The Health and Human Services Secretary has launched a string of ambitious and aggressive initiatives, but he's also careful not to get too far in front of President Donald Trump.
It's been another interesting week of pronouncements from Health and Human Services Secretary Alex Azar.
In the past month, Azar has called for mandatory transparency in drug pricing, floated the idea of linking Medicare Part B drug prices to an international index, and strongly suggested that mandatory alternative payment models for radiation oncology and other subspecialties are on their way.
On Wednesday, Azar said the federal government will lead efforts to develop care models that factor in social determinants of health.
"Social determinants would be important to HHS even if all we did was healthcare services, but at HHS, we cover health and human services, all under one roof," Azar said in his prepared remarks. "In our very name and structure, we are set up to think about all the needs of vulnerable Americans, not just their healthcare needs."
At first glance, Azar's advocacy for an expanded or aggressive role for HHS in healthcare delivery sound odd coming from a conservative Republican, private sector champion, and former president of Eli Lilly USA.
However, Paul Keckley, managing editor of The Keckley Report, says Azar "is staying safely within the guardrails."
"I haven't seen anything that shocked me," Keckley says. "His view on the alternative payments and applying global pricing index to drugs are the two most edgy things that he's done so far."
"These are definitely more aggressive strategies than what his predecessor Tom Price would have put on the table, sure. But I don't see anything that would be viewed as really a stretch, such as we're going to get wholeheartedly behind drug importation," Keckley says. "He's holding those cards, seeing if the industry is going to comply, and politically that's probably the sensible thing to do right now."
Keckley says Azar is an experienced pragmatist who knows he can't get out too far ahead of the president.
"He won't do anything to make the private sector think he's not driven by a private system view of the world," he says. "He's knows he's carrying baggage from Eli Lilly, and he's got to do something with drugs prices and he knows that one wins votes, so he's going to push the envelope on that as much as he can."
Azar's proposals on drug pricing are not a surprise to the pharmaceutical industry, Keckley says, and he sees the industry working with HHS because it knows that drug pricing will be a big issue in the 2020 elections, and that the Trump administration needs a plan.
"If you think of it from the drug companies' vantage point, if you're going to be subject to increase price pressure and if that's going to be an issue in 2020, then they want to have some control over how it's implemented," he says. "All this transparency stuff is interesting, but it doesn't break the backs of the PhRMA companies, and I'm sure those 33 companies had input."
As for Azar's speech this week on HHS's enhanced role with social determinants, Keckley says he's just "piggybacking on an industry discussion."
"Where he's talking about allowing housing be reimbursed and Medicare Advantage being able to code for nutrition, I don't think he's taking a lot of risk moving that direction," Keckley says. "He's signaling that this is the right direction. He's telling us that HHS is not going to lead in this process, but we are going to create some kind of regulatory swim lanes for you to play in."
In 2019, Keckley says Azar will likely focus on drug pricing, but he may be forced to examine hospital consolidation and its effect on the cost of care delivery.
"The numbers of consolidations have shrunk a little, but they're bigger deals now," he says. "They're being sold to communities as eliminating duplication of services and reducing redundancies to save money, and yet that hasn't been the result."
The next big hurdle for the mega-merger will be in New York, where regulators have threatened to block the deal unless the companies agree not to raise premiums and submit their PBM to state oversight.
California has approved CVS Health Corp.'s $69 billion acquisition of Aetna Inc.
The go-ahead came this week after the two companies agreed to pump $240 million into the California's healthcare infrastructure and guarantee against premium hikes to cover the cost of the deal.
"The Department thoroughly examined this merger and determined enrollees will have continued access to appropriate healthcare services and also imposed conditions that will help increase access and quality of care, remove barriers to care and improve health outcomes," Shelley Rouillard, director of California's Department of Managed Health Care, said in a media release.
The go-ahead marks another big hurdle cleared for a merger that many observers believe could fundamentally change healthcare delivery in the United States and pose a direct challenge to traditional care providers.
The U.S. Department of Justice approved the deal inOctober, with the stipulation that Aetna sell its Medicare Part D business to WellCare Health Plans.
