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Toomey and Portman tasked with hashing out Senate Medicaid compromise: When senators met Tuesday for formal healthcare discussions, there was general agreement on giving states more flexibility over Medicaid (which Sen. Ted Cruz is working on), according to an aide familiar with discussions, but the main disagreement remains over how quickly Medicaid spending should be allowed to grow. Senate Majority Leader Mitch McConnell led the conversation, with Sen. Rob Portman, representing Republicans who are more supportive of Obamacare's Medicaid expansion, and Sen. Pat Toomey representing conservatives pushing harder for repeal. Specifically, Portman wants to see the federal Medicaid match grow at the rate of medical inflation plus 2 percentage points, but Toomey is pushing for growth that would be slower – either the standard rate of inflation for all urban consumers, or by calculating a measure of historical Medicaid growth rates. McConnell ended the meeting by asking Portman and Toomey to work together to come up with a compromise. For context, on the House side, the compromise ended up creating two growth rates – with the program growing at the standard medical inflation rate for the broader Medicaid population, but at a faster medical inflation plus 1 percentage point for the elderly and disabled. Sens. Shelley Moore Capito and Ron Johnson participated in Tuesday's discussions. The Senate group will meet next on Thursday to tackle Obamacare's regulations, which is likely to be one of the major sticking points as Senate negotiations continue.

Prediction: The "Cadillac Tax" will make a comeback: If Republicans are going to attract the more liberal and centrist senators in their caucus, they're likely going to have to find a way to come up with more money to feed into Medicaid and to finance more generous subsidies. One of the easiest things they can do is have Obamacare's tax on expensive employer plans go into effect sooner than it would under the House GOP plan. The tax is loved by economists who believe it can help control costs by discouraging overly generous plans that drive up unnecessary spending on healthcare services, but it's politically unpopular – deferred during the original Obamacare negotiations until 2018, then to 2020 by subsequent congressional deal making. On paper, the House bill would push back its effective date to 2026. Senate Republicans could raise roughly $50 billion relative to the House bill by simply moving up the effective date of the tax until 2022. Among all of Obamacare's taxes, this is the one to which conservatives have the least ideological objection. Though designed differently, previous Republican healthcare proposals have capped the employer tax exclusion or scrapped it altogether in favor of an individual standard deduction. Because the tax is politically unpopular, nobody in Washington thinks it will ever go into effect anyway – so if Republicans can make their lives easier with the CBO by shifting around the effective date of the tax, I expect that they would go ahead with it.

CBO eyes week of May 22 for updated healthcare score: As they carry out negotiations, Republican Senators are eager to know how the CBO will evaluate the final House-passed healthcare bill, but the Congressional beancounting group has said it wouldn't come until "early" in the week of May 22. The Senate is expected to be out the following week for Memorial Day week recess. What makes scoring the House bill particularly tricky for CBO analysts is that the legislation gives states the option of waiving certain Obamacare regulations, so the CBO is going to have to do some guess work as to which states may pursue a waiver based on assumptions about the political dynamics in each state.

Welcome to the inaugural edition of 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.

The group dynamics of the healthcare working team: Generally speaking, the group tasked with coming up with a compromise can be divided into three subgroups: The first, pushing for full repeal, includes Cruz and Sen. Mike Lee as the staunchest members, but also has allies in Toomey, who is taking a leading role in the Medicaid discussions, and Sen. Tom Cotton. The second group includes Portman and Sen. Cory Gardner, who are more reluctant to aggressively do away with Obamacare. The rest of the senators can be generally described as "pro consensus" – that is, they would be inclined to support a compromise reached by the first two groups. This group includes McConnell himself, Senate Majority Whip John Cornyn, Conference Chairman John Thune, Policy Committee Chairman John Barrasso, Finance Committee Chairman Orrin Hatch of Utah, HELP Chairman Lamar Alexander of Tennessee, and Budget Committee Chairman Mike Enzi of Wyoming.

Senate women are missing from Democratic working groups, too: "Senate Republicans are fielding criticism for establishing what is so far an all-male working group to write a proposal to repeal and replace Obamacare.... But Senate Democrats have often left women out of their own back-room negotiations as they drafted major legislation, including Obamacare."

Cassidy: Medicaid expansion may not go away: Sen. Bill Cassidy, R-La., told reporters on Wednesday that if President Trump will keep his promise to the American people, there will be "some sort of Medicaid expansion."

Someone please ask anything else: Sen. Susan Collins, R-Maine, was navigating through the Senate basement in a massive scrum of reporters Tuesday peppering her with questions about President Trump's firing of FBI Director James Comey. As she got to the subway car to head to the Dirksen Senate Office Building, one reporter asked a quick question about whether the Comey matter will impede the Senate's work on healthcare. "Healthcare, there's an issue I want to talk about," Collins said as the subway doors closed.

Dave Brat faces voter anger at town hall over healthcare vote: "Only five days after his vote in support of the American Health Care Act, Rep. Dave Brat of Virginia became the latest Republican to return home and square off with hoards of angry voters at a town hall Tuesday evening. The public forum featured contentious exchanges, attendees nearly being thrown out for repeated disruptions and non-stop discussion of the bill and how it deals with pre-existing conditions."

