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Here comes the money: Senate Majority Leader Mitch McConnell, R-Ky., has money to spend, and he isn’t afraid to spend it. On Thursday, the leader made changes to the healthcare bill in an effort to woo both centrists and conservatives in hopes of getting to the 50 votes needed to pass a bill, according to a source familiar with the plan.   

What centrists get: An additional $45 billion in funding to fight opioid abuse, which Sen. Shelley Moore Capito, R-W.Va., in particular, had been pushing for.

What conservatives get: Individuals will now be able to use health savings accounts to help pay their premiums. This change is expected to burn another $60 billion in deficit reduction.

How much is left: This leaves McConnell with about another $100 billion to work with to win over holdouts and still meet the deficit reduction requirements necessary to pass a bill through reconciliation. Otherwise, McConnell will have to delay or scale back repeal of the Obamacare tax increases. 

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.

Senate leadership scrambles to lock down healthcare votes. Some senators are skeptical they will leave for the July 4 recess with an agreement in hand. Several senators said Senate McConnell wanted to reach a deal on healthcare by the end of the week and have the Senate vote after returning from the week-long recess on July 10. Sen. Susan Collins, R-Maine, a centrist who opposes the bill, said a deal this week is "going to be very difficult." She said meetings such as the luncheon, however, "where people have a chance to advance their ideas and have a full debate on them are valuable in trying to reach an agreement." Other senators are fairly optimistic. When asked about how to bridge the divisions between centrists and conservatives, Sen. Pat Roberts, R-Kan., used a nature metaphor to prove his point. "Even porcupines make love," he said.

Republicans pressure GOP leaders to drop tax cuts in healthcare bill: The lawmakers include Sen. Bob Corker of Tennessee, who says he opposes the cuts in their current form because they come at the expense of low-income individuals, who would be provided less federal money to buy health insurance than under Obamacare. McConnell is said to be considering a change to the tax cuts. "It's very important to me in the initial draft bill if you looked at lower-income citizens … they were going backwards," Corker told reporters after a meeting with Republican leaders in McConnell's office Wednesday. "And at the same time the 3.8 percent tax on the wealthy was being done away with." Corker said he and fellow lawmakers are not comfortable with the idea of cutting taxes for the wealthy while leaving some without the money to buy healthcare. "That is not an equilibrium that is appropriate," Corker said. "It's important to me we look at that in a different way, and my sense is the leader's office is really trying to accommodate the many issues like this that have arisen."

Sen. Mike Rounds proposes keeping Obamacare tax on investments to greatly expand access to the law’s tax credits. The South Dakota Republican said leadership has committed to getting his idea scored. Obamacare's tax credits that help customers pay for insurance should go to certain dependents, he said. "Under existing Obamacare rules they forbid tax credits to be given to a dependent of an individual who was on an employer plan," he said. Rounds added that these folks "get nothing. They are part of the uninsured population today. Why is it we won't help those folks with a tax credit to at least give them a chance to have the same opportunity as someone in the group market?"

Sen. Rand Paul suggests splitting bill into two: The Kentucky Republican on MSNBC Thursday compared the stalled healthcare bill to the Compromise of 1850 that saw Congress pass several separate bills related to disputes between slave states and free states. He said that could be a way around current hurdles in the Senate, where conservatives want a bill that's much closer to repeal of Obamacare, while moderate Republicans are worried that the bill takes away too much money from Medicaid. "Remember Henry Clay's compromise of 1850," Paul said. "It couldn't pass, they broke it into four pieces and they passed them individually." He continued: "I think if we take this bill and split it into two pieces. We pass one that is more ... looks like repeal that conservatives like, and then the other one you load up with all kinds of Christmas ornaments and gifts and money, just pile money on it that the Democrats will vote for, and some of the Republicans will vote for. Then I think both end up passing. It may not be completely good for the country, but you at least get the repeal that way.”

Sen. Shelley Moore Capito, R-W.Va., outlines her wish list: In addition to the increased opioid abuse funding, which she has already won, Capito had also pushed for changes to Medicaid's growth rate. The key centrist, who is opposed to the current bill, went to a meeting with McConnell Wednesday that focused on her demands for changing the Senate bill. Capito said on her way to McConnell's office that she wants to adjust the growth rate for Medicaid, which the current bill caps. She said she wants a growth rate that "matches the projected spending in Medicaid over 10 years." She also wants to create "more robust help for older and less affluent rural people.

