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How McConnell can pass a healthcare bill: Senate Majority Leader Mitch McConnell, R-Ky., is in a difficult spot as he tries to scrap together 50 votes to pass a healthcare bill. After releasing a new version of the bill, early opponents Sen. Rand Paul, R-Ky., and centrist Sen. Susan Collins, R-Maine, said they could not support the motion to proceed that would advance the bill toward a final vote. That means if he loses just one more vote, this version of the bill goes kaput. Thus, while he has an extremely narrow path, a path does nonetheless exist, and it goes something like this: Lock down conservatives, buy off centrists. On the first front, McConnell gained an important ally in Sen. Ted Cruz, who came out in support of the bill after the latest iteration included a modified form of his proposal that would set up a fund to help cover individuals with high medical costs. The fund would be available to insurance companies that agreed to offer Obamacare-compliant plans, and those companies would be allowed to offer plans that wouldn’t be bound by nine of Obamacare’s mandates. Cruz now will try to bring aboard other conservative holdouts, most prominently, his ally Sen. Mike Lee, R-Utah, who had helped Cruz draft an earlier version of the proposal. Lee says he is reviewing the updated text before making a decision. The hangup for Lee? The latest version of the Cruz amendment put in the bill would preserve the requirement that insurers in every state have one single risk pool, rather than one for sicker individuals and one for healthier individuals. Having plans in a single risk pool operate with two sets of rules is something that has been criticized as unworkable, and the prior version of this proposal that Lee helped craft would not have kept the single risk pool regulation intact. Lee wants to study whether the tweaked version can still bring down premiums. If Cruz can deliver the conservative bloc (minus Paul, who has long been seen a lost cause by leadership), then McConnell can focus on picking off centrists one by one. No matter what you hear from centrists in the coming days, it’s worth keeping something in mind. Centrists are often celebrated by the media for being open minded and more willing to reach across the aisle. But in reality, the fact that they are less ideological means that they are more transactional and thus more easily won over with more money. Back in 2009, opponents of Obamacare held out hope that a handful of centrist Democrats would hold strong and kill the bill. That was not the case. Notoriously, Sen. Ben Nelson provided a litany of reasons why he couldn’t vote for the bill just days before announcing his support for it, after then-Senate Majority Leader Harry Reid offered Nebraska more Medicaid money. Does this mean that McConnell will get there? Not by any measure. It’s possible that Cruz won’t be able to win over Lee and that centrists will hold firm on demands that would move the bill in a drastically different direction and thus blow up the fragile support of conservatives. The point is, if McConnell is going to be succeed, this is how we we expect it to play out.  

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 dailyonhealthcare@washingtonexaminer.com 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.

The two nos: Paul explained his position in an opinion piece published in the Washington Examiner titled “Crony capitalism isn't a right, so why does Senate healthcare bill give insurance companies the right to a bailout?” Collins said Thursday she will vote no because the bill includes cuts to the growth rate of Obamacare's Medicaid expansion. Collins has said before that she would like to pivot to making fixes to Obamacare and would like to include Democrats in the conversation.


Republican leaders try to flip wary centrists: Senate GOP leaders hope offering more money for reducing insurance premiums for poor people is enough to get centrists to support their healthcare bill after they were cool to the latest version. "I want to make sure that with regards to those people who are currently getting coverage under Medicaid expansion there are some options for them," said Sen. Rob Portman, R-Ohio, a key centrist vote. McConnell held a closed-door meeting Thursday afternoon with GOP Sens. Portman, Shelley Moore Capito of West Virginia, Dean Heller of Nevada, John Hoeven of North Dakota and Alaska Sens. Lisa Murkowski and Dan Sullivan, among others. The focus was on Medicaid, and Centers for Medicare and Medicaid Services Administrator Seema Verma attended.

Senate Republicans don't trust leaders' Obamacare repeal process: The freewheeling procedure for debating Republican legislation to overhaul healthcare in the Senate calls for hundreds of proposed amendments to receive a floor vote, providing both parties ample opportunity to alter the bill. But with Democrats unanimously opposed to the Better Care Reconciliation Act, a handful of Republicans — more than enough to kill the bill — are hesitant to vote to begin the reconciliation process. With many Senate Republicans who do plan to vote for the motion to proceed with the debate, they fear that the bill is cooked and that McConnell and his leadership team will block any attempt at substantial change. "We're concerned about that, yeah," Sen. Jeff Flake said Thursday.
 

