Witching hour

The government will shut down at midnight tonight without a stopgap funding bill, and a deal doesn't look promising.

Senate Minority Leader Chuck Schumer (D-N.Y.) said Democrats shared two demands during their meeting with President Trump: extend the enhanced premium tax credits that have made ACA marketplace plans more affordable, and ensure that Republicans can't renege on government spending deals with recissions and impoundments, which Democrats say is illegal.

Republican leaders, who also attended the meeting, said they want to fund the government at current levels until Nov. 21 to buy time to negotiate over the credits. Republicans are open to temporarily renewing the credits, with reforms such as means testing, in a year-end funding bill.

Schumer said that approach would lead to enrollment losses. Notices of premium increases will be sent out in a matter of days, though some states are waiting until the middle of October to send them, and enrollment for next year starts on Nov. 1. Schumer fears that people will decide against enrolling once they see those premium spikes, and it will be impossible to win them all back, even if Congress renews the credits later.

Schumer said Democrats are willing to negotiate reforms to credits in the year-end funding bill, after Republicans agree to renew them.

"You can't wait until January," he told STAT. "You have to do that now."

drug prices

Drug pricing deadline passes

Yesterday was the deadline for drugmakers to tell the White House how they plan to lower prices in the U.S. to levels charged in other rich countries.

Elaine Chen and Daniel Payne wrote about how companies scrambled at the last minute to highlight initiatives to lower prices with direct-to-consumer sales, invest in American facilities and research, and raise prices abroad.

But the industry hasn't publicly announced plans to actually implement a most-favored-nation policy, which is what Trump really wants. Read more for the administration's reaction to pharma.

tariffs

Pay the piper

In the lead-up to the drug pricing deadline, Trump threatened pharmaceutical companies with a 100% tariff unless they build manufacturing plants in the U.S., Daniel reports.

The tariffs are seen as part of a whole-of-government pressure campaign to bend drug companies to Trump's will on prices and onshoring.

hospitals

Losing hospital care at home

A large segment of the public doesn't feel the impact of a government shutdown, at least not right away.

But for Medicare beneficiaries receiving hospital-level care in their homes, the impact will be felt immediately, Mario Aguilar and I report, as they'll be sent from their homes to hospitals, assuming there is room.

Since the pandemic, hospitals have been able to request waivers to provide inpatient hospital care in patients' homes. But that program must be renewed each year, typically when Congress funds the government. Without even a stopgap funding bill as a vehicle for the program's reauthorization, hospitals will have to find a way to get those patients into facilities.

Medicare advantage

Trump's plan to audit MA plans in jeopardy without Biden rule

A federal judge vacated a Biden-era rule that would have allowed the government to audit private Medicare plans more aggressively, Tara Bannow reports.

The ruling throws a wrench in the Trump administration's plan to build off the 2023 RADV rule by expediting Medicare Advantage audits, including hiring more coders and using technology to comb through insurers' data.

The Biden rule was estimated to recoup billions of dollars in overpayments over the next decade. Read more.

drug safety

Revenge xeet?

Is George Tidmarsh, the FDA's top drug regulator, trying to exact revenge on a prominent Wall Street investor after a run-in with him six years ago?

That's the question that STAT's Adam Feuerstein says investors are gossiping about, after a highly unusual post on LinkedIn from Tidmarsh's personal account criticizing the lupus nephritis treatment voclosporin.

Read more about why investors are worked up and their speculation over the reason for Tidmarsh's post.

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What we're reading

Lilly executives: How the FDA's new PreCheck program can unleash the future of U.S. medicine manufacturing, STAT
PhRMA CEO: Want lower drug prices? So does Big Pharma, The Washington Post
Doctors face off with Cigna over new policy that may cut reimbursements, STAT
White House considers funding advantage for colleges that align with Trump policies, The Washington Post