CVS said earlier this month that it hopes to complete the deal by Thanksgiving.
However, one of the last major state regulatory hurdles is in New York. That state's Department of Financial Services is expected to issue a decision on the merger in the coming weeks, after threatening last month to block the merger unless the companies agreed not to raise premiums and to submit their pharmacy benefits manager to state regulation.
CVS Health and Aetna did not return requests Friday for comment.
In addition to their pledge not to raise premiums to cover the acquisition costs, CDMHC said CVS and Aetna agreed to "keep premium rate increases to a minimum," and to invest nearly $240 million in California's healthcare delivery system.
This includes:
$166 million to support California's healthcare infrastructure and employment, including building and improving facilities in the state.
$22.8 million to increase the number of providers in underserved by funding scholarships and loan repayment programs.
$22.5 million to support joint ventures and accountable care organizations, and value-based pay for performance to improve clinical quality, resources and patient experience.
$6 million to support efforts to provide accurate and accessible provider directories, and standardize and improve the quality of encounter data.
$5.55 million to expand the California Quality Collaborative Practice Transformation Initiative to increase access and healthcare quality for underserved areas.
$3 million to provide free dental care to underserved patients.
$3 million in consumer assistance to seniors, people with disabilities, and Medi-Cal/Medicare dual eligibles.
$3 million to expand Project Health to CVS Pharmacy locations across California, which provides free preventative services.
Improve enrollee care through rating and oversight programs under the DMHC and Office of the Patient Advocate, including a $3 million investment to that end.
$1.65 million to integrate emergency medical services providers into community opioid treatment and prevention programs, and to expand a pilot community paramedic project.
$1.5 million to support programs that address the social determinants of health.
$750,000 to implement programs to help address the opioid crisis. CVS will also stock Naloxone in all CVS pharmacies in California and provide training on the drug.
The 168-bed community hospital was lauded for its consistent placement in top national rankings for quality and patient safety, financial stewardship, and engaged leadership.
Memorial Hospital and Health Care Center in Jasper, Indiana has been named one of five winners of the 2018 Malcolm Baldrige National Quality Award.
Memorialwas the only hospital selected for the prestigious award, which "recognizes exemplary organizations and businesses that demonstrate an unceasing drive for radical innovation, thoughtful leadership, and administrative improvement," the U.S. Department of Commerce said in a media release.
A person who answered the telephone at Memorial said the hospital would issue a statement "probably in a day or so."
Generally considered to be one of the most prestigious awards offered by the federal government, Baldrige winners are evaluated in seven areas: leadership; strategy; customers; measurement, analysis and knowledge management; workforce; operations; and results. The award was established by Congress in 1987 and there have been 123 winners.
Organizations can compete in one of six categories: manufacturing, service, small business, healthcare, education and nonprofit (including government agencies).
Memorial is a168-bed community hospitalthat is sponsored by the Sisters of the Little Company of Mary. The Jasper-based health system includes 32 outpatient primary and specialty care clinics and medical practices. The health system provides care for 6,600 inpatients and 254,000 outpatients through 29,000 emergency department visits annually.
Among the many accolades cited for the award, the Baldrige committee noted that Memorial has consistently received top scores from the Centers for Medicare & Medicaid Services and private rating entities in the areas of value-based payment performance, and patient safety, with no cases of pressure ulcers, central line-associated bloodstream infections since 2016, and no methicillin-resistant staphylococcus aureus since 2015.
Financially, Memorial was lauded for improving its cash on hand from 180 days in 2016 to 215 in 2018. In addition, Memorial's long-term debt as a percentage of capital improved from approximately 25% in FY2016 to approximately 21% in FY2018, and its days in accounts receivable improved from 48 days in FY2017 to 41 in FY2018.
Memorial's leadership was singled out by the Baldrige committee for embracing "a faith-based culture focused on 'Radical Loving Care' and the core competency of 'Being for Others.'
"Enterprise-wide, members of the workforce are enthusiastic about the distinctive culture and are empowered to meet their patients' medical, emotional, and spiritual needs," according to the National Institute of Standards and Technology, which oversees the award.
