Doing the math on Clinton's health plans Presented by

Pharma deals are down, but health services deals are up, and Medicare finally issues its star ratings. But first: Clinton supporters talked up the campaign's health plans at the Democratic National Convention.

UNDERSTANDING CLINTON'S HEALTH PLANS — Liberal analysts on Wednesday focused on the Democratic nominee's health care proposals and how she might seek to implement them.

Jennings: Medicare buy-in could be great option. Chris Jennings, an adviser to Hillary Clinton's campaign and a Democratic health care expert, said that a Medicare "buy in" option for people aged 55 to 65 could be an enticing option in the Clinton administration, especially if insurers are fleeing the ACA exchanges.

"I think it's exactly the direction we should be seriously thinking about, particularly if the exchanges aren't working to provide serious competition and choice," Jennings said Wednesday at an Americans United for Change health care panel in Philadelphia. "That should be a message to the health plans: you know, don't pull out of these exchanges. If we need to work with you, we can work with you. But there's got to be a choice."

The Medicare buy-in that Clinton has proposed would create a separate pool for the 55 to under 65 population, he said, and it would be a "new option" for that population, too.

Clinton: All about affordability. That was the key focus of the rest of the panel, which included top Democratic health care minds Neera Tanden, Ron Pollack, Nancy-Ann DeParle and former Sen. Tom Daschle. "Affordability is an issue for the broad public that we all have to address," Tanden said.

Clinton's latest health care proposals wouldn't add to the deficit. That's according to the Committee for a Responsible Federal Budget, which is out with new reports analyzing both candidates.

In addition to a Medicare buy-in, Clinton proposed increasing funding for community health centers and the National Health Service Corps and empowering the HHS secretary to block certain premium increases.

"The net cost of Clinton's additional health policies would likely be about $50 billion over 10 years," CRFB says. To offset the policy, as well as a new proposal to expand access to college, Clinton would change the 3.8 percent investment surtax that applies to income above $200,000 for individuals and $250,000 for couples.

While the new proposals wouldn't increase the debt, "both spending and revenue will likely be higher than our previous estimates," CRFB concludes. See the analysis: http://bit.ly/2aiCiZH

THIS IS THURSDAY PULSE — Where we're constantly losing things — documents, socks, track of time — and are prepared to reward mightily for anyone who can help. Know any services that might be available and responsive to rush-in orders? Send tips and state secrets to [email protected] or @ddiamond on Twitter.

With help from Nancy Cook (@NanCook), Jen Haberkorn (@JenHab) and Rachana Pradhan (@RachanaDixit).

STAR RATINGS

ICYMI: Medicare finally issues quality star ratings. The once-delayed ratings were finally released on Wednesday, and CMS says that it's an important step to help patients shop for care.

"We have received numerous letters from national patient and consumer advocacy groups supporting the release of these ratings because it improves the transparency and accessibility of hospital quality information," CMS's Kate Goodrich writes in a blog post.

The ratings are on a five-star scale, but many well-known hospitals were only awarded four stars or less, Jordan Rau writes at Kaiser Health News: http://bit.ly/2anRF6K

Industry reaction: Displeased. Wednesday's Afternoon Pulse carried critiques from hospital leaders, who say the ratings don't fully account for the sociodemographics of the patient mix, and here are a few more sharp responses.

— Chip Kahn, Federation of American Hospitals: "The new hospital star ratings fall short and are not ready for primetime… CMS should go back to the drawing board."

— Atul Grover, Association of American Medical Colleges: "Perhaps we in the medical community should start issuing Star Ratings for agencies, starting with CMS."

Local hospitals don't fare so well. No hospital in the Washington metro area received five stars, and many prominent facilities received just a fraction, including

· George Washington University Hospital: 1 star

· MedStar Georgetown University Hospital: 1 star

· Sibley Memorial Hospital: 3 stars

· Virginia Hospital Center: 4 stars

MORE FROM THE CONVENTION

Speakers tackle HIV/AIDS, contraception, gun violence. Across the day, speakers vowed that Democrats would make progress on a slew of public health priorities if Clinton was elected to office.

· Connecticut Sen. Chris Murphy framed gun violence as a public health crisis that claims the lives of 90 Americans per day. "I have had enough," he said, invoking his nearly 15-hour filibuster in the Senate last month, to protest the lack of gun control legislation. "It's time to take Washington back from the gun lobby," and Clinton is prepared to do it, he argued.

· NARAL's Ilyse Hogue attacked Trump's criticism of abortion providers and patients; "he says women like me who have abortions should be punished," she said. (Trump has walked those statements back.) She also linked Trump's position with Republican VP nominee Mike Pence's efforts in Congress and Indiana to propose "some of the most outrageous abortion restrictions in the country."

Several Democratic lawmakers also praised the White House cancer "moon shot" as a program that must continue under Clinton. California Rep. Judy Chu said that it's been an inspiration to America's patients — and helped inspire her colleague, Hawaii Rep. Mark Takai, who passed away from pancreatic cancer last week at age 49. "I will never forget the tears in his eyes when he learned about the cancer moon shot initiative," she said. "In his memory, we've got to keep hoping — and fighting."

