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Health March 15, 2017

Pelosi Says Democrats Have A Responsibility To Look For Common Ground On Health Law

House Minority Leader Nancy Pelosi says the proposed Republican health bill would lead to an enormous transfer of wealth from poorer Americans to richer ones.

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Marian Carrasquero/NPR

When Democrats held a majority of the seats in the U.S. House of Representatives, and Rep. Nancy Pelosi was the House speaker, she helped pass the Affordable Care Act, also known as Obamacare.

Now, after more than six years in the minority party, she is watching House Republicans move to repeal and replace parts of the law.

She says that although Democrats don’t have the votes to stop the GOP legislation alone, they can still show their opposition to it.

“In my office I have a painting of Abraham Lincoln, who said, ‘Public sentiment is everything,’ ” Pelosi told NPR’s Robert Siegel. “Regardless of the number of Democrats in the House, the number of people who are affected, 24 million [people] who would lose their care, I’m depending on public opinion. … The fact is the more we point out the shortcomings of the legislation, the fewer votes [Republicans] will have.”

The interview below has been edited for length and clarity.

Interview Highlights

On the shortcomings of the Affordable Care Act

Let’s go back to where we were before the Affordable Care Act, because that was a time where [some people] wouldn’t even be able to have any insurance. So what was the purpose of the Affordable Care Act? [It was] threefold. One, to lower cost. Two, to improve benefits. And three, to expand access for millions more people. And it’s done all three. …

Look, there hasn’t been a bill ever passed of this magnitude, whether it was Social Security, Medicare, Medicaid, voting rights, civil rights bill, that was not revisited. Some of the improvements we [could] have [had] in the Affordable Care Act were there, but the Republicans prevented them from happening. So you can be a self-fulfilling prophecy and say, “I’m gonna make sure this doesn’t work now. Now see, it didn’t work.”

On whether the Democrats could work with President Trump or House Speaker Paul Ryan on health care legislation

We have a responsibility to the American people to find as much common ground as we can. There has to be sincerity, though. … I don’t think he has the faintest idea — the president — about the health care thing.

[But Rep. Paul] Ryan … is [a] philosophical, right-wing, anti-government [person], and so an act of mercy for him is to reduce the government’s role. So we’re talking about two different things. They’re debating whether it’s “Trumpcare” or “Ryancare,” but neither of them wants it identified with themselves because it’s such a failure in the public mind.

On Trump’s knowledge of health care

The more the president might learn about [health care], then he might see where there’s a path [to working with Democrats], because to tell you the truth, the Affordable Care Act is a private sector initiative. It contains many Republican ideas.

Understand this about Republicans, and then you’ll understand part of what our challenge is here: They always are gearing whatever they do to benefit the high end. This is the biggest transfer of wealth in the history of our country, in terms of hundreds of billions of dollars going into the pockets of the top 1 percent of the people in our country, at the expense of the good health of our middle class and those who aspire to the middle class.

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Health March 14, 2017

Planned Parenthood Would Lose $178 Million In Payments Under GOP Health Plan

Cecile Richards, the president of Planned Parenthood, says the health care provider takes in about $400 million per year in reimbursements under Medicaid and other federal programs.

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The proposed American Health Care Act targets the health provider Planned Parenthood with a set of proposed limits on Medicaid payments to the organization.

Monday, the nonpartisan Congressional Budget Office confirmed the magnitude of those limits. The Republican plan would block $178 million in Medicaid reimbursements to Planned Parenthood in 2017.

“The vast majority of our patients are on some kind of federal program,” Cecile Richards, president of Planned Parenthood, told NPR’s Ari Shapiro on Tuesday.

In all, she said, about 1.6 million patients receive health care from the organization each year through federal programs such as Medicaid, totaling upwards of $400 million in annual federal reimbursements.

“Planned Parenthood operates just like every other health care provider in this country that provides abortion services. We get reimbursed for preventive care,” she explained.

“I guess if you want to reduce unintended pregnancy and the need for abortion, the last thing you should do is try to deny women the access to family planning,” Richards said.

Tom Glessner, the president of the National Institute of Family and Life Advocates, which lobbies against abortion, is optimistic about the projected savings for the federal government.

“On the positive side, taxpayers benefit from this provision,” he told NPR.
“Taxpayers would spend $156 million less, over a decade, by defunding Planned Parenthood, even if women used more Medicaid dollars during their pregnancies.”

Glessner was referring to the increase in births the CBO projects if Medicaid patients are cut off from Planned Parenthood. The costs associated with about 45 percent of all births in the U.S. are paid for by the Medicaid program.

