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Hopes for Obamacare deal fade in the Senate. Republican senators are still working to revive an Obamacare repeal bill even though some in their own party are starting to doubt anything can be done. The Senate and White House are trying to pick up the pieces after a humiliating defeat last week of a bill aimed at kickstarting talks with the House. But, as some senators are meeting with the White House to write a new proposal, other Republicans are not optimistic they can get anything done this summer, if at all. Sen. Chuck Grassley, R-Iowa, didn't mince words when asked about how hopeful he is if anything can get done on healthcare reform. "Right now I'm very pessimistic," he said. But others aren't giving up. Sen. Bill Cassidy, R-La., held a listening session Monday with Health and Human Services Secretary Tom Price and governors on the proposal. Centers for Medicare and Medicaid Services Administrator Seema Verma also attended, according to a White House aide.

One idea being discussed is to give states block grants for the Medicaid expansion and tax credits to buy coverage on Obamacare's exchanges. The proposal would repeal some of the law's taxes and eventually phase out the enhanced federal matching funds for Medicaid.

Sen. Mike Rounds, R-S.D., said the proposal could be taken up as a standalone bill or other measures could be added, such as amendments from Sen. Rob Portman, R-Ohio, and Sen. Ted Cruz, R-Texas. 

GOP leaders plan to move on. Senior Republicans plan to let President Trump know that they expect to move on from healthcare legislation, Senate Finance Committee Chairman Orrin Hatch said Monday. "There's just too much animosity and we're too divided on healthcare," the Utah Republican told Reuters in an interview. He said he had not given up, but that it was time to move on to tax reform. Hatch plans to tell Trump himself, with other congressional leaders, including House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell.

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McConnell: Healthcare bill up next, but not the one you think. The Senate majority leader outlined the goals for the rest of the Senate’s work period before starting its three-week recess on Aug. 11. Repealing Obamacare was not on the list, but the Food and Drug Administration was. McConnell said it was a priority to pass a reauthorization of the FDA’s user fee program. The program has wide bipartisan support and a bill has already passed the House.

Trump may force Congress to act on Obamacare insurer payments. Republicans in Congress soon may have to appropriate federal funds to insurers they fought to hold off for several years under Obamacare, or otherwise risk being blamed for a chain reaction of insurer exits and premium hikes. Trump is expected to issue a decision as early as Tuesday on whether his administration will continue to deliver the payments, known as cost-sharing reduction subsidies. If he chooses to end them, members of Congress have signaled that they may consider appropriating the funds. "I hope the president will use his authority to extend those payments. He can do that," said Sen. John Thune, R-S.D., the No. 3 Senate Republican. "If he doesn't then Congress will have to look at what our options are." Without the funds, insurers will look to exit the exchanges as quickly as they are able, resulting in people losing coverage. They alternatively will look to increase their premiums by about 20 percent.

Sen. Lindsey Graham: 'If we fail on healthcare, we're going to fail on taxes.' The South Carolina Republican doubts that Congress will be able to pass tax reform if it cannot first respond to Obamacare. "We need to keep trying on healthcare. If we fail on healthcare, we're going to fail on taxes," Graham told Fox News' "Fox and Friends" Tuesday morning. Graham, who proposed the block grant amendment with Cassidy, said the GOP-led Senate is "not moving on" and is "going to listen to President Trump." "We're going to git-r-done. We should be politically horse-whipped if we do not deliver for the American people. The best idea's still on the table — mine hasn't even been tried.” 

Sen. Dick Durbin: States need to expand Medicaid now. The Illinois Democrat called on holdout states to expand Medicaid now that Obamacare repeal has failed in the Senate. Durbin, a member of Democratic Senate leadership, said that about 4.5 million people could gain coverage if the 19 states would decide to expand their Medicaid coverage. “If Republicans are serious about wanting to provide access, then Medicaid expansion is the most common approach we can take,” he said on the Senate floor Tuesday.

