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What Trump’s Election REALLY Means for Obamacare

“President-elect Donald Trump will likely enter the White House seeking to ‘repeal and replace’ the six-year-old Affordable Care Act (ACA).”

So reads the first sentence of the PwC’s Health Research Institute’s post-election report. The rest of this thoughtful and timely analysis—overseen by the Institute’s leader, Benjamin Isgur—explains why Trump probably won’t be able to do it—or at least not in the black-and-white terms the statement implies.

In an interview yesterday morning—before the first votes were counted—Isgur says that a “literal repeal” would likely be off the table almost from the start, if only for the sheer logistical hurdle it would involve. “Do you really go through more than 1,000 pages of law—more than 1,000 pages of law that has been turned into multiple thousands of pages of regulations over the last six years” and toss all that out overnight? “Some of those things have been quite popular with industry, some of it not so popular,” he says. “Some has been very popular with consumers, some not so popular. Does the Trump administration try to repeal every bit of it? I think that most people think that’s not very realistic.”

Instead, he predicts that Trump emissaries and Congress will negotiate something in the middle between full repeal and status quo. Anyproposed change, of course, would face challenges from one entrenched stakeholder or another: Insurers would be happy to lose the taxes and fees assessed under the ACA, for instance, but don’t want to lose enrollees in health insurance exchanges or in Medicaid managed plans. Drug and device makers, likewise, might be thrilled to cast off a shackle of fees and regulations—but if the number of insured drops with the demise of Obamacare, so too would spending on meds. The same goes for individual mandates, employer mandates, subsidies, and so on. For every winner, there’s a loser.

But even apart from that win-loss calculus is simply the barrier of time. “The people who are running the large health systems, insurance companies, and pharmaceutical companies are pilots of these massive ships,” says Isgur. “They do not turn on a dime. “Many insurance companies took two to three years to get their exchange offerings up and running—to run the numbers, to think about how they were going to market and implement them.” And so, if Congress moves to repeal ACA, industry leaders will demand to know the timeline not only for unwinding this yarnball of a system, but also for rewinding that thread into something else.

Less discussed by the commentariat but important are Trump’s other claimed priorities in health reform: from the cross-state selling of insurance, to allowing Medicare to negotiation drug prices, to expanding health savings accounts. The PwC report offers perspective on all of it.

As for those who are wondering how Isgur and team predicted a Trump win in the first place, well, they didn’t. Ever since the 2000 presidential election, when George W. Bush faced off against Al Gore, the firm’s Health Research Institute has prepared two reports on the outlook for the healthcare industry—one for each candidate.

The Trump one was emailed to me at 2:52 a.m.this morning—when it was at last certain that this agonizing gladiatorial battle for the presidency was over. The other one, says Isgur, was fed to the lions.

Clifton Leaf
@CliftonLeaf
clifton.leaf@fortune.com

DIGITAL HEALTH

This device helped paralyzed monkeys take control of their limbs. A team of researchers managed to give a rhesus macaque control over its legs in a promising advance for spinal cord injury treatment. The scientists placed electrodes in the monkey's brain near the area that's responsible for lower body movement and then another set of electrodes below the non-functioning area beneath its spine injury. They then used a neurotransmitter to record brain data (with the help of a transmitting device on the monkey's skull) and then feed it to the second set of electrodes—a digital bridge of sorts between the monkey's command processes and its legs. After a few days, the test subject was able to use a treadmill. Scaling the tech to a human brain and body for long-term use will be a lot more complicated, though. (Nature)

The biggest and boldest moments from our first-ever Brainstorm Health. Missed out on our Brainstorm Health conference livestreams and coverage? Don't worry—we've got you covered. Follow everything from Sean Parker's talk on the role of tech entrepreneurs in healthcare to Arianna Huffington's pitch for a more rested worker in our wrap up for our inaugural digital health conference. (Fortune)

Government officials say there's still a lot of work to be done on electronic health record interoperability. The Office of the National Coordinator for Health IT says that there's been promising advances in getting health information system's to effectively talk to each other. But there's plenty that still needs to happen, according to the agency's yearly report to Congressional lawmakers. For instance, hospitals and EHR vendors must adopt universal standards and crack down on data silos in order to improve treatment. "Despite progress on standards and economic incentives, many health IT developers, healthcare providers and hospitals still choose not to share electronic health information for a variety of reasons," wrote the authors. (Healthcare IT News)

