Senate Republicans push forward with repeal effort Presented by

SENATE LEADERS PUSH FORWARD ON REPEAL — Senate leaders plan to move forward next week with a procedural vote on their health care bill, although they are still struggling to scrape together the required 50 votes for passage. Senate Majority Leader Mitch McConnell confirmed that an updated text will be released by Thursday. A new CBO score of that bill is expected early next week before the vote.

Summertime blues — The Upper Chamber will continue working two weeks into the planned August recess, McConnell said, as Republicans struggle to win support for the health care bill. It’s unclear if the House will follow suit.

Stop me if you think you’ve heard this one before — Senate leaders canceled the first part of August recess in 1994 in an unsuccessful attempt to pass health reform legislation pushed by then-First Lady Hillary Clinton.

Senate Republican leaders hope their August non-recess won't lead to the same doomed result.

“I’m hoping for better this time,” said Sen. Chuck Grassley (R-Iowa), who said he he was “very pessimistic” the GOP would succeed. In 1994, Democrats “kept us in and we didn’t accomplish anything.”

POLITICO's Jen Haberkorn and Burgess Everett report that McConnell wants to finish health care well before August. Of course, he originally promised a vote in June, Republicans say they are serious about completing their work in the coming days, though. More here.

Senate Majority Leader Mitch McConnell is pushing for the Senate to pass their health care bill before August. | AP Photo

Welcome to Wednesday and thanks for reading PULSE. I'll be steering the ship the rest of the week while your usual host, Dan Diamond, finishes up a project. Say hi and send tips to [email protected] and on Twitter @BriannaEhley

With help from Sarah Karlin-Smith (@SarahKarlin) Adam Cancryn (@AdamCancryn) David Pittman (@David_Pittman) and Jason Millman (@JasonMillman)

HOUSE DEMS TO PROPOSE OBAMACARE FIXES — A group of House Democrats this morning are proposing a handful of Obamacare fixes in hopes that Republicans may be convinced to drop their repeal push and work toward bipartisan improvement of the health law. "There are things that we could do to stabilize the marketplace," Rep. Ami Bera (D-Calif.) told Pro's Adam Cancyrn. "The Affordable Care Act's made a lot of progress. Now is the time to fix it." Bera wouldn't say what the specific proposals will be, but he ruled out any concerted effort to move health care toward a single-payer system: "We'll leave that to the rest of the caucus."

The group includes moderates as well as more progressive members. This is the latest in the Democrats' renewed push to persuade Republicans to give up their repeal efforts. Senate Minority Leader Chuck Schumer on Monday sent a letter to McConnell outlining Senate bills that they could work on to stabilize the insurance market.



A message from PhRMA: Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. More.



LAST CALL ON HHS' ACA REGULATIONS REQUEST FOR INFO — Today is the deadline to respond to HHS's request for information on the Affordable Care Act. As part of an executive order on Obamacare signed by Trump earlier this year, HHS was instructed to seek comments from stakeholders on ways to reduce regulatory "burdens" imposed by the ACA.

The National Restaurant Association's president, Dawn Sweeney, for example, urged HHS to use "available regulatory flexibility and support legislative efforts to change the definition of a full-time employee" from someone working 30 hours a week to a 40-hour worker.

HOUSE VOTES ON FDA USER FEES TODAY — The House is expected to vote today on legislation to reauthorize the FDA's user fee programs. If the fee programs for drugs and medical devices are not reauthorized by Aug. 1, the agency must send out notices of potential layoffs to thousands of employees. The industry-funded agreements account for about half of FDA's annual budget.

Senate HELP Committee Chairman Lamar Alexander told reporters Tuesday that he hopes to pass the bill before the August recess. The House bill is now "virtually identical" to the measure already approved by his committee, he said, "so either bill should do the job." But the bill could get stalled in the Upper Chamber as the Senate focuses on Obamacare repeal.

House appropriators release FDA report language — Besides the directives aimed at loosening FDA’s policies on compounded medicine, which PULSE flagged for you yesterday, the report language of the House FDA appropriations bill tells the agency to spend $60 million of its 21st Century Cures money on work related to continuous manufacturing of drug products. It says $24.6 million in FDA funding should go towards a medical countermeasures initiative, and directs FDA to hold off on finalizing a draft guidance related to laboratory- developed tests and to instead work with Congress on a new pathway for regulating them. FDA should rethink its guidance regarding third-party payments for the expenses of research participants, says the bill, to increase enrollment and retention in cancer clinical trials, particularly for minorities.

