Daily on Healthcare: Where Republicans stand on Obamacare overhaul

Here’s where Republicans stand on Obamacare overhaul. Senate Republicans emerged from a closed-door meeting Tuesday pledging they will make another attempt at an Obamacare overhaul bill before a Sept. 30 deadline. “There is a lot of interest in the bill Senator [Lindsey] Graham and Senator Cassidy have been working on,” Majority Leader Mitch McConnell, R-Ky., said after the meeting. Graham said he “has never felt better about where we are at. At the end of the day, I really believe we are going to get 50 Republican votes, and I make a prediction,” he said. While the measure has developed sudden momentum, it has yet to earn the backing of the minimum 50 GOP votes that would be needed to pass it with Vice President Mike Pence serving as the tiebreaker. Key holdouts include Sen. Lisa Murkowski of Alaska, whose governor came out against the Graham-Cassidy bill Tuesday afternoon, and Sen. Susan Collins of Maine, who told reporters Tuesday she is waiting to see a Congressional Budget Office analysis and also introduced a reinsurance bill later in the day. “It seems to have many of the same flaws of the bill that we rejected previously,” Collins said. “In fact it has some additional flaws because it has some language that leads me to believe people with pre-existing conditions might not be protected in some states.” Sen. Rand Paul of Kentucky said he opposes the bill because it does not fully repeal Obamacare. Sen. John McCain of Arizona, who voted against the last attempt to repeal and replace Obamacare, is undecided. He has complained the measure was not churned through the full deliberative process in the Senate and that it would lack a full CBO analysis. The CBO plans to release a preliminary score by next week but not a detailed analysis of the impact of the bill. “It’s an important issue to me,” McCain said Tuesday. But he may be more likely to back the bill because it has earned the support of Arizona Gov. Doug Ducey and is sponsored by Graham, who is perhaps his closest friend in the Senate. Senators on Tuesday left town for the rest of the week with no clear plan on when to bring up the bill.

How Graham-Cassidy could kill idea of interstate purchasing of insurance. The idea of allowing insurers to sell policies across state lines has been one of the few consistent parts of President Trump’s healthcare rhetoric. It’s an idea that many conservatives have advocated for decades as a way to bring down costs through added competition and choice. But if Republicans pass something along the lines of the Graham-Cassidy bill, the concept likely will have to be discarded. The reason is that one of the central selling points of Graham-Cassidy, which would give Obamacare’s funding to the states as block grants, is that every state can choose its own healthcare system. To conservative states, it offers the promise of more flexibility to get around Obamacare’s regulations. But to liberal ones that like Obamacare, it promises that they can keep it. Adding the concept of interstate purchasing to such a system would seriously undermine that promise. It would mean that a state couldn’t necessarily keep Obamacare, because if another state had a looser regulatory environment, healthier residents could choose to buy insurance there, rocking the market. Liberals have often attacked the idea of interstate purchases of insurance as a “race to the bottom,” and that argument will become politically toxic for Republicans if they pass a bill on the basis that every state can choose its own path.

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.

Analysis: Bill could lead to $4 trillion in funding cuts over 20 years. Analyses of Graham-Cassidy are starting to show the bill could have severe cuts for some states as well as states overall. States would get federal health funding cut by $215 billion through 2026 and by as much as $4 trillion over 20 years, according to an analysis from consulting firm Avalere Health. The funding under the bill expires in 2026, creating a funding cliff in 2027, and Avalere anticipated more spending reductions after that. Supporters of the bill spearheaded by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana say funding would be reauthorized by Congress, but Avalere said it can’t say for certain. Even if the funding is reauthorized, it could be “constrained by the need to offset the costs,” Avalere said. “As such, by 2027, states would see significantly larger declines in funding compared to current law.” Avalere projected total federal funding to states would be cut by $489 billion through 2027. In the following decade, the cuts likely would grow because of a shift to lower Medicaid growth rates in 2026 and if the block grants don’t get funded beyond 2026. The bill seeks to eventually convert all of Medicaid to a per-capita system, which provides money to states per beneficiary. Avalere said the growth rate for those caps would slow in 2025. The combination of lower rates and block grant funding ending in 2026 means significant cuts to states through 2036, Avalere found. It projected that ffederal funding would get cut by $4.15 trillion from 2020 to 2036. “Federal funding restrictions range from $4 billion in South Dakota to $800 billion in California,” the firm said.

