SIGN UP! If you’d like to continue receiving Washington Examiner's Daily on Healthcare newsletter, SUBSCRIBE HERE:

Bill Cassidy says Obamacare overhaul bill is close to 50 votes, Mike Lee ‘encouraged.’ Going into this week, not many people in Washington gave Republicans a chance of passing healthcare legislation before the end of the month, when reconciliation language allowing them to pass a bill with a simply majority expires. Even President Trump and congressional leaders had seemingly moved on. But now, it looks like the the bill released by Republican Sens. Bill Cassidy of Louisiana., Lindsey Graham of South Carolina, Dean Heller of Nevada and Ron Johnson of Wisconsin has gained some real momentum. While still an uphill climb, there’s now a non-zero chance of something passing. Cassidy said Friday that more senators have told him they support his proposal to overhaul Obamacare, bringing the total to as many as 49 votes. Whether this is true or a typical lawmaker exaggeration in the midst of boosting his legislation, a spokesman for conservative Sen. Mike Lee told Daily on Healthcare he was “encouraged” by the latest Obamacare bill because it provided flexibility to states to get around several key Obamacare regulations. Though Lee isn’t fully a “yes” yet, he is at least receptive and is working on some tweaks to the language about state regulatory waivers. The spokesman described the tweaks as “technical” in nature, and not substantive changes that could broaden the waivers in such a way that it would be more likely to scare off centrists. Getting Lee on board would be a huge coup for supporters of the bill, because it was the Utah senator’s opposition that helped kill an earlier proposed healthcare compromise. On the other hand, Sen. Rand Paul, R-Ky., has come out against the overhaul amendment. "I can't support a bill that keeps 90% of Obamacare in place. #GrahamCassidy is not repeal or replace, it is more Obamacare Lite," Paul tweeted Friday. With Paul a “no,” Cassidy can afford no more than one additional “no” vote, or else it will sink the legislation and likely kill any sort of Obamacare overhaul for the remainder of the year.

McConnell asks for CBO score. In another sign of momentum for the bill, the office of Senate Majority Leader Mitch McConnell, R-Ky, confirmed that he has asked the Congressional Budget Office to release a score of the legislation, another step that would be necessary before the Senate can vote on the legislation. After spending months twisting arms to try and pass some sort of compromise on repealing and replacing Obamacare, McConnell has been taking a mostly hands-off approach to the bill up until this point. He’s likely to support it if the bill’s sponsors can show him that they have commitments from the 50 senators needed for passage, but he’s unlikely to stick his neck out or waste precious Senate floor time on legislation that will go down in flames. In addition to the CBO, the bill must pass muster with the Senate parliamentarian before McConnell will move ahead. Cassidy and his fellow authors have been in contact with both the CBO and the parliamentarian throughout the drafting process in an effort to avoid any tripups near the goal line. The Senate calendar is tight, and Democrats have the opportunity to delay the bill, possibly until after the Sept. 30 deadline, by offering an endless number of amendments. But ultimately, there’s a lot Republicans can do if they’ve secured the votes.  

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 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.

Obamacare hearings wrap up in shadow of healthcare divisions. Members of the Senate Health, Education, Labor and Pensions Committee are hoping to ease rising premiums and insurer exits from Obamacare in the face of a tight deadline, though they aren't certain if Senate leaders will up take the proposal in time or if it would receive a warm welcome in the House or from President Trump. They also are divided in their goals: Democrats want to inject more funding into the exchanges so that premiums will drop, while Republicans seek to give states more flexibility over their healthcare systems. Sen. Lamar Alexander, chairman of the HELP Committee, said he hopes that committee members can agree to the trade-off as a compromise. "Obviously when both sides have to give we have some discussions to make," the Tennessee Republican told reporters. Alexander will be working this weekend with Washington Sen. Patty Murray, the committee's top Democrat, to come up with an agreement that they will present early next week, which Alexander said he hopes the executive and legislative branches will agree to. The deadline for a bipartisan deal is set for before Sept. 27, when insurers have to sign contracts in most states to sell coverage on the Obamacare exchanges. It's possible the administration could push back the deadline, however.

