Daily on Healthcare: Graham-Cassidy is dead until enough senators say it isn’t

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 [email protected] 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 ‘plugging away’: Cassidy wouldn’t say whether Collins’ decision to oppose his Obamacare overhaul bill will kill the effort Republicans have called their last shot at repealing Obamacare. “We’ll just keep on plugging away,” Cassidy said at the conclusion of the Senate Finance Committee hearing on his bill Monday evening.

Cassidy opposes more changes to waivers in Obamacare bill. Cassidy said he opposes making further changes to state waivers for Obamacare’s insurance regulations or anything else the bill. The remarks come after Sen. Ted Cruz, R-Texas, reportedly wanted more changes to the waivers to win his support. A GOP aide said that Cruz wants more authority for states to gut Obamacare regulations that include protections for people with pre-existing conditions.  A revised version of the bill aims to make it easier for states to eliminate an Obamacare mandate called community rating that prevents insurers from charging sick people more money. Cassidy said during a break in the Senate Finance Committee hearingl that he wasn’t in favor of making further changes to the waivers. He said Cruz should support the bill because it gives a lot of money to his state. “Texas comes out ahead by about $18 billion from 2020 to 2026,” Cassidy told reporters. “It is a tremendous sum of money for those who are working families in Texas.” The bill would cut Obamacare funding overall, but it also would cut funding to states that expanded Medicaid and give that funding to states that did not expand it. Cruz said this weekend that he also is a no unless change are made to the waivers.

Democrats call for Obamacare overhaul to be put ‘aside’ after Collins defects. Democrats ripped the Obamacare overhaul bill after Collins announced she would oppose the bill. Shortly after Collins became the third GOP senator to come out publicly against the bill — seemingly enough to kill it — Sen. Mark Warner, D-Va., said it was time to put the bill to the side and move to a bipartisan solution. “There’s a reason why this bill is opposed by nonpartisan groups from every sector of the health industry, including the American Medical Association, health insurers, hospitals, patients, the American Cancer Society, and the American Heart Association,” Warner said Monday. “It is time for the Senate to put this bill aside and recognize that we must work in a bipartisan way to stabilize the health insurance markets and put in place permanent fixes to lower costs and expand health care options for Americans. I stand ready and willing to work with any senator, Republican or Democrat, who seriously shares that goal.” Sen. Dianne Feinstein, D-Calif., criticized the Graham-Cassidy bill by saying the measure was “devastating” for women’s health. “#GrahamCassidy is devastating for women’s health: Ends guarantee that maternity care and contraception are covered,” Feinstein tweeted Monday, in response to the release of a Congressional Budget Office score regarding the bill.

Capitol police arrest 181 during protests at hearing. The U.S. Capitol Police arrested 181 people for protesting during the Senate Finance Committee hearing. Demonstrators were arrested after they failed to cease and desist from their activities during the hearing, which was disruptive. Fifteen were arrested and charged with disrupting Congress. Most of the protesters in the hearing room were with the disability rights activist group Adapt and some of them were in wheelchairs. The second that Finance Committee Chairman Orrin Hatch, R-Utah, started the hearing, the protesters started shouting, “No cuts to Medicaid, save our liberty.” The chanting went on for a good 10 minutes before Hatch decided to call off the hearing temporarily. Capitol police officers dragged protesters out of their wheelchairs and out of the hearing room. After most of the protesters were taken away, shouting and chanting could still be heard inside the room.

Acrimony throughout lone hearing on Graham-Cassidy. Things continue to be pretty heated after the protesters were removed from the hearing. Democrats on the Senate Finance Committee grilled their own colleague, Cassidy, who was testifying. Normally when a senator testifies at a hearing, he or she doesn’t stick around for questions. That was the case with Cassidy’s co-sponsor, Graham, who read a statement before Sen. Mazie Hirono, D-Hawaii, at the beginning of the hearing. Cassidy got into several testy exchanges with Democrats throughout the nearly five-hour hearing.

