Daily on Healthcare: Trump, Pence bear down on Graham-Cassidy holdouts

Trump, Pence bear down on holdout senators as final Graham-Cassidy push nears. After initially taking a lukewarm approach to the Obamacare overhaul legislation authored by four senators led by Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, the White House is now enthusiastically backing the legislation and putting heat on senators who have yet to get behind it. After flying back from New York on Tuesday to attend the Senate lunch, Vice President Mike Pence has been working the phones and went on Alaska talk radio to put pressure Sen. Lisa Murkowski, one of the holdouts, to vote for the bill. It has become clear that Graham-Cassidy is the last real opportunity to pass legislation that would allow Republicans to claim that they have delivered on their promise to repeal and replace Obamacare — even though the bill would leave most of the law’s taxes and spending in place. But time is tight as they have about a week before the deadline on using the current reconciliation language that would allow them to pass a bill with a simple majority.

Trump warns Rand Paul: He ‘will forever’ be known as the ‘Republican who saved Obamacare.’ President Trump on Friday warned that Republicans who choose not to support the Graham-Cassidy bill will face a challenging future in politics. “Rand Paul, or whoever votes against Hcare Bill, will forever (future political campaigns) be known as ‘the Republican who saved ObamaCare,’” Trump tweeted Friday morning. On Wednesday, Trump urged the Kentucky Republican senator to stop opposing the Senate’s last-ditch effort to overhaul Obamacare by giving states control of billions of dollars in healthcare funding. “Rand Paul is a friend of mine but he is such a negative force when it comes to fixing healthcare. Graham-Cassidy Bill is GREAT! Ends Ocare!” Trump tweeted. “I hope Republican Senators will vote for Graham-Cassidy and fulfill their promise to Repeal & Replace ObamaCare. Money direct to States!” In a Fox News interview that aired Wednesday as Trump was tweeting, Paul listed the reasons he would continue to rally against the bill. “This bill actually keeps the Obamacare spending and just redistributes it among the states. It’s a $1.2 trillion federal grant program and that’s just not repeal,” Paul said. “It’s barely Obamacare light. It keeps Obamacare.” Paul said a number of caucus members have objected to the bill, but did not name any lawmakers who oppose the legislation. “There are a number of people wary of this. They are holding their nose to vote for this thing,” Paul added. He tweeted Friday, “I won’t be bribed or bullied into backing it.”

Pence goes on Alaska talk radio to urge callers to contact Murkowski. Pence, who himself was a talk radio show host before pursuing a career in politics, returned to the medium to try to rally support for the bill in the home state of Murkowski, who could potentially be the deciding vote on the bill. “Senator Dan Sullivan and Senator Lisa Murkowski are two outstanding legislators,” Pence said on the “Dave Stieren Show” when asked what Alaskans could do to help ensure the legislation passes. “And they’ve been great champions for Alaska on this legislation and in virtually every bill that moves through the Congress. But I think that if people want to see us repeal and replace Obamacare; if people believe that leaders in Juneau know better what’s for Alaska than Washington, D.C. ever will; if people want to get rid of the mandate that requires them to buy health insurance or pay a penalty, I just encourage you to call both of your senators and let them know you support the Graham-Cassidy bill.”

Pence said, “We’ve been in regular communication with Senator Sullivan and Senator Murkowski, and talking with them about this legislation.”

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Actual Graham-Cassidy deadline may be Sept. 29 because of Yom Kippur. The deadline for Republicans to pass Graham-Cassidy under reconciliation rules is technically midnight Sept. 30, but in practice, it is likely to be sooner. That’s because Yom Kippur — the holiest day of the year for Jews — begins the night of Friday, Sept. 29, and runs through sundown Sept. 30. On Yom Kippur, observant Jews must fast and refrain from work. Though all nine Jewish senators are Democrats who won’t be voting for the bill, the optics of scheduling a vote when Jewish senators, including the Democratic leader, cannot be there will be difficult to navigate. Graham, who has close ties to a number of Jewish organizations, said this week he wouldn’t like to work during the holiday. “I want to honor every religion’s holiday, so if we have to break for the Jewish holiday we have to break for the Jewish holiday,” he said. “I don’t want to get on the wrong side of God.” But Graham did point out that the Senate voted on Obamacare on Christmas Eve 2009, which he said was an important day. In theory, Republicans could hold a vote before sundown Sept. 29 or after sundown and before midnight on Sept. 30 and not be technically voting on the holiday. However, that would make it difficult for any Jewish members to travel home.

