Revenge of the mandate? Republicans consider ways to stabilize Obamacare: One thing that many Republicans seem to agree on is that at least in the short run, Obamacare’s exchanges will remain in place. The House bill, as written, would not start phasing out Obamacare’s subsidies for purchasing insurance on exchanges until 2020, and though the Senate bill is still being crafted, it’s unlikely to immediately put an end to Obamacare. As a result, Senate Republicans are discussing ways to prop up Obamacare’s markets in the near term, which isn’t surprising with the 2018 midterm elections coming up. "We are trying to grasp what we can do short term to stabilize these markets," said Sen. Ron Johnson, R-Wis., as he left a closed-door meeting of the healthcare working group with about 17 Republican senators.” He added that, “The clock is ticking.” One source familiar with discussions said that Republican senators have even raised the idea of delaying the repeal of the dreaded individual mandate penalties until after 2020. If they went that route, it would be a stunning development, given that the mandate has been central to opposition to Obamacare, and part of a historic Supreme Court case. Elsewhere, Sen. Bill Cassidy of Louisiana told reporters he was intrigued by a proposal to give cost-sharing reduction subsidies to Obamacare exchange customers in the form of health savings accounts, rather than provide the funds directly to insurers. "In this case, the payment is not to the insurance company, not a bailout of the insurance company per se, but is actually a helping hand to low-income Americans,” he said.

Bipartisan healthcare reform still a unicorn, Senate edition: A nascent effort to reach a bipartisan consensus on healthcare reform struck the harsh wall of reality. Several senators said they weren't interested in anything that has the word "repeal" attached to it on Obamacare. They also balked at planned cuts of $880 billion to Medicaid and repealing most of Obamacare's taxes. The short talks on Monday night comprised of several Republicans and three Democrats up for re-election in states Trump won: Joe Manchin of West Virginia, Heidi Heitkamp of North Dakota and Joe Donnelly of Indiana.  

Healthcare putting budget process on hold: The ongoing healthcare talks in the Senate are creating a roadblock to Republican efforts to pass a budget for fiscal 2018, which starts Oct. 1. Republicans, as most readers know, are using the reconciliation process to allow them to pass a healthcare bill through the Senate with a simple majority. That reconciliation bill is tied to the 2017 budget. Though there’s some debate about this among House members, Republican leaders are worried that if they work to pass a new budget for next year, the Senate parliamentarian will immediately indicate that the previous reconciliation language had expired, forcing Republicans to pass a new healthcare bill that would be subject to a 60-vote majority. Not wanting to risk blowing up the entire healthcare process, House Republicans are staying put for now. However, their patience may not be endless, so that’s putting some pressure on Senate Republicans working to hash out a compromise. In an interview with Bloomberg TV, Senate Majority Leader Mitch McConnell declined to set a timeline for getting a healthcare bill passed but acknowledged that the Senate “can’t take forever.”

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.

Cassidy says his influence on healthcare is being felt: The centrist Republican from Louisiana has grabbed headlines in recent weeks for saying that he supports the “Jimmy Kimmel test” for Obamacare repeal efforts, meaning that he wants a piece of legislation that offers adequate protections for people with pre-existing illnesses. His bill, the Patient Freedom Act, co-sponsored by Sen. Susan Collins, R-Maine, would allow states to keep portions of Obamacare if they choose or allow them look at other ways to structure health plans for residents. He believes that he’s having an impact on the healthcare legislation talks happening in the Senate, particularly a provision that would provide for auto-enrollment. “I can already see the ideas that we’ve had in Cassidy-Collins becoming part of their deliberations … there was a nice conversation the other day about how senior Republican aides say auto-enrollment is the direction we should go in … We think we’re changing the conversation on specific features.”

The Louisiana Republican rejects idea of opt-in for Obamacare regulations: Conservative Sen. Mike Lee, R-Utah, has proposed a plan that would more aggressively go after Obamacare’s insurance regulations -- a key feature being that states that wanted to keep the regulations would be required to actively opt-in to them. That is a major departure from the House-passed bill, which would maintain Obamacare’s regulatory architecture as the national default and require states to apply to waive them. "That would clearly violate President Trump’s pledge," Cassidy said in a meeting with reporters, answering a question about the Lee proposal. "So if you decide that President Trump's pledge, his contract with the voter, is not important, then do what you want. But if you think Trump's pledge, to those Trump voters [matters] … then you have to worry about it."

Hoeven pitches Medicaid reinvestment proposal: "One of the things I'm still talking about and pitching our caucus is that if a state takes the block grant, in a year that they come in under their allotment they can actually get some savings or credit toward a year where they might exceed their allotment," Sen. John Hoeven, R-N.D., said in an interview with the Washington Examiner after a working group meeting and lunch with fellow Republicans. "That still gives them an incentive to save and innovate, but then they don't have to worry about getting capped out ... if they have a bad year because they actually can generate some savings to compensate for that." 

