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D.C. Week: Senate GOP Targets Key Obamacare Provision in Tax Bill
Also, FDA advisors pan an inhaled form of Cipro for severe lung infections
by Shannon Firth, Washington Correspondent, MedPage Today November 18, 2017
WASHINGTON -- Senate Republican leadership announced plans to scrap a key pillar of the Affordable Care Act in their tax reform bill -- the penalty for individuals who don't buy health insurance -- and the House passed its own version of tax reform, minus the mandate.
Senate Tax Bill to Dump Individual Mandate
Senate Republicans introduced a new version of their tax bill that would eliminate the Affordable Care Act's (ACA) penalty for not enrolling in qualified health plans.
The Congressional Budget Office (CBO) estimated last week that repealing the individual mandate would raise the number of insured Americans by 4 million by 2019, and by 13 million in 2027 -- but also reduce the deficit by $338 billion.
That was a small boon to Republican leaders whose tax bill would otherwise balloon the deficit by $1.5 trillion from 2018-2027.
The CBO report estimated that payments to so-called Disproportionate Share Hospitals costs would rise by more than $40 billion.
Robert "Bob"Laszewski, president of Heath Policy and Strategy Associates, in a recent blog post wrote that "killing the mandate while simultaneously opening up the market to cheaper, stripped down alternatives would combine to create unintended consequences the Republicans haven't appeared to comprehend." He was referring to President Trump's recent moves to allow partial-coverage health plans with low premiums but that leave enrollees on the hook for potentially huge bills.
The House passed its version of the tax reform bill on Thursday.
Surgeon General Ready to Take On Opioids
Surgeon General Jerome Adams, MD, MPH, expressed support for once-controversial policies such as needle exchanges and "Housing First" initiatives during a hearing of the Senate Health, Education, Labor, and Pensions (HELP) Committee on Wednesday.
While the purpose of the hearing was to focus on healthy communities, with an emphasis on things businesses and local communities can do to help residents and employees, that discussion was at times derailed by Democrats blasting a Republican decision to include a repeal of the individual mandate in their tax reform bill.
Sen. Tim Kaine (D-Va.) asked the new surgeon general whether a lower percentage of uninsured individuals was a sign of a healthier community: "If, as you testify, and as the statistics would seem to suggest, one [piece of] evidence of being healthier is reducing the percentage of uninsured, why would we want, in a tax bill, to do something that would increase the number of uninsured?"
Adams argued, "Health insurance coverage is one part of the equation, but it's not going to solve the problem if we don't focus upstream."
FDA Panel Says No to Inhaled Cipro for Severe Lung Infections
Citing inconsistent data, concerns about drug resistance and ability to meet only one of four primary endpoints in two studies, a majority of the FDA Antimicrobial Drugs Advisory Committee voted not to recommend ciprofloxacin dry powder for inhalation (Cipro DPI) for treatment of the severe non-cystic fibrosis bacterial bronchiectasis.
The committee voted down two regimens of Cipro DPI: 9-6 against a 14-day course and 14-1 against a 28-day regimen.
Despite the vote on the 14-day regimen, the majority did not seem to have a strong opinion, with members who voted yes and those who voted no agreeing they were "smack in the middle," "right on the line" or "could've voted either way."
"It was a very close call and a very challenging question," said committee chairman Lindsey R. Baden, MD, citing his reservations about the language in the vote that called for evidence of substantial efficacy and safety. "What are the data that support that level of proof?" Baden said.
CRISPR Backers Wax Enthusiastic at Senate Hearing
Members of the Senate Health Education, Labor and Pensions (HELP) Committee on Monday heard testimony from several experts in CRISPR, the gene-editing technology that has taken the genetics community by storm.
They mostly extolled the technology's promise for, yes, curing diseases that currently can only be managed as chronic conditions, often not well.
But not much was said about the ethics of altering individuals' genomes. Concerns about the technology's potential to create "designer babies," for example, were mentioned only in passing.
Katrine Bosley, CEO and president of Editas Medicine, based in Cambridge, Massachusetts, spoke of possible new treatments for diseases of the eye and liver, instead of cures -- for fear of "overpromising." She described an Editas' research program that targets Leber's Congenital Amaurosis Type 10 (LCA10), a disease that causes vision loss or blindness in children.
Matthew Porteus, MD, PhD, said that if his research lab, or another researcher in the scientific community, finds a cure for sickle cell disease, it might take only a few "tweaks" to then find a cure for other illnesses, such as severe combined immunodeficiency or "bubble boy disease."
HHS Official Downplays Fears Over Contraceptive Rule Changes
Worries that big corporations are going to roll back their contraceptive coverage benefits now that the Supreme Court has ruled they can do so are unfounded, Roger Severino, director of the Office for Civil Rights at the Department of Health and Human Services (HHS), said Thursday.
"The fear that [hotel chain] Hilton is somehow going to change its policies on contraceptive coverage ... I just don't see that happening," Severino said here at a meeting of the Federalist Society's National Lawyers Convention. "It's really going to be the Hobby Lobbys of the world, and those are very limited in number, and those rights should be protected."
Severino was referring to Hobby Lobby, the arts-and-crafts-store chain that was the plaintiff in the Supreme Court case successfully challenging the Affordable Care Act's (ACA) contraceptive mandate.
The chain's ownership maintained that it should not have to offer contraceptive coverage to its employees because doing so would conflict with the owners' religious beliefs. Although the ACA includes an exemption to the mandate for religious organizations, it doesn't include one for for-profit corporations whose owners object. The justices ruled that the government must include such corporations in the exemption.
On Monday, the American Enterprise Institute will discuss "The Future of Delivery System Reform."
And on Monday and Tuesday, the FDA's Pharmacy Compounding Advisory Committee will discuss "six bulk drug substances nominated for inclusion on the section 503A Bulks List."
Congress is on recess.
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