Trump promises to veto Sanders' bill. President Trump vowed to veto Sen. Bernie Sanders' bill to create a government-run healthcare system if it passed the House and Senate. "Bernie Sanders is pushing hard for a single payer healthcare plan - a curse on the U.S. & its people..." Trump tweeted Thursday afternoon "...I told Republicans to approve healthcare fast or this would happen. But don't worry, I will veto because I love our country & its people." The Vermont independent introduced the bill Wednesday with the backing of 17 Democratic senators. Sanders did not take questions from reporters about the bill at a press conference Wednesday, but criticized the current healthcare system as one that has allowed "insurance companies and drug companies to make billions of dollars in profits and make industry CEOs extremely wealthy." In a tweet following Trump's tweet, the Vermont independent slammed the idea that single-payer healthcare is a curse. "No Mr. President, providing healthcare to every man, woman and child as a right is not a curse, it's exactly what we should be doing," he said.

GOP asks CBO: How much does Sanders' bill cost? Sen. John Barrasso, chairman of the Senate Republican Policy Committee, on Thursday asked CBO to determine the cost of the single-payer health insurance bill. The score would make projections about how many people would have health insurance under the bill, called the Medicare for All Act, and would project how much the government would spend on the system, including through increases in the debt and taxes. Barrasso is also requesting that the report make projections about the impact the bill would have on employment. "It is being sold as a new health system paid for completely by the government, with no restrictions and at no cost to the patient," the Wyoming Republican wrote in a letter to CBO Director Keith Hall. "Of course, such a system would be anything but free to the American taxpayer … as the country engages in a serious debate about how best to reform our healthcare system, it is imperative that the public understand the cost of Senator Sanders' Medicare for All proposal."

Cassidy says 'Berniecare' bill indicates Democrats believe Obamacare isn't working. Cassidy raised Sanders’ socialized medicine proposal during a meeting with reporters Friday, saying it showed Democrats agree the healthcare system under Obamacare has problems. "It’s now bipartisan that the status quo isn't working," Cassidy said. "Berniecare is an indictment of status quo." The single-payer bill has support from 17 Democratic senators. Cassidy noted that under Obamacare, middle-class people have had difficulties affording the cost of premiums because if they make more than $48,240 a year they do not qualify for subsidies. "The status quo is not addressing their needs," Cassidy said. "That's why we're coming in with a different solution, which is giving power to that patient and to that state as opposed to continuing this concentration in Washington. We think our solution is going to be more likely to give them access to quality coverage at an affordable price."

CBO: Uninsured to jump because of Obamacare price hikes. Higher Obamacare premiums will cause 2 million more people than expected to become uninsured between this year and next, according to a report published Thursday by CBO and the Joint Committee on Taxation. Roughly 1 million of those who will become uninsured compared to CBO's initial projections had bought their coverage on the Obamacare exchanges, and 1 million others had purchased it directly through a broker or health insurance company. Because of the uncertainty over Obamacare funding, CBO and JCT project that mid-level plans will cost about 15 percent more than in 2017. After that, the agencies project 5 percent increases per year from 2017 to 2027, assuming the funds, known as cost-sharing reduction subsidies, are appropriated. The lower enrollment will result in the government spending $137 billion less from 2017 to 2026, largely because of the reduction in subsidies that the federal government provides to help people pay for Obamacare coverage and for the Basic Health Program, a coverage option some states provide under Obamacare. The net decrease in spending is $88 billion.

Anti-abortion groups turn up heat on GOP to pass Graham-Cassidy. Major anti-abortion groups are pushing for an Obamacare overhaul bill that seeks to defund Planned Parenthood and stop tax credits from paying for abortions. The Family Research Council and Susan B. Anthony's List made a joint statement in support of the bill. The groups are pushing for Republicans to take the last push on gutting Obamacare seriously. "The pro-life majority controls both chambers of Congress and the White House. The GOP is without excuse," the leaders of the two groups said. “Failure to keep their promise to voters will bring into question whether this Congress can truly be called the ‘pro-life Congress.' Rhetoric must be translated into verifiable action."

