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Why we’re not betting on a healthcare vote next week: For weeks, Senate Majority Leader Mitch McConnell, R-Ky., has been signaling that he’d like to have a vote on a healthcare bill before the July 4th recess – which now effectively means voting on legislation by the end of next week. Sen. Bob Corker, R-Tenn., raised eyebrows on Tuesday morning by saying he expected legislative text on Thursday and a vote next week. Though anything is possible if all the ducks line up perfectly, the prospect of a vote coming so soon should still be viewed as very remote. For a vote to happen in the next 10 days, Republicans would have to complete the legislative text, obtain a score from the Congressional Budget Office, and have a critical mass of Republicans agree to the bill’s details. It’s theoretically possible that, because Republican Senators have been given a rough outline of some elements of the bill, and that the drafters have been sending parts to the CBO as they write it, that everything could come together. But it’s unlikely that everything will come together in such a perfect storm.
Though the broader caucus has only been given basic bullet points on what’s in the developing legislation, the details that have come out have been a big disappointment to conservatives, as policy has been to the left of the House bill in key ways – more upfront spending to prop up Obamacare markets, a slower phase out of the Medicaid expansion, tax credit subsidies that more closely resemble Obamacare, and less leeway for states to waive Obamacare regulations. And centrists have raised concerns about everything from Planned Parenthood defunding to projected coverage losses. Though it’s theoretically possible that McConnell could throw a bill on the floor even at risk of it getting voted down – daring Senators to vote “no” – there’s no reason to expect he will. This isn’t a situation in which there is a hard deadline, such as with a government funding bill or the expiration of tax cuts on a specific date. If McConnell doesn’t have the votes, but he thinks he can get there with more time to hash out a compromise, there’s no reason why he wouldn’t wait. Regardless of whether it actually happens, however, creating an impression that a July 4th vote is a real possibility is a way to help keep the process moving along and make as much progress as possible before the Senate adjourn, with the more genuine hope of a vote before Congress leaves for a month long August recess.
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.
Sen. Mitch McConnell outlines healthcare priorities: He said stabilizing the Obamacare insurance markets is a top priority for the GOP as it works to rewrite the embattled health care law, signaling the party backs subsidies for insurance companies that President Trump has threatened to withhold. In addition, he said, the GOP healthcare legislation seeks to “free Americans from the Obamacare mandates which forced them to buy insurance that they don’t want.” Republicans are also seeking to lower premiums for health insurance, McConnell said, and to “strengthen Medicaid for those who need it most,” as well as preserve access to care for people with pre-existing conditions, who are currently protected under Obamacare. McConnell did not signal when Republicans will take up a health care bill, but said lawmakers “will continue working,” because Obamacare is collapsing. “The American people deserve relief and we’ll keep working to provide it,” he said.
But priorities may collide with desires of House conservatives. The 151-member Republican Study Committee is sending a letter to Senate Majority Leader Mitch McConnell, R-Ky., detailing what the group’s members want to see in a bill repealing and replacing portions of Obamacare, raising new questions about whether Republicans will be able to come together to pass the legislation. This includes phasing out Medicaid expansion beginning in 2020, repealing Obamacare’s taxes, cutting off family planning funding from medical facilities that also perform abortions, and prohibiting tax credits from going to health plans that cover abortions. The Republican Study Committee continues to support a controversial amendment that would allow some states to apply for waivers to opt out of insurance mandates, including the obligation for insurers to cover a range of medical benefits, and for them to charge people who are the same age the same amount for coverage regardless of their healthcare status. Centrists in both the House and Senate have raised concerns about these waivers because they worry that they would make insurance prohibitively expensive for people with pre-existing illnesses, an outcome was projected by the Congressional Budget Office. In comparison, last week President Trump asked key Senators to make the bill less “mean.”
Democrats complain about GOP healthcare process, but can’t stop it. Democrats on Monday harshly criticized Republicans for drafting its version of the American Health Care Act behind closed doors and without Senate hearings. “Most Republicans don’t have a clue what is in that legislation. I should think every Republican should be embarrassed,” Sen. Bernie Sanders, I-Vt., said on the Senate floor. “This is an insult to the American people,” added Sen. Catherine Cortez Masto, D-Nev. Senate Democrats will start objecting to all unanimous consent requests in the Senate, a procedure used to curtail debate on noncontroversial bills, a senior Senate Democratic aide said. Democrats are also issuing unanimous consent requests to attempt to force the AHCA to a committee, but Republican leadership has squashed those requests so far. However, other than gumming up the works there isn’t much that Democrats can do to prevent the bill from reaching the floor or getting out of the Senate.
