President-elect Donald Trump is increasing pressure on congressional Republicans to vote at the same time to both repeal and replace the Patient Protection and Affordable Care Act (PPACA), according to the Wall Street Journal.

Trump, who backs simultaneously repealing and replacing the 2010 health care act, is finding allies in the Senate, where a half-dozen Republicans are worried about repealing the law without having a replacement plan ready.

“I believe we should vote on replacement the same day we vote on repeal,” Senator Rand Paul (R–Kentucky) said in a recent interview. Trump promptly called the senator “to say he agrees completely,” according to Paul.

Paul, a libertarian who ran unsuccessfully for president last year, has a replacement plan of his own, which includes some of the best ideas floated by Republicans in recent years, according to an article in the Fiscal Times. He hopes to have it ready for Trump’s consideration early this week.

Paul didn’t offer any details regarding what he would include in his health care bill. In a recent op-ed article, however, he wrote that the PPACA should be replaced with the freedom to choose inexpensive insurance free of government dictates. He also said he favors allowing unlimited savings in health savings accounts and letting major insurers sell policies across state lines––proposals that Trump has also endorsed.

The president-elect recently told reporters in New York that he is “not even a little bit worried” about how Republicans will replace the PPACA, and that in the end “everything will work out.” Senate Majority Leader Mitch McConnell of Kentucky has said that Congress would follow up Obamacare repeal legislation with a replacement program “very quickly,” but he declined to set a timetable.

In her farewell speech, Health and Human Services Secretary Sylvia Burwell remarked: “If the Affordable Care Act is repealed without a replacement, the damage to the country’s individual insurance market will begin this spring. If health insurance companies don’t know what the market will look like going forward, many will either raise prices or drop out. That means more Americans won’t be able to afford coverage, and others won’t be able to find it at all.”

Senate Democratic Leader Chuck Schumer of New York announced that he and his members are preparing to delay Senate action on a budget reconciliation package to repeal key elements of Obamacare by offering scores of “poison pill” amendments late this week in a “Vote-a-Rama” that could last a day or more.

Sources: Wall Street Journal; January 9, 2017; and Fiscal Times; January 9, 2017.

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There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.