Republicans like Mike

At long last, Republicans have ended a grueling three-week odyssey and chosen a new leader: newly elected House Speaker Mike Johnson.

Johnson led the Republican Study Committee, which is responsible for putting out policy ideas, from 2019 to 2021. During that time, the panel released a health care plan. There's no reason to believe that Johnson would push to implement this outline anytime soon (he's got a full plate with simply keeping the government open), but it may be a helpful barometer for where he stands.

The plan included creating "federally-funded, state-administered Guaranteed Coverage Pools" for patients with high-cost illnesses, turning Affordable Care Act subsidies and Medicaid expansion funding into block grants for states, allowing HSAs to be used to cover more expenses, eliminating "mandates" for people to pay for coverage they don't want, enhancing HSAs to enable people to carry health coverage from job to job, and promoting telehealth, association health plans, direct primary care, and health sharing ministries.

At the time, Johnson said the Affordable Care Act caused "sky-rocketing premiums, egregious deductibles, and outrageous out-of-pocket costs."

Johnson is also close with Energy & Commerce Chair Cathy McMorris Rodgers, who nominated him for the role, according to Rep. Brett Guthrie, chair of the committee's health subcommittee. "We have to work together [on] The Transparency Act, the SUPPORT Act," Guthrie told reporters. "They have some snags right now, but they're moving…they absolutely can be bipartisan."

congress

Democrats' hospital divide

Mike Reddy for STAT

Democrats have campaigned election cycle after cycle on lowering health care costs, and they confronted both the health insurance and pharmaceutical industries without a single Republican vote. But the elephant in the room is reining in hospitals, which make up the largest portion of U.S. health care spending. Efforts to take on the industry are dividing Democrats, I write in a new story out this morning.

This Congress so far has shown that Democrats can't agree on even marginal measures to remove hospitals' ability to charge more to Medicare for the same services provided cheaper in doctors' offices, and codify price transparency rules that already exist. And it's not looking like a Sen. Bernie Sanders-led effort to ban some facility fees and implement contracting reforms in the Senate is going anywhere fast.

Medical debt is a potent kitchen table issue, and it's disproportionately carried by Black and Hispanic adults. It's also part of the rude awakening facing the party: that the decadelong push to expand insurance coverage through the Affordable Care Act still has not made health care affordable for many. If Democrats can't unite, advocates for change will have to pursue bipartisan reforms in an increasingly polarized Congress.

legal watch

Hospitals threaten to sue over 340B pay fix

HHS is in the unenviable position right now of trying to figure out how to pay some hospitals back for money they should have gotten for administering discounted medicines. The problem is, that money already went to other hospitals.

Hospitals are accusing HHS of pursuing an illegal plan to fix the situation, my colleague Bob Herman writes. They're arguing that the department shouldn't claw back any of the money it gave to hospitals who don't participate in the 340B drug discount program in the name of balancing the program's budget. And if they don't get their way, the Federation of American Hospitals is threatening to sue.

It's a big pot of money that could be clawed back: $7.8 billion, to be exact. Hospitals sued HHS all the way to the Supreme Court to get this ruling in the first place, so it's worth tracking.

nih confirmation

A small step for the Senate, a big step for Monica Bertagnolli

After months of delay, a few Republicans joined Democrats on the Senate health committee in advancing Monica Bertagnolli's nomination to be the new director of the NIH yesterday, my colleague Sarah Owermohle writes.

The vote bodes well for Bertagnolli's chances on the Senate floor. Even though the panel's chair Bernie Sanders (I-Vt.) opposed her confirmation, several Republicans including Sens. Bill Cassidy (La.), Roger Marshall (Kan.), Susan Collins (Maine), Lisa Murkowski (Alaska), and Mitt Romney (Utah) joined the rest of the Democrats to confirm her.

The Republicans who opposed her raised concerns about NIH research and her stance on certain politicized issues such as the origins of Covid-19 and funding gender-affirming care research. Stay tuned for details on a Senate floor vote.

drug shortages

Europeans act on drug shortages

European drug regulators are updating their plan to stem drug shortages while proposals in the U.S. stall.

Drug shortages are not solely an American problem. With 27 countries and less emphasis on private enterprise, there will be some differences in the approach that the Europeans take to stem drug shortages than the Americans, my colleague John Wilkerson writes in a story about what the U.S. could learn from Europe. But the underlying reason for shortages is the same in Europe as in the United States, according to the head of the generic drug trade group in Europe. Prices have been driven down so low that generic drug makers either exit the market or they don't update their facilities, which can result in production interruptions.

The European Medicines Agency plans to issue guidelines early next year that will ask countries to factor supply chain criteria to their drug purchasing, instead of buying drugs based solely on the cheapest prices.

In the U.S., there are private sector efforts to get hospitals to do likewise, and some drug shortage experts say the U.S. government should harness those initiatives by rewarding hospitals that put measures in place that prevent shortages.

More around STAT

Check out more exclusive coverage with a STAT+ subscription

Read premium in-depth biotech, pharma, policy, and life science coverage and analysis with all of our STAT+ articles.

What we're reading

Pharma industry readies for drug pricing lawsuit second wave, Bloomberg Law
Giant sloths and woolly mammoths: Mining past creatures' DNA for future antibiotics, STAT
Helicopter ambulance operator Air Methods to shed debt in Chapter 11, Wall Street Journal
WHO considers adding 'noma,' a rare childhood disease, to its list of neglected conditions, STAT