Daily on Healthcare: McConnell has them right where he wants them

Welcome to Philip Klein’s Daily on Healthcare, compiled by Washington Examiner Managing Editor Philip Klein (@philipaklein), Senior Healthcare Writer Kimberly Leonard (@LeonardKL) and Healthcare Reporter Robert King (@rking_19).  Email [email protected] for tips, suggestions, calendar items and anything else. If a friend sent this to you and you’d like to sign up, click here. If signing up doesn’t work, shoot us an email and we’ll add you to our list.

When should we expect them to try to vote again? In a couple of weeks, according to McConnell. The Senate is leaving for recess tomorrow and will reconvene Monday, July 10.

But GOP still hopes to iron out healthcare differences by end of week: Republican senators said after the meeting that the plan now is to use the rest of this week to reach a deal for at least 50 senators to support the bill. The Senate would then take up the bill when it returns July 10. “Ultimately I’d rather do it right than do it fast,” said Sen. Marco Rubio, R-Fla, ahead of Tuesday’s lunch. “We are going to have to live with these consequences. Otherwise we’ll have to come back and do it again. That was the experience of Obamacare.”

More Republican senators came out against the bill after it was delayed: Conservative Sen. Mike Lee of Utah and centrist Republican Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia announced Tuesday they can’t support the Senate’s draft healthcare bill, which increased the number of Republicans in opposition to nine. Other Republicans opposed are Sens. Susan Collins of Maine, Ted Cruz of Texas, Dean Heller of Nevada, Ron Johnson of Wisconsin, Mike Lee of Utah, Jerry Moran of Kansas and Rand Paul of Kentucky. Portman and Capito’s opposition isn’t a surprise as both declined to support the bill since its release. They also both come from states that expanded Medicaid under Obamacare. Lee, who had lamented the process by which the healthcare bill was quickly moved through the Senate, said he was glad the vote had been delayed and hoped the next version could reduce prices for working families. “The first draft of the bill included hundreds of billions of dollars in tax cuts for the affluent, bailouts for insurance companies and subsidies for lower-income Americans,” he said. “But it ignored the middle-class families who have borne the brunt of Obamacare, and who have been left behind by both parties in Washington for too long. That’s why I opposed it.”

Sen. Lisa Murkowski, R-Alaska, explains her opposition to cutting off federal funding from Planned Parenthood. “People support greater access to healthcare,” she said on MSNBC. “Planned Parenthood provides for that. Provides for greater access, particularly to lower income women, for purposes of screening services that I think are important. When we are talking about healthcare reform, shouldn’t it be about increasing access? As I’m talking to Alaskans, that’s what they are telling me is important.”

Does McConnell know when to hold ’em and when to fold ’em? Sen. Bill Cassidy, R-La., was asked after leaving the GOP luncheon Tuesday if McConnell was optimistic about getting a vote after the July 4 recess. “The leader is never optimistic,” Cassidy joked. “He is a poker player.”

Conservatives target insurance requirements in Senate health bill, but they aren’t saying whether the community rating requirement that shields sick people from high premiums must be on the table. “My central focus from day one has been the need to lower premiums to make health insurance more affordable for families who are struggling,” Cruz said shortly after leaving a Senate luncheon Tuesday. “There is not enough in the current draft to do that.” Several senators said the bill leaves in too many of Obamacare’s insurer mandates. “We have to repeal more regulations,” Paul said Monday. Johnson also railed against the mandates. “I would recommend people go back to what were the conditions prior to Obamacare, embrace those conditions and get rid of those mandates that drive up the cost of insurance,” he said, adding that high-risk pools should be set up to help people with pre-existing illnesses. When asked whether the final bill must repeal community rating, Johnson replied: “In the end I will make the decision based on whether or not we are better off tomorrow with whatever we are voting on than we are today.”  

Paul wants GOP to abandon ‘bailouts:’ The Kentucky lawmaker urged fellow Republicans on Wednesday to abandon the “bailouts” that would go toward health insurance companies to help stabilize the Obamacare exchanges in the short term. In a letter to Senate Majority Leader Mitch McConnell that detailed his reasons for opposing the healthcare bill’s draft, Paul said that the funding for insurers under Obamacare is designed to “backfill the losses the insurers take in the Obamacare exchanges, while they make huge profits in the group markets.” He lamented that insurer profits from 2008 to 2015 had grown from $8 billion per year to $15 billion per year.  

The draft, the Better Care Reconciliation Act, calls for providing billions of dollars in funding for four years for states to stabilize the exchanges, and would also fund cost-sharing reduction subsidies, which help insurers offer lower out-of-pocket medical costs to consumers. The funding is meant to reduce disruption for customers in the exchanges, but a Congressional Budget Office report projects that if the bill is signed into law, then 15 million people would be uninsured by 2018.

