeal legislation to putting it aside to work on tax reform. Also, as in, here are five promises the president and his team have made about health care reform that Politico says probably won’t happen.

Read on

  • Joe Kennedy III: The AHCA is the “single largest attack on mental health care in recent history.”

  • This is how Tom Price wants to reorganize HHS, and he wants to present a draft of his plan by June 30

  • How the AHCA could impact women: States could say no to maternity care

  • They showed up to march, but will scientists show up to the polls?

Tuesday, May 2

Taking stock of biotech

In his first 100 days, and even before, President Trump’s propensity to tweet about drug prices would send the stock market through all kinds of drama. But biotech stocks have done well overall, outpacing the S&P 500. Here are three that have ridden the waves well, from companies working on cholesterol, leukemia, and lupus therapeutics.

She said this

“We need to be constantly pushing to get folks to do a bipartisan fix of the ACA. We have to keep blocking and tackling until we get there.”

— Sister Carol Keehan, president and CEO of the Catholic Health Association, on health care reform. Many health care providers and associations have come out against the current iteration of health care reform, warning of negative consequences for patients and, in some cases, hospital finances.

Meanwhile, in the Senate

With all the bluster over health care reform and the House bill comes this: The thing might change when it gets to the Senate. Among proposed changes are tax credits and flexibility for states. But some things won’t change — Senator Susan Collins of Maine said that she likely wouldn’t vote for a bill that would remove funding for Planned Parenthood.

Protecting health benefits

Whether the House votes or not this week on the amended health care proposal, a point of compromise that the GOP made to bring some of its more conservative members aboard could have wide-reaching implications for the 156 million Americans who get their health insurance through their employer. The provision allowing for states to determine what are the essential health benefits that insurers would have to cover could reduce coverage, and the cost of plans, allowing employers to shop outside their state for the lowest possible group coverage rate. Catastrophic protections often built into large group plans could go out the window.

Read on

Monday, May 1

Congress vs. Trump

You might remember a few weeks ago, when the White House proposed slashing about $1.2 billion from the National Institutes of Health budget for 2017. Well, Sunday night, Congress did the opposite, pledging $2 billion to the agency for 2017 in its spending plan. The bipartisan effort is being seen as a reaffirmation of the 21st Century Cures Act, which calls for more biomedical research and faster drug development efforts.

What’s in the bill?

President Trump’s administration is pushing for a vote on the current health care bill, perhaps as early as Wednesday. But confusion abounds. The bill, as it stands now, doesn’t seem to guarantee preexisting condition coverage. But the president keeps promising that health care reform will keep that Obamacare benefit. It’s not clear the president knows what’s in the amended bill to begin with.

In the tweet of the moment

Number of the day: 20

That’s the number of undecided GOP members in the latest push to get a health care reform vote through the House.

Read on

  • Dr. Toby Cosgrove did a lot for Cleveland Clinic in his nearly 13-year tenure. But, amid his work for President Trump and a Mar-a-Lago fundraiser clash, he’s decided to leave

  • OPINION: A group of Harvard students heads to Washington, D.C., to meet with government scientists, thinking no one would be around. They were wrong

  • Blockchain technology (think Bitcoin) is touted as a solution to many computing problems. These folks think health care data could be the latest and greatest target

Friday, April 28

Trump and Puerto Rico

Earlier this week, while tweeting about health care reform, President Trump injected Puerto Rico into his 140 characters, hinting that he would not sign a spending bill that included funding for the island territory. Turns out Puerto Rico has about 1 million people who could lose health care coverage if their Medicaid program falters, and HHS Secretary Tom Price said the program needs about $900 million to survive through June 2018. But it’s not just Democrats that want to help. Republican Marco Rubio, among others, has also joined in the chorus.

Number of the day: 3.8

That’s the percent tax on high earners with capital gains that the Affordable Care Act put into place to help subsidize health plans for lower-income folks. It’s one of the taxes that’s on the chopping block in the president’s tax reform plan. The plan has come under fire for helping the wealthy at the expense of public programs, like in health care, that depend on a solid tax base.

99 days in

The White House was pushing the GOP to give Trump a health care victory on the eve of his first 100 days, but it’s not going to happen. The House Republicans don’t have the votes, Politico says. By their count, the GOP has 15 “no” votes, and another 20 are either thinking no or are undecided. The House only has 22 votes to spare. Among the stumbling blocks of the bill with its current amendment? Preexisting coverage and affordable plans.

