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Majority Leader Mitch McConnell unveils new healthcare bill: Senate Republicans are meeting as we write to discuss the latest version of the their healthcare bill, which will be the first indication of whether the revisions have gained any votes.
Here’s what you need to know about the changes:
* Revised Cruz amendment: The bill does not include an amendment from Sens. Ted Cruz, R-Texas, and Mike Lee, R-Utah, as originally written, but it includes a provision that’s based on the idea. Under the original proposal, an insurer that offered a plan that met all of Obamacare’s requirements in a state could then offer any additional plans free of the regulations. A new version would set up a fund to help cover those with higher medical costs, but to access the money, an insurer would have to offer at least one compliant plan. At that point, the insurer can offer plans that get around nine of the insurance requirements. The idea is to provide more choices of lower premium plans to healthier individuals with low medical costs who have seen their premiums soar under Obamacare. The waivable requirements include: the requirement to offer all plans to those with pre-existing conditions, the requirement that all plans meet a certain actuarial value, the community rating requirement preventing insurers from pricing plans based on health status, and the mandate that all plans cover a certain set of essential health benefits. Full list here. It’s important to keep in mind that the bill would not waive the requirement that all states have a single risk pool, which means both the compliant plans offered on the Obamacare exchange and the exempted plans being offered off the exchange would be in the same risk pool. Expect the effects of that distinction to be hotly debated among wonks today.
*More spending: The bill includes an additional $70 billion in funding to states to help them bring down premiums and $45 billion more to fight opioid abuse.
* More taxes: The bill keeps Obamacare’s tax on investment and Medicare surtax. The taxes combine for about $231 billion, according to an earlier estimate by the Congressional Budget Office. It also keeps a smaller tax on insurance executive compensation. In addition to raising more money, keeping the taxes is an effort to blunt Democratic attacks that the bill is a major tax cut for the wealthy.
*Keeps changes to Medicaid: The Medicaid changes that were the cause of much consternation among centrists have largely been left intact. But the bill would allow Disproportionate Share Hospital payments to fund hospitals for uncompensated care, but changes the calculation from per Medicaid enrollee to per uninsured.
* HSAs: Allows individuals to use health savings accounts toward the payment of premiums.
* Catastrophic coverage: Allows individuals to use federal subsidies toward the purchase of high-deductible plans that are intended to cover major medical events.
Read more: You can read Kimberly Leonard’s in-depth story on the bill here. A full version of the bill here. And section by section summaries here and here.
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Paul opposes new bill: Sen. Rand Paul, R-Ky., remains steadfastly opposed to the new bill. “I can’t object more strongly than I am against this bill,” he said on the Laura Ingraham show Thursday. “A vote for this is a breaking of a promise we made to voters.” Paul said repeatedly that the bill doesn’t repeal Obamacare and breaks promises Republicans made to voters.
Two Republicans announce their own bill. The plan from Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana would send revenue from Obamacare’s taxes for states to use to craft their own health plans. The alternative approach, first reported by CNN, would keep a lot of Obamacare’s taxes but send that revenue to the states. The taxes that would be repealed are for medical device makers and the individual and employer mandates. It is not clear if there is much appetite for the proposal, which Graham has said he hopes will win bipartisan support.
Democrats demand more money: Senate Democrats, who are talking with some GOP senators on a bipartisan healthcare bill, say their main demand is a new reinsurance program to prop up Obamacare’s exchanges. “I talked to a lot of them,” said Sen. Tom Carper, D-Del., declining to name specific lawmakers. “Some of them are the usual suspects and not the usual suspects.” A reinsurance program is a top priority for Democrats in both chambers. A group of 10 House Democrats outlined a proposal that would devote $15 billion a year to a reinsurance program, which helps cover the highest medical claims on the exchanges. “We gotta focus on reinsurance, stabilize the private market and take steps to clamp down on prescription drugs,” said Sen. Ron Wyden, D-Ore., earlier this week. McConnell made waves when he recently said that if the Republican health bill fails in the Senate, he would reach out to Democrats on a bipartisan solution to stabilize the individual insurance market. But more federal spending for reinsurance is a nonstarter for hardline conservatives. “A bailout of insurance companies while failing to repeal Obamacare would be a serious abdication of the responsibility that we have and the mandate from this election,” Cruz said Wednesday.
Republicans get key win on Senate rules for health bill. The Senate parliamentarian ruled Wednesday in Republicans’ favor in a dispute with Democrats over part of the original version of the healthcare bill, according to a Senate leadership aide. The challenge from Democrats focused on the repeal of cost-sharing payments to insurers to reduce co-pays and deductibles for low-income Obamacare customers. Democrats said the cost-sharing payments fell under the Senate Finance Committee’s jurisdiction, and Republicans argued they belonged under the Health, Education, Labor and Pensions Committee. The parliamentarian ruled that the cost-sharing payments fall under HELP, meaning that the bill meets the deficit reduction targets laid out in reconciliation instructions passed earlier this year.
President Trump: ‘I think it would be very bad’ if GOP doesn’t pass a healthcare bill. Trump said he’s waiting for the Senate to send a bill to the White House and warned he would be “very angry” if Republicans failed in their efforts to repeal and replace Obamacare. “I think it would be very bad,” Trump said when asked what would happen if Republicans failed. “I will be very angry about it and a lot of people will be very upset. But I’m sitting waiting for that bill to come to my desk. I hope that they do it. They’ve been promising it for years. They’ve been promising it ever since Obamacare, which is failed. It’s a failed experiment.”
