Daily on Healthcare: Two key senators move to ‘yes,’ mandate repeal looking more likely

Two key senators move to ‘yes,’ GOP tax bill that repeals mandate looking more likely. The Senate Republican tax bill got a major boost this morning ahead of planned votes as holdouts Ron Johnson and Steve Daines said they would vote “yes.” Their support would appear to bring the GOP to the 50 votes needed to pass the major tax overhaul. Johnson and Daines said Friday morning that they had received a deal from leadership to add about $100 billion in tax cuts for small businesses, a priority for them that had previously led them to oppose the bill. “I’m planning to vote ‘yes’ today on the tax bill,” Daines, from Montana, said on Fox News. “This is a historic moment for our nation.” “It looks like we have 50 votes,” Johnson in an interview with Milwaukee radio host Jay Weber. Republicans were regrouping Friday morning on the tax bill to try to rework the details to gain the support of Tennessee’s Bob Corker and others, who said they wanted the tax cut to add less to deficits. No deal had been announced yet to change the bill to appease Corker, Arizona’s Jeff Flak, and others who are worried about the debt. Others in the conference have yet to say whether they will support the bill, including Susan Collins of Maine, who has sought to add a deduction for state and local property taxes to the bill. Marco Rubio of Florida and Mike Lee of Utah have called for expanding the increased child tax credit to low-income families. If passed, the tax bill would nix the Obamacare individual mandate fine in time for coming tax season.

What health amendments are in today’s vote-a-rama? The vote-a-rama will feature some healthcare items including:

*Repeal of the health insurance tax. Sen. John Barrasso, R-Wyo., submitted an amendment that would repeal Obamacare’s tax on insurance plans sold on the individual market. The insurance industry has been clamoring for getting rid of the unpopular tax. But missing from the latest round of amendments is a repeal of the other unpopular tax in Obamacare: an excise tax on certain medical device makers such as manufacturers of MRIs.

*Changing the medical expense deduction. Collins has an amendment that changes to the medical expense tax deduction. Currently a person can claim a medical tax deduction if his or a family member’s medical expenses exceed 10 percent of gross income. Collins’ amendment would change that from 10 percent to 7.5 percent. The House tax bill that passed last month fully eliminates the medical expense tax deduction.

*Retroactive Obamacare penalties. Some people who paid the penalty for being uninsured in 2014 and 2015 would be reimbursed under an amendment filed by Sen. Steve Daines, R-Mont.

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.

What about the medical device tax? The industry hasn’t given up on repealing Obamacare’s device tax this year. It believes that it stands a better chance at passage if it is part of a continuing resolution, rather than turned into an amendment as part of a partisan tax bill. Government funding runs out Dec. 8.

Kombucha tea may avoid alcohol tax. Sen. Cory Gardner, R-Colo., is proposing an amendment to exempt the fermented tea Kombucha from alcohol sales taxes. Kombucha has gained popularity for its possible health effects, which are not backed by scientific studies. The drink is a fermented tea with a strong vinegar flavor. Back in 2015, the Alcohol, Tobacco Tax and Trade Bureau warned five manufacturers that their Kombucha contained too much alcohol, according to a 2015 CNN article. Kombucha makers warn that alcohol could result from the fermentation process, but told CNN that it would be impossible to get drunk on the yucky tea.

Collins, Murkowski defend opposition to individual mandate. Republican Sens. Susan Collins and Lisa Murkowski helped doom the GOP’s efforts to repeal Obamacare over the summer by voting against a bill that would have repealed the law’s individual mandate. Now Alaska’s Murkowski and Maine’s Collins are backing a repeal of the mandate’s penalties. Collins and Murkowski said separately that the “skinny” repeal bill included more than just repeal of the individual mandate, which requires everyone to buy health insurance or pay a penalty. The senators joined Sen. John McCain, R-Ariz., who said Thursday he would back the tax legislation, and all Senate Democrats to defeat the measure in late July. They also opposed a last-ditch effort in September to repeal and replace Obamacare. “The skinny repeal bill had many other provisions in it,” Collins said. “It repealed the employer mandate, eliminated funding for Planned Parenthood and had many other provisions and so it is not comparable at all [to mandate repeal].”

Will states implement their own individual mandates? The District of Columbia is the only locality that has begun considering such a change, but questions about this possibility surfaced in Twitter chatter among legal and health policy experts Thursday. Massachusetts already has its own mandate, as much of Obamacare was built around its model. “Dear States: Now would be a very good time to consider adopting your own individual mandates,” tweeted Nicholas Bagley, an administrative law expert from the University of Michigan Law School. In an opinion piece in the Los Angeles Times, Bagley said Democrat-controlled states such as California, Connecticut, New York, Washington and Oregon may opt to pass legislation that would replace the individual mandate at the state level.

Republicans not concerned tax bill would trigger Medicare cuts. Several Republican senators doubted their tax reform legislation would raise the deficit enough to trigger $25 billion in mandatory cuts to Medicare next year, despite a new estimate that it would. A major concern from Collins is that the bill would trigger a 2010 law that installs mandatory spending cuts if the deficit reaches a certain threshold. Collins said she recently received assurances from Senate Majority Leader Mitch McConnell that he would pursue a waiver to the 2010 law’s deep cuts. But Republicans said there would be enough growth from the tax bill to prevent a major spike in the deficit that triggers the cuts. “We are presupposing it is going to cause a deficit and I am not sure that is a correct presupposition,” said Sen. Bill Cassidy, R-La.