Graham, Cassidy agree to spar with Sanders over healthcare on CNN. CNN will hold a town hall Monday night featuring Graham and Cassidy debating Sen. Bernie Sanders, I-Vt. and Amy Klobuchar, D-Minn. The town hall comes a few days before the Senate is expected to vote on the Republicans’ bill to cut Obamacare’s funding and distribute it to states through block grants.

Sanders a few weeks ago reintroduced his own bill that would create a government-run, socialized healthcare system that drew 16 Democratic co-sponsors, several of whom are 2020 presidential hopefuls. Republicans say Sanders’ legislation helped them sell a competing vision to senators wary of taking another tough vote on healthcare. Klobuchar, who comes from a swing state, did not endorse Sanders’ bill. She is up for re-election in 2018.

Medicaid directors oppose Graham-Cassidy. State Medicaid directors are opposing the Republican Obamacare overhaul bill that would greatly restructure the federal-state healthcare program for the poor in their jurisdictions. The National Association of Medicaid Directors said Thursday that the bill would impose significant challenges to states, chiefly that they would shoulder too much risk under the legislation. The group is the latest stakeholder to oppose the measure, joining doctors, insurer and hospital groups skeptical of what is considered by Republicans their last chance to overhaul Obamacare. The directors say the bill doesn’t give states enough time to set up new programs.

Less than a quarter of voters approve of Graham-Cassidy. Less than a quarter of registered voters said they support Senate Republicans’ most recent effort to overhaul Obamacare, according to a poll released Thursday. Just 24 percent of respondents approve of Graham-Cassidy, while 50 percent disapproved and 27 percent said they were not sure. Fifty-four percent of respondents said they approved of the Affordable Care Act and 63 percent said they want to keep what works and fix what doesn’t, while 32 percent want to repeal and “start over” with a new healthcare law. The poll was conducted by Public Policy Polling, a Democratic firm in North Carolina. The firm surveyed 638 registered voters.

Public wants to fix, not repeal Obamacare, according to another poll. A different poll found a majority of the public say stabilizing Obamacare’s markets and reauthorizing the Children’s Health Insurance Program are more important than repealing the healthcare law. The poll from the nonpartisan Kaiser Family Foundation comes less than a week before the Senate is expected to take up Graham-Cassidy. The poll found 69 percent of Americans said it was extremely or very important to stabilize Obamacare’s insurance markets and 75 percent said they support reauthorizing CHIP. The children’s insurance program expires at the end of this month. However, only 47 percent of Americans said they want Congress to repeal and replace Obamacare. There are stark differences between party affiliation, with 71 percent of Republicans favoring repeal compared to 28 percent of Democrats and 47 percent of independents. The Kaiser poll was of 1,179 adults surveyed from Sept. 13 to 18 and has a margin of error of plus or minus 3 percentage points.

Graham’s call with Pence gets interrupted by Trump. A phone call about healthcare between Graham and Pence was interrupted by Trump Thursday, the senator said. Graham told the Post and Courier’s Jamie Lovegrove that Pence hesitated, saying it was OK. “You should definitely take the president’s call,” Graham was quoted as saying. The call focused on the healthcare bill.  “All good news,” Graham said, according to Lovegrove. Graham said Pence called him back afterwards.

