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Extend and repeal of Medicaid expansion: Earlier this year, as Republicans embarked on their healthcare journey, the phrase of the day was “repeal and delay” – the idea being that they would pass a bill to repeal Obamacare but delay the implementation of the repeal for two or three years. But if Sen. Rob Portman, R-Ohio, gets his way on the Medicaid expansion, “extend and repeal” would be a more accurate description of the GOP bill – or, even more likely, “extend and never repeal.” Speaking to reporters Wednesday, Portman said he wanted a “significant glide path” to phase out the Medicaid expansion as it exists under Obamacare. Specifically, he wants the phaseout to start slowly in 2020 and occur over seven years until 2027, while Senate Majority Leader Mitch McConnell, R-Ky., wants the phaseout to happen over three years to 2023. Liberal Brookings Institution policy analyst Loren Adler lamented on Twitter, “This makes no sense! Eliminating ~10 million people’s health coverage in 7 years is still eliminating ~10 million people’s health coverage.” But another way of looking at it is that by deferring the repeal of the expansion for so long, Portman in all likelihood would be ensuring that it never gets repealed. As Dan Holler of the conservative Heritage Action noted, in December 2015, nearly all Republican senators including Portman voted for a bill that would have repealed the Medicaid expansion after December 2017 (or roughly within two years). But just about a year and a half later, Portman is pushing for a phaseout that wouldn’t be completed until a decade from now. If Portman can change so radically when facing the reality of repeal (as opposed to voting on a symbolic bill that was going to be vetoed by President Obama), why is there any reason to believe that future Congresses would feel tied to the 2017 Republican healthcare plan? Between now and 2027, there will be five more congressional elections and two more presidential elections. If this Republican Congress, which has been campaigning on repeal and replace for four straight election cycles, is punting on repeal when given the opportunity, it’s hard to see lawmakers in power in the 2020s seeing it through.

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The OTHER hearing going on in D.C: While his hearing wasn’t the reason Washingtonians lined up to drink at local bars this morning, Health and Human Services Secretary Tom Price’s appearance before the Senate Finance Committee still generated some news.

Here are some highlights:

  • Price dodges on cost-sharing reduction payments: Price told Democrats that the Trump administration isn’t seeking to sabotage the healthcare system. However, he refused to commit to funding cost-sharing reduction payments to insurers next year. The dodge comes as some insurers are threatening to raise rates if the cost-sharing payments are not made next year.
  • McCaskill goes off: Sen. Claire McCaskill, D-Mo., used the hearing as an opportunity to bash Republicans for not holding a hearing on the Senate version of the American Health Care Act. Sen. Orrin Hatch, R-Utah, seemed taken aback by the unexpected attack, as an aide quickly huddled with him to offer a response that was caught on C-SPAN’s broadcast of the hearing. Hatch said that Democrats were open to offer ideas and suggestions. McCaskill shot back that "When you are saying that you inviting us, for what? We don't even know. We have no idea what is being proposed."
  • Hatch, Wyden clash over Medicaid: Partisan fireworks erupted before the hearing even got started as Hatch and top committee Democrat Ron Wyden, D-Ore., fought over Trump’s proposed Medicaid cuts. ““This is the budget you write if you think seniors and working families have it too easy,” said Wyden, referring to the proposed cuts to Medicaid and other programs such as Meals on Wheels. Hatch responded that the budget doesn’t “incorporate the specific legislative proposals.” He added that the budget doesn’t assume that “Medicaid reform proposals will be enacted into law. Any attempt to make that connection is simply unfounded.”

Cadillac tax to survive? Republican senators are searching for ways to make their healthcare reform bill more generous than the House version, and questions are flying on how to pay for it. Sen. John Thune, of South Dakota, told reporters that some Obamacare taxes definitely will be eliminated in the Senate version. Those are the “consumer healthcare taxes” such as those on medical devices and insurers, according to Thune, the third-ranking GOP senator. However, a decision hasn’t been made on whether to nix Obamacare’s controversial “Cadillac tax” on high-cost health plans. The tax has gotten stiff pushback from not only business groups but also labor unions that negotiate for pricey plans for members. Thune said some members are “very interested” in the tax but “at this point those are still fluid.” The House bill keeps the Cadillac tax to help fund the American Health Care Act, its bill to partially repeal Obamacare, but the tax wouldn’t kick in until nearly a decade from now.

