Daily on Healthcare: The final-ish countdown…revisions and CBO score out today…Cornyn says door is closed after this week

Senate Whip Corynin “closing the door” this week: Senate Majority Whip John Cornyn, R-Texas, had to clarify that he still wants a vote this week. After being quoted as saying that the final deadline to pass the bill is by the start of the August recess, he began a heavy pushback against reports suggestion deadline was slipping. Cornyn then had to clarify on Twitter. “I think we need to do it this week if we hope to pre-empt huge Obamacare rate increases for 2018 — already up 105% since 2013,” he tweeted. Then he followed up by saying even more emphatically, “I am closing the door. We need to do it this week before double digit premium increases are announced for next year.”

America’s Health Insurance Plans has signaled support for a six-month delay provision. In a letter to Sen. Hatch, R-Utah, in May, AHIP wrote: “Effective incentives are needed to encourage consumers to get and maintain insurance coverage continuously as part of a broader strategy to make coverage more affordable for everyone. Well-designed and effective continuous coverage policies — such as late enrollment penalties or waiting periods — are a critically important element in stabilizing markets, especially if the tax penalties associated with the individual coverage requirement are eliminated, as contemplated under the AHCA.”

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.

President Trump is ready to single out GOP senators who oppose the healthcare bill. “I cannot imagine that these very fine Republican senators would allow the American people to suffer a broken ObamaCare any longer!” he tweeted. The president also attacked former President Barack Obama’s often-used line to sell his signature healthcare law, a promise that Americans could keep their health plan, which Politifact dubbed 2013’s “Lie of the Year.” “Democrats slam GOP healthcare proposal as Obamacare premiums & deductibles increase by over 100%. Remember keep your doctor, keep your plan?” Trump said. The president also confirmed that he called the House healthcare bill “mean” because he wants legislation with “heart.”

Trump: I want to work with Democrats but ‘their theme is resist.’ “It would be so great if the Democrats and Republicans could get together, wrap their arms around it, and come up with something that everybody’s happy with. It’s so easy, but we won’t get one Democrat vote, not one,” Trump said on Fox News in an interview taped Friday that aired Sunday. “And if it was the greatest bill ever proposed in mankind, we wouldn’t get a vote. And that’s the terrible thing. So there is – well look, their theme is resist. I’ve never heard of anything like this resist.”

Democrats aren’t the only ones standing in the way of a vote. Here’s a roundup of some of the proclamations senators made on the Sunday talk shows …

Sen. Ben Sasse: ‘I have nothing to announce’ on healthcare bill. The Nebraska Republican declined to say whether he supports or opposes the Republican healthcare bill. Sasse was asked to describe his position at a gathering of donors to groups founded by Charles and David Koch, but Sasse quickly noted that Senate Majority Whip John Cornyn, R-Texas, was at his speech. “I have a bruise just inside my collarbone from his thumb on me,” he said. “This session is actually on the record, right?” Sasse asked. When reminded that press was in the room, Sasse quickly said, “I have nothing to announce.”

John Barrasso says GOP leadership can get healthcare passed. The Wyoming Republican said he believes the Senate will pass the healthcare draft bill because it’s the only way to “cut down costs of care and insurance” for all Americans. “I believe we will get it passed and that is the only way we can fundamentally change … and cut down the cost of care and insurance,” Barrasso said on “Fox News Sunday” after Brit Hume asked if the senator believed they can sway Republicans who aren’t currently supporting the bill. Barrasso praised the five GOP senators who oppose the bill in its current form, saying he believes each of them has “good points.” He said he’s ready to work with them. “Every one of them [Republican senators who don’t support the healthcare bill draft] is committed to a fundamental change away from Obamacare and central government control and into local control and patients making decisions,” Barrasso said.

Sen. Ron Johnson: ‘There’s no way’ Senate should vote on bill before July 4 break. “We don’t have enough information, I don’t have the feedback from constituencies who will not have time to review the Senate bill,” said Johnson, a Wisconsin Republican. “We should not be voting on this bill next week.” Johnson — who refused to characterize himself as a “no” vote on the bill, instead saying “I’m not a yes yet” — said the bill released by Senate GOP leadership last week doesn’t appear to be the full fix that he wants to Obamacare. He said lawmakers “don’t have the courage” and “don’t have the honesty” to talk about healthcare in a real, meaningful way. Instead, it’s all political rhetoric that gets in the way of policymaking, he said. “These bills aren’t going to fix the problem,” he said. “They’re not going to fix the root cause.”

Johnson then wrote in an op-ed in the New York Times that the bill doesn’t do enough to repeal Obamacare. He wrote that the defenders will say it repeals the law’s taxes and reduces Medicaid spending. “But it also boosts spending on subsidies and it leaves in place the pre-existing condition rules that drive up the cost of insurance for everyone,” he wrote.

