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Republicans shift from repealing Obamacare to rescuing it: With Republicans having failed to repeal Obamacare, at least some of them are now shifting to try to rescue it ahead of the 2018 midterm elections. Senators will begin hearings during the first week in September to confront the problems with rising premiums and insurer exists from the exchanges, with the hopes of coming up with a solution by mid-month. In a Health, Labor, Education and Pensions Committee hearing Tuesday, committee Chairman Lamar Alexander said he has urged Trump to make cost-sharing reductions payments through September as Congress works on its solution. Congress should then work not only to allocate the funds but also to include provisions that provide greater flexibility for states in approving health insurance policies. The hearings will bring in insurers, patients, healthcare providers and governors. "There are a number of issues with the American healthcare system, but if your house is on fire, you want to put out the fire," Alexander said. "The fire, in this case, is the individual health insurance market. Both Republicans and Democrats agree on this."

Obamacare rescue package will have to pass without support from many Republicans. If anything is done on this front, it will most likely pass, as budget compromises have over the past several years -- with support from some Republicans and Democrats and amid major defections from conservatives, who have zero appetite for what they see as a “bailout” of Obamacare absent broader repeal. "I would think if you could do something bipartisan where there is give and take, then there ought to be something given in return in terms of market reforms to lower premiums," said Sen. Ron Johnson, R-Wis. Other Republicans were reticent to make the cost-sharing reduction payments long term without any reforms. "I don't think you can simply just say, well, we will send money into it right now without any reforms included," said Sen. Mike Rounds, R-S.D. "That doesn't fix the situation." Meanwhile, Democrats don’t want a one-year fix. Sen. Chris Murphy, D-Conn., said that if Democrats and Republicans get together to "forge a compromise then let’s do it for more than one year."

States can join Obamacare lawsuit fight.  A federal appeals court ruled that states could join a lawsuit in an effort to keep payments to Obamacare insurers flowing. The order released Tuesday by the District of Columbia Circuit Court of Appeals comes at a pivotal time for the fate of the payments that reimburse Obamacare insurers for reducing out-of-pocket costs for low-income enrollees. President Trump has not made a commitment to the payments for 2018, and some insurers plan to raise rates if they aren't made next year. However, the new ruling could mean that 16 Democratic-leaning states that filed the motion to intervene in the lawsuit could keep the legal fight alive. The appeals court unanimously found that the states would be injured if the payments were eliminated.

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.

Mick Mulvaney: Healthcare failure will 'haunt' GOP. The Office of Management and Budget director warned Wednesday that Republicans will be hurt politically if they fail to get anywhere on their promise to repeal and replace Obamacare, and said the Senate needs to try again as soon as it can. "I don't know how you run saying something for seven years that we'll repeal and replace Obamacare if you give us the House, if you give us the Senate, if you give us the White House," Mulvaney said on Fox News. "And then when the voters give that to you, you don't follow through on that promise … That's the type of mistake that really follows through to haunt you in the future if you don't fix it," he said. "So I do think it's important to continue to work on healthcare."

Trump's disapproval rating spikes after Obamacare failure, palace intrigue. Trump's disapproval numbers spiked in late July, following the failure of the Senate to advance any bill to repeal parts of Obamacare. A July 27-29 survey from Morning Consult/Politico found 53 percent of voters do not approve of Trump and 42 percent approve of him. That ties the high disapproval level Trump saw in mid-May, just after it was reported that Trump encouraged then-FBI Director James Comey to drop the Russia probe. The president's approval rating has continuously dropped this month. Trump started July with a 46 percent approval rating, but shakeups with the White House staff and his concerns with Attorney General Jeff Sessions and Special Counsel Robert Mueller may be affecting public opinion, as just 42 percent approved of him by the end of July.

Democrats make gains. The Morning Consult/Politico survey also found that Democrats are becoming more appealing to voters, with less than 18 months before the midterm elections. It said a generic Democratic candidate was beating a generic Republican candidate by 7 percentage points. Forty-four percent of registered voters picked the Democratic Party's candidate compared to the 37 percent who opted for the GOP option. Another 19 percent of voters said they did not know who they would pick.

Schumer says Trump holding insurer payments hostage. The Senate’s top Democrat said that payments to insurers for lowering out-of-pocket Obamacare costs need to be made to avoid higher premiums. Senate Minority Leader Chuck Schumer said on the Senate floor Wednesday that without the cost-sharing reduction payments, insurers would raise rates in 2018. He listed three states that would raise rates by 20 percent without the payments: Iowa, North Carolina and Pennsylvania. “Every American will see that increase in their monthly bill and know that it is a Trump premium tax,” he said.

