Daily on Healthcare: Democrats zero in on healthcare as Senate braces for tax fight

Democrats zero in on healthcare as Senate braces for tax fight. Democrats focused on healthcare, not taxes, in the first batch of amendments to the Senate Republican tax bill Wednesday night, trying to raise the alarm about how the bill would affect Obamacare by repealing its individual mandate. “This tax bill is now officially a healthcare bill,” Sen. Ron Wyden of Oregon, the ranking Democrat on the Senate Finance Committee, said Wednesday in the early going. Democrats on the panel offered several amendments to slow or undo the tax bill, the Tax Cuts and Jobs Act. One measure would require the Congressional Budget Office to certify that the bill would not increase uninsured rates or insurance premiums before the tax cuts could take effect. Another would have required the creation of a stability fund for state-run insurance exchanges. A third would have undone the corporate tax rate reduction if insurance coverage for substance abuse decreased. Other amendments would have required that the bill didn’t lead to less insurance coverage for veterans or rural Americans. Republicans voted down all the amendments or ruled them not in order.

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Trump to rally House Republicans in favor of tax reform. President Trump plans to drum up support for the Republican tax bill today when he makes the trek across town to address the House GOP conference. But he doesn’t plan to suggest any tweaks to the legislation Republican leaders hope to pass just hours after he departs, a White House official told the Washington Examiner Wednesday. “It doesn’t make a lot of sense to go in there and say, ‘Hey, let’s change a bunch of stuff, we’re going to vote on this thing in an hour,’” the official said. “He’s not going to go in there and ask for specific policy changes or anything like that in the House.” Trump has expressed hope that the tax reform bill Congress ultimately puts on his desk will repeal Obamacare’s individual mandate. Trump’s aim will be to “rally the troops in his own way,” however, and not to negotiate the details of the bill, the White House official said. “While we do have some prepared remarks, in these settings, there’s a good chance that he takes it in whatever direction he’s feeling at the moment,” the official said of preparations for Trump’s address to the GOP conference. “I can’t imagine that he’s going to get up there and give a buttoned-down speech.”

House Republicans express some support for adding individual mandate repeal to bill. On their way into the speech, congressmen, including Reps. Tom MacArthur and Dave Brat, told reporters the addition of the individual mandate in the Senate bill “complicates things” but that they were supportive of it. Rep. Mia Love, R-Utah, said, “What I would like to see them do is actually pass a bill. That should be their end goal … Whatever they do, if they don’t pass something it was for nothing.” Love also said she was in favor of funding cost-sharing reduction subsidies. “Until we are able to fix our healthcare system, absolutely,” she said.  

Kevin Brady: House Republicans have the votes to pass tax plan. House Ways and Means Committee Chairman Kevin Brady said Wednesday that House Republicans had the votes to pass their tax plan bill, which is scheduled to be brought to the floor Thursday. “Do we have some members who aren’t there yet? Yes,” Brady said. “But also, we have those members who are saying, ‘We’re hopeful for that final vote when we work out the differences with the Senate because I already know good ways we can continue to improve tax relief at every step.'” One difference that would have to be ironed out is the repeal of the Obamacare’s individual mandate penalties. House Speaker Paul Ryan said repealing the mandate will hinge on whether the Senate can pull it off. “It really is whether or not the Senate has the votes for this or not,” the Wisconsin Republican said Wednesday on CNBC. If the upper chamber can repeal the individual mandate penalties, “we’ll meet them in conference and assess at that time,” Ryan added, noting that his chamber has voted several times to undo the mandate.

Some key differences in tax bill await a reckoning in conference. The House bill likely to pass today could be substantially different from the one that emerges from a conference committee if the Senate passes its own version. For one thing, the Senate version includes the individual mandate repeal, while the House version does not. But there are other key differences related to healthcare. The House bill includes cutting the medical expense deduction, while the Senate bill leaves the deduction alone. Another major issue is what to do about the state and local tax deduction. The House bill cuts the deduction but the Senate eliminates it altogether. That could complicate things politically because of concerns from House Republicans in high-tax blue states such as New York and New Jersey. But some  health groups say that eliminating the tax deduction could have a spillover effect into healthcare. The Association for Community Affiliated Plans said in a letter to congressional leaders that eliminating the deduction would force states to cut Medicaid.