Obamacare repeal and replace vote drops Trump's approval further: That's according to a survey published Wednesday by Morning Consult/Politico. Forty-eight percent of voters said they disapproved of his job performance in the days after House Republicans passed a repeal and replace bill, while 44 percent said they approved. The results represent a 7-point swing from another poll that was conducted shortly after Republicans pulled the original bill from the House floor. The survey also found that Obamacare is becoming more popular as it faces repeal. Half of voters strongly or somewhat approve of Obamacare, while 42 percent disapprove of it. The American Health Care Act, the Republican bill, received a 38 percent approval rating, while 44 percent of participants in the poll said they disapproved of it.

Overshadowed by news about the firing of FBI Director James Comey was: the confirmation of Scott Gottlieb, who will oversee the Food and Drug Administration. Gottlieb was confirmed 57-42.

BlueCross Tennessee to expand in Obamacare markets: BlueCross of Tennessee said it will offer Obamacare plans in Knoxville next year after the city was going to be without any Obamacare insurer. The insurer's decision comes as the stability of the individual market is being thrown into doubt after insurers in three states said they want to raise prices by double digits next year.

Pharma's main lobbying group to kick out members that skimp on research: Pharma's biggest lobbying group is trying to rehabilitate its image by excluding drugmakers that spend too little on researching new products.The Pharmaceutical Research and Manufacturers of America, or PhRMA, created new membership rules that emphasize spending on research and development.

What HHS Secretary Tom Price has been up to: A listening tour on opioids. He was in West Virginia and Michigan on Tuesday, and was joined by Kellyanne Conway, counselor to the president. Today he will be in New Hampshire and Maine.

Chris Collins, self-proclaimed millionaire-maker, wades into another drug lobby fight: Tim Carney looks at the New York Republican congressman's ties to the health sector as a Medicaid prescription drug fight looms.


Boston Globe West Virginia journalist arrested for shouting questions at HHS Secretary Tom Price and Kellyanne Conway

JAMA Safety problems common for new novel drugs even after approval

Politico GOP pins healthcare hopes on unlikely figure: Ted Cruz

The Hill Ads launched thanking GOP lawmakers for passing health bill

Axios Blue Cross and Lyft partner to offer free rides to doctors' appointments

STAT Does the White House need its own drug policy office? A former insider says yes

LA Times GOP senators can cut Obamacare taxes or preserve coverage for millions, but probably not both

Fox News New Jersey's new opioid law raises concerns among some doctors

Roll Call Some Democrats "adopt a district" to talk about healthcare




Health Summit on Aging Americans. New York. Agenda.

TBD. G-50 Dirksen. Senate HELP Committee hearing on Food and Drug Administration Reauthorization Act and Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act. Began 10 a.m.

12:30 p.m. Rayburn 2456. American Association for the Advancement of Science Capitol Hill briefing on the opioid epidemic, with Dr. Nora Volkow, director of the National Institute on Drug Abuse.

2:30 p.m. SR-418 Russell. Veteran's Affairs Committee hearing to examine the Veterans Choice Program and the future of care in the community.

2:30 p.m. SD-562 Dirksen. Aging Committee hearing on aging with community, focus on building connections that last a lifetime.


10:30 a.m. Stanford University. Office of Management and Budget Director Mick Mulvaney will speak on a panel called, "What Happens Now? The Future of Healthcare Delivery." Facebook Livestream.

7:10 p.m. Stanford University. Centers for Medicare and Medicaid Services administrator Seema Verma to speak on "Radical Change or Gradual Evolution – What will the Health Care System Be Like in Five Years?" Facebook Livestream.


Monday to Thursday. Sheraton Pentagon City. "Developing Solutions for the Next Generation of Veteran Care." Details.

9 a.m. Sheraton Pentagon City. VA Interim Deputy Secretary Scott Blackburn to deliver keynote on "The Future of Healthcare Delivery to Our Nation's Veterans." Details.

9:30 a.m. Sheraton Pentagon City. A Principal Deputy Under Secretary for Benefits Thomas Murphy Performing to deliver keynote on" Benefit Delivery: Providing for Those Who Gave the Most." Details.

10 a.m. Sheraton Pentagon City. Karen Ott, VA Director for Policy, Education and Legislation in the VA's Office of Nursing Services to appear on panel discussion about addressing the nursing shortage. Details.

1:30 p.m. Sheraton Pentagon City. Tara Galovski, VA director of Women's Health Sciences Division, to discuss "Identifying and Mitigating the Potential Toll Combat Deployments can have on Women's Health Functioning and Well-Being." Details.


House returns from recess. Schedule.

9 a.m. Sheraton Pentagon City. Curtis Coy, VA Deputy Under Secretary for Economic Opportunity, to deliver keynote on "Providing for the Economic Well Being of the Veterans." Details.

9:30 a.m. Sheraton Pentagon City. Dr. Thomas Lynch, VA Assistant Deputy USH for Clinical Operations and Management, to speak on "Managing the Continued Improvement of Clinical Care in Today's Veteran Population." Details.

1 p.m. Sheraton Pentagon City. Scott Blackburn, VA Interim Deputy Secretary, to speak on "Update on MyVA and How It Is Affecting Veterans Benefit Delivery." Details.

1 p.m. Sheraton Pentagon City. Tiffany Love, VA Deputy Associate Director of Patient Care Services, to speak on "Social Media and Its Evolving Impact on Veterans." Details.

1:30 p.m. Sheraton Pentagon City. Joseph Ronzio, VA Deputy Chief Health Technology Officer, to speak on "Incorporating Wearable and Implantable Technology into the Next Generation of Healthcare Delivery." Details.