“In the one-year period in which federal funds for Planned Parenthood would be prohibited under the legislation, the number of births in the Medicaid program would increase by several thousand, increasing direct spending for Medicaid by $21 million in 2017,” the CBO report notes.

The Republican plan technically cuts off funding to Planned Parenthood for only one year. If the organization stops providing abortions, it will be eligible for Medicaid reimbursements again. But Richards said there is no chance that will happen.

“We provide full reproductive health care for people in this country,” she said. “And even though abortions may make up a small portion of what we do, women and families and young people come to Planned Parenthood because they count on us to be on their side, and to provide them with health care they need.”

Federal spending on abortions is already illegal, except in the case of pregnancies that are the result of rape or incest or that threaten the life of the mother, as NPR has reported.

Republican lawmakers and some clinicians have said that if Planned Parenthood closes clinics, other health providers would try to take on those patients. But community health clinics say they are already overburdened.

The Republican plan currently calls for tens of billions of dollars for states to spend as they see fit, including on preventive care for women.

“How will the states use that money? They have great flexibility,” Douglas Holtz-Eakin, former director of the Congressional Budget Office and current president of the conservative think tank American Action Forum, told Ari on Tuesday.

“They can give it to insurers as reinsurance for expensive patients; they can give it directly to individuals to cover out-of-pocket costs; they can create a variety of other programs like high-risk pools for expensive patients.”

But Richards argued that spending would need to address a supply problem in rural or poor communities.

“The public health community has been abundantly clear that they cannot absorb the 2.5 million patients that Planned Parenthood sees each year,” she said. “And particularly for women who have found a lump in their breast or need birth control immediately, and maybe a community health center can see them in a month or two months, that’s not good enough.”

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Health March 13, 2017

Congressional Budget Office Releases Report On GOP Health Care Bill

The non-partisan Congressional Budget Office released an analysis of the House GOP health care bill on Monday. Proponents of the bill downplayed the importance of what the CBO is likely to do.

AUDIE CORNISH, HOST:

Congressional forecasters are warning that 14 million more Americans will be without health insurance next year if Republicans succeed in their plan to repeal and replace Obamacare. The report put out by the Congressional Budget Office says the number of uninsured would grow by about 24 million over the next decade. NPR’s Scott Horsley joins me now in the studio. Hey there, Scott.

SCOTT HORSLEY, BYLINE: Hi, Audie.

CORNISH: So let’s start with this analysis from the CBO. They’re trying to predict what the GOP plan would cost the government and also how it would affect the insurance market, right? What are they saying?

HORSLEY: Well, as you say, the forecast from the CBO says the GOP plan would insure a lot fewer people than Obamacare does – 14 million fewer next year, 24 million fewer by 2026. Some of that would be voluntary. The GOP plan eliminates the tax penalty for not having insurance, so some people who were buying reluctantly just to avoid that penalty would stop doing so. House Speaker Paul Ryan says that’s OK.

(SOUNDBITE OF ARCHIVED RECORDING)

PAUL RYAN: They sort of overestimate the uninsured number, just like they overestimated who would be insured by Obamacare. But I do believe that if we’re not going to force people to buy something they don’t want to buy, they won’t buy it. And that’s kind of obvious.

HORSLEY: Now, CBO also cautioned, though, that some people would stop buying insurance because they won’t be able to afford it. Now, the government subsidies and the Republican plan are, on balance, less generous than in Obamacare, especially for the poor and older people. And finally, forecasters say we’re likely to see a drop in the Medicaid rolls as the federal government starts to limit its funding for that program and states cut back on eligibility.

CORNISH: Now, what about the cost of insurance itself? I mean, what could happen to premiums?

HORSLEY: Initially, CBO predicts that we will see an increase in insurance premiums on the individual market. Premiums will be 15 to 20 percent higher than under Obamacare. After about 2020, though, forecasters are predicting somewhat lower premiums as more stripped-down policies are introduced. That’s one of the few things in this report that White House budget director Mick Mulvaney likes. He says greater competition would be good for insurance prices.

(SOUNDBITE OF ARCHIVED RECORDING)

MICK MULVANEY: Every place else where the market is allowed to function, quality goes up and costs go down. And I think if you look for something the CBO may have gotten right in this report, it’s that the premiums are actually going to come down in cost.

HORSLEY: Now, the CBO also says the mix of people buying coverage would likely shift, with more healthy, young people who can afford that bare-bones coverage, but fewer people in their 50s and 60s who might need or want more comprehensive policies.

