Daily on Healthcare: Republican senators skeptical of new Obamacare overhaul push…Doubts also swirl around chances for bipartisan bill

Republican senators skeptical of new Obamacare overhaul push A last-gasp attempt to overhaul Obamacare is coming from Republican Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana and Dean Heller of Nevada. NBC News had reported that the bill, expected to be released this week, would provide $1.2 for Obamacare’s Medicaid expansion and tax credits directly to states in an attempt to get the states to craft their own healthcare programs. But a Senate aide familiar with the writing of the bill cautioned the Washington Examiner that this was from a draft that was a week and a half old. Once released, the bill will have a lot of hoops to jump through in a very short amount of time. Republicans have until the end of the month before a budget resolution expires that outlines the instructions for passing Obamacare repeal via reconciliation, which bypasses a filibuster. So the GOP would have to pass another resolution to start again. Senators were skeptical that they could push the bill through by the end of the month, since it hasn’t been scored by the Congressional Budget Office. Sen. John Cornyn, R-Texas, the second-ranking GOP senator, told reporters Monday that he doesn’t know how much support the bill has without a CBO score.

“I don’t know on what basis could you determine whether you would support it since it hadn’t been written or scored,” he said. “We need to keep working. I think we need a score and that will tell people a lot.” Other senators were skeptical that the bill could be passed by the end of the month. Sen. Ron Johnson, R-Wis., said “it would be threading the needle, there is no doubt about it.”

Doubts also swirl around chances for bipartisan bill Democrats and Republicans tasked with forging a bipartisan bill to stabilize Obamacare are at odds over how much flexibility to give to states to avoid some of the law’s regulations. The Senate Health, Education, Labor and Pensions Committee held another hearing Tuesday in a series on stabilizing the individual market, which includes Obamacare’s marketplaces. The hearing focused on how much flexibility to give to states on insurance coverage and plans. Democrats opened the hearing worried that the push for more flexibility from Republicans is a move toward eroding Obamacare’s protections. HELP Chairman Lamar Alexander, R-Tenn., said there needs to be improvements to the state innovation waiver, called the 1332. He said the application process for the waivers, which allow states to waive key requirements that insurers must abide by, are too cumbersome and inflexible. He added that he doesn’t support changing the patient protection guardrails, which include protections for people with pre-existing illnesses.

Alexander plans to put together a bipartisan bill by the end of this week, but it faces a tough path to approval. The biggest obstacle is avoiding another “b” word: bailout. Republicans are reticent to approve any bill that includes funding for Obamacare, even if it is a one-year fix of the insurer subsidies known as cost-sharing reduction payments. Sen. Orrin Hatch, R-Utah, blasted the bipartisan package. “The status quo under Obamacare is not improving. I don’t believe we should spend more energy to prop up a system that is already hurting millions of Americans,” the chairman of the Senate Finance Committee said in his opening statement.

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.

How much of an effect is Obamacare having on reducing the rate of uninsured? Analysts from the U.S. Census Bureau aren’t sure. In their report on 2016 health insurance coverage released Tuesday, they said they were unable to tease out the proportion of insurance gains that happened because of Obamacare versus because of an improved economy, which would allow more people to get coverage through work. According to the report, an increase in health insurance coverage last year brought the total insured population to 91.2 percent, which was 0.3 percentage points higher than in 2015. The gains in coverage varied widely across geography and race. Whites have the lowest rate of uninsurance, at 6.3 percent, and Hispanics have the highest uninsured rate, at 16 percent, even though they had overall declines in poverty in recent years. The uninsured rates for blacks and Asians were 10.5 percent and 7.6 percent, respectively. Massachusetts, which has a state health insurance system that Obamacare was modeled after, had the lowest uninsurance rate, at 2.5 percent, while Texas had the highest, at 16.6 percent.

Opioid maker cites FDA decisions in lawsuit defense. Purdue Pharma is arguing that an Ohio lawsuit should be thrown out because the Food and Drug Administration approved the use of its popular painkiller. Ohio is among several states suing opioid makers, and says the companies falsely marketed the drugs and downplayed the addictive effects of opioid painkillers that are driving an epidemic ravaging the United States. Purdue Pharma, maker of popular painkiller Oxycontin, argues that it marketed the drugs according to FDA guidelines. Ohio argued in its lawsuit that Purdue Pharma marketed the drugs to treat chronic pain. Ohio defines chronic pain as noncancer pain lasting three or more months. However, Purdue Pharma says that the FDA approved Purdue’s long-acting products to treat chronic pain that includes noncancer pain. Purdue also said the lawsuit is pre-empted by federal law and prior decisions made by the FDA.

More 2020 hopefuls sign on to Sanders’ Medicare-for-All bill. Democratic Sens. Cory Booker and Jeff Merkley signed on to Sen. Bernie Sanders’ single-payer healthcare bill expected to be released Wednesday. The bill, which would expand Medicare to all Americans, has won signatures from prominent Democrats, a sign of the party moving to a fuller embrace of government-run healthcare. Booker is the latest 2020 Democratic hopeful to sign on to the bill. Sens. Elizabeth Warren of Massachusetts and Kamala Harris of California also are co-sponsoring the bill.

