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McConnell’s ‘murky’ path: Having failed before the August recess to pass legislation repealing or altering Obamacare, Senate Majority Leader Mitch McConnell said at a Chamber of Commerce event in Louisville "the way forward now is somewhat murky." The problem confronting Republicans is multifaceted. Republicans are up for re-election just over a year from now and Obamacare is still on the books. If they let Obamacare markets deteriorate further, they will bear the brunt of the political blame for collapsing markets, rising premiums and insurer exits. That’s why McConnell highlighted the effort by Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander of Tennessee to work with Democrats to continue funding Obamacare payments to insurers, known as cost-sharing reduction subsidies, as a way of helping to stabilize the markets. McConnell told the audience Monday that he would wait to see the legislation that Alexander comes up with, but cautioned that the idea of providing further subsidies to insurance companies absent broader reforms was "pretty controversial." That is, if Republicans, after failing to deliver on their promise to repeal and replace Obamacare, then take action to prop up the law by keeping up with payments to insurers that they had sued the Obama administration over, it would be a devastating blow to conservatives, which could depress turnout. In midterm elections, which tend to draw fewer voters than presidential elections, an enthusiastic base is a key to victory. This is the dilemma McConnell will be facing when the Senate returns to work next month.

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.

Bipartisan hearings on healthcare scheduled. The Senate Health, Education, Labor and Pensions Committee is holding hearings Sept. 6 and 7 about stabilizing the Obamacare exchanges. Several counties are facing the prospect of significant increases in gross premiums, which could dissuade healthier, middle-class enrollees who don’t receive subsidies from signing up. No more empty counties remain for now, but that could change if cost-sharing reduction payments are ended. Witnesses at the hearing will include governors and health insurance commissioners.

Govs. John Kasich, John Hickenlooper creating Obamacare rescue package. Kasich, an Ohio Republican, and Hickenlooper, a Colorado Democrat, plan to make their proposal public in a week. "We're getting very close," Kasich said in a joint interview Monday with Hickenlooper on Colorado Public Radio. "I just talked to my guys today, men and women who are working on this with John's people, and we think we'll have some specifics here ... I think we could have it within a week." They would provide their proposals for Congress to consider when they return from recess in September. Kasich said he was optimistic that he and Hickenlooper would be able to come to an agreement that they would send to other governors. He declined to provide specifics about what the plan might include but said it would not be "some pie in the sky way up there kind of stuff." "There will be things that we will address that will have specific solutions," he said. He raised the possibility of the exchanges becoming more stable by ensuring that cost-sharing reduction subsidies are provided to insurers. Hickenlooper cited the option of reinsurance, a program that allows federal funds to go directly to insurers so they can pay the claims of higher-cost enrollees and keep costs for healthier enrollees at bay. He admitted that he and Hickenlooper disagree on the individual mandate that requires people to buy insurance or pay a fine, but they agree on increasing the threshold for the employer mandate, which requires employers with more than 50 full-time workers provide coverage. "The key here is bipartisanship, and that doesn't just immediately blossom forth,” Hickenlooper said.

House Speaker Paul Ryan: Tax reform 'far easier' to pass than healthcare. The Wisconsin Republican said Monday that tax reform should be easier to pass than healthcare reform, which has no clear path forward after it failed in the Senate. "I believe it's going to be far easier for us to do tax reform than it was, say, for healthcare reform," Ryan told CNN during a town hall in Racine, Wis. He pointed specifically to Congress’ inability to include measures in the healthcare bill because of Senate rules, including medical liability reform and interstate shopping. "Tax reform is different," he said. Lately, Ryan has been striking an optimistic tone on the potential for tax reform in the coming months despite strife that has plagued healthcare in past months since the House passed the American Health Care Act. In a recent interview, Ryan said that unlike during the healthcare debate, there is "consensus" among the party on tax reform, despite divisions early on over Ryan's proposed border-adjustment tax, which has been shelved. Ryan also called on the Senate to pass a healthcare reform package when they return to Washington from August recess. "Doing nothing really isn't an option," Ryan said. "Honestly, the Senate has to get back and keep at it. What I've been telling our friends in the Senate: get back to work, get a bill passed. We will meet you in conference and figure things out, but we can't take no for an answer."