Cruz takes a swipe at CNN over healthcare tweet after it shared a link to a story about the Senate healthcare reform bill with a tweet that teased his "so-called Consumer Freedom amendment." "Weird … my search for tweets from CNN mentioning the 'so-called Affordable Care Act' turned up no results," Cruz said in response, adding a link to the Twitter search.

Senate Republicans weigh asking administration to analyze Cruz amendment: A Republican Senate aide told Independent Journal Review that Senate Republicans may ask the Department of Health and Human Services to score Cruz's amendment, called the Consumer Freedom Act, instead of waiting for the nonpartisan CBO. Using a score from the Department of Health and Human Services would speed up the timeline for a vote on the Senate's healthcare bill, since an analysis of the Cruz amendment from the CBO could take weeks, insiders told IJR.

President Trump pleads for Obamacare repeal in series of tweets. On Friday, he pressed Republican senators who are withholding support for the GOP's Obamacare reform bill to support the bill and get it passed quickly. "After all of these years of suffering thru Obamacare, Republican Senators must come through as promised!" Trump tweeted Friday from Paris, where he was visiting the French president for Bastille Day. "Republican senators are working hard to get their failed Obamacare replacement approved," Trump added. "I will be at my desk, pen in hand!" Trump credited Vice President Mike Pence for his work on healthcare negotiations in the Senate. Pence did not accompany the president on his trip to France and instead stayed behind in Washington, where he labored behind the scenes to broker a deal similar to the one that helped healthcare reform pass a divided Republican caucus in the House. Trump singled out McConnell via Twitter on Friday, urging him not to fail in his efforts to bring the bill to the floor for a vote.

Trump: Finding a deal on healthcare is harder than finding peace between Israeli and Palestinians. "We have a thing called healthcare. I'm sure you haven't been reading about it too much," Trump told reporters aboard Air Force One as they traveled to Paris on Wednesday. "It is one of the — I'd say the only thing more difficult than peace between Israel and the Palestinians is healthcare." Trump described the challenge his team has encountered in attempting to fashion a healthcare bill that satisfies both moderate and conservative critics. "It's like this narrow road that about a quarter of an inch wide," Trump said. "You get a couple here and you say, great, and then you find out you just lost four over here. Healthcare is tough."

Chuck Schumer: New GOP healthcare bill 'even meaner.’ The Senate minority leader used this term because of the provision that would allow health insurers to sell plans without adhering to all of Obamacare's mandates. The New York Democrat said his party will not support the GOP plan because of provisions reducing the growth of Medicaid and changes that would raise premiums for older Americans. "It appears little has changed at the core of the bill," Schumer said on the Senate floor. "The Republican Trumpcare bill still slashes Medicaid. The cuts are every bit as draconian as the previous version."

Kathleen Sebelius: Republican push to roll back Medicaid expansion an 'assault' on poor Americans. Sebelius, who resigned as HHS secretary in 2014 after the shaky rollout of healthcare.gov, focused her ire on the proposed changes to Medicaid. "We have 11,000 people a day turning 65, we're going to have more people in nursing homes, more people needing home healthcare so they can remain independent, more poor seniors than we have today," said Sebelius, speaking Thursday morning on an episode of the Center for American Progress' "Thinking CAP" podcast. "I think it is absolutely an assault on the lowest-income individuals, the most vulnerable individuals, and the notion that governors have flexibility. Flexibility to do what?”

Hospitals slam GOP healthcare bill over Medicaid cuts. "If enacted, the Better Care Reconciliation Act would mean real consequences for real people — among them people with chronic conditions such as cancer, individuals with disabilities who need long-term services and support, and the elderly," said Rick Pollack, president and CEO of the American Hospital Association. America's Essential Hospitals called the bill "entirely unacceptable" largely because of the changes it would make to the Medicaid program. The group took issue with the Cruz amendment as well. "Making a bad bill worse, the Senate added measures that would destabilize the private market by creating a two-tiered system that funnels the sick and others most in need of affordable coverage into the highest-cost plans," said Dr. Bruce Siegel, president and CEO of America's Essential Hospitals.

Doctor group also slams bill over Medicaid changes. Dr. David Barbe, president of the American Medical Association said: “The revised bill does not address the key concerns of physicians and patients regarding proposed Medicaid cuts and inadequate subsidies that will result in millions of Americans losing health insurance coverage. The additional funding to address the opioid epidemic is a positive step, however, those suffering from substance use disorder have other health care needs that are not likely to be addressed if they lose coverage through a rollback of the Medicaid expansion. While stabilizing the individual market is an initial step, more bipartisan collaboration is needed in the months ahead to improve the delivery and financing of health care.”

