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What A GOP Senate Would Mean For Obamacare - Health Care Edge: Brought to you by ACS CAN

What A GOP Senate Would Mean For Obamacare

By Sophie Novack and Sam Baker


GOP PLAYBOOK TAKES SHAPE: The odds of a Republican takeover of the Senate seem pretty strong, and that has serious implications for Obamacare. Sure, the GOP's campaign pledge of full repeal will turn out to be politically impossible -- President Obama will still be, well, President Obama. But if Republicans do capture the upper chamber, they could pick up significant bipartisan support for several smaller measures, from repealing the tax on medical devices (possibly the easiest lift, according to conversations with GOP aides) and maybe even as big as weakening, delaying or repealing the employer mandate. Obama would veto some of those bills, but not necessarily all of them -- and even for the Senate to force the president to actually veto something would be a big change.

Top Health Care News

GOP SENATE: "The ultimate goal is to fully repeal Obamacare and replace it with common sense proposals that solve the cost problem," said a senior GOP aide. "But recognizing that Obama will be President for the next 3 years, we will use every lever we can in the meantime to lay the groundwork for its repeal." (Sam Baker, National Journal)

OBAMACARE IS GETTING A MANAGEMENT OVERHAUL: Two weeks into the job, new HHS Secretary Sylvia Mathews Burwell announced a reorganization of the management structure overseeing the health law's implementation. Andy Slavitt--heading the repair effort for consulting firm Optum--will join CMS as principal deputy administrator, responsible for the exchanges, Medicare, and Medicaid. Two other positions will be created specifically for the exchanges: a CEO and a chief technology officer.


Controversy could be brewing around Slavitt's appointment: the day before HHS's announcement, Republican Sens. Orrin Hatch and Chuck Grassley raised concerns about possible conflicts of interests, given that Optum is a subsidiary of UnitedHealthcare, which sells plans in the Affordable Care Act's exchanges. (Sam Baker and Sophie Novack, National Journal)

HEALTH PLANS PUSH BACK AGAINST RISING DRUG PRICES: More insurers are refusing to cover certain drugs unless the manufacturers charge less, which seems to be creating greater price competition among pharmaceutical companies. The concern is particularly felt with expensive specialty drugs, used to treat more complex conditions like cancer or multiple sclerosis. Spending on specialty drugs increased 14.1 percent in 2013 and by even larger margins in previous years, according to Express Scripts, the largest pharmacy benefits manager. (Andrew Pollack, New York Times)

STATE EXCHANGES DON'T KNOW HOW THEY'LL PAY FOR THE ACA IN 2015: The administration issued $4.6 million in federal grants to the states creating their own insurance exchanges, to get their new online systems running. But the health law requires the exchanges to be self-sustaining by the beginning of next year, and states have to figure out how to continue to cover the costs of running the websites, and pay for staff, outreach, and office space. (Sarah Kliff, Vox)


VIRGINIA GOV. MAINTAINS VOW TO EXPAND HEALTH COVERAGE: Gov. Terry McAuliffe vetoed portions of the state budget that Republicans included in the hopes of blocking Medicaid expansion, but stopped short of committing to expand health coverage through the ACA's Medicaid expansion. The state government had been in a budget standoff for the past few months, due to McAuliffe's commitment to expand Medicaid, and Republican lawmakers' staunch opposition. McAuliffe said he would have vetoed the entire budget if not for the time crunch to pass one before July 1 or risk a government shutdown.