Republicans blame tax hikes on Obamacare. Sen. Orrin Hatch, R-Utah, used Obamacare to fight back over an analysis Thursday from the nonpartisan Joint Committee on Taxation that said the Senate tax bill would raise taxes on some middle-income earners. JCT said the revised tax bill would lower taxes on all income groups at first but then would increase taxes on middle-income families. Hatch brushed off some of those middle-income tax hikes by pointing to the repeal of the individual mandate. He noted that some people would choose not to buy Obamacare because they wouldn’t have to comply with the individual mandate and wouldn’t receive Obamacare tax credits, and some of the tax hikes on paper could reflect people not getting those credits. “This is the result of an assumption about economic behavior that is 100 percent voluntarily,” he said. Sen. Mike Crapo, R-Idaho, added that if someone chooses not to buy insurance then the or she wouldn’t see a tax increase. “This bill doesn’t take one dollar away from them or charge the one dollar more,” he said.

Some Democrats reluctant to join Chuck Schumer in opposing Obamacare deal. Some Democrats were reluctant to join Senate Minority Leader Chuck Schumer in opposing a bipartisan Obamacare stabilization deal if Republicans repeal the law’s individual mandate penalties in their tax reform legislation. Sen. Patty Murray, D-Wash., on Wednesday brushed off a question on whether she would reject the deal she created with Alexander. She instead focused on the problems repealing the individual mandate would create for insurance markets and how the deal won’t help with that. “The Alexander-Murray bill does not fix the problems that they are creating with their tax proposal,” she said. Repealing the mandate “means insurance premiums go up 10 percent more and 13 million people lose coverage.” Wyden said he strongly opposes the new version of the GOP tax reform bill but didn’t say if it would lead to his opposition of Alexander-Murray. Sen. Bob Casey, D-Pa., also wouldn’t say if he is committed to opposing the bipartisan deal if the repeal is included. “I’ve always believed we should try to make bipartisanship work,” he said.

Surgeon general: Trump administration not against coverage. Surgeon General Jerome Adams on Wednesday defended the Trump administration against Democratic attacks about Obamacare, saying that it was not opposed to healthcare coverage. “I would be remiss if I did not … check the insinuation from several folks that the current administration is against coverage for folks,” Adams said in response to several Democrats blasting the Trump administration for supporting Obamacare repeal. “I do agree that there is a direct link between the health of a community and the number of people who are insured. The administration is not against being insured. We have a different mindset about how we can achieve that,” he said during the hearing by the Senate Health, Education, Labor and Pensions Committee, which was intended to focus on how Congress could work to build healthier communities.

Report: State spending increases in 2017, largely because of Medicaid. According to a report out today from the National Association of State Budget Officers, state spending on various programs rose marginally, but the highest rate of increase was in Medicaid spending. In 2017, states that expanded Medicaid under Obamacare began to pick up 5 percent of the costs, and as a result they spent 5.2 percent on average more in 2017 after having seen a slowdown of 2.2 percent in 2016, when the federal government picked up 100 percent of expansion costs. Medicaid also continued to increase as a share of total state spending, representing 29 percent of all state spending in fiscal 2017. State spending on K-12 education made up 24.9 percent of budgets.

Study: Despite Medicare, seniors sicker in U.S. than in other countries. A study published Wednesday in Health Affairs, conducted by the Commonwealth Fund, found that adults 65 and older in the U.S., despite having Medicare coverage, are sicker than those in other countries and more likely to go without needed care, like going to the doctor or filling a prescription, because of costs. Other countries included in the survey were Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom.  

RUNDOWN

The Hill Trump officials eye work requirements for Medicaid recipients

Washington Post The GOP plan to kill Obamacare’s least popular provision could backfire on some in the middle class

Politico How Cotton brought Obamacare repeal back from the dead

STAT News He rails against the drug industry, but Trump turns to its ranks to fill his administration

Axios ACA enrollment isn’t as strong as you might think

CNN Doctors attempt to gene-edit a living patient’s DNA

Forbes Codeine is still being prescribed after tonsillectomies, despite FDA warning

Calendar

THURSDAY | Nov. 16

Nov. 16-17. National Academies of Sciences, Engineering and Medicine colloquium on the Science of Science Communication. Details.

Noon. President Trump to visit GOP Senate lunch to discuss tax bill.

MONDAY | Nov. 20

9 a.m. 1789 Massachusetts Ave. NW. American Enterprise Institute event on “The future of delivery system reform.” Details.