The most heated was between Sen. Ron Wyden, R-Ore., and Cassidy over protections for patients with pre-existing conditions. Wyden asked if the entire healthcare industry, from doctors and hospitals to insurers, is wrong that the bill would erode protections for people with pre-existing conditions. Cassidy responded that Wyden was begging for an answer. He then pivoted to say that red state governors who didn’t expand Medicaid love the bill, quoting Tennessee’s governor as calling it a “godsend.” Hatch tried to cool down Wyden, saying that Cassidy should be treated with more respect. “Let’s show some respect,” he said. “This is not easy for him. The fact that you disagree is fine.” Republicans chafed several times at Democrats’ line of questioning. At one point Sen. Sherrod Brown, D-Ohio, asked one of the panel’s witnesses if people would die if Graham-Cassidy is passed. “Oh, come on,” responded Sen. Pat Roberts, R-Kan.

Graham vows to ‘put a stake into the heart of single-payer.’ During the hearing, Graham said he would do everything he could to stop Democrats from moving the country in the direction of a healthcare system that is funded and run by the federal government. “To my friends to the left, I will do everything I can to stop and put a stake into the heart of single-payer healthcare,” Graham said. “You don’t like Obamacare, you don’t think it’s big government enough, I’m here to stop you. You care as much as I do about healthcare, but going beyond Obamacare is a nightmare for this country. It will ruin healthcare and bankrupt the American people.” Graham said he believed that making healthcare systems more local would improve results and allow patients to have more of a say in the kind of healthcare they want, and that states could set up their own healthcare systems if they chose. “My goal is to get the money and power out of Washington, closer to where people live so they’ll have a voice about the most important thing in their lives,” Graham said. “I don’t need a lecture from anybody about healthcare, but what you have created is not working. It’s time to try something new.”

Jimmy Kimmel applauds Susan Collins for pulling her support from Graham-Cassidy bill. The comedian expressed his gratitude to Republican Sen. Susan Collins Monday for her opposition to the GOP’s latest effort to overhaul Obamacare.

“Thank you @SenatorCollins for putting people ahead of party,” Kimmel tweeted. “We are all in your debt.”

Trump trolls John McCain by posting video of him repeating ‘repeal and replace.’ On Monday night, following the Arizona Republican’s decision to oppose the Graham-Cassidy bill, Trump tweeted, “A few of the many clips of John McCain talking about Repealing & Replacing O’Care. My oh my has he changed-complete turn from years of talk!” Accompanying the message was a video documenting McCain saying he would try to repeal and replace Obamacare.

ICYMI: Debate live blog: Lindsey Graham and Bill Cassidy vs. Bernie Sanders and Amy Klobuchar on the future of healthcare on CNN. Highlights:

Emotional Graham: McCain can ‘vote any way he wants to.’  “He’s one of my dearest friends in the world and John McCain can do whatever damn he wants to, he’s earned that right,” Graham said during the CNN healthcare debate Monday night. “John has said he wants to repeal and replace Obamacare. He’s voted in 2015 to repeal Obamacare through the same process. He also says that we want to have a bipartisan solution. The difference between John and myself is I really don’t see much space here. If I thought I did, I would tell you otherwise, but let me tell you about Sen. McCain. He’s not for Berniecare, Bernie. I know you like the vote he took, but he doesn’t want socialized medicine and I know you do and I think you believe it’s best for America. I believe it’s the end of healthcare as we know it.” “So Senator McCain has talked about a better process,” he added. “John, if you’re listening, if we fall short, we’ll try to have a better process. Nobody respects you more than I do. “So to any American who has got a problem with John McCain’s vote, all I can tell you is that John McCain was willing to die for this country and he can vote any way he wants to and it doesn’t matter to me.”

Graham: Sanders is the ‘most honest person in the Senate.’ “Is the bromance over already?” CNN anchor Dana Bash asked Graham after the senators sparred over payments to insurance companies. “No,” Graham said. “Bernie is the most honest person in the Senate because he believes in government running healthcare from cradle to grave.”

