Major groups announce anti-AHCA push Presented by

HERE COME THE PROVIDERS: MAJOR GROUPS ANNOUNCE ANTI-AHCA PUSH — Eight major groups have announced a series of national events bringing together patients, providers and advocates to warn the Senate against repealing the Affordable Care Act.

— Who's involved: AARP, the American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Hospital Association, American Medical Association, Federation of American Hospitals and March of Dimes.

— Where they're targeting: The groups will start by holding events in Colorado, Ohio, Nevada and West Virginia — all states that have expanded Medicaid and where Republican senators have expressed concerns over repealing the ACA.

— What they're saying: "The American Health Care Act would jeopardize health coverage for tens of millions of Americans while making deep cuts to Medicaid," AHA's Rick Pollack said in a statement. "We are proud to join with our partners in the health field to call on the Senate to reject this approach and to protect access to health care coverage."

SENATE BILL: STATE OF PLAY — Republicans already are exchanging information with the CBO, but they're trying to manage expectations on timing and fend off growing criticism of their behind-closed-doors approach to crafting the bill.

— The bill's not coming today. That's what Senate Majority Whip John Cornyn (R-Texas) told POLITICO's Jen Haberkorn, as GOP leaders are still working to finalize the package.

— And the vote could slip until July. While GOP leaders had been targeting June 30, they're deliberately avoiding hard-and-fast deadlines and say there are factors outside their control that could cause the vote to slip, POLITICO's Burgess Everett reports.

"It's like having a baby," said Cornyn. "It's not here yet, but it's coming." More.

— The bill's secrecy is vexing other Republicans. The working group has avoided direct questions about the legislative language and has no plans to publish a framework. Their goal: to tamp down leaks and avoid criticism of the bill's provisions.

But that's not sitting well with Democrats, let alone some GOP senators who say they're confused about legislation that they're expected to vote on in several weeks.

"I want to know exactly what's in the Senate bill. I don't know yet," Sen. Ron Johnson told Bloomberg. "It's not a good process."

— When will GOP lawmakers see their own bill? An aide to a conservative senator, speaking to IJR's Haley Byrd on Monday: "We are assuming since they sent it to CBO today that it will then make its way to K Street, then to POLITICO, then we will see it. You know, the way government is supposed to work."

OBAMACARE ENROLLEES FELL BY 2 MILLION — That's according to the latest CMS enrollment report, which found that 10.3 million Americans were covered through the ACA's exchanges as of mid-March. That's down from the 12.2 million people who picked plans during the enrollment period.

Why enrollment dropped off: According to CMS, high costs and lack of affordability were the most common factors individuals cited when asked why they didn't keep their coverage. More for Pros.

Dems see it differently. Ben Wakana, who served as HHS spokesperson during the Obama administration, notes that “the report shows that about 85 percent of people effectuated their coverage — just like in previous years … . [A]nd premiums for people with tax credits went up $1.”

IOWA MAKES EMERGENCY BID TO PREVENT ACA MARKET COLLAPSE — Several health experts said the state's proposal, which represents a broad rewrite of the Affordable Care Act's structure, will indicate how much flexibility CMS is willing to give states to push the boundaries of Obamacare.

There are 72,000 Iowans at risk of having zero insurance options in 2018 without some kind of fix to bring carriers back to the market. Under the plan, which needs federal approval, lower-income people could end up seeing higher deductibles and copays, and people in high-cost areas could be exposed to steeper premiums.

Keep reading: More for Pros.

THIS IS TUESDAY PULSE — Where we've been reflecting on the circle of life, after reading this interview with the Economist's legendary obituary writer and watching the fascinating film OBIT, a new documentary of the New York Times obituary section.

Don't shuffle off this mortal coil yet! … We need you to send tips. Find me at [email protected] or @ddiamond on Twitter.

With help from Renuka Rayasam (@renurayasam), Victoria Colliver (@vcolliver), Brent Griffiths (@brentgriffiths), Rachana Pradhan (@rachanadixit) and Paul Demko (@PaulDemko)

EXPECTED TODAY: AHCA SCORE FROM CMS ACTUARY — House Republicans are bracing for another assessment of the American Health Care Act, with a score from CMS’ Office of the Actuary expected to drop today. Previous analyses from the CBO have been ugly, with projections of 23 million more uninsured if the GOP repeal bill is enacted.

SENATE HELP COMMITTEE TO ADDRESS Rx DRUG PRICES — Pro reporters will be watching the 10 a.m. hearing to see if lawmakers — particularly Republicans — are seriously floating new policies to tackle the problem or are simply allowing an airing of grievances. The hearing comes as HHS Secretary Tom Price is working on recommendations to tackle the rising costs of medicines, POLITICO’s Brent Griffiths reports.

