Daily on Healthcare: Trump meets with GOP leadership…draft of healthcare bill is near…is Obamacare the Republicans’ BATNA?

Do Republicans see keeping Obamacare as their BATNA? Sen. Lindsey Graham on Monday became the latest Republican senator to express skepticism about the ability of Republicans to pass a healthcare bill this year. “I don’t think we can put it together among ourselves,” the South Carolina senator told reporters. He went on to say, “I’ve always believed let Obamacare collapse … that has always been my preferred route.” In the spheres of business and international relations, academics often refer to the Best Alternative to a Negotiated Agreement, or BATNA, which is the best of the options available to parties if they fail to reach a deal. As healthcare talks stall in the Senate, Obamacare may be emerging as the BATNA. President Trump himself has expressed similar sentiments, saying on many occasions that if he were to just let Obamacare implode, it would force Democrats to the negotiating table to cut a deal to save it. There are certainly a number of centrist Republicans who have been supportive of the Medicaid expansion and Obamacare’s regulatory framework and are pushing for more generous income-based subsidies for individuals. All of those changes would make a Republican replacement more like Obamacare than the House-passed bill, which already conceded a lot to Obamacare. Will these centrists shed tears if the replacement effort fails?

As tempting as it may be for some senators to default to Obamacare, the problem that Republicans face is that the status quo is unsustainable. Insurers continue to lose money, seek higher premiums and exit markets. That is leaving individuals in many states with dwindling choices and higher costs. And though Democrats want to blame all of that on uncertainty caused by Republican repeal efforts, in reality it is only a partial explanation. The problems pre-date Trump’s election (indeed, Obamacare’s woes contributed to his election as news of rate hikes came out in the weeks leading up to Election Day). So, if Republicans simply “let Obamacare fail” they will have to defend the chaos in insurance markets during the 2018 election year to the broad electorate while explaining to their base why they didn’t deliver on their long-standing promise to repeal and replace Obamacare. Spokeswoman for the conservative House Freedom Caucus, Alyssa Farah, is already pushing this very point. “Repubs shouldn’t see failure to act as an option,” she tweeted in response to Graham’s remarks. “This is what they ran on for 6 yrs!”

Trump meets with GOP leadership: Bereft of big legislative victories, Trump is expected to meet with GOP House and Senate leaders to come up with a game plan for pushing a healthcare bill across the finish line. The meeting is expected to be held this afternoon and will feature House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell alongside other members of leadership for both chambers. The meeting comes as Trump is still searching for a major legislative victory, with healthcare reform stalling in the Senate and tax reform set in a quagmire. “Big meeting today with Republican leadership concerning Tax Cuts and Healthcare,” Trump wrote on Twitter. “We are all pushing hard — must get it right!”

Draft of healthcare bill is near: The Trump administration is encouraging a vote by the summer recess, and a draft Senate bill could be released this week, with a rough outline emerging as early as today. Sen. Pat Roberts, R-Kansas, told reporters that senators would see a “draft of the draft” for a bill Tuesday, and Sen. Ted Cruz, R-Texas, part of the initial healthcare working group, said they made steady progress but still had “quite a bit of work” to do. Medicaid spending levels and growth rates remain a major sticking point, among other issues. Senators stressed that the details were still being discussed, both at working group meetings happening twice a week and healthcare lunches being held three times a week. Sen. John Barrasso, part of the initial healthcare working group, said he expects the debate to continue. “I assume we will hear a lot from members about what they heard when they were at home and talk about different options that we have,” the Wyoming Republican said. In contrast to other senators, he said he was optimistic that Republicans could pass a bill this year, though he would not say whether the Senate would be able to vote before the summer recess. “I’m confident we’ll get a bill passed and get something working together with the House and get something the president is going to sign,” he said.

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.

Is Wellmark leaving the door open to re-entering the exchange in Iowa? The company’s CEO appeared to hint at this in an op-ed this weekend in the Des Moines Register, in making recommendations for stabilizing the exchange, such as a reinsurance program, and also commenting about off-exchange plans, where the company owns a large share of grandmothered plans sold in the state. When asked by the Washington Examiner to clarify the intent of the op-ed, spokeswoman Teresa Roof replied: “Our decision will depend on if the existing protections mentioned in the editorial are in place and if all three principles are true – no decision has been made but we are committed to being a part of an Iowa-based solution.”