Sen. Chuck Schumer: Senate Republicans ‘shouldn’t expect business as usual’ from Democrats over healthcare. “If Republicans won’t relent and debate their healthcare bill in the open for the American people to see, they shouldn’t expect business as usual in the Senate,” he said. “This radical departure from normal procedure on a bill of such consequence leaves the Senate minority with little choice but to depart from normal procedure as well.” He added that Senate Democrats will “begin objecting to all unanimous consent requests” in the Senate, save for honorary resolutions, beginning Monday night and would ask for the American Health Care Act to be referred to committee.
Poll: Few Americans like GOP’s closed door process: A new poll finds the secrecy behind the GOP’s drafting of a healthcare bill isn’t sitting well with wide swaths of the public. About 73 percent of respondents to a poll from CBS News believe that Senate Republicans should discuss their plans publicly, and only 25 percent say it should be privately. About 56 percent of Republicans and 81 percent of Democrats surveyed decried the secrecy. Meanwhile, 41 percent of Republicans are fine with a private approach as opposed to only 18 percent of Democrats and 22 percent of independents. The poll’s findings come at a critical time for the GOP’s efforts to pass healthcare reform in the Senate. Majority Leader Mitch McConnell hopes to get a vote on healthcare before the week long July 4 recess. The poll was of 1,117 adults and had a margin of error of four percentage points.
Republicans point to Obamacare to defend their healthcare process. “The last time I had a major piece of legislation on healthcare they gave me 30 minutes and it was 3,000 pages,” said Sen. James Risch, R-Idaho, on Monday. He added that whatever the Senate comes up with would be “a lot shorter than 3,000 pages.” Reporters asked Sen. Chuck Grassley, R-Iowa, whether the GOP’s process on the healthcare bill was a new template for lawmaking. “It follows what [then Senate Majority Leader Harry] Reid did in November and December of 2009,” he said in response. He was then asked how long he needed to review a healthcare bill before voting. “I hope they get more time than we had on Christmas Eve when Reid produced his bill,” he responded. Democrats on the Senate floor made the point that the passage of Obamacare was much more transparent, saying Republicans won’t allow them to see the bill, let alone amend it. “From 2009 to 2010, the Senate Finance Committee held more than 53 hearings on health reform,” said Sen. Debbie Stabenow, D-Mich., who was on the panel at the time. “During the finance committee markup when we were working through and voting out the bill, we considered 135 amendments often late into the night.”
Higher premiums, fewer insurers expected in Obamacare next year. Proposed 2018 exchange premiums for the silver plan, the most popular of Obamacare’s three metal plan tiers, are 18 percent higher than this year, according to an analysis from the healthcare research firm Avalere Health. The data is based on the eight states that have submitted early rate filings from insurers. Avalere posits that both sides are to blame. The firm notes that uncertainty around the future of Obamacare and the law’s cost-sharing reduction payments to insurers are likely contributors to premium growth. But there are serious problems connected to Obamacare that are also contributors. These include inadequate risk mitigation strategies, poor enrollment and declining plan participation, Avalere said.
Health insurers ask for double-digit rate hikes in Washington state, and an insurer fills one of the state’s “empty” counties. Health insurers who plan to sell coverage on the Obamacare exchange in Washington state next year have asked for a 22.3 percent increase on average for the cost of monthly premiums, with state officials blaming the uncertainty caused by the Trump administration. Grays Harbor county was facing the prospect of no insurers, but Premera Blue Cross said shortly after the rate hike proposal announcement that it would be offering plans there. Residents of Klickitat county, however, continue to face the possibility of having no insurer to buy plans from next year, even though seven insurers applied to sell plans in the state overall.