Key lawmakers and witnesses provided PULSE a preview of what to expect.

— Chairman Lamar Alexander (R-Tenn.) will frame the hearing as an opportunity to "understand this complex subject and agree on some basic facts," according to remarks shared with PULSE.

"We want to know as prescription drugs move from FDA approval through a complex process and into the hands of patients, where does the money go?" Alexander is scheduled to say. "What are rebates and what is their impact on consumers? Who actually pays the cost of prescription drugs?"

— Allan Coukell, senior director of health programs at Pew Charitable Trusts, will testify that current pricing trends are "largely the result of rising costs of new medicines, particularly high-cost specialty products." He says that increased competition in Medicare Part B and D would help defray that spending. Read his full testimony.

— Dan Mendelson, president of Avalere Health, says he'll plan to address how reforming benefit design, enhancing competition and shifting to outcome-based contracting can bring down costs.

— AHIP isn't testifying, but the trade group submitted comments that puts the blame squarely on pharma. "This starts and ends with the pharmaceutical industry," the testimony warns. "To put it simply, they have a monopoly on medications."

Ron Wyden to introduce bill aimed at thwarting price gouging. The Oregon senator will introduce the SPIKE Act, which is aimed at thwarting price gouging. The act would require drug makers to submit a price justification to the HHS secretary, which would be available online.

The act also requires HHS to notify drug makers if their product hits certain thresholds:

— If their drug costs at least $10 per dose and had a price increase of at least 300 percent over five years or 100 percent over one year

— If their drug represents the top 50th percentile of net drug spending in the Medicare or Medicaid programs and had a price increase of at least 50 percent over five years or 15 percent over one year.

THE WHITE HOUSE

Vice President Pence at HHS today. He'll deliver remarks, scheduled for 9:55 a.m., alongside HHS Secretary Tom Price and CMS administrator Seema Verma about the continued need to reform the health care system.

President Trump meeting senators for lunch, 'Obamacare victims' in Wisconsin this afternoon. Trump is reportedly meeting with at least several members of the Senate health care working group. Later in the day, the president is scheduled to spend a few minutes talking with the ACA critics in Milwaukee and then deliver a statement about health care.

As noted in PULSE yesterday, Trump's trip comes nearly eight years to the day after then-President Barack Obama made his own visit to Wisconsin to push Democrats' health reforms at a local town hall.

Tom Price to Trump: 'I can't thank you enough.' The HHS secretary profusely thanked the president in the first full meeting of the Cabinet, part of an unusual 11-minute spectacle where each attendee took turns on-camera praising the president.

Price's comments:

"Mr. President, what an incredible honor it is to lead the Department of Health and Human Services at this pivotal time under your leadership. I can't thank you enough for the privileges you've given me and the leadership that you've shown. It seems like there's an international flair to the messages that are being delivered. I had the opportunity to represent the United States at the G-20 Health Summit in Berlin and at the World Health Assembly in Geneva. And I can't tell you how excited and enthusiastic folks are about the United States leadership as it relates to global health security."

… CNN's Chris Cillizza ranked Price's comments as the second-most "obsequious" of all Cabinet members, after Pence's own remarks.

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.

EYE ON THE INDUSTRY

Health care costs expected to rise by 6.5 percent in 2018. That's a half-percentage point more than anticipated for this year, according to a report by PwC’s Health Research Institute. It would mark the fourth straight year that the cost trend has hovered between 6 and 7 percent. While that’s an improvement from previous years, when increases routinely approached double digits, it’s still well over twice the inflation rate.

“Slowing growth and a new normal is not the time to declare victory,” Benjamin Isgur, head of the Health Research Institute, told POLITICO's Paul Demko.

What's driving up costs: PwC flags a few factors including

1) An overall uptick in medical inflation, driven by a strong economy

2) A slowdown in the movement toward high-deductible plans as employers fear antagonizing workers

3) Fewer branded drugs becoming available as generics.

But PwC says those factors could be mitigated through public pressure on drug companies to hold down price hikes and better care management by employers.

IN THE COURTS

Supreme Court ruling may boost investment in biosimilars. Monday's ruling gave biosimilar companies more control of the patent litigation process, Pro's Sarah Karlin-Smith reports.

— The ruling: Justices in Sandoz v. Amgen unanimously reversed a lower-court ruling that biosimilar companies could not give branded biologic makers the legally required 180 days' notice of their intent to sell a copycat until after they receive FDA approval. That will in many cases allow biosimilars to come to market six months sooner.

— The impact: More companies may have an incentive to bring copycat versions of pricey biologic medicines to market.

Keep reading: More for Pros.

AROUND THE NATION

American Medical Association adopts new policies to improve health of immigrants, refugees. The association on Monday voted on a series of policies intended to boost protections, such as opposing detention of families seeking refuge and increasing access to health insurance for refugees.