Signs of bipartisanship? Johnson on Wednesday ripped the Republican Party for not including congressional Democrats in its work to write a healthcare reform bill. “I wish we were doing this on a bipartisan basis. I think it was a mistake right away saying we’re going to do this partisan. That’s where we’re at,” Johnson told CNN’s “New Day.” “The problem in Washington, D.C., is we talk policy absent and void of information,” Johnson said. “That was my problem with the process, is it started with all these policy arguments, void of any information. We finally have some information.” The Wisconsin lawmaker said that while Republicans focus on their bill, perhaps Democrats will take up their own, and both parties can tackle it together in the future. Dr. Ben Carson, secretary of housing and urban development, also suggested in a Fox News appearance Tuesday that Democrats should be invited to the table.

White House says President Trump is not concerned with timeline, but getting bill that ‘helps the most Americans.’ White House deputy press secretary Sarah Sanders said Tuesday the White House has never been concerned about the timeline for passing a bill to repeal and replace Obamacare but is concerned with getting a bill that “helps the most Americans.” “The president is committed — he’s said and all the members of the administration have said repeatedly — to repealing and replacing Obamacare, working with the Senate, working with the House, making sure we get the best bill,” Sanders told reporters Tuesday. “For us, it’s never been about the timeline, but about getting the best piece of legislation that helps the most Americans. That’s what we’re continuing to do day in, day out.”

In meeting with GOP senators, Trump said bill’s passage was close, but hinted Obamacare might stay in place. “So we’re going to talk and we’re going to see what we can do,” Trump told senators. “We’re getting very close. But for the country, we have to have healthcare, and it can’t be Obamacare which is melting down … This will be great if we get it done. And if we don’t get it done, it’s just going to be something that we’re not going to like.” After the meeting, he tweeted, “With ZERO Democrats to help, and a failed, expensive and dangerous ObamaCare as the Dems legacy, the Republican Senators are working hard!” He tweeted moments later that he had just finished a “great meeting” with GOP senators about healthcare. “They really want to get it right, unlike OCare!” he said.

Behind closed doors: Trump warns GOP of ‘cost of failure’ on healthcare bill. He warned them they could face the wrath of voters, lose the majority and ultimately face socialized healthcare in America if they don’t pass a bill. “He was encouraging us to figure out a way forward and kind of the cost of failure, of what it would mean not to get it done,” Rubio said as he returned to the Capitol from the White House. Trump, Rubio said, predicted if the Republicans do not send a bill to his desk that repeals and replaces Obamacare, “We would wind up in a situation where the markets would collapse, Republicans would be blamed for it and potentially have to fight off an effort to expand to single payer [healthcare] at some point.” Other GOP lawmakers described the meeting as one in which lawmakers were able to voice their objections to the bill in the presence of Trump and administration officials. “This was the first time the various sticking points were aired in a forum like this with the president and the vice president and healthcare administration officials listening and taking notes,” said Sen. Roger Wicker, R-Miss. “So I think this was a good exercise. I think, basically, every sticking point is now out there on the table and we know what parts need to move.”

The Better Care Reconciliation Act is unpopular. Only 17 percent of Americans approve of Senate Republicans’ healthcare bill, according to a new poll released Wednesday from NPR, PBS NewsHour and Marist. Fifty-five percent of people don’t approve of the bill. Independents and Democrats widely dislike the bill, with only 13 percent of independents liking it and 68 percent disapprove. Among Republicans, 21 percent disapprove of the bill and 35 percent approve of it. A USA Today/Suffolk University poll finds approval at just 12 percent.

Sen. Chuck Schumer: ‘The fight is not over.’ “We know the fight is not over, that is for sure,” the Senate minority leader, said. He said Democrats don’t have a “sense of accomplishment” over the delay of the healthcare bill. Schumer predicted that McConnell will try to buy off skeptical Republicans with a “slush fund” in the bill once lawmakers return. “We’re going to fight the bill tooth and nail,” Schumer said, adding that there’s a good chance to defeat the bill. “The Republicans cannot excise the rotten core at the center of their healthcare bill.”

Wait, the next step is single payer? At least according to Sen. Elizabeth Warren, D-Mass. Warren told the Wall Street Journal that Obamacare was the first step in moving forward healthcare coverage. “Now it’s time for the next step. And the next step is single payer,” she told the newspaper. But Warren’s comments come as Democrats are trying to fight GOP efforts to repeal Obamacare, which Republicans have constantly complained is already too much government interference into healthcare.

