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Trump throws the repeal schedule, Ryan sends mixed messages, and CVS will sell an EpiPen competitor

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Presented By UnitedHealth Group
By David Nather ·Jan 13, 2017

Good morning, happy Friday the 13th, and welcome back to Vitals. The Obamacare repeal schedule has gotten trickier, GOP leaders are trying to deal with conflicting demands, CVS will sell a cheaper EpiPen competitor, and it looks like we have another FDA candidate.

Thanks to all of you for giving us your time and attention. We're always trying to perfect what we cover and how we do it, to make it as easy for you as possible, so please keep the feedback and suggestions coming. And tell your favorite smart people to sign up here.

How Trump threw sand in the gears of Obamacare repeal

The House is pretty sure to approve the budget resolution starting the Obamacare repeal process today — but what's the next step? That part got a lot harder after President-elect Trump's mixed signals this week about how he wants to move forward. Caitlin Owens reports that the original plan was for the House to move first, voting to gut key pieces of the law the second or third week of February, followed by the Senate.

Then, Trump started talking about his timeline, and things got confusing.

  • Tuesday: Trump said he wanted to repeal the law, then replace it quickly afterwards.
  • Wednesday: Trump said a replacement plan will be introduced as soon as Tom Price is confirmed as secretary of the Department of Health and Human Services. When that will happen is still TBD.

Senate moderates and House conservatives say they want to repeal and replace the law at the same time, or at least have a replacement ready by the time they vote to repeal. So that means to get everyone on the same page, there needs to be a replacement ready to go. Right now, there are lots of outlines, but nothing written, analyzed and ready to become law.

What we know about the next steps
  • House Speaker Paul Ryan says the House will move the detailed repeal legislation through its health care committees, "the way that Congress is supposed to work."
  • He also says Republicans will talk a lot about Obamacare replacement at the GOP retreat in Philadelphia Jan. 25-27.
  • Senate HELP Committee Chairman Lamar Alexander has his own, multilayered repeal-and-replace plan that we wrote about earlier this week.
  • Senate Finance Committee Chairman Orrin Hatch said in a floor speech Thursday that the "budget reconciliation" legislation — the next step — should include "the largest possible down payment" on replacing Obamacare, not just repealing it.
  • Hatch also said Republicans need the Trump administration to "work with us to produce a full replacement plan and then to execute it."
  • The (nonbinding) deadline for all of the health care committees to report their legislation, per the budget resolution: Jan. 27.
  • That's not happening.
Paul Ryan and the angst of the GOP

Source: Giphy


Here's how Ryan described the timeline for House Republicans to tackle repeal and replacement at his Thursday press conference:

  • "We are determined to provide relief as soon as possible, because this law is collapsing while we speak."
  • But they're going to go through all of the health care committees, because "I like to run a bottom-up process."
  • "We have to do it all at the same time so that everybody sees what we're trying to do."
  • "We're not holding hard deadlines, only because we want to get it right."
  • "But we do feel the need to act quickly."
Between the lines: Put yourself in Ryan's shoes. He has to satisfy the nervous Republicans who want a quick replacement plan (good quotes in this Washington Post piece), and the committee chairmen who don't want to be sidestepped, and the conservatives who are signaling to hardliners that a workable replacement is going to take some time. Try to do all of that, and you're probably going to sound the way he did.

A Message From UnitedHealth Group

Solutions for a modern, high-performing, simpler health care system

  1. Expand access to care.
  2. Make health care more affordable.
  3. Support and modernize Medicare.
  4. Reinvest in health.

Learn more about these ideas at

The headlines from Ryan's CNN town hall

Here are the main takeaways from Ryan's appearance at a CNN town hall with Jake Tapper Thursday night:

  • He cited state high-risk pools — not coverage for people who keep themselves insured — as the main way Republicans want to cover pre-existing conditions after Obamacare.
  • His other main selling points for a GOP replacement: tax credits to buy "a plan of their choosing" and more flexible benefits.
  • He pretty much acknowledged that Trump has zero interest in his Medicare reform plan. "We've had a couple of conversations about it. Look, we don't all agree on everything."
CVS takes a big step against EpiPen prices

The mega-pharmacy chain announced Thursday that it's going to start selling the generic version of one of EpiPen's competitors — a version that will sell for $109.99 for a two-pack, compared to the more than $600 price of EpiPens, USA Today reports. The new generic is based on Impax Laboratories' Adrenaclick.

Why it matters: It means that Mylan, which makes EpiPens, may finally have serious competitors — and they're not off the hook after offering to sell their own generic version. That was going to cost $300.

The fallout: Mylan stock was down 1.4 percent at the end of Thursday, on a day when most pharmaceutical stocks stabilized after falling on Wednesday following Trump's blistering comments on drug prices, my colleague Christopher Matthews reports.

Get ready for more questions about Price's investments

Price has informed the HHS ethics officer that he'll divest his financial interests in a long list of health care companies, and the Trump transition team says it's now time for the Senate to move on his nomination. But you can still expect a lot of questions about his finances at next week's courtesy hearing in the Senate HELP Committee, and eventually at his hearing before the Finance Committee.

The Atlanta Journal-Constitution set up those hearings by posting an exhaustive investigation of his financial ties to the health insurance industry. The main findings: Price has been among the top five or six House members in campaign contributions from the industry, and "has a poor record of identifying his contributors."

Oh hey, there may be another FDA candidate

The new name that surfaced Thursday is Balaji Srinivasan, the chief executive officer of, a bitcoin startup. He met with Trump Thursday, on the same day that Jim O'Neill, a venture capitalist who was already in the mix, met with the president-elect. Incoming White House press secretary Sean Spicer said both are being considered for FDA positions, per CNBC — and while he wasn't more specific, the implication is pretty obvious.

What it means: It's a sign that Trump really wants a Silicon Valley type to head the agency — and it wouldn't hurt to be an ally of Peter Thiel, the venture capitalist who's advising Trump. What does Srinivasan know about medical research? He was the co-founder and chief technology officer of Counsyl, a genomics startup — and as his tweets show (h/t Matthew Herper), he's no fan of the current FDA leadership.

And speaking of Silicon Valley, don't forget to sign up for my colleague Dan Primack's Pro Rata newsletter (special one-click sign-up here).


What we're watching today: House vote on the budget resolution that starts the Obamacare repeal process.

What we're watching next week: Senate HELP Committee holds confirmation hearing on Tom Price, Jan. 18, 10 a.m. Eastern.

Thanks for reading, and as always, let me know what we missed:


A Message From UnitedHealth Group

Solutions for a modern, high-performing, simpler health care system

  1. Expand access to care.
  2. Make health care more affordable.
  3. Support and modernize Medicare.
  4. Reinvest in health.

Learn more about these ideas at

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