Daily on Healthcare: Obamacare emerges as wildcard in tax debate

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Tom Cotton defends using tax reform to repeal individual mandate. Arkansas Sen. Tom Cotton defended the idea of Obamacare’s individual mandate penalties being repealed through the tax reform process because it’s a step lawmakers must take to end former President Barack Obama’s harmful policies. The junior Republican senator said repealing the individual mandate would have “no impact” on people who want health insurance. Instead, it would simply ensure people who can’t afford health insurance won’t get fined, he said. “We need to solve the problems that Obama made worse,” Cotton said on CBS’ “Face The Nation.” “We worked over the summer, we failed, I wish that wasn’t the case but we have a tax bill now that will repeal the most hated and unpopular the individual mandate, which is no more than a tax on working families and poor Americans. I hope next year we return to healthcare, but I’m focused on this tax bill.” When asked if that could cause a tax increase on some individuals who are receiving health insurance through government exchanges, Cotton said that’s a choice people will have to make. He said the tax reform package will lead to lower income tax rates for individuals, but their choices will determine how much money they pay.

Steven Mnuchin: Mandate repeal not a bargaining chip in tax reform talks. Treasury Secretary Steven Mnuchin on Sunday hit back at claims that repealing Obamacare’s individual mandate was being used as a bargaining chip in tax reform negotiations among congressional Republicans. “The president thinks we should get rid of it, I think we should get rid of it,” Mnuchin told “Fox News Sunday.” “I think right now our objective is to keep [the Senate’s repeal of the mandate] in. It provides a big tax cut for the middle class, it gets rid of the penalty, but we are going to work with the Senate as we go through this.” Mnuchin said he didn’t believe the GOP tax plan favored wealthy and corporate America. But, he said he couldn’t be certain Congress would re-up the proposed individual tax cuts in 2025, only that he had “a lot of confidence” that those in power then would do “the right thing.”

Mick Mulvaney: White House is open to dropping the mandate repeal. But the White House is open to removing the individual mandate if it is an impediment to getting the bill to Trump. White House Budget Director Mick Mulvaney said on CNN’s “State of the Union” Sunday that Trump wants to repeal and replace Obamacare. However, he’s going to be pragmatic about the tax reform process. “I don’t think anybody doubts where the White House is on repealing and replacing Obamacare,” Mulvaney said. “We absolutely want to do it. If we can repeal part of Obamacare as part of the tax bill and have a tax bill that is still a good tax bill that can pass, that’s great. If it becomes an impediment to getting the best tax bill that we can, we’re OK with taking it out.” Mulvaney said he doesn’t think mandate repeal is an impediment, even though some centrist senators have warned against it.

Trump legislative director: Official analysis of GOP tax bill ‘misleading’ and ‘dishonest.’ A White House official issued a harsh criticism of Congress’ nonpartisan group of tax experts Friday, calling a recent analysis from the outfit “incredibly misleading” and “dishonest.” “There’s probably been no more dishonest or misleading study than that one that came out yesterday,” said Marc Short, the White House director of legislative affairs, referring to an analysis from the Joint Committee on Taxation published Thursday that found that the Senate GOP tax bill would raise the taxes of some middle-income groups. Short was asked about the analysis on CNN. The Joint Committee on Taxation is a nonpartisan entity that provides tax expertise to Congress. It is controlled by Republicans, who are in the majority, and its experts received praise from Senate Republicans Thursday at the bill’s markup. The analysis found that adding repeal of the Obamacare individual mandate to the bill would result in some middle-income groups seeing tax increases.

McCain bullish on tax reform, heartening GOP leaders. Sen. John McCain said Friday he was supportive of the Senate Republican tax bill’s advancement, an encouraging sign for Trump and GOP leaders hoping that the bill can be passed shortly after Thanksgiving. The Arizona senator issued a statement applauding the Senate Finance Committee for advancing the Tax Cuts and Jobs Act late Thursday, calling it “another step forward in providing much-needed tax relief for hard-working American families.” McCain added that he was “pleased” that the bill had advanced through regular order, which he has said would be critical to his support. Criticisms about regular order are part of what doomed Obamacare repeal in late July. McCain joined Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, and all Senate Democrats to sink a “skinny” repeal bill that gutted the individual mandate.

Murkowski denies making Obamacare deal precondition for tax vote. Sen. Lisa Murkowski pushed back on earlier comments that the Senate needs to pass an Obamacare stabilization deal to get her vote on the Senate’s tax reform legislation. Her statement on Friday was in response to a report in Roll Call in which the Alaska Republican said the deal spearheaded by Sen. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., must be passed before the tax legislation if a repeal of Obamacare’s individual mandate remains in the bill. Murkowski said Friday that passing the Alexander-Murray deal is “important to stabilizing the individual market and it may be particularly so if the individual mandate is repealed.” However, “one should not assume this is a precondition for my support for the tax bill,” she said. “I plan to look at the entire package before coming to any conclusion on the legislation.”

Susan Collins not sure about tax bill. Sen. Susan Collins, R-Maine, said she is still unsure about the Senate Republicans’ tax reform proposal. “You can’t vote for it as written?” George Stephanopoulos asked Collins, a centrist and a key swing vote in the Senate, during an appearance on ABC’s “This Week” Sunday morning. “I haven’t reached that conclusion yet because I think there are going to be further changes,” Collins replied. Collins said the “biggest mistake” was putting in the repeal of the individual mandate, which is not in the House bill. “And I hope that will be dropped, or that bills that have been introduced […] will be adopted to mitigate the impact of those provisions,” she added. Speaking on CNN’s “State of the Union,” Collins said the measure would cause families who have healthcare through Obamacare to pay more for their insurance.