Trump’s Council of Economic Advisers slams CBO findings on Medicaid. The council is pushing back on an analysis from the Congressional Budget Office that projected the first version of the GOP’s healthcare plan would cause 12 million fewer people to be enrolled in government-sponsored Medicaid. The council said the CBO’s estimates, which look ahead to 2026, should be discounted “because of the large errors made by the agency in estimating the toll” of Obamacare. The Trump administration has used the argument before, as CBO overestimated the number of people who would sign up for private coverage under the Obamacare exchanges. The council made its own projections about what would happen to Medicaid enrollment, saying that 4 million people would leave the program in 2018 and 7 million people would leave by 2026. “This estimate is likely substantially inflated since Medicaid enrollees currently pay little to no out-of-pocket costs and most are not subject to the individual mandate penalty,” the council concluded.
Meanwhile, the legislation to renew the user fee program for the Food and Drug Administration is gathering steam:
*House advances Food and Drug Administration funding bill. Lawmakers passed a bill that would let the FDA continue to collect user fees from drug and device makers, with the agency using that revenue to speed up approval of new products. The user fee bill included several provisions aimed at speeding up approval of new drugs or devices.
*But the user fee faces hurdles. While the bill got through the House pretty quickly, it is expected to have a rockier road in the Senate. Sen. Ron Johnson, R-Wis., plans to throw up procedural roadblocks to the bill if it doesn’t include his right-to-try bill, according to Politico.
The Senate is already under a tight timeframe. The FDA has said it could send out layoff notices as early as this month if a user fee package isn’t approved. The user fee program is scheduled to expire baty the end of September. Sen. Lamar Alexander, R-Tenn., chairman of the Senate HELP Committee, said he wants the bill to pass “as soon as possible.”
*The White House isn’t backing down. The White House has been adamant about 100 percent of the FDA’s federal funding coming from user fees, but the agreements for user fee funding have been negotiated for more than a year. The White House is again hoping to get more user fee money out of the deal, sending out a statement Wednesday that it wants “100 percent user fee funding within the reauthorized programs.” It isn’t clear at this late stage if renegotiating with the drug industry is feasible.
*Lots for drug industry to like in user fee bill: The House version has several provisions sure to please the pharmaceutical industry. Chief among the changes are speeding up approval of generic drugs. The bill includes a provision that forces the FDA to act within eight months on a priority generic drug application. Another big change is expanding clinical trials so that more people who could benefit from the drug would get access to it. Big Pharma also dodged more stringent amendments sought by Democrats, but were scuttled to advance the measure quickly in the House.
‘Largest healthcare fraud takedown operation’ in U.S. history. That’s what Attorney General Jeff Sessions called his announcement that the Justice Department charged 412 people, including 56 doctors, for defrauding taxpayers of roughly $1.3 billion. At least 120 of those charged were charged for their roles in “prescribing and distributing opioids and other dangerous narcotics.”
House panel bucks Obama, approves bill allowing higher-fat flavored milk in schools. House Republican lawmakers on Wednesday advanced legislation to undo some of the public school lunch menu rules installed during the Obama administration. Among other things, the $20 billion fiscal 2018 Agriculture Appropriations bill would end the prohibition of flavored, higher-fat milk in school cafeteria lines. It also would halt implementation of a plan to reduce sodium levels in school cafeteria foods. The legislation codifies a move made in May by the Trump administration to undo the Obama-era cafeteria rules, and it was approved by the House Appropriations Committee.
RUNDOWN
Washington Post Doctors make last-ditch effort to sink GOP healthcare bill
The Hill Rand Paul: Split GOP bill in two if latest version fails
Reuters FDA panel backs Novartis’ pioneering new cancer gene therapy
CNN Trump threatens anger if healthcare bill fails
Kaiser Health News Whichever way repeal and replace blows, pharma is up for a windfall
Bloomberg Failing or doing fine? How Obamacare’s marketplaces are shaping up for 2018
Calendar
THURSDAY | JULY 13
Medicare Trustees expected to release their annual report on the state of the program.
July 12-13. Children’s Hospital Association holds family advocacy day. Details.
2 p.m. 334 Cannon. House Veterans’ Affairs Committee hearing on “Maximizing Access and Resources: An Examination of VA Productivity and Efficiency.” Details.
FRIDAY | JULY 14
9:15-11 a.m. American Enterprise Institute Auditorium. “Medicare in the Trump era: The 2017 Trustees Report.” Details.
TUESDAY | JULY 18
8:20 a.m. The Hill event on “The State of Mental Health Care: Challenges and Solutions.” Details.
9 a.m. Food and Drug Administration public meeting on “Administering the Hatch-Waxman Amendments: Ensuring a Balance Between Innovation and Access.” Details.
WEDNESDAY | JULY 19
10 a.m. 1100 Longworth. House Ways and Means hearing on “Efforts to Combat Waste, Fraud, and Abuse in the Medicare Program.”
Noon. 485 Russell. The American Association for Cancer Research and the Society for Immunotherapy of Cancer will host a congressional briefing on “Progress in Immunotherapy: Delivering Hope and Clinical Benefit to Cancer Patients.”
