Daily on Healthcare: Trump demands for Obamacare stabilization package unlikely to woo Democrats

Trump demands for Obamacare stabilization package unlikely to woo Democrats. The Trump administration on Wednesday detailed how it could be won over to support an Obamacare stabilization bill, saying Wednesday that a package must include “relief” from the unpopular individual mandate that requires people to have health insurance or pay a fine. “In order for the White House to support similar legislation, it must provide immediate benefits to American families, workers and small businesses,” a White House official said in an email. “These benefits should include relief from the individual and employer mandates; an expansion of affordable coverage options, such as the ones referenced in last week’s executive order; a greater ability for middle-income families to control their healthcare dollars; and meaningful flexibility for states to allow their residents to escape onerous Obamacare requirements.” The details suggest that President Trump has not fully closed the door on supporting an Obamacare stabilization bill, known as Alexander-Murray, though he said earlier in the day that he did not support the current draft. Trump has wavered in his support for the bill, telling Sen. Lamar Alexander, chairman of the Health, Education, Labor and Pensions Committee, that he supported his efforts, but then said when the details became public that he did not want to do anything that would be a “bailout” for insurers or that would “enrich the insurance companies.”

It’s difficult to see Democrats agreeing to changes along the lines suggested by Trump. Given that after months of negotiations, Sen. Patty Murray consented only to modest tweaks to state waivers, it’s hard to see her getting behind Trump’s demands. Also, absent other changes, providing “relief” from mandate penalties would make it more tempting for younger and healthier individuals to go uninsured, potentially counteracting efforts to stabilize the Obamacare markets. What Trump is describing sounds closer to the Graham-Cassidy bill, which was unanimously rejected by Democrats as well as several Republicans.

Senate Minority Leader Chuck Schumer has already said he did not believe Democrats should re-open negotiations on the bill.  On Thursday morning on the Senate floor, he said he hopes Trump ends up backing the legislation. “We can only hope he comes around and grasps what’s in the bill. The Alexander-Murray deal bill is not a bailout to insurance companies at all, it’s the opposite; we’ve taken pains to ensure that insurance companies do not reap any benefits from this program.” Murray gave a more measured response when asked by reporters if she was open to further changes. “We put together principles that we absolutely agree on,” she said. “If there are provisions that strengthen anything for consumers, of course, but at this point we stand with our principles.” Whether the bill will reach the Senate floor is not known. Schumer hinted that the deal could be part of another must-pass vehicle, such as a spending bill, but he would like to see it done sooner rather than later.

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Bill moving forward, despite opposition. Alexander said Thursday that he will enter the legislation into the congressional record, despite opposition to the bill by Trump and House Speaker Paul Ryan. Alexander said during a HELP Committee hearing that he spoke with Trump Wednesday night. “He encouraged the process, which he asked me to begin, and said he looked forward to considering it,” Alexander said. “I said, ‘If you have suggestions for improving it that’s certainly your prerogative to do, and that’s what we would expect to happen in the legislative process.'” Alexander said that he will appear on the Senate floor at 1 p.m. with Murray, the committee’s top-ranking Democrat, whom he called a “straightforward, tough negotiating partner.”

Republicans behind the package are trying to keep the deal alive. “We are kind of in a holding pattern right now until there is some kind of a breakthrough between the president and Sen. Alexander,” said Sen. John Thune, R-S.D., the third-ranking Republican senator. “That could happen sooner, but it also could be a December issue.” He said the deal could be included in an omnibus spending deal that must be passed to prevent a government shutdown in December, or it could be included in another must-pass vehicle sooner if Trump jumps on board. Sen. John Cornyn, R-Texas, the number two ranking senator, applauded the effort of Alexander and Murray but said, “I think this is the beginning of a longer conversation. Until the president is on board, yes, probably some changes need to be made to satisfy the president.” Sen. Mike Rounds, R-S.D., a co-sponsor of the bill, said many Republicans agree with the president and want to ensure the bill does not provide federal money to bail out the insurance companies. “What the president is expressing is what a lot of us have expressed,” Rounds told reporters Wednesday. “We want it to be clearly defined within law, that the money has to be expended to take care of those people that it is intended for. We think the president brings up a good point and we think the legislation will specifically address the concerns that he has because it is the same concern that we have as well.” Some senators are still open to the deal, including Sen. Tim Scott, R-S.C., who wants to bolster flexibility options for states. “This is a strong step in the right direction,” he said. “My support of it is not quite there yet.”