Pennsylvania Rep. Matt Cartwright: John McCain will make a ‘good choice’ on healthcare because ‘he’s staring death in the face.’ Pennsylvania Democratic Rep. Matt Cartwright told a group of voters he doesn’t believe Sen. John McCain will vote in favor of the latest attempt to overhaul Obamacare because “he’s staring death in the face right now.” Cartwright was in his district during the House’s week away from Washington and was caught on video making the comment about McCain, who had surgery for brain cancer this summer. “McCain I’m worried about,” he said on Tuesday at a town hall meeting at Lehigh Carbon Community College in Tamaqua, Pa. “Also because the governor of Arizona came out in favor of the Lindsey Graham-Bill Cassidy bill so that puts pressure on McCain. But, man, something tells me McCain, he’s staring death in the face right now, so he’s probably going to make good choices and he’s not going to bend to political pressure.” After the statement triggered a backlash, Cartwright later put out a statement saying he reached out to McCain and his family to apologize.

House Dems ask for Obamacare, Medicare extension in wake of hurricanes. House Democrats have asked the Trump administration to extend the open enrollment period during which people can sign up for Obamacare and Medicare health plans to account for customers who will be recovering from hurricane damage. Hurricanes Harvey, Irma and Maria have demolished homes and forced medical facilities to be evacuated. The Department of Health and Human Services has several tools at its disposal to allow people in the affected areas to access healthcare services more quickly. “We ask that you use your authority to provide additional leeway for enrollment-related choices,” wrote Democrats from the House Energy and Commerce Committee in a letter to Health and Human Services Secretary Tom Price.

David Axelrod says he cried after Obamacare passed. The former Obama adviser said he cried the night the Affordable Care Act was passed by the House as he remembered the struggles he and his wife faced as they learned their daughter had epilepsy when she was a baby. “All those memories came rushing back the night the ACA passed — all the pain and financial worry we had felt as young parents, struggling to keep our baby alive,” Axelrod wrote in an op-ed published by CNN Thursday. “I cried because I knew that because of the law that had passed that evening, many other families would not have to face the same ordeal.”

Jimmy Kimmel: Trump would sign copies of the Koran in Fallujah to abolish Obamacare. Television host Jimmy Kimmel responded to Trump’s support of Graham-Cassidy by saying Trump would sign copies of the Koran in Iraq if it meant abolishing Obamacare. Kimmel shared Trump’s tweets from Wednesday in which the president said he would not support a bill that did not cover pre-existing conditions. “I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions,” he tweeted. “It does! A great Bill. Repeal & Replace.” “Which those are the key words: repeal and replace,” Kimmel said. “Because for Donald Trump, this isn’t about the Graham-Cassidy bill, it’s about getting rid of Obamacare, which he hates, primarily because Obama’s name is on it. He likes to have his name on things. At this point, he’d sign anything at this point if it meant getting rid of Obamacare,” he added. “He’d sign copies of the Koran at Barnes and Noble in Fallujah if it meant he could get rid of Obamacare.”

Avalere analysis shows deep cuts for states under Graham-Cassidy. Healthcare consulting firm Avalere released an analysis Friday that shows Graham-Cassidy would cut Medicaid funding to states by $713 billion through 2026 and more than $3.5 trillion over the next 20 years, though after a decade the current funding would be up for reauthorization. States would see $593 billion in reductions through 2026 due to lower Medicaid funding in the block grants. States would have another $120 billion cut through 2026 due to the installation of a per capita cap funding system for all of Medicaid. A per capita caps system would provide Medicaid funding per beneficiary to a state and likely would result  in lower federal funding for the entitlement program that provides healthcare to low-income people. Avalere found problems with the block grants that would replace Medicaid expansion funding and funding to lower costs for people on the individual market, which includes Obamacare’s exchanges.”States are only permitted to use 15 percent of these block grant funds for Medicaid and are therefore limited in their ability to use an existing and currently operational program to provide coverage,” it found. However, states would be able to us the balance of the block grants to finance coverage outside of the existing Medicaid program.