Sanders says government-run healthcare builds on Obamacare. Sanders said his bill to roll all Americans into Medicare is one that would build upon Obamacare. The Vermont independent said during the town hall that his plan was “building upon and improving” Obamacare. His legislation, which is backed by 16 other Democrats, would take people who are uninsured, as well as people on private health insurance and Medicaid, and place them in Medicare. Republicans have been mobilizing in recent weeks in light of the Democratic support for such a system. Cassidy countered during the town hall that the reason Democrats are supporting the socialized healthcare bill is because they believe Obamacare is unsuccessful. “They think it has failed and we should be doing something else,” Cassidy said.

Graham, Cassidy clash with Sanders over pre-existing illnesses. The Republican senators defended their Obamacare overhaul bill from concerns about whether it would erode protections for pre-existing conditions such as cancer, diabetes and arthritis. Cassidy and Graham said Republican governors wouldn’t eliminate pre-existing condition protections in Obamacare under their new legislation. Their bill allows states waive key Obamacare insurer regulations such as community rating that keeps insurers from charging people more money. They say that for states to do that, they have to prove to the federal government that they will provide affordable and adequate coverage to people with pre-existing conditions. However, there is no definition for “adequate and affordable” in the bill. Sanders doubted that claim. He noted that before Obamacare, 43 states didn’t allow community rating. “The Affordable Care Act has done some important things,” he said. “Let’s not throw the baby out with the bath water.”

Cassidy: Money from Planned Parenthood defunding would go to rural areas. Cassidy defended his Obamacare overhaul bill’s defunding of Planned Parenthood for one year, saying the money would go toward health centers in more rural areas. “Most Planned Parenthood settings are in urban areas,” he said during the CNN town hall, noting many OB/GYN doctors in those areas can offer cancer screenings. Cassidy said the bill, which would Obamacare funding to states through block grants and would cut Medicaid, would ensure more funding goes to rural centers so women don’t have to travel as far to get a cancer screening. “I feel bringing healthcare to the person than bringing the person to healthcare,” he said. “It’s just a question of how you distribute those dollars.” The overhaul bill would keep federal funding from going to medical facilities that provide abortions. The Hyde Amendment prevents federal funding from being used for abortions, but federal facilities can get grant funding that pays for other services such as birth control or cancer screenings. Planned Parenthood receives about $500,000 in federal funding each year, and the bill would cut off funding for a year.

RUNDOWN

Axios The states spending the most out of pocket on healthcare.

Politico Senate GOP weighs how to fail at Obamacare

Wall Street Journal Mitch McConnell’s stature left bruised by healthcare, runoff woes

Bloomberg Demise of Obamacare repeal shows how far GOP actually remains from goal

Associated Press As health bill teeters, Medicaid recipients watch nervously

Roll Call Hill flounders on kids’ care

Vox How Republicans could still revive Obamacare repeal after Sept. 30 deadline

Washington Post Bill Cassidy: The public face of a doomed healthcare bill

New York Times Puerto Rico’s governor warns of humanitarian crisis

Calendar

TUESDAY | Sept. 26

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.

8 a.m. Newseum. 555 Pennsylvania Ave. NW. Politico event on “The Doctor-Patient [and Government] Relationship.” Details.

8:30 a.m. 1775 Massachusetts Ave. NW. Brookings Institution event on “The Medicare Physician Fee Schedule and Alternative Payment Models.” Details.

WEDNESDAY | Sept. 27

Deadline for insurers to sign rate contracts with states.

8 a.m. Washington Court Hotel, 525 New Jersey Ave. NW. Politico event on “Aging in America.” Details.

1 p.m. Health and Human Services event on the opioid crisis titled, “Recovery, Prevention, & Hope: Live Stream Panel of National Experts on Opioids Equip Faith and Community Leaders.” Details.

3 p.m. Ronald Reagan Building and International Trade Center. 1300 Pennsylvania Ave.  Education Development Center  and the National Action Alliance for Suicide Prevention event on “From Pain to Promise – Addressing Opioids & Suicide in Communities Across America.” Details.

THURSDAY | Sept. 28

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.