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

How the McCain delay benefits McConnell: Senate Majority Leader Mitch McConnell delayed consideration of the healthcare bill Saturday after Sen. John McCain, R-Ariz., underwent surgery to remove a blood clot above his left eye. McCain will spend the week at home in Arizona. After wishing him a "speedy recovery," the Kentucky Republican added: "While John is recovering, the Senate will continue our work on legislative items and nominations, and will defer consideration of the Better Care Act." Washington insiders immediately began speculating about how the delay would affect the upcoming healthcare vote. Some argued that it was a blow. McConnell had hoped for a quick-strike strategy that put pressure on holdouts to get to yes, and now doubts have more time to fester and opposition more time to build. In addition, this will give the Congressional Budget Office more time to evaluate Sen. Ted Cruz’s amendment, which allows insurers to offer plans that don’t have to meet Obamacare’s regulatory requirements as long as they offer plans that do, and that could scare away votes. All of that having been said, the McCain delay would have been more damaging if McConnell were operating in an environment in which he already had 50 votes in the bag and a delay could lose a critical mass of senators. But heading into this week, there’s no indication that he has the votes, and it’s likely that further changes will be required to get the bill across the finish line. It was always a longshot that McConnell was going to be able to pull off a vote this week with so many unanswered questions, but if he were forced to delay it for a second time due to a lack of votes, it would be an embarrassment and the sense of failure might start to percolate among GOP senators. Given this, McCain’s recovery provided McConnell with the cover to delay the vote without those repercussions.  

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.

CBO no longer expected to release analysis of revised Senate healthcare bill today. Lawmakers said they think the CBO's analysis of the new draft will take longer because the score would include the complicated Cruz amendment. Some Republicans are waiting for the CBO's analysis before deciding whether to support the Better Care Reconciliation Act.

Senate Majority Whip John Cornyn promises an 'open process' for healthcare debate. "This is going to be an open process where anybody on the Democratic or Republican side can offer an amendment, and it will get a vote," Cornyn, R-Texas, said Sunday in an interview with NBC. Cornyn said Republicans will "keep trying" to pass a plan to repeal and replace Obamacare if the current proposal fails, but he conceded his party may have to start over. "At some point, if Democrats won't participate in the process, then we're going to have to come up with a different plan," the Texas Republican said. Though he didn't specify when a vote on the healthcare bill would be held, Cornyn said the Senate would move forward once McCain returns to Washington. "I believe as soon as we have a full contingent of senators that we'll have that vote," he said. "It's important we do so."

Democratic leaders say healthcare votes delay allows time for public hearings: Senate Minority Leader Chuck Schumer, D-N.Y., and other Democratic leaders including Patty Murray, D-Wash., and Ron Wyden, D-Ore., sent a letter to Republican leaders formally requesting that they use the delay, expected to last a week, to bring in experts and different medical groups that represent hospitals, health insurance companies and doctors. "This will allow members to hear unfiltered and unbiased analysis of how the bill will affect their states and the health and financial security of the constituents they represent, including the impact of Medicaid cuts to vulnerable populations like children, people with disabilities, and people with pre-existing conditions," the senators wrote.

The tweak that could cost Sen. Mike Lee's vote and sink the healthcare bill. The issue, which various members of the healthcare industry have said makes the bill unworkable, arose as McConnell moved to integrate the Cruz amendment into the broader bill. The amendment allows insurers to offer less expensive plans that don't have to comply with most of Obamacare's wide range of regulations as long as they also offer a plan that is fully compliant. Presumably, people who have more medical needs would buy the plans that are more expensive and cover more medical care, but it would mean that healthier customers could buy plans that include less and cost less. In a new twist, the final version of the amendment leaves in place Obamacare's requirement for insurers in every state to have one single risk pool rather than one for sicker individuals and one for healthier individuals as had been originally envisioned. That means that as currently written, the Cruz proposal would be asking insurers to operate plans governed by two different regulatory regimes within a single risk pool. The novel idea comes with many complicated implications, has left even the most seasoned healthcare experts scratching their heads as they try to game out how this might work in the real world, and has left many inside the insurance industry uneasy.

Ron Johnson: McConnell’s reported Medicaid comments a ‘breach of trust.’ Wisconsin Republican Ron Johnson seemed to be gettable on the Senate health bill after agreeing to vote on a procedural vote. But Johnson told the Green Bay Press-Gazette late last week that he is undecided on the revised bill. Johnson was among four conservative senators who opposed the first version. Johnson was miffed that McConnell reportedly told wary centrist senators that major Medicaid cuts probably won’t end up going into effect. Johnson said the reported comments were “a breach of trust.” McConnell's office hasn't confirmed that he told centrists the Medicaid cuts won't go into effect, which was reported by the Washington Post from unnamed sources.