CORNISH: Now, even before the forecast came out this afternoon, you had the White House and some of their allies on Capitol Hill essentially discrediting the numbers. I thought this was a nonpartisan office. What’s going on here?

HORSLEY: Nobody wants to look like they’re knowingly taking health insurance away from millions of people, so the White House is trying to inject as much uncertainty as it can in these CBO numbers. White House spokesman Sean Spicer says lawmakers should take this forecast, which is known as a score, with a big grain of salt.

(SOUNDBITE OF ARCHIVED RECORDING)

SEAN SPICER: Obviously, they’re going to look at the score. I get it. But in the same way that members relied on the score last time, they were way off.

HORSLEY: The CBO did overestimate the number of people who’d gain coverage through the Obamacare exchanges. They also underestimated the number that would gain coverage through the Affordable Care Act’s Medicaid expansion. So this is tricky business, Audie, and the CBO concedes there is considerable uncertainty around these predictions.

CORNISH: In the meantime, there’s still a lot of criticism of the Affordable Care Act, right? What’s going on there?

HORSLEY: Yeah, Republicans are highlighting the rising premiums in the individual market, the drop in insurance company competition. President Trump tweeted this morning, Obamacare is imploding. He and other Republicans are trying to create a yardstick that will make the GOP plan look better by comparison. However, the Congressional Budget Office forecasts that in most parts of the country the individual insurance market will remain stable whether or not Obamacare is repealed.

CORNISH: That’s NPR’s Scott Horsley. Scott, thanks so much.

HORSLEY: Good to be with you, Audie.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Health March 12, 2017

Pence Makes Case For Republican Health Plan In Kentucky

Vice President Pence visited Kentucky to rally support to repeal and replace the Affordable Care Act. It’s a hard sell for some Republicans who favor a full repeal, like Kentucky Sen. Rand Paul.

LOURDES GARCIA-NAVARRO, HOST:

Vice President Mike Pence stopped in Louisville Saturday to rally support for the Republican plan to repeal and replace the Affordable Care Act. As Ryland Barton from Kentucky Public Radio reports, replacing Obamacare is a hard sell for some Republicans.

RYLAND BARTON, BYLINE: The White House dispatched Vice President Mike Pence to pitch the repeal-and-replace effort to conservatives. On Saturday, Pence admitted, it’s a challenge.

(SOUNDBITE OF ARCHIVED RECORDING)

VICE PRESIDENT MIKE PENCE: Folks, let me be clear. This is going to be a battle in Washington, D.C. And for us to seize this opportunity to repeal and replace Obamacare once and for all, we need every Republican in Congress. And we’re counting on Kentucky.

BARTON: Kentucky’s U.S. Senator Rand Paul has been one of the loudest opponents of the repeal-and-replace bill, favoring an outright repeal instead. He says the current version of the bill would be dead on arrival in the Senate.

(SOUNDBITE OF ARCHIVED RECORDING)

RAND PAUL: We are divided. We have to admit we are divided on replacement. We are united on repeal, but we are divided on replacement.

BARTON: About 500,000 Kentuckians got health care through the Affordable Care Act, mostly through the expansion of Medicaid. That helped bring the state’s uninsured rate from more than 20 percent down to 7 percent. After the Pence event, Republican Congressman Brett Guthrie of Kentucky argued it wouldn’t be possible to pass a bill scrapping Obamacare without a replacement.

(SOUNDBITE OF ARCHIVED RECORDING)

BRETT GUTHRIE: So I think if you just do a full repeal and you don’t have a replacement in place, it would send us right back to where we were. And I don’t think that’s the right policy.

BARTON: Meanwhile, Erica Williams, a physician who attended the Pence event, said she just wants Obamacare repealed but a replacement should be tried first.

(SOUNDBITE OF ARCHIVED RECORDING)

ERICA WILLIAMS: The main thing is that we want a hundred percent repeal. So we want all of the power to go to patients and their doctor.

BARTON: For NPR News, I’m Ryland Barton in Louisville, Ky.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Health March 11, 2017

Illinois Congressman On Why He Supports The Republican Health Care Plan

Congressman Rodney Davis of Illinois supports the Republican Health Care Plan that’s making its way through the House. But he says that there will likely be hurdles before the bill becomes a law.

LAKSHMI SINGH, HOST:

We want to turn now to Congressman Rodney Davis. He is a Republican speaking to us from Decatur, Ill., and he is in favor of the bill being advanced by House Republicans. Congressman Davis, thanks so much for joining us.

RODNEY DAVIS: Thanks for having me on.

