Trump’s 2020 budget proposal: 5 healthcare takeaways

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President Donald Trump released his $4.75 trillion budget for fiscal year 2020 on March 11. The proposal, titled “A Budget for a Better America: Promises Kept. Taxpayers First,” calls for reductions to Medicare and Medicaid over 10 years and includes provisions related to drug pricing and many other health-related issues.

Below are five healthcare-related proposals in the president’s budget:

1. Discretionary funding for HHS. The budget requests $87.1 billion in discretionary spending for HHS, a 12 percent decrease from 2019 funding levels.

2. Efforts to curb HIV. Keeping with President Trump’s promise in his State of the Union address to end the spread of HIV in the U.S. over the next decade, the budget plan calls for HHS to receive $291 million next year to help curb the spread of the virus. A large portion of the funding — $140 million — would go to the CDC to improve diagnosis and testing for HIV in areas of the U.S. where the virus is continuing to infect people not getting proper treatment.

3. Broad overhaul of Medicaid. Under the budget, nearly $1.5 trillion would be cut from Medicaid over 10 years. However, the budget seeks $1.2 trillion over the next decade for block grants or per-person caps that would start in 2021, according to The Washington Post. The budget plan would also end funding for Medicaid expansion.

4. Medicare funding changes. Under the budget, Medicare spending would be reduced by an estimated $800 billion over 10 years. The budget would reduce the growth of various Medicare provider payments and includes changes aimed at addressing waste and abuse in healthcare and lowering drug prices, according to The Washington Post.

5. Medical research. The plan includes a proposal to cut $897 million from the National Cancer Institute’s budget and an additional $1 billion in cuts to other institutes that do medical research, according to Politico.

Read the full budget plan here.



Penn State’s THON 2018 raises more than $10 million for children, families impacted by pediatric cancer

Penn State’s THON 2018 went from Feb. 16-18 and it was revealed on Sunday that more than $10 million was raised this year.

The Penn State IFC/Panhellenic Dance Marathon (THON) raises money, awareness and provides support for children and families to fight pediatric cancer. The support THON receives and provides helps to conduct research at Penn State Children’s Hospital.

This year, THON 2018 raised $10,151,663.93.

According to, it is the largest student-run philanthropy in the world and has raised $147 million since it began in 1973. That total came prior to Sunday’s announcement of more than $10 million.

The annual dance marathon — which takes place for 46 hours — has a number of performances that take place over the weekend at Penn State’s Bryce Jordan Center.


Gene therapies save lives, but how to pay for them?

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Stem cell and gene therapies for cancer and other diseases used to be considered exotic. But stunning successes are fast moving them into the medical mainstream.

While only a few of these therapies have yet been approved, many more are being tested experimentally. In addition to treating otherwise fatal cancers, they may relieve sickle cell disease, restore failing hearts and even cure HIV infection.

And with mainstream success comes a mainstream worry: How will patients pay for these expensive treatments? Or to look at it another way, how much is it worth to save a life?

Drug company representatives discussed these issues Wednesday at Cell & Gene Meeting on the Mesa, an annual event in La Jolla devoted to stem cell and gene therapy.

At the end of August, drug giant Novartis marked a milestone by receiving U.S. approval for a blood cancer treatment made from the patient’s own genetically modified immune cells. The treatment, Kymriah, has rescued children and young adults who were gravely ill with acute lymphoblastic leukemia and placed them into remission.

Kymriah costs $475,000. But Novartis made an unusual guarantee: If patients don’t respond in a month, the company won’t charge for it.

However, these arrangements, like the therapies themselves, are so new that federal regulators are hesitant, said Pascal Touchon, a senior vice president with Novartis Oncology.

“The system is not organized for that,” Touchon said at a morning panel. “So when you ask for the first time whether we can do that, the answer is no. That’s the starting point.”

Novartis eventually reached agreement with the Centers for Medicare and Medicaid Services, or CMS.

The challenge now is to make general rules for such therapies, instead of making rules case-by-case, said Bob Azelby, chief commercial officer of Juno Therapeutics. Juno is developing a cancer immune therapy similar to Novartis’.

“They’re getting value for the dollars they’re spending,” Azelby said of CMS.

Cell & Gene Meeting in La Jolla began more than a decade ago as a purely scientific conference on stem cells. But it has grown as stem cell technology has been augmented with gene therapy, the delivery of disease-fighting genes.