Veterans and accountability

The president wants to create an office of accountability and whistleblower protection for the VA as part of efforts to improve health care at the massive agency. VA Secretary David Shulkin said the office will help root out employees who aren’t serving veterans properly. But, as we mentioned yesterday, 4,000 jobs at the VA involving health care will go unfilled as part of efforts to encourage veterans to seek private health care. It’s not clear whether vacancies left by people removed via the accountability office will be filled as part of the same idea.

Read on

  • The president’s drug pricing talk hasn’t impacted first quarter pharma earnings that much

  • The president appoints an anti-abortion advocate to HHS public affairs

  • The GOP health care plan would make it easier for governors to fashion health care through waivers. But it’s not clear which states will take advantage

  • The president has talked a lot about increasing access to opioid addiction treatment. This company is trying to make it easier to receive treatment at home

  • Climate change skeptic Representative Lamar Smith of Texas’ seat is being challenged

Thursday, April 27

A vote this week?

Probably not, as Democrats hold funding the government over Republican heads. The question, as ever, though, is will the GOP have the votes? The changes offered to the bill essentially give states more leeway in how they broker health care.But, as with the last go-round, people aren’t pleased: this time, centrists, providers, and patient advocates — if you’re healthy, you’ll do better, but if you’re not, you’ll likely pay more, for possibly less.

In the tweet of the moment

After postponing his vote, on Thursday, the Senate HELP committee voted in favor of FDA commissioner nominee Scott Gottlieb, sending the candidate to a full Senate vote sometime soon. But the vote came with a little drama — some of the Republicans needed to move Gottlieb along had to be hunted down.

He said this

“I think one of the biggest people to blame for the failure of the health care bill was me.”

— Budget director Mick Mulvaney, on the AHCA and his assertion that he misread the divide between GOP moderates and the far-right

Number of the day: 4,000

The number of health care jobs at the VA that may go unfilled, even as President Trump lifts the federal hiring freeze. The vacancies are all part of a plan to encourage veterans to seek private health care.

Read on

  • It looks like insurer subsidies, once a sticking point for insurers staying in the market, are safe for now

  • A long-shot proposal would bring universal, government-based coverage to Californians

  • President Trump said health care reform would be quick. Here’s why it hasn’t been

Wednesday, April 26

Today in health care reform

You can’t please all of the people all of the time. As a new bill works it way off of congressional computers, what makes the Freedom Caucus happy (letting states opt out of some ACA guarantees) is bound to irritate the Tuesday Group. Even when a Tuesday Group co-chair is helping negotiate. A few no votes are turning to yes, but some Americans may bristle when they see that Congress’s mandated individual market health plans are exempt from some of the major cuts written into the new proposal.

Number of the day: 80

That’s the amount per premium dollar that the industry group representing health insurers says goes to paying for health care. But this analysis of the report, from JAMA Forum, raises red flags. The number is simplistic, and if the Affordable Care Act is repealed, that number will surely drop.

Today in confirmation hearings

The Senate HELP committee was supposed to vote today on FDA nominee Dr. Scott Gottlieb, but it’s been postponed until tomorrow. Criticism still swirls about his ties to industry, including this nugget about his role, while at the FDA, in helping a company being investigated for pushing opioid drugs get more fentanyl for a pain-relieving lollipop. Still, it is expected that he will get enough votes to head to the Senate floor for a full confirmation vote.

She said this

“I’m feeling optimistic, but I want to see it in writing.”

— West Virginia Senator Shelley Moore Capito, on efforts to shore up a health care fund that benefits coal miners. The president, who had the support of many voters in coal country, has remained silent on the issue.

Today in nominations

President Trump’s pick to run the nation’s mental health agency is causing a stir. Dr. Elinore McCance-Katz, former chief medical officer of SAMHSA, the Substance Abuse and Mental Health Services Administration, is President Trump’s nominee to run the agency as assistant secretary for mental health and substance use. The position was created under the 21st Century Cures Act by Pennsylvania Congressman Tim Murphy, who said (he had another candidate in mind) she’s a bad pick because she was at SAMHSA when it being investigated for wasteful spending. Advocates like her because, for one, she believes in medication-assisted treatment for addiction. After leaving SAMHSA in 2015, she was highly critical of the agency, saying it didn’t do enough to directly treat psychiatric illnesses.