... For all of Congress's directives to the FDA, jump to page 62 of this document.

LAWMAKERS PROBE VALUE-BASED PAYMENTS FOR DRUGS — A bipartisan group of senators wants the GAO to study performance-based drug pricing. But a recent report shows the practices doesn’t seem to save money. Sens. Mark Warner, Bill Cassidy, Michael Bennet and Todd Young asked the GAO to study how structure, data collection methods and potential savings of outcomes-based payments. “As our country focuses on advancing a health care system that delivers better care and lowers cost for all Americans, pharmaceuticals should be held to a similar standard of demonstrating real, measurable outcomes to stakeholders,” said the letter, made public Tuesday. Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering, told ProPublica and the New York Times that the arrangements look good in theory, “but as long as you control all the contract terms, it can be a lot of optics but no substance.” The full story.

Opioid maker fined for not reporting suspicious orders — Mallinckrodt Pharmaceuticals will pay $35 million to settle charges it failed to notify the Drug Enforcement Agency of suspicious drug orders from 2008 to 2011, Attorney General Jeff Sessions announced Tuesday. Sessions said those failures resulted in millions of oxycodone pills being sold on the streets. The Justice Department said this is the first settlement of its magnitude, with the drug company resolving nationwide claims that it failed to help detect and notify suspicious orders, thereby fueling the opioid epidemic. As part of the agreement, Mallinckrodt will also analyze data it collects on orders from customers to help the government indentify future suspicious orders. More here.

Zimmer Biomet CEO steps down — David Dvorak, the CEO for the medical device manufacturer, Zimmer Biomet, abruptly resigned on Tuesday, according to a press release. The company recently drew scrutiny amid news that HHS Secretary Tom Price invested in it and then days later introduced legislation that would've benefited its business by delaying new regulations on Medicare payments for hip and knee replacements. Daniel P. Florin, the senior vice president and chief financial officer, will serve as interim CEO.

PhRMA launches campaign on drug costs — PhRMA is launching a campaign today "to convene a national dialogue on medicine costs" called "Let's Talk About Cost." The drug industry faces increasing scrutiny over rising drug prices. Ads will run in papers around Washington, as well as national print, radio, digital and social media through the rest of the year.

TRUMP ADMIN APPROVES OBAMACARE WAIVER FOR ALASKA — The Trump administration granted its first Obamacare waiver to Alaska, to prevent the state's individual market from collapsing, Pro's Rachana Pradhan reports. Alaska had been seeking federal aid for a reinsurance program to prop up the only insurer offering plans on the state's exchange. Under the approved plan , HHS will provide an estimated $323 million to Alaska between 2018 and 2022 to help offset claims from high-cost patients. Alaska's plan leverages an Obamacare provision allowing states to pursue their own health reforms starting this year. In a call with reporters Tuesday, CMS Administrator Seema Verma said the so-called Section 1332 waiver is a temporary mechanism to stabilize Alaska's shaky market.

Alaska submitted the waiver application to HHS at the end of last year. State officials attributed the long wait to a state budget issue that wasn't resolved until just weeks ago.

Minnesota, Iowa and Oklahoma are among the states also considering reinsurance programs. Hawaii is the only other state with an approved Obamacare waiver.

AHRQ: Hospital stays for mental health and substance abuse on the rise — A new AHRQ study shows the number of hospital stays for mental health or substance abuse issues jumped by 12.2 percent between 2005 and 2014. Meanwhile, surgical stays declined by 12 percent and all other hospitalizations decreased by less than 10 percent.

The study found the percentage of uninsured inpatient stays decreased by 13 percent over the period, as did stays by those with private insurance. The percentage of stays covered by Medicaid increased by 15.7 percent. More here.

By Rachana Pradhan

PBS Newshour examines what West Virginia Medicaid enrollees want from health care reform. More.

The Justice Department has reached its first settlement with an opioid manufacturer, the Washington Post reports. More.

Montana insurers are proposing rate hikes amid the ACA's uncertain future, according to the AP. More.

Why the Senate's health bill wouldn't give states much Medicaid flexibility, from the Advisory Board's Daily Briefing. More.

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