Daily on Healthcare: The race to 50 votes…Pence flies back from UN to lunch with Republicans, talk Graham-Cassidy

The race to 50: Cotton is a ‘yes.’ Sen. Tom Cotton, R-Ark., told the Washington Examiner on Tuesday that if the bill released by were to come to the Senate floor, he would back it. If Cotton is a “yes,” it’s possible that nearly all conservatives would be on board. Last week, a spokesman for Sen. Mike Lee, R-Utah, said the senator was “encouraged” by the legislation, although he stopped short of backing it. The only conservative who has vocally opposed the bill has been Sen. Rand Paul, R-Ky., who sounds like a firm “no.” That leaves the remaining focus on Sens. John McCain, Lisa Murkowski and Susan Collins, who helped kill the most recent attempt by Republicans to pass a healthcare bill. Assuming Paul remains a no, to pass anything, Republicans would have to win over at least two of those three senators and hold everybody else. Though McCain has been highly critical of the rushed process used to advance the legislation, the bill received a boost when his state’s governor, Republican Doug Ducey backed the legislation. Additionally, Graham, a leading author of the bill, is a close friend and ally of McCain’s. On the other hand, Alaska Gov. Bill Walker raised alarms of “drastic cuts” to Medicaid funding in the state, comments that are sure to weigh heavily on Murkowski.    

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.

Hearings scheduled on Graham-Cassidy. Republicans sought to quell criticism from in and outside their caucus by holding two hearings on the latest overhaul bill. The Senate Homeland Security and Governmental Affairs Committee initially announced a hearing on the bill’s block grants to states, which are a major part of the new bill. The selection was an odd choice as the committee doesn’t have jurisdiction over healthcare issues. A few hours later, the Senate Finance Committee announced it would hold its own hearing on the bill. The Senate Finance Committee holds jurisdiction over healthcare bills with the Senate Health, Education, Labor and Pensions Committee. “Senators have expressed a strong desire to examine the details of the Graham-Cassidy proposal through a public hearing,” said Sen. Orrin Hatch, Senate Finance Committee chairman. “A hearing will allow members on both sides of the aisle to delve deeper into its policy and gain a better understanding of what the authors hope to achieve.” One of McCain’s biggest gripes has been the process used by GOP leadership to get Obamacare repeal passed. He has said there needs to be hearings and participation from both sides of the aisle, and he cast the fatal blow to the “skinny repeal” in July. Now he has two hearings, but the bill released only last week and no Democrats are likely to support it. McCain chafed when asked whether a week was enough time to pass a bill through regular order. “We’ve had nine months to get it done and we haven’t,” McCain responded. “Is it my problem now that we only have a week?”

Arizona governor supports Obamacare overhaul. The Republican governor, Doug Ducey, said Monday that he supports the Obamacare overhaul bill, which could draw support from McCain. The bill is the “best path forward to repeal and replace Obamacare,” Ducey said. The bill would give Obamacare funding to states in the form of block grants. It also would repeal the law’s individual and employer mandates and would let states waive insurer mandates such as one that prevents insurers from charging people with pre-existing conditions higher premiums. McCain has said that Ducey’s position could affect his thinking on the new legislation, although he has been strident that he wants any legislation to overhaul Obamacare to go through regular order with hearings and bipartisan participation. “Senator McCain continues to review the bill to assess its impact on the people of Arizona,” a representative told the Washington Examiner. “As he has said before, Senator McCain believes healthcare reform should go through the regular order of hearings, open debate and amendments from both sides of the aisle.”

But Alaska’s governor warns of ‘drastic cuts’ to Medicaid program. Alaska Gov. Bill Walker, an independent, is concerned that the Obamacare overhaul bill would cut Medicaid funding to his state. Walker’s concerns come as Republicans are trying to woo Sen. Lisa Murkowski, R-Alaska, to support the legislation billed as a last-minute hope to repeal Obamacare. “Given Alaska’s current fiscal challenges, any proposal to shift federal costs to the states would likely result in drastic cuts to our Medicaid program,” Walker said in the Daily News Miner. Murkowski has expressed similar concerns about how much money the state would receive under the bill. The bill would give states $1.2 trillion from 2021 to 2026. States that expanded Medicaid under Obamacare, such as Alaska, would receive less funding initially than non-expansion states, although eventually the two groups of states would receive the same base rates. Murkowski, who voted against prior Obamacare repeal bills, has major questions about the funding formula. “We understand what block grants do, but if we get more flexibility without enough money to utilize the flexibility, that makes a difference,” she said Monday.