Pro-Trump group to pull ads attacking Heller. America First Policies, a group created to support the president’s policies, decided Tuesday to pull an advertising campaign aimed at highlighting Heller’s opposition to the GOP healthcare plan in his home state of Nevada. America First Policies scrapped the seven-figure ad buy after vowing earlier this week to move ahead with the cable and digital campaign regardless of whether Heller shifted his position on the Obamacare repeal measure. A source familiar with the group’s plans confirmed the decision to the Washington Examiner on Tuesday. “America First Policies is pleased to learn that Senator Dean Heller has decided to come back to the table to negotiate with his colleagues on the Senate bill,” said Erin Montgomery, the group’s communications director. “We have pulled the ads we released earlier today in Nevada, and we remain hopeful that Senator Heller and his colleagues can agree on what the American people already know: that repealing and replacing Obamacare must happen for America to move forward and be great again. 

Study: Premiums rise 74 percent for some plans in Senate health bill. The analysis from the nonpartisan Kaiser Family Foundation comes on the same day GOP leadership delayed a procedural vote on the healthcare bill because of a lack of support. The increase of 74 percent for a silver plan, the middle tier of Obamacare plans, is in stark contrast to an estimate from the Congressional Budget Office that said premiums would be about 30 percent lower than the current law. Kaiser found that premiums for certain age groups and incomes would suffer more. For instance, people 55 to 64 years old would pay 115 percent more under the Senate bill and people with incomes under 200 percent of the federal poverty level would pay 177 percent more than under Obamacare. “Increases for younger people are modest, and they could lower their premiums if they opt for higher deductible plans,” the foundation said.

Enough is enough for Mass. co-op. One of the five remaining Obamacare taxpayer-funded co-ops doesn’t want to be a co-op any more. Minuteman Health announced Tuesday it seeks to become a new insurance company that doesn’t have to abide by federal rules it must meet now as a consumer oriented and operated insurance plan under Obamacare. The company said it hopes to transition its 37,000 members to the new business by the beginning of the year. The co-op bashed the federal government’s risk adjustment program that seeks to shift costs from lower-risk insurers to ones with higher-risk enrollees. Minuteman said the program unfairly penalizes smaller insurers that have low cost and experience high growth. The new entity hasn’t been created yet, but Minuteman said it would not be subjected to federal co-op rules.

With Minuteman’s decision, only four co-ops remain out of the 23 created to spur more competition on Obamacare’s exchanges.  

Rick Perry: Give states ways to reach their own healthcare solutions. The energy secretary and former Texas governor said Tuesday he believes governors should be given the ability to develop their own healthcare solutions for the residents of their states and that Washington needs to step back and give states those options. “I happen to believe that the states are laboratories of innovation. They’re innovators just like we have in our national labs. Governors, I think, have within their states and their bright young people who work with them in the private sector, they will come up with ways to deliver healthcare that can put more people under coverage for less money and give options to their citizens,” Perry told reporters during the White House press briefing.

AARP warns senators to ‘start from scratch’ after CBO score released. The organization dedicated to representing Americans 50 years old and older said Tuesday it will blast its 38 million members online, through the media, and with direct alerts about any senator who votes in favor of the healthcare legislation. “Under the BCRA, premiums and out-of-pocket costs for 50-64 year olds buying their own insurance would skyrocket, Medicaid coverage for millions of seniors and people with disabilities would be at risk and the fiscal sustainability of Medicare would be weakened,” AARP wrote. 

Club for Growth also to oppose Senate healthcare bill. Club for Growth, a prominent outside conservative group, is not happy with the Senate draft and is causing McConnell another headache. The group said Tuesday it would oppose the bill because it doesn’t fully repeal Obamacare. “Only in Washington does repeal translate to restore. Because that’s exactly what the Senate GOP healthcare bill does: it restores Obamacare,” President David McIntosh said. “And while it’s hard to imagine, in some ways the Senate’s legislation would make our nation’s failing healthcare system worse.” Club for Growth also opposed initial versions of the House healthcare bill, but got on board after the bill added state waivers for certain Obamacare mandates. The opposition could help embolden conservative senators who already oppose the bill and are pushing for more changes.

Billionaire Warren Buffett called the Senate and House Obamacare repeal bills are tax relief for the rich. In an interview with PBS, Buffett, who has a net worth of $76 billion according to Forbes, criticized Republicans for removing Obamacare taxes on higher income earners. “I will be given a 17 percent tax cut. And the people it’s directed at are couples with $250,000 or more of income,” Buffett said. “You could entitle this, you know, Relief for the Rich Act or something, because it — I have got friends where it would have saved them as much as — it gets into the $10-million-and-up figure.”

Democrats grill Labor Secretary Alexander Acosta on healthcare bill. Acosta may be in charge of the Trump administration’s labor policy, but that didn’t stop Senate Democrats from grilling him instead on the subject of healthcare during an appearance before a Senate committee Tuesday to discuss his department’s budget. Democrats repeatedly asked him about the impact the Senate Republican leadership’s legislation to partially replace and repeal Obamacare would have on the economy, arguing that the Republicans were making a grave mistake. Acosta repeatedly pushed back against the Democrats’ arguments, while also noting that healthcare wasn’t his area of expertise and he was there to discuss his department’s budget.