Read on

Tuesday, April 25

Today in health care reform

About half of Americans in one poll aren’t convinced that the GOP effort will make anything better, President Trump says we’re close, but Paul Ryan says we need to focus on the government shutdown first. And moderate Republicans are being rather quiet about a bill in the works that could end a lot of consumer protections afforded by Obamacare.

She said this

“Hi, my name is Dana from the University of Maryland. Would you take a quick survey on my tablet, please?”

— Sociologist Dana Fisher, who conducts research on protests, at the March for Science last Saturday. She’s trying to understand if the March for Science, the Women’s March, and the upcoming climate march are indicators of a 1960s-style movement against President Trump or the work of seasoned protesters.

Number of the day: $2.3 billion

That’s the increase in federal costs for 2018 if cost-sharing subsidies, which insurers use to offer lower deductibles and copays to some people in the individual market, are taken away.

Read on

Monday, April 24

A march in April

On Saturday, all over the world, people marched for science. The marches were political — organizers said they were by no means partisan, but anti-Trump messages were clear at some rallies. People marched for many reasons, including this woman, who said science saved her life. The president, for his part, said Saturday he would not forsake jobs in protecting the environment.

He said this

“I would never willfully abandon my commitment to my Commissioned Corps officers, to the American people, and to all who have stood with me to build a healthier and more compassionate America.”

— Dr. Vivek Murthy, former surgeon general, on why he refused to resign his post. He was fired on Friday and replaced by Rear Admiral Sylvia Trent-Adams, a nurse.

A research summit in May

Vice President Mike Pence and a host of other Trump administration officials are meeting with biomedical research leaders from government, academia, and industry on May 8 to talk shop. The summit is presumably an effort to save federal funding for basic medical research — President Trump has called for cutting about $1.2 billion in funding this year and close to $6 billion in funding for 2018.

Number of the day: 35

That’s the percent of the nation’s job growth since 2007 that has come from health care. President Trump’s job creation platform would seem to be a good fit for the health care sector, which has benefited many American cities hit hard by the recession, but promises to repeal Obamacare are what some industry experts call “incompatible” with his job creation goals.

Read on

  • Kentucky’s Medicaid reform proposal includes a rewards program that would earn recipients their benefits

  • With a government shutdown looming, President Trump is lobbying hard to revive health care reform

  • With health care reform in limbo and deadlines approaching, states are looking to appease skittish insurers

  • Human civilization exists because of climate conditions. Changing those conditions could wreak havoc on human health

Friday, April 21

Today in health care reform

President Trump’s first 100 days in office are coming to a close, and the White House is pressuring Congress for another go at repealing Obamacare ASAP to get a win under its belt. But it’s not clear what’s going to be in the revamped bill or if any proposed changes — changes to community rating, invisible risk-sharing, etc. — will please the various GOP factions who were dissatisfied with the first go-round. All this is happening with the backdrop of a government shutdown.

Science in the White House

A White House official said the annual science fair, started during the Obama administration, will continue under President Trump. No date has been set, but the news comes a day before the March for Science in Washington, D.C., and satellite marches all over the country. It’s an interesting move for the White House, as Trump still has not appointed a director for the Office of Science and Technology Policy and has proposed cutting billions from the budget of the National Institutes of Health.

Tweet of the day

Number of the day: $44 billion

The total value of pharma and biotech acquisitions in the first quarter of 2017, a drop of 13 percent from the previous year. Bloomberg says President Trump’s drug pricing rhetoric is partly to blame.

Read on

  • Visa reform could affect the hiring of doctors (Kaiser Health News)

  • Some states are extending deadlines for insurers to submit 2018 rates (Modern Healthcare)

  • The FDA had plans to release 100 draft guidances this year, but has so far only released six (MassDevice)

Thursday, April 20

Today in health care reform

The bell is about to ring for the end of congressional recess, and health care reform looks to be back on the table. Politico reports that a new deal is in the works to give states more flexibility to opt out of different parts of Obamacare, while, at the same time, keeping provisions on preexisting conditions. It’s not clear if this plan will sway any Republican votes, but both centrist Republicans and tea party leaders have had their hand in it, and Vice President Pence believes the deal will be done.

He said this

“There’s a rumor that he is going to do something in that area. But maybe I and others will convince him that that’s not worthwhile.”

— Microsoft cofounder Bill Gates, on President Trump and a possible vaccine safety inquiry, in an interview with STAT’s Helen Branswell (@helenbranswell).

