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July 4 goal for healthcare vote fading out of reach: Republican Sen. Bill Cassidy didn't seem too concerned if the Senate fails to vote on healthcare reform by Congress' July 4 recess. "It's not like your wife's birthday. You miss your wife's birthday, there is hell to pay," the Louisiana lawmaker said Thursday. "On the other hand, if you don't cut the grass on Friday but do it on Saturday it is not a big deal. I am not saying it isn't a big deal, but you know what I am saying." Complicating a July 4 vote is that no text has been publicly released, which has rankled some Republicans who want any bill to receive a fair amount of scrutiny. "We need time to fully understand it," said Sen. Ron Johnson, R-Wis. "I don't want to see us vote before the July 4 break. I think that would be too soon." Johnson said he hoped that there would be a short-term bill to stabilize markets, separate from a long-term overhaul. But no such bill has emerged. He understood the reluctance by leadership to put together a short-term bill now. "By not doing anything, we have put pressure on ourselves to get this completed," he said. Sen. John Thune, R-S.D., summed up the mindset surrounding the July 4 goal. "It is a hope, an aspiration, [and] it's a plan," the third-ranking GOP senator said Thursday. But Thune then issued an important caveat. "You've got to be realistic based on where we are," he said. Other Republicans were more optimistic about a vote before the recess. "I do think that there is no line in the sand, but it does feel like we are gonna be ready by the end of this period," said Sen. Bob Corker, R-Tenn.

Rand sure seems like a no: Sen. Rand Paul, R-Ky., left the bipartisan Senate lunch Thursday feeling dismayed about the current state of Obamacare repeal negotiations. "My promise to the voters was to repeal Obamacare and it looks like we are keeping a good chunk of Obamacare,” he told the Washington Examiner on the way back to his office. Paul was concerned that Republicans are looking to subsidize rates to make them lower, which goes against “every Republican principle you can imagine.” He added: “I don’t know how we strayed so far from repealing Obamacare.” Paul’s feelings on the healthcare reform negotiations have caused some of his colleagues to believe he won’t vote for it. Sen. Lindsey Graham, R-S.C., recently told reporters that Paul is a definite no. But Paul’s office responded he has not made any decision.

And Lisa Murkowski doesn’t seem so hot for the bill, either: “I want greater access and lower costs,” she told Vox’s Dylan Byers. “So far, I'm not seeing that happen. Remember, Republicans can afford to lose no more than two votes.

Column: Republicans have already given up on repealing and replacing Obamacare: “Conservatives should come to understand that what Republicans are talking about now is really just making changes to Obamacare. They have already given up on repeal.”

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.

Republicans disagree over how to make insurer subsidies: Some key Republicans are calling for a long-term commitment to insurer subsidies under Obamacare to help stabilize insurer markets. But the question is who is going to make them. Sen. Lamar Alexander, R-Tenn., on Thursday said the cost-sharing reduction payments to insurers should be made by Congress, the White House or a combination of the two. Calling for the White House to make them is a major development. The House sued the Obama administration in 2014 because it was making the cost-sharing payments without a congressional appropriation.

Schumer trolls secretive healthcare process: Senate Minority Leader Chuck Schumer, D-N.Y., seizing on the criticism of the opacity of the GOP’s drafting of the healthcare bill, released a letter to Senate Majority Leader Mitch McConnell, R-Ky., on Friday inviting Republicans to an “all senators” meeting on healthcare. “Please accept our invitation to sit down together in the old Senate Chamber so we can hear your plans and discuss how to make healthcare more affordable and accessible in the United States,” Schumer wrote.

Analysis blames Obamacare rate hikes partly on uncertainty: About two-thirds of 2018 Obamacare rate increases will be due to uncertainty caused by the Trump administration, according to a new analysis from the consulting firm Oliver Wyman. The analysis released Friday projected that uncertainty over the enforcement of the individual mandate and whether the White House will pay 2018 cost-sharing reduction payments are driving up costs. “For example, if an insurer submits a rate increase of 30 percent, two-thirds of that increase will be attributable to the CSR and individual mandate uncertainty,” the analysis said. Some insurers have hinted they will charge more due to uncertainty over the CSRs or the mandate. However, others have given other reasons such as the resumption of Obamacare’s insurer tax and lingering problems with the risk pools. The firm said that the analysis is based on a micro-simulation model on the impact of the non-enforcement of the individual mandate and looked at publicly available data on the impact of the CSRs.