“The millions of refugees who have sought shelter in the United States need greater availability and access to health care insurance as these groups are typically at a higher risk for chronic conditions,” said AMA's Andrew Gurman. “The medical profession’s response to disease is supported by minimizing gaps in health care and ensuring that all patients in need can access medical treatment, regardless of legal status.”

Florida: Gov. Rick Scott moves to give 56,000 low-income Floridians Medicaid HMO coverage. Florida health officials are asking the Trump administration to approve a $300 million program providing Medicaid managed care for about 56,000 people, mostly ages 19 and 20.

That would replace the state's $466 million Medically Needy program that pays the hospital bills of about 28,000 frail Floridians. The request is part of negotiations over the state's $1.5 billion Low Income Pool. More for Pros.

California: Budget bill offers some gives for health care. The tentative budget fails to extend Medi-Cal coverage to undocumented young adults, but it restores some previously cut services, such as adult dental and vision care, and includes up to $800 million in increased Medi-Cal provider payments, POLITICO's Victoria Colliver reports from Sacramento.

The budget bill adds up to $50 million for women’s health at a time when federal lawmakers are cutting off support to Planned Parenthood. But the additional funds for Medi-Cal providers appear contingent on retaining federal funds now jeopardized by efforts to repeal the Affordable Care Act.

… The major sticking point this year: how to use the $1.2 billion-plus anticipated from the new state tobacco tax. Gov. Jerry Brown has proposed using the money for overall cost increases in the Medi-Cal program, not to boost provider rates or expand coverage. Legislators have until midnight Thursday to approve the budget, or they don’t get paid.

Texas: Governor nixes $120 million from state budget. Gov. Greg Abbott on Monday signed the $217 billion budget passed by the Legislature last month — but not before using his line-item veto to cut funding to the state’s Legislative Budget Board, air quality programs and education. Health care spending largely escaped the governor’s red pen, but some of the cuts could have an impact on health of state residents, POLITICO's Renuka Rayasam reports from Austin.

For example, the governor cut about $860,000 that the Legislature set aside specifically for colonias, impoverished areas along the Texas-Mexico border, saying that they receive funding through other agencies. But many residents in these areas lack running water, electricity and plumbing, making them susceptible to waterborne diseases and other health problems.

ON THE HILL

FIRST IN PULSE: Abortion-rights groups urge Senate to reject 'offensive' judicial nominee. Fourteen groups are calling on the Senate Judiciary Committee to reject John Bush's nomination to the 6th Circuit Court of Appeals, saying that he's used a pseudonym for nearly a decade to author an "inflammatory and offensive" blog that shows he's not suited for the role.

"He has voiced strong hostility toward a wide range of important issues, demonstrating that he has prejudged these topics and lacks the independence and temperament that are necessary for a federal judgeship," the groups write. For example, the blogger that the groups say is Bush equated abortion and slavery as "the two greatest tragedies" in U.S. history.

Bush's hearing is Wednesday morning. Read the letter.

AROUND TOWN

Pro Health Care Briefing: Medicaid as a driver of innovation in the states. The morning conversation at the Mayflower Hotel, moderated by POLITICO's Joanne Kenen, will tackle how states are reshaping Medicaid to deliver more value to patients and taxpayers, regardless of the ACA.

Scheduled to speak: Thomas Barker of Foley Hoag; Chris Koller of Milbank Memorial Fund; Meg Murray of the Association for Community Affiliated Plans; Trish Riley of the National Academy for State Health Policy; and Bruce Siegel of America's Essential Hospitals. The event will livestream starting at 8:20 a.m.

WHAT WE'RE READING by Jennifer Haberkorn

Sen. Jerry Moran faced a rowdy town hall meeting in Kansas on Monday morning and told the crowd he doesn't like how the Obamacare repeal bill is being drafted, the Kansas City Star's Bryan Lowry reports. More.

Nassau County in New York filed a lawsuit Monday against several pharmaceutical companies, arguing their painkillers fueled the opioid epidemic that costs the county money to fight, The Wall Street Journal's Joseph De Avila reports. More.

Several philanthropists have pledged $790 million in an quest to eradicate polio by 2020, the WSJ's Betsy McKay reports. More.

Medicaid per-capita caps — a change to the program that Republicans are pushing — would hurt patient care, Emma Sandoe argues, and she offers one hypothetical example: then-Gov. Mike Pence's efforts to fight Indiana's HIV outbreak. More.

An Atlanta Journal-Constitution poll found that voters in Georgia's 6th congressional district — where there's a heavily contested special election to replace Tom Price — don't like the House's health care repeal bill, AJC's Tamar Hallerman reports. More.

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