Brainstorm Health Daily: August 1, 2017

As the U.S. Senate engaged in frenzied gavel-to-gavel combat, trying to vanquish the Affordable Care Act, a quieter effort was underway on the other end of the Capitol building. Forty-three members of the House of Representatives, split almost evenly between Republicans and Democrats, spent much of July doing something downright radical: working together to try to fix Obamacare rather than destroy it. What’s more, over tacos and beer and plenty of tough but respectful conversation, they arrived at a real plan, which they announced yesterday.

The most immediate aim of the group, which calls itself “the Problem Solvers caucus,” was to stabilize the shaky individual health insurance marketplace, said Congressman Tom Reed, a Republican from upstate New York, who co-led the effort with Congressman Josh Gottheimer, a freshman Democrat from New Jersey. The caucus plan would, first off, continue the ACA’s cost-sharing payments to insurers in order to offset the cost of covering sicker patients in the exchange plans—and avoid the market-rupturing disruption that would almost certainly be caused by their sudden removal, said Reed on a conference call yesterday afternoon. (Such a rupture, of course, is precisely what President Trump has gleefully tweetened—my portmanteau for a threat delivered in 140 characters or less—in recent days, as he slammed those payments as mere “bailouts” to the insurance companies.)

The plan also pushes some legislative liberalization. “We’ve committed to the state stability funds a significant sum of money that would allow states to innovate and put together programs to try to stabilize their own marketplaces, be it through reinsurance, high-risk pools, etcetera,” said Reed. And the group has, importantly, proposed a change to the ACA’s employer mandate. In the current law, “if you have 50 employees, as you all know, you’re mandated to have health insurance. We raised that threshold to 500 employees,” Reed said. (The group backs a tweak to the rule that defines the number of hours a person needs to work in order to be guaranteed coverage as a “full-time” employee, from the current 30 hours per week to 40.)

In addition, the bipartisan caucus is supporting the elimination of an Obamacare tax on medical devices (a change Republicans have sought), encourages the cross-state sale of insurance (a provision that is already part of the ACA), and puts in place some Medicare reimbursement policies (that Democrats have wanted), particularly those that reward quality healthcare as opposed to the quantity of procedures performed.

“That’s what brought 43 members together as a block of the Problem Solvers Caucus,” said Reed, who noted that each of these provisions managed to reach consensus among at least 75% of the group—the threshold necessary to be included in the collective proposal. “We are now ready to govern and organized to get to ‘Yes,’” he said.

The Problem Solvers have been buttressed along the way by another cabal of unabashed cooperators, a nonprofit organization called No Labels, cofounded by veteran politicos Nancy Jacobson and Bill Galston, along with a dozen others. In an age when government has become so bitterly polarized, groups like No Labels (featured in Fortune last year) and the Problem Solvers are practically antiestablishment.

And more essential than ever. “When you’re in the middle and getting beaten up by both sides, it’s good to know there are people who have got your back,” said first-termer Gottheimer. “I just want to praise all my colleagues who put a lot of political capital on the line and who are going to get beaten up by people because of it. I tell you, my phone has been ringing off the hook today by as many people who want to complain about different aspects of this as by people who say, ‘Good job.’”

Indeed, that’s what makes the Problem Solvers’ proposal worth celebrating, said No Labels cofounder Galston on the same call. “It’s worth backing away from the details [of the proposal] and just making a large, obvious point: It has been a very long time since a group of Democrats and Republicans, who have to answer to their respective electorates, have been able to sit down and reason together and come to a consensus on significant issues regarding healthcare. So we can argue about particular details, but I think the significance of the overall moment is beyond question.”

DIGITAL HEALTH

Theranos reaches confidential settlement with Walgreens. Ending a multi-year legal scuffle that at times grew ugly, Theranos announced Tuesday that it has reached a confidential settlement agreement with Walgreens, its former partner which eventually stopped selling Theranos blood tests. "The agreement will result in the dismissal of Walgreens’ lawsuit against Theranos, with no finding or implication of liability," the company said in a statement.

Robots are on the rise in health care. IDC Health Insights is out with a new analysis finding that an increasing number of medical providers will use robots for purposes such as food services and automating other processes over next one to three years. In fact, 31.3% of those surveyed by IDC say they already use robots in one form or another. But one technology that hasn't quite broken into the mainstream? The use of drones for health care purposes—for instance, potentially delivering automated external defibrillators to the site of a heart attack patient. (MobiHealthNews)

INDICATIONS

Playwright and actor Sam Shepard dies after battle with ALS. We're a long way from a cure. Sam Shepard of The Right Stuff and Black Hawk Down died last week after a previously undisclosed battle with ALS, or Lou Gehrig's disease. The degenerative condition has no cure and only two treatments on the U.S. market—including one that was approved just earlier this year. But a cure is still a long ways off, and for many, an ALS diagnosis spells a death sentence—often, patients die within five years as they lose the ability to control their muscles, eat, and breathe. (Fortune)

Pfizer's Prevnar sales slump, leading to revenue miss. Pfizer posted second quarter 2017 financials that missed analyst expectations on revenue, a decline driven by falling demand for its blockbuster pneumonia vaccine Prevnar. Sales of that flagship treatment fell 8.2% while sales of generics and biosimilars fell 13.5%. Analysts from Berenberg noted that the trend indicates the company's "growth drivers are still insufficient to drive meaningful sales growth against the backdrop of generic erosion." Analysts have been pushing for Pfizer to make some sort of major deal to shore up its pipeline in the face of multiple major patent expirations, including impending patent cliffs for Viagra and Lyrica. (Reuters)

THE BIG PICTURE

White House opioid commission urges state of emergency on crisis. A highly-anticipated interim report from a White House opioid commission urges President Trump to follow several states' lead and declare a state of emergency over the opioid epidemic on a federal level. "With approximately 142 Americans dying every day, America is enduring a death toll equal to September 11th every three weeks," wrote the report authors (which include addiction experts and governors from states grappling with the crisis), who also recommend parity on mental health treatment and crackdowns on particularly dangerous opioids like fentanyl. (Fortune)

Congress could be getting ready to buck Trump on Obamacare's insurer subsidies. A number of prominent GOP Senators, including Sen. Bill Cassidy, are sounding a defiant note on President Trump's proposal to end Obamacare payments to insurance companies—payments that help reduce the deductibles and out-of-pocket costs paid by low-income Americans who purchase a mid-level "Silver" plan in Obamacare's markets. Without these payments, insurers would likely exit the marketplaces or have to substantially hike premiums. And according to Cassidy, these payments should be made because cutting them off would likely harm consumers.

The fight to end suicide. The Guardian is out with a fascinating look at an ambitious campaign to eradicate suicide. Aptly dubbed "Zero Suicide," the planned initiative (still at its earliest and informal stages) emphasizes prevention over reactive mental health treatment, with interventions focused on at-risk individuals the moment they show signs of possibly lapsing into suicidal ideation. The entire piece is worth a read. (The Guardian)

REQUIRED READING

Diabetes' Impact Is Rising Fastest Among Millennials, by Laura Entis

Plants Are Invading the Meat Aisle at Kroger, by Beth Kowitt

Bitcoin Split Causes Legal Backlash for Coinbase, by Jeff John Roberts

Apple Is Looking for More Tax Breaks in India, by Reuters