TODAY: Senate to vote on bill making it easier to fire Veterans Affairs employees. The bipartisan legislation would reform civil service protections at the Department of Veterans Affairs, making it easier and faster to fire employees, including executives, and remove them from the payroll should they contest their dismissal. “I am thrilled to see the Senate moving quickly on this important piece of legislation, and I encourage my colleagues to support this measure as we take steps to change the culture at the VA and improve care for our veterans,” said Sen. Johnny Isakson, R-Ga., co-author of the Department of Veterans Affairs Accountability and Whistleblower Protection Act. “I thank Majority Leader [Mitch] McConnell, R-Ky., for his commitment to ensuring our veterans receive the quality care that they deserve.” The VA has been plagued with numerous scandals in recent years, most notably the manipulation of waiting lists for veterans, with some dying while waiting for treatment. A report by the VA’s Office of the Inspector General released last month confirmed that a Hines, Ill., hospital had food service areas so filthy that they had become infested with cockroaches. The vermin were even found on patients’ food trays. Congressional critics have argued that a major problem at the department is the existing civil service system, which makes it too difficult to discipline or fire employees found guilty of wrongdoing. Isakson’s bill, co-authored by Sens. Marco Rubio, R-Fla., and Jon Tester, D-Mont., would ease those restrictions as well as prohibit disciplined workers from getting bonuses or being compensated for being relocated. The legislation also would require the VA to evaluate supervisors on their ability to protect whistleblowers.

Trump: VA’s health IT modernization one of the “biggest wins for veterans in decades.” “Of course there’s still much work to do, but today’s action shows that determined leadership and what it can accomplish — great, great reform,” Trump said. VA Secretary David Shulkin announced Monday morning that the VA would be adopting the same electronic health records system as the Department of Defense, a move that follows calls for the VA to modernize its IT systems. “VA’s adoption of the same EHR system as DoD will ultimately result in all patient data residing in one common system and enable seamless care between the departments without the manual and electronic exchange and reconciliation of data between two separate systems,” Shulkin said. “It’s time to move forward, and as secretary, I was not willing to put this decision off any longer.”

Trump nomination: Robert Charrow of Maryland to be general counsel of Health and Human Services. Charrow is a principal shareholder in the Washingto office of Greenberg Traurig, LLP, where he specializes in litigation arising under the Administrative Procedure Act, the federal regulation of healthcare, and federal appellate litigation. Before joining Greenberg Traurig in 2002, he was with the law firm Crowell & Moring. Previously, he served as the deputy and then principal deputy general counsel for the U.S. Department of Health and Human Services.

Arizona Gov. Doug Ducey declares state of emergency over opioids. The state of emergency declaration directs the state’s department of health services to respond quickly to the drug epidemic, including by distributing the overdose-reversal drug naloxone throughout the state and educating doctors about prescribing painkillers. The declaration also directs the health department to increase access to medicines that help curb withdrawal symptoms for people who have addictions to opioids. “As the number of opioid overdoses and deaths increase at an alarming rate, we must take action,” Ducey said in a statement. “It’s time to call this what it is — an emergency … I’m declaring a statewide health emergency because we need to know more about the epidemic, including enhanced data that illustrates when and where these overdoses occur so that we can develop real, targeted solutions.” Maryland and Florida have made similar declarations.

User fees coming along: While the Senate haggles over what to do about Obamacare repeal, must-pass legislation to fund a big part of the Food and Drug Administration keeps chugging along. The House Energy and Commerce Committee is expected to meet Wednesday to advance legislation to reauthorize the FDA’s user fee program. Under the program, which must be renewed every five years, drug and device makers pay the FDA a fee as part of every new application and the agency uses that money to hire more people and speed up approval times. The Senate Health, Education, Labor and Pensions Committee advanced to the full Senate companion reauthorization legislation last month. Time is of the essence as Congress usually hopes to get the legislation wrapped up by July. The FDA’s user fee program expires at the end of the fiscal year in September, but the agency has said it will have to start sending pink slips to agency employees in July. The legislation has largely gone under the radar as Congress deals with other major issues such as Obamacare repeal, which has been bogged down in the Senate.

Puerto Rico says Zika outbreak over: Puerto Rico’s government officially declared an end to the raging Zika outbreak that infected thousands of people since 2016. The Puerto Rico Department of Heath said it has found few cases of Zika transmission now.

