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Where does the Senate go from here? Probably somewhere else. Reactions from several Republican senators to Wednesday’s estimate from the Congressional Budget Office on the American Health Care Act didn’t bode well for passage in the Senate. “With today’s news, the ‘collapse and replace’ of Obamacare may prove to be the most effective path forward,” tweeted Sen. Lindsey Graham of South Carolina. Sen. Dean Heller of Nevada, who is probably the most vulnerable GOP senator up for re-election next year, said the bill doesn’t do enough to protect the state’s Medicaid population or people with pre-existing conditions. Sen. Bill Cassidy of Louisiana doesn’t believe the AHCA passes the “Kimmel test,” a reference to late-night host Jimmy Kimmel, whose monologue about his newborn son, who was born with a heart defect, and healthcare coverage went viral a few weeks ago. “Congress’s focus must be to lower premiums with coverage which passes the Jimmy Kimmel Test. The AHCA does not,” said Cassidy, who has been pushing his own bill with Sen. Susan Collins, R-Maine, that would let states choose whether to keep Obamacare or use federal funding for their own version. The CBO score said that 23 million people would go without insurance over the next decade and it would cut $119 billion from the deficit. But one of the most damning parts of the score said that an amendment that lets states opt out of key Obamacare insurance mandates could force sicker people to pay more for healthcare and quickly make coverage unaffordable. Senate leadership always hinted they would start from scratch and go their own way, but some senators have said they will keep parts of the bill in their version. The Senate healthcare working group is scheduled to meet today, as they do every Tuesday and Thursday to discuss their version of healthcare reform. Wonder just how much of the agenda the CBO score will take up?
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Vote before August recess? Maybe? Sen. John Cornyn, R-Texas, the No. 2 in the Senate, hinted that there could be a vote on healthcare in the next few months. “My own guess is we will have it done some time before August,” he told reporters Wednesday. But Cornyn didn’t commit to any deadline, saying that if “we miss it by a day or two that isn’t a big story.” Full disclosure, it probably would be. Cornyn downplayed Majority Leader Mitch McConnell’s comments in a Reuters interview Wednesday that the Senate doesn’t have the 50 votes needed to pass any healthcare bill. “There’s no bill. That’s the reason why we don’t have 50 votes,” Cornyn said. A group of more than a dozen GOP senators from all sides of the political spectrum have been meeting for weeks. Focusing on topics such as Medicaid spending, tax credits and Obamacare’s insurance mandates. But those meetings have yet to bridge major divisions between centrist and conservative senators. Cornyn said the Senate doesn’t “have the luxury of time,” since insurers have to submit their proposed rates for the 38 states that use healthcare.gov next month. He also hinted that the Senate is likely to vote on some type of healthcare legislation. “I don’t think we have any choice,” Cornyn said. “Even if we were to do nothing on repeal and replace, we would still have to salvage the failing Obamacare individual markets.”
Highlights from the CBO report: Here are the quick takeaways from the score:
- 23 million people would go without insurance over the next decade, which is down from the previous estimate of 24 million people not having insurance.
- One-sixth of the population will be affected by Rep. Tom MacArthur’s waiver that lets states opt out of insurer mandates such as community rating, which prevents insurers from charging sick people more money. People who are healthier would choose to buy less expensive, skimpier plans, the report projects, while people who are have more medical needs would have only expensive plans to choose from, and may not be able to buy coverage at all.
- Premiums would decline, sort of. The score shows that premiums would rise by 20 percent in 2018, an election year, and then by 5 percent the following year. After that, results would vary by state depending on which applies for a waiver.
- Spending on Medicaid, which was largely unchanged from the prior estimate, would fall by $834 billion over 10 years.
Industries blast latest CBO report. The American Hospital Association says the estimates “only reinforce our deep concerns about the importance of maintaining coverage for those vulnerable patients who need it.” The American Medical Association said the estimates “show that last-minute changes to the AHCA made by the House offered no real improvements.”
Senate Minority Leader Chuck Schumer calls “Trumpcare” a “Nightmare”: “Unless you’re a healthy millionaire.” He concluded: “This report ought to be the final nail in the coffin of the Republican effort to sabotage our healthcare system.”
Score leads to more funding? After the CBO’s estimate found people with pre-existing conditions could pay more under the AHCA, House Freedom Caucus leader Mark Meadows floated providing more money for high-risk pools. “The president is committed to making sure pre-existing conditions are covered in principle and in practice, which means that funding has to be there to make it work,” the North Carolina Republican said Wednesday. “One of the critical things that we are going to make sure of is there is the appropriate funding to do that.” But it is not clear how much money will be needed. The most likely recipient is high-risk pools, which received $23 billion in funding in the AHCA. States also could use whatever is leftover from a $115 billion stability fund intended to improve the individual market. Meadows paused during talking with reporters and then started to tear up when he recounted how his sister died of breast cancer and father of lung cancer. “I am not going to make a political decision today that affects somebody’s sister or father because I wouldn’t do it to myself,” he said. “In the end what we’ve gotta do is make sure there is enough funds there to handle pre-existing conditions and drive down premiums. If we can’t do those three things, then we will have failed.”
