What’s next for the Trump administration on Medicaid

WHAT’S NEXT FOR THE TRUMP ADMINISTRATION ON MEDICAID — Officials remain committed to pushing controversial changes to state programs, despite multiple lawsuits over work requirements and new data showing that thousands of Arkansans could lose their coverage in just a few weeks.

Among the looming developments:

— CMS is poised to approve Medicaid work requirements in three more states, your author scooped Thursday. The waivers for Arizona, Maine and Wisconsin are at the Justice Department, as officials work to make them “bulletproof” ahead of ongoing legal challenges.

— Native Americans are set to lose out. Arizona has repeatedly tried to exempt the tribes from work requirements, and Trump officials — including CMS administrator Seema Verma — support the idea. But they’ve continued to be rebuffed by agency lawyers, who say it would constitute an illegal racial preference.

The tribes will be “disappointed,” said one official, who added that there was a slim chance the lawyers’ decision could be reversed before Arizona’s waiver goes through.

— Other waivers also in the pipeline. CMS is reviewing Utah’s request for partial Medicaid expansion, although the White House has resisted the model.

Meanwhile, CMS is working with Mississippi and Alabama as the two states — neither of which expand Medicaid through the Affordable Care Act — seek to impose work requirements on their Medicaid populations.

— HHS says the work-requirement strategy isn’t about cutting costs. “There’s actually a clinical rationale for having community engagement,” Deputy Secretary Eric Hargan told POLITICO, arguing there’s evidence that requiring people to work or participate in other activities makes them healthier. “I think it could be additive to health care.”

Keep reading: More here.

— Meanwhile: Advocacy groups are threatening more lawsuits. Several groups have already sued to try and stop work requirements, successfully halting Kentucky’s Medicaid changes pending appeal and filing this week to stop Arkansas’s ongoing implementation. They say more litigation will come if CMS rolls out further changes.

“The Trump administration knows National Health Law Program and its partners will continue countering the administration’s abuse of laws that impact heath care every step of the way,” NHeLP spokesperson Jeremy Leaming told PULSE.

FIRST IN PULSE: SENATORS QUESTION ALEX AZAR ON PBM CLAIMS — Sens. Elizabeth Warren (D-Mass.) and Tina Smith (D-Minn.) are asking the HHS secretary to clarify his June testimony about pharmacy benefit managers’ role in drug pricing.

Nine companies — including CVS, Express Scripts and Humana — issued blanket denials of Azar’s claim that PBMs had “pushed back” against drugmakers’ plans for price cuts. CVS said there was only one example of a drug company committing to lower prices: when Pfizer rolled back planned increases in the wake of President Donald Trump’s tweet.

… In their letter, the lawmakers highlighted Azar’s past as the head of Eli Lilly’s U.S. division and concerns that he is still tied to the drug industry, writing that it may be an “unusual coincidence” that Azar’s earlier testimony aligned with the industry’s own talking points on high prices.

The senators asked that Azar name any drug companies that had said they wanted to cut prices, list when those conversations happened and detail discussions between HHS staff and drug companies on PBM hurdles — all by August 31.

CNN HITS BACK AT MAYO CLINIC — The news organization defended its series about a teenage patient purportedly being held at Mayo’s flagship hospital against her and her family’s will.

“Mayo refuses to acknowledge that the patient in this story, Alyssa Gilderhus, an adult, asked to be transferred, and that her family asked as well,” CNN said in a statement. CNN also said that Mayo has been “inaccurate and untruthful” about a meeting that the health system asked to remain off-record, according to email exchanges produced by CNN.

CNN also says it gave Mayo “ample time” to relate its version of the story — about 17 months — but Mayo repeatedly changed its position on how and whether it would go on record.

... The two organizations have spent three days publicly arguing over the facts in the story, with Mayo vigorously disputing CNN’s reports about the patient’s “escape.” The acclaimed health system on Wednesday issued a point-by-point rebuttal of CNN’s series, calling it “inaccurate, incomplete and irresponsible reporting.”


THANK GOODNESS IT’S FRIDAY PULSE — Tips to [email protected].

Heidi Heitkamp pushes pre-existing conditions. The North Dakota Democrat, who’s facing a tough Senate re-election fight, is out with an ad zinging rival GOP Rep. Kevin Cramer, who supporting striking protections for pre-existing conditions as part of ACA repeal. Watch ad.