NIST also noted Memorial's senior leadership "encourage frank, two-way communication and engagement of MHHCC's workforce, providers, patients, and other customers."
"Their extensive efforts include senior leaders regularly visiting departments; an open-door policy; hand-written, thank-you cards; the 'Really Impressive Moments' recognition program; the Friday Facts email by the CEO, which lists his personal cell phone number; and Patient Family Advisory Councils," NIST said.
In addition to Memorial, the award was given to two educational institutions, an organ donor group, and a project management firm.
"These awardees are inspiring in so many ways," said Walter G. Copan, Under Secretary of Commerce for Standards and Technology at NIST.
"Each honoree strengthens our economy through its organizational excellence and positive impacts for its customers, students, patients and employees," Copan said. "They exemplify the American spirit in action and are role models for success in business and commerce."
Federal prosecutors had alleged that Atrium's restrictions on coverage options prevented insurers from promoting cost-effective healthcare services. Atrium admits no wrongdoing.
Atrium Health has agreed to end what the federal government said are anticompetitive steering restrictions in contracts between commercial health insurers and its providers in the Charlotte, North Carolina service area, the Department of Justice announced.
If the settlement is approved by a federal judge, it will end two years of civil antitrust litigation that challenged Atrium's alleged use of steering restrictions that prevented health insurers from promoting cost-effective healthcare services to consumers, DOJ said.
"Competition encourages healthcare providers to reduce costs, lower prices, and increase quality," said Makan Delrahim, Assistant U.S. Attorney General for the Antitrust Division. "Atrium's steering restrictions interfered with the competitive process, resulting in fewer choices and higher costs for consumers."
DOJ claimed that Atrium, the dominant provider in Charlotte, used its market power to restrict health insurers from encouraging consumers to choose healthcare providers that offer better value. The restrictions also constrained insurers from providing consumers and employers with information regarding the cost and quality of alternative health benefit plans, DOJ said.
Atrium issued a statement noting that there was "no admission on the part of Atrium Health of wrongdoing in this settlement agreement, and Atrium Health did not violate the law. In addition, Atrium Health will not pay any penalties or fines."
"The language in question is from contracts created as long ago as 2001 and was originally added to ensure Atrium Health was provided an equal opportunity to compete for patients," Atrium said. "As the healthcare landscape continues to rapidly evolve, Atrium Health's contracting language has also evolved to reflect current healthcare practices."
Atrium is North Carolina's largest healthcare system and one of the largest not-for-profit healthcare systems in the United States. Atrium's flagship Carolinas Medical Center is the largest hospital in North Carolina. Atrium also operates eight other general acute-care hospitals in the Charlotte area and owns, manages, or has strategic affiliations with more than 40 hospitals in the Carolinas.
In 2017, Atrium's owned, managed, and affiliated hospitals and other healthcare providers earned net operating revenue of close to $10 billion.
Branded prescription drugs were 17% of total prescriptions filled by Blue Cross Blue Shield commercial plans in 2017, but they accounted for 79% of the payers' $100 billion drug spend.
Spending on branded specialty and patent-protected drugs is up 4% since 2016 and continues to outstrip spending on generic drugs by nearly $80 billion a year, the Blue Cross Blue Shield Association says in a new report.
Nationally, BCBS commercial plans spend more than $100 billion each year on drugs, which account for 20% of overall healthcare spending for the payers. Branded prescription drugs represent 17% of the total prescriptions filled by BCBS commercial plans, but they account for nearly $80 billion of the total spend, BCBSA said.
"The report findings underscore the underlying cost drivers in the prescription drug market and identify potential surges in overall drug costs in the future," Maureen Sullivan, chief strategy and innovation officer for BCBSA, said in remarks accompanying the study.
The report reviews eight years of drug use, price changes and overall spending to determine why the rising use of generic drugs has been unable to contain the overall cost increase for branded prescription drugs.
The study found that:
More expensive branded prescription drug spending is up 4% since 2016. Branded prescription drugs are 17% of total prescriptions filled but account for 79% of overall drug spending at $79.5 billion.
Steady annual increases in branded patent-protected prescription costs drive the majority of spending in the branded drug space, growing 5% in the past year.
