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Conservative concerns fester as judgment day inches closer: Last week, we wrote that Senate Majority Leader Mitch McConnell, R-Ky., was risking a conservative rebellion by racing healthcare legislation to the floor that was to the left of the House-passed bill. Now, as insiders begin to game out a potential vote, the difficulty McConnell faces from his right flank is coming into clearer focus. On Sunday, Sen. Mike Lee told ABC’s “This Week” that he had “grave concerns” about the direction the Senate bill was heading in. Earlier in the process, Lee, who has been a part of the Senate working group, declared that he wanted to see Medicaid grow at a slower rate than the House bill and that he wanted Obamacare’s regulations to be repealed by default, leaving states the ability to “opt-in” if they wanted to keep those regulations. Instead of moving closer to Lee’s position, the bill being discussed would move further away. It is expected to include a more gradual wind down of Medicaid (without offsetting constraints that conservatives were pushing for on the long-term growth rate). It also would allow less flexibility for states to opt out of Obamacare’s regulations, leaving the requirement that insurers charge healthy people as much as sicker ones (known as community rating) intact nationally. It’s difficult to see circumstances in which the bill changes significantly enough in the final stretch to earn Lee’s vote. Also, Sen. Rand Paul, R-Ky., who has passionately opposed the concept of refundable tax credits, has been widely seen as a “no” from the outset. This is especially true because the tax credits in the Senate bill are expected to become even more like Obamacare than the House-passed bill by the time the dust settles. For now, a Paul spokesman tells Daily on Healthcare that he is “keeping an open mind” until the text of the legislation is released. If Lee and Paul are firm nos, that means McConnell cannot afford to lose another vote. He’d have to hold all other conservatives, including Sens. Ted Cruz, R-Texas and Tom Cotton, R-Ark. A Cruz spokesperson said, “Sen. Cruz wants to get to ‘yes’ but there is still much work left to be done to get there.” At the same time, McConnell would have to completely run the table with centrist Republicans who were deeply critical of the House bill. Sen. Susan Collins, R-Maine, who touted the Senate version as an improvement over the House one, nonetheless told CNN’s “State of the Union” that the bill still had “a ways to go” to reassure her that Medicaid coverage losses would be limited. And with Collins, Sen. Lisa Murkowski of Alaska has concerns about the Planned Parenthood defunding provision, which is a big motivating factor for the bill for pro-life conservatives.
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.
Pressure grows for President Trump fund insurer subsidies: More pressure is being put on Trump to make a decision on whether to fund Obamacare’s insurer payments for the long term.
Last week, Rep. Kevin Brady, R-Texas, called for the White House to immediately fund the cost-sharing reduction payments. The funds reimburse insurers for reducing co-pays and deductibles for low-income Obamacare customers. The White House is making the payments for now, but it hasn’t made any decision for 2018. That has rankled insurers that say they are making plans now for 2018 markets and will have to raise rates if they don’t get the payments.
Pennsylvania insurers, for instance, proposed a nearly 9 percent hike for Obamacare plans next year. But that increase would balloon to roughly 30 percent without the payments, they said. The White House told the Washington Examiner Monday that it is still considering its options. So for now the stalemate continues.
Stabilization plan in Iowa: Iowa’s health insurance commissioner released a plan Monday to help stabilize its Obamacare exchange, which is facing the prospect of having few insurers participate next year. The plan includes allowing subsidies to be restructured so that young adults would receive more funding assistance to help them buy health insurance, and the income cutoff would increase. Under current law, a single person who makes more than $48,000 a year typically does not qualify for premium assistance. The state also would create a reinsurance program that helps compensate insurers for costly care. The state has one patient whose care costs $1 million a month and an overall pool of unhealthy, expensive customers on the exchange. Iowa is asking the federal government for $80 million in funding to assist with the plan. Instead of buying plans through healthcare.gov, the federal exchange that most states use, customers would purchase plans through independent agents or directly from the health insurance company. The state would review whether people qualify for tax credits to pay for coverage.