McConnell: 'Judge this Congress at the conclusion.’ McConnell urged Kentuckians to judge the 115th Congress at the end of its two-year term rather than after just seven months, as President Trump has done. "You've heard a lot of comments about the new Congress and suggestions that we haven't done much yet. My counsel to all of you is judge this Congress at the conclusion of the Congress," McConnell told attendees at a Louisville rally with Treasury Secretary Steven Mnuchin. The GOP senator returned home to Kentucky this month for the congressional recess and has had to explain to voters why his party could not repeal Obamacare when Trump had promised action on it by summer. McConnell pointed to the two years it took congressional Democrats to pass the Affordable Care Act in 2010. McConnell was also asked about whether he trusts the media's reports and said he does for the most part, but looks at various outlets' coverage to get an overview of an issue. "What I do every morning — there are a couple of services I look at before I leave home every morning. It gives me a synopsis of the articles and virtually everything. My view is most news is not fake," McConnell said. Trump mocked McConnell earlier this month for failing to reform federal healthcare policy after years of calling for a replacement to Obamacare. "Can you believe that Mitch McConnell, who has screamed Repeal & Replace for 7 years, couldn't get it done. Must Repeal & Replace ObamaCare!" Trump tweeted. McConnell defended Republicans in Congress following the president's message. "Part of the reason I think that the storyline is that we haven't done much is because, in part, the president and others have set these early timelines about things need to be done by a certain point," McConnell told a Rotary Club gathering in Kentucky Monday.
 

Trump administration halt mountaintop removal study. The Interior Department has asked the National Academies of Science, Engineering and Medicine to stop a review of the public health risks Appalachian residents face when they live near mountaintop removal coal-mining sites, the group revealed in a statement Monday. Interior sent a letter to the National Academies on Aug. 18 saying that it is reviewing its grants and agreements that are more than $100,000, because of a changing budget. Trump’s budget proposal for fiscal 2018 would cut $111 million from the Office of Surface Mining Reclamation and Enforcement, reducing its budget to $129 million. Final decisions about federal funding, however, are written by members of Congress, and the House Appropriations Committee voted to provide $213 million to the agency. The National Academies shared news of the study as it was planning to convene for a meeting in West Virginia. It said it was allowed to hold the meeting, which began Monday and ends Wednesday. The influential group, formerly known as the Institute of Medicine, helps guide policy decisionmaking. The Department of the Interior said last year, under former President Barack Obama, that it was providing more than $1 million to study the issue after various reports showed that exposure to mountaintop removal contributed to birth defects, cancer and premature deaths

Obamacare program spends $22 million to enroll small fraction of enrollees: Report. The enrollment assistance program signed up 14,500 people in tax-subsidized coverage, a small fraction of the 11 million people who enrolled in the health plans, according to an investigation by the Washington Free Beacon. The Trump administration announced in July that it did not renew the contracts with groups who helped enroll people in coverage called Cognosante LLC and CSRA Inc., which operated enrollment stations in 19 cities across the country. According to the report, the program spent more than $1,500 a person for helping people with signing up. Democrats sent a letter to the administration last week saying they were concerned about the assistance program being cut off, particularly because the enrollment period was cut in half under the Trump administration, to 45 days. The sign-up period begins in mid-November. The Trump administration pointed to the report from the right-leaning Free Beacon as evidence of problems with Obamacare. The story also noted that enrollment had dropped by 1.9 million by the third month premiums were due, a trend that has occurred in the past. Defenders of the law say that attrition is normal as people change life circumstances, such as getting a job that has coverage, while critics say it's additional evidence of the law's dysfunction and say people were unable to afford their plans. "Obamacare failed to create a thriving, competitive market that offers the kind of coverage people want to buy at prices they can afford," Matt Lloyd, principal deputy assistant secretary for public affairs at the Department of Health and Human Services, said in an email. "On Obamacare's exchanges premiums continue to surge, insurers continue to abandon wide swaths of the country and choices continue to vanish – an unfortunate reality for the American people who are required to buy Washington-approved health insurance or pay a fine."

RUNDOWN

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TUESDAY | Aug. 22

Aug. 21-22. NIH Task Force meeting on Research Related to Pregnant Women and Lactating Women. Details.

Noon HST. Sen. Brian Schatz, D-Hawaii, to hold town hall. Details.

THURSDAY | Aug. 24

9 a.m. Reporter conversation with congressional staff, hosted by the Alliance for Health Policy. Details.


 

Calendar


TUESDAY | Aug. 22

Aug. 21-22. NIH Task Force meeting on Research Related to Pregnant Women and Lactating Women. Details.

Noon HST. Sen. Brian Schatz, D-Hawaii, to hold town hall. Details.

THURSDAY | Aug. 24

9 a.m. Reporter conversation with congressional staff, hosted by the Alliance for Health Policy. Details.