What you need to know about the forces reshaping our industry.


December 29, 2017

The 5 top health policy movers and shakers of 2017 (plus 5 runners-up)

Daily Briefing

    This year brought major health care reform efforts that could shape the U.S. health system for years to come—from major payment reforms under Medicare to the lengthy, still-unfolding congressional effort to repeal the Affordable Care Act. Here's the Daily Briefing's annual list of the top players who influenced health policy.

    Scott Gottlieb, FDA commissioner

    When he was confirmed as FDA commissioner, Gottlieb vowed to focus on ending the opioid misuse crisis and curbing prescription drug costs. And while he clearly has more work to do, Gottlieb's first few months in office have laid the foundation for action.

    Gottlieb wasted little time announcing a new FDA committee, the Opioid Policy Steering Committee, to combat the epidemic. The agency under Gottlieb also unveiled plans to improve providers' access to opioid prescriber training, fuel the development of new generic misuse-deterrent opioids, and for the first time remove an opioid from the market over misuse concerns.

    FDA also has taken several steps to increase generic drug approvals—which Gottlieb has identified as a key tactic to lowering prescription drug prices. Those steps include publishing a list of off-patent brand name drugs that currently do not have any approved generic competitor, expediting the review of generic drugs that seek to compete with certain brand name drugs, and overhauling processes to curb anticompetitive practices among drugmakers.

    FDA under Gottlieb also approved the first of two gene therapy drugs to treat cancer. Gottlieb in September said the agency would be reviewing its approach to gene and cell therapy drug approvals. "Our ability to fully capitalize on new science, and maintain FDA's gold standard for product review means FDA also needs to modernize itself alongside the new platforms that [it's] evaluating," Gottlieb said.

    Republican Sens. Susan Collins, John McCain, and Lisa Murkowski

    On July 28, Collins, Murkowski, and McCain cast the three "no" votes that brought the GOP's efforts to repeal the Affordable Care Act to a halt.

    In the span of 48 hours, Senate GOP leaders brought forth three separate health reform bills. Collins and Murkowski were the only two Republican senators to vote against all three proposals. McCain voted against both the repeal-and-delay bill and, in a rare moment of C-SPAN drama, walked in to the Senate chamber to cast the final "no" vote against the skinny bill.

    Speaking on the final "no" vote, Collins said, "While I support many of the components of this plan, this approach will not provide the market stability and premium relief that is needed."

    Murkowski said, "I have said pretty consistently that process really does matter, particularly when you're dealing with something that is as direct and personal as health care, something that has an impact on one-sixth of the nation's economy."

    And McCain in a speech called on Congress to "return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation's governors, and produce a bill that finally delivers affordable health care for the American people."

    However, the ACA did not survive 2017 intact. Last week, all three senators voted in favor of a tax reform bill that would eliminate the ACA's individual mandate penalty—a provision that observers have noted formed the backbone of the Senate's "skinny" ACA repeal bill.

    Seema Verma, CMS administrator

    As CMS administrator Verma oversees a key tool in the industry's transition to value-based payment models: the Center for Medicare and Medicaid Innovation (CMMI), which develops and implements alternative payment models among Medicare providers, including accountable care organizations and episode-based payment models.

    While CMS under Verma has indicated the agency is shifting away from the mandatory payment models spearheaded under former President Barack Obama's administration, Verma has left little doubt that the agency intends to continue on the industry's path toward value-based care. In September, she unveiled the agency's plans to revamp CMMI and introduce new voluntary payment models related to physician specialties, prescription drugs, and mental and behavioral health that will continue the industry's "move toward a system that holds providers accountable for outcomes and allows them to innovate." CMS under Verma also released a final rule detailing policy updates for year two of MACRA's Quality Payment Program—the 2018 reporting year—which will affect the payments providers will receive in 2020.

    Under her leadership CMS also has broadened the agency's approach to Medicaid waivers, encouraging states to incorporate conservative initiatives, such as health savings accounts and employment requirements, into their Medicaid programs. According to Kaiser Health News, several states—including Arizona, Arkansas, Indiana, Kentucky, Maine, New Hampshire, Utah, and Wisconsin—have requested such changes to their Medicaid programs, though CMS has yet to approve any of the requests.

    Verma minced no words in her endorsement of this approach: "Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration," she said in a November speech to state Medicaid directors. "Those days are over."

    Honorable mentions

    Republican Sens. Bill Cassidy and Lindsey Graham

    After ACA repeal efforts appeared dead, the authors of the Graham-Cassidy bill put forward a plan to overhaul Medicaid and replace the Affordable Care Act. The bill would have ended the ACA's Medicaid expansion and insurance subsides and provided funding through 2026 for HHS to distribute block grants to states for a variety of purposes. The measure also would have instituted a per-capita cap on federal Medicaid funding. While Cassidy and Graham's bill did not gain sufficient support to pass in 2017, Graham said last week, "To those who believe—including Senate Republican leadership—that in 2018 there will not be another effort to Repeal and Replace Obamacare—well you are sadly mistaken."

    Andy Slavitt, former acting CMS administrator and current senior advisor to the Bipartisan Policy Center

    Few people could have predicted Slavitt's rise to health care wonk fame when he left CMS in January 2017. Slavitt's Twitter feed has become a must-read for industry followers, providing snarky yet insightful analysis of GOP bills to repeal and replace the Affordable Care Act. Slavitt's tweet-by-tweet breakdowns offered followers a clear picture of what legislation and policy changes could mean in reality.

    John Kasich, Republican governor of Ohio

    Ohio Gov. John Kasich fell off the national radar after he dropped out of the Republican primaries in May 2016, but he came roaring back onto the scene this year as Republican lawmakers worked to repeal and replace the Affordable Care Act and overhaul Medicaid. Kasich is no fan of the ACA, but his state was one of the first Republican-led states to expand Medicaid under the law. Kasich railed against the House and Senate bills, calling the House-passed American Health Care Act "inadequate."  Kasich went on to lead a bipartisan group of governors who crafted their own health reform proposal and strongly opposed the Senate's Graham-Cassidy bill.

    @RealDonaldTrump, President Trump's twitter account

    Trump may not have made Twitter's 10 most retweeted tweets of 2017 list, but his ability to churn out health care-related tweets make him a contender on our list. Trump's 2017 health care tweets ran the gamut: Trump both cheered and attacked House and Senate Republicans as they crafted their respective health bills, all while sharing his takeaways on the bills' potential effects that left some industry experts scratching their heads.

    Trump even used Twitter to announce major policy shifts, such as his series of tweets announcing plans to ban transgender servicemembers from the military, which appeared to take both the Department of Defense and Trump's own communication staff by surprise. Trump also took to Twitter to push for Senate rule changes, praise the insurer stock market declines following his decision to cut off cost-sharing reduction payments under the ACA, and promote the effects of his health-related executive orders.

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