Genetically modifying stem cells provides a virtually unlimited source of cells with useful properties. These could fight cancer, or perhaps correct a disease caused by a faulty gene.

Many of these therapies, such as Kymriah, are made from a patient’s own cells, collected, modified, grown and re-infused into the body. Such custom-made treatments are extremely expensive. They belong to a class of treatments called CAR T cell therapy.

Bluebird Bio, also represented on the panel, is developing its own version of CAR T cell therapy, in its case for another blood cancer called multiple myeloma.

In addition, Bluebird is developing gene therapies for a rare disease called cerebral adrenoleukodystrophy, and the blood disorders sickle cell disease and beta-thalassemia.

“For Bluebird … it’s ultimately putting together a value story, that allows for a dialogue” about pay-for-performance, said Jeffrey Walsh, chief financial and strategy officer.

Vericel, which grows replacement skin from a burn patient’s own skin cells, also makes such a value pitch, said Nick Colangelo, president and CEO.

“When we treat a catastrophic burn patient, an order of our skin grafts can cost a couple hundred thousand dollars,” Colangelo said. “But it’s a one-time treatment.”

Moreover, treated patients have nearly a 90 percent survival rate, he said.

“That clearly is a product that has a lot of value,” Colangelo said.

Besides helping patients and the companies that make successful therapies, treatments like Kymriah also benefit companies that supply their research tools. One of them is Thermo Fisher Scientific, which had an early collaboration with Carl June, the physician who pioneered the therapy at the University of Pennsylvania.

Thermo Fisher supplied its Dynabeads, microscopic magnetic beads that attach to specified cells using an antibody linker, said Mark Stevenson, the company’s chief operating officer.

“They help extract and amplify the cells prior to the therapy … to actually enrich the cells that you want to pull out, also that you’re able to develop and expand the correct CAR T cells,” Stevenson said. “And for Novartis we scaled up that therapy to make a successful launch.”

“It’s a very exciting time for cell therapy,” Stevenson said. “We’ve been involved in it for 10 years and we’re finally seeing the benefits coming to patients.”

Trump budget would force tough choices in disease research

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What goes on the chopping block: Research into cancer or Alzheimer’s? A Zika vaccine or a treatment for superbugs?

Health groups say President Donald Trump’s proposal to slash funds for the nation’s engine of biomedical research would be devastating for patients with all kinds of diseases — and for jobs.

“It is possible that the next cure for some cancer is sitting there waiting to be discovered, and it won’t get to the table,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

In his budget blueprint Thursday, Trump called for a cut of $5.8 billion from the National Institutes of Health. That’s a staggering 18 percent drop for the $32 billion agency that funds much of the nation’s research into what causes different diseases and what it will take to treat them.

It comes despite Trump recently telling Congress about the need to find “cures to the illnesses that have always plagued us.”

“All of us woke up this morning in a state of shock about this number,” said Dr. Blase Polite, a cancer specialist at the University of Chicago who chairs the American Society for Clinical Oncology’s government relations committee.

Trump’s proposal would roll back NIH’s 2018 budget to about what it was in 2003. The president called for a “major reorganization” of NIH to stress the “highest priority research,” but only specifically targeted for elimination the $69 million Fogarty International Center that focuses on global health and has played a big role in HIV research abroad.

Drops in deaths from cancer and heart disease, breakthroughs in genetics, and new ways to treat and prevent HIV and other infectious diseases all are credited to decades of NIH-funded basic research.


Trump budget proposes 19 percent cut in NIH funding, leaving life science institutions reeling


As part of Trump’s budget proposal, he wants to chop $5.8B from the National Institutes of Health, or 19 percent, as part of a spending overhaul the Department of Health and Human Services.  The budget calls for a major reorganization of NIH’s institutes and centers, describing the move as a way to “help focus resources on the highest priority research and training activities.”

The proposal would also consolidate the Agency for Healthcare Research and Quality within NIH, and it would also mean “other consolidations and structural changes across NIH organizations and activities”.

Life science institutions are horrified.

It seems like only yesterday that Congress was prepared to boost NIH spending by $2 billion  — the biggest increase in 12 years.

Here is a round-up of reactions from national and regional institutions.

The American Cancer Society Cancer Action Network released a statement estimating that the NIH budget cuts were likely to cut $1 billion from the National Cancer Institute, noting it would be the biggest budget cut to the institution in its history.