Trump donates third-quarter salary to HHS to help tackle opioid epidemic. President Trump wrote a check to the Department of Health and Human Services that will go toward a public information campaign about the opioid crisis, fulfilling part of his pledge not to take a salary in his role in the Oval Office. The donation is part of Trump’s pledge to give his $400,000-a-year presidential salary away. His first-quarter salary went to the Department of the Interior and his second-quarter salary went to the Department of Education. The latest check will go toward a public awareness campaign that will detail the dangers of opioid addiction, which involves prescription painkillers and illegal drugs such as heroin and fentanyl. The awareness campaign was one of the recommendations that Trump’s opioid commission made this month. Eric Hargan, acting secretary for HHS, made the announcement during the press briefing Thursday. “His decision to donate his salary is a tribute to his compassion, his patriotism and his sense of duty to the American people,” Hargan said.

HHS adds context to reports about Trump shortening open enrollment period. In an email sent Friday morning to reporters, the Department of Health and Human Services pointed out that the Obama administration had issued a final rule for the open enrollment period to be shorted to 45 days by 2018, writing that “as the exchanges grow and mature, a month-and-a-half open enrollment period provides sufficient time for consumers to enroll in or change [qualified health plans] for the upcoming coverage year.” The Trump administration moved the planned change up a year, saying that aligned the provision more with Medicare enrollment and noting that if people buy plans by Dec. 15 their coverage can begin Jan. 1. The move also would help improve the risk pools, they said, because it would prevent people from waiting to sign up later. Democrats have cited the shortened open enrollment as evidence that the Trump administration is working to “sabotage” Obamacare, and they point to cuts the administration made to advertising and outreach.

Reporters press White House for update on Trump’s health. The White House said Thursday it is looking into whether Trump plans to get a physical, and whether he will publicly report the findings, as some predecessors in the Oval Office have done. The review certifies from a physician whether the president is “fit for duty” and includes information about medical history and past tests, as well as information about new testing like a colonoscope. A 2010 exam for former President Barack Obama concluded that he was “fit for duty” and noted that he was using nicotine replacement therapy, which helps curb the urge to smoke cigarettes. An exam in 2001 for former President George W. Bush also concluded he was “fit for duty” and included information about his medical injuries in the past, some of which were sports-related. White House Press Secretary Sarah Huckabee Sanders said she didn’t know what Trump’s plans were for reporting his health outcomes, but said she would check on it.

Collins: ‘No reason to be concerned’ about Trump’s mental state. Collins on Thursday brushed aside a Washington Post reporter’s question about Trump’s mental health. Collins, who has spent hours with the president discussing and negotiating tax reform, said, “First of all, let me say, my conversations with the president recently have given me no reason to be concerned in that regard.” She was answering a question from the Post’s Jonathan Capehart at a media breakfast sponsored by the Christian Science Monitor. “I’m wondering how concerned you are about the mental health of the president?” asked Capehart. Collins did, however, said that Trump is wrong to raise conspiracy theories and to have tweeted questionable anti-Muslim videos this week. “Do I think that it’s helpful that he raises these conspiracy theories or puts out a tweet of an anti-Muslim video that turns out to not even be accurate? No. I don’t,” she said.

RUNDOWN

Washington Post Obamacare’s centerpiece is hanging by a thread.

The Hill House dems introduce bill to provide $45 billion for opioid epidemic

STAT News FDA approves Indivior’s monthly injection to treat opioid addiction

Bloomberg ‘Pharma bro’ Martin Shkreli’s Wu-Tang Album could be seized by federal prosecutors

Kaiser Health News Desperate for coverage: Are short-term plans better than none at all?

New York Times Without Obamacare mandate ‘you open the flood gates’ for skimpy plans

Reuters U.S. health regulator Seema Verma eyes new method for drug pricing

Los Angeles Times National science panel calls for aggressive steps to control drug prices

Associated Press Health nominee Azar is no stranger to management controversy

Calendar

FRIDAY | Dec. 1

Nov. 30-Dec. 1. Washington Hilton. 1919 Connecticut Ave. NW. ONC Annual Meeting on “Tackling Barriers to Interoperability and Usability.” Details.

Noon. Dirksen G50. Alliance for Health Policy and Commonwealth Fund event on “What’s Next for Medicare Provider Payment?”  Details.

TUESDAY | Dec. 5

7:30 a.m. Ajax. 1011 4th St. NW. Axios event on “A New Era in Healthcare.” Details.

  10 a.m. Dirksen 124. Senate Appropriations Committee hearing on “”Addressing the Opioid Crisis in America: Prevention, Treatment & Recovery.” Details.

  WEDNESDAY | Dec. 6

  10 a.m. 2175 Rayburn. House SHealth, Employment, Labor, and Pensions Subcommittee hearing on “Workplace Leave Policies: Opportunities and Challenges for Employers and Working Families.” Details.

  THURSDAY | Dec. 7

  10 a.m. 430 Dirksen. Senate Health, Education, Labor and Pensions Committee hearing on the 21st Century Cures Act. Details.