Other GOP senators appear to have closed the door. “It would last two years, spend a whopping amount of money and not solve the problem and lead us down a path of never getting the problem done,” said Sen. Orrin Hatch, R-Utah, chairman of the Senate Finance Committee. “I have trouble with it.” Sen. Ted Cruz, R-Texas, suggested he also opposes the legislation. “I don’t think we should be bailing out giant insurance companies,” Cruz said. “That would be a mistake.” Others were concerned they were propping up a collapsing law. “I don’t want to vote to just put paint on rotten wood,” said Sen. John Kennedy, R-La.

Insurers back the legislation. The lobbying group representing insurers said Wednesday that it supports the bill. America’s Health Insurance Plans said it was “encouraged” by the legislation, saying it would continue working with Congress and the Trump administration on improving access to coverage. “Millions of Americans depend on the individual market for their healthcare coverage,” the group said. “This bill will provide American consumers with a more stable insurance market, states with more flexibility to meet the needs of their citizens, and more choice and more affordable care.”

Judge signals ruling next week on states’ lawsuit against Trump over Obamacare insurer subsidies. A federal judge indicated that he plans to rule next week on a request to require the Trump administration to continue Obamacare cost-sharing reduction payments after the White House announced that it would discontinue them. Attorneys general from 18 states and the District of Columbia teamed up last week for a lawsuit filed in a San Francisco federal court against Trump’s decision to discontinue payments to Obamacare insurers. They requested the Department of Health and Human Services be forced to continue the payments. On Wednesday, California Attorney General Xavier Becerra asked the court for a temporary restraining order. U.S. District Court Judge Vince Chhabria said would like to rule on the issue next week but didn’t say what his decision would be. Chhabria has scheduled a hearing for Saturday and is requesting the government file arguments against the restraining order by Friday morning. States and other can file additional briefs until Saturday morning.

Pat Tiberi plans to resign from Congress. Rep. Pat Tiberi, chairman of the House Ways and Means health subcommittee, announced Thursday that he planned resign from Congress by the end of January to take a job as head of the Ohio Business Roundtable. The Ohio Republican is the latest pragmatic conservative to call it quits ahead of the 2018 midterm elections. He and other Congressional Republicans have been frustrated by party infighting with Trump’s White House and the slow pace of legislative action on GOP-dominated Capitol Hill. “While I have not yet determined a final resignation date, I will be leaving Congress by January 31, 2018. I have been presented with an opportunity to lead the Ohio Business Roundtable that will allow me to continue to work on public policy issues impacting Ohioans while also spending more time with my family. Leaving Congress is not a decision I take lightly, but after a lot of consideration, it is the best one for me, my wife, Denice, and our four wonderful daughters,” Tiberi said in a statement issued by his office.

Medicaid enrollment slows but spending growth increases. ​According to a report from the Kaiser Family Foundation, ​Medicaid enrollment growth is slowing​ as those who have become eligible under Obamacare, meaning people with low incomes, were already enrolled, and because the economy has stabilized. Growth in spending on the program increased, however, because of rising prescription drug​ costs​ and ​because of long-term care, such as nursing home care. States also increased rates they paid providers, and those that expanded Medicaid under Obamacare are paying 5 percent of costs this year, contributing to the growth at the state level.

North Carolina insurer says rate increases would be ‘near zero’ if Trump hadn’t cut off payments. Blue Cross Blue Shield of North Carolina, the state’s largest insurer, said Wednesday that if Trump had not cut off insurer payments, it would be requesting barely any increase in premiums in its Obamacare plans. The rate increase “would have been near zero” if the payments had continued, the company said. Instead, rates are expected to rise by an average of 14.1 percent for mid-level plans, with Blue Cross continuing to sell plans in every county in the state.  Rep. Robert Pittenger, R-N.C., cast doubt on Blue Cross’s claim about its projected costs in a statement to the Associated Press. “Blue Cross has raised Obamacare premiums every year,” Pittenger said. “Nonsense on the rhetoric from Blue Cross.” Blue Cross had said in May that it would be requesting rate increases of 22.9 percent, but lowered its formal request in August, saying that the marketplace was becoming more stable. North Carolina Attorney General Josh Stein is one of 18 Democratic state attorneys general who filed the lawsuit against the Trump administration.