Johnson said the Senate instead should “return more flexibility to states, to give individuals the freedom and choice to buy plans they want without Obamacare’s ‘reforms.’” Johnson surprised everyone by opposing the Senate bill mere hours after it was released. He told reporters he was upset that leadership didn’t give lawmakers enough time to evaluate it before this week’s vote.

Sen. Jerry Moran raises doubts about vote by the end of the week. The Kansas Republican said it wasn’t clear that leadership had the votes for passage and may need to extend the session into the Fourth of July recess to finish its work. “I just don’t know whether the votes will be there at the end of the week,” Moran said in an Fox News interview Sunday. Moran said he was among those whose vote for support for his party leadership could not be taken for granted. He said he wanted to be certain that the eventual legislation did not end up punishing states such as his own that did not expand Medicaid coverage. “Those states that were expanded are insisting that they be protected (by the reform), at least for a period time, for the costs from that expansion,” Moran said. “From a Kansas perspective … we want to make sure that we are not being penalized in this Senate bill for not doing so.”

Rand Paul signals willingness to switch on GOP healthcare bill. The Kentucky Republican, one of five Republicans who has said he would vote against the the Senate healthcare reform bill, said Sunday he would change his stance if the White House and GOP leadership changed its approach. “If they cannot get to 50 votes, if they get to (an) impasse, I’ve been telling the leadership for months now that I will vote for a repeal. It doesn’t have to be 100 percent repeal. So, for example, I’m for 100 percent repeal. That’s what I want, but if you offer me 90 percent repeal, I’d probably vote for it. I might vote for 80 percent repeal,” Paul told ABC on Sunday.

Another conservative who has voiced opposition, Sen. Mike Lee, lays out what GOP healthcare bill needs to get his vote. “Far short of ‘repeal,’ the Senate bill keeps the Democrats’ broken system intact, just with less spending on the poor to pay for corporate bailouts and tax cuts,” said Lee, R-Utah, bemoaning that conservatives have “compromised on every substantive question in the bill.” But Lee conceded he could support the legislation if it were amended to allow states and individuals more flexibility. “For all my frustrations about the process and my disagreements with the substance of [the bill], I would still be willing to vote for it if it allowed states and/or individuals to opt out of the Obamacare system free-and-clear to experiment with different forms of insurance, benefits packages and care provision options,” Lee said. “Liberal states might try single-payer systems, while conservatives might emphasize health savings accounts. Some people embrace association health plans or so-called ‘medishare’ ministry models. My guess is different approaches will work for different people in different places – like everything else in life.”

Sen. Bill Cassidy ‘undecided’ on healthcare reform bill. “Right now, I am undecided. There are things in this bill that adversely affect my state, that are peculiar to my state.. but if those can be addressed, I will [vote for it]. If they can’t, I won’t,” Cassidy told CBS on Sunday. Cassidy has been uncommitted on the legislation for weeks and has proposed alternate legislation. Cassidy had appeared earlier in the week to be leaning toward supporting the GOP leadership’s bill, saying it included elements of the the reforms he proposed, “which is positive.” However, his comments Sunday indicate that he does not believe those changes are sufficient.

Whip count update: No more senators came out against the bill over the weekend, so for now there remains five publicly opposed. However, some key senators are wavering, including Sen. Bill Cassidy, R-La. Sen. Susan Collins, R-Maine, listed a slew of concerns with the bill on ABC’s “This Week,” including the cost of premiums and deductibles for low-income people.  As a reminder, leadership can afford to lose only two Republicans. See the list.

Jimmy Kimmel urges Sen. Bill Cassidy, R-La., to stick to the ‘Kimmel test.’ The comedian defines the test as meeting the stipulation that coverage is available to everyone regardless of their ability to pay. “Reminder for Sen @BillCassidy: Kimmel test is ‘No family should be denied medical care, emerg or otherwise, because they can’t afford it,'” Kimmel tweeted Sunday. He also retweeted someone else’s opinion of the bill that stated it would fail the Kimmel test. Cassidy has said that a bill must meet several requirements to get his vote, including that it must not discriminate against people with pre-existing illnesses.

Ohio Gov. John Kasich: ‘The resources just aren’t there’ in the Senate healthcare bill. Kasich said on CNN Sunday the Senate bill is an improvement from the House healthcare bill, but it still isn’t going to do enough to help his state. He said it’s going to harm children, seniors, disabled people and people struggling with drug addiction. “It’s just not enough resources there and I’ve been very concerned here in my state … if you look at the entire Medicaid pie, there are a few challenges to do it because the resources are just not there,” he said. He stopped short of calling on Ohio Republican Sen. Rob Portman to vote against the bill, but he said if he was in Congress he wouldn’t be able to support the bill. “I don’t think the bill’s adequate now and unless it gets fixed, I’m against it,” he said.

