POLITICO's Pulse Check

Tevi Troy helped lead the nation's health department under President George W. Bush. Now he's helping steer JUUL — the nation's most popular e-cigarette company — through the Washington policymaking process and public health scrutiny.

"Using a JUUL is worse than doing nothing," Troy acknowledged on the podcast. But"if we can get people to switch away from [traditional] cigarettes… there's a potentially huge public health benefit."

In conversation with POLITICO’s Dan Diamond, Tevi explains why he joined JUUL and how he sees the company’s mission (starts at the 2:00 mark), why JUUL has a special responsibility given its market-leading position (6:00), the public health risks of e-cigarettes and resulting FDA scrutiny (8:30), the politics of vaping (15:30), the New Yorker’s article on JUUL (18:30), why opening a JUUL feels like unboxing an Apple iPod (20:00), and Tevi's views on the current HHS, having served as deputy HHS secretary during the George W. Bush administration (24:00).

Then in the recurring “Steal My Job” segment, Tevi talks about how he became a published book author and offers tips for anyone interested in writing a book (36:20).

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MENTIONED ON THE SHOW

Some of FDA Commissioner Scott Gottlieb's March 2017 comments on e-cigarettes. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm601690.htm

Jia Tolentino's New Yorker article on JUUL. https://www.newyorker.com/magazine/2018/05/14/the-promise-of-vaping-and-the-rise-of-juul

Tevi's books, "What Jefferson Read, Ike Watched, and Obama Tweeted: 200 Years of Popular Culture in the White House." https://www.amazon.com/dp/B00APDG0VK/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1

and "Shall We Wake the President?: Two Centuries of Disaster Management from the Oval Office." https://www.amazon.com/Shall-Wake-President-Centuries-Management-ebook/dp/B01LWCUH4N/ref=la_B001HPAYYE_1_1?s=books&ie=UTF8&qid=1528929225&sr=1-1

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For the past year, Sen. Bill Cassidy has played a pivotal role in Republicans’ health care strategy. The doctor-turned-lawmaker helped craft the Graham-Cassidy proposal to repeal the Affordable Care Act, sparking outrage from public health groups (and a certain talk show host) who warned that the legislation would lead to millions more people being uninsured.

Now Cassidy’s out with a new package of ideas that the Louisiana Republican argues will “make health care affordable again.” The wide-ranging blueprint includes pushing price transparency, studying racial disparities and resurrecting the stalled bill to prop up the Affordable Care Act’s individual insurance market.

Cassidy joined POLITICO’s Dan Diamond to discuss the reception to his new proposals (starts at the 1:40 mark), why he wants more Americans to use health savings accounts (3:30), why Cassidy is betting big on price transparency (5:30), the fight over the ACA’s high premiums and Democrats’ concerns about short-term health plans (10:30), his criticism of monopolies in health care (16:45), why Cassidy wants HHS to investigate social determinants of health (19:45) and how he’s blasting a “rigged” health system (21:45).

After the break, Cassidy discussed whether there should be another ACA repeal vote this year (25:40), what he and the GOP learned from last year’s health care fights (27:45) and his feud with Jimmy Kimmel and public health groups (31:00).

Then in the recurring “Steal My Job” segment, Cassidy discussed his decision to leave medicine to get into politics and who’s influenced his thinking about health care (36:20).

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MENTIONED ON THE SHOW

Bill Cassidy’s new plan: “Ideas to Make Health Care Affordable Again.” https://www.cassidy.senate.gov/imo/media/doc/Dr%20Bill%20Cassidy%20-%20Make%20Health%20Care%20Affordable%20Again.pdf

Hospitals have reported a rise in bad debt as patients increasingly shift to high-deductible health plans. https://www.hfma.org/Content.aspx?id=50653

Cassidy referenced a CalPERS initiative to use reference pricing to lower prices of many procedures, which Austin Frakt wrote about at the New York Times. https://www.nytimes.com/2016/08/09/upshot/how-common-procedures-got-20-percent-cheaper-for-many-californians.html

However, a 2017 Health Affairs study concluded that CalPERS’ price transparency tool didn’t reduce patients’ spending. https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1636