Bipartisan deal to stabilize Obamacare collapses. The Senate Health, Education, Labor and Pensions Committee on Tuesday abandoned efforts at reaching a bipartisan deal to help stabilize the health insurance exchanges under Obamacare, saying they were unable to arrive at a consensus. Sen. Lamar Alexander, HELP Committee chairman, wanted to see more flexibility for states in terms of crafting their own healthcare plans, as well as one year of funding for cost-sharing reduction subsidies. Sen. Patty Murray, the committee’s top Democrat, had raised concerns about whether the flexibility requested would jeopardize Obamacare’s protections for people with pre-existing illnesses or would mean higher costs for maternity care or mental health. “Senator Murray and I had hoped to agree early this week on a limited, bipartisan plan to stabilize 2018 premiums in the individual health insurance market that we could take to Senate leaders by the end of the month,” Alexander said. “During the last month, we have worked hard and in good faith, but have not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted.” He did not detail their disagreements, and Murray said she believed she had made “tough concessions” to Republicans on state flexibility. “If anybody is walking away, it’s only the GOP. Democrats are ready to make a deal,” tweeted Matt House, spokesman for Senate Minority Leader Chuck Schumer. Murray said she was “disappointed” the effort had been halted in favor of “trying to jam through a partisan Trumpcare bill, but I am confident that we can reach a deal if we keep working together, and I am committed to getting that done.”

Graham bullish on House passage. House Speaker Paul Ryan has said the House would pass the Senate Obamacare overhaul bill, according to Graham. “Paul Ryan told me to my face, ‘if you pass it, we pass it,'” Graham told reporters Tuesday. If the bill gets through the Senate, the House would not be able to make any changes. It is not clear if Ryan has the votes to pass the legislation. The House Obamacare repeal bill squeaked through in May, and only after Ryan was able to add sweeteners to entice members. Already some Republican members from New York and California, which would lose out under the bill, are skeptical.

Trump, Pence working the phones. Pence said he and Trump are personally working the phones to help Senate Republicans succeed in their last-ditch effort to overhaul Obamacare. As Pence departed New York on Air Force Two after watching Trump’s speech to the U.N. General Assembly, he met extensively with Graham, who has led the push to rally support for the Graham-Cassidy healthcare bill and who flew with Pence from New York to Washington. Pence and other senior administration officials have phoned senators to express their support for Graham-Cassidy, the vice president and Graham told a reporter traveling with them back to Washington for the Senate policy lunch. Pence has even called Democrat Sen. Joe Manchin of West Virginia to gauge his position on the healthcare bill. Graham said Trump had called him late Monday evening to convey his desire to see the Obamacare repeal measure pass. He noted Trump’s tenacity in the healthcare push has given him a newfound appreciation for the president. The South Carolina Republican also touted his unlikely partnership with Steve Bannon, the ousted White House chief strategist who Graham referred to as “Darth Vader.” “I have got Alan Greenspan, Jeb Bush and Steve Bannon” behind this bill, Graham said. “If anyone can do better, I’d like to meet them.”

Trump urges ‘negative force’ Rand Paul to jump on board. President Trump on Wednesday urged Sen. Rand Paul, R-Ky., to stopopposing the Senate’s last-ditch effort to radically alter Obamacare by giving states control of billions of dollars in healthcare funding. “Rand Paul is a friend of mine but he is such a negative force when it comes to fixing healthcare. Graham-Cassidy Bill is GREAT! Ends Ocare!” Trump tweeted. “I hope Republican Senators will vote for Graham-Cassidy and fulfill their promise to Repeal & Replace ObamaCare. Money direct to States!” It remains unlikely the president’s tweet would change Paul’s mind. Since the bill was released last month, Paul has repeatedly criticized it for not fully repealing Obamacare and keeping too much of the law’s taxes. Key among his criticisms are that the bill keeps in $1.2 trillion in Obamacare’s funding.

Plurality of voters support single payer but less federal control over healthcare. A plurality of voters hold some degree of support for a single-payer system in which they would receive health insurance from the government, finds a poll released Wednesday by Politico and Morning Consult. Of respondents to the poll, 24 percent said they “strongly” support such a system and 25 percent said they “somewhat” support such a system. But when respondents were asked what degree of control they thought the federal government should have over the U.S. healthcare system, 39 percent said it should have less control while 26 percent said they thought the government should have more control. The poll also asked respondents to share how they felt about the government offering a public option. It had slightly less support than a proposal about single-payer, according to the poll, which found that 15 percent “strongly” support a public option while 29 percent “somewhat” support it.  Slightly more voters said that the private sector should have less control over the U.S. healthcare system, 32 percent, compared to 28 percent who said it should have more control.