Zika is spread via mosquito bites and can cause the birth defect microcephaly. In 2016, Puerto Rico had nearly 35,000 cases of Zika, according to data from the Centers for Disease Control and Prevention. This year, the U.S. territory has had 460.

Senate panel to hold drug prices hearing: The Senate Health, Education, Labor and Pensions Committee is going to tackle high drug prices in a hearing scheduled for June 13. The hearing comes as Congress has done little this session to combat high drug prices, which polls have pegged as a major area of concern for consumers.

RUNDOWN

New York Times Obamacare didn’t destroy insurance markets, but it also didn’t fix them
STAT News Failure to warn: Hundreds died while taking arthritis drug but nobody alerted patients
The Hill Too many cooks threaten GOP healthcare bill
Politico Senate aims for June vote on healthcare
Roll Call The real 13 senators to watch on healthcare
Axios Opioid epidemic rises in intensity and scale
Washington Post Senate aims to conclude divisive healthcare push one way or the other
Associated Press Seattle city council OKs tax on soda, sugary drinks
Morning Consult Congressional Republicans losing voters’ trust on healthcare, other issues

Calendar

TUESDAY | JUNE 6

House back in session.

Meeting of the National Vaccine Advisory Committee for HHS. Agenda.

June 6-9. New York. Jefferies 2017 Global Healthcare Conference. Details.

Facebook hosting a Health Summit for drug companies. Details.

Information Technology and Innovation Foundation discussion on “Speeding Cures for Patients: How Congress Can Update the Prescription Drug User Fee Act to Spur Biopharmaceutical Innovation.” Began 10 a.m. Details.

3 p.m. President Trump meets with Republican leaders at the White House.

WEDNESDAY | JUNE 7

June 7-9. Austin, Texas. America’s Health Insurance Plans Institute and Expo. Agenda.

8 a.m. Newseum. Atlantic event on “The Next Drugs: An Atlantic Policy Update on Biosimilars.” Details.

10 a.m. 1300 Longworth. House Agriculture Committee hearing on “The Next Farm Bill: The Future of International Food Aid and Agricultural Development.” Details.

10 a.m. Bipartisan Policy Center. 1225 I St. NW. Discussion on “Preparing Healthcare Providers for Obesity Care.” Details.

10:30 a.m. American Enterprise Institute. 1789 Massachusetts Ave. NW. Discussion on policies around “Deaths of Despair: Opioid, Community and the Economy.” Details.

2 p.m. 1100 Longworth. House Ways and Means subcommittee on Health Medicare Advantage hearing on “Promoting Integrated and Coordinated Care for Medicare Beneficiaries.” Details.

THURSDAY | JUNE 8

June 8-June 11. Boston. Annual scientific meeting for the American Headache Society. Webcast.

8 a.m. Patient Safety Forum. Jacksonville University. Includes presentations by Florida Blue Foundation.

9 a.m. Reserve Officers Association. 1 Constitution Ave. NE. Health Affairs media-only briefing on the future of the Affordable Care Act with Texas Republican Reps. Michael Burgess and Gene Green.

9:45 a.m. 215 Dirksen. Senate Finance Committee hearing on President Trump’s budget with Health and Human Services Secretary Tom Price. Details.

10 a.m. 1100 Longworth. Joint Economic Committee holds hearing on “Economic Aspects of the Opioid Crisis.” Details.

10:15 a.m. 2322 Rayburn. House Energy and Commerce Hearing on “Examining the Role of the Department of Health and Human Services in Healthcare Cybersecurity.” Details.

1 p.m. 1100 Longworth. House Ways and Means Committee hearing on budget for the Department of Health and Human Services. Details.

TUESDAY | JUNE 13

8:30 a.m. State Room. Boston. The Atlantic conference on “Pulse: On the Front Lines of Health Care,” will explore topics ranging from policy and the economy to global public health and the future of biotechnology. Details.

8 a.m. 1777 F St. NW. Event hosted by The Hill on “Prioritizing Patients: A Discussion on Outcomes-Based Care,” with Sen. Bill Cassidy, R-La., and Rep. Doris Matsui, D-Calif. Details.

2:30 p.m. Dirksen 628. Senate Indian Affairs Committee will review bills involving the Indian Health Service and housing for Veterans Affairs. Details.