Coming today: New organ donation rules

Presented by The American Hospital Association

With Rachel Roubein, Rachana Pradhan, Alice Miranda Ollstein and Victoria Colliver

Editor’s Note: This edition of Pulse is published weekdays at 10 a.m. POLITICO Pro Health Care subscribers hold exclusive early access to the newsletter each morning at 6 a.m. Learn more about POLITICO Pro’s comprehensive policy intelligence coverage, policy tools and services at www.politicopro.com.

Quick Fix

— The Trump administration is announcing rules to overhaul organ donation today, POLITICO scooped.

— Congress’ year-end spending package punts many of its health care priorities to 2020.

— Kentucky is dropping its Medicaid work requirements, nearly two years after it won permission to be the first state to move forward with the rules.

WELCOME TO TUESDAY — Where PULSE is reflecting on this New Yorker piece, “The Art of Dying,” by 77-year-old Peter Schjeldahl. Two lines that stuck around: “You get to be clueless in a new place only briefly. Don’t waste the chance to have truths, great and small, burst upon you.”

Your regular author yearns to discover tales and facts of all sizes; find him at [email protected] when he returns tomorrow. Meanwhile, Rachel Roubein is pinch-hitting on the newsletter tonight; she’s at [email protected] this evening.

PROGRAMMING NOTE: POLITICO’s Morning Pulse will not publish from Monday, Dec. 23-Friday, Jan. 3. We’ll be back on our normal schedule on Monday, Jan. 6.

Driving the Day

COMING TODAY: HHS RULES TO OVERHAUL ORGAN DONATION — The Trump administration is moving forward with two proposed rules to boost the number of organ donors and cut down on wasted donations, POLITICO’s Dan Diamond and Rachel Roubein scooped Monday night.

It’s part of President Donald Trump’s move to overhaul U.S. kidney care, which POLITICO first reported this summer. HHS declined to comment on the pending rules.

— Public health advocates say that the rules are overdue, given that more than 100,000 people are perpetually on the waiting list for transplants. One major complication: Many donated organs fail to be recovered and are even thrown away, Greg Segal of the nonprofit ORGANIZE told POLITICO in October.

The issue appealed to senior officials in the White House and HHS last year, who saw an opportunity for reform. “There are 28,000 lives on the line here,” said an individual familiar with the effort, citing estimates of how many donated organs don’t make it to patients in need every year. “We should be acting to save as many of those lives as possible — this regulation is the proposal for how to get there.”

— Trump’s organ donation overhaul is arguably his most popular public health effort, with bipartisan support for cracking down on the organ procurement organizations that are responsible for recovering organs. OPOs currently self-report and self-measure their performance — a lack of oversight that’s led to thousands of wasted donations per year, public health advocates say.

“Every month that OPOs avoid accountability, another 1,000 patients die,” said Jen Erickson, who worked on organ donation efforts for the Obama administration. “OPOs have been failing for decades and HHS should move quickly to enforce the highest standards possible in patients’ interest.”

Meanwhile, the KidneyX initiative would get $5 million in the congressional spending package being finalized this week. The public-private partnership between HHS and the American Society of Nephrology is helping drive Trump administration efforts to develop an artificial kidney.

Speaking of that spending package...

CONGRESS’ LENGTHY 2020 TO-DO LIST — Congress spent most of the year debating what to do about drug prices and “surprise” medical bills. But lawmakers largely punted on both issues in the year-end spending package, Rachel writes.

What didn’t get done:
— Bringing down the cost of drugs. The package included only one narrow provision aimed at lowering drug prices, and Congress will see if it can cut any deals on more ambitious proposals in 2020.

— Stopping “surprise” medical bills. A last-ditch effort to pass “surprise” medical bill legislation faltered this year. But, like drug pricing, it could feasibly hitch a ride on an extension of health programs that expire at the end of May.

— Reforms aimed at transparency and lowering health care costs. This includes proposals aimed at pharmacy benefit managers and hospital and insurance contracts.

— Extending health care programs. Health extenders received only five months of funding in the spending bill, keeping them afloat through May 22. That leaves lawmakers staring down another extension, or a permanent reauthorization, for programs like community health centers and training for health care providers in underserved areas.

MEANWHILE: SMALL FUNDING INCREASE FOR STD PREVENTION AMID RECORD RATES — Congress’ final spending bill includes a $3.5 million increase in funding for CDC to address sexually transmitted diseases, POLITICO’s Alice Miranda Ollstein reports.

That’s less than half the spending hike that the House approved earlier this year — despite record rates of syphilis, gonorrhea and chlamydia, Alice notes. Funding for CDC to fight STDs also has declined over the years; Congress has budgeted about $160 million for the agency to tackle STDs in fiscal year 2020, compared to $168 million in 2003.

But public health advocates argue that the small increase is still meaningful since funding for STD prevention has been either flat or cut back since 2003, leading to clinic closures and staffing cuts.