The health insurance lobby criticized the Trump administration's push on short-term health plans. https://www.ahip.org/ahip-responds-to-administrations-proposed-rule-on-short-term-health-plans/

Industry expert John Gorman appeared on POLITICO's podcast last month, where he said that short-term plans would be "junk" insurance. https://simplecast.com/s/2d8d7d17

Dan’s 2017 story: “Kimmel, not Cassidy, is right on health care, analysts say.” https://www.politico.com/story/2017/09/20/jimmy-kimmel-bill-cassidy-obamacare-repeal-242932

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Two years ago, anti-abortion leaders attacked then-candidate Donald Trump as a “pro-choice” liberal who couldn’t be trusted. This week, the movement's most prominent leader praised Trump as “the most pro-life president in history” as he spoke at the Susan B. Anthony List’s gala. How did Trump became an unlikely anti-abortion hero, and what has Trump actually accomplished?

First, POLITICO’s Jennifer Haberkorn joins Dan Diamond to discuss Trump’s recent moves, including this week’s changes to the Title X program (starts at the 1:55 mark), and why public health experts say Trump’s proposed limits on abortion amount to a “gag rule” on physicians (6:35).

Then Marjorie Dannenfelser, who leads SBA List and chaired Trump’s “Pro-Life Coalition” during his campaign, discusses why anti-abortion groups are surging under Trump (starts at the 12:50 mark), the passionate politics around abortion issues (13:45), how she went from Trump critic to top Trump supporter (20:30), her relationship with the White House (25:10), the anti-abortion strategy ahead of the midterms (26:25) and whether being “pro-life” includes supporting measures like gun control (31:15).

Then stick around after the credits for Marjorie’s thoughts on how to build an advocacy organization in the latest “Steal My Job” segment (35:30).

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MENTIONED ON THE SHOW

Jen Haberkorn and Chris Cadelago’s story on how the anti-abortion movement came to love Trump: https://www.politico.com/story/2018/05/22/anti-abortion-forces-trump-561191

Jen’s story on how abstinence advocate Valerie Huber gained new powers at HHS to manage the Title X program: https://www.politico.com/story/2018/03/06/abstinence-advocate-family-planning-dollars-389453

Equity Forward’s Mary Alice Carter appeared on PULSE CHECK in April and criticized the Trump administration’s abortion policies: https://simplecast.com/s/e5b29eb9 (Starts at the 1:50 mark).

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One week ago, HHS Secretary Alex Azar joined President Donald Trump in the Rose Garden to announce his signature initiative: A long-awaited plan to lower drug prices.

The secretary’s been on a tour to explain the plan — which has faced resistance from pharma and was panned by some Wall Street analysts — and POLITICO’s Dan Diamond joined Azar at HHS headquarters to review the latest developments.

On this episode, Azar discusses where drug prices rank as an administration priority and how he wants taxpayers to judge success (starts at the 1:40 mark), why the plan doesn’t include importing drugs from Canada, an idea that Trump supported as a presidential candidate (5:15), why Azar wants to put drug prices in TV ads (9:00), whether he was prepared for the backlash to the plan (10:15), why he suggested that the media doesn’t want the drug plan to be perceived as successful (12:10), how Azar wants to combine Medicare Part B and Part D negotiations (13:10), and what Azar sees as a former pharma executive (16:45).

Then stick around after the credits for a closing thought from Azar on his time at HHS (19:30).

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MENTIONED ON THE SHOW

The Trump administration's "American Patients First" drug pricing plan: https://www.hhs.gov/sites/default/files/AmericanPatientsFirst.pdf

Former Obama appointee Tim Gronniger, who steered CMS’ failed efforts to reform drug prices in 2016, joined POLITICO's podcast this week to share his perspective on the Trump plan: https://simplecast.com/s/7b2ddfbc

The Community Oncology Alliance warned against the Trump plan: https://www.communityoncology.org/2018/05/16/may-16-coa-physician-survey-medicare-part-b-proposals-will-harm-patients-increase-costs-and-bureaucracy/