Sen. Joni Ernst on health insurance: ‘We’re in a world of hurt in Iowa.’ Ernst, an avid motorcyclist, veteran and expert pig farmer, who once famously deadpanned in a campaign ad that she would “cut pork” the way she castrated hogs on her family’s Iowa farm, spoke to the Washington Examiner just days before her Third Annual Roast and Ride fundraiser at the Central Iowa Expo in Boone. The retired Army National Guard veteran discussed a variety of issues, from healthcare to tax reform to infrastructure to the passion behind the Roast and Ride.
EXCERPT: Washington Examiner: Do you think the genie’s out of the bottle, that people just have this expectation that they’re just going to get free healthcare?
Ernst: Yes, I do. I worry about that, and that was demonstrated in one of my very rowdy town hall meetings. Everybody was demanding — and this was earlier in the year — and they were demanding, “What are your plans for healthcare? What is your solution for healthcare then, if you’re going to repeal and replace Obamacare?” I was listing off a number of items, and I mentioned HSAs as part of the equation, and somebody in the audience yelled out, “But that’s using your own money.” That is so frustrating. Who else is supposed to pay for your healthcare? Who else is supposed to do that? It’s coming from somebody, whether you’re paying for it or your neighbor is paying for it. Somebody is paying for it. We all need to make responsible choices, and we all need to have skin in the game. We want Americans to be healthy, but there is no such thing as free healthcare. Read more.
Mike Pence rips Democrats for not working with GOP on healthcare. Pence said in a speech in Wisconsin on Saturday that it’s clear to him and most other policymakers in the GOP that Obamacare is failing; he even described it as “dead.” “Truth is, you’d have to be blinded by partisanship not to believe otherwise,” Pence said. “But, unfortunately, some people are; Democrats in Congress to be exact.” Pence echoed many of Trump’s criticism of obstinate Democrats who refuse to work with Republicans to repeal Obamacare.
Democrats slam GOP senators’ efforts to fast-track healthcare bill: Congressional Democrats say their Republican colleagues are blocking them out of talks about how to proceed with the House-passed healthcare reform bill through reconciliation. “To accomplish this ‘Robin Hood in reverse’ approach without bipartisan support, Republicans are using an arcane process known as reconciliation. That’s not a term that’s likely to come up at coffee shops around the country, but it’s important,” Sen. Ron Wyden, D-Ore., said in the party’s weekly address. “Reconciliation amounts to ‘my-way-or-the-highway,’ not both parties working together to solve the nation’s problem as Americans expect them to.” Wyden complained the current version of the bill, which would repeal and replace Obamacare, was “deeply unpopular” in the House, partially because it contains the “basic architecture that takes from middle-class Americans to give large tax breaks to the well-to-do.” Other Democrats have taken issue with Republicans for not holding a hearing on the Senate version of the American Health Care Act. Sen. Claire McCaskill, D-Mo., called out Sen. Orrin Hatch, R-Utah, when he said Democrats were welcome to offer ideas and suggestions for the legislation. “When you are saying that you inviting us, for what? We don’t even know. We have no idea what is being proposed,” McCaskill replied. Chris Coons, D-Del., said when Democrats were in power they took a different approach for the Affordable Care Act. “There were hearings after hearings after hearings, over a year before they came to a conclusion they would have to pass the bill without Republicans,” Coons said on CNN Monday.
Medicaid faces growing pains as possible overhaul looms. Facing the need to balance their budgets next year, states are examining a variety of changes to their Medicaid programs even as Republicans weigh a major spending overhaul to the healthcare program for the poor. The changes underscore the difficulties of structuring the Medicaid program, which has little consensus across states or residents over who should qualify for it and what constitutes an appropriate level of spending. Obamacare aimed to make Medicaid more uniform by requiring states to expand it to more low-income people, but the Supreme Court ruled that portion of the bill would be optional. The District of Columbia and 31 states expanded Medicaid, leaving uneven strides in coverage from state to state. Facing shortfalls overall, state lawmakers continue to look at Medicaid as a target for cuts or changes.
