Daily on Healthcare: McConnell risks conservative healthcare rebellion…WH pushes for summer end game…Anthem bailing on Ohio

As Senate healthcare bill moves left, McConnell risks conservative rebellion: Senate Majority Leader Mitch McConnell, R-Ky., has signaled that he is willing to take a major risk on healthcare, moving swiftly to put legislation on the floor and daring conservatives to vote against it even as the policy moves in a more liberal direction. On Tuesday, McConnell joined other congressional leaders in a meeting with President Trump on how to bring the healthcare debate to a conclusion and move on to other priorities. He also presented some details about the direction that the healthcare bill is moving to a broader group of Republican senators. Though centrists came away pleased, conservatives were disappointed. The emerging bill would allow states to waive Obamacare’s essential health benefits, but not community rating – a policy mix that has been criticized by analysts across the ideological spectrum as destabilizing to markets. An earlier version of the House bill, which took that approach, had to be pulled from the floor amid widespread opposition among conservatives. It wasn’t until the bill was amended to allow for the additional opt-out of community rating (which allows insurers to charge healthy people less) that conservatives rallied around the bill and legislation was able to escape the House. But the margin for error is much smaller in the Senate, where McConnell can lose no more than two votes, so ditching the community rating opt-out alone risks losing conservatives and sinking the bill.

Further rankling conservatives was that the presentation outlined areas of consensus between conservatives and centrists, but, according to one conservative aide familiar with the meeting, several items that were presented as “consensus” items were ones that conservatives agreed to only on a conditional basis. For instance, conservatives would be OK with more gradually phasing out Obamacare’s Medicaid expansion, but only if the long-term growth of the program is set to a slower rate of inflation. Yet it was presented as if everybody agreed to slow walking the rollback of the Medicaid expansion, even without a concession to conservatives on the long-term growth rate. Furthermore, though it is not resolved, all indications are that the tax credits in the Senate bill are going to become more like Obamacare. Rather than being mostly age-based, they are likely to be more income-based and adjusted for region.

Senators were told that if they did not act, they would have to explain to their constituents why they aren’t addressing the problems in the individual market, as insurers raise premiums and exit markets. The hope is to vote on a bill before the Senate leaves for the July 4 recess. As it is, the House-passed healthcare bill required conservatives to make major concessions, abandoning the idea of a full repeal and a true market-based plan. By moving the bill even further left, McConnell would be testing the will of conservatives. “We’ve had plenty of time to discuss this issue,” McConnell told reporters after leaving the meeting with senators. “We are getting close to having a proposal to whip and to take to the floor. We’ve had seven years to talk about healthcare.”

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Trump to meet with Obamacare ‘victims:’ President Trump said he will meet with “victims” of Obamacare in Ohio later today, as part of his effort to keep up pressure on Congress to pass legislation to repeal and replace the healthcare law. “Getting ready to leave for Cincinnati, in the GREAT STATE of OHIO, to meet with ObamaCare victims and talk Healthcare & also infrastructure!” Trump tweeted.

House Obamacare repeal bill meets Senate rules for simple majority vote: The Senate Budget Committee said Tuesday that the legislation to repeal and replace Obamacare complies with the rules for reconciliation set by the Senate parliamentarian.

Republican leaders boast ‘good productive meeting’ with Trump and Vice President Mike Pence: “We had a good, productive meeting with President Trump, Vice President Pence, and congressional leadership,” Senate Majority Leader Mitch McConnell, R-Ky., and House Speaker Paul Ryan, R-Wis., said in a joint statement. “The discussion focused on the continued progress of our shared legislative agenda and how we can accomplish our goals.” They did not provide details on what was discussed, but the meeting was expected to focus on healthcare reform and tax reform.

Trump expects Senate to vote on healthcare bill ‘this summer’: “The Senate I’m sure will follow suit and get a bill across the finish line this summer that will be great healthcare for Americans,” Trump said. He called the process of getting the American Health Care Act passed in the House a “very, very long and difficult negotiation.”

Senate weighs options for Obamacare repeal bill, including initial stabilization: Senate Republicans received a list of options Tuesday on how to handle major healthcare sticking points such as Medicaid and pre-existing illnesses as lawmakers edge toward drafting a bill to repeal and replace Obamacare. Sen. John Barrasso, R-Wyo., said the Senate is discussing keeping the expansion in place longer than the 2020 deadline in the House legislation. Another option discussed was creating a new fund for stabilizing market​s​. Sen. Bill Cassidy, R-La., said the fund would provide $15 billion a year for the first several years to help stabilize premiums on the individual market, which includes Obamacare’s exchanges and is used by people who don’t have insurance through work.