Number of the day: 428,000

The number of veterans under the age of 65 who got health care coverage through the Affordable Care Act between 2013 and 2015 but who may not have been eligible for VA services. This represents a 40 percent drop in veterans being uninsured, from 9.6 percent to 5.9 percent. On Thursday, President Trump signed a bill extending some veterans’ ability to use private health care providers.

Paying to party

Drug makers Pfizer and Amgen and health insurers including Anthem and Aetna gave heavily to gain access to the Trump administration, Federal Election Commission documents show. Kaiser Health News reports that the money paid for the inauguration, candlelight dinners, and black-tie balls. Tobacco companies, interested in expanding their vaping footprint, also gave handily. These gifts come as the president has vowed to lower drug prices and his administration has been unclear whether cost-sharing reductions will be paid to insurers.

He said this

“I think that the march is a bad idea. It threatens to undermine the objective nature of scientific research that is so critical to its integrity.”

— Postdoctoral researcher Arthur W. Lambert, at the Whitehead Institute for Biomedical Research in Cambridge, Mass., on why he won’t participate in the March for Science on Saturday, seen by some as political action against anti-science decision-making out of the Trump administration

Read on

Wednesday, April 19

No assurances

Insurance executives met with CMS Administrator Seema Verma Tuesday, and left without knowing whether they’d be getting cost-sharing reductions for 2018. According to the Washington Post, Verma referred the conversation to Congress. CSRs, as we’ve noted before, are Obamacare subsidies paid to insurers to help offset the out-of-pocket costs for lower-income people on the exchanges. The payments are being argued about in court, and while some people say that without them, the individual market will collapse, we noted Tuesday that insurers may cautiously stay in the market.

She said this

“It’s become increasingly difficult over the past few decades for scientists to call themselves Republican as part of their core identity. The Republican party has been moving further and further away from recognizing the neutrality of science. Now it’s reached a peak.”

— Katharine Hayhoe, an evangelical Christian and atmospheric scientist at Texas Tech University in Lubbock, on being a conservative academic.

The pressure is on

During a speech Tuesday in Kenosha, Wis., President Trump urged his audience to talk to their members of Congress about health care reform and repealing the Affordable Care Act. He has previously said he wants to push through health care reform before tax reform, and believes, despite what his Treasury secretary says, it can be done by August.

Corporate cash

Pharma is second only to tech in the amount of money companies have stashed overseas. Both industries, and others, are waiting for promised tax relief to bring the dollars back stateside. But the money will likely do little to help job growth, CBS says. Instead, it will go toward mergers, stock buybacks, and higher dividends.

Read on

  • How the ankle replacement industry (and, some say, HHS head Tom Price) might benefit from a proposed Medicare payment rule

  • Consumer advocates want the Trump administration to make it easier to get a costly prostate cancer drug

  • President Trump signs an executive order to reform the H-1B visa program, which could impact life science hiring

  • Who are the different groups of people going to the March for Science? For one, journalists, including STAT. Talk to us

Tuesday, April 18

Tax reform vs. health care reform

Efforts to reform health care, which continue to start and stop under President Trump, will almost definitely push back tax reform, said Steven Mnuchin, the US Treasury secretary. The original goal was August, which was “aggressive,” Mnuchin said. Trump has said that health care reform will make tax reform easier, and is pushing ahead.

He said this

“We spend a lot of time looking at media and social media to see if we can glean any useful information.”

— Kirk Zimmer, executive vice president of Sanford Health Plan, which serves the Dakotas, on what role the federal government will play in the individual health insurance marketplace in 2018. Some companies have just a few weeks to decide whether to participate in the exchanges for the next year and to set prices for plans. While there are concerns that some companies will bow out because of uncertainty out of the White House, in general, insurers say they will stay in the market. The question is how much plans will cost consumers. Insurance executives are slated to meet with the Trump administration today.

Deregulating hospitals

A proposed rule that was released on Friday by the Trump administration is asking hospitals that are owned by doctors to comment on their role in health care and their thoughts on regulations that apply to them. Modern Healthcare says that for-profit and nonprofit hospital trade associations have lobbied against physician-owned hospitals because of what they call cherry-picking high-profit clientele, such as in orthopedics. Industry groups that support physician-owned hospitals see these requests as a way to prove their worth.

Number of the day: 3 million

The price tag on the ad campaign being run by Trump supporters America First Policies to garner support to repeal Obamacare.