On the other side, liberal groups pivot to fighting the bill. The liberal group MoveOn sent an e-mail to supporters late Thursday aiming to get support for Sanders’ single-payer bill. “There's never been this much momentum for single payer, and we need to keep it going,” MoveOn Washington Director Ben Wikler wrote. But things have changed in the past 12 hours. News quickly spread of Republicans’ progress on getting votes for Graham-Cassidy. So liberal groups are quickly pivoting to mobilize against the bill in the final two weeks before the Senate’s reconciliation deadline. “If we don't push back now, hard, relentlessly, we've got to believe that the GOP could actually pass this thing,” Wikler tweeted Friday. Topher Spiro, senior fellow at the liberal Center for American Progress, also quickly urged people Friday to call senators to oppose the bill after hearing Cassidy’s optimistic whip count. “A non-zero threat is a serious threat,” he tweeted.

Louie Gohmert: GOP a 'bunch of liars' if it fails on Obamacare. Rep. Louie Gohmert, R-Texas, said he and other Republicans will pressure the Senate to pass some kind of Obamacare repeal bill before the end of the month, before the Senate loses its chance to pass a bill with just a simple majority, without help from Democrats. "We have until Sept. 30 to keep from being about as big a bunch of liars as has ever been in Congress," he said on the House floor. Gohmert spoke just before the House left for a week-long break, after which it will return for just one more week before the end of September. At the end of the month, the Senate will lose its authority to pass a repeal bill by a simple majority. Gohmert said House Speaker Paul Ryan, R-Wis., is also interested in putting pressure on the Senate when they return. "He has agreed with me and some other of the kind of pressure we're going to put on when we get back the last week of September, if the Senate has not passed their Obamacare repeal bill," Gohmert said. "They have got to pass something or we can't get it to conference," he said. "We can't get the American public what they need." Gohmert didn't say how the House might pressure the Senate, but he talked about shaming GOP senators to pass a bill. In late July, the Senate was one vote shy of passing a placeholder bill that would have let the House and Senate meet to negotiate a final bill. "I'm looking forward, if the Senate doesn't get a decent bill done, I want us to pass a sense of the House bill ... that says it is the sense of the House that the Senate absolutely must pass a bill to give the American public the help they need with healthcare by repealing the worst parts of Obamacare at a minimum," Gohmert said. "And then follow the speaker out here on the steps and every one of us point to the Senate, and keep putting the pressure on ... until hopefully they would do something," he said.


The Hill Price says working toward declaring opioid epidemic a national emergency

Axios Lamar Alexander’s ACA balancing act

Science NIH quietly shelves gun research program

Washington Post Why Congress might fail to fund extra Obamacare subsidies

Associated Press Vulnerable residents a concern in the aftermath of Irma

Kaiser Health News This gift voucher might just get you a kidney

Storify Aaron E.Carroll on inherent tradeoffs with single-payer health care


FRIDAY | Sept. 15

Sept. 15-19. Chicago. American Academy of Pediatrics conference.

Noon. 325 Russell. Alliance for Health Policy event on “Chronic Pain & Opioid Addiction: The Role of Integrated Care.” Details.

MONDAY | Sept. 18

8:30 a.m. 1717 K St. NW. Personalized Medicine Policy Forum. Details.

3 p.m. 1301 K St. NW. Washington Post event on Chasing Cancer; includes FDA Commissioner Scott Gottlieb. Details.

TUESDAY | Sept. 19

8:15 a.m. Ronald Reagan Building. 1300 Pennsylvania Ave. NW. Bloomberg Live event on “The Future of Healthcare: Unlocking and Supporting Value.” Details.

Noon. Harvard T. Chan School of Public Health event on “In Pursuit of a Single Payer Plan: Lessons Learned” with Vermont Gov. Peter Shumlin. Live Stream.

3 p.m. 430 Dirksen. PCORI event on “Addressing America’s Opioid Problem: The Need for Evidence-Based Strategies” with Sen. Shelley Moore Capito, R-W.Va. Details.

WEDNESDAY | Sept. 20

9 a.m. 562 Dirksen. Senate Special Committee on Aging hearing on “Disaster Preparedness and Response: The Special Needs of Older Americans.” Details.  

9 a.m. National Press Club. 529 14th St. NW. Researchers to announce global study from

Journal of Adolescent Health on “Common Cause of Multiple Social Maladies.”