SINGH: So please tell us briefly why you are in favor of this bill.

DAVIS: Because the status quo is collapsing. The health insurance marketplace as we know it is not sustainable under the current law. And if we do nothing and watch states like Illinois have to come up with hundreds of millions of dollars under the current law just to keep the Medicaid expansion in place that we have, then I’m abdicating my responsibility as a policymaker. The bill that I’m supporting I’m sure will be changed by the time it goes to the Senate and comes back to us. But I’m looking forward to the debate to make our health care system better than it is today.

SINGH: We just heard from the president of the American Medical Association, who says that this bill will put health insurance out of reach for millions of Americans, especially older, lower-income patients. What do you make of that?

DAVIS: Well, I disagree with the statements. And I’ve talked to many doctors over my time in Washington over the last four years who were very frustrated with the current status quo, with the Affordable Care Act as implemented. Doctors that I talked to are seeing less patients because of the compliance issues that they have to follow under Obamacare. We want to make the system better, and I look forward to having their input. But I would argue looking in Illinois, where we’ve had 45 to 55 – and friends of mine have had 87 percent increases in their premiums – Obamacare’s already costly. And frankly, the promise for families of saving $2,500 on average did not come true.

SINGH: Well, as you’re well aware, there has been pushback from the right as well, a lot of Republicans, especially in the Senate, who say that this bill does not go far enough in repealing the current health care law, the Affordable Care Act, also widely known as Obamacare. Rand Paul has called the Republican plan Obamacare lite. What do you make of his resistance to this current bill?

DAVIS: Well, I know Rand. Rand’s a friend of mine. I think this is a publicity stunt, though, that is not based on facts. His own plan has refundable tax credits just like our plan does. You know, I want to make sure that we don’t just pull the rug out from those who are dependent on coverage, those who may need the assistance through our Medicaid programs.

I think our program as designed is a great off-ramp to be able to get to a system that’s going to be affordable for every single American, that’s going to stop the collapsing status quo we know as Obamacare, and also actually be able to provide opportunities for families to get off of Medicaid and then be able to afford the coverage that they need or be offered more affordable coverage through their employers or future employers.

SINGH: Well, Congressman Davis, we know, though, that this is probably not going to be smooth sailing for this bill to be approved. There is enough resistance that there are going to be obstacles to getting to where you want to get. What is it going to take, you think, to get enough Republicans to bend behind this bill finally?

DAVIS: Well, we’ll see when we go back next week. I’m part of the deputy whip team, so we’ll be asking members what their concerns are. But I would – I would let you know that no major piece of legislation that I’ve seen go across the House floor in my four years has ever been easy. And this one will be no different. But we also have to remember as Republicans we are now the majority and we have the White House. We have to move from an opposition party to a proposition party. Now’s our time to put our ideas forward. And this is going to be a test for the Republicans, no doubt.

SINGH: Congressman Rodney Davis, representing Illinois’ 13th District, speaking to us from Decatur. Thank you so much for joining us.

DAVIS: Thanks for having me on.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Health March 10, 2017

Trump Chooses Dr. Scott Gottlieb To Head Food And Drug Administration

Scott Gottlieb, FDA deputy commissioner for policy, speaks to reporters at the Reuters Health summit in New York in 2005.

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Updated 7:30 p.m. ET

Dr. Scott Gottlieb is President Trump’s choice to lead the Food and Drug Administration, according to a statement from the White House.

Gottlieb is a political conservative and fellow at the American Enterprise Institute, where he has focused his research on the FDA and the Centers for Medicare & Medicaid Services.

An internist and hospitalist, Gottlieb has played leading roles in various government health agencies, including as deputy commissioner for medical and scientific affairs at the FDA during the George W. Bush administration. Before that, he was a senior policy adviser at CMS working on the implementation of Medicare’s then-new drug coverage for seniors.

Gottlieb is a prolific writer on health care issues, particularly the pharmaceutical industry. He is seen as a strong supporter of that industry and has championed deregulation.

“I think Scott is absolutely qualified,” lawyer John Taylor of Greenleaf Health tells STAT. “He has good professional credentials and personal integrity, and a track record that shows the ability to make difficult decisions.”

While Trump has promised at various times to make fairly radical changes at the FDA, Gottlieb is a seen as a conventional choice for commissioner by a Republican president.

Earlier in the year, odds were favoring the nomination of Jim O’Neill, an associate of Silicon Valley entrepreneur and billionaire Peter Thiel, a close Trump adviser. O’Neill created waves when he called for drugs to be approved as soon as they had been judged to be safe but before they are proved to be effective, as required under current law.