Labor Department begins monitoring opioid use by federal workers. The Department of Labor announced Tuesday that it had officially begun monitoring use of opioid prescriptions by workers under the Federal Employees’ Compensation Act, which provides benefits for sick and injured workers. The announcement follows an executive order Trump signed in March intended to combat opioid addiction. The department’s Office of Workers’ Compensation Programs instituted a regulation requiring all doctors who want to prescribe any compounded medications containing opioids to file a Letter of Medical Necessity justifying the prescription and explaining why alternate treatments are not feasible.

Rep. Chris Collins may have lost millions after stock crashed Tuesday. Collins, R-N.Y.,  a businessman before shifting to politics, bought into Australian company Innate Immunotherapeutics 15 years ago and had reportedly tried to convince other lawmakers to buy in as well. Collins invested in the company’s multiple sclerosis drug, MIS416. Before the weekend, he had owned nearly 17 percent of the $45.5 million brand, now worth a mere $1.5 million. On Tuesday, the company’s stock closed at five cents a share in the Australian Stock Market after clinical trials in Australia and New Zealand failed. The news came before the product was set to be tested in the U.S. Collins told the Buffalo News he did not sell any shares prior to the price drop Tuesday but did not share how much money he lost in the plunge.

Highlights from annual report on nation’s health, from the Centers for Disease Control and Prevention.

• Between 1975 and 2015, life expectancy increased for the total population. Between 2014 and 2015, however, life expectancy declined by 0.1 years for the total population.
• The percentage of adults ages 20 and over with obesity increased from an average of 22.9 in a report that looked at trends between 1988 and 1994, to 37.8 percent on average in a report that examined trends between 2013 and 2014.
• Among adults 65 and over, use of five or more prescription drugs in the past 30 days increased from 13.8 percent on average, between 1988 to 1994, to to 42.2 percent on average in 2013 and 2014.

RUNDOWN

Washington Post ‘Repeal and replace’ was once a unifier for the GOP. Now it’s an albatross

The Hill Paul: We have to raise taxes if you want to ‘provide all this extra healthcare’

Kaiser Health News Analysis: Mitch McConnell plans to hide Trumpcare’s pain until after midterms

Wall Street Journal Intra-party disputes stall GOP’s agenda

Politico Inside the GOP’s surprise healthcare flop

Associated Press Trump group’s Republican war over healthcare frustrates GOP

New York Times With Obamacare, more breast cancers diagnosed at earlier stages

STAT News FDA may shorten grim list of side effects on drug ads

 

WEDNESDAY | JUNE 28

Noon. SVC-200. Doctors join senate Democrats to protest GOP healthcare bill. Livestream.

Noon. Urban Institute. 2100 M St. NW. Event on “Stabilizing the Individual Health Insurance Market.” Details. 

Noon. 2044 Rayburn. Cato Institute event on “A ‘Modern Plague?’ How the Federal Government Should Address the Opioid Crisis. Details.

Noon. 2167 Rayburn. Capitol Hill briefing on “What’s the Right Decision for Me? Shared Decision Making in Prostate Cancer,” hosted by the Patient-Centered Outcomes Research Institute (PCORI) and the Men’s Health Network.  

4 p.m. House to vote on Protecting Access to Care Act of 2017.

THURSDAY | JUNE 29

10 a.m. Bipartisan Policy Center. 1225 I St. NW. Event on “Future of Healthcare: Balancing Coverage and Cost in Medicaid.” Details.

10:30 a.m. American Enterprise Institute. 1789 Massachusetts Ave. NW. Event on “Sensible Regulation of E-Cigarettes: Opportunities for Reform.” Details.

4 p.m. American Enterprise Institute. 1789 Massachusetts Ave. NW. Event on “The Role of Government in Medical Innovation. Details.  

6 p.m. 101 Constitution Ave. NW. Independent Women’s Forum event on “Oops! Sorry We Were Wrong … How Public Health Guidance Often Harms the American Public.” Details.  

Congress leaves for Fourth of July recess.   

FRIDAY | JUNE 30

June 30-July 3. Marriott Marquis San Diego Arena. San Diego. Annual conference for the National Association of School Nurses. Details.

10 a.m. CST/11 a.m. EST. Living Faith Christian Center. 6375 Winbourne Ave., Baton Rouge, La. Sen. Bill Cassidy, R-La., to hold a town hall. Details.

TUESDAY | JULY 4

Fourth of July holiday.

THURSDAY | JULY 6

11:30 a.m. CST/12:30 a.m. EST. McKenna Youth and Activity Center. 311 Main St, Palco, Kan. Sen. Jerry Moran, R-Kansas, to hold a town hall. Details.