Read on

  • President Trump is expected to sign legislation on Wednesday to extend a program that allows veterans to seek private health care

  • Wisconsin is looking to expand Medicaid, so long as some adult recipients can be drug tested

  • EPA chief Scott Pruitt’s predecessor outlines why cuts to EPA programs are cuts to public health

Monday, April 17

Concerns about opioid promises

During his campaign, President Trump said he would expand access to treatment for people suffering from opioid addiction, but experts are worried he’s opting instead for tough-on-crime policies. The president’s opioid commission is calling for more study — but people who treat addiction say the problem is pretty well-defined. They point to actions to curb National Institutes of Health funding and a lack of action on prescription opioid makers as further evidence the president is turning away from his campaign platform.

The March for Science: More than just Trump

Lydia Villa-Komaroff may not be a household name, but the research she did in the 1970s helped spawn an entire US industry — biotechnology. She’s an honorary co-chair of the March for Science and talks with STAT’s Pat Skerrett about the sentiments behind it. Lack of support for science and budget cuts existed long before President Trump, she said, even if he sparked the fire that led to the march. And while the march tends toward progressive participation, she knows many conservative scientists who support the march, and many liberals who aren’t sure the march will change anything.

Tomorrow is tax day: Do you have insurance?

Tax returns are due tomorrow, and with it, fines for not having insurance. It’s called the “shared responsibility payment” and not everyone who is uninsured has to pay it. Last year, the IRS says, about 6.5 million people paid an average of $470. Who leads the pack in paying the fine? Texas, with about 1 million returns filed in 2015 showing a fine.

Read on

  • Fact check: What members of Congress say about where their health care comes from and who pays for it

  • Health and taxes: The president’s renewed push on health care underlines the complicated relationship between it and tax reform

  • Market stabilization: A proposed rule that insurers like but consumer groups don’t could affect the individual insurance market in these ways

Friday, April 14

Mar-a-Lago is missing

Dana-Farber Cancer Institute holds a yearly fundraiser at Mar-a-Lago, President Trump’s resort in Florida, and this year was no different. Almost. For the first time, the cancer center’s newsletter, which has a write-up of the event, has no mention of Mar-a-Lago, no mention of the president, who attended this year, and no pictures including him. The decision might have to do with the president’s immigration orders, the effect such orders had on medical personnel traveling to the US immediately after, and backlash the institute received for not canceling the event. Dana-Farber has said it will avoid controversial venues in the future.

Ensuring insurer participation

With the president threatening to hold insurer payments hostage to bring Democrats to the table to negotiate health care reform comes a rule enacted on Thursday to try and stabilize the individual health insurance market. The rule shifts costs away from insurers and shortens the open enrollment period for 2018, satisfying some insurer demands, but causing worry for those that say people will buy fewer plans as a result.

He said this

“This action is another example of EPA implementing President Trump’s vision of being good stewards of our natural resources, while not developing regulations that hurt our economy and kill jobs.”

— EPA chief Scott Pruitt, on a decision Thursday to postpone compliance deadlines for an Obama-era rule regarding arsenic and mercury ending up in public waterways. The rule would affect power plants and coal producers, among others. Arsenic exposure can cause organ toxicity and mercury is a potent neurotoxin.

She said this

“Trump’s decision to attack our right to clean water on behalf of coal executives is just another indication of who this administration works for — and it isn’t American families.”

— Mary Anne Hitt of the Sierra Club, in response to Pruitt. Hitt said that more than one-third of coal-powered power plants discharge wastewater within five miles of drinking water intakes from downstream communities. She also said the administration was ignoring peer-reviewed research on the effects of heavy metal exposure.

Read on

  • Conservationists and politicians sue to stop the border wall until an environmental impact assessment is done on health and ecological impact

  • A new survey finds scientists are wary of FDA nominee Dr. Scott Gottlieb’s ties to industry and are concerned about the effect of budget cuts to the NIH

Thursday, April 13

You can never go home again

Especially if you’re a Republican on recess during a political fight over health care. Especially if you represent more purple places in the US. Especially if you decide to host a town hall. As Axios reports, siding with Trump over Trumpcare can get you booed, and not just from Democrats. It can earn you serious opposition in an upcoming election. It can earn you angry TV ads and put you on the spot on your commitment to sparing preexisting condition coverage. And, as we mentioned Wednesday, for this congressman, it can get one of your most famous moments as a politician thrown back at you.

She said this

“Carbon dioxide is not a pollutant, and carbon is certainly not a poison. Carbon is the chemical basis of all life on earth. Our bones and blood are made out of carbon.”