The growing market share of inexpensive generic drugs continued to slow the increase in total drug spending. While generic drug spending has declined 3% since 2016, it hasn't kept pace with the rapid rise in specialty branded drugs.
Horizon Blue Cross Blue Shield of New Jersey said spending on branded specialty drugs used to treat complex, chronic health conditions grew by 62% between 2013 and 2017. Those specialty drugs represent no more than 6% of prescriptions issued for branded drugs, but account for between 32% and 44% of the total spend on branded drugs.
Horizon CEO Kevin P. Conlin says prescription costs account for 29% of Horizon's total healthcare spending and are rising faster than any other component of claims, which he said is driven by the substantial increase in spending on these branded specialty drugs.
"Horizon has devoted considerable resources to programs designed to manage and contain overall drug spending, but this challenge requires that everyone who plays a role in health care join the effort to lower drug costs," Conlin said.
"Just as we are collaborating with our value based providers to improve quality and lower costs, effectively addressing the cost of prescription drugs requires a multi-stakeholder approach that includes pharmaceutical companies, policymakers, payers, doctors, employers, and patients," he said.
BCBSA published a list of the top five medications by spending in 2017 across the BCBS system, the top three of which are used to treat autoimmune disorders.
Humira
Remicade
Enbrel
Novolog
Neulasta
The Health of America Report is a collaboration between BCBSA and Blue Health Intelligence, and relies on a claims database to find trends in healthcare affordability and access.
Models show that personalized patient drug regimens can reduce treatment times and save money without jeopardizing efficacy.
The high-cost, highly effective 12-week drug regimen used to treat and often cure hepatitis C was reduced by up to six weeks for some patients without compromising outcomes, a new study shows.
"There's a potential to save up to 20% of the costs of hepatitis C drugs," said study co-first author Harel Dahari, a researcher at Loyola Medicine.
In addition to cutting costs, Dahari said shorter treatment regimens would help hepatitis C patients with limited health insurance benefits.
The Centers for Disease Control and Prevention estimates that about 2.5 million Americans have hepatitis C, and that the disease accounts for more than 18,000 deaths annually, although that number is believed to be underreported.
A highly effective array of new drugs that cure more than 90% of hepatitis C patients can cost more than $50,000 per patient. However, asnew drugs enter the market, such as oral medications called direct acting anti-virals, prices are continuing to drop.
The Loyola-led study, presented this week during the annual meeting of the American Association for the Study of Liver Diseasesin San Francisco, used modeling-based response-guided therapy to reduce treatment times for half the 22 patients in a control group.
After the patients had undergone treatment for a few weeks, researchers measured how much hepatitis C virus levels had decreased. They used mathematical modeling to estimate how long it would take to completely eliminate the virus.
The modeling predicted that treatment could be shortened to 10 weeks for one patient, eight weeks for eight patients, and six weeks for two patients. The remaining 11 patients needed the standard 12-week regimen.
Within the control group, 21 patients remained virus-free. The only patient who relapsed had the most difficult-to-treat form of the hepatitis C virus, known as genotype 3.
The proof-of-concept pilot study showed that using response-guided therapy to reduce treatment times is feasible. To validate the results, a large multicenter trial is underway in Israel.
The study was supported in part by the National Institutes of Health and Clalit, a health service organization in Israel.
A study examines 'subjective workload' among NICU nurses, and finds a number of perceived stressors that take time away from essential care and could lead to sub-optimal outcomes.
Patient volume and acuity play a role in a nurse's ability to provide optimal care, but they aren't the only factors, a new study shows.
Researchers at The Ohio State University found that a nurse's "subjective workload"—which could include everything from the mental pressures of the job to relentless time constraints—affects her or his ability to provide optimal care, no matter how many patients they're attending.
The study, in the journal JAMA Pediatrics, calls for developing broader workload strategies to ease nurses' stress and improve care quality.
"We were surprised to discover how important subjective workload is to care quality, and it's something we typically don't measure in healthcare. This is really the nurse's voice telling us how intense things were," said study lead author Heather L. Tubbs-Cooley, RN, an associate professor of nursing at Ohio State.