RUNDOWN

Washington Post How Tom Price decided chartered, private jets were a good use of taxpayer money

Politico Trump publicly backs healthcare effort, privately harbors doubts

Axios New estimate shows how key holdout states lose funding under Graham-Cassidy

The Hill Graham and Cassidy go into overdrive to win Murkowski vote

Roll Call Healthcare.gov could be crippled under latest GOP Obamacare repeal bill

Washington Post Graham-Cassidy’s abortion ban workaround

Bloomberg The Senators to watch on Obamacare repeal

New York Times Latest Obamacare repeal effort is most far-reaching

Nevada Independent Republican Nevada Gov. Brian Sandoval doubles down on criticism of Obamacare bill Dean Heller supports

NBC News New GOP health plan could sow healthcare chaos

Calendar

FRIDAY | Sept. 22

1:15 p.m. Sen. Bernie Sanders to appear host healthcare town hall at CREDO event. Watch Live.

3:30 p.m. EST/2:30 p.m. CST. Johnson County Town Hall, Iowa. Sen. Joni Ernst, R-Iowa, to hold town hall. Details

4 p.m. EST/1 p.m. PST. Marion County Town Hall, Oregon. Sen. Ron Wyden, R-Ore., to hold town hall. Details.

8 p.m. EST/5 p.m. PST. Clackamas County Town Hall, Oregon. Sen. Ron Wyden, R-Ore., to hold town hall. Details.

SATURDAY | Sept. 23

Noon. 200 New Jersey Ave NW. Tea Party Patriots D.C. rally on healthcare in support of Obamacare overhaul.  

6 p.m. EST/3 p.m. PST. Deschutes County Town Hall, Oregon. Sen. Ron Wyden, R-Ore., to hold town hall. Details.

9:30 p.m. EST/6:30 p.m. PST. Lane County Town Hall, Oregon. Sen. Ron Wyden, R-Ore., to hold town hall. Details.

SUNDAY | Sept. 24

Sept. 24-28. AHIP’s conference on Medicare, Medicaid and duals. Includes keynote by CMS Administrator Seema Verma. Details.

MONDAY | Sept. 25

Senate vote and CBO score expected this week on Graham-Cassidy.

10 a.m. 215 Dirksen. Senate Finance Committee to hold a hearing on the Graham-Cassidy-Heller-Johnson proposal. Details.

10 a.m. National Press Club. 529 14th St. NW. Discussion on “Mental Health and the Opioid Crisis” with healthcare workers and Rep. Tim Ryan, D-Ohio, co-chairman of the House’s Addiction Treatment and Recovery Caucus. Details.

5 p.m. Sen. Joe Manchin, D-W.Va., holds Facebook live town hall. Details.

9 p.m. CNN to host healthcare town hall. Details.

TUESDAY | Sept. 26

Sept. 26-28. The Atlantic Washington Ideas Forum. Includes speakers Mark Bertolini, chairman and CEO of Aetna and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Details.

8 a.m. Newseum. 555 Pennsylvania Ave. NW. Politico event on “The Doctor-Patient [and Government] Relationship.” Details.

WEDNESDAY | Sept. 27

Deadline for insurers to sign rate contracts with states.

8 a.m. Washington Court Hotel, 525 New Jersey Ave. NW. Politico event on “Aging in America.” Details.

3 p.m. Ronald Reagan Building and International Trade Center. 1300 Pennsylvania Ave.  Education Development Center  and the National Action Alliance for Suicide Prevention event on “From Pain to Promise – Addressing Opioids & Suicide in Communities Across America.” Details.

FRIDAY | Sept. 29

9 a.m. 1789 Massachusetts Ave. NW. AEI event on “Unbundling and rebundling health benefits: Innovative rethinking of healthcare delivery and competition.” Details.

SATURDAY | Sept. 30

Reconciliation and CHIP reauthorization deadlines. End of federal fiscal year.