— Kathleen Hartnett White, director of the Texas Public Policy Foundation’s Armstrong Center for Energy & the Environment and former Texas state official, on whether carbon dioxide should be regulated as part of climate change. The climate change skeptic is in the running to lead the White House Council on Environmental Quality.

He said this

“Think of President Trump as the Martin Luther King of healthcare. ”

— CNN political commentator Jeffrey Lord, during a Thursday morning television appearance. He went on to say that the president’s effort to garner congressional support for the repeal of Obamacare was similar to the work of the civil rights leader in promoting equal rights legislation seen as unpopular during its time.

A sword over their heads

The battle over insurer subsidies continues, as President Trump has said he will stop paying them as a way to get Democrats to bargain on the Affordable Care Act. To be clear, these aren’t the subsidies people get to buy policies, but payments that the federal government gives insurers to offset losses from reduced copays and deductibles in some plans. Congress has sued to stop the payments, and a judge upheld its claim. In the meantime, though, the payments continue. For their part, however, top Democrats aren’t biting.

Read on

Wednesday, April 12

A new drug czar

Reports have surfaced that President Trump may be close to picking a drug czar. Tom Marino, a congressman that represents a chunk of northern Pennsylvania, appears to be getting the nod. Marino is a former prosecutor and author of an Obama-era law that was supposed to increase coordination between the Drug Enforcement Administration, pharmacies, and distributors regarding prescription drug abuse, but instead has been charged with limiting the DEA’s ability to shut violators down.

He said this

“We’re going to have a phenomenal tax reform, but I have to do health care first. I want to do it first to really do it right.”

— President Trump to Fox Business Network on Tuesday. This is a change of course for the president, who, after the failure of AHCA, said he would turn his attention to tax reform while waiting for Obamacare to fail.

Forensic junk science

When President Obama convened a panel of scientific advisers to investigate some of the different forensics techniques used as courthouse evidence, the goal was to identify best practices, says the Atlantic. There were multiple ways to analyze bite marks, blood spatter, and the like, and there were concerns that poor methods were putting the wrong people in jail. The findings were never acted upon, and with Attorney General Jeff Sessions disbanding the committee, it’s unclear what will happen to the burgeoning and sometimes troubled field of forensic science.

Read on

Tuesday, April 11

A long and winding road

Scientists are concerned about federal efforts to determine whether basic research is “in the national interest.” Some discoveries seem far removed from life-changing breakthroughs, but scientists argue you can’t know what early discoveries will save lives. Ike Swetlitz takes a look for STAT Plus at some basic research findings, and the medicine they helped spawn. One of the discoveries? An enzyme from geyser bacteria that allows researchers to copy DNA. Without it, we might not have some of the drugs and biologics we have now.

The power of uncertainty

One of the ways that the Trump administration can hasten the fall of Obamacare is through uncertainty. Insurers have a few more weeks to decide whether they want to participate in the individual marketplace for 2018, but it may not be clear that they will get what they want in return — payments from the government that the Trump administration and House Speaker Paul Ryan say will happen, but whose existence is being battled over in court.

Housing as health care

Health care providers across the nation are trying their hand as housing developers, with the idea that giving people who are homeless and chronically ill a place to live might give them the stability to manage their diseases. But many of these housing developments rely on government subsidies and tax credits through the Department of Housing and Urban Development. Patients and providers both fear the loss of health-related gains should deep cuts proposed for housing programs happen.

He said this

“The only effective way of addressing climate change is to make the price of fossil fuels include their cost to society.”

— Climate scientist James Hansen, on the demise of the Clean Power Plan and what he thinks (as do some Republicans) would reduce carbon emissions — a fee that fossil fuel companies pay that is repaid to the public as a dividend.

Read on

Monday, April 10

Behind the hearing, Gottlieb edition

Many people are praising Dr. Scott Gottlieb’s performance on Wednesday during his confirmation hearing with the Senate HELP committee. In his responses, says Endpoints News, are a few less obvious things that Gottlieb would do as head of FDA. Gottlieb is likely to promote different ways to do clinical trials, but still with an eye toward safety and efficacy. He’ll also likely look at complex generic drugs and drugs for rare diseases.

He said this

“Asking the NSF to certify that what they do is in the national interest is like asking the Defense Department to certify that what they do is in the national interest.”

— Jonathan Moreno, a professor of medical ethics and health policy at the University of Pennsylvania, on calls by Republicans, including Representative Lamar Smith, to verify that what the National Science Foundation funds is in “the national interest.” The language was written into the law that created the agency, but has been recently brought back up in efforts to examine the agency’s spending.