Jimmy Kimmel: Cassidy ‘not very honest’ in healthcare proposal. Comedian and ABC television host Jimmy Kimmel slammed the Graham-Cassidy proposal Tuesday night on his show “Jimmy Kimmel Live.” Kimmel showed footage of Cassidy, R-La., from May when the senator said he would support a bill that would ensure no child could be denied healthcare, if a family could not afford it. He dubbed this “the Jimmy Kimmel test.” In May, Kimmel’s son was born with congenital heart disease and received open heart surgery shortly after his birth. Kimmel said Cassidy was “not very honest” and that the measure, introduced also by Sen. Lindsey Graham, R-S.C., would pass Kimmel’s test in only the most literal sense. “With this one, your child with pre-existing conditions will get the care he needs, if and only if your father is Jimmy Kimmel, otherwise you might be screwed,” he said.

Re-upping opinion piece: Jimmy Kimmel is everything that’s wrong with America’s healthcare debate.

Chuck Schumer: GOP will get ‘clobbered’ if 2018 midterms are a referendum on healthcare. The Senate minority leader said Tuesday Republicans will get “clobbered” in the 2018 midterm elections because of healthcare. “We’re doing this because we care about people,” Schumer said of Democrats’ ramped-up opposition to the bill during the Senate Democrats’ weekly press conference. “If the 2018 election is a referendum on Trumpcare, they’re going to get clobbered, and they know it.” The New York Democrat said GOP senators should be walking around with “blindfolds” on over the Graham-Cassidy healthcare bill. “Our Republican colleagues should be walking around with blindfolds because they don’t want to see what’s in the bill they are being forced to vote for,” Schumer said, adding once more that they are “ashamed” of the legislation put forward.

Democrats declare ’emergency’ to defend Obamacare. House Minority Leader Nancy Pelosi urged Democrats in an “emergency request” to hold town hall meetings and press conferences and to fire off a “tweet storm” this week to help kill the momentum building behind a last-ditch GOP plan to overhaul Obamacare. “It is all hands on deck to defeat the latest version of Trumpcare, Graham-Cassidy,” Pelosi wrote to House Democrats Tuesday. Democrats, Pelosi said, “will be fully mobilized to amplify the organizing of outside groups and lift up the voices of families who would be devastated by Trumpcare.” Pelosi said Saturday would be a “day of action” against the GOP measure.

15 GOP governors support Obamacare overhaul. A group of 15 Republican governors called Tuesday for senators to support an overhaul of the “broken” Obamacare system. The governors sent a letter to McConnell on Tuesday outlining their support. The governors touted the use of block grants to reform welfare in 1996, just as the latest healthcare bill aims to provide the law’s funding for Medicaid expansion and Obamacare’s tax credits through block grants. “Adequately funded block grants to the states, along with maximum flexibility and control, is the best option on the table,” the governors said. “We call on the members of the United States Senate to move quickly to repeal Obamacare and replace it with flexible block grants to the states.” The governors who signed the letter were Scott Walker of Wisconsin, Asa Hutchinson of Arkansas, Eric Holcomb of Indiana, Kim Reynolds of Iowa, Sam Brownback of Kansas, Matt Bevin of Kentucky, Paul LePage of Maine, Phil Bryant of Mississippi, Eric Greitens of Missouri, Pete Ricketts of Nebraska, Doug Burgum of North Dakota, Mary Fallin of Oklahoma, Dennis Daugaard of South Dakota, Bill Haslam of Tennessee, and Gary Herbert of Utah.

But bipartisan group of 11 governors oppose overhaul. Ten governors sent a letter to Senate leaders calling for them not to consider an overhaul bill. The governors slammed the process Republicans are using to bring forward the bill, which was released last week. “Legislation should receive consideration under regular order, including hearings in health committees and input from the appropriate health-related parties,” the governors wrote. Alaska Gov. Bill Walker, an independent, Republican Govs. Brian Sandoval of Nevada, John Kasich of Ohio, Phil Scott of Vermont, Charles Baker of Massachusetts, and Democratic Govs. John Hickenlooper of Colorado, Steve Bullock of Montana, Terry McAuliffe of Virginia, Tom Wolf of Pennsylvania and John Bel Edwards of Louisiana signed the letter. Republican Gov. Larry Hogan of Maryland also announced his opposition to the bill.