HHS refugee office scrutinized for safety concerns. The Senate Homeland Security and Government Affairs subcommittee on investigations grilled HHS official Jonathan White, a career staffer, over whether the Office of Refugee Resettlement “lost” migrant children by failing to track them after they were discharged to sponsors.

The senators also insisted that HHS must aggressively monitor the children’s whereabouts once they’ve been discharged to sponsors in the United States, citing a bipartisan subcommittee report that some children were placed at risk.

“Please don’t make us a law enforcement agency,” White responded at one point. “I think it’s very important that HHS remain the agency tasked with the best interests of the child rather than to assign it enforcement duties.” More by WaPo’s Colby Itkowitz.

HHS has repeatedly rebuffed the suggestion that the children were lost, calling it an example of the adage “No good deed goes unpunished.”

Chirlane McCray on the migrant crisis and mental health. Writing in Health Affairs, the first lady of New York City decries the long-term effects of the Trump administration’s border separation policy and touts her city’s ThriveNYC program to address mental health.

“While this immediate crisis may pass, these senseless and cruel family separations show how much cultural change is still needed when it comes to mental health,” McCray writes. “It is imperative that government guidelines and laws reflect our growing body of knowledge about mental health and trauma.” Read post.

FDA approves first generic competitor to EpiPen. Thursday’s announcement came two years after Mylan’s EpiPen sparked a congressional inquiry over its rising price tag.

“Today’s announcement of the first FDA-approved generic version of EpiPen represents meaningful progress for American patients, and is good news for everyone who needs access to life-saving treatments for severe allergies,” Azar tweeted.

FDA scientists praise Gottlieb’s leadership. That’s according to a survey conducted by the Union of Concerned Scientists, which found that FDA’s scientists are happier than their counterparts at 16 other agencies surveyed. One major factor: They say Gottlieb has given them the space to do their work without political interference.

“Scientists across many federal agencies have been unable to do their jobs to the best of their ability under the Trump administration,” UCS’ Genna Reed writes, but at FDA, “the job satisfaction and ability to work appear to be even better than in years past.” More.

California: State advances bill to ban short-term plans. The state Assembly on Thursday approved a measure to prohibit new short-term health policies from being sold starting next year — a move that rebuffs’ the Trump administration’s plan to extend these policies from three months to a year, with the option to renew up to three years.

The measure now returns to the Senate for concurrence on amendments before moving on to the governor’s desk.

... While several states have proposed laws to limit these plans, California is the only state to propose a flat-out ban, POLITICO’s Victoria Colliver reports. The bill’s author, Sen. Ed Hernandez, called the policies “dangerous and deceiving” and said they subject people to high medical bills because patients often think they’re covered for services when they’re not.

Assemblyman Randy Voepel, a Republican who worked in the health industry, argued there’s a place for short-term policies in the marketplace: “Many consumers don’t need maternity, they don’t need mental health and they don’t want to pay for it.”

— Other bills heading to floor votes: A measure to make California the first state to require its public universities to make medication abortion available at student health centers starting in 2022 cleared Assembly appropriations on Thursday. The full Assembly will also get to vote on a third-party payment bill involving kidney dialysis centers and a measure that would extend and strengthen existing drug-pricing protections.

— What didn’t make the cut: Bills that would have extended the state’s Medicaid program to undocumented adults and expand coverage affordability. Health advocates pushed for these bills throughout the session, but the efforts failed to get funded in the budget.

By Paul Demko

In Health Affairs, Paula Atkeson and David Jones unpack how the outcome of November’s elections will shape Medicaid expansion in Arizona, Ohio, Michigan and New Hampshire. More.

Purdue Pharma has hired a law firm to provide advice on financial restructuring as the OxyContin manufacturer faces hundreds of lawsuits over the opioid crisis, reports Reuters’ Jessica DiNapoli and Nate Raymond. More.

Opioid overdose survivors might have severe brain damage and never live normal lives again. Harvard Medical School’s Daniela Lamas looks at one family’s struggle with the aftermath in the New York Times. More.

The health care industry is responsible for nearly 10 percent of all greenhouse gas emissions, but some hospitals are taking dramatic steps to reduce their carbon footprints, reports Kaiser Health News’ Julie Appleby. More.