Trump effect, Kansas and Georgia edition

Outside of Washington, some elections are raising eyebrows as possible rebukes for Trumpcare. The Tuesday special election for the House seat representing the 4th District of Kansas could be the first test of GOP popularity in the US after the failure of the AHCA. The Democratic candidate seems popular, and the GOP governor vetoed efforts to expand Medicaid, so key Republicans have descended to stump for the Republican candidate. The Democrat running to take over HHS Secretary Tom Price’s seat in Congress in Georgia has raised large sums of money and appears to be doing well in early voting.

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Friday, April 7

Fallout in the GOP over the failure of health care bill

Congress has left town for its spring recess. Before lawmakers scooted, House Republicans proposed setting up a federal insurance pool for those with serious and expensive medical conditions. But there is reportedly growing tension between the White House and GOP lawmakers, and administration aides are under pressure to help the House deliver another bill soon.

Protecting US leadership in medicine

The Trump administration has proposed cuts to the budget of the National Institutes of Health, and Tom Price, the secretary of health and human services, has argued that there are plenty of savings to be had. But in a new op-ed, a former president of MD Anderson Cancer Center says that failing to invest in NIH “will have long-term consequences for America’s leadership in biomedical research in the 21st century.”

A matter of time

Dr. Tony Fauci, director of the National Institute of Allergy and Infectious Diseases, said it’s only a matter of time before the Trump administration has to confront a major disease outbreak. “Absolutely something is going to happen,” he said. Why? According to Fauci, every administration in modern history has had an outbreak on its watch.

Quote of the day

“I will admit that was somewhat gratifying.”

— Hillary Clinton on the GOP’s failure to pass a health care bill

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  • Trump eyes combining infrastructure with health care, tax reform

  • Republicans are trying to save their health plan with more money to cover sick people

  • A modest proposal for the march for science

Thursday, April 6

A congressman marching

There is but one PhD-level scientist in Congress, and he’s decided to join the March for Science on April 22. Representative Bill Foster of Illinois is a former Fermilab physicist who tells STAT’s Lev Facher he’s not marching as a politician, but as a researcher. He says that being a scientist allows him to be political without some of the partisan side effects: When he sees policymaking that ignores evidence, he says he criticizes the policy, not the politicians who proposed it.

He said this

“We want to do a great infrastructure plan, and on that side I will say that we’re going to have, I believe, tremendous Democrat support. We are also going to have some good Republican support, and I think it’s going to be one of the very bipartisan bills and it’s going to happen. I may put it in with health care.”

— President Trump in an interview with the New York Times, suggesting that he might tie infrastructure legislation to efforts to repeal and replace Obamacare.

Repeal efforts march on

Congress is about to go on recess, but before it does, Trump wants more action on repealing Obamacare. Bloomberg reports that the White House wants any new replacement bill to protect seriously ill patients, and the House is expected to propose a high-risk pool amendment for people with grave illnesses. The Washington Post reports that Trump needs a win on health care, in part because of fears that in-party rancor will grow, but it’s unclear whether a high-risk pool amendment will get to the House floor by the end of the week.

Insurance brokers marching away

Politico says the White House may be looking to cut certain insurance subsidies in an effort to destabilize the individual market, and insurers have until June to decide whether to stay in the market, but Modern Healthcare says that insurance brokers are bowing out now, and have been for a while. Why? Insurance companies aren’t paying brokers commissions on higher-tier plans or special plans that they sell to consumers. Between 2015 and 2017, nearly 35 percent of healthcare.gov brokers have left the system.

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Wednesday, April 5

A White House science advisor

What is a science advisor and why do we need one? John P. Holdren, President Obama’s science advisor and the director of the Office of Science and Technology Policy, addresses this in a column for STAT. His key points? A science advisor helps plan the nation’s science and technology budget, he says, but more broadly, the office provides the science and technology data needed to inform policy in many areas, from economics to urban affairs to agriculture.

In the tweet of the moment

Dr. Scott Gottlieb was grilled today in a confirmation hearing to become the head of the FDA. He answered several questions about potential conflicts of interest and his well-known views about the FDA approvals process, but also about opioids.

Trump and GMOs

While one arm of the biotech industry waits to see what Trump will do to drug prices, supporters of another arm are hoping he’ll start enforcing an Obama-era decree that USDA, EPA, and FDA update their regulatory framework to account for GMOs, agriculture made by biotechnology. Among the recommendations that the nonpartisan Information Technology & Innovation Foundation makes? Enforce food labeling laws, and open up national lands for planting biotech seeds.