Biosimilar drugs get Supreme Court win: The Supreme Court on Monday issued a major decision that could lead to cheap versions of pricey drugs getting to the market faster. The court unanimously ruled in favor of drug maker Sandoz in a key case about the marketing and approval of biosimilars, which are drugs that are similar but cheaper than pricey and complex biologic drugs. The ruling essentially means that biosimilars don’t have to wait an extra six months to get approval. The case focused on the drug filgrastim, a biologic that is used to stimulate production of white blood cells. The fight began in 2014, when Sandoz told Amgen, which marketed the brand name drug with filgrastim, that it was going to start marketing the biologic before receiving FDA approval. Amgen tried to block the approval by saying it violated FDA rules that a drug could be marketed only after winning approval. The court ruled that the Obamacare, which created the regulatory structure for biosimilars, didn’t specify that it had to wait for an FDA license before starting commercial marketing.
Democrats look to California for single-payer healthcare. A longtime goal of the Democratic Party for the government to take over health insurance may become a reality in California if it can get past major concerns about cost that could lead to its defeat. The California Senate recently approved a bill that would create a single-payer healthcare program in which the state is the only payer for healthcare. California essentially would eliminate private insurance, with residents signing up for a state program that would give them access to healthcare with no out-of-pocket costs. Single-payer, long a goal of Democrats, has received renewed energy this year in Congress, despite Republican control of Congress and the White House. Advocates say there is broad support for single-payer, not just among Democrats. “There is broad support for single-payer not only in California, but nationally, even among registered Republicans and Republican and conservative business leaders,” said Charles Idelson, spokesman for National Nurses United and the California Nurses Association, which is pushing the California bill.
Trump headlines glitzy fundraiser for Rep. Tom MacArthur, R-N.J. The event at Trump National Golf Club in Bedminster, N.J., was closed to the press, despite multiple requests. An invitation to the event showed tickets started at $5,400 per couple for the reception. There were also $25,000 tickets for a “co-host” and a $100,000 ticket for “hosts,” which all came with photo opportunities with Trump for a maximum of 20 people. “It was a great event with about 100 guests, and the congressman raised more than $800,000,” a MacArthur aide told reporters. “The theme of his remarks were about making tough decisions and solving problems. He didn’t run for Congress to decorate a chair. Obamacare is failing, premiums are rising and choices are dwindling. Tom decided sitting on the sidelines and letting it completely collapse was not an option. His efforts will ensure access to quality healthcare, protect people with pre-existing conditions and lower costs for families and small business.”
Rep. Tom Rice proposes nationwide veteran survey to fix the VA. The Republican from South Carolina is proposing a new way to settle the debate: Ask veterans what they think. Rice has proposed the Survey Our Servicemembers Act, which would create an annual survey of veterans who actually use the department, or try to use it, to access healthcare. He proposed the bill after a survey in his district that showed many veterans are still having trouble with the VA. “By making this a nationwide survey, more veterans will have their voices heard, and we can use their feedback to help provide veterans with the care they deserve,” he said. Some of the results from his local survey were devastating. “More than 25 percent of respondents had to contact the VA facility between two and five times to schedule their appointment,” Rice’s office said. “Roughly 13 to 18 percent of those who tried making an appointment at a VA medical center were unable to schedule one, depending on the facility.
FDA shocks lawmakers by pulling opioid off the market. The agency’s decision Thursday evening to ask Endo Pharmaceuticals to remove the painkiller Opana Extended Release from the market — the first such request by the FDA — came after years of lawmakers saying that the FDA approved too many opioids and contributed to a growing epidemic. “I have advocated for years for the FDA seek the advice of its expert advisory panel and seriously follow its recommendations concerning the approval and re-evaluation of dangerously addictive drugs,” Sen. Joe Manchin, D-W.Va., said Friday. The agency’s decision on Opana came after a group of experts voted 18-8 in March that the long-acting painkiller was doing more harm than good. In announcing the decision, new FDA Commissioner Scott Gottlieb said the FDA must “take all necessary steps to reduce the scope of opioid misuse and abuse.”
