Daily on Healthcare: Lots of healthcare policy runs through the tax code

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.

Senate Republicans pull plug on Graham-Cassidy Obamacare overhaul effort. Senate Republicans will not vote on a bill to overhaul Obamacare this week, extinguishing the chances of passing the measure by a Sept. 30 deadline that would have allowed the GOP to avert a filibuster by the Democrats. Majority Leader Mitch McConnell, R-Ky., pulled the plug on the effort a day after a third Republican came out against the legislation, authored by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., which would have replaced Obamacare funding with a block grant system that would have let states control both the fate and funding of the embattled healthcare law. “We don’t have the votes,” Cassidy said after Republicans emerged from their meeting. “We made the decision because we don’t have the vote, we’ll postpone the vote,” said Cassidy, a physician who added that he is “disappointed.” An upbeat Graham said after the meeting they are going to try to move the bill again next year. “We are coming back to this after taxes,” Graham said, referring to the tax reform legislation that Congress hopes to complete by the end of the year. “We are going to have time to explain our concept. We’ll have a better process and we are going to take this show on the road.” Lawmakers have not abandoned their desire to try to pass a healthcare bill, and are now examining whether language might be included in an upcoming tax reform bill that is the only remaining legislative vehicle immune to a filibuster by Democrats. McConnell said the next step for Republicans would be to tackle tax reform.

Republicans disagree on their next move to repeal Obamacare. Senate Republicans are disagreeing about when exactly to try again to fulfill their seven-year promise to repeal and replace Obamacare, and they have no plan for how to bridge the major ideological divisions among them. Many Republicans said they are pivoting to tax reform and then will return to repeal afterward. But some division already exists among lawmakers on the best step for taking up the repeal fight again. Some favor adding Obamacare repeal to a budget resolution that would give them reconciliation authority to pass tax reform with only 51 votes. But others are wary of that approach since it might gum up the effort to overhaul the tax code. Graham and Sen. Ron Johnson of Wisconsin, who also sponsored the Graham-Cassidy bill, are urging Senate leadership to add healthcare to the tax reform budget resolution. “We’re telling leadership we want the ability to address Obamacare and tax reform in the next budget,” Johnson told reporters after leadership pulled the bill Tuesday. But members of Senate leadership were skeptical. “I think that is going to be very challenging,” said Sen. John Thune of South Dakota, the third-highest-ranking Republican in the chamber. “I think tax reform is gonna have to ride on its own. Confusing those issues might make it complicated for both.”

Murkowski slams ‘lousy’ process. Sen. Lisa Murkowski broke her silence Tuesday about the Obamacare overhaul bill soon after Republicans announced they would halt the effort, saying that the process had been “lousy” and that time had run out. The Alaska Republican said that while she appreciated the work that her colleagues had put into it, they “have run up against a hard deadline and a lousy process.” “Time has not been on their side,” she continued. “The U.S. Senate cannot get the text of a bill on a Sunday night, then proceed to a vote just days later, with only one hearing — and especially not on an issue that is intensely personal to all of us.”

Chuck Schumer: America breathing sigh of relief. Senate Minority Leader Chuck Schumer, D-N.Y., said Tuesday that it is a “sigh of relief” to many Americans that the Graham-Cassidy healthcare bill will not pass the Senate. “Today, Americans breathe a sigh of relief because the healthcare of millions has been protected and preserved,” Schumer said during Democratic leadership’s weekly press conference. “We Democrats believe this isn’t a day for celebration, but a day to roll up our sleeves and work to make the healthcare system better than it is today.” Schumer told reporters that he hopes Republicans do not try to revive the Graham-Cassidy legislation, either later this year or next year as Graham had indicated moments earlier. “We hope that the Republicans don’t come back to this bill. It’ll meet with the same fate it met this time,” Schumer said, referring to the failed attempts to pass the Better Care Reconciliation Act and the “skinny” repeal of the Affordable Care Act.

Sponsors aim to move forward. The sponsors of the Obamacare overhaul bill said it was only a matter of time before their bill, which was pulled Tuesday because of lack of support, would become law and replace Obamacare. The four Republicans blamed process and timing for the bill’s defeat. “Due to circumstances under our control, and not under our control, the process and timing of this vote did not line up this time,” the senators said in a joint statement Tuesday. “However, our idea of sending the power and money to the states clearly resounded with our colleagues.” They continued: “The most frequent frustration we heard from our colleagues ranging from Senator McCain to Senator Murkowski was that time and process were the biggest obstacles to their support. There is no doubt about their commitment to repeal and replace Obamacare and no doubt about their support of local control.”

Trump: ‘We have’ the healthcare vote, just ‘not for Friday.’ President Trump said Wednesday that Senate Republicans will have the votes to pass conservative healthcare reform, just not this week. “With one Yes vote in hospital & very positive signs from Alaska and two others (McCain is out), we have the HCare Vote, but not for Friday!” Trump tweeted Wednesday morning.