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  • Some insurers may be pulling out of the individual market because of losses, but this company is reaping huge profits from Obamacare

  • Democrats write a letter to Trump, telling him the legal framework already exists to lower drug prices and to fulfill his promise quickly

  • As Republicans continue efforts to repeal it, for the first time, a majority of Americans approve of the Affordable Care Act

  • Health care in Alaska is expensive, so its residents are watching to see what happens to the Affordable Care Act

Tuesday, April 4

More family planning cuts

The Trump administration has pulled about $32 million in US funding to the United Nations Population Fund under a contested claim that the organization promotes abortion and sterilization in China. The cuts affect the organization’s 2017 budget and keep in line with Trump’s call to reduce US financial involvement in the United Nations. The money will instead go into the US Agency for International Development’s coffers for its family planning work.

More work on repeal and replace

The White House circled the wagons Monday with both moderate and conservative Republicans in an effort to revive the Obamacare repeal effort. Vice President Mike Pence led the effort, including meeting with the Freedom Caucus, whose resistance to the American Health Care Act derailed its progress. The president is anxious to continue the repeal effort — the bill could materialize as early as today, and the White House wants a vote before spring recess.

He said this

“This is no time to undercut progress, for God’s sake. It’s time to double down.”

— Former Vice President Joe Biden, on Trump’s proposed cuts to the National Institutes of Health.

She said this

“Half of our present GDP is due to investments in science and technology and much of that investment has been by the federal government.”

— France Córdova, director of the National Science Foundation, on proposed cuts to federal research spending. Dr. Robert Califf, former FDA commissioner, also spoke out against cuts to research.

More insurers bowing out

The Trump administration will continue to subsidize insurers in the marketplace while the subsidies get debated in court, but for some companies, it may not matter. Wellmark Blue Cross and Blue Shield announced Monday that it would pull out of the Iowa individual market for 2018, even as an insurance stabilization measure gets finalized. Wellmark, which has also pulled out of the South Dakota market, said it’s lost $90 million over the past three years. Wellmark isn’t alone. Insurers in Minnesota have announced a $687 million loss for 2016, an announcement that could portend massive rate hikes in the future, Minnesota Public Radio says.

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Monday, April 3

A Medicaid vote

The state Legislature in Kansas has just narrowly failed to override the governor’s veto of a Medicaid expansion in the state. The bill would have allowed up to 180,000 more people in the state to receive health insurance. The governor, Sam Brownback, vetoed the bill, over what he said would be “unrestrainable” costs to the state. The vote was 81-44 in the state house; they needed 84 votes to override the veto.

Up in smoke

The president’s perspective on some aspects of the pharma industry is well-known (lower drug prices, faster approvals), but what about drugs like nicotine and marijuana, and the small businesses they’ve seeded? The pro-business president has talked about leaving medical marijuana machinations to states, but at the same time, his administration has talked about stricter enforcement of drug laws. Experts hope he’ll stick to his states-first thinking. As for e-cigarettes and vaping, there is hope that he will back off regulations that affect this estimated $10 billion industry.

Revealing disclosures

Financial disclosures released late last week by the White House revealed some interesting health- and science-related connections. The president’s senior counselor, Kellyanne Conway, was once paid as a consultant for the American Association for the Advancement of Science, one of the groups behind the upcoming March for Science. Deputy White House counsel Makan Delrahim counts Bayer Healthcare, Ardent Healthcare, and the Medical Device Manufacturers Association as larger sources of income. The president’s top economic advisor, Gary Cohn, owns stock in Samumed, an anti-aging company valued at $12 billion, even though one of its founders said the company couldn’t deliver returns to investors right away if it went public.

He said this

“Yeah, I don’t lose. I don’t like to lose.”

— President Trump, on the failure of GOP health care reform, in an interview with Financial Times. He follows up with promises to work with Democrats, even if the end result isn’t “as good a form of healthcare” as he wants.

She said this

“Just a single health condition could drain a state’s entire high-risk pool, with no money remaining for those with cancer, heart attacks, diabetes, or other medical conditions.”

— Houston writer Melanie Ormand, on the cost of care following her brain aneurysm, and how high-risk pools wouldn’t affect just her if she needs more treatment post-ACA, but everyone in Texas who might end up in such a system.

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