The study examined data collected during 332 12-hour shifts from 136 neonatal intensive care nurses caring for 418 infants. Researchers during each shift collected objective measures of infant-to-nurse staffing ratios and infant acuity.
The NICU nurses were asked to fill out the NASA Task Load Index to measure perceived workload based on mental demand, physical demand, time constraints, and overall effort needed to accomplish patient care.
The nurses also gave the researchers reports on "essential care" that they missed during shifts—including hourly assessments of the patients' intravenous sites, oral feedings, collection of laboratory results and safety checks of equipment and alarms.
The researchers used the data to create multiple statistical models to evaluate the relationships between objective and subjective workload measures and quality of care. They found that, regardless of the model, the nurses' perceived workloads had a consistently strong influence on missed essential care.
Some of the models showed that higher patient ratios contributed to missed care, which has been demonstrated in other studies. However, the researchers saw little connection in this study between the severity of patients' health status and missed care.
"Subjective workload was the one variable that was consistently and strongly associated with missed care," Tubbs-Cooley said. "Staffing ratios get a lot of attention—and they’re important—but nurses' in-the-moment workload judgments matter as much or more."
While NICU nurses are under tremendous stress while caring for the sickest, most-fragile patients, Tubbs-Cooley says her study's implications suggest "a universal phenomenon among front-line caregivers in hospitals and even those in outpatient and community settings."
With repealing the ACA off the table, Democrats and Republicans might find common ground on issues such as drug pricing.
For healthcare economist Gail Wilensky, the big message that voters sent to their elected officials during Tuesday's midterm elections was straightforward and simple.
"Don't mess with my healthcare," says Wilensky, a senior fellow at Project HOPE and a former MedPAC chair.
"It's as clear as that. There were no subtleties involved here," she says. "That includes protections for preexisting conditions and added coverage under Medicaid."
Consider what happened on Tuesday:
Overall, Democrats wrested control of the House from Republicans in an election where healthcare was seen as the single biggest issue. Democrats ceaselessly hammered Republicans with the claim that the GOP would eliminate protections for preexisting conditions.
Ballot initiatives in three bright-red Republican states all passed with healthy margins. A similar ballot initiative in Montana failed, but observers blamed the failure on an unpopular $2-per-pack tax on cigarettes that would have paid for the expansion.
Wisconsin Attorney General Brad Schimel, a plaintiff in a Texas v. Azar, was ousted by Democrat Josh Kaul, who promised to withdraw Wisconsin from the suit.
Three-term Wisconsin Gov. Scott Walker lost a reelection bid to Democrat Tony Evers, likely scuttling that state's recent waiver approval for Medicaid work requirements. Evers also pledged to expand Medicaid.
Phil Weiser, Colorado's Democratic Attorney General-elect, and a former Obama administration staffer, told Colorado Public Radio that one of his first actions would be to join the 17 Democratic attorneys general intervening to defend the ACA in Texas v. Azar.
Wilensky says the midterm results reinforce one of the oldest truisms in politics: Once an entitlement is proffered, there's no going back.
"There is no precedent that I'm aware of in American political history where a benefit can be taken away," she says. "Once granted, it can be modified, it can be increased, it can be augmented in some way, but there's no taking it away after it's been in place."
When Democrats took control of the House, Wilensky says, they drove a stake through the heart of the "repeal and replace" movement.
"Republicans couldn’t even get that done when they control both houses of Congress, she says. "It's a non-issue, in part because a lot of Republicans support major provisions of the Affordable Care Act."
With repealing the ACA off the table, Democrats and Republicans might find common ground on issues such as drug pricing.
"That's clearly is the most obvious, in general, but the specifics of what you want to do become much more challenging," Wilensky says. "Typically, Democrats want to use administered pricing the way that we use administer pricing in parts of Medicare. I don't know how much Republican support there is for that."
The two parties could reach some sort of bipartisan agreement on Medicare Part B drugs, Wilensky says, because it's a smaller program and the drugs are generally much more expensive.