Norman Sharpless named director of the National Cancer Institute. Sharpless is a physician and director of the Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill. The appointment received praise from the American Cancer Society and the American Association of Cancer Research.
Delaware protects abortion rights in new law. Delaware Gov. John Carney Jr. signed an abortion rights bill into law Thursday to prepare for restrictions on the practice that may come from the Supreme Court or the Trump administration. The bill makes the provisions of Roe v. Wade, the 1973 Supreme Court decision that made abortion legal, codified into state law. President Trump, who has the support of abortion foes, has pledged to appoint justices to the Supreme Court who will overturn Roe v. Wade, turning decisions over the legality of abortion back to the states. He has appointed various abortion foes to his administration and reversed protections for abortion providers when it comes to accessing family planning funds.
RUNDOWN
Virginian-Pilot Veterans Affairs official downplays Agent Orange risks, questions critics
Politico Fate of Planned Parenthood funding tied to Senate moderates
Vox The case for prescription heroin, which is being prescribed in Canada
Axios FBI investigating Oregon healthcare startup Zoom
Bloomberg Cruz goes from ‘Lucifer’ to dealmaker on healthcare
The Hill Senate GOP sees path to Obamacare repeal
Associated Press GOP’s pursuit of healthcare overhaul comes with big risks
Atlanta Journal-Constitution Georgia 6 voters reject House GOP’s healthcare overhaul
CNN GOP senators might let their healthcare bill fail
New York Times Seizing on opioid crisis, a drug maker lobbies hard for its product
Calendar
MONDAY | JUNE 12
June 10-June 14. Hyatt Regency Chicago. American Medical Association Annual Meeting. Agenda.
1:30 p.m. Commonwealth Fund briefing on the 2018 health insurance exchanges. Details.
5 p.m. Capitol H-313. House Rules Committee to meet on Department of Veterans Affairs Accountability and Whistleblower Protection Act.
TUESDAY | JUNE 13
House will vote on the Veterans Affairs Accountability and Whistleblower Protection Act.
10 a.m. Vice President Pence will deliver speech on healthcare alongside Health and Human Services Secretary Tom Price and Centers for Medicare & Medicaid Services Administrator Seema Verma at HHS headquarters in D.C.
June 13-15. Rancho Palos Verdes, Calif. Goldman Sachs Global Healthcare Conference. Details.
8 a.m. Mayflower Hotel. 1127 Connecticut Ave. NW. Politico Pro briefing on “Medicaid as a driver of care innovation.” 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.
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.
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
8:30 a.m. PDT/11:30 EDT. Smashbox Studios. 8549 Higuera St. Culver City, Calif. Axios event on the human brain and artificial intelligence. Details.
9 a.m. Manhattan Institute event with former Sen. Tom Coburn on “Solving the drug-pricing challenge: Policy reforms to expand drug access, accelerate innovation, and grow the economy.” Details.
9 a.m. 1775 Massachusetts Ave. NW. Brookings Institution. Fostering competition in the pharmaceutical distribution chain. Details.
10:14 a.m. 2322 Rayburn. House Energy and Commerce Committee hearing on CHIP reauthorization. Details.
2:30 p.m. Dirksen 106. Special Committee on Aging Hearing on “Military Caregivers: Families Serving for the Long Run.” Details.
THURSDAY | JUNE 15
8:30 a.m. 1101 K St. NW. Bloomberg Law event on “Affordable Care Act repeal and replace: Now what?” Details.
10 a.m. Dirksen 138. Senate appropriations hearing on Department of Health and Human Services budget. Details.