Judge rules teen in U.S. illegally must be allowed to get an abortion. A federal judge in Washington ordered the Trump administration to allow a teen who is in the U.S. illegally and under the custody of the U.S. government to have an abortion. U.S. District Judge Tanya Chutkan, who was appointed by former President Barack Obama, said Wednesday she was “astounded” to learn that the 17-year-old girl from Mexico, who is being detained in South Texas, was not allowed to obtain the procedure. She ordered the federal government to transport the girl to an abortion facility or to allow a guardian to take her “promptly and without delay” to have a counseling appointment on Thursday and an abortion by Friday or Saturday. The girl is represented by the American Civil Liberties Union, which sued over the federal government’s actions, calling them unconstitutional, and also asked the judge to implement a preliminary injunction for when other women face similar cases. In a statement, the administration for Children and Families at the U.S. Department of Health and Human Services said it was considering its next steps and that the court made a “troubling ruling that exceeds the U.S. Constitution and sets a dangerous precedent by opening our borders to any illegal children seeking taxpayer-supported, elective abortions.”

Karen Pence will champion art therapy: ‘This is not arts and crafts.’ Karen Pence on Wednesday announced Wednesday that she will use her platform as second lady to tout the benefits of art therapy through her “Healing with the heART” initiative. “I chose one initiative to champion, and it is art therapy, which is near and dear to my heart,” Pence said Wednesday while speaking at Florida State University in Tallahassee. “From children with cancer to struggling teens, to grieving families, to people with autism, to military service members experiencing Post Traumatic Stress Disorder, to those with eating disorders, art therapy is changing lives. Unfortunately, art therapy is not well-known, but I hope to change that.” Art therapy is used to resolve conflict, promote self-awareness, and advance personal development through internal reflection and outward action. “We have three goals. One is to elevate the profession and explain it. This is not arts and crafts. The second is to encourage young people to go into this profession, and the third is to make people aware that this is an option. If you want some type of therapy, if you’ve had a trauma, this is something you can look into,” Pence said on Fox News’ “Fox and Friends” Wednesday. Pence has a master’s degree in art education and been a teacher for 25 years. She will speak publicly about her initiative, visit programs around the country, meet art therapists and students, and advocate for more scientific and medical research on the benefits of art therapy.

RUNDOWN

Politico Obamacare fix could end up in year-end package

The Hill Obamacare allies fear deal won’t mitigate Trump attacks

Washington Post Obamacare’s rates are already baked

Wall Street Journal Gilead gets approval from FDA for new cancer therapy

Axios Don’t rush to judgment on Alexander-Murray

Bloomberg Congress is inching closer to a shutdown over Obamacare and immigration

NPR Administration sends mixed signals on state Obamacare innovation waivers

Kaiser Health News Despite GOP efforts to curtail Medicaid spending, states expand benefits

Associated Press Are insurers enriched by Obamacare as Trump says?

Calendar

THURSDAY | Oct. 19

Senate in session. House not in session this week.

TUESDAY | Oct. 24

10 a.m. 2358-C Rayburn. House Appropriations Committee hearing on “The Role of Facilities and Administrative Costs in Supporting NIH-Funded Research.” Details.

10 a.m. 2123 Rayburn. House Energy and Commerce Committee hearing on “Examining HHS’s Public Health Preparedness for and Response to the 2017 Hurricane Season.” Details.

1:30 p.m. Alliance for Health Policy webinar previewing open enrollment. Details.

WEDNESDAY | Oct. 25

8:30 a.m. 1777 F St NW. The Hill event with Dr. Ben Carson, secretary of Housing and Urban Development, on “The Future of Housing.” Details.

10 a.m. 2358-C Rayburn. House Appropriations Committee hearing on “Down Syndrome: Update on the State of the Science and Potential for Discoveries Across Other Major Diseases.” Details.

10 a.m. 2123 Rayburn. House Energy and Commerce Committee hearing on “Federal Efforts to Combat the Opioid Crisis: A Status Update on CARA and Other Initiatives.” Details.

THURSDAY | Oct. 26

Oct. 26-30. San Francisco. World Conference of Science Journalists. Details.

FRIDAY | Oct. 27

11:45 p.m. G50 Dirksen. The National Institute for Health Care Management briefing on “Transforming Health Care to Drive Value.” Details.