"Most members of Congress are not talking about messing around with Part D, the ambulatory prescription drug coverage," Wilensky says. "So it really has to do either with the expensive infusion drugs that are administered in the physician's office or maybe something about drug advertising. Even then, it's going to be hard lift when you actually get down to the specifics."
Besides, Wilensky says, it's not the cost of drugs that's at the heart of voter agitation.
"You have to unpack what they're saying to figure out what they're actually pushing for," she says. "People couldn't care less about drug prices. They only care about what it costs them. So when they talk about drug prices they mean, 'I want to spend less for the drugs I want, and I don't want any constraints about what I can order.'
More likely, she says, common ground could be found in arcane areas such as mandating greater transparency for pharmacy benefits managers, and changing PBMs' rebate structure.
Wilensky warns that giddy Democrats should learn from the mistakes of Republicans in the midterms and not attempt to force a Medicare-for-All solution on a wary public.
"First of all, they're going to have to define what it means," she says. "But, you have to be very careful because historically there's not been warm and fuzzy response to taking away people's employer-sponsored insurance."
"Again, historically, when candidates mess around with employer-sponsored insurance they have gotten themselves into trouble," she says. "Most people would like to keep what they have, because keeping what you have is much safer than going with something as yet to be defined."
In a sharp departure from Trump Administration policy, HHS Secretary Alex Azar pushes mandatory payment models.
The Centers for Medicare & Medicaid Services in the coming weeks will roll out mandatory Medicare payment models for cancer and "revisit" voluntary cardiac care models, Health and Human Services Secretary Alex Azar said Thursday.
"Bundled Payments for Care Improvement is a voluntary model, where potential participants can select whether they want to join. But we're not going to stick to voluntary models," Azar said in a speech Thursday before the Patient-Centered Primary Care Collaborative Conference.
"BPCI Real experimentation with episodic bundles requires a willingness to try mandatory models. We know they are the most effective way to know whether these bundles can successfully save money and improve quality," Azar said.
The mandatory payment models would be a sharp departure for the Trump administration, which in the past has steered away from forcing providers into downside risk models.
Azar on Thursday said the HHS has "reexamined" last year's decision to reduce the size of the Comprehensive Care for Joint Replacement Model, and its decision to pull back on cardiac care episode payment models before they were even launched.
"We intend to revisit some of the episodic cardiac models that we pulled back, and are actively exploring new and improved episode-based models in other areas, including radiation oncology," he said.
"We're not going to stop there: We will use all avenues available to us—including mandatory and voluntary episode-based payment models," he said.
Azar's comments will likely irritate physicians who generally support voluntary alternative payment models, but who've warned that there's not enough evidence to show that at-risk models work.
American Society for Radiation Oncology CEO Lauran Thevenot said her association has "aggressively pursued" adoption of CMS's proposed radiation oncology APM, but she stopped short of endorsing mandatory participation.
"While ASTRO is enthusiastic about the prospects for a RO-APM, we have concerns about the possibility of launching a model that requires mandatory participation from all radiation oncology practices at the outset," Thevenot said.
"ASTRO believes it is important to acknowledge that any radiation oncology payment model will represent a significant departure from the status quo," Thevenot said. "Care must be taken to protect access to treatments for all radiation oncology patients and not disadvantage certain types of practices, particularly given the very high fixed costs of running a radiation oncology clinic."
Azar warned that anyone who "doubts our ambitions in this area" should look at HHS's proposed mandatory International Pricing Index for drugs that was rolled out last month.
"We want to advance models like these in a collaborative manner. That has been a key priority for this administration since day one," Azar said. "But there is nothing virtuous about maintaining outdated systems within Medicare fee-for-service—effectively a mandatory system for so long—when we know we could be exploring better alternatives."
"We need results, American patients need change, and when we need mandatory models to deliver it, mandatory models are going to see a comeback," he said.
Mandatory alternative payment models have never been popular with physicians. A Medical Group Management Association poll in March found that 72% of medical group practices oppose the idea.
"Despite support for APMs, a large majority of physician practices oppose government mandated participation, citing lack of evidence, diversity among medical practices, and the negative impact on practice innovation," Anders Gilberg, MGMA's senior vice president of government affairs said at the time.