Senate Minority Leader Chuck Schumer to Trump: 'Let's turn over a new leaf. Let's start over.' The New York Democrat called on President Trump and Senate Republicans to ditch their approach to overhauling the Affordable Care Act and "start over" by working hand in glove with Democrats to fix healthcare. "I would make my friends on the Republican side and President Trump an offer: Let's turn over a new leaf. Let's start over," Schumer said on the Senate floor. He called for Trump to invite all 100 senators to Blair House — the president's guest house across from the White House — to discuss the issue as former President Barack Obama did in 2010. President Trump, I challenge you to invite us, all 100 of us, Republican and Democrat to Blair House to discuss a new bipartisan way forward on healthcare in front of all the American people," Schumer said, pointing to Trump's campaign promise to cover everybody.

Collins continues to stress need for bipartisanship, saying that to win her support a bill would need a “fundamental overhaul.” "I want to make clear to the Republican leaders that just tinkering with the bill will not be sufficient to win my support," said Collins, speaking on local Maine radio station WGAN. Asked whether she saw a path forward for Republicans, Collins replied: “It’s going to be very difficult to thread the needle, there’s no doubt about it … I think the answer is to have some public hearings, bring in experts. This is enormously complex ... when you change one part [of the healthcare system] it has a ripple effect.” Collins introduced a bill earlier this year with Sen. Bill Cassidy, R-La., which would allow states to keep Obamacare or craft their own plans. She raised the possibility of starting with that bill, called the Patient Freedom Act, and said she was meeting with centrist Democrats, including Sen. Joe Manchin of West Virginia. The approach on healthcare, she said, should be to bring both parties together. Initially, she said, “the Democrats had decided they were not going to be negotiating. I think that’s about to change."

Insurers strand Nevada’s Obamacare residents: Nevadans living in 14 of Nevada's 17 counties who want to purchase coverage on the state's Obamacare exchange won't have any insurers to choose from next year, after two insurers decided to exit the marketplace for 2018. Anthem Blue Cross Blue Shield said it has decided not to offer plans on the exchange in rural Nevada. The insurer cited uncertainty in "federal operations, rules and guidance, including cost-sharing reduction subsidies," and volatility in the individual market as its reasons for leaving. Prominence Health Plan, a smaller carrier, also announced it will leave the state entirely. Heather Korbulic, executive director of the Silver State Health Insurance Exchange, said that as a result, more than 8,000 Nevadans will lose coverage come Jan. 1.

Another GOP governor not happy: Republican New Hampshire Gov. Chris Sununu is the latest in a growing list of Republican governors not very happy with the Senate bill. The reason? The rough $770 billion in Medicaid cuts. Sununu said on CNN that his state doesn’t have income or sales tax and that makes it unfair that the state has to shoulder more of the costs.

Sununu joins other Republican governors who are worried about the cuts to Medicaid, including Govs. John Kasich of Ohio and Brian Sandoval of Nevada.

President Trump previews 'big surprise' on healthcare bill. "Healthcare is working along very well," Trump told reporters at the White House. "We're going to have a big surprise. We have a great healthcare package. We're going to have a great, great surprise.”

When is a cut really a cut? On Twitter, President Trump shared a graphic about Medicaid spending projections: “Democrats purposely misstated Medicaid under new Senate bill - actually goes up.” This has re-ignited an age old debate in Washington about the distinction between outright cuts to spending and a reduction in the projected spending under current law. It is true that more money would be spent in 2026 on Medicaid than will be spent in 2017. At the same time, it’s also true that, according to the Congressional Budget Office, there will be $772 billion less spent on Medicaid over the next decade under the Senate bill than if Obamacare stays in place.