Should Gottlieb be approved by the Senate, one early target he may aim for is so-called off-label promotion of prescription drugs. The Obama administration issued tighter restrictions on how companies could market drugs for conditions not mentioned on drug labels — signifying the lack of FDA approval for that cause. Gottlieb has been highly critical of the Obama rules.

Gottlieb has many possible financial conflicts that could feature prominently in his confirmation hearings. He serves on advisory boards for several major pharmaceutical companies.

“Gottlieb is entangled in an unprecedented web of Big Pharma ties,” says Dr. Michael Carome, the director of Public Citizen’s Health Research Group, a pro-consumer advocacy group. “He has spent most of his career dedicated to promoting the financial interests of the pharmaceutical industry, and the U.S. Senate must reject him.”

According to the ProPublica website Dollars for Docs, Gottlieb received more than $400,000 between August 2013 and December 2015 in promotional talks, research, consulting and travel while practicing at Stamford Hospital in Connecticut.

As FDA commissioner, Gottlieb would oversee an agency that has regulatory power over a quarter of the U.S. economy, including not just pharmaceuticals but medical devices, food safety, cosmetics and other areas of human and animal health.

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Health March 9, 2017

The Winners And Losers In The Republican Health Care Plan

NPR takes a look at who stands to benefit and who could be hurt if the House GOP plan to repeal and replace Obamacare becomes law.

AUDIE CORNISH, HOST:

Medical and consumer groups alike are warning that millions of people could lose their health care if Republicans make good on their promise to scrap the Affordable Care Act. But as their legislation makes its way through Congress, President Trump is saying pay no attention to the critics. Trump tweeted this afternoon that the end result will be, quote, “a beautiful picture.” NPR’s Scott Horsley reports what that picture looks like depends on where you’re standing.

SCOTT HORSLEY, BYLINE: Every insurance system relies on a basic bargain. People pay in during good times so they can draw out when times are tough. With health insurance, people in good health subsidize those who are less so. And since none of us knows when we might get sick, we play along.

Obamacare adds two more subsidies to that basic formula. Young people are asked to pay more for insurance so older people can pay less, and the wealthy pay additional taxes to help cover costs for the poor. By undoing those subsidies, the Republican replacement plan would shift costs from young to old and rich to poor. The forecasting firm S&P Global estimates on balance, 6 to 10 million people might lose insurance coverage. But S&P director Deep Banerjee says more young people would likely sign up.

DEEP BANERJEE: We expect gains from individuals in the age group of 21 to 35 but losses from individuals in the age group of 45 to 64.

HORSLEY: That’s because the Republican plan allows insurance companies to offer stripped-down policies that would be cheaper and more attractive for young people even as the price of policies for older customers goes up.

A typical 21-year-old, for example, might be able to find coverage for around $2,600 dollars a year, most of which could be paid for with a $2,000 tax credit from the government. But a 64-year-old trying to buy insurance might have to pay five times as much, and the maximum tax credit in the GOP plan of $4,000 would cover less than a third of that.

BANERJEE: Two-thousand dollars for someone in their 20s does go a long way, which is why we think there will be more people in that age group who can afford it and will sign up. But the 3,500 or 4,000 for somebody in the 50s and 60s really doesn’t go a long way.

HORSLEY: So young people win, and older people lose under the GOP plan. There are regional variations as well. Unlike Obamacare in which subsidies are based on actual insurance costs in a given area, tax credits in the Republican plan are the same all over the country. That’s good for people living where health care and insurance costs are low, trouble everywhere else.

The American Medical Association and the American Hospital Association have come out against the Republican plan. Both groups say they’re worried about what would happen to the 20 million people who got coverage thanks to the Affordable Care Act.

KAREN TEITELBAUM: People who are just getting used to having care may feel that they don’t have a choice now in terms of primary care physicians and good prenatal care.

HORSLEY: Karen Teitelbaum is CEO of Sinai Health System which operates four safety-net hospitals in Chicago. Before the Affordable Care Act, about 15 percent of her patients were uninsured, and the system spent $50 million a year on charity care. Both those figures have been cut in half thanks to Obamacare. Teitelbaum says Sinai’s been able to invest the savings in preventive health measures and improve treatment for mental illness, programs that could be in jeopardy under the GOP plan.

TEITELBAUM: We’re going to have to perhaps cut back on services if the plan really rolls back coverage for those most in need because those are the very people that we see.