Vermont became the first state this week to permit drug imports from Canada: https://www.politico.com/story/2018/05/16/vermont-drug-imports-canada-546107

The FDA approved a biosimilar for an anemia drug this week: https://www.upi.com/FDA-approves-biosimilar-drug-for-anemia-treatment/4561526408086/

Azar appeared on the “Hugh Hewitt” radio show to discuss the drug plan this week: http://www.hughhewitt.com/hhs-secretary-alex-azar/

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President Donald Trump finally unveiled his plan to lower drug prices last week, and on this week’s episode, POLITICO looks closer at what’s in the strategy and how it builds (or doesn’t) on the Obama administration’s own efforts.

First, POLITICO’s Sarah Karlin-Smith discusses her reporting on the Trump administration’s drug plan (starts at the 2:05 mark), what’s in the bill and how it’s being received.

Then after the break, Tim Gronniger — who served as CMS Chief of Staff and led the agency’s work on drug spending under the Obama administration — discusses his impression of the Trump plan (starts at the 14:05 mark), and what he learned from Obama-era efforts to try and lower drug prices, which met with significant resistance and were largely stalled.

Stick around for a new segment — “Steal My Job” (starts at the 37:00 mark) — where Tim discusses how he got his jobs in the Obama administration and tips for people interested in a similar career path.

GLOSSARY OF TERMS ON THIS EPISODE

Average sales price (ASP): A manufacturer's sales of a drug divided by the total number of units, which is used to help set government reimbursement.

Biosimilars: A type of product that’s highly similar to existing FDA-approved biologic drugs (like Remicade) but intended to offer a lower-cost alternative.

Pharmacy benefit managers (PBMs): A third-party manager of a prescription drug program that helps insurers and others negotiate on drug prices. Drug companies say that PBMs are middlemen that drive up prices.

STORIES REFERENCED ON THIS EPISODE

Adam Cancryn and David Pittman’s story on the Trump drug plan: https://www.politico.com/story/2018/05/11/trump-administration-drug-price-plan-535667

Sarah’s piece on Trump’s ‘America First’ agenda for drug pricing: https://www.politico.com/story/2018/05/09/trump-drug-pricing-prescriptions-514925

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The health care safety net is rarely glamorous, but for tens of millions of Americans, it's often necessary. These low-income patients depend on Medicaid, public hospitals and other services for care — although safety-net resources have been increasingly strained in recent years, partly because of decisions made in Washington.

On this episode of PULSE CHECK, we meet one person trying to make the safety net stronger: Veenu Aulakh, the executive director of the Center for Care Innovations (www.careinnovations.org), which tests safety-net ideas and works to implement solutions across California and beyond.

In this conversation (recorded in Oakland in January), Veenu talks about her center’s mission (starts at the 1:10 mark), the state of the health care safety net (4:00), the focus on “innovation” buzzwords in health care (7:30), how consolidation is affecting safety-net patients (9:30), how policymaking in Washington is playing out on the front lines in Oakland and beyond (13:30), and why Veenu walked away from a Fortune 500 health care company to work on safety-net projects (17:45).

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The Trump administration is sending mixed signals to health insurers, pushing controversial changes to the ACA markets while giving big pay bumps in Medicare Advantage. Meanwhile, companies like UnitedHealth, Walmart and even Amazon are circling deals that could shake up the industry.

To make sense of this moment, this week’s PULSE CHECK features John Gorman, the head of the Gorman Health Group — one of Washington’s most thoughtful experts on the health care industry and government health programs.

John sits down with POLITICO’s Dan Diamond to discuss why he left government to open his own consulting firm (starts at the 1:25 mark), the growth of Medicare Advantage (5:30), the state of private insurers and the rise of UnitedHealth (8:30), the CVS-Aetna deal (15:45), Walmart-Humana’s possible deal and Amazon’s looming presence (20:00), the Trump administration’s impact on insurers (22:20), and a quiet change to Medicare Advantage that could let health plans tackle social determinants of health (28:15).