Cassidy ‘encouraged’ by healthcare talks, says he could support Senate bill: “It’s very cognizant of pre-existing conditions, which is a good thing,” he said, adding that initial talks suggest the final product will pass his requirement to pass the “Jimmy Kimmel test.” Cassidy coined the phrase “Jimmy Kimmel test” after Kimmel delivered a monologue in which he shared difficult circumstances about his son’s birth and pleaded for politicians to keep Obamacare’s guarantee for coverage of people with pre-existing illnesses. Cassidy had criticized the House-passed bill, the American Health Care Act, saying that it did not satisfy his requirement because it allows states to apply for waivers to opt out of certain Obamacare-created insurance protections.“I think, personally, they’re moving in the right direction,” he said of the Senate talks. Without details, it’s not clear whether the provisions that he favors might be opposed by conservatives, but Cassidy said that he was “encouraged” and that he could see himself supporting the bill based on the initial conversations. “Of course it’s not everything I want, but that’s life,” he said. “Welcome to my house.”

McConnell promises healthcare vote ‘in the near future’: “We are getting closer to having a proposal,” Senate Majority Leader Mitch McConnell, R-Ky., said after meeting privately with Republicans. “And we’ll bring it up in the near future.”

House bill finally heads to the Senate: The House has sent the American Health Care Act to the Senate now that it got a clean bill of health (hah!) from the Senate on meeting reconciliation standards. The Senate parliamentarian ruled late Tuesday that the Obamacare repeal bill meets the rules for reconciliation, which allows a bill to be approved in the Senate by only a 51-vote majority instead of getting the 60 to break a filibuster. Ryan spokeswoman AshLee Strong told the Washington Examiner the bill would have been sent late Tuesday, but the Senate had already adjourned by the time the ruling was announced.

Chuck Schumer: Senate GOP in ‘no man’s land’ on healthcare: Senate Minority Leader Chuck Schumer, D-N.Y., argued Tuesday that Senate Republicans are getting nowhere in their quest to write a new healthcare bill, and that some GOP members are openly questioning if they’ll be able to pass a bill. “More and more, Senate Republicans appear to be realizing that healthcare reform through budget reconciliation leads right into a box canyon. Republicans are stuck in no man’s land,” Schumer said, even as he hit Republicans for not working with Democrats on the bill.

Obamacare is the ending of Thelma and Louise? Sen. Pat Roberts, R-Kan., said the Senate should vote this month on Obamacare repeal to give comfort. “We just give people more comfort that we are getting out of Thelma and Louise’s car,” he said. Wait, what? “Getting out’s pretty tough. We didn’t ever start driving that car, but now we’re in it,” he continued. Roberts was referring to the end of the 1991 movie where Thelma and Louise, played by Geena Davis and Susan Sarandon, end their flight from the law by attempting to jump over the Grand Canyon in their car. Roberts was then asked by reporters what happens if the Senate doesn’t get out of the car. “Then you go into the Grand Canyon,” he responded. The film basically ends when they jump, so Roberts is probably correct in assuming they don’t make it. There have been some interesting metaphors in the Obamacare repeal debate. The best may still be Rep. Drew Ferguson, R-Ga., comparing Obamacare to an unruly goat. But Roberts’ metaphor is a worthy challenger.

Meanwhile, Anthem to leave the exchange in Ohio, though appears open to changing its mind: The move would leave participants in 20 counties without any insurer. The company cited uncertainty over the future of the law, referring to whether the Trump administration would continue making cost-sharing reduction payments, which allow insurers to offer lower out-of-pocket costs to customers. The company also cited an “increasing lack of overall predictability” as contributing to its decision, likely referring to whether Republicans would succeed in repealing Obamacare and whether it could count on the federal government to enforce the individual mandate that obligates Americans to purchase insurance or pay a fine.

“The current regulatory climate and the uncertainty it has produced in our industry do not give us the clarity and confidence we need to commit to offering broad-based, affordable health plans for 2018,” the company said. “So, while we wait for new regulations to be released, we’ve made the difficult decision to reduce the number of Individual health plans we’ll offer next year.” The company appeared to leave the option open for re-entering the exchange, saying that if cost-sharing payments were paid it would “re-evaluate whether a more robust presence in the exchange is appropriate in the future.”