Trump’s comments about healthcare in the leaked Wall Street Journal interview. Trump said he had no regrets pursuing repeal and replacement of Obamacare — a Republican-only initiative — before tax reform and infrastructure because he didn't want to "waste" the potential for bipartisanship too early. The interview came before the collapse of Senate Republicans' healthcare reform efforts. "You know, a lot of people said you should have started with taxes, or you should have started with infrastructure," Trump said. "Well, infrastructure I'll actually have bipartisan support, and I can use infrastructure to carry other things along. So, I don't want to waste it at the beginning, if that makes sense."

California Obamacare rate hike could double without CSRs. Insurers that sell coverage on California's exchange will increase premiums by an average of 12.5 percent for 2018, state officials announced Tuesday. That number, however, could almost double if the Trump administration chooses to cut off cost-sharing reduction payments, said Peter Lee, the executive director of Covered California, the name of the state's exchange. Dropping the subsidies would cause premiums to rise by an additional 12.4 percent. Lee said the state needs clear guidance from the administration on CSRs and "a tweet would not be enough."

After reinsurance program, Alaska’s proposed insurance rates drop 22 percent. The state’s only insurer, Premera Blue Cross Blue Shield, filed a proposal for rate decreases for 2018 for its exchange customers. It credited a reinsurance program that was implemented last year and that the Trump administration recently approved a waiver for. The insurer also said people were using fewer medical services. The state has struggled with Obamacare because of its massive land mass and low population, which results in an unbalanced risk pool in the exchanges and high healthcare costs. A national reinsurance program is one idea that may receive bipartisan support in Congress to reel in rate increases proposed in other states.

Sen. Cory Booker introduces bill to legalize marijuana at federal level. The legislation from the New Jersey Democrat would amend the Controlled Substance Act to eliminate marijuana's status as a Schedule 1 drug, which would decriminalize it at the federal level. The former mayor of Newark formally announced the Marijuana Justice Act on Tuesday during a Facebook Live event. The legislation, Booker said, will "go even further in an effort to remedy many of the failures of the War on Drugs." "The effects of the drug war have had a disproportionately devastating impact on Americans of color and the poor," Booker added. "This is the right thing to do for public safety and will help reduce our overflowing prison population." 

Senate votes to boost VA healthcare funding by $2.1 billion. The Senate quickly passed legislation Tuesday night that would boost funding for a key Department of Veterans Affairs healthcare program by $2.1 billion, in a vote that sends the bill to Trump's desk. The legislation is a response to recent warnings from the VA that funding for its Veterans Choice Program would expire soon without an act of Congress. The Choice Program gives veterans the option of seeking care outside the VA system in certain circumstances, such as when the veteran lives too far away from a VA clinic. The program was created in response to the 2014 wait-list scandal at the VA. "It is critical that the Veterans Choice Program has the funding to continue offering timely appointments for veterans in their own communities," said Senate Veterans' Affairs Committee Chairman Johnny Isakson, R-Ga., after the vote.

Longtime director of D.C. VA medical center fired from VA headquarters. The agency said Tuesday that Brian Hawkins "failed to provide effective leadership at the medical center. D.C.'s VA Medical Center had reassigned Hawkins in April to the new position at the VA headquarters after an internal inspection of the Washington, D.C., VA Medical Center found shortages of medical supplies and unsanitary conditions. Congressional leaders and military veterans criticized Hawkins' reassignment to a significant position. In June, NBC4 reported the D.C. VA Medical Center experienced a cockroach infestation in 2015. A report released Tuesday by the U.S. Department of Veterans Affairs Office of Inspector General said Hawkins also shared "sensitive" agency information on a private, unsecure email address with his spouse. Problems at the D.C. VA Medical Center have continued since Hawkins' departure. The House Committee on Veterans Affairs is reviewing how a missing military veteran's body was found after being undiscovered in a parking lot for almost two days.

RUNDOWN

Wall Street Journal Some insurers seeking premium hikes of 30 percent or more

Axios What could be in a bipartisan healthcare deal?

Politico Heller under fire over Obamacare gymnastics

NPR Trump threatens Congress’ healthcare, Senate Republicans don’t seem worried

Kaiser Health News Little-known middleman saves money on medicines, but maybe not for you

Washington Post Can this marriage be saved? Relationship between Trump and GOP hits new skids

MIT Tech Review New medical devices promise to fight pain without opioids

Forbes Humana shifts focus from Obamacare to Medicare and outlook improves

Vox Former healthcare.gov CEO joins insurer betting big on Obamacare



Calendar

WEDNESDAY | AUG. 2 

2 p.m. President Trump to meet with Sen. Rob Portman, R-Ohio, to discuss the opioid crisis and tax reform.

THURSDAY | AUG. 3

Aug 3-5. Walter E. Washington Convention Center. 801 Mount Vernon Place NW. American Psychological Association Annual Convention. Details.

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

FRIDAY | Aug. 4 

8 a.m. Cigna second-quarter earnings call. Details.

10 a.m. 215 Dirksen. Senate Finance Committee considers nomination of Matthew Bassett to be an assistant secretary of Health and Human Services. Details.