What is Trump talking about? Reporters were flummoxed by Trump’s tweet as to who exactly is in the hospital. Seung Min Kim from Politico tweeted that Sen. Thad Cochran, R-Miss., missed Monday’s vote due to getting treatment for a urological issue but he is not in the hospital. So does Trump mean someone else or did he mean Cochran? We may never know.

Health insurers face key Obamacare deadline Wednesday. Insurers are set to finalize contracts with states about how much they will charge customers who buy Obamacare plans.

Many of the largest insurers have decided not to sell plans on Obamacare’s exchanges at all, and many of those that are staying have filed rate increase proposals in the double digits. Those increases could go higher without payments the insurers expect to receive from the federal government, called cost-sharing reduction subsidies. Insurers say the pullouts and premium hikes are a result of uncertainty about the future of the healthcare law and financial losses. The Trump administration has the authority to move the Sept. 27 deadline back, but it has not changed, according to a spokesman from the Department of Health and Human Services. In some states, insurers have filed several rate requests to account for various sets of assumptions, including whether they can expect funding from the federal government and to what extent the government will enforce Obamacare’s individual mandate that requires people to buy insurance or pay a fine. “While final rates have been filed, our assumption is everyone will work to be flexible if we can all agree on a good solution for the American people,” a health insurance industry expert said. Insurers are waiting to hear from Trump about cost-sharing reduction subsidies and to what extent his administration will enforce the individual mandate. From Congress, they are waiting to see whether lawmakers will resume talks of a bipartisan stabilization package.

Anthem leaves Obamacare in Maine. Anthem is leaving Maine’s Obamacare marketplace next year because it remains “volatile.” It is the latest defection by the insurer, which has been worried about the uncertainty in the exchanges for 2018. Anthem said that planning and pricing for Obamacare plans has become difficult because of a “shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including the regulation of the health insurance tax on fully insured coverage and continued uncertainty around the future of cost-sharing reduction subsidies.” Anthem has given similar reasons for pulling out of other states such as Virginia and scaling back in states such as Kentucky.

Jimmy Kimmel: “I haven’t been as happy about something being dead since bin Laden.” Late-night comedian Jimmy Kimmel celebrated the decision to pull Graham-Cassidy, which he has repeatedly criticized on his show for eroding protections for people with pre-existing conditions. “Officially now, Graham-Cassidy is dead,” Kimmel declared Tuesday evening on “Jimmy Kimmel Live.” “I haven’t been this happy about something being dead since [Osama] bin Laden, I’ll tell you.” He also defended McCain from an attack by President Trump for flip flopping on Obamacare repeal and replace. “The idea that Donald Trump would criticize anyone for changing his position is very rich,” Kimmel said. “It’s definitely richer than he is. Donald Trump has more flip flops than a Jimmy Buffett concert. No one contradicts himself more. No one ever, in history.”

Kimmel has had an unusually prominent role in the Obamacare repeal debate. He criticized the repeal bill the House passed in May for letting states waive protections for pre-existing conditions. Cassidy said then that he wants a bill that passes “the Kimmel test” through which families won’t be denied medical care because they can’t afford it. He went on Kimmel’s show to further talk about healthcare. Kimmel then criticized Cassidy for “lying to his face,” citing state waivers in the bill to let states waive protections such as community rating, which prevents insurers from charging sick people more.

Cassidy: I haven’t spoken with Kimmel. Soon after the press conference announcing the bill’s defeat, Cassidy told reporters that he hasn’t talked to Kimmel recently about the new bill. He seemed to take the criticism from Kimmel in stride. “Having people speak of me on late night television has no affect on anything,” he said as he walked away from the Capitol back to his Senate office.

Cassidy cites ‘Harry Potter.’ Cassidy cited the lack of time as the biggest problem facing the bill. He told reporters he wanted more time to fight what he called “mischaracterizations” by the left that it was cutting $1.2 trillion from Medicaid but instead was just redistributing the funding. Cassidy has been running ragged over the past few weeks to try and get the bill done. He once told reporters that he is going to bed at 1 a.m. and getting up at 5 a.m. Cassidy also lamented he didn’t have the ring Hermoine from Harry Potter used to take multiple classes at once, adding he knows about it because of his daughters. Technically, it wasn’t a ring but a pendant called the “time turner” and it was used in the third book, Prisoner of Azkaban. But we can let that slide.

Frustration with GOP’s inability to deliver on Obamacare contributes to Moore victory in Alabama. Roy Moore defeated Sen. Luther Strange Tuesday in a closely watched special election for an Alabama Senate seat, as frustrated Republican voters rebuked their party’s leadership in Congress for failing to repeal Obamacare and deliver marquee promises. Moore, the former chief justice of the Alabama Supreme Court, removed twice for ignoring federal court orders, won despite Trump’s endorsement of Strange. Angry Republicans in the low-turnout election sided with the candidate they perceived as the political outsider, versus the appointed incumbent who was defined by Washington and the support he received from McConnell.