HORSLEY: So safety-net hospitals and their patients could be losers. Big winners include the wealthy. Obamacare is funded in part with extra taxes on people making more than $200,000 a year. Roberton Williams of the nonpartisan Tax Policy Center says scrapping those taxes would put tens of billions of dollars back in the pockets of the wealthy.

ROBERTON WILLIAMS: It’s almost all the very richest tax payers. And the bulk of the money is coming from people in the very top 1 percent, people with incomes over about $700,000 a year.

HORSLEY: Republican House Speaker Paul Ryan wants the House to pass the repeal and replace bill within weeks. Scott Horsley, NPR News, the White House.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Health March 8, 2017

Trump, Democrats Look For Common Ground On Drug Prices

Rep. Elijah Cummings, D-Md., listens as Rep. Peter Welch, D-Vt., speaks to members of the media Wednesday outside the West Wing of the White House in Washington following their meeting with President Trump.

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For years, congressional Democrats have tried to pass legislation to allow Medicare to negotiate prescription drug prices for millions of beneficiaries.

Now, they believe they have a not-so-secret weapon: President Donald J. Trump.

On Wednesday, U.S. Reps. Elijah Cummings (D-Md.) and Peter Welch (D-Vt.) met privately for about an hour with Trump and his newly appointed HHS secretary, Tom Price, to discuss ways to combat high drug prices. They were joined by Dr. Redonda Miller, president of Johns Hopkins Hospital.

The Congressmen pitched a House bill that would expand the federal government’s ability to negotiate drug prices, and they left feeling optimistic about what Trump will do.

“He made it clear to us that he wanted to do something,” Cummings said, characterizing Trump as “aware of the problem” and “enthusiastic.” Cummings is ranking member of the House Committee on Oversight and Government Reform.

Trump tweeted the day before his meeting with Cummings and Welch that he is “working on a new system where there will be competition” in the drug industry.

I am working on a new system where there will be competition in the Drug Industry. Pricing for the American people will come way down!

— Donald J. Trump (@realDonaldTrump) March 7, 2017

After the meeting, the president relayed his desire to work “in a bipartisan fashion to ensure prescription drug prices are more affordable for all Americans.”

Allowing the federal government to negotiate drug prices is not a new idea, but Cummings and Welch painted a picture Wednesday of a political landscape that is ripe for change. They said they have a president who “gets it.”

And, Welch said, “the price is starting to kill us, we just can’t afford it.”

The lawmakers said they handed Trump and Price the most recent draft of the bill for their review and to make comments. Cummings said he hopes to file the bill in two weeks.

A summary posted on the House committee website, said the proposed legislation would enable HHS secretary to negotiate lower prices with drug manufacturers under Medicare Part D, which provides coverage for prescription drugs bought at pharmacies.

An estimated 41 million Americans are covered by Part D. The drug benefit is provided through private insurers who each have their own formulary (a list of allowed drugs) and generally use pharmacy benefit managers for drug purchasing. The latest proposal would direct the HHS Secretary to establish a formulary.

The formulary would be used to “leverage” the purchasing power of the government, according to the summary.

Douglas Holtz-Eakin, a former director of the Congressional Budget Office and now president of the American Action Forum, said the idea of lowering prices through Medicare Part D negotiations is “completely unrealistic.”

Holtz-Eakin points out that insurers are already used to managing health care for beneficiaries and there are formularies in those plans. Adding into the law that the HHS Secretary should be part of the negotiations merely adds a “bully pulpit,” he said.

“The problem with the negotiation in Part D is not a political, partisan problem — it’s that it won’t work,” said Holtz-Eakin, adding that the Medicare Part D program is already holding prescription drug costs down because of the negotiating ability of the drug plans.

Trump himself, though, has long embraced the idea of Medicare negotiating drug prices. On the campaign trail in January 2016, he reportedly told a crowd in New Hampshire that Medicare could save a huge amount of money by getting discounts, as the biggest buyer of prescription drugs.

“We don’t do it,” Trump said that day, according to the Associated Press. “Why? Because of the drug companies.”

PhRMA, the drug industry’s powerful lobbying group, says price negotiation is already happening.

“Large, powerful purchasers negotiate discounts and rebates directly with manufacturers, saving money for both beneficiaries and taxpayers,” PhRMA’s Holly Campbell said Wednesday, in an email.

She pointed to a Congressional Budget Office report that said HHS would not be able to negotiate lower prices than already exist.

Trump met with pharmaceutical executives in January and told them, “We have to get prices down for a lot of reasons. We have no choice.”

Umer Raffat, a research analyst at Evercore ISI, said the industry felt less jittery after that meeting. They walked away understanding that President Trump wants to “promote innovation” while addressing prices.