Paul Ryan touts the Obamacare overhaul bill. The Graham-Cassidy healthcare bill is “our best, last chance to get repeal and replace” of Obamacare done, House Speaker Paul Ryan said Monday, signaling that the House would quickly pass the Republican senators’ bill if it can clear the upper chamber in time. Ryan addressed the Senate legislation after touring Harley-Davidson’s Menomonee Falls, Wis., factory to tax talk reform. Ryan, who had previously spoken positively about the legislation, noted that the House would not have time to amend the bill if the Senate did clear it. Instead, it would face having to simply approve the Senate measure. “A conference committee is probably not possible,” he noted.

Bill will get ‘preliminary’ CBO score next week, as Democrats insist on comprehensive report. The Congressional Budget Office said it would provide a “preliminary assessment” by early next week of the Graham-Cassidy bill. CBO officials said the assessment would include whether the proposal would reduce the deficit “by at least as much” as a House-passed repeal and replace plan. The CBO is aiming to provide information about the impact of the Graham-Cassidy legislation but “will not be able to provide point estimates of the effects on the deficit, health insurance coverage or premiums for at least several weeks.” That means Republicans would have to push for a vote on their latest bill without a full CBO score, since the GOP is under pressure to hold a vote by next week. If the GOP holds to that schedule, they would have to vote on the bill without a complete CBO score, something Democrats will likely use as an argument against holding the vote. Democrats, who oppose Graham-Cassidy, are insisting on a comprehensive CBO score ahead of the vote, but they are in the minority and do not control the floor schedule. Warning of a “hasty, dangerous vote” on a last-ditch attempt to repeal and replace Obamacare, Democrats wrote a letter to CBO asking for a comprehensive report on the cost and impact of the plan. “Before votes are taken … the public needs a full understanding of the impact this legislation would have on hard-working families,” House Minority Leader Nancy Pelosi, D-Calif., and Senate Minority Leader Chuck Schumer, D-N.Y., wrote Monday to CBO Director Keith Hall.

Susan Collins: Lack of full CBO score ‘problematic.’ The Maine Republican said she is upset that CBO won’t have enough time to fully review a last-minute bill to overhaul Obamacare. “That’s problematic because that is part of the problem of short-circuiting the process,” she told reporters Monday. Collins was among three Republican senators to vote against a “skinny” Obamacare repeal bill in late July that would have scaled back big parts of the law. Collins has not taken an official position on the latest bill but hinted she has major concerns about how it would affect Maine. “The Maine Hospital Association has calculated that Maine would receive $1 billion less in Medicaid and other federal healthcare spending in the next decade,” she said. “That is obviously of great concern to me.”

Rand Paul looks like a hard ‘no.’ The Kentucky Republican continues to criticize the bill. He told a group of reporters on Wednesday that the last-minute effort doesn’t seem terribly thought out. “I don’t think anybody realizes the enormity of this,” he said. Paul noted that the two-year transition may not be enough time for states to adopt their own Medicaid and individual market programs, which they would have to do under the bill. “Obamacare took a long time to get in place. It took them a year to get their website,” he said. “Can you imagine every state now has to go through this and start completely over with all of these different subsidies at the same level? I think it will be a chaotic nature for two years.” It doesn’t appear like a deal on some tweaks or amendments would be enough to win Paul’s vote. He said the bill leaves in too much of the law’s taxes. “I would vote for repeal,” he said. “This doesn’t look, smell or feel like repeal.”

Schumer working hard against Graham-Cassidy. The Senate minority leader argued Tuesday that the Graham-Cassidy bill would destroy a bipartisan effort to stabilize Obamacare’s markets, after saying Monday that the legislation was a “red siren moment” for the U.S. and is more dangerous than any of the previous Republican-led bills. The statements come after his and Pelosi’s letter to CBO requesting a full score of the Graham-Cassidy bill. “After a few weeks of lying dormant, Trumpcare is back and it’s meaner than ever,” Schumer said in a press conference at the Capitol Monday. “While this latest version of Trumpcare may live under a new name… no matter how many ways Republicans try to dress it up, this bill is even more dangerous than its predecessors. Let me be clear: This is a red-siren moment for the entire country.” On Tuesday, he pushed the legislation that Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander and Sen. Patty Murray, the committee’s top Democrat, have been working on. “Democrats and Republicans have been working in good faith to come up with bipartisan agreement on healthcare,” he said on the Senate floor. He said the Republican majority will “toss all of that away” if they pursue Graham-Cassidy next week. The HELP Committee held a series of hearings on how to stabilize Obamacare’s exchanges on the individual market. But no deal has been announced. Schumer said that any pursuit of the new bill sponsored by four Republican senators will quickly halt any attempts at bipartisanship.

