In an insult to democracy, the GOP is hiding its Trumpcare legislation from those it will affect.

By Clifton Leaf and Sy Mukherjee
June 13, 2017

“It is the policy of this state that the deliberative process of governmental bodies shall be open to the public during meetings.” So begins Section 36-25A-1 of the Alabama code.

South Carolina’s General Assembly has determined “that it is vital in a democratic society that public business be performed in an open and public manner so that citizens shall be advised of the performance of public officials and of the decisions that are reached in public activity and in the formulation of public policy.”

In Section 551.003 of the Texas Code, lawmakers have wisely exercised their “powers to adopt rules to prohibit secret meetings of the legislature, committees of the legislature, and other bodies associated with the legislature, except as specifically permitted in the constitution.”

Likewise, lawmakers in Kansas have made it absolutely clear how vital to democracy such transparency is: “In recognition of the fact that a representative government is dependent upon an informed electorate,” Statute 75-4317 begins, “it is declared to be the policy of this state that meetings for the conduct of governmental affairs and the transaction of governmental business be open to the public.” Moreover, says the law, “It is declared hereby to be against the public policy of this state for any such meeting to be adjourned to another time or place in order to subvert the policy of open public meetings.”

Each of the 50 states and the District of Columbia has a similar “open meeting” law—or “Sunshine law,” as they’re often called. So does the federal government. The statutes vary—excluding one or another agency or executive process from public scrutiny—but in each case, red state and blue, the rationale for the law is as straightforward and sacred as that for the republic itself: “We the people of the United States, in order to form a more perfect union, establish…insure…provide for…secure…ordain and establish.” It’s us, baby. We are the establishers of the laws that govern us.

This framework is the fundamental structure that keeps our great and rare democracy thriving. And that’s what makes the efforts of a slim, cynical majority of U.S. senators to subvert this structure—to plot in secret legislation that could affect virtually every citizen in the nation—so bone-chillingly frightening.

Republican senators are drafting their version of Trumpcare without hearings or public testimony of any kind. There are to be no “committee markups,” no full-throated debate on the floor of the Senate, no time for the 48 senators in the minority party to weigh in or ask questions or express grievances, no chance for independent watchdogs or associations of physicians, nurses, phlebotomists, hospitals, insurers, and especially the insured to study the bill…until, that is, it’s time for a vote. All of the traditional steps in the Senate’s legislative process will either be done away with entirely or be done in secret.

In an extraordinary statement captured on video (< a must-watch), Senator Claire McCaskill, Democrat of Missouri, pleaded to her colleagues: “We have no idea what’s being proposed. There’s a group of guys in a backroom somewhere that are making these decisions. There were no hearings in the House. I mean, listen, this is hard to take, because I know we made mistakes on the Affordable Health Care Act, Mr. Secretary. And one of the criticisms we got over and over again, that the vote was partisan. Well, you couldn’t have a more partisan exercise than what you’re engaged in right now. We’re not even going to have a hearing on a bill that impacts one-sixth of our economy.”

The Senator from the Show-Me State’s plaintive call was simple: “Show me.” That’s what democracy is all about.

Senate Majority Leader Mitch McConnell, a Kentucky Republican, doesn’t seem interested in doing that. The law in his home state says the “formation of public policy is public business and shall not be conducted in secret.”

Clearly, he hasn’t read it.

Clifton Leaf, Editor in Chief, FORTUNE
@CliftonLeaf
clifton.leaf@fortune.com

DIGITAL HEALTH

Former Intel health exec Eric Dishman dishes on NIH’s “All of Us” precision medicine program. Eric Dishman, a cancer survivor and the former head of health innovation and policy at Intel, delivered the opening keynote address during the HIMSS Precision Medicine Summit in Boston on Monday. And his speech centered on the ambitious NIH project to track the health metrics of one million Americans so that they can be used as a baseline dataset for many types of research (Dishman was appointed to head this “All of Us” initiative last year). “Our taxpayer dollars are being used to build the free resource,” he said, according to MobiHealthNews. “We are not funding the science except for some pilots we’ll fund to make sure our systems are working for different kinds of scientific questions. That will come from the rest of the NIH and foundations and companies that want to use this large resource that would be very difficult for them to create for themselves.” That could even include, eventually, scaling up datasets from wearables and fitness trackers, among other biometrics. (MobiHealthNews)