Sarah Jane Tribbleis a senior correspondent atKaiser Health News, an editorially independent newsroom that is part of the nonpartisan Henry J. Kaiser Family Foundation. KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

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Health March 7, 2017

Public Clinics Fear Federal Cuts To Planned Parenthood Would Strand Patients

About 35 percent of the patients at this clinic in York, Pa., receive Medicaid. The clinic offers STD testing, cancer screening and contraception services as well as abortion services.

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Opponents of abortion rights have long argued that public funds for services like cancer screenings and contraception should go solely to health clinics that don’t provide abortions. They’ve made “defunding Planned Parenthood” — or, to be more precise — blocking the organization from receiving funding through federal programs like Medicaid — a major goal.

Now, Republicans in Congress have proposed an Affordable Care Act repeal that would, for one year, prevent Planned Parenthood from receiving Medicaid reimbursements for providing services like contraception and cancer screenings to low-income patients.

Dawn States, 26, says she wouldn’t be able to safely carry a pregnancy because of spinal problems that required two surgeries. She has turned to Planned Parenthood for years to obtain contraceptives and gynecological care.

Sarah McCammon/NPR

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Worry about just that kind of action under a Trump administration and Republican-controlled Congress is what brought Dawn States of Lancaster City, Pa., back into her local Planned Parenthood recently.

“I wasn’t sure what was going to happen in the next foreseeable future — and I actually physically can’t have kids,” States says, after having two spinal surgeries as a teenager.

She’s now 26 and has come to the Planned Parenthood clinic in York, Pa., to get a long-acting intrauterine device, or IUD.

“My spine is fused, and I have two rods. So it’s just not really set up for carrying around an infant,” she says.

States says she worries what will happen to women like her who receive Medicaid and depend on Planned Parenthood for this kind of care.

The organization has been a focus of anti-abortion activism because it provides about a third of the nation’s abortions, according to data gathered by the Guttmacher Institute — though, under current law, the clinics can’t and don’t use federal money to pay for the procedure, in most cases.

For other services, like screening for sexually transmitted diseases, Planned Parenthood gets more than $500 million in public funds — much of it from Medicaid — according to the organization’s most recent annual report.

“Whether this funding goes directly for abortion or indirectly allows them to have access to a large population of potential abortion clients, and to keep the lights on and man their call centers and do all their political activity, they should not be receiving taxpayer dollars,” says Eric Scheidler, executive director of the Pro-Life Action League, one of the groups pushing to cut off federal funding to Planned Parenthood.

Instead, Scheidler says, those patients should go to community health centers that specialize in treating low-income patients.

Other anti-abortion-rights groups, like Students for Life, also have been promoting the idea of redirecting those funds to federally qualified health centers, known as FQHCs — which perform a range of primary care services, often with a large share of Medicaid dollars.

The locations, hours and availability of services at these public health clinics vary from place to place. For patients in York, there’s a center less than a mile from Planned Parenthood — but it’s busy.

Ever wonder where pregnant women and their families would go when Planned Parenthood is defunded? #prolife#prolifegenpic.twitter.com/VpdgxaR4Zr

— Students for Life (@Students4LifeHQ) March 3, 2017

“There are more patients who seek our care than we’re able to provide care for,” says Jenny Englerth, CEO of Family First Health, which offers primary medical care and dental care at several clinics in the area. More than half of the patients at these clinics receive Medicaid.

Englerth says her patient loads keep growing, and the organization frequently has to turn away patients — sometimes daily, depending on the time of year.

“Sometimes in the height of the cold and flu season there just isn’t enough capacity to go around,” she says.

What’s more, doctors here can decline to provide birth control if it violates their religious beliefs. Englerth says she tries to hire a good mix of providers so that patients are able to get the care they need. But some, like Dr. Luis Garcia, choose not to offer birth control options like implants and IUDs. Garcia says he does screenings for sexually transmitted diseases and talks with patients about a technique called fertility awareness that can reduce unwanted pregnancies.

“But if a patient comes in and they want to get a Nexplanon or IUD or other birth control, then they can go to another provider,” Garcia says.

Heavy patient loads are common at these clinics, says Sara Rosenbaum, a health policy professor at George Washington University. Rosenbaum says these community health centers provide important services but aren’t as equipped to provide the reproductive services that Planned Parenthood is known for.

“There are all kinds of reasons why it’s not just a simple substitution of X for Y,” she says.

