HealthCare Roundtable e-News – September 12, 2018

Supreme Court Nominee Kavanaugh Won’t Say If He Will Uphold Obamacare Pre-Existing Conditions Protections

Supreme Court Nominee Kavanaugh Won’t Say If He Will Uphold On day two of his confirmation hearing, Supreme Court nominee Brett Kavanaugh told senators he could not give assurances that he would uphold pre-existing condition requirements under Obamacare as constitutional.

When asked by Sen. Sheldon Whitehouse (D-RI) whether he could assure that he would protect coverage for people with pre-existing conditions under the Affordable Care Act, Kavanaugh pressed that he could not “give assurances on a specific hypothetical,” adding that his declining to speak on the matter is consistent with how other nominees have discussed issues they may rule on in the future.

Many Democrats fear that Kavanaugh will overturn Obamacare’s pre-existing condition protections, and key moderate senators are watching Kavanaugh’s comments closely. Sen. Joe Manchin (D-W.Va.) who appeared at Kavanaugh’s hearing earlier on Wednesday, has warned about the disastrous effect Obamacare’s repeal could have on residents of his state.

Kavanaugh was also questioned on his views of Roe v. Wade, to which he reaffirmed that he views the case as settled law and precedent. However, while being questioned by Sen. Dianne Feinstein (D-CA) about whether he thought Roe as decided was correctly, he explained his judicial interpretations are separate from policy influences.

Leaders Welcome ACO Revamp, But Voice Concerns Over Proposed Shared Savings Cut

In a letter to the Center for Medicare & Medicaid Services, leaders of the U.S. House of Representatives Ways and Means Committee weighed in on the agency’s efforts to revamp Medicare accountable care organizations. The proposed regulations are primarily related to burden reduction, including the agency’s overhaul of Medicare Accountable Care Organization (ACO) program and proposal to extend current contacts.

Ways and Means Committee Chairman Kevin Brady and Subcommittee Chair Peter Roskam both provided feedback on the proposals, praising many of the recent efforts toward reducing regulatory burden on physicians; however, they requested the agency to reconsider reducing shared savings down to 25 percent for those ACOs that don’t take on risk.

The letter is part of the Committee’s initiative to pare down Medicare regulations, and mentions several rules recently put forward by the Administration. The letter also offers feedback on CMS’ recent proposals to the Medicare ACO program, including urging CMS to reconsider its aggressive push to move providers into taking on higher levels of risk.

Brady and Roskam also raised concerns with cutting the shared savings rate and suggested that CMS include some level of regularity and payment stability for ACOs across Medicare during the length of their shared savings arrangements.

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McCain’s Replacement Has History of Lobbying Against Drug-Price Measures the Late Senator Supported

Jon Kyl, the former Arizona senator selected to temporarily fill John McCain’s seat in the Senate, has been lobbying for the brand drug industry since 2015, according to lobbyist filings for Kyl’s firm, Covington & Burling.

Drug industry trade group PhRMA and several of its member companies had been among Kyl’s most prominent clients. For PhRMA, he has lobbied on a host of bills concerning the trade and regulation of prescription drugs and, although McCain advocated for drug imports and against the brand drug industry practice of using post-market drug safety plans to block generic competition, Kyl lobbied on the other side of those policies.

McCain was among the earliest supporters of letting Americans import drugs and supported the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act, which aims to stop brands from using Risk Evaluation and Mitigation Strategies to deny generic-drug makers samples needed for generic-drug approvals. Since leaving the Senate, Kyl has lobbied against drug importation and lobbied for Celgene against the CREATES Act.

Kyl has not yet committed to serving until 2020, when there would have to be a special election to fill the final two years of McCain’s term.

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GOP Bill Proposing Pre-Existing Condition Protections Leaves Some Democrats Skeptical

GOP senators introduced legislation last month that would bar issuers from denying coverage to people due to pre-existing conditions and from charging higher premiums due to a person’s health status. The Ensuring Coverage for Patients with Pre-Existing Conditions Act (S. 3388) would protect many of the Affordable Care Act’s market reforms and indicates that the GOP could be ready to embrace key provisions of the law and end their efforts to fully repeal it.

“Oral arguments in Texas v. United States will begin on September 5th, and if the judge rules in favor of the plaintiffs, protections for patients with pre-existing conditions could be eliminated,” a joint release from several sponsors says. Thom Tillis (R-NC), says the legislation is “a common-sense solution” to guarantee those with preexisting conditions will have health coverage, regardless of the court’s ruling.

Despite the title of the bill, Democrats pointed out that the GOP legislation does not ensure full protections for those with pre-existing conditions. Larry Levitt, vice president for health reform at the Kaiser Family Foundation wrote on Twitter that the legislation does not include the ACA’s ban on pre-existing condition exclusions, even though the measure would be knocked out if the court rules in favor of the plaintiffs or the DOJ.

Senate health committee ranking Democrat Patty Murray (WA) called the legislation a “gimmick,” claiming, “if Republicans are serious about protecting health care for millions of families, they should join Democrats to defend patient protections already in place and work with us on solutions that actually drive down costs for families and prevent health care discrimination.”
Sen. Lamar Alexander (R-TN), who was among the GOP senators who introduced the bill and has advocated for bipartisan healthcare reform, said that he will continue to find lawmaking solutions that enforce protections described in the bill.

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