“Hopefully this is a down payment towards addressing the crisis,” said Matthew Prior of the National Coalition of STD Directors.

Around the Nation

KENTUCKY DROPS MEDICAID WORK REQUIREMENTS — Kentucky Gov. Andy Beshear on Monday axed the initiative, fulfilling a pledge that he made as part of his winning campaign to unseat Republican Matt Bevin, POLITICO’s Rachana Pradhan reports.

“Rescinding this waiver is not only the right thing to do, it is the moral, faith-driven thing to do,” said Beshear, a Democrat who was Kentucky’s attorney general before taking office this month.

The state also is dropping its legal defense of Medicaid work requirements, saying that a long-running lawsuit is now moot. That case is currently in front of a federal appeals court.

— Kentucky was the first state to get its Medicaid work requirements approved by CMS in January 2018, a controversial effort that’s spurred multiple lawsuits against the Trump administration and similar rules in nearly a dozen states. The Kentucky initiative, which included costs on enrollees and other coverage penalties for not following rules, would have resulted in nearly 100,000 fewer enrollees in the state’s program, according to state projections.

PULSE also recalls Bevin’s seemingly arbitrary decision to cancel vision, dental and other benefits for almost 400,000 Medicaid beneficiaries in July 2018 after a federal judge froze the state’s work requirements. Under pressure, Bevin reversed course a few weeks later.

Opioids

SENATE DEMOCRATS CALL ON PURDUE PHARMA TO SCRAP $1.3M BONUS FOR CEO — Eleven Democrats, including four running for president, are urging the opioid manufacturer to cancel Craig Landau’s bonus, POLITICO’s Dan Goldberg writes.

Purdue Pharma should “reevaluate your incentive payment plan to ensure your company puts patient safety ahead of profits,” the Democrats write to Purdue Pharma’s board, dated today. The letter was led by Sen. Tammy Baldwin and was signed by presidential candidates Sens. Cory Booker, Amy Klobuchar, Bernie Sanders and Elizabeth Warren.

Purdue is in bankruptcy proceedings. The company and Landau are accused of supporting deceptive marketing campaigns that helped fuel the opioid epidemic.

— Meanwhile: Sacker family withdrew more than $10 billion from Purdue. That’s according to an audit posted this weekend, providing fresh fodder to critics who say the Sackler family — which controlled Purdue for years — should be held personally responsible for perpetuating the opioid crisis.

New York Attorney General Letitia James, who has filed suit against the Sacklers as well as opioid manufacturers and distributors, cited the $10 billion figure in calling for a review of the family’s financial records. “We need full transparency into their total assets and must know whether they sheltered them in an effort to protect against creditors and victims,” she said in a statement.

Inside the Humphrey Building

MEDICARE WEBSITE MAY HAVE LEAKED THOUSANDS OF PATIENTS’ DATA — A flaw on a CMS website that provides Medicare claims data to app developers and patients may have leaked the data of some of the 74,000 people using it, the agency said Monday evening.

The agency detected a problem in the code of its Blue Button 2.0 application programming interface on Dec. 4 and immediately shut down the site. It has been investigating the cause and impact of the problem since then, an agency spokesperson said.

WATCHDOG GROUP WANTS HHS TO INVESTIGATE TITLE X AWARDEE — The Campaign for Accountability says HHS should review the Title X family planning grant application of the Obria Group, a California-based health organization that opposes abortion as well as condoms and all other forms of contraception other than natural family planning methods. HHS in March awarded Obria $1.7 million this year — and a total of $5.1 million over three years — in Title X family planning grants.

According to a draft version of a letter being sent to HHS today, the liberal watchdog group says HHS “should investigate whether Obria deliberately lied in its grant application and whether it is effectively administering the grant it already has received,” POLITICO’s Victoria Colliver writes. The watchdog argues that Obria’s application contained misrepresentations and inaccuracies, such as promising to refer patients seeking hormonal contraception to other clinics but failing to do so.

Names in the News

ADJOA ADOFO KYEREMATEN joins CMS innovation center. Adofo Kyerematen is serving as senior adviser for public affairs and communications. She was previously director of communications for Better Medicare Alliance.

What We're Reading

With Victoria Colliver

The Labor Department is considering a plan that would skirt Obamacare restrictions — and the lobbying effort has ties to former Trump campaign officials, Bloomberg’s David Glovin reports.

Jeff Rawson, a postdoctoral research fellow from Harvard, writes a cautionary tale in the Boston Globe about his near-death experience from vaping THC.

Reuters’ Julie Steenhuysen writes about a study, among the first to show the long-term health effects of vaping, that found e-cigarettes increase the risk of lung disease by about a third compared with those who’ve never smoked or vaped.

Ars Technica’s Beth Mole examines this year’s weird and early flu season in Wired.

Considering the glitches right before the Obamacare signup deadline, Vox’s Dylan Scott asks this question: Do we really need an open enrollment period, or is there another way?