Americans rank healthcare as most important issue for first time in 2017.  American voters ranked healthcare as the most important issue for the first time this year, according to a poll released Wednesday. Health issues and economic issues were ranked by 24 percent of registered voters as the top priority for Congress in a Sept. 22-24 survey by Morning Consult/Politico. Despite the setback from the Obamacare overhaul, 40 percent of voters still want lawmakers to undo Obamacare and 52 percent do not support focusing on the policy. The online poll was conducted with 1,987 registered voters nationwide and had a 2 percentage point margin of error.

Nine arrested for blocking Capitol subway. Dozens of demonstrators laid down in front of the subway entrance as others covered themselves with white sheets to symbolize what they view as the many lives that would be lost under the GOP’s healthcare plan. Senate leadership said Tuesday they would not consider the Graham-Cassidy legislation after opposition from key Republicans left the measure at least one vote shy of passing. Almost 200 protesters were arrested Monday for disrupting a Senate hearing about the measure. Protesters chanting “No cuts to Medicaid, save our liberties” forced the hearing into a recess. Activists from several liberal groups, including the Working Families Party and the March to Confront White Supremacy say their message to Congress and Democrats, in particular, is to join Sen. Bernie Sanders, I-Vt., in pushing for government-run helathcare.

Ron Johnson tries to end health insurer tax. Sen. Ron Johnson, R-Wis., introduced a bill to delay Obamacare’s health insurer tax a few hours after the collapse of Graham-Cassidy. The tax was already delayed but will go back into effect in 2018. Obamacare insurers have said the tax is one of the key contributors for rising premiums for Obamacare next year, with other factors such as uncertainty over the law’s future. “With the faulty architecture of Obamacare continuing to burden middle-class families, this legislation would provide relief from Obamacare’s health insurance tax that serves to further increase skyrocketing premiums,” Johnson said in a statement on the bill, which has 10 other Republican co-sponsors.

David Brat: McConnell is in trouble and Senate is ‘embarrassing.’ House Freedom Caucus member David Brat, R-Va., criticized McConnell’s inability to pass Obamacare repeal and that the chamber is in trouble after Alabama’s runoff election. “They couldn’t even get, right after they voted on it 50 times over seven years … and they couldn’t get a vote through on any form of Obamacare repeal,” he said on C-SPAN. “I mean, they had a skinny bill that was more like a Madison Avenue marketing tagline,” Brat added. “What is a skinny bill? It’s one-fifth of the economy. And they couldn’t even get a tagline passed. It’s embarrassing.”

Anti-abortion groups push for inclusion of defunding Planned Parenthood in tax reform. Anti-abortion groups were dismayed after the failure to pass Graham-Cassidy, which would have cut off federal family planning funds for a year from facilities that also provide abortions. The funds go toward birth control, STD testing and cancer screenings, but not toward most abortions. Anti-abortion groups have called for the policy to change and want tax reform to be a vehicle by which this can occur. “The failure to pass this reconciliation bill means abortion giant Planned Parenthood remains funded by the taxpayers under a Republican Congress and President,” Susan B. Anthony List President Marjorie Dannenfelser said. “This is completely unacceptable. We call on Congress and the president to include the urgent priority of re-directing Planned Parenthood’s taxpayer funding to comprehensive healthcare providers in the [fiscal 2018] reconciliation bill.” Planned Parenthood warned in a call with reporters Wednesday that taking that route was a “poison pill” because at least two Republicans and all Democrats in the Senate would oppose it. The group warned that cutting federal funding from birth control services would result in unintended pregnancies.

RUNDOWN

The Hill GOP health effort on hold indefinitely

Associated Press Congress at crossroads after another ACA failure

Wall Street Journal Failure of ACA repeal brings “momentary relief” for hospitals and insurers

Politico Inside the life and death of Graham-Cassidy

CNN New STD cases hit record highs, CDC says

Los Angeles Times Amid power outages, hospitals pushed to their limits in Puerto Rico

New York Times McConnell gambled on healthcare and Alabama Senate race. He lost.

Reuters FDA picks companies to help make rules for advanced personal health monitors

Calendar

WEDNESDAY | Sept. 27

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

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.

Deadline for insurers to sign rate contracts with states.

Noon. Health and Human Services event on the opioid crisis titled, “Recovery, Prevention, & Hope: Live Stream Panel of National Experts on Opioids Equip Faith and Community Leaders.” 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.

THURSDAY | Sept. 28

10 a.m. National Press Club. 529 14th St NW. Health and Human Services Secretary Tom Price to discuss flu prevention. 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.

12:30 p.m. National Press Club. 529 14th St NW. Luncheon with Dr. Scott Gottlieb, FDA commissioner. Details.

SATURDAY | Sept. 30

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

MONDAY | Oct. 2

Oct. 2-6. National Health IT Week. Details.

8:30 a.m. National Press Club. 529 14th St NW. Poynter event on “Covering Healthcare Policy Changes.” Details.

TUESDAY | Oct. 3

House to vote on 20-week abortion ban, Pain Capable Unborn Child Protection Act.

WEDNESDAY | Oct. 4

8 a.m. Westin New York. S&P Global Ratings’ Health Care Conference. Agenda.