Tom Price says GOP lawmakers opposing healthcare bill don’t understand Trump’s plan: In responding to comments made by Sen. Dean Heller, R-Nevada, last week saying that the second biggest healthcare lie was the Senate bill would lower premiums, the Health and Human Services secretary said the bill is a part of a larger plan that would accomplish that goal. “The plan, in its entirety, will absolutely bring prices down,” he said. Price said increased healthcare costs “just wouldn’t happen, and we’ll continue to work with the governors to make sure they understand the plan in its entirety.”

Price, speaking with the Atlantic at Spotlight Health at the Aspen Institute, addressed the coming CBO score bill. “CBO does a relatively poor job on what the coverage consequences of a health plan are … the fact of the matter is their ability to predict what human behavior is going to be without looking at entire construct is difficult, so I would suggest to you that the numbers CBO had before with the ACA and the numbers that they’ve put forward now are not accurate,” he said.

On proposals to cut CDC funding, Price said: “I would suggest to you that there are efficiencies that can be had and we can actually bring more resources to the battle of — whether it’s innovation, whether it’s NIH research and funding, whether it’s CDC, whether it’s global health security — the kinds of things that are an absolute priority for the United States and for the president.”

Obamacare architect: ‘Cheating’ will get the Senate healthcare bill a better CBO score. MIT economist Jonathan Gruber says the Senate healthcare bill likely will receive a better CBO score than its House counterpart only because the GOP senators who devised it are “cheating.”

“I know we’re going to get a horrific CBO score next week,” Gruber said. “The CBO score will be horrible but it won’t be as bad as the House bill because the Senate is cheating by pushing the damage out by a few years.”

Sen. Bernie Sanders defends escalating rhetoric over Senate healthcare bill. The Vermont independent and other liberals have been slammed for their attempts to brand Republicans as being a part of the “Party of Death,” calling the tax cuts in the Senate healthcare bill “blood money” and repeatedly saying people will die because of the bill. The statements came a week after House Majority Whip Steve Scalise, R-La., and three others were shot during a baseball practice in Alexandria, Va., and Republicans criticized that kind of rhetoric as inappropriate. But, Sanders refused to back off his statements because he believes they’re factually accurate. “What Harvard University … and the scientists there determined is when you throw 23 million people off health insurance — people with cancer, people with heart disease, people with diabetes — thousands of people will die,” Sanders said. “I wish I didn’t have to say it, this is not me. This is study after study saying if you have cancer and your insurance is taken away from you, there is a likelihood you will die.”

Similar rhetoric was echoed by Hillary Clinton: “Forget death panels. If Republicans pass this bill, they’re the death party,” Clinton wrote in a tweet.

Former Vice President Joe Biden on Senate healthcare draft: ‘Bill isn’t about healthcare at all — it’s a wealth transfer.” Biden brought up the opioid addiction epidemic that is sweeping the nation, saying the draft bill hurts all those struggling with addiction with its cuts to Medicaid. “Let’s see a bill that actually tries to improve folks’ healthcare, and then we can have a responsible debate about how to best do that,” Biden wrote in his last tweet of the thread.

Americans for Prosperity: States proving that voters reward ‘bold reform.’ The success conservatives have had at the state level pushing for right-to-work policies and other reforms should encourage politicians in Washington to be bold as they consider healthcare and tax reform in the coming weeks, according to one of the leaders of Americans for Prosperity. Sean Lansing, the chief operating officer of the Koch-backed group, said conservatives have run off an impressive string of state-level victories in the last few years. Lawmakers in Washington should take note that voters have rewarded those decisions by voting them back into office, he said. Read more.

Koch groups: ‘Immoral’ not to rein in Medicaid expansion. “Medicaid expansion is a big piece of it, because overall what we’ve seen is it’s crowded out care for those that are truly the most vulnerable, and added able-bodied individuals to that,” Freedom Partners executive vice president James Davis told reporters when asked what most worries the groups about the Senate bill.

Americans for Prosperity President Tim Phillips, who met Friday with Vice President Mike Pence, agreed that Medicaid expansion under Obamacare has flooded an already failing system with more people who won’t be able to get quality care. “We’ve taken Medicaid to more than 70 million folks,” Phillips said. “It was a struggling, frankly failing federal program before this dramatic expansion.” “The wait times for folks on Medicaid have gone up, and especially when they’re trying to get in to see a specialist,” he said. “It’s terrible what happened here.”