“We’ve seen bipartisan sprouts bloom in the last month,” he said. “Graham-Cassidy would snuff them out. Nobody wants that.”

GOP senator wants to block states from adopting single payer. Sen. John Kennedy, R-La., said he wants to ban states from setting up a government-run healthcare system as part of the Graham-Cassidy bill. “I think a single-payer system is a bad idea,” Kennedy said Monday. “I think if you give a big chunk of money to California they’re going to go set up a single-payer system run by the state and then come back and say, ‘We don’t have enough money, we need more.’ I think the only way we are going to solve the healthcare problem in America is through the private sector.” Kennedy defended his position to reporters who asked why he was in favor of handing decisions to states but not allowing them to set up a healthcare system funded and run by the state and federal government. “I don’t think states should have the authority to take money from the American taxpayer and set up a single-payer system,” Kennedy said. “Some people think that’s inconsistent with the idea of flexibility, but that’s what the United States Congress is for. I very much believe in flexibility, and I know governors want flexibility, but it’s our job to make sure that money is properly spent.”

Patient groups oppose Graham-Cassidy. A collection of 16 patient and healthcare provider groups is opposing the last shot Republicans have at tackling Obamacare. The groups, which include the American Heart Association and American Cancer Society Cancer Action Network, say Graham-Cassidy would “limit funding for the Medicaid program, roll back important essential health benefit protections and potentially open the door to annual and lifetime caps on coverage, endangering access to critical care for millions of Americans.” Among the 16 groups signing the statement were the ALS Association, American Lung Association, American Diabetes Association, March of Dimes, and National Organization for Rare Diseases.

Tea Party group supports the Obamacare overhaul. The conservative Tea Party Patriots on Monday gave a tepid endorsement of the Graham-Cassidy bill. The group said most of its supporters do not back the bill, but they believe the group should endorse it because it is a step toward full repeal, according to Tea Party Patriots President Jenny Beth Martin. Now the group is calling on Senate leadership to hold a vote as quickly as possible to shortcut any attempts by Democrats to run out the clock. The group said the bill’s waiver process that lets states waive key insurer regulations such as preventing insurers from charging sicker people more money should be amended. States currently can waive the mandate against charging sick people more, called community rating, but only if they show that it won’t affect access to affordable care for people. It is not clear what that criteria would be. But Martin said the language needs to go further than what is in there.

RUNDOWN

The Hill Trump reportedly invited key senator to lunch ahead of new repeal push

Axios What’s missing from the latest Obamacare repeal bill?

Roll Call McConnell in difficult spot with latest healthcare push

STAT News Under GOP health bill, states would struggle to hang on to Obamacare

Politico Momentum builds for Obamacare repeal

Talking Points Memo Louisiana health official warns repeal bill will ‘disproportionately hurt’ Cassidy’s own state

Kaiser Health News Bemoaning budget cuts, Obamacare navigators say feds don’t appreciate the scope of the job

NPR As federal government cuts Obamacare ads, private insurer steps up

Associated Press Christie: Drugmakers to work on non-addictive pain medication

Calendar

TUESDAY | Sept. 19

Sept. 19. Chicago. Last day of the American Academy of Pediatrics conference. Schedule.

Noon. Harvard T. Chan School of Public Health event on “In Pursuit of a Single Payer Plan: Lessons Learned” with Vermont Gov. Peter Shumlin. Live stream.

3 p.m. 430 Dirksen. PCORI event on “Addressing America’s Opioid Problem: The Need for Evidence-Based Strategies” with Sen. Shelley Moore Capito, R-W.Va. Details.

WEDNESDAY | Sept. 20

9 a.m. 562 Dirksen. Senate Special Committee on Aging hearing on “Disaster Preparedness and Response: The Special Needs of Older Americans.” Details.  

9 a.m. National Press Club. 529 14th St. NW. Researchers to announce global study from

Journal of Adolescent Health on “Common Cause of Multiple Social Maladies.”

4 p.m. Washington Post event with Dr. Francis Collins, director of the National Institutes of Health. Details.

SUNDAY | Sept. 24

Sept. 24-28. AHIP’s conference on Medicare, Medicaid and duals. Includes keynote by CMS Administrator Seema Verma. Details.

MONDAY | Sept. 25

10 a.m. National Press Club. 529 14th St. NW. Discussion on “Mental Health and the Opioid Crisis” with healthcare workers and Rep. Tim Ryan, D-Ohio, co-chairman of the House’s Addiction Treatment and Recovery Caucus. Details.

TUESDAY | Sept. 26

10 a.m. Senate Homeland Security and Governmental Affairs Committee hearing on “Block Grants: How States Can Reduce Healthcare Costs.”  Details.