Insurers demand McConnell drop the Cruz proposal, calling it 'unworkable.’ "As the U.S. Senate considers the Better Care Reconciliation Act, we are writing to urge you to strike the 'Consumer Freedom Option' from the bill," wrote America’s Health Insurance Plans and Blue Cross Blue Shield Association. "It is simply unworkable in any form and would undermine protections for those with pre-existing medical conditions, increase premiums and lead to widespread terminations of coverage for people currently enrolled in the individual market."

Pence tries to sell health plan to nation's governors. "Help is on the way. We are going to give the American people access to the kind of world-class healthcare every American deserves," Pence said during a speech at the National Governors Association's summer meeting in Rhode Island Friday. "We believe the Senate healthcare bill begins to make the president's vision a reality." Pence touted the revised Senate healthcare bill, which faces an uncertain future amid wavering Republican support. "The Senate healthcare bill gives states the freedom to redesign your health insurance markets and most significantly, under this legislation, states across the country will have an unprecedented level of flexibility to reform Medicaid and bring better coverage, better care and better outcomes to the most vulnerable in your states," the vice president said. "This is your chance. The Senate healthcare bill restores Medicaid to its original purpose," Pence added. "I really believe, as the president does, that we're saving Medicaid."

John Kasich spokesman calls out Pence’s comments on Medicaid. Pence told the governors that "far too many able-bodied" adults were placed in Medicaid under Obamacare. "I know Gov. Kasich isn't with us, but I suspect that he's very troubled to know that in Ohio alone, nearly 60,000 disabled citizens are stuck on waiting lists, leaving them without the care they need for months of even years," Pence said. The vice president has been making a case for a Republican healthcare bill that would repeal parts of Obamacare, which would also make changes to Medicaid. Kasich spokesman John Keeling shared links about Pence's claim on Twitter and called it "#FakeNews."

Sen. Susan Collins breaks with Pence: Senate GOP's healthcare bill 'would affect the most vulnerable.' "This bill would impose fundamental sweeping changes in the Medicaid program and those include very deep cuts. That would affect some of the most vulnerable in our society, including disabled children, poor seniors. It would affect our rural hospitals and nursing homes, and they would have a very difficult time even staying in existence," she said on CNN's "State of the Union." "You can't take more than $700 billion out of the Medicaid program and not think that it's going to have some kind of effect.” She added that eight to 10 Republican senators have "serious" concerns about their party's bill and she doesn't know whether it will pass. "I do know this: We should not be making fundamental changes in a vital safety net program that's been on the books for 50 years … without evaluating what the consequences will be," Collins said. 

Liberal groups plan ‘People’s Filibuster.’ Activists are holding a protest expected to go for more than two days on the Senate’s health bill. The “People’s Filibuster” is scheduled to start at 2 p.m. Monday and last through Tuesday evening and possibly into the second half of the week, according to a statement from, which is helping to organize it. Liberal groups such as UltraViolet and the think tank Center for American Progress’ action fund are hosting the protest. Others hosts include Planned Parenthood, which would lose federal Medicaid funding for a year if the bill passes. A planned vote on the bill this week was delayed because of the unexpected surgery of Sen. John McCain, R-Ariz.

In some states, federal Medicaid funding could be cut by nearly 40 percent. The healthcare bill would result in a federal funding drop of Medicaid between 27 percent and 39 percent by 2036, depending on the state, according to an analysis presented at the National Governors Association summer meeting. The analysis, assembled by consulting firm Avalere Health, was first obtained and reported on by Politico. It finds that federal funding would fall by 35 percent in 15 states by 2036, including in California, Kentucky, Nevada, New Mexico, North Dakota, Oregon and Washington. In Arizona, Arkansas, Colorado, Ohio, Pennsylvania, Tennessee, and Utah, federal funding would fall by 30 and 35 percent, the report shows.

CMS pushes back Medicaid analysis. The Trump administration said the Senate's healthcare bill provides enough money to help low-income adults, countering the Avalere Health analysis   showing that federal funding for certain states could drop by nearly 40 percent. The Centers for Medicare and Medicaid Services on Sunday said the new health bill includes "significant new funding to states, including tax credits, a stability fund with over $180 billion that states can use to help low-income Americans purchase coverage, and $45 billion to address the opioid epidemic." Any "fair and accurate" analysis of the Senate bill needs to account for the stability fund, tax credits and opioid funding, CMS said. "CMS is ready to partner with states to develop options that work best for their low income population," Administrator Seema Verma said.