Public health group calls the bill ‘irresponsible policy.’ Said Dr. Georges Benjamin, executive director of the American Public Health Association: "The revised Senate plan to replace the Affordable Care Act is still irresponsible policy. Millions would lose insurance coverage, the sickest could still be denied access to critically needed care and far too many would pay even more for fewer benefits, creating an expanded class of underinsured. The bill, like previous versions, guts essential investments in public health by eliminating the Prevention and Public Health Fund.”

Health agency report: Alaska stands to lose $3.1 billion from Medicaid under GOP healthcare plan. The report likely caught the attention of Sen. Lisa Murkowski, who has urged Senate leaders not to make changes to Medicaid. By cutting federal funding from expansion, 34,000 low-income people would lose coverage, the report estimates. The report didn't speculate how many could lose coverage under traditional Medicaid, which covers children, people in nursing homes and people with disabilities, saying only that they were "at increased risk for cuts." Overall cuts would amount to a 28 percent reduction in federal funding.

Medicare Trustees report shows Independent Payment Review Board won’t need to be triggered yet. Medicare costs are projected to grow from about 3.6 percent to 5.6 percent of the economy from 2016 to 2041. As the population ages and the Medicare population, which covers adults 65 and older, continues to grow, costs will increase gradually to about 5.9 percent of the gross domestic product by 2091. The projections show that income will be enough to pay for Medicare's Hospital Insurance program until 2029, a year later than was projected in last year's report. The results mean that the Independent Payment Advisory Board, which some Republicans attacked as Obamacare's "death panels," would not be triggered as was projected last year. The healthcare law's provision calls for a board of experts to be established if Medicare surpasses a certain rate of growth. The panel would be responsible for deciding how to cut Medicare funding for healthcare providers and possibly prescription drugs to slow the growth rate. The trigger is now projected to occur in 2021.

Susan B. Anthony List mobilizing anti-abortionists for Trump nominee to 6th Circuit Court of Appeals, Michigan state Supreme Court Justice Joan Larsen. The influential anti-abortion group's action comes on the heels of the right-leaning Judicial Crisis Network's six-figure ad campaign launched last month to boost Larsen. Both the Susan B. Anthony List and Judicial Crisis Network worked to confirm Justice Neil Gorsuch to the Supreme Court and have become active in targeting Michigan's Democratic senators that are capable of blocking Larsen's confirmation. "Larsen's nomination is now in the hands of the U.S. Senate, where Michigan Senators Gary Peters and Debbie Stabenow are shamefully blocking her nomination," wrote Marjorie Dannenfelser, Susan B. Anthony List president, to her network of activists this week. "These two Democratic senators are clearly afraid of a well-qualified conservative woman serving on the court of appeals."

 

RUNDOWN

Politico Nevada governor undecided on health bill, will meet with Pence

Stat
NIH fetal tissue research would be barred under House panel’s spending plan

The Hill Senate healthcare bill includes key provision for Alaska

Advertising Age Deflategate 2.0: Big-spending Viagra and Cialis are pulling out of the NFL

Kaiser Health News Millions more uninsured could affect health of those with insurance, too

Los Angeles Times Medi-Cal patients sue state, claiming widespread discrimination


 



Calendar

CALENDAR

FRIDAY | JULY 14

July 13-15. Providence, R.I. National Governor’s Association Summer Meeting. Details.


TUESDAY | JULY 18

8:20 a.m. The Hill event on “The State of Mental Health Care: Challenges and Solutions.” Details.

8:30 a.m. 50 Massachusetts Ave NE. Alliance for Health Policy event on “ Coordinated Care and Beyond: The Future of Chronic Care.” Details.

9 a.m. Food and Drug Administration public meeting on “Administering the Hatch-Waxman Amendments: Ensuring a BalancDetails.

9 a.m. 1330 G ST. NW. Altarum Institute event on “Beyond the ACA: Health Policy and Sustainable Health Spending.” Details.

 
WEDNESDAY | JULY 19

10 a.m. 1100 Longworth. House Ways and Means hearing on “Efforts to Combat Waste, Fraud, and Abuse in the Medicare Program.”

Noon. 485 Russell. The American Association for Cancer Research and the Society for Immunotherapy of Cancer will host a congressional briefing on “Progress in Immunotherapy: Delivering Hope and Clinical Benefit to Cancer Patients.”

 1:45 p.m. National Press Foundation Webinar on “Preventive Health – What’s Next?” Details.