A cadre of billionaires has become hospitals' worst nightmare

Power to the Patients

At an extravagant concert earlier this spring, rap legends Busta Rhymes and Fat Joe interspersed their songs with … mini-lectures about hospitals' high prices.

"In health care, it's your right to know the prices," Fat Joe half-shouted to a sea of health policy staffers bopping to the beats. The concert was financed by billionaire businesswoman Cynthia Fisher as a way to convince Congress and other policymakers to crack down on hospitals that aren't disclosing their prices.

The strategy seemed to work. Just three weeks later, a prominent House health care committee held a hearing with a strikingly similar title: "Health Care Price Transparency: A Patient's Right to Know." The committee's chairman met with Fat Joe before the session.

Read my latest feature about the group of billionaire philanthropists who have made it their mission to challenge hospitals' multimillion-dollar lobbying operation in Washington, and the unorthodox tactics they are using to do it.

personnel

Matt Eyles exits AHIP

In yet another departure from a major health care lobbying organization, AHIP CEO Matt Eyles announced he's leaving this fall, my colleague Bob Herman writes.

Eyles led the insurance industry's largest trade group for five years, and three executives and lobbyists told Bob that the departure came as a surprise to some in the industry. AHIP said Eyles has nothing else lined up yet, and the group's board of directors will convene a search committee this summer to look for his successor.

Bob distills the major moments in Eyles' tenure, and even provides a throwback to how he leveraged his experience as a former drug lobbyist. Read more.

capitol hill

The opening salvo on extenders

The House Energy & Commerce Committee has now passed its initial offer to extend funding for key health care programs that expire on Sept. 30 — with some new policies that would beef up transparency requirements for hospitals, insurers, and PBMs, a small step toward site-neutral payments, and transparency in the 340B program.

The most controversial bill, interestingly, would write into law an existing rule that allows Medicaid programs to enter into outcomes-based contracts with drug companies. Rep. Anna Eshoo (D-Calif.) excoriated her fellow Democrats who expressed opposition to the bill.

"Democrats, the Biden administration is not opposed to this," Eshoo argued. "These value-based payments are voluntary. Did you know that? Did you maybe read it last night to prepare for this?"

The bill passed out of committee 31-19, with fellow California Democrats Reps. Tony Cárdenas and Scott Peters joining Eshoo in voting for the bill.

default watch

A debt ceiling nail-biter

As negotiations over the debt ceiling creep along ahead of a June 1 deadline, health care lobbyists are holding their breath, anxiously waiting to see what hits the industry could take.

Lobbyists who spoke with STAT are tracking a few different issues, with varying levels of concern — primarily whether lawmakers really rescind unspent Covid-19 funding (and how that could affect the White House's new initiative on next-generation Covid-19 vaccines and treatments), and any work requirements for federal programs. And in a less likely realm, they're also watching for any tweaks to Medicare Advantage coding or to the Inflation Reduction Act's drug pricing provisions.

Negotiators are holding information very tightly, and any potential deal is very much in flux. but we will be tracking — keep your eyes peeled!

coverage

Who gets to decide what's reasonable and necessary?

STAT is out with a new, deep-dive report on the way Medicare determines how to cover drugs and devices.

Longtime health care reporter Kerry Dooley Young explored 10 case studies that illustrate a trend of Medicare demanding more and more evidence for the safety and effectiveness of new drugs and devices — as it did with new Alzheimer's medicines. It looks at CAR-T, too, and new weight loss medications like Ozempic. She also looks at exactly how Medicare defines "reasonable and necessary" when it makes those decisions.

The kerfluffle over Alzheimer's drugs and how they are covered has ignited a new conversation about the standards to get the government to pay for care, and opened an opportunity for potential changes. Get the full report here.

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What we're reading

Congress took on high drug prices in Medicare. Now Biden wants to take it to Medicaid, STAT
In the "Wild West" of outpatient vascular care, doctors can reap huge payments as patients risk life and limb, ProPublica
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How Vivek Ramaswamy helped make Martin Shkreli the 'pharma bro', Politico