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Tom Price’s scandal roils phase two of Republican plans to repeal and replace Obamacare. Earlier this year, Republicans were touting a three phase approach to repealing and replacing Obamacare. Phase one was the passage of a healthcare bill by a simple majority through reconciliation. Phase two was a series of administrative actions by the secretary of HHS to provide relief from the law and take actions that would lower premiums and increase choices. Phase three would be additional legislative changes, which cannot pass through reconciliation, to be negotiated with Democrats. With the demise of Graham-Cassidy, Republicans missed their last, best hope to overhaul Obamacare. The idea that Democrats would agree to significant changes to the law is as laughable as ever. And now, the brewing scandal over HHS Secretary Tom Price’s use of taxpayer-funded charter jets for travel is complicating phase two, as he was supposed to be the point person for administrative changes. Were he to be forced out, Trump would have a heck of a time confirming a replacement and getting that replacement up and running.   

Trump ‘not happy’ with reports of Price’s jet use. Trump said Wednesday that he is not happy about Price’s use of the jets and hinted that he might consider firing him. "We'll see," he said when asked whether he might consider firing Price. When asked about the trips, Trump replied, "I'm looking into it. I'm not happy about it." The White House is looking into news that Price took private jets to fulfill his job obligations rather than take lower-cost commercial planes. He was found to have combined some his official trips with personal business, according to Politico.

Price insists he still has Trump’s confidence. "I think we've still got the confidence of the president," Price said when asked about Trump’s comments. Price added his agency was committed to carrying out public health priorities, such as raising awareness about flu season. Price made the comments following a speech he gave at the National Press Club, where he participated in an annual event kicking off the flu season with the National Foundation for Infectious Diseases. He spoke at the event for less than 10 minutes and left immediately after receiving his flu vaccine.

Senate Democrats demand answers on Price jet travel. Democrats on the Senate Health, Education, Labor and Pensions Committee are demanding information from Price about his use of private planes for official government travel. "This decision is particularly shocking as you serve in an administration that routinely calls for draconian spending cuts and a reduction in government waste, and you yourself have repeatedly advocated for fiscal restraint," Democrats on the HELP Committee wrote in a letter to Price. "It is therefore especially difficult to understand the use of taxpayer funds for your luxury travel." They asked Price to turn over documents related to each flight for which he used a private jet, and detail how much each flight cost. The committee members also requested all communications with the White House regarding Price's travel, since White House press secretary Sarah Sanders told reporters the secretary's travel "wasn't approved" by the White House.

Trump to move ahead with executive order aimed at interstate purchasing, but it has limited purpose in Obamacare world. Regardless of what happens with Price down the road, Trump is still expected to release an executive order aimed at allowing insurers to sell insurance across state lines, possibly through association health plans (i.e., individuals who work in a given profession and who band together to form a larger group). It’s important to remember, however, that whatever the merits of allowing interstate purchase of insurance, it isn’t likely to make much of a difference within the context of Obamacare. Remember, the idea for allowing interstate purchase of insurance originated in the pre-Obamacare days. Back then, states had thousands of regulatory mandates, and premiums varied widely from state to state. Insurance was much more expensive, for instance, in the highly regulated New York than in the neighboring Pennsylvania. In such an environment, the case for interstate purchase was that it would provide more choices and cheaper insurance options, especially to younger and healthier individuals who would be fine with policies offering fewer benefits if it meant premiums were much lower. Democrats typically charged that such a policy would create a “race to the bottom” where insurers would issue all their policies in the lowest regulation state, thus undermining any state-level regulations. But with Obamacare, regulations are imposed at the federal level. Regardless of state, insurers have to offer coverage to everybody with pre-existing conditions, charge the same regardless of health status, offer a specified set of benefits, and so forth. So the variation of premiums and choices from state to state is much narrower. Even if interstate purchasing were allowed, a person would not be able to escape New York’s regulations by purchasing a plan originating out of Pennsylvania, because both states live under Obamacare.  

