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It’s Day 24 of the partial government shutdown — and here in Washington, Day 1 of the snow shutdown for everyone.
— Medicare’s innovation lab is poised to announce at least three new models this month, with more in the pipeline, POLITICO scoops.
— The Trump administration’s birth control rules were blocked by a federal judge on Sunday, a day before they were slated to take effect.
— Democrats vowed to fight a Trump plan to encourage Medicaid block grants, following on a POLITICO scoop Friday.
WELCOME TO MONDAY PULSE — Where your author is struck by the all-new John Boehner. (Guess a little cannabis can really change a guy.) Tips to email@example.com.
** A message from PhRMA: Medicare Part B reimburses for medicines using a market-based Average Sales Price, which includes the rebates and discounts negotiated between manufacturers and insurers in the commercial market. Replacing this market-based system with government price setting is the wrong approach. Protect seniors’ Medicare Part B. **
DRIVING THE DAY
INSIDE TRUMP’S MEDICARE INNOVATION LAB — The Obamacare-created office empowered to test radical new health care ideas has been mostly quiet under this administration, but that’s about to change, POLITICO’s Rachel Roubein and Dan Diamond scoop.
The Center for Medicare and Medicaid Innovation (CMMI) is planning to announce three care models this month and at least three more in early 2019, current and former staff tell POLITICO.
— Upcoming models include a pilot to redesign emergency triage, treatment and transport, which is being called “ET3“; a new approach to designing insurance plans to encourage quality, efficient care, known as “VBID 2.0“; and a new track on the existing “CPC+” program meant to strengthen primary care for patients.
— The center is now led by Trump appointee Adam Boehler, who’s leaned on his entrepreneurial background and pushed staff to develop pilots at a faster pace than under the Obama administration.
He’s also got fans inside HHS leadership — Secretary Alex Azar tapped him as an adviser — and among Obama-era veterans like Andy Slavitt, who calls Boehler “a person who wants to do what’s right and make progress.”
— But some CMMI staff say the focus on speed is raising safety concerns. Boehler’s streamlined CMMI’s reliance on legal review, for instance, and staff worry that rushing out pilots could ultimately put some frail, elderly patients at risk. A bipartisan letter from House Ways and Means Committee leaders last week also raised concerns that CMMI has given Congress too little insight into its operations.
A CMS spokesperson denied that the center is reducing reliance on HHS lawyers and said that the agency is focused on safe care.
Keep reading: More for Pros.
TRUMP’s BIRTH CONTROL RULES BLOCKED IN SOME STATES — A federal judge in California on Sunday blocked the Trump administration rule that was set to go into effect Monday — one that would have allowed virtually any employer to refuse to cover workers’ birth control by citing religious or moral objections. POLITICO’s Victoria Colliver and Alice Miranda Ollstein have more.
— What happened: U.S. District Judge Haywood Gilliam ruled the policy would cause harm to the Democratic states suing over the rules, and he issued an order staying the rules from going into effect while the lawsuit proceeds. The temporary block is just for the 13 states (plus Washington, D.C.) involved in the lawsuit.
— The backstory: This rule marks the second attempt by the Trump administration to expand an exception to a requirement stemming from Obamacare that employers must provide no-cost contraception. An earlier attempt was blocked after courts found that the Trump administration didn’t give the public a chance to weigh in.
— What’s next: We’re still waiting to hear from a second court considering a similar case. On Thursday, Democrat attorneys general asked the 3rd Circuit Court of Appeals in Philadelphia to provide a nationwide injunction to block the rule. The court has not yet ruled on the request for an injunction but may do so by Monday.
DEMOCRATS VOW TO OPPOSE TRUMP’S MEDICAID PLAN — Congressional Democrats said they’d fight a plan, scooped by POLITICO, to bypass Congress and encourage Medicaid block grants.
CMS is quietly devising guidance that would give states more flexibility to manage their Medicaid programs while capping their spending, POLITICO’s Rachana Pradhan and Dan Diamond detailed on Friday. That’s alarmed advocates and Democrats, who say that spending caps will lead to beneficiaries being pushed off coverage.
“Hell no,” Sen. Bob Casey tweeted. “If the Administration tries to decimate Medicaid through executive action after its scheme was rejected by Congress and the American people, I will fight it with everything I have,” including blocking Trump nominees.
… House Energy and Commerce Chairman Frank Pallone was among the other Democrats warning the Trump administration against proceeding with the plan. PULSE notes that congressional Republicans, meanwhile, were silent on the long-held conservative priority.