Opioid panel calls for Trump to declare federal state of emergency. Trump's commission aimed at combating opioid abuse is recommending the president declare a federal "state of emergency" on the epidemic. The commission, led by New Jersey Gov. Chris Christie, called for dramatic action to address an opioid overdose crisis that killed more than 33,000 Americans in 2015, more than in any previous year. "Your declaration would empower your Cabinet to take bold steps and would force Congress to focus on funding and empowering the executive branch even further to deal with this loss of life," the commission wrote in an interim report released Monday outlining a recommended strategy for the federal government to fight opioid abuse. "It would also awaken every American to this simple fact: if this scourge has not found you or your family yet, without bold action by everyone, it soon will." Governors in Florida, Arizona and Maryland have declared states of emergency, granting those governments access to millions of dollars. 

Idaho blames Trump for big Obamacare rate increases. Idaho's insurance regulator blasted the Trump administration's unwillingness to pay Obamacare insurers as the reason premiums could rise by up to 38 percent next year. The state's Department of Insurance posted proposed rates for 2018 Monday. The state's six Obamacare insurers are calling for an average 38 percent rate hike, including a 50 percent increase for the silver plan, which is the most popular of Obamacare's three plan options. Idaho said the proposed increase for silver plans was because of "the potential refusal by the federal government to fund the cost-share reduction mechanism." Insurers are required under law to lower co-pays and deductibles for lower-income Obamacare customers, with the government reimbursing them. But the Trump administration has not decided if it will make the payments in 2018. Idaho's insurance director, Dean Cameron, said the uncertainty is leading to price increases. "I call on Congress to either repeal the CSR requirement or fund the program," he said. "That action alone would reduce the proposed increase by at least 20 percent on the silver plans." 

Minnesota to see lower Obamacare rates if reinsurance approved. Minnesotans could see their Obamacare rates drop by up to 40 percent for some plans if a program to cover the sickest claims for insurers is approved by the Trump administration, the state's insurance regulator said Monday. On the other hand, if the program doesn't receive federal approval, it could raise premiums by roughly 30 percent for some plans. Minnesota passed a law that subsidizes insurers' sickest claims through a process called reinsurance. That in turn lets insurers reduce claims for everyone else. Minnesota has a waiver application before the federal government for the reinsurance program, which would cost the state nearly $600 million up front for 2018. Minnesota's insurance commissioner said rates for all of the five insurance companies selling Obamacare plans would be lower in 2018 compared to current rates, if the reinsurance program is approved.  Without reinsurance, four of the five insurance companies would raise rates.

Ryan Zinke calls reports 'laughable' that he threatened Sen. Lisa Murkowski.  "The moon has been characterized as a threat, too, so I think it's laughable," the Interior secretary  told reporters Sunday in his first comments after reports characterized the phone call as threatening. Zinke made the statement Sunday in talking to reporters while on a tour of national monuments in the West. He refuted claims that he suggested his agency would make it difficult for Alaska because of Murkowski's no vote on a procedural measure to begin debate on a bill to partially repeal and replace the Obamacare. Zinke spoke to Murkowski and fellow Alaska Republican Sen. Dan Sullivan by phone on Wednesday. Sullivan later characterized the call as "troubling." By Thursday, top House Democrats had formally asked the Interior Department's inspector general to investigate the reported phone calls and the possibility that Zinke had broken the law. Murkowski said only that Zinke had told her that President Trump was not pleased with her vote. The vote to begin debate passed 51-50, with Vice President Mike Pence casting the tie-breaking vote. "I talk to Sen. Murkowski and Sen. Sullivan all the time," Zinke said, according to E&E News. "A lot's been said about a lot of things. But I talk to them all the time. We get along well."


Politico Newest GOP healthcare attempt faces some long odds

Washington Post Will Republicans work with Democrats to fix Obamacare?

Axios Tom Price’s unprecedented predicament

Forbes Hospitals brace for unpaid bills if Trump kills Obamacare subsidies

Roll Call What’s next for Dean Heller after healthcare votes?

STAT News With Tom Price in charge, doctors are winning again in Washington

CNBC Trump on tricky legal ground with Obamacare threat

New York Times Lesson for Trump: Hard ball against senators is a game he could lose

NPR Trump’s tweets threaten to destabilize insurance markets



9 a.m. Humana second-quarter earnings call. Details.


8:30 a.m. Aetna second-quarter earnings call. Details.

FRIDAY | Aug. 4 

8 a.m. Cigna second-quarter earnings call. Details.

10 a.m. 215 Dirksen. Senate Finance Committee considers nomination of Matthew Bassett to be an assistant secretary of Health and Human Services. Details.