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Alexander resumes bipartisan Obamacare talks with Murray. Sen. Lamar Alexander, chairman of the HELP Committee, told reporters Thursday that he and Sen. Patty Murray, the committee’s top-ranking Democrat, are resuming talks on an Obamacare stabilization bill Thursday evening. Previously the committee held discussions over how much flexibility to allow states and to what extent Congress should appropriate cost-sharing reduction subsidies. If the senators are able to come to an agreement, they would need the support of 60 senators and the House, as well as President Trump. It’s not clear what the appetite will be for passing such a bill. Conservatives have labeled the potential deal a “bailout” for Obamacare, and Democrats have suggested that they are unwilling to appropriate CSRs if it signals that they are admitting that the funds were illegally authorized by former President Barack Obama. Senate Minority Leader Chuck Schumer said Thursday on the Senate floor that the duo was “on the verge” of a healthcare agreement.

Trump preparing executive order on selling across state lines. Trump is preparing an executive order to allow people to buy health insurance across state lines, a reform conservatives have long championed as a way to bring costs down and stir greater competition in the national marketplace. The executive action gives the White House a chance to follow through on at least one promise related to healthcare reform after Senate Republicans' attempt to overhaul Obamacare failed this week. Kentucky Sen. Rand Paul first mentioned the action during a TV appearance Wednesday morning, saying Trump was considering taking matters into his own hands. "I think there's going to be big news from the White House in the next week or two, something they can do on their own," Paul told MSNBC, adding that Trump "can legalize on his own the ability of individuals to join a group or a health association across state lines and buy insurance." A Senate GOP source told the Washington Examiner the executive action is considered "a done deal" and likely to be announced "in the next few weeks." Obamacare already lets insurers sell plans across state lines, but only if the plans meet the insurance requirements of the state they are being sold in.

Trump blames Republicans who ‘grandstand’ for blocking Obamacare overhaul. Trump bemoaned lawmakers who "want to grandstand" as spoilers to the Republican effort to overhaul Obamacare. Trump said that Republicans have the votes but can’t vote this week because Sen. Thad Cochran, R-Miss., was getting treatment for urological issues. Trump also lashed out at Republicans who were opposed to the effort. “You know, when you have 52 votes and you need 51, it's you know, it's very hard to get, because you always have somebody — and in some cases, they want to grandstand. A lot of bad things happen," he said. Trump didn’t mention any names about who was doing the grandstanding, but three Republicans said they would not vote for the overhaul bill: Sens. Rand Paul of Kentucky, Susan Collins of Maine and John McCain of Arizona.

Lindsey Graham heads to the White House. The South Carolina Republican said he plans to meet with Trump at the White House Thursday to discuss healthcare, just two days after the Senate halted a bill co-sponsored by Graham to overhaul Obamacare. Graham told McClatchy he is meeting with Trump "to plot a strategy to move forward."

Trump still has confidence in McConnell. Trump said Thursday he still has confidence in Senate Majority Leader Mitch McConnell despite the most recent failure of Republicans' attempts to overhaul Obamacare. "I do," Trump said on Fox News when asked if he still has confidence in the Kentucky Repuboican. "I think he has to get rid of the filibuster rule. It's a disaster for the Republican Party because it means you need 60 votes on most pieces of legislation, and you're not going to get it." Despite the most recent failure of the Senate's healthcare bill, Trump said Republicans will try again to overhaul Obamacare next year, but in the meantime, the president said he plans to begin talking with Democrats to work on a bipartisan proposal. "I'm going to start negotiating with Democrats, and we'll see what happens," Trump said in an interview before his speech in Indiana. "If we can do a really great healthcare bill, bipartisan, I'm OK with that. … I'll negotiate with the Democrats. If we can come up with a fantastic healthcare bill, that's OK for me. Good for both parties. Bipartisan."

The mystery hospitalized Republican senator. Trump on Wednesday repeatedly tried to spin the healthcare defeat by saying that a vote couldn’t happen by Friday, the deadline when the authority to pass a health bill with only 51 votes expires, because of a Republican senator who is in the hospital. But no senator is in the hospital. Sen. Thad Cochran, R-Miss., is home being treated for a urological issue, but his office has repeatedly said he is not hospitalized.

Schumer predicts GOP tax effort will fail like healthcare. Schumer predicted Wednesday that the Republican effort to pass a major tax package would fail, and he previewed a line of attack centered around the claim that the bill would raise taxes for low-income earners. "The Republicans are going to have the same problem with tax reform that they had with healthcare," he said, referring to the failed GOP effort to replace Obamacare. "The public will be equally strong against this plan that is so perverse in helping the wealthy and hurting the middle class, and it will fail," Schumer said. The Trump administration and Republican leaders published the plan Wednesday. Schumer said 30 to 50 Republican lawmakers would rebel against the tax plan, on the grounds that it would raise their constituents' taxes.