Congress wants drug policy funding restored: A group of more than 70 House members from both sides of the aisle are fuming over the Trump administration’s plan to cut a drug control office. The group sent a letter to the Office of Management and Budget Wednesday urging for funding to be restored to the Office of National Drug Control Policy, which houses the U.S. drug czar. The Trump administration had planned to cut its entire budget of more than $300 million in fiscal 2018. The budget office said in a leaked proposal that the office’s job is duplicative and redundant, but the lawmakers disagreed. “The office and the programs it supports are uniquely positioned to address the causes and effects of the current opioid crisis with proven strategies and broad reach,” according to the letter spearheaded by Reps. Elijah Cummings, D-Md., and Bill Johnson, R-Ohio. On the Senate side, Sen. Maggie Hassan, D-N.H., introduced a bill to reauthorize the office for five years. 

Problems with waivers: Republicans selling the American Health Care Act said that the waiver to let states opt out of a mandate that prevents insurers from charging sicker people more wouldn’t affect that many people with pre-existing conditions. The main reason is that insurers would be able to charge higher prices for people with pre-existing conditions only if they have a lapse in coverage of more than 63 days. But an analysis released Wednesday from the nonpartisan Kaiser Family Foundation discovered that about 6.3 million people with pre-existing conditions had a gap of several months of insurance in 2015 on the individual market, which is for people that don’t get insurance through work. Those 6.3 million people could face higher premiums under the AHCA because they had a lapse in coverage. However, the analysis, which relies on data from a National Health Interview Survey taken in 2015, comes with several caveats. For one, we don’t know how many states are going to get a waiver. Another is that the penalty for not keeping coverage could act as an incentive for people to do everything they can to not lose it, Kaiser said. 

Council for Affordable Health Coverage releases new report on lowering drug costs: The council, which is supported by pharmacy benefit manager Express Scripts and biotech industry group BIO, released a new set of recommendations for reducing drug costs. The report, which can be read in full here, calls for bringing more generics to market and new ways for rewarding value, among other ideas.  


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House Energy and Commerce Committee meeting about “Examining Initiatives to Advance Public Health.” Meeting began at 10:15 a.m. Details and Playback.

Noon. Senate Republican luncheon on healthcare.

Noon. 201 AB U.S. Capitol Visitors Center. Congressional Men’s Health Caucus to hold briefing on prostate cancer screening guidelines.

2 p.m. Senate Swamp. U.S. Capitol. Senate Democrats to discuss Medicaid cuts under Republican efforts to repeal and replace Obamacare and “the effect of these cuts on children and schools.” Livestream.

2 p.m. House Triangle, U.S. Capitol. Press conference with Rep. Tom Garrett, R-Va., on the Ending Federal Marijuana Prohibition Act of 2017, which would remove marijuana and tetrahydrocannabinols from the federal schedule of controlled substances, leaving regulation up to the states.


8 a.m. Ronald Reagan Building and International Trade Center. 1300 Pennsylvania Ave. NW. Meeting on how how the SMART Student Health and Wellness model can transform healthcare for public school students and impact their education, careers and communities. Includes Democratic Reps. Jan Schakowky of Illinois and Terri Sewell of Alabama.

Noon. Senate Republican luncheon on healthcare.

2 p.m. 1100 Longworth. House Ways and Means Committee hearing on the “Current status of the Medicare Program, Payment Systems and Extenders.” Details.


9:30 a.m. Rayburn 2123. House Energy and Commerce Committee hearing on Drinking Water System Improvement Act and Related Issues of Funding Management and Compliance Assistance under the Safe Drinking Water Act. Details.


CBO report on the American Health Care Act expected this week.

Trump administration must provide the D.C. Circuit Court of Appeals an update in the case House v. Price on cost-sharing reduction subsidies.

May 22 to 24. Atlanta Marriott Marquis, Georgia. 2017 Spring Hospital & Healthcare I.T. Conference. Details.


10 a.m. Bipartisan Policy Center. 1225 Eye Street NW, Suite 1000. Roundtable on “Patient Safety and Information Technology,” including Former Senate Majority Leader William Frist, former Rep. Bart Gordon from Tennessee; former Health IT National Coordinator Karen DeSalvo and former FDA commissioner Andrew von Eschenbach.


11 a.m. Kaiser Permanente Center for Total Health. 700 2nd St NE. Council of Accountable Physician Practices and the American Cancer Society to hold a press briefing on the “The State of Cancer Care Today.” Will include experts from the Biden Foundation and the CDC. Details.

1: 30 p.m. Alliance for Health Reform webinar on “Where Medicaid Stands: From the AHCA to State Waivers.” Details.