Bernie Sanders calls Trump’s complaints about Democratic obstruction ‘total nonsense.’ Sen. Bernie Sanders called Trump’s complaints about Democratic obstruction over the tax bill “total nonsense” and put the blame on Republicans for not including Democrats in negotiations. Sanders, I-Vt., said on CNN’s “State of the Union” on Sunday that Trump’s complaint in a tweet Saturday — that Democrats don’t understand the power of low taxes and are only interested in obstruction — is mistaken on its face. “Well, that’s total nonsense,” Sanders said. “Democrats have been completely shut out of this process just as they were shut out of the healthcare legislation process. Here’s the facts, and Trump should understand this: What this legislation is about is fulfilling the promises, Republican promises, made to wealthy campaign contributors. There is a reason why the billionaire class provides hundreds of millions of dollars in campaign contributions to Republicans. And now it’s payback time.”

DEA puts fentanyl on par with heroin and meth. The Drug Enforcement Administration is cracking down on the use of synthetic opioid fentanyl, which is much more potent than heroin. The DEA announced Monday it published a temporary order to put cyclopropyl fentanyl in the same category as heroin, cocaine and meth. Fentanyl is responsible for rising opioid deaths due to its potency. The agency said the temporary order is needed to “avoid an imminent hazard to the public safety.” Fentanyl has been used to treat severe pain, typically associated with cancer. But most of the recent cases of fentanyl overdoses are linked to illegally made versions, according to the Centers for Disease Control and Prevention. Previously, the drug was not on any DEA schedule. The agency puts drugs on a schedule of one to five, with one being the most serious.

States, feds scramble to preserve children’s health insurance. Several states and the Trump administration are fervently searching for stopgap measures to keep insurance for low-income children while Congress debates spending for the national program. The Trump administration has taken steps to shore up states that will run out of funding soon as states try to figure out where to plug funding holes. The Centers for Medicare and Medicaid Services has a national redistribution fund that has unused CHIP funding from previous years. CMS is working on a month-to-month basis to send redistribution funds to states that request it.

Former U.S. attorney running for Tim Murphy’s old House seat. Conor Lamb, a 33 year-old former U.S. attorney and Marine veteran from a suburban Pittsburgh neighborhood, is the official Democratic nominee to compete for the seat held by disgraced former Rep. Tim Murphy. Lamb said in an interview with the Washington Examiner after his win that his work on the cases in the U.S. attorney’s office on the opioid epidemic were part of what inspired him to run. “We need to do a better job in tackling the heroin addiction in this region, I don’t know if people understand how bad it is,” he said. Lamb said adding jobs and securing meaningful infrastructure projects are key issues he will run on. “But it is the heroin addiction that is really personal to me,” he said. In Allegheny County alone had 613 fatal overdoses last year, a 44 percent increase over 2015. Lamb, a practicing Catholic, supports the law of the land on abortion and is pro-Second Amendment. The special election will be held March 13.

White House puts the cost of the opioid crisis at $504 billion in 2015. The economic cost of the opioid crisis was $504 billion in 2015 — more than six times the most recently estimated cost of the epidemic, according to a new White House report. According to the Council of Economic Advisers report, more than 50,000 Americans died of a drug overdose in 2015, of which 63 percent reportedly involved opioids. The rate of opioid-involved overdoses has quadrupled in the past 16 years, according to the CEA report. The report also revealed most of the opioid-involved deaths were of those between the ages of 25 and 55. The overall fatality rate ranged from 16 to 22 deaths per 100,000 people. Because of research showing that opioid usage is underreported on death certificates, the CEA estimates 41,000 overdose deaths involved opioids as opposed to the original number of 33,000 official reported deaths. The report to be released in full on Monday is the first of its kind, but the CEA says it will not be the last. “A better understanding of the economic causes contributing to the crisis is crucial for evaluating the success of various interventions to combat it,” CEA said.

David Shulkin: Fixing VA ‘a matter of national security.’ Allowing systemic problems at the Department of Veterans Affairs to persist could put the country at risk, according to VA Secretary David Shulkin. “I think both the president and I believe not only have veterans earned this, but this is actually a matter of national security,” Shulkin told the Washington Examiner in an interview last week. “If we have a system that, when people are deciding if they want to serve their country, that they don’t believe that when they get home, they have a system that’s going to take care of them that they can rely upon, the approach towards having a voluntary Army and people who want to come and protect the country is at risk, and I think we have seen some recent reports that it’s getting tougher to meet recruitment standards.” Shulkin, who has worked at some level of the VA since June 2015, said he agrees with Trump’s criticism of the agency he now oversees. “People say, ‘Well, you know, he’s been so critical of the VA.’ Well, you know, I actually think that’s a good thing,” Shulkin said. “When you’re the boss, you get to hold up a mirror and tell people where the problems are and if you don’t do it, then the rest of the organization doesn’t really have a chance to respond.”

RUNDOWN

Kaiser Health News FDA raids Florida stores that consumers use to buy drugs from Canada

Associated Press Hard to believe: Some consumers find free healthcare

Wall Street Journal Why opioid addicts find medication-assisted treatment hard to find

Axios Individual mandate is important but underperforming

Politico Obamacare mandate repeal may not deliver predicted blow

Roll Call Franking fracas hits open enrollment ads

STAT News Motorcycle crashes are alarmingly common and incredibly costly

Washington Post Republicans are right. The individual mandate is a tax on the poor

Calendar

MONDAY | Nov. 20

Congress is out all week.

THURSDAY | Nov. 23

Nov. 23-24. Thanksgiving holiday. No Daily on Healthcare newsletter.

MONDAY | Nov. 27

Senate in session. House not in session.