JOE GROGAN EYED FOR KEY WHITE HOUSE ROLE — Grogan, a top health care official at OMB, is seen as the front-runner to lead the Domestic Policy Council, POLITICO’s Nancy Cook and Adam Cancryn scooped on Friday.
Hiring Grogan fits with Acting Chief of Staff Mick Mulvaney’s push to shape White House policy and personnel, in whatever time he has in the post. (An Axios storySunday night illustrated the difficulty of Mulvaney’s role.) Grogan, an adviser to Mulvaney at OMB and a former Gilead lobbyist, would be in position to influence the administration’s drug price plan.
Lance Leggitt, the council’s current deputy director and former HHS chief of staff, will also be considered.
SHUTDOWN WATCH: DAY 24 — FDA Commissioner Scott Gottlieb on Sunday announced additional activities that would be considered excepted, unpaid work during the shutdown.
— Among those new activities: More food safety checks, more monitoring of imports and more activities related to possible recalls.
“It is not business as usual at FDA,” Gottlieb tweeted. “But we’re focused on maintaining core activities that directly impact consumer safety and save lives.”
Is FDA crackdown on e-cigs already having an impact? PULSE chattedwith an attendant at the Chesapeake House on I-95 (readers may know it well) who said that JUUL sales have fallen since the e-cigarette’s fruity flavors were effectively pulled from stores, with fewer young people seeking out the product.
The Trump administration last year advanced regulations to crack down on e-cigarettes, arguing that flavors like mango and cucumber were too appealing and leading to new nicotine addictions.
“Our data continues to demonstrate that flavors are a leading factor in driving youth appeal and use of e-cigs,” Gottlieb tweeted. Surgeon General Jerome Adams chimed in too, writing that staff at an Indiana gas station told him that “they made more on ecigs last year than on gas.”
… Meanwhile, JUUL and vaping advocates are arguing that the crackdown will backfire by limiting an off-ramp for cigarette smokers. JUUL recently released data showing that cigarette pack volumes fell even as JUUL’s market share rose.
AROUND THE NATION
Democratic governors steer party to the left for universal health care. Gov. Gavin Newsom wants California to be the first state to offer Medicaid to undocumented adults. Gov. Jared Polis wants Colorado to pioneer a multi-state single-payer system. And in Minnesota, Gov. Tim Walz wants residents to be able to buy into Medicaid.
The moves are a test to see how far Democrats are willing to go in pushing universal health care, POLITICO’s Dan Goldberg writes. And they’re inspired by the Trump administration’s attacks on Obamacare, the legal threats to the law arising from a court case brought by conservative-led states and the shortcomings of the health law itself. More for Pros.
House committee leaders press HHS on foster care. Democrats are concerned that HHS is seeking to use the Religious Freedom Restoration Act to allow a South Carolina ministry to sheer children toward Christian foster homes, Education and Labor Chairman Bobby Scott and Ways and Means Chairman Richard Neal wrote to Azar on Friday.
“We urge the Department not to adopt any exemptions under RFRA,” the chairmen wrote in a letter shared with PULSE, arguing that it would be a misapplication of the law and allow discrimination. Read letter.
ON TAP THIS WEEK
Tuesday: Azar to keynote ‘Price of Good Health’ event. The daylong eventis being held by the Council for Affordable Health Coverage and the Partnership for Employer-Sponsored Coverage. POLITICO’s Rachana Pradhan will be moderating one session.
Friday: March for Life. The nation’s largest anti-abortion march will be held on the National Mall. Expect to hear a message as part of this year’s theme: “Pro-life is pro-science.”
… Ahead of the march, Americans United for Life issued its annual “Pro-life state rankings,” finding that Arizona and Arkansas were atop this year’s list.
WHAT WE’RE READING
Inside the legal theory behind the latest ACA lawsuit, via the Houston Chronicle’s Jenny Deam.
How Tennessee state health officials privately reacted after newly elected Rep. Mark Green questioned vaccines.
Meet the federal worker forced to ration her insulin because of the government shutdown.
** A message from PhRMA: The Centers for Medicare & Medicaid Services has recognized the market-based nature of Part B drug reimbursement, noting just last month that “there are a number of competitive market factors at work” in the program. Despite evidence the system is working to control costs, the Department of Health and Human Services has proposed changes that could put seniors’ access to medicines at risk. Any changes to Medicare should help, not hurt, patients. Protect seniors’ Medicare Part B and stop the International Pricing Index Model. **