Walgreens is suing Theranos for $140 million. In a complaint filed in Delaware on Tuesday, Walgreens lobbed breach of contract allegations against embattled blood testing upstart Theranos. The controversial firm, whose woes have stacked up over the last year and a half, lost its partnership with Walgreens in the wake of news that its proprietary finger-prick blood tests didn't work as advertised (and sanctions from federal regulators for lab deficiencies). Now, the pharmacy giant reportedly wants to claw back $140 million from Theranos, claiming that it had been "misled" about the blood testing technology. Unfortunately, there's not much more information about the suit available since the court complaint has been sealed. (Fortune)

INDICATIONS

Pharma had its own Election Night upset—on drug prices. You'd think Proposition 61 would have been an easy sell in deep-blue California. And originally, it seemed like it was. The Bernie Sanders-backed initiative took on drug pricing through a proposed cap on how much the state's public health programs have to pay for medicines (in a year when pharma has been one of the biggest public and political punching bags in the country). But big pharma pulled out a win on Tuesday night, when the initiative was handily defeated. It seems that the industry's massive campaign spending on the issue and warnings that drug makers would be forced to hike prices to counteract the the proposed cap left an impression. Proposition 61 went down 46%-54%. (Fortune)

Generic drugs and biosimilars get a big FDA boost. In a decision with potentially big consequences for generic drug firms, the Food and Drug Administration (FDA) on Tuesday announced that it would no longer pause regulatory approval for generics and biosimilars (copycats of pricey biologic therapies) just because a branded drug maker files a citizen petition to prevent a treatment from reaching the market. That's a common tactic used by pharma companies that don't want cheaper competition for their branded products, especially with the growing emergence of biosimilar therapies in the U.S. Of course, approvals could still be delayed for scientific reasons. But the hope is that the new guidance, which goes into effect in January, will cut down on frivolous lawsuits against generics companies. (FiercePharma)

Amgen's pricey multiple myeloma treatment hits a road bump in the U.K. The U.K.'s National Institute for Health and Care Excellence (NICE), the gatekeeper for National Health Service (NHS) funding for drugs, has decided that biotech giant Amgen's cancer treatment Kyprolis is too expensive for use in combination with certain other drugs. Kyprolis is used to treat the blood cancer multiple myeloma and has EU approval; but NICE has been on a mission to aggressively control NHS spending by restricting the types of therapies it recommends for funding. The agency argues that Kyprolis' survival benefit isn't strong enough to justify its cost; but, on the other hand, multiple myeloma has relatively few effective treatments compared with other cancers. (Pharma Times)

THE BIG PICTURE

Biopharma stocks soar on Trump victory. Election 2016 concluded in the same stunning tone that has shaped much of the race, with businessman Donald Trump upsetting Democratic nominee Hillary Clinton to win the presidency. The result shocked many political commentators and media outlets. But at least one sector is pretty happy with the turn of events: health care and biopharma firms. Drug makers ranging from Novo Nordisk to Sanofi to Mylan and Eli Lilly saw shares rise anywhere from 2% to 7% in Wednesday trading. The likely reason? Industry players believe that the combination of a Donald Trump presidency and Republican-controlled Congress will prevent any dramatic actions when it comes to drug pricing. Trump has previously argued for proposals opposed by U.S. biopharma firms, such as allowing for the importation of cheaper drugs from overseas. But the GOP victories in the Senate and House of Representatives might prevent that sort of proposal from getting passed. (Fortune)

Colorado voters handily reject single payer, approve physician-assisted suicide. Colorado's Amendment 69 would have established a single payer health system in the state and displaced the private insurance market. But the ballot initiative was defeated handily on Tuesday night in a big victory for health insurance companies, which had spent millions of dollars making sure the measure wouldn't pass. The defeat isn't all that surprising—it trailed consistently in polls and would have imposed a 10% payroll tax that was unappealing to many voters. But the state also passed Proposition 106, becoming just the sixth state in the country to legalize physician-assisted suicide. (Fortune)

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