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.

ON THE TRAIL

Trump blasts Democrats — and blasts email — on Obamacare. In the middle of President Obama's convention speech on Wednesday night, the Republican nominee sent a mass email to his listserv, attacking Democrats' signature health reform.

"Owning the 3rd term: Obamacare has been an absolute disaster," the email reads, pointing to reports of insurance premium growth compiled by Kaiser Family Foundation, Politifact, and more.

McCain hits the air with new Obamacare-themed ad. GOP Sen. John McCain of Arizona is hitting the air with a new TV ad attacking his Democratic opponent, Rep. Ann Kirkpatrick, over her vote for Obamacare, Pro's Theo Meyer reports.

"Liberal Ann Kirkpatrick bragged about helping Nancy Pelosi pass Obamacare," the ad's narrator says, followed by a clip of Kirkpatrick saying that her vote for the bill was "the one I'm most proud about." See the ad: http://bit.ly/2acMIPO

PHILANTHROPHY

Foundations join on chronic illness. Five major national health care foundations are working together on a new project aimed at reducing the costs of caring for chronically ill patients, the groups announced in the New England Journal of Medicine.

The Commonwealth Fund, the John A. Hartford Foundation, Robert Wood Johnson Foundation, the Peterson Center on Healthcare, and the SCAN Foundation said they will launch the initiative later this year. More for Pros from Brianna Ehley.

MERGERS

FTC requires unprecedented divestiture. The FTC is requiring the country's largest generic drug company, Teva, to divest more than 75 generic drugs to competitors as a condition of acquiring the third largest generic drug company, Allergan.

The agreement marks the largest drug divestiture order in a pharmaceutical merger case, FTC said on Wednesday. If finalized, it would settle FTC charges that the proposed $40.5 billion acquisition of Allergan's generic drug business would be anti-competitive. More for Pros from Sarah Karlin-Smith

… Meanwhile, FTC will permit Mylan to acquire Swedish drug maker Meda for $7.2 billion, but the company must divest rights to two generic drugs. More from FTC.

Pharma dealmaking falls, health services deals are up. That's according to a pair of new PwC reports out this morning, which conclude that the total number of pharma deals fell 19 percent since last year. One key factor for the slowdown? The chilling effect of Brexit on global markets, PwC concludes.

Meanwhile, the deal volume in the health services sector is up 16 percent since last year, with physicians, hospitals and long-term care facilities among the most aggressive employers engaging in M&A.

ZIKA VIRUS

Florida steps up investigation of non-travel-related infections. The state's Department of Health is now investigating two new cases of the Zika virus that may have come from local transmission, bringing the total number of cases in question to four. If confirmed, these cases would signal the arrival of Zika in the continental United States and would mean that local mosquitos now carry the virus, Pro's Nancy Cook reports. (So far, Zika has only shown up here through sexual transmission, or from people who traveled abroad to infected areas like Brazil).

This discovery would also reignite the somewhat toxic political debate over which party is responsible for blocking emergency federal funding.

… This pattern of four mysterious cases is consistent with the way the dengue virus appeared in the United States in 2013, Florida health officials say. Now, the health department is going door-to-door to try to suss out the number of infected people and is collecting urine samples from residents in Broward and Miami-Dade counties. Overall, Florida has counted 328 cases of travel-related Zika infections, and 53 additional cases involving pregnant women.

AROUND THE NATION

Mercatus on Medicaid. CMS' latest update on Medicaid's financial outlook shows that expansion enrollees are costing way more than initially anticipated, the Mercatus Center's Brian Blase writes, arguing that Congress must boost its oversight of the program.

The CMS Office of the Actuary's 2015 report estimates that newly eligible adults had $6,366 in costs last year on average, an increase from $5,488 in 2014, Pro's Rachana Dixit reports. The 2015 cost figure is substantially higher than what had been expected previously: actuaries had estimated that per enrollee costs for 2015 would be roughly $4,300.

The agency's actuaries say the increase in costs could be the result of several factors, including that managed care plans' rates were set higher than anticipated to care for the expansion population. CMS, however, responded that total actual Medicaid spending in 2014 was $4.4 billion less than projected last year by agency actuaries.

The 2015 spending report: http://bit.ly/2avNpSp

Blase's column in Forbes: http://bit.ly/2avNaXy

WHAT WE'RE READING by Nancy Cook

Hillary Clinton and Tim Kaine hold different positions on abortion funding: http://on.wsj.com/2abckHT

A take from the JAMA Forum on the partisan divide in this year’s election on health care by Larry Levitt: http://bit.ly/2ao4OwJ

Anthem is getting past Cigna merger blues: http://on.wsj.com/2ae2Pqw

Being unfit may be almost as bad for your health as smoking: http://nyti.ms/2aLCz8u

Large employers are key to reforming health care, according to an op-ed from the Harvard Business Review: http://bit.ly/2auNgi8

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