Chris Hansen, president of the network said the cuts would be a significant setback for millions of American cancer patients, survivors and their families and would “dramatically constrain the prospect for breakthrough American medical innovation”.

For the last 50 years every major medical breakthrough can be traced back to investments in the NIH. Because of these investments, there are more than 15.5 million American cancer survivors alive today and researchers stand on the cusp of numerous innovative new diagnostic tools and treatments. From new immunotherapies that harness the body’s own immune system to destroy cancer cells to less toxic and more precise chemotherapies and advanced diagnostic and preventive tools.

“These developments save lives and spur economic progress. NIH-funded medical research is conducted in thousands of labs and universities across the country. These grants in turn spawn increased private investment and development. Drastically reducing NIH’s budget would jeopardize our nation’s potential to save more lives while simultaneously risking America’s position as the global leader in medical research.


An infographic of healthcare cuts in Trump’s draft budget



Healthcare groups bash Trump’s budget proposal: Cuts threaten public health

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Nurses, docs and medical research groups said the budget cuts proposed by President Donald Trump threaten the future of healthcare.

Among the cuts: Nearly 18% of HHS’ budget, with the largest cuts coming to National Institutes of Health. The agency would see a $5.9 million decrease in its budget and a significant reorganization effort that would fold the Agency for Healthcare Quality and Research into its ranks and close the Fogarty International Center

Nurses came out in force against the budget cuts. The American Nurses Association urged Congress to reject Trump’s proposal, which they said in a statement will  “weaken the nation’s healthcare system and jeopardize the scientific research needed to keep America healthy.”

The ANA is especially upset about plans to reduce funding for health professions and nursing workforce programs by $403 million. The proposal “drastically hampers efforts to address critical faculty shortages and recruit new nurses into the profession,” the association said.

Furthermore, the National Nurses United called the cuts a “broad attack on public protections that also targets some of the nation’s most vulnerable people while shifting resources to the least needed areas.”

The American Public Health Association agreed, stating that the proposal undermines the health and well-being of Americans.

“Cuts to these agencies would threaten programs that protect the public from the next infectious disease outbreak, polluted air and water, health threats due to climate change and our growing chronic disease epidemic,” APHA Executive Director Georges C. Benjamin, M.D., said in the statement.

And Andrew Gurman, M.D., president of the American Medical Association, said the cuts cause great concerns about future medical research and public health in general and in the wake of Zika, Ebola.

The Association of American Medical Colleges noted in a statement that medical research can’t be “turned on and off like a faucet.” Indeed, “the proposed cuts would set back progress toward critical advancements that could take decades to regain, prevent new ideas from being explored, and have a chilling effect on those who would potentially enter the biomedical research workforce.”

And the American Cancer Society said the reduction in funding would set cancer research back at least two decades.

“For the last 50 years every major medical breakthrough can be traced back to investments in the NIH,” Chris Hansen, president of the ACS Cancer Action Network, said in the statement. “Because of these investments, there are more than 15.5 million American cancer survivors alive today and researchers stand on the cusp of numerous innovative new diagnostic tools and treatments.”

20 Questions for President Trump

20 Questions for President Trump


The last six and a half years have been uncharted territory in our nation’s century-long debate over health reform. For the first time the fight was about how to implement an attempt at near-universal coverage rather over what this plan should look like and what could win enough support in Congress. The Affordable Care Act (ACA) has survived major political, legislative, and legal tests, including dozens of repeal votes, two Supreme Court decisions, the 2012 presidential election, and state-level resistance.

I was outside the Supreme Court on June 25, 2015 when the King v. Burwell decision was released. I was there the moment activists switched their signs from saying “Don’t you dare take my care” to “The ACA is here to stay.” I wrote that we could finally say with some certainty that they were right, the law is here to stay. They were wrong. I was wrong.

Donald Trump’s victory throws the future of health reform into complete chaos. He will take office in January 2017 with Republican majorities in the House and Senate. President Trump, Speaker Ryan, and Senate Majority Leader McConnell have all made repeated promises to get rid of Obamacare. They will face enormous pressure to follow through with their threats of repeal. Approximately 21 million people are projected to lose insurance if they follow through with their initial proposals.

The first step to figuring out where to go from here is understanding what decisions are on the horizon. Here are my first 20 questions about health reform under the Trump administration , in no particular order:

15 things for healthcare leaders to know about Obama’s 2017 budget