Azar's reversal of Trump administration policy on mandatory payment models should not come as a complete surprise. Azar has always been more receptive to the idea than his predecessor Tom Price, MD.
During his confirmation hearing in January Azar told the Senate Finance Committeethat "we need to be able to test hypotheses."
"I want to be a collaborative in doing this. I want to be transparent and follow appropriate procedures. But if to test a hypothesis around changing our healthcare system it needs to be mandatory as opposed to voluntary to get adequate data, then so be it," Azar told the committee.
Democratic Attorney General-elect Josh Kaul vows to withdraw Wisconsin from a multistate suit that challenges the constitutionality of the Affordable Care Act.
A lead plaintiff among the 20 Republican attorneys general suing to dismantle the Affordable Care Act has lost his re-election bid, and the man who defeated him says the state will withdraw from the suit.
Wisconsin Attorney General Brad Schimel narrowly lost to Democrat Josh Kaul by about 22,000 votes in Tuesday's statewide election that also saw the defeat of embattled three-term Republican Gov. Scott Walker to Democrat Tony Evers.
Schimel is a lead plaintiff in a suit brought by 20 Republican attorneys general who argue that the ACA is unconstitutional.
Led by Texas Attorney General Ken Paxton, who won re-election on Tuesday, the Texas v. Azar plaintiffs claim that the ACA became unconstitutional when Congress zeroed-out the tax penalty for the individual mandate, thus invalidating the sweeping legislation in its entirety.
The case was argued before U.S. District Judge Reed O'Connor in early September, but O'Connor has yet to issue a ruling.
When the suit was filed in February, Schimel said the ACA's "irrational design wreaks havoc on health insurance markets."
"Obamacare causes premiums to rise and coverage to fall, forcing Wisconsin and other states to take extreme, costly measures to protect their citizens' health and pocketbooks," he said.
"I bring this challenge to Obamacare because, as Wisconsin's attorney general, I swore to uphold the rule of law and protect our state from overreaching and harmful actions from the federal government."
It's not clear if Schimel's vocal role in the ACA suit was a factor in his narrow defeat, but the state's AG-elect made it clear Wednesday that he would reverse course.
In his acceptance speech, Kaul, a former federal prosecutor, pledged to work with Evers to withdraw Wisconsin from Texas v. Azar.
Kaul also pledged to expand Medicaid coverage to about 80,000 people under Wisconsin's Badgercare program, which he said would save the state about $190 million a year.
Paxton, a conservative Republican in deep red Texas, won re-election after defeating Democrat Justin Nelson by four percentage points.
During the campaign, Nelson accused Paxton of filing the suit to distract voters away from his felony indictments for securities fraud, for which he is awaiting trial.
"I will withdraw Texas from the lawsuit on my first day on the job," Nelson told POLITICO.
"Texas has one of the worst rates of uninsured people and one of the highest rates of pre-existing conditions in the country," he said. "We should be the leader in fighting to protect people from insurance companies, but instead we're the face of the lawsuit to end coverage of pre-existing conditions."
Nationwide, Republican attorneys general in Wisconsin, Nevada, Colorado and Michigan lost to Democrats, but no Democrats lost to Republicans, according toBallotpedia.
Colorado's Democratic AG-elect Phil Weiser, a former Obama administration staffer, told Colorado Public Radio that one of his first actions would be to join the 17 Democratic attorneys general intervening to defend the ACA in Texas v. Azar.
"I'm not prepared to tell you which is the first lawsuit Colorado will join when I become AG, but I will tell you one of the first is standing up for the protection of the ACA against the action by the Texas AG and others to undermine this critical protection," Weiser told CPR.
The other Republican states that joined the Texas v. Azar lawsuit are Alabama, Arkansas, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Utah and West Virginia.
Led by California, Democratic attorneys general from 17 states and the District of Columbia have filed a motion to intervene. Those states are Connecticut, Delaware, Hawaii, Illinois, Kentucky, Massachusetts, Minnesota, North Carolina, New Jersey, New York, Oregon, Rhode Island, Virginia, Vermont, Washington, and the District of Columbia.