Sean Spicer points to Anthem as example of Obamacare collapse: “We just don’t have time to waste,” he said. “Just today, Anthem, the only state-wide insurer left in the state of Ohio, announced it will be pulling out of every county’s Obamacare exchange, leaving 19,000 Ohioans without any options,” he said during Tuesday’s White House briefing. “The American people have been saddled with the bill for Washington’s inability to get this disaster taken care of, and it’s simply not right for them to have to pay it any longer.”

New Hampshire insurer seeking 30 percent rate hike: Minuteman Health told the New Hampshire Union Leader that it is seeking the increases partly because of the federal risk adjustment program and Medicaid. New Hampshire’s Medicaid expansion program calls for most beneficiaries to buy coverage on Obamacare’s exchange on the individual market, used by people who don’t get insurance through their employer. The state uses Medicaid funds to pay the premiums for Medicaid-eligible enrollees. The rate hike wouldn’t fall on the Medicaid beneficiaries on the exchange since their premiums and deductibles are covered. However, people who are not Medicaid beneficiaries on the exchange would feel the brunt of the proposed hikes, Minuteman CEO Tom Policelli said.

Dr. Francis Collins will stay on as National Institutes of Health director: Collins, who has headed NIH since 2009, had been serving as acting NIH director during the presidential transition. Trump has asked him to stay on despite calls from some House Republicans to replace him with someone who is more staunchly opposed to stem cell research and a form of cloning. Collins, who has spoken openly about his Christian faith, will continue to helm an agency that has been targeted by the Trump administration for steep budget cuts. The agency, however, has bipartisan allies on Capitol Hill, so those cuts look unlikely.

Ivanka Trump tweets: “Congratulations to @NIHDirector Dr. Francis Collins for his vision, leadership & continued service at the @NIH.”

Response to Collins news from the Alliance for Aging Research president and CEO Susan Peschin: “Dr. Collins is an exceptional scientist and leader, who is highly respected by the NIH institutes and centers, academic research centers across the nation and the world, patient advocacy organizations, industry, and political parties on both sides of the aisle. In a time when scientific breakthroughs are moving faster than ever, the NIH needs Dr. Collins’ steadfast leadership.”

Niall Brennan, former chief data officer at the Centers for Medicare and Medicaid Services, will become president and executive director of the Health Care Cost Institute: “HCCI has incredible data resources that can be used to develop better insights into what is driving changes in healthcare spending. I am excited to lead HCCI, and work with policymakers, researchers, consumers, and others to identify strategies and interventions to better understand costs, improve quality, and promote transparency,” Brennan said in a statement.

Senate passes bipartisan VA reform bill: The legislation, dubbed the “Department of Veterans Affairs Accountability and Whistleblower Protection Act” would make it easier to fire federal employees, including executives. The legislation, which passed by voice vote, follows numerous scandals at the VA in recent years, most notably the manipulation of waiting lists for veterans, with patients dying while waiting for treatment. The bill’s authors, Sens. Marco Rubio, R-Fla., Jon Tester, D-Mont., and Johnny Isakson, R-Ga., argue that a key problem has been the department’s inability to sanction or terminate employees because of existing civil service protections. “This is a change in the laws of our country that will bring accountability to one of the most important functions that our government provides to the men and women who serve us in uniform,” Rubio said. “This spring marks three years since light was shed on the veterans who died — died — while they were stuck on secret waiting lists at the Department of Veterans Affairs.”

STUDY: Mosquitoes can carry Zika and chikungunya in their saliva: That means people can be infected with both after a single bite, according to a study that will be published this week in PLoS Neglected Tropical Diseases.

RUNDOWN

Kaiser Health News GOP Medicaid cuts hit rural America hardest, report finds

Axios Don’t like high-deductible plans? Don’t blame the ACA

Modern Healthcare GOP health plan could doom Medicaid managed care

NPR Patients worry about healthcare law’s fate in Arizona

Associated Press DEA warns police of possible accidental overdoses

Washington Post White House touts ACA’s demise as insurers seek help to stabilize markets

Politico Freedom Caucus wants to cancel Congress’ month-long August recess

Morning Consult Voters back birth control mandate, divided on religious exemption

Calendar

WEDNESDAY | JUNE 7

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

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

10 a.m. Dirksen 430. Senate HELP committee meeting on “The Cost of Prescription Drugs: How the Drug Delivery System Affects What Patients Pay. 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.

WEDNESDAY | JUNE 14

9 a.m. 1775 Massachusetts Ave. NW. Brookings Institution. Fostering competition in the pharmaceutical distribution chain. Details.

2:30 p.m. Dirksen 106. Special Committee on Aging Hearing on “Military Caregivers: Families Serving for the Long Run.” Details.