Ivanka Trump talks paid family leave in Tuesday meeting with Rubio, Fischer. President Trump’s daughter, also a mother of three children, has called for six weeks of mandatory paid leave for mothers and fathers. The policy has struggled to gain support from conservatives but has won backing from some centrists.Trump’s proposal would have to be carried out by businesses, which is a conflict of interest to Republicans who say the government should not attempt to tax or impose mandates on the private sector. Rubio and Fischer have each been proponents on the issue. This year, Fischer introduced a bill to give tax credits to companies that offer employees paid maternity and paternity leave. Rubio backed the idea during his presidential campaign in 2016.
FDA guidance aims to take on drug prices: The Food and Drug Administration released regulatory guidance that tells drug makers how they can jump ahead in the approval process and get to market faster. The agency’s guidance tells drug makers what they need to submit in order to become a priority generic drug, which gets a faster review time. A priority generic is a drug that can compete with a drug that is at a high price or is in shortage. Under a new user fee program that still needs to be reauthorized by Congress, the FDA agreed to shorten the review of priority generics by two months. Normally it takes about 10 months for a generic to get approved, and the new pathway would let a drug be approved within 8 months. The faster process is in response to criticism from Congress that the FDA takes too long to approve new generics to compete with high-priced products. Some of the most egregious price spikes have been generics that are older and have no competition. A drug maker swoops in and buys the rights to the generic and then jacks up the price.A long lag time for FDA approval has been pegged by lawmakers as a reason for the lack of competition that let high prices to run rampant.
Aetna details opioid reduction strategy. In a letter to senators, the health insurance giant shared its goals for tackling opioid addiction. By 2022 the company plans to increase the number of customers on medication assisted treatment who have opioid use disorder by 50 percent, reduce inappropriate prescribing by 50 percent and increase the number of those treated for chronic pain through different approaches by 50 percent. Beginning last year it alerted providers who tended to have the highest rates of prescribing opioids of their habits, and sent along education materials, resulting in a overall decrease in prescribing for these painkillers by 7 percent. In March 2017, the company removed preauthorization requirements for customers to get buprenorphine, a drug that helps assuage the symptoms of withdrawal for people with opioid addictions. The letter was signed by Aetna’s chairman and CEO, Mark Bertolini.
OPINION: Why the GOP is struggling to repeal Obamacare. “It’s almost July and the Republican Party has yet to repeal Obamacare due to divisions within its own ranks. Everything that we thought we knew about the GOP suggests that this should not be the case. What explains this sudden change in the policy views of Republicans? One explanation is that party affiliation is not as important as previously thought in explaining member behavior once in office. But far from suggesting that parties don’t matter, the GOP’s present struggles demonstrate that parties matter in a different way. Obamacare’s fate ultimately depends on how Republicans view their party,” writes James Wallner.
RUNDOWN
Washington Post In just one year, nearly 1.3 million Americans needed hospital care for opioid-related issues
Axios How state laws treat sexual assault, pre-existing conditions
The Hill A frantic scramble before possible healthcare vote this week
New York Times The Senate is close to a healthcare bill, but do they have the votes?
STAT News New York City officials detect mosquitoes carrying the West Nile virus
Boston Globe Susan Collins won’t back down on healthcare, and that is a problem for Mitch McConnell
Roll Call Senate Democrats can’t slow GOP health bill once it’s written
Atlanta Journal-Constitution Rural Georgia hospital gets a reprieve
Calendar
TUESDAY | JUNE 20
June 19-22. San Diego Convention Center. 111 W Harbor Dr. Biotechnology Innovation Organization annual convention. Details.
10:30 a.m. Dirksen 192. Senate Appropriations hearing on FDA’s budget. Details.
Noon. Rayburn 2103. Briefing on neuroscience research with the Congressional Neuroscience Caucus.
4:30 p.m. Carnegie Library. 801 K St. NW. Bipartisan Policy Center panel discussion on documentary “Unseen Enemy” with Johnson & Johnson and the Blue Ribbon Study Panel. Details.
WEDNESDAY | JUNE 21
11:30 a.m. National Press Club. Roundtable on “Healthcare in the Trump Era: Politics, policy and people.” Details.
THURSDAY | JUNE 22
Mylan annual shareholder meeting.
10 a.m. Dirksen 138. Senate Appropriations committee hearing on NIH’s budget. Details.
FRIDAY | JUNE 23
9 a.m. 2123 Rayburn. House Energy and Commerce Committee hearing on CHIP reauthorization. Details.
MONDAY | JUNE 27