Freedomworks says it won’t stand in the way of Graham-Cassidy. The conservative activist group signaled Wednesday that it will not oppose the Graham-Cassidy bill. “Although this amendment fails to meet more than seven years of promises to repeal Obamacare and does not truly represent an approach grounded in the principles of federalism, there is a path to win our support,” FreedomWorks President Adam Brandon said. He said Graham-Cassidy should be a “step” toward repealing Obamacare and called on lawmakers to tweak the bill to make it harder for the executive branch to deny state Obamacare waivers and to ensure Congress does not perpetually renew Obamacare’s expanded Medicaid funding. Brandon said FreedomWorks is “encouraged” by legislation’s provisions providing more flexibility to the states to waive Obamacare regulations “that are driving up the cost of health insurance coverage.”

Graham: Bernie Sanders helps lift up Graham-Cassidy. Graham is crediting Sen. Bernie Sanders’ latest push for socialized healthcare for the momentum the GOP legislation is gaining. “It was the gift from the political gods,” Graham said Tuesday when asked about Sanders’ impact on his legislation. Sanders announced his Medicare for All bill, which would create a government-run healthcare program, on the same day that Graham and three other Republicans released their last shot at dismantling Obamacare. Graham called the Obamacare overhaul bill “Bernie Sanders’ worst nightmare.” When asked if Sanders’ rollout helped in selling the bill to a Republican caucus anxious about taking on Obamacare repeal again, Graham quickly responded, “totally.”

Major hospital group opposes Obamacare overhaul. The American Hospital Association said it opposes Graham-Cassidy. “We believe that coverage could be at risk for tens of millions” under the bill, said Rick Pollack, president and CEO of the American Hospital Association. “We continue to urge senators to work in a bipartisan manner to address the challenges facing our healthcare system.” It is the latest major healthcare group to oppose the last-ditch effort. The American Medical  Association and a slew of healthcare groups have also come out in opposition.

Cassidy battles with Louisiana health official. Cassidy is fighting with his state’s top health official over how his Obamacare overhaul bill would affect healthcare access. Louisiana Secretary of the Department of Health Rebekah Gee wrote to Cassidy Monday, saying the harm to Louisiana from the bill “far outweighs any benefits.” Cassidy responded on Tuesday that she was using faulty numbers and she wants to continue Obamacare mandates that are hurting state residents.

Tom Price took five private jets for official business. Health and Human Services Secretary Tom Price flew in private jets on five occasions to carry out official business last week, costing tens of thousands of dollars more than a commercial travel bill and breaking away from the status quo of previous secretaries. Internal HHS documents reveal he visited a resort in Maine to join a question-and-answer session with a healthcare industry CEO and New Hampshire and Pennsylvania to visit community health centers, Politico reported. The three sites where Price made appearances confirmed they did not pay for Price’s flights. HHS declined to comment on how the flights were paid for, but said Price occasionally charters flights when commercial ones are not available. “As part of the HHS mission to enhance and protect the health and well-being of the American people, Secretary Price travels on occasion outside Washington to meet face to face with the American people to hear their thoughts and concerns firsthand,” an HHS spokesman said. “When commercial aircraft cannot reasonably accommodate travel requirements, charter aircraft can be used for official travel.” This means of travel deviates from the practice followed by Obama administration HHS officials. For example, former HHS Secretaries Sylvia Matthews Burwell and Kathleen Sebelius flew commercially while traveling in the U.S.

RUNDOWN

The Hill The two senators who will likely decide fate of Obamacare repeal

Politico Republicans rip Rand Paul for rejecting Obamacare repeal

STAT News Last-ditch Obamacare repeal bill could upend markets for the elderly, women, people with heart problems

Kaiser Health News In stark contrast to Obamacare plans, premiums for job-based plans show modest rise

New York Times A stress link to lupus

Nevada Independent In new ad, liberal super PAC attacks Heller over healthcare bill

Roll Call Bipartisan healthcare talks shut down amid rush to repeal

Forbes After 20 years, a drug that silences genes succeeds

Calendar

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. 215 Dirksen. Senate Finance Committee to hold a hearing on the Graham-Cassidy-Heller-Johnson proposal. Details.

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.

WEDNESDAY | Sept. 27

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.