The Virginia governor still vowed to expand coverage to Virginians, saying he was exploring several options available, though he declined to offer specific details on his plan at this time. (Jeffrey Young and Samantha Lachman, Huffington Post)

PENNSYLVANIA GOV. FINDS INSURER SUPPORT FOR MEDICAID EXPANSION PLAN: Gov. Tom Corbett's office said Friday that nine insurers have signed up to provide Medicaid-subsidized insurance under his plan to use federal expansion dollars to buy private insurance for low-income Pennsylvania residents, though only one of the insurers would cover the entire state. The Obama administration would still need to approve the proposal. (Associated Press)

MOVEMENT BY STATES TO COVER SEX-CHANGE SURGERY UNDER MEDICAID: Gender reassignment surgery and hormone therapy for transgender individuals will soon be covered by MassHealth, the state Medicaid program, according to an announcement from the state Executive Office of Health and Human Services. (Jeremy C. Fox, Boston Globe)

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  • Only two other state Medicaid programs—in California and Vermont—guarantee coverage for treatment of transgender issues, according to Gay & Lesbian Advocates and Defenders.
  • A lawsuit was filed against New York last week, seeking Medicaid coverage for transgender individuals in the state. (Larry Neumeister, Associated Press)
  • The action on Medicaid follows a decision at the end of last month that allows Medicare to cover gender reassignment surgery. (Sophie Novack, National Journal)


HOSPITALS FACE MEDICARE CRACKDOWN FOR HIGH INJURY RATES: One-quarter of U.S. hospitals--more than 750 hospitals--will lose 1 percent of their Medicare payments beginning in October, as a penalty for having the worst patient injury rates. (Jordan Rau, Kaiser Health News)

SOURCE EYED IN MEDICARE INSIDER TRADE PROBE: The Securities and Exchange Commissions said for the first time Friday that it believes Brian Sutter, staff director of the House Ways and Means Committee's health-care subpanel, could have been a source for lobbyist Mark Hayes--the latest development in a long-running federal investigation into whether congressional aides or other government officials leaked news of a change in Medicare payment policy to traders. According to SEC court filings, Hayes--the central figure in the probe--spoke on the phone with Sutter about an hour before stock trading closed on April 1, 2013, just before the health care announcement. (Andrew Ackerman and Brody Mullins, Wall Street Journal)

HOUSE COMMITTEE ORDERED TO COURT IN PROBE: A U.S. district judge on Friday set a July 1 hearing date for the Ways and Means Committee--along with Sutter--to appear, and show why it should not be required to produce documents that the SEC demanded in May. (Larry Neumeister, Associated Press)


STATES AND TECH FIRMS BATTLE OVER MORE THAN $100 MILLION IN ACA EXCHANGE FUNDS: Oregon, Maryland, Nevada, and Massachusetts are trying to recoup funds or withhold money for work by contractors that they say was not properly done, and hampered enrollment success. Meanwhile, some technology companies responsible for the exchanges point fingers in the opposite direction, saying government officials in those states changed deadlines or parameters of the job. (Stephanie Armour, Wall Street Journal)

CALIFORNIA INVESTIGATES INSURER PROVIDER NETWORKS: State regulators are looking into whether Anthem Blue Cross and Blue Shield of California have violated the law through inaccurate and misleading provider lists and narrow doctor networks in their ACA plans. (Chad Terhune, Los Angeles Times)

MASSACHUSETTS REACHES SETTLEMENT WITH CGI: In an agreement signed Friday, Massachusetts agreed to pay a total of $52 million to end its relationship with CGI, the Canadian technology company that built the state's failed insurance website. The agreement calls for an additional $35 million in payments to the technology company, on top of the $17 million already paid, all of which comes from federal grants to replace the state's existing site to meet ACA requirements. (Felice J. Freyer, Boston Globe)


CDC WORKERS TAKING ANTI-ANTHRAX DRUGS: At least 52 workers at the Centers for Disease Control and Prevention are taking antibiotics as a precautionary measure, following a lapse in lab safety this month that may have exposed them to anthrax. The agency raised its estimate of potentially affected workers from 75 to 86, and possibly more. (Marilynn Marchione, Associated Press)

CDC REASSIGNS LAB DIRECTOR BEHIND ANTHRAX PROBLEM: The agency reassigned Michael Farrell, head of the CDC's Bioterror Rapid Response and Advanced Technology Laboratory, as it investigates the incident that may have exposed workers to live anthrax, according to two CDC scientists. (Hilary Russ and Julie Steenhuysen, Reuters)

CONGRESS, THE ANTI-VACCINATION MOVEMENT, AND THE RESURGENCE OF MEASLES: "In 2000, I was a counsel for the Democratic staff of the House Government Reform Committee working on public health issues, including immunization policy. The committee was in its second year of hearings whose purpose on paper was to oversee various aspects of the nation's immunization program. But in reality, these hearings had become a forum for spouting unproven, and eventually disproven, allegations, linking the measles-mumps-rubella vaccine to autism.