Hillary Clinton says Democrats should have litmus test for abortion. Clinton urges the Democratic Party not to support candidates who are anti-abortion. In her book What Happened, released Tuesday. She refers to a campaign event with Sanders, I-Vt., and Heath Mello, who is opposed to abortion. “After the election,” Clinton writes, “Bernie suggested that Democrats should be open to nominating and supporting candidates who are anti-choice. Other topics, such as economic justice, are sacrosanct, but apparently women’s health is not. … I don’t mean to criticize only Bernie here, a lot of progressives join him in thinking that reproductive rights are negotiable.” She distinguished between supporting abortion rights and holding different personal views about the procedure. “I’ve been working for a quarter century with Democrats and Republicans alike to reduce the number of abortions, in part by expanding access to birth control and family planning, and we’ve made progress,” she said. “And I picked as my running mate Tim Kaine, a Democrat personally opposed to abortion because of his Catholic faith but supportive of women’s rights as a matter of law and policy. But, when personal views on abortion become public actions —votes on legislation or judges or funding that erode women’s rights — that’s a different matter.”

House Dems seek answers from HHS on open enrollment. Democrats on the House Energy and Commerce Committee sent a letter to Health and Human Services Secretary Tom Price and CMS Administrator Seema Verma to raise questions about the Trump administration’s plan to slash 90 percent in funding for navigators who help people sign up for coverage during Obamacare open enrollment. The letter raises questions about whether the plan is an effort by the administration to intentionally reduce enrollment and further destabilize the marketplaces. “It appears that the decision fits within a pattern of administration efforts to depress enrollment and sabotage the [Affordable Care Act], including the decision to pull advertising during the final days of open enrollment in January 2017, as well as the use of public funds to conduct an ongoing propaganda campaign designed to damage public opinion of the ACA,” the letter says. Other navigators expect to hear this week about whether they will be receiving funding from the administration.

CMS issues waivers after Hurricane Irma. The waivers allow people to more quickly receive care in nursing homes or hospitals or to stay in facilities longer if they need to. They also will allow Medicare funds to go to doctors from out of state who are treating patients in Florida. “CMS has been working closely with officials in Florida and granted several waivers to help provide immediate medical relief to those affected by Hurricane Irma,” Verma said. “We hope these waiver provisions will provide healthcare providers, facilities and suppliers the flexibility they need so they can focus on the health and safety of those impacted by the hurricane.”

RUNDOWN

The Hill Dems worry GOP is pulling healthcare negotiations in a partisan direction

Axios CDC cracks down on communication with reporters

Washington Post Pet store puppies linked to bacterial outbreak, CDC says

New York Times Houston flood waters tainted with toxins, testing shows

Marketplace Anesthesia providers to turn to opioid alternatives during surgery

Miami Times Herald Florida hospitals evacuated for Harvey now opening back up

STAT News Former CDC Director Tom Frieden to launch global health initiative

Calendar

TUESDAY | Sept. 12

Sept. 10-12. Swissôtel, 323 East Upper Wacker Drive. Chicago. Eighth International Congress on Peer Review and Scientific Publication. Details.

Sept. 11-13. Hogan Lovells. 555 13th St. NW. Food is Medicine Coalition National Symposium.

Sept. 12-13. Marriott Wardman Park. 2660 Woodley Road NW. 2017 Association for Accessible Medicines Biosimilars Council Conference. Includes keynote by CMS Administrator Seema Verma. Agenda.

2:30 p.m. Brookings Institution. 1775 Massachusetts Ave. NW. Event on “Inclusive School Environments: Improving Outcomes for Students With and Without Disabilities.” Details.

6:30 p.m. President Trump to hold bipartisan Senate dinner.

WEDNESDAY | Sept. 13

8 a.m. Marriott Marquis Hotel. 901 Massachusetts Ave. NW. Friends of Cancer Research to host event on “A Blueprint for Breakthrough – Charting the Course for Precision Medicine Agenda.” Will include remarks from FDA Commissioner Scott Gottlieb.

8 a.m. AJAX. 1011 Fourth St. NW. Event hosted by The Hill on “America’s Opioid Epidemic: Search for Solutions” with Sen. Rob Portman, R-Ohio, and Rep. Paul Tonko, D-N.Y. Details.

9 a.m. National Press Club. 529 14th St. NW. Event on “Understanding the Value of Innovation in Medicine.” Details.

10:30 a.m. 1100 Longworth. House Committee on Ways and Means markup of Medicare bills. Details.

11 a.m. Dr. Tom Frieden, former director of the CDC, expected to announce a new global public health initiative.

Noon. 485 Russell. American Association for Cancer Research to host a congressional briefing to announce the “AACR Cancer Progress Report 2017.”

1 p.m. G50 Dirksen. Congressional briefing hosted by the American Psychiatric Association on “Telemedicine in America: Increasing Patient Access to Care & the Physician Perspective.”

1 p.m. National Press Club. 529 14th St. NW. Covered California to release a report on the importance of marketing and outreach for the Obamacare exchanges.

THURSDAY | Sept. 14

10 a.m. 430 Dirksen. Senate Health, Education, Labor and Pensions Committee hearing on stabilizing the Obamacare exchanges, with testimony from healthcare stakeholders. Details.

1:30 p.m. Alliance for Health Policy Webinar on “New Administration, New Approach to Medicaid Waivers?” Details.

FRIDAY | Sept. 15

Sept. 15-19. Chicago. American Academy of Pediatrics conference. Schedule.

8 a.m. Newseum. 555 Pennsylvania Ave NW. Atlantic forum on “Children and Cancer.” Details.

Noon. 325 Russell. Alliance for Health Policy event on “Chronic Pain & Opioid Addiction: The Role of Integrated Care.” Details.

TUESDAY | Sept. 19

8:15 a.m. Ronald Reagan Building. 1300 Pennsylvania Ave NW. Bloomberg Live event on “The Future of Healthcare: Unlocking and Supporting Value.” Details.

Noon. Harvard T. Chan School of Public Health event on “In Pursuit of a Single Payer Plan: Lessons Learned” with Vermont Gov. Peter Shumlin. Live Stream.