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Referenced on the podcast:

Zach Tracer’s Bloomberg story on UnitedHealth’s physician acquisitions: https://www.bloomberg.com/news/articles/2018-04-09/30-000-strong-and-counting-unitedhealth-gathers-a-doctor-army

POLITICO’s Darius Tahir and Paul Demko reported on the CVS-Aetna deal: https://www.politico.com/story/2017/12/04/aetna-cvs-merger-drugs-205514

Dan’s look at Walmart’s potential purchase of Humana: https://www.politico.com/newsletters/politico-pulse/2018/03/30/walmart-might-buy-humana-what-it-means-154555

Incoming AHIP leader Matt Eyles’s PULSE CHECK interview on the insurance industry and the Trump administration: https://simplecast.com/s/4e376b02

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The Trump administration has discarded or reworked a number of Obama-era programs. But this week's Health Datapalooza — an annual conference launched by Obama officials and hosted by Academy Health — has received the current administration's full support, a reminder that the desire to improve data can trump partisan politics.

On the podcast, Academy Health CEO Lisa Simpson joined POLITICO’s Dan Diamond to discuss the Datapalooza conference (starts at the 1:25 mark), why the Trump administration continues to supports the event and how the White House has shaped the current climate for researchers (3:20), why Academy Health focuses on "health services research" and how Lisa would like academic research to change (8:15) and the state of data, particularly as Silicon Valley firms eye health care (13:30).

After the break, POLITICO’s Mohana Ravindranath discusses her reporting on the Trump administration's data-access initiatives. (Starts at the 18:45 mark.)

Dan also remembers POLITICO’s Brett Norman, who died last week at age 43. (Starts at the 29:35 mark.)

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In six weeks, Matt Eyles will become the CEO of America’s Health Insurance Plans, taking over for Marilyn Tavenner — one of the most prominent seats in health policy.

But before that, Eyles sat down with POLITICO to preview his agenda, critique the Trump administration’s changes to the insurance markets and rebuff concerns that AHIP has lost influence in Washington.

On the podcast, Eyles discussed what it’s like to be a lobbyist in the Trump era and how he arrived at AHIP (starts at the 1:30 mark); how his leadership will differ from Tavenner’s (6:05); his thoughts on UnitedHealthcare and other top insurers choosing to leave AHIP, and whether his organization has lost juice on Capitol Hill (9:00); his views on Medicaid and why AHIP is touting the public program's benefits (16:40); the Trump administration’s changes to Obamacare and the insurance markets (19:40); the employer insurance market (26:30); and insurers seeking mergers with players like CVS Health (27:30).

After the break, POLITICO insurance reporter Paul Demko joins Dan Diamond to analyze Eyles’ comments, discuss the future of AHIP and review the Trump administration’s insurance market changes. (Starts at the 30:00 mark).

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Referenced on the podcast:

The 2016 episode of PULSE CHECK with Marilyn Tavenner: https://simplecast.com/s/7e1c82f7

Paul’s story on Obamacare insurers having their best year yet — despite Trump: https://www.politico.com/story/2018/03/17/obamacare-insurers-2017-profit-analysis-422559

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When the Affordable Care Act was first signed into law, the state of Virginia led the fight against it. Eight years later, Virginia — with state Democrats on the upswing — is on the verge of expanding Medicaid, and more than 300,000 state residents could get covered as a result.

First, POLITICO reviews the windy road that led to 32 states saying yes to Medicaid expansion. Then Del. Alfonso Lopez, the whip for Virginia House Democrats, explains what's ahead as he and his colleagues work to finalize a Medicaid expansion deal. (Starts at the 8:20 mark.)

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Referenced on the podcast:

Virginia Republicans said the backlash to Medicaid expansion has been milder than expected: https://www.washingtonpost.com/local/virginia-politics/republican-medicaid-expanders-in-va-say-backlash-is-milder-than-expected/2018/03/29/dde9e0fc-329d-11e8-94fa-32d48460b955_story.html

The Commonwealth Institute for Fiscal Analysis is arguing the benefits of Medicaid expansion in Virginia: http://thehalfsheet.org/post/172599067503/evidence-shows-medicaid-expansion-is-not-a-budget

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