Sen. Rand Paul warns Trump against overselling Senate healthcare bill. The Kentucky Republican told "Fox News Sunday" he wouldn't be promoting the Senate healthcare bill in the way Trump is, promising massive fixes to the system's problems. "I would caution about overselling what's going to happen," he said. Paul said the problem with new legislation that tries to shape the system a decade into the future is that U.S. government is too fluid to realy commit to such a plan. "We do things in the first two or three or four years and by the time we get to year seven, eight, or nine, there's a new Congress or a new president and the whole thing goes out the window," he said.

NIH Director Francis Collins: 'Virtually everything' would be affected by Trump's budget cuts. The director of the National Institutes of Health in June became the latest holdover to join the Trump administration from the Obama administration. The appointment comes as President Trump proposes slashing $8 billion, or roughly 20 percent, from Collins' agency, which oversees grants for medical research. Congress in recent years has shown bipartisan support for increasing funding for the agency, so the cuts are unlikely to take effect. Still, the proposal concerned many in the scientific and medical community, and in budget hearings, Collins has been asked by lawmakers how the cuts would affect his agency. In an interview with the Washington Examiner, Collins spoke about the proposed cuts, about NIH's ethical approaches to research and about his Christian faith.

Despite some good news, the opioid epidemic isn't slowing down. Illegal drugs such as heroin and fentanyl are fueling the opioid epidemic despite progress in getting doctors to prescribe fewer painkillers. Federal officials and lawmakers say more must be done to stem a growing tide of overdose deaths from illicit opioids such as heroin and the synthetic opioid fentanyl, which is even more potent and cheaper than heroin. The emergence of fentanyl especially has caught the attention of Congress, with lawmakers trying to clamp down on the sources of heroin and fentanyl.

Maryland 'price gouging' law meets immediate legal challenge. The law, formally known as the "Prohibition Against Price Gouging for Essential Off-Patent or Generic Drugs," gives the state attorney general authority to challenge drug companies when they have significantly raised the prices of a generic drug to an "unconscionable" level or one that is "excessive" and "not justified." Advocates of the law say they hope it can reduce healthcare costs and health insurance premiums. Opponents, including generic drugmakers, counter that the law's language is not only too vague but is likely in violation of the U.S. Constitution. They note that prescription drug prices are not set by states, and that the power to regulate interstate commerce belongs to the federal government.

VA’s fixer uppers: The Department of Veterans Affairs is trying to unload hundreds of vacant and useless buildings, potentially saving taxpayers $23 million every year, but historic preservation tags have been slapped on many of them, blocking action. VA Secretary David J. Shulkin said the agency owns thousands of buildings from the Revolutionary War, Civil War, World War I, and World War II, many vacant and under historical preservation status. Citing 100 buildings that are from the Civil War and Revolutionary War, Shulkin said "even though they are buildings that we aren't using or buildings that are too old to viably use, they still have historic preservation status." Overall, 2,226 VA buildings, hospitals, private garages, and even a bowling alley in Iowa — 35 percent of its 6,297 real estate holdings — have historic status, blocking destruction or major renovations. One dates to 1735.


Politico How hospitals got richer off Obamacare

Axios Biden: GOP’s health bill should make your blood boil

Bloomberg GOP leaders brace for CBO estimate on revised health bill

New York Times McCain’s surgery may be more serious than thought, experts say

Washington Post Insurers join the din of opposition to the Senate health bill

Kaiser Health News Senate’s latest health blueprint cuts costs at the expense of the chronically ill

The Hill GOP lawmaker: Tax reform will not happen without healthcare reform

CNN Does the healthcare vote delay help or hurt its chances?

LA Times Obamacare repeal bills could put coverage out of reach for millions of sick Americans


House budget expected.

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 Balance Between Innovation and Access.” Details.

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

10:15 a.m. 2322 Rayburn. House Energy and Commerce Committee hearing on “Examining HRSA’s Oversight of the 340B Drug Pricing Program.” Details.

Noon. National Pharmaceutical Council webinar on “Same Condition, Different Costs: Should Patients Pay Different Amounts?” Details.  

2:30 p.m. New York Times Insider call on “Healthcare Conference Call: What Does Policy Actually Mean for Your Health?” Details.


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

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.


529 14th St. NW. National Press Club lunch even with the House Freedom Caucus. Details.