Ryan: House is on track, but bills are tied up in Senate. House Speaker Paul Ryan, R-Wis., said the House has passed many bills, but the legislation is getting tied up in the Senate. "We've done all these things. We passed 337 bills in the House as of this week," Ryan said in an interview with Fox News host Sean Hannity Wednesday. "The challenge we have is, is this chart," Ryan added, while showing a chart. "Two hundred and seventy four of them are still being – are still in the Senate. So we haven't gotten them over the finish line in the Senate. Now, is that frustrating for the House? You bet it's frustrating for the House." Ryan did acknowledge the Senate has certain procedures, such as the filibuster, that the House does not encounter.

Congress won’t renew kids’ insurance program on time. Congress is expected to miss a deadline to renew the Children’s Health Insurance Program by the end of the week. However, the funding for the program won’t run out for a couple more months for some states. Three states and the District of Columbia are expected to run out of funds in December, according to the Medicaid and CHIP Payment and Access Commission, a congressional advisory body. Most states are expected to run out of CHIP funds by March. Rep. Michael Burgess, R-Texas, who chairs the House Energy and Commerce Committee’s health subcommittee said he expects the House to pass the bill by early October.

Cummings calls out Trump on drug prices. Rep. Elijah Cummings, D-Md., was pretty perturbed that President Trump hasn’t done anything to lower drug prices, even after promising to do so after a meeting earlier this year. He tweeted that the government holds the patent for the multiple sclerosis drug Zinbryta and licenses it to the company Biogen. Cummings was upset Biogen is charging $87,000 per year for the drug. “Why are American families being forced to pay more for a drug that we own?” he tweeted. Cummings added that the drug costs three to four times more in the U.S. than in other countries, a common occurrence. Congress has taken action to fight higher drugs through improving the Food and Drug Administration’s review process for brand name and generic drugs. However, Democratic reforms championed by Cummings and Sen. Bernie Sanders, I-Vt., such as letting Americans buy cheaper drugs from Canada and giving Medicare the power to negotiate to lower drug prices have gone nowhere.

RUNDOWN

Axios Price on thin ice

Wall Street Journal GOP senator is examining whether some states got undue Medicaid funds

Bloomberg Legal weed may be a windfall for McDonald’s and Taco Bell

New York Times Flesh-eating bacteria from Harvey’s floodwaters kills a woman

Roll Call 7 years of Republican efforts to repeal and replace Obamacare

Politico Dems see 2018 gains in repeated Obamacare repeal tries

STAT News A patient’s guide to enrolling in Obamacare in the age of Trump



Calendar

THURSDAY | Sept. 28

Sept. 24-28. AHIP’s conference on Medicare, Medicaid and duals. Includes keynote by CMS Administrator Seema Verma. Details.

Sept. 26-28. The Atlantic Washington Ideas Forum. Includes speakers Mark Bertolini, chairman and CEO of Aetna, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Details.

10 a.m. National Press Club. 529 14th St NW. Health and Human Services Secretary Tom Price to discuss flu prevention. Details.

FRIDAY | Sept. 29

9 a.m. 1789 Massachusetts Ave. NW. AEI event on “Unbundling and rebundling health benefits: Innovative rethinking of healthcare delivery and competition.” Details.

12:30 p.m. National Press Club. 529 14th St NW. Luncheon with Dr. Scott Gottlieb, FDA commissioner. Details.

SATURDAY | Sept. 30

Reconciliation and CHIP reauthorization deadlines. End of federal fiscal year.

MONDAY | Oct. 2

Oct. 2-6. National Health IT Week. Details.

Oct. 2-3. Hyatt Regency Capitol Hill, 400 New Jersey Ave NW. Behavioral Heal Hill Days. Details.

8:30 a.m. National Press Club. 529 14th St NW. Poynter event on “Covering Healthcare Policy Changes.” Details.

TUESDAY | Oct. 3

House to vote on 20-week abortion ban, Pain Capable Unborn Child Protection Act.

WEDNESDAY | Oct. 4

8 a.m. Westin New York. S&P Global Ratings’ Health Care Conference. Agenda.

THURSDAY | Oct. 5

10 a.m. 430 Dirksen. Health, Education, Labor and Pensions Committee hearing on the “Federal Response to the Opioid Crisis.” Details.