Apple snatches up Stanford digital health exec. In a sign of its continuing ambitions in the mobile health and research space, tech giant Apple has recruited Stanford Medicine’s executive director of the Center for Digital Health Dr. Sumbul Desai to its own health team. It’s still unclear exactly what Desai will oversee. But there are plenty of possibilities, ranging from the ResearchKit platform for population health and life science studies to other mHealth apps in the Apple suite. (Healthcare Dive)


INDICATIONS

Merck halts Keytruda blood cancer trial enrollment after patient deaths. Merck is hitting the pause button on enrollment in two late-stage clinical studies of its new flagship cancer immunotherapy treatment Keytruda for the rare blood cancer multiple myeloma. There’s been a reported spike in deaths in the Keytruda arm of the study and Merck is looking into what may be driving the adverse events. The drug is already approved for a slew of cancers, including skin and lung cancer, and is being tested in dozens of others.

Johnson & Johnson’s diabetes drug shows a significant heart benefit, but comes with risks. A new class of diabetes drugs continues to show promise in, not just controlling type 2 diabetes, but slashing risks commonly associated with the disease such as heart disease, stroke, and other cardiovascular conditions. The latest treatment to produce impressive results is Johnson & Johnson’s Invokana, which protected against heart failure and kidney function decline, as well as strokes and other conditions. However, the therapy also significantly increased the risk for amputation of toes or feet compared with placebo, presenting some safety challenges for the drug as it tries to take on a rival treatment from Eli Lilly and Boehringer Ingelheim called Jardiance. (Reuters)

How the opioid crisis—and the backlash to it—is wreaking havoc on McKesson. My Fortune colleague Erika Fry has an absolutely amazing feature in the latest issue of the magazine exploring how the opioid crisis has devastated small communities all across America—and how some are choosing to fight back by waging legal war against some of these addictive medications’ biggest distributors. Consider the story of Martin West, a pastor, sheriff, and treasurer in McDowell County, West Virginia. “West now had a new target for his frustration about the growing toll of opioids: the so-called wholesalers. “In my thinking, they were no different than drug dealers selling on the street,” he tells Fortune. The sheriff wanted a criminal prosecution, or failing that some compensation from those companies for the damage they’d done. In December, McDowell became the first county in the state to file a lawsuit against the “big three” drug distributors: McKesson, No. 5 on this year’s Fortune 500, with $192 billion in revenue; AmerisourceBergen, No. 11, with $147 billion; and Cardinal Health, No. 15, with $122 billion. All of the companies deny the charges and say that they comply with all relevant laws and are working with authorities to prevent abuse in the system.” (Fortune)


THE BIG PICTURE

Nearly 2 million people ditched their Obamacare plans through mid-March. The initial signup numbers for Obamacare aren’t really the final ones. That’s because people can wind up not paying their premiums or transitioning to a different kind of coverage (for instance, through an employer). And that’s exactly what about two million Americans did through the middle of March, according to a new government report. Of the 12.2 million who signed up for plans last fall, 10.3 million still had an active plan as of mid-March, with many of those dropping off ineligible for subsidies that would reduce monthly premiums and others gaining employer-sponsored coverage.

But one insurer is planning on expanding offerings. Bucking the trend of insurers exiting Obamacare’s marketplaces, individual insurance player Centene (a mainstay of the exchanges) is actually planning to offer plans in three new states next year despite uncertainty surrounding the health law’s future. The firm will enter the markets in Kansas, Missouri, and Nevada in 2018 and also expand operations in six other states where it already does business. “Centene recognizes there is uncertainty of new healthcare legislation, but we are well positioned to continue providing accessible, high quality and culturally-sensitive healthcare services to our members,” CEO Michael Neidorff said in a statement. (Reuters)


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