Heritage Action: You can’t always get what you want: That was essentially the message of a revealing op-ed from Mike Needham, the CEO of Heritage Action. Needham wrote in an op-ed Thursday that conservatives shouldn't be dismayed that they are not fully repealing Obamacare and to work with what they have got. He also said that conservatives need a harsh dose of reality. Conservatives who say that full repeal is possible now or after the 2018 midterms are "not being honest with themselves regarding the long-term nature of this challenge,” Needham wrote. But he did propose several changes to the bill to help make it more conservative. Chief among them is an idea from Sen. Ted Cruz, R-Texas, He reminded conservatives that whatever happens on Obamacare repeal, Democrats will "not stop in their quest for a nationalized, single-payer scheme. Conservatives cannot cede the playing field despite justified disappointment with the current process."

Union leader blasts Obamacare tax: The head of a powerful union reminded Democrats that they hate Obamacare’s “Cadillac” tax on high-cost health plans. D. Taylor, president of the service employee union Unite Here, blasted Senate Democratic leadership for attacking Senate Republicans’ healthcare bill as a big break for the wealthy, in part, because it delays the tax for four years. Taylor pointed out that union members also benefit from the high-cost health plans that would face the tax. The letter is a reminder that both Democrats and Republicans aren’t too fond of the tax, which was delayed several times by the Obama administration.

House Republicans pass part of third phase of healthcare agenda. The House on Wednesday passed a bill that would cap medical malpractice lawsuits by limiting plaintiff damages to $250,000. The House passed the Protecting Access to Care Act, largely along party lines, by a 218-210 vote. At least 18 Republicans opposed the bill. If the bill were to become law, it would implement other limits, including on attorney fees, and implement a three-year statute of limitations. It would apply to healthcare lawsuits that involve coverage provided through a federal program such as Medicare or Medicaid or to coverage that is partly paid for by a government subsidy or tax benefit. Supporters of the legislation said it would limit unnecessary medical tests and procedures and reduce healthcare costs, but critics said it could inappropriately limit the compensation of plaintiffs who file a healthcare lawsuit and could increase medical errors. A Congressional Budget Office score of the bill projected that it would reduce deficits by $50 billion by 2027.

Capitol Police arrest 40 people during healthcare protests: Police said those arrested were not complying with the cease-and-desist orders being given, so they were taken in and charged with "Crowding, Obstructing, or Incommoding," according to Sinclair Broadcast Group. "After officers arrived on the scene, they warned the demonstrators to cease and desist with their unlawful demonstration activities," authorities said. 

RUNDOWN

Politico Portman and McConnell clash over health bill

The Hill GOP senator: We all want to get to yes on healthcare

Axios Reports: Trump routinely confuses Medicare and Medicaid

Washington Post How the push for a Senate healthcare vote fell apart amid GOP tensions

New York Times As Obamacare repeal teeters, prospects for bipartisanship builds

Associated Press If GOP can’t repeal Obamacare, how can it overhaul taxes?

Bloomberg What GOP holdouts want before unblocking the health bill

Des Moines Register Grassley says he won’t take stance on health bill while it’s a work in progress



THURSDAY | JUNE 29

4 p.m. American Enterprise Institute. 1789 Massachusetts Ave. NW. Event on “The Role of Government in Medical Innovation. Details.

6 p.m. 101 Constitution Ave. NW. Independent Women’s Forum event on “Oops! Sorry We Were Wrong … How Public Health Guidance Often Harms the American Public.” Details.  

Congress leaves for Fourth of July recess.  

FRIDAY | JUNE 30

June 30-July 3. Marriott Marquis San Diego Arena. San Diego. Annual conference for the National Association of School Nurses. Details.

10 a.m. CST/11 a.m. EST. Living Faith Christian Center. 6375 Winbourne Ave., Baton Rouge, La. Sen. Bill Cassidy, R-La., to hold a town hall. Details.

TUESDAY | JULY 4 

Fourth of July holiday.  

WEDNESDAY | JULY 5 

6 p.m. 1900 Gateway Blvd, McKinney, Texas. Sen. Ted Cruz holds town hall with Concerned Veterans of America. Details.  

THURSDAY | JULY 6 

11:30 a.m. CST/12:30 a.m. EST. McKenna Youth and Activity Center. 311 Main St, Palco, Kan. Sen. Jerry Moran, R-Kansas, to hold a town hall. Details.  

6 p.m. 9721 Arboretum Blvd, Austin, Texas. Sen. Sen. Ted Cruz holds town hall with Concerned Veterans of America. Details.

Calendar