House passes Veteran Act and the Broader Options for Americans Act: The first bill ensures that veterans will continue to have assistance purchasing health insurance, while the Broader Options bill helps people who recently lost their job continue using the health insurance they received through work by providing people access to tax credits under the American Health Care Act. The legislation have been billed as companion pieces to the Republican healthcare bill. “House Republicans made it clear that we will continue to pass legislation to build on the American Health Care Act,” House Ways and Means Committee Chairman Kevin Brady said. “These two bills …  deliver on our promise to ensure our veterans and workers have access to the health care that’s right for them. I appreciate their leadership and look forward to our continued work to fix our broken health care system and deliver patient-centered solutions.”

Opioid panel starts work today: A presidential commission tasked with fighting the opioid crisis is holding its first meeting today at 12:30 p.m. New Jersey Gov. Chris Christie is leading the commission. The panel, which includes several Republican and Democratic governors, has 90 days to draft a report on the opioid crisis.

Vaping down among teens, reversing years of upward use. For the first time since 2011, when the Centers for Disease Control and Prevention began tracking rates, the use of e-cigarettes declined among teens from 3 million in 2015 to 2.2 million in 2016. The findings, published in the CDC's Morbidity and Mortality Weekly Report, contributed to overall decreases in tobacco use among children in middle school and high school from 4.7 million in 2015 to 3.9 million in 2016. Despite the reductions, CDC acting director Dr. Anne Schuchat said in a statement that rates were still too high. "Far too many young people are still using tobacco products, so we must continue to prioritize proven strategies to protect our youth from this preventable health risk," she said. Gregory Conley, president of the American Vaping Association, a nonprofit that advocates on vaping policies, said in an email that the latest report provided evidence that vaping does not necessarily lead to smoking traditional cigarettes. "Not only is that not happening, but this new data shows that many teens who have tried vapor products are not continuing to use them. Regrettably, it is unlikely that studies like this will change the rhetoric being spewed by disingenuous special interest groups, as their opposition to vaping is rooted not in science, but in ideology and dogma."

Bipartisan medical marijuana bill introduced in the Senate. On Thursday Sens. Cory Booker, D-N.J., Mike Lee, R-Utah, Kirsten Gillibrand, D-N.Y., Rand Paul, R-Ky., Al Franken, D-Minn., and Lisa Murkowski, R-Alaska, introduced the Compassionate Access, Research Expansion and Respect the States (CARERS) Act. The bill would protect users of medical cannabis who comply with state laws from unwarranted federal prosecution and would expand medical and scientific research on the uses and effects of medical marijuana.

Highlights from the annual conference for America’s Health Insurance Plans: Anthem CEO Joseph Swedish said, “I can’t think of a more challenging time” given all the changes ahead in the healthcare industry. “Our industry needs to forcefully drive change” despite “tremendous shortcomings.” On cost-sharing subsidies, Peter Lee, executive director of Covered California, the state’s exchange, said they are “the secret sauce. The reason people buy coverage that they didn’t get before is because they get financial help to do it.”


CNN Outlook poor for healthcare vote by July 4, but not impossible

Politico Schumer asks for all 100 senators to meet on Obamacare repeal effort

Washington Post America’s new tobacco crisis: The rich stopped smoking, the poor didn’t

Vox We asked 8 Senate Republicans what their healthcare bill is trying to do

Forbes Cancer’s big infrastructure problem At Philadelphia hospital, 1 in 5 infants died after heart surgery

The Hill Warren rips GOP for secrecy on healthcare bill

Axios McKesson’s CEO’s $98 million pay comes amid opioid crisis




June 14-16. Hyatt Regency. 400 New Jersey Ave. NW. Mental Health America annual conference on "Drugs, Sex and Rock and Roll." Details.

June 14-16. Oregon Convention Center. Portland. Annual conference for the Association for Professionals in Infection Control. Details.

Trump administration to discuss executive order on containing high drug costs.


The Children's March for Humanity will hold nationwide marches and rallies in more than 24 U.S. cities. Details.


June 19-22. San Diego Convention Center. 111 W Harbor Dr. Biotechnology Innovation Organization annual convention. Details.


10:30 a.m. Dirksen 192. Senate Appropriations hearing on FDA’s budget. Details.

Noon. Rayburn 2103. Briefing on neuroscience research with the Congressional Neuroscience Caucus.

4:30 p.m. Carnegie Library. 801 K St. NW. Bipartisan Policy Center panel discussion on documentary “Unseen Enemy” with Johnson & Johnson and the Blue Ribbon Study Panel. Details.


11:30 a.m. National Press Club. Roundtable on “Healthcare in the Trump Era: Politics, policy and people.” Details.


10 a.m. Dirksen 138. Senate Appropriations committee hearing on NIH’s budget. Details.