...My message to Congress is simple: What you say matters...People are watching, they are listening and the outcomes of "oversight" that some legislators took part in years ago can today be seen in the resurgence of a disease that was eliminated in the United States around the time these hearings took place." (Sarah Despres, Politico)

JUDGE UPHOLDS NYC POLICY BARRING UNVACCINATED STUDENTS DURING ILLNESS: A federal judge ruled against three families who claimed the city's immunization policies violated their right to free exercise of religion, by keeping their children from school, sometimes for a month at a time. The judge cited a Supreme Court ruling from 109 years ago that gives schools states broad power in public health matters, saying the Court "strongly suggested that religious objectors are not constitutionally exempt from vaccinations." (Benjamin Mueller, New York Times)

STATE-FEDERAL SHOWDOWN BREWING OVER WHETHER GOVERNMENT SHOULD REGULATE BEHAVIOR OF DYING PATIENTS: "In May, Colorado Gov. John Hickenlooper (D) signed into law a controversial measure that allows terminally ill patients to obtain experimental medications before they've been approved by the Food and Drug Administration...Missouri and Louisiana have since joined Colorado in passing Right-to-Try laws, and Arizona, where the Goldwater Institute is based, is expected to consider legislation later this year...The Right-to-Try laws exist in a legal gray area, because the state statutes are in direct conflict with federal law." (Jonathan Easley, Morning Consult)

White House

OBAMA ENCOURAGES FAMILY-FRIENDLY WORK POLICIES: The president is holding a daylong summit today to encourage more employers to adopt family-friendly policies.

"Only three countries in the world report that they don't offer paid maternity leave - three - and the United States is one of them," Obama said in his weekly address. "It's time to change that. A few states have acted on their own to give workers paid family leave, but this should be available to everyone, because all Americans should be able to afford to care for a family member in need." (Nedra Pickler, Associated Press)


FDA EXTENDS COMMENT PERIOD FOR E-CIGARETTE REGULATIONS: The agency announced it will extend the public comment period from July 9 to Aug. 8, after receiving a great deal of input. (Michael Felberbaum, Associated Press)

LAWMAKER PROPOSES E-CIGARETTE REGULATIONS: Democratic Rep. Jackie Speier unveiled legislation Friday that would regulate e-cigarettes the same way as tobacco products, addressing concerns that e-cigarette companies market their products to children. (Associated Press)

Happening This Week

The Supreme Court will issue decisions Monday, Wednesday, and Thursday at 10 a.m. We're monitoring decisions on the contraceptive mandate case and the abortion protest "buffer zone" case; justices have one week to issue 14 opinions before the session ends.



  • House Appropriations full committee markup of the FY 2015 State and Foreign Operations Appropriations Bill, which maintains the ban on emergency abortion funding for Peace Corps volunteers and restrictions on foreign aid for family-planning groups. The Senate Appropriations Committee voted 19 to 11 last week to pass amendments that lift these restrictions, to be included in the 2015 State Department spending bill. The battle over these abortion funding provisions is a familiar one in the appropriations process. The markup will be at 10 a.m.


  • House VA Committee hearing titled "Veteran Benefits Administration and Veterans Health Administration Interactions: Ordering and Conducting Medical Examinations" at 10 a.m.


Don't Miss Today's Top Stories

Health Care Edge is one of my top resources."

Meghan, Associate Specialist

Great news in short form along with much needed humor."

Patrick, President of private healthcare consulting firm

Informative and help[s] me stay on track. "

Director of Scientific Affairs, Non-profit medicial society

Sign up form for the newsletter