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Is the GOP healthcare bill a dead shark? In the film “Annie Hall,” Woody Allen’s character observes, “A relationship, I think, is like a shark. You know? It has to constantly move forward or it dies. And I think what we got on our hands is a dead shark.” As Republicans turn to Washington during “Shark Week,” Senate Majority Leader Mitch McConnell is having to contemplate whether his healthcare push is dead in the water. The Senate is scheduled to hold its most pivotal vote yet to repeal Obamacare, but major questions remain over which legislation Republicans will vote on, let alone which can actually pass. On Tuesday, GOP leadership is expected to call for a vote on a procedural motion to start debate on the House-passed healthcare bill. If that motion gets the 50 votes it needs, the House bill would be stripped out and a new bill would be swapped in, but no one is sure which bill that would be. It could be something along the lines of the Better Care Reconciliation Act, which is the bill Republican senators have been negotiating for months that would include elements of repealing and replacing Obamacare. Or it could be an updated version of a 2015 bill that would repeal the taxes and spending of Obamacare without offering a replacement. Though we wouldn’t wager a guess on the outcome, we would say this: If McConnell brings up the “repeal only” bill, it will mean he has reached the conclusion that no amount of negotiation will forge an agreement on healthcare, so he wants to create an opportunity for those who want to be on the record as having supported repealing Obamacare. Assuming that goes down, he would be able to put aside healthcare and move on to other items on the agenda such as cutting taxes.

Trump prepares to blame GOP Senate for Trumpcare failure: If the healthcare bill goes down this week, President Trump will face an avalanche of criticism that despite his boasts of being a master dealmaker, he failed to get a top priority across the finish line and has no major legislative accomplishments to show for a first six months in office that has been dominated by Russia news and daily battles with the media. In the past few days, he has made it clear how he would handle such criticisms: blame congressional Republicans. In a series of tweets over the weekend that spilled into this morning, he referred to Republicans as if he were a critical outside observer rather than the leader of the party. “Republicans have a last chance to do the right thing on Repeal & Replace after years of talking & campaigning on it,” he wrote Monday morning. On Sunday, he tweeted, “If Republicans don't Repeal and Replace the disastrous ObamaCare, the repercussions will be far greater than any of them understand!” During the weekend, he hammered Senate Republicans over the need to repeal and replace Obamacare before moving onto other policy reforms. "The Republican Senators must step up to the plate and, after 7 years, vote to Repeal and Replace. Next, Tax Reform and Infrastructure. WIN!" Trump tweeted Saturday morning.

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.

Parliamentarian complicates the situation. The Senate parliamentarian on Friday said the health bill's Planned Parenthood defunding and six-month waiting period don't meet the requirements for using reconcilation. The Better Care Reconciliation Act would prohibit tax credits that help people buy private health coverage from going to plans that cover abortions. It also would cut off family planning funding for one year for facilities that also provide abortions, often known as a provision that would "defund Planned Parenthood." Excluding the anti-abortions provisions could complicate the bill's passage, as the defunding of Planned Parenthood is one of the selling points for onservatives who are otherwise skeptical of the bill. According to the Senate parliamentarian, the anti-abortion provisions violate reconciliation's Byrd rule, as does the "six-month lockout" that Republicans planned to use as an alternative to Obamacare's individual mandate, which requires people to buy health insurance or pay a fine. The provision would require people who do not stay enrolled in coverage to wait six months before enrolling again. That said, McConnell spokesman Don Stewart noted that at this stage the parliamentarian is offering preliminary guidance based on the way current legislation is written. It’s possible that with some tweaks to the text, Republicans may be able to achieve the same ends in a way that passes muster.

Sen. John Thune: McConnell will decide 'at some point this week' which bill to bring up. South Dakota Sen. John Thune, the third highest-ranking Republican in the Senate, said on "Fox News Sunday" that McConnell will make the decision on which healthcare bill to take up this week but didn't give any clues as to which bill the Senate would consider. "Ultimately, that's a judgment that Sen. McConnell will make at some point this week before the vote," he said.

Sen. Ted Cruz: His amendment would lower premiums, giving GOP a 'big win.’ "I believe it's the key for bringing everybody together," the Texas Republican said. "If premiums go down, that's a big win, for conservatives, moderates, for everyone in the party, because it's a win for our constituents," the Texas Republican said on Fox Business. The Congressional Budget Office has not scored the Cruz amendment, which would let insurers sell plans that don't comply with Obamacare's mandates as long as they sell one that does. Cruz said the nonpartisan office would not have time, with the Senate expected to vote on a healthcare bill next week, but pointed out that the Department of Health and Human Services did its own assessment. "They projected with the Consumer Freedom Amendment, 2.2 million more people will get health insurance … would lower consumer premiums by $7,000 a year," Cruz told Fox Business. Healthcare experts have criticized the HHS analysis as flawed, saying the methodology is wrong and it leaves out key data.

Sen. Rand Paul won't back Senate GOP bill. "The real question is what are we moving to," the Kentucky Republican said on CNN's "State of the Union" when asked if he'd vote on a procedural motion to advance a healthcare reform bill. "Last week, Senate leadership said it would be clean repeal ... and I think that's a good idea." However, if Senate Republican leadership brings up the Better Care Reconciliation Act again, Paul said, "I'm not for that because I'm not for taxpayer money going to rich insurance executives."