Rosenbaum points to Texas, where state lawmakers in 2011 reduced Planned Parenthood’s funding. Dozens of family planning clinics closed and the birthrate for low-income women went up.

Some patients, Rosenbaum says, are unwilling to use a clinic that, by design, serves the whole family.

“There may be people who were younger users who were uncomfortable where they might run into their aunt sitting in the waiting room,” Rosenbaum says.

Sally Gambill, a certified nurse midwife at the Planned Parenthood in York, says she has seen too many patients over the years who became pregnant because they weren’t able to obtain birth control efficiently.

“The sperm and egg really, really want to meet; they just do. That’s why we’re all here,” Gambill says. “And if we don’t help people, if they want to be on contraception [and] we don’t help people when they want to be helped — that day, that hour — then sperm and egg find each other.”

If Planned Parenthood were no longer an option for some patients, Englerth says, her network of health clinics would try to meet the need.

“But I also understand the reality of what we try to do every day and the pressures that we feel every day with our existing demand,” she adds, “so there are going to be gaps and shortfalls. And I can only project the stories of those individual women that will fall in between.”

If there are major changes to federal funding for low-income patients’ reproductive health services, Englerth says, she hopes they don’t happen too quickly, so centers like hers have time to try to close those gaps.

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Health March 6, 2017

House Republicans Release Affordable Care Act Replacement Bill

House Republicans released their plan on Monday to redo the Affordable Care Act. Congressional Republicans have voted several times to repeal the law, but President Obama vetoed those attempts.

ROBERT SIEGEL, HOST:

House Republicans have released the text of a bill that’s designed to remake the Affordable Care Act, also known as Obamacare. Congressional Republicans have voted dozens of times in the past to repeal the ACA. But that was when President Obama was in office, and he vetoed those attempts. That is expected to change under President Trump.

And joining us now with more on the changes being proposed in Congress is NPR health policy correspondent Alison Kodjak. And Alison, give us the main points here. I assume the Republicans are getting rid of the requirement that everyone have health insurance, the individual mandate.

ALISON KODJAK, BYLINE: Yeah. They’re getting rid of that by repealing the penalty that people would have to pay if they don’t have insurance. And that they’re doing that retroactively, meaning people who didn’t have insurance even last year, if this bill goes through, would not have to pay that tax penalty.

And what they’re going to do is change that – what they call the stick approach to a carrot by offering refundable tax credits to people to allow them to use that money to buy a health plan in hopes that more and more people will actually buy in voluntarily, rather than have to do it under a mandate.

SIEGEL: Refundable in this case means it could actually be in excess of what somebody owes in income taxes?

KODJAK: Yeah. It does. The tax credits that they have put forth are $2,000 for individuals under the age of 30. And they go up to about $4,000 if you’re over 50 years old. They’re per person, so a family could, you know, accumulate a lot of those tax credits up to $14,000.

But that refundable part is actually a point of contention. There are some of the most conservative Republicans who don’t appreciate the refundable tax credit because that means people, like you said, who don’t even pay federal income tax could get that money back. They see that as an additional entitlement.

SIEGEL: What about Medicaid? More than 10 million low-income Americans have gotten coverage under the Obamacare expansion of Medicaid. Does that survive in this House bill?

KODJAK: It survived in a way. The bill proposes that they freeze the program in 2020. And all of those people who are covered under Medicaid can stay covered. But if they leave Medicaid because they get a job or something, they can’t then re-enroll if they are over the regular Medicaid limit, which was much lower – the poverty line, rather than 130 percent of the poverty line, which is what the expansion allowed.

So it’s sort of a compromise between those who are afraid of throwing people off Medicaid and those people who don’t want to see that expansion stay in place.

SIEGEL: This is a House bill. As you’ve mentioned, there are some conservatives who object to provisions of it. I assume the Democrats object to it very broadly. What are its chances?

KODJAK: Well, that’s a bit of a question because yes, there are several conservatives in the House who object to it. All Democrats don’t want to see this – the Obamacare repealed at all. And in the Senate it’s even more complicated because there are already several conservative senators who’ve come out against this whole plan calling it, quote, “Obamacare-lite” and several senators who have said they’re concerned that it is not generous enough and people will be thrown off their health insurance.

The Republicans only have a small majority in the Senate. So it’ll be hard for them to lose any Republican senators and still be able to get this bill through.

SIEGEL: What happens next?

KODJAK: Well, this week, two House committees will mark up the bill, which means they’ll vote it out to the House. And then we’ll see where it goes from there.

SIEGEL: OK. That’s Alison Kodjak. Thank you.

KODJAK: Thanks, Robert.

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