Rep. Chris Collins reportedly talked up drug stocks: The New York Republican reportedly talked up an Australian drug company company on Capitol Hill, a move some of his colleagues view as inappropriate. According to a report in The Hill, Collins has earned some wealth through investing in Innate Immunotherapeutics, which has developed a drug to fight advanced multiple sclerosis. Half a dozen lawmakers who spoke to the Hill anonymously said that Collins had urged them to purchase the stock, saying it would make them a lot of money. Collins denied that he had ever recruited members of Congress to buy Innate stock or bragged about making them money. “I never once talked about that. … I’ve never encouraged anyone to buy the stock. Ever,” he said. “I’ve presented opportunities in Buffalo. I’ve said, ‘Here’s an opportunity. Listen. Read. Study. Make a decision.’ That’s the only thing I ever did, and that was in Buffalo.” He added, however, that he had talked about Innate to colleagues, saying it was likely to do well and that the drug it is working on would be good for patients. “I talk about it at every turn, just like you talk about your kids hitting a home run and your daughter getting into law school,” he said. “In all the things that I’ve done in my business career, I’m most proud of this.”

Bill advances unanimously to speed up drug and device approval. The FDA Reauthorization Act would reauthorize a program in which the FDA collects user fees for each drug and device application and uses that money to hire more staff and speed up approvals. The program must be approved every five years, and the House Energy and Commerce Committee advanced the bill to the House floor by a 54-0 vote. The user fee program needs to be renewed before the August recess, given that the program expires at the end of September. Otherwise, the agency may have to send layoff notices to more than 5,000 employees beginning in July.

Top committee Democrat Frank Pallone Jr. on passage: “In addition to reauthorizing the user fee programs, this important legislation will enable FDA to better incorporate the patient perspective in the regulatory process, advance regulatory science and support the modernization of the clinical trial and review process.”

Trump blasts 'obstruction' by Democrats on fixing healthcare. "We are having no help, it's only obstruction from the Democrats," Trump said in a speech in Cincinnati. "The Democrats are destroying healthcare in this country. We have had no help. We will get no votes." Trump blamed the "Obamacare catastrophe" on congressional Democrats. "Obamacare is in a total death spiral," he said. "And the problems will only get worse if Congress fails to act. Obamacare is dead; I've been saying that for a long time." Democrats have said that they are open to fixes to the law but will not work to repeal it, leaving Republicans to work with a budget tool called reconciliation that will require 51 votes to pass, instead of the 60 needed to break a filibuster. "If we gave you the greatest plan in the history of the world you would have no Democratic vote," Trump said. "It's all going to be Republicans or bust and the Republicans are working very, very hard on getting a great healthcare plan."

Opioids hitting low-income Americans: A new analysis found that 51 percent of all Americans battling an opioid use disorder have incomes below 200 percent of the federal poverty level. The analysis was presented by Richard Frank, a Harvard economist and former HHS official, at a hearing before the Joint Economic Committee that examined the economic aspects of the opioid crisis. People below 200 percent of the federal poverty level make up 32 percent of the population overall. According to the Congressional Budget Office, that group is projected to have the largest coverage losses under the American Health Care Act, points out former HHS spokesman Ben Wakana.   


Politico GOP uncertainty over Obamacare drives out insurers

Axios Children’s Hospital Association CEO: Medicaid cuts put kids “in the firing line”

STAT News From the lab to Congress: A lawmaker wages a solo fight to shake up NIH

Atlanta Journal-Constitution Jitters for Georgia’s Obamacare exchange

The Hill Senate GOP paves the way for healthcare bill

Morning Consult GOP focus on premiums eclipses broader issues with healthcare costs

Roll Call Senate Democrats say GOP health bill has a fatal flaw



June 8-June 11. Boston. Annual scientific meeting for the American Headache Society. Webcast.

Joint Economic Committee holds hearing on “Economic Aspects of the Opioid Crisis.” Began 10 a.m. Details.

2322 Rayburn. House Energy and Commerce Hearing on “Examining the Role of the Department of Health and Human Services in Healthcare Cybersecurity.” Began 10:15 a.m. Details.

1 p.m. 1100 Longworth. House Ways and Means Committee hearing on budget for the Department of Health and Human Services. Details.


8:30 a.m. State Room. Boston. The Atlantic conference on “Pulse: On the Front Lines of Health Care,” will explore topics ranging from policy and the economy to global public health and the future of biotechnology. Details.

8 a.m. 1777 F St. NW. Event hosted by The Hill on “Prioritizing Patients: A Discussion on Outcomes-Based Care,” with Sen. Bill Cassidy, R-La., and Rep. Doris Matsui, D-Calif. Details.

10 a.m. Dirksen 430. Senate HELP committee meeting on “The Cost of Prescription Drugs: How the Drug Delivery System Affects What Patients Pay. Details.

2:30 p.m. Dirksen 628. Senate Indian Affairs Committee will review bills involving the Indian Health Service and housing for Veterans Affairs. Details.


9 a.m. 1775 Massachusetts Ave. NW. Brookings Institution. Fostering competition in the pharmaceutical distribution chain. Details.

2:30 p.m. Dirksen 106. Special Committee on Aging Hearing on “Military Caregivers: Families Serving for the Long Run.” Details.