Trump plugs healthcare during USS Gerald R. Ford speech. Trump urged people to lobby their lawmakers to pass a budget that contains an additional $54 billion in Defense Department funding for fiscal yar 2018, during his remarks on the aircraft carrier. "And you will get — believe me, President Trump, I will tell you — you will get it. Don't worry about it. But I don't mind getting a little hand. So call that congressman, and call that senator and make sure you get it," Trump said. "And by the way, you can also call those senators to make sure that you get healthcare."

Vice President Mike Pence: 'Congress needs to do their job' on Obamacare. "Congress needs to step up. Congress needs to do their job," Pence said at a meeting with business and conservative leaders at his office to discuss ways to encourage Republican holdouts to vote in favor of beginning debate. "Every [Republican] member of the United States Senate should vote to begin the debate to rescue the American people from the disastrous policy of Obamacare." He later said: "Our message today is make sure the American people know that it's time for Congress to act. ... And frankly, as the president said, any senator who doesn't vote to begin the debate is essentially telling the American people that they're fine with Obamacare. And that's just unacceptable. Because we all know Obamacare is collapsing all across the country as we speak."

Senate Minority Leader Chuck Schumer: 'Single-payer is on the table.’ The New York Democrat told ABC's "This Week" that while Democrats’ economic plan will get the attention coming up as they roll out their “Better Deal” plan, they will look at single-payer amid continued chatter from high-profile Democrats about how to attack on the healthcare issue. "Week after week, month after month, we're going to roll out specific pieces here that are quite different than the Democratic Party you heard in the past," Schumer said. "We were too cautious. We were too mamby-pamby."

Here’s what Democrats said about healthcare in their video rolling out ‘A Better Deal.’ “Working families should be able to … live with dignity with healthcare. It is ridiculous that Big Pharma has controlled Washington for so long and has refused to even budge on the notion that we ought to negotiate for lower prices.” Full video.

States think reinsurance might fix Obamacare troubles. Regardless of what happens in Congress over how to change Obamacare, the fifth open enrollment season will be held in the fall. The landscape looks dire: Insurers are fleeing, leaving empty counties behind, and premiums in many states will rise by double digits. Enter reinsurance, a measure with bipartisan support that has a track record of reducing premiums. The program injects federal funding into the system, with parameters, so that medical costs for sicker enrollees are covered without significantly raising the cost of premiums for those who use the system less. Reinsurance programs were implemented nationwide under Obamacare, with $10 billion paid out in 2014, $6 billion in 2015, and $4 billion in 2016. The program was intended to provide stability as the exchanges were starting and was never meant to be permanent. Now, some lawmakers would like to bring it back.

Medicaid expansion boosts mental health coverage in four states. A federal watchdog found that one-third of Medicaid expansion enrollees received mental health treatment in four states. The GAO looked at four states that expanded Medicaid: Iowa, New York, Washington and West Virginia. It found that in 2014, 1 in 3 expansion enrollees got behavioral health treatments. Psychotherapy visits and antidepressant prescriptions were the most common services used, the GAO said. The study from the federal watchdog come as Congress will decide the fate of the Medicaid expansion during a planned Obamacare repeal vote likely Tuesday.

States begin to allow sunscreen in schools. Students in Florida no longer will need a doctor's note and a trip to the nurse to protect themselves from the sun's cancer-causing rays. The Sunshine State this summer joined the ranks of states allowing students to bring sunscreen, which is considered an over-the-counter drug by the Food and Drug Administration, to school and apply it without a nurse's help or a prescription.

 

RUNDOWN

 The Hill Trump to speak on healthcare Monday

Associated Press More reasons for rejecting GOP health bill than passing it

Wall Street Journal Jimmy Carter believes U.S. eventually will go to single-payer healthcare system

Kaiser Health News Opioid treatment funds in Senate bill would fall far short of needs

STAT News DEA solicited applications to grow marijuana for research. It hasn’t approved one

Bloomberg Trump’s FDA chief takes wide aim at opioid addiction crisis

Axios The sky-high pay of healthcare CEOs

Washington Post Former GOP senator tells Republicans to vote no on the ACA repeal efforts this week

Politico The unnecessary risk with over-the-counter drugs



Calendar

MONDAY | JULY 24


3:15 p.m. President Trump to give a statement on healthcare.

4 p.m. Senate convenes.

TUESDAY | JULY 25
10 a.m. 1225 I St NW. Bipartisan Policy Center event on “The Future of Comparative Effectiveness Research.” Details.

Noon. 2103 Rayburn. The American College of Preventive Medicine lunch briefing on "Transforming Medical Education to Prevent Chronic Disease." Register.

WEDNESDAY | JULY 26

7:30 a.m. 1101 K St NW. Bloomberg Government event on the “Cost of Healthcare” with Sen. Bill Cassidy, R-La. Details.

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

8:30 a.m. 660 North Capitol St. NW. Urban Institute event on “Addressing Housing and Health: How Cities Are Making a Difference. Details.

9:30 a.m. Dirksen 106. Special Committee on Aging hearing on ““Progress Toward a Cure for Type I Diabetes: Research and the Artificial Pancreas.” Details.

10 a.m. Congressional Black Caucus to host “Trumpcare Twitter Town Hall” using the hashtag #CBCOnHealthcare.

10:15 a.m. 2322 Rayburn. House Energy and Commerce hearing on “Examining the Extension of Special Needs Plans.” Details.