The good news: Meadows was pretty surprised when he was asked by reporters about the CBO’s findings that the MacArthur amendment could force sicker people to pay much higher prices. He told reporters that House Speaker Paul Ryan was excited at first and wanted to reach out to find MacArthur for making the bill better. Ryan did put out an optimistic statement on the CBO report, saying that it confirmed the bill would lower premiums. While the bill does lower premiums, especially for younger people, the problem is that people with pre-existing conditions could face higher premiums if they live in a state that opts out of community rating.
MacArthur didn’t take kindly to CBO: Tom MacArthur wasn’t too happy the CBO found that his last-minute change to the AHCA could make it harder for people with pre-existing conditions to get affordable healthcare. :I respect the CBO’s role but just because a group of auditors down the block has created a model with ifs ands or maybes that doesn’t make it a gospel,” the New Jersey Republican said. “That is somebody’s opinion at CBO.” MacArthur was then asked if lawmakers don’t trust the CBO, what should they do to evaluate legislation. He responded that the CBO score is just a data point, and other ones lawmakers should consider include insurers and businesses.
More mixed messages: Ryan’s initial cheery mood on the score was evident in a statement that said the CBO score confirms the AHCA would lower premiums and the deficit. However, about a half an hour later Health and Human Services Secretary Tom Price said the CBO score was wrong. “The CBO was wrong when they analyzed Obamacare’s effect on cost and coverage, and they are wrong again,” he said. So which is it?
America’s Health Insurance Plans writes wish list for GOP Senate: Senate Finance Committee Chairman Orrin Hatch, R-Utah, asked the industry for its recommendations. The insurance group asked for more certainty through 2019 that the exchanges would continue to operate as they have been, and asked for better cost controls on healthcare as well as adequate federal funding when considering high-risk pools or changes to Medicaid. The government also would need to find a way to incentivize people to obtain health insurance if the individual mandate is repealed.
Lawmaker stands by bill: Rep. Brian Mast, R-Fla., was a last-minute switch to support the AHCA and told reporters he stands by it even after the CBO score. When asked about the score’s estimate that people with pre-existing conditions could have to pay more money under the bill, Mast replied, “I think it’s great all of the different ways we cover pre-existing conditions,” he said before going to final votes before a week-long recess. “There are about four different layers that exist to cover pre-existing conditions.”
Blue Cross gives itself wiggle room: Blue Cross Blue Shield requests rate increases of 22.9 percent in North Carolina but said the request would drop to 8.8 percent if the federal government agrees to fund cost-sharing reduction subsidies. “We’re seeing the market begin to stabilize after three years of coverage,” Brian Tajlili, director of actuarial and pricing services for Blue Cross N.C., said to a local ABC affiliate. “Unfortunately, the lack of CSR funding significantly increases the rates for all ACA customers. We are still required to offer the additional CSR benefits to participate in the exchange, so covering these costs without CSR funding will drive up our average rate for next year.”
RUNDOWN
STAT News Andy Slavitt can’t stop: How a healthcare wonk became a rabble rouser
Axios Experts weigh in on how to prepare for the next pandemic
Politico Healthcare or Russia? Democrats divided on 2018 focus
Washington Post Senate Republicans have all the evidence they need to reject the House-passed healthcare overhaul
New York Times Nevada and Connecticut are latest states to ban discredited “conversion therapy”
NPR The Zika virus made it to Miami much earlier than previously thought
Wall Street Journal FDA chief proposes rules change to fight high drug prices
Calendar
CALENDAR
THURSDAY | MAY 25
House Budget Committee hearing on the president’s fiscal 2018 budget with OMB Director Mick Mulvaney. Began 9:45 a.m. Details.
House Appropriations Committee budget hearing on the Food and Drug Administration with FDA Commissioner Scott Gottlieb. Began 10 a.m. Details.
12:25 p.m. 1789 Massachusetts Ave, NW. AEI. Remarks from Mark Coffman, R-Colo., on “From War to Work: Saving Veterans from the Disability Trap.” Details.
MONDAY | MAY 29
Memorial Day holiday. Congress in recess for the week.
WEDNESDAY | MAY 31
10 a.m. 1225 I St. NW, Suite 1000. Bipartisan Policy Center. Discussion on “Stabilizing the Individual Insurance Market” that includes Tom Daschle, former Senate Majority Leader; Mila Kofman, executive director of the D.C. Health Benefit Exchange Authority; and Brad Wilson, president and CEO of Blue Cross and Blue Shield of North Carolina. Details.
Noon. The Big Cities Health Coalition, the National Association of County and City Health Officials and the March of Dimes will host a webinar for reporters to discuss the threat posed by the Zika virus this summer.