Medicaid directors blast Senate bill: The National Association of Medicaid Directors is blasting the Senate healthcare reform bill’s cuts to Medicaid. The association of state-based directors said in a letter Monday that “changes in federal responsibility for financing the program must be accompanied by clearly articulated statutory changes to Medicaid to enable states to operate effectively under the cap.” The directors charge the Senate bill shifts the burden to states. It added that the per capita growth rates for Medicaid in the bill are “insufficient and unworkable,” directors said.

Some Republicans fighting for the bill Sen. Pat Toomey, R-Pa., defended the Senate bill, saying in an op-ed on Philadelphia Inquirer that it would stabilize Obamacare’s markets and keep Obamacare’s Medicaid expansion. “Under the Senate bill, both the 700,000 Pennsylvanians who signed up for this expansion and future expansion enrollees will retain their federal eligibility for the program,” Toomey wrote. The bill would keep Medicaid’s expansion in place but then start to phase out federal payments over four years. It also would cap Medicaid spending and let states receive federal funding through a block grant or a per capita cap. So while the expansion would be kept in place, federal spending on Medicaid would be cut. Toomey said the cuts would help sustain Medicaid for future generations and for taxpayers. “For decades, Medicaid spending growth has been out of control,” he wrote. “It is now a major driver of our federal deficits and debt.”

Meanwhile, in other healthcare issues: Democrats are beginning to think Trump isn’t going to work with them on high drug prices, or at least on the reforms they want. Democrats are getting angry that Trump hasn’t embraced changes such as giving Medicare the power to negotiate for lower drug prices and letting Americans buy cheaper drugs from Canada. But Trump appears likely to move toward more pharma-friendly policies. The White House is expected to issue an executive order soon that aims to protect patents for drugs sold overseas. Reps. Elijah Cummings, D-Md., and Peter Welch, D-Vt., were miffed since they met with Trump in March and thought he was receptive to their ideas. “Your statements and your promises gave many of us hope, but your planned executive actions suggest you have abandoned these promises in favor of the very pharmaceutical lobby you warned of,” the letter said.

Naloxone for opioid overdoses faces hurdles in schools: States are increasingly turning to schools as they work to stave off the devastating opioid epidemic, which is claiming a growing number of lives and ravaging the lifespans of middle-aged white people. Yet local laws prevent some districts from stocking a life-saving antidote, and critics worry it won’t discourage drug use. A 2015 law in Rhode Island took the most aggressive approach by requiring all public middle, junior and high schools be equipped with naloxone, which reverses the effects of an overdose when someone passes out. Read more. ​

RUNDOWN

Roll Call Senate at a deliberative crossroads

Politico Freedom Caucus holds its fire on Senate Obamacare bill

Kaiser Health News In the end, the middle class would feel GOP cuts to nursing home care

Associated Press Promises, Promises: What Trump has pledged on healthcare

Wall Street Journal What the healthcare vote means for the 2018 midterms

Atlantic Of all the categories of fake news, health news is the worst

The Hill McConnell allies confident of healthcare win

Axios Trump’s backup plan for a healthcare failure

Associated Press Martin Shkreli defies advice to keep quiet before fraud trial

Calendar

CALENDAR

MONDAY | JUNE 26

CBO score on Better Care Reconciliation Act, the GOP healthcare bill, expected.

TUESDAY | JUNE 27

8:30 a.m. W Hotel 515 15th St. NW. Politico event on “Is Population Health Popping?” Details.

10 a.m. 529 14th St NW. National Press Club. National Safety Council will unveil its State of Safety report. Details.

6:30 p.m. Newseum. 555 Pennsylvania Ave. NW. Documentary showing of “Written Off,” about the opioid crisis. Trailer.
 

WEDNESDAY | JUNE 28

10 a.m. Bipartisan Policy Center. 1225 I St. NW. Event on “Cybersecurity and Medical Devices.” Details.

Noon. Urban Institute. 2100 M St. NW. Event on “Stabilizing the Individual Health Insurance Market.” Details.

Noon. 2167 Rayburn. Capitol Hill briefing on “What’s the Right Decision for Me? Shared Decision Making in Prostate Cancer,” hosted by the Patient-Centered Outcomes Research Institute (PCORI) and the Men’s Health Network.

THURSDAY | JUNE 29

10 a.m. Bipartisan Policy Center. 1225 I St. NW. Event on “Future of Healthcare: Balancing Coverage and Cost in Medicaid.” Details.

10:30 a.m. American Enterprise Institute. 1789 Massachusetts Ave. NW. Event on “Sensible Regulation of E-Cigarettes: Opportunities for Reform.” Details.

6 p.m. 101 Constitution Ave. NW. Independent Women’s Forum event on “Oops! Sorry We Were Wrong … How Public Health Guidance Often Harms the American Public.” Details.

FRIDAY | JUNE 30

June 30-July 3. Marriott Marquis San Diego Arena. San Diego. Annual conference for the National Association of School Nurses. Details.