Daily on Healthcare, presented by Coalition for Contact Lens Consumer Choice: 7 things to look for in the Senate healthcare bill…no deal yet…deadline day for Obamacare insurers

Medicaid: Over how long of a period will Obamacare’s Medicaid expansion be phased out, and at what rate will it be set to grow at over time? Conservatives have been pushing for an expedited wind down of Obamacare, and want the program to grow more slowly in the long-run. But centrists want more a more gradual phaseout of the expansion, and more generous funding thereafter.

Tax credits: Do they become more like Obamacare than in the House-passed bill, particularly, does the bill adjust the value of the credit by income instead of by age? How does the Senate bill apply anti-abortion language to the credits to get around concerns about whether the language would be violating reconciliation rules?

Regulations: How will the Senate handle the roll back of Obamacare’s regulations? Conservatives see deregulation as a key to lowering premiums, but centrists are reluctant to undo them. Any Senate bill is expected to place more limits on the ability of states to opt out of federal requirements.

Stabilization funding: McConnell has argued that one of the key goals of legislation is to stabilize individual insurance markets. That suggests money is going to be pumped into the markets over the next few years, during the transition time from when the bill becomes law and when it would begin to wind down Obamacare’s major coverage provisions and establish a new system of tax credits. Anything that smacks of a “bailout” of Obamacare will create issues among conservatives.

Abortion: Will Planned Parenthood defunding get axed from the bill to assuage centrists? If so, does this cause conservatives to bolt, as they lose one of the items that they could take away as a legitimate social conservative win?

Spending: How much do any adjustments to Medicaid, tax credits, and stabilization funding affect the overall cost of the legislation?

Obamacare’s tax hikes: If Senators want to spend more then the House, they’re going to have to come up with the financing to meet reconciliation rules for deficit reduction. The most obvious way would be to delay the repeal of various Obamacare tax hikes.

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.

No deal yet: Republican leadership is aiming to hold a vote next week on healthcare reform and expect to release a “discussion draft” on Thursday. However, this shouldn’t be confused with them having a “deal” on healthcare. Members of leadership insist they are getting close. “We are down now to the fine points as opposed to big differences, but we’ve still got to get to where we get consensus and settle on some of these major points of the bill,” said Sen. John Thune, R-S.D., the third-ranking GOP senator, after exiting a closed-door meeting on healthcare Tuesday. Thune didn’t elaborate on what the “fine points” are or how small they are, but added he wasn’t concerned that the Senate hasn’t gotten consensus yet on major issues. “We expected this was going to be complicated and it is,” he said. Thune’s optimistic take, however, should be taken with a grain of salt, because most Republican Senators have not seen a healthcare bill, and what has leaked out has been subjected to criticism from both conservatives and centrists.

Medicaid needs ironing out: Leadership and centrists have yet to get any deal on how to phase out Obamacare’s Medicaid phase out. Thune told reporters yesterday that the goal is for a phase out by 2023. However, centrists are still pushing for a seven-year phase out and so far aren’t budgeting. A source familiar with the talks told the Washington Examiner that leadership thinks that a three-year phase out will fly but so far centrists haven’t agreed to that figure. The rift over the phase out comes as leadership wants to put out the discussion draft on healthcare reform on Thursday.

Mike Lee to critics of GOP healthcare bill process: ‘I share your frustration.’ Lee lamented the process by which Republicans in the Senate are working to write a healthcare bill, saying he had not read a version and that members were needlessly rushing toward a vote. “If you’re frustrated by the lack of transparency in this process, I share your frustration. I share it wholeheartedly,” Lee said, speaking in a video he posted on his Facebook page after noting his office had received a lot of calls. “We should have been able to see it weeks ago if we are going to be voting on it next week,” he added. Lee, a conservative member of the party, said that he had understood that as being part of the healthcare working group he would contribute to writing the bill. “It has become increasingly apparent in the last few days that even though we thought we were going to be in charge of writing a bill within this working group, it’s not being written by us, it’s apparently being written by a handful of staffers who are members of the Republican leadership in the Senate,” he said.

Other Senate Republicans don’t know who is writing the bill: Senate Republicans don’t just know what is in the healthcare bill, but who is actually writing it. Several Republicans gave a wide range of answers on who exactly is responsible for crafting the legislation, which leadership expects to released tomorrow. When asked if he knows who is writing the bill, Sen. Rand Paul, R-Ky., responded “not exactly.” Sen. Susan Collins, R-Maine, said she didn’t know either. “I assume Sen. McConnell and his staff are, with input from his working group, but I really don’t know,” she said. Some senators thought that committees such as Senate Finance and the Health, Education, Labor and Pensions Committee are drafting it. But others thought it was just McConnell’s office. “We can say the finance committee is [drafting it], the budget committee is or the HELP committee is but the leadership office is really writing the bill,” he said Tuesday.

Sen. John Cornyn, R-Texas, the second-ranking GOP senator, tried to clear things up. He said that the Senate Budget Committee is taking the lead.

Ted Cruz: Public debate on healthcare bill would lead to senators ‘shooting at each other’: “I think if we were debating this publicly, there would not be a way to have reasonable good-faith negotiations, where conservatives and moderates could lay out their views, go back and forth and find middle ground,” Cruz, R-Texas, said in an interview with conservative radio host Mark Levin. “I think what you would end up with is people grandstanding for the cameras and drawing lines in the sand and shooting at each other, and we wouldn’t get there.” Cruz, a key conservative, told Levin he hasn’t yet seen what’s in the bill, but he noted McConnell and his staff have consulted the views of conservatives. He said that if the GOP fails to repeal Obamacare, “that’s how you get a Speaker [Nancy] Pelosi and a Leader Chuck Schumer.”

Deadline day for insurers to participate in the exchanges: Rate filing requests are due in the 39 states that use Healthcare.gov, and the pattern will demonstrate to what extent double-digit rate hikes are a trend or a blip among a handful of states. Results from states who had earlier requests varied. Pennsylvania is facing single-digit requests on average, while insurers that have filed in Connecticut, Maryland, Virginia and Washington state are requesting increases in the double digits. Insurers have blamed both the structure of the exchanges and the uncertainty injected by the Trump administration for the hikes, and some that have requested lower increases say their proposals could change if the Trump administration stops paying out cost-sharing reduction subsidies. Heading into Wednesday’s deadline, residents in dozens of U.S. counties already face the prospect of having no insurers to purchase plans from. Stop the HIT Coalition, sent a letter to GOP leaders urging them to repeal of the health insurance tax, a move they say could reduce premiums by between 3 and 5 percent. The tax was suspended this year, following double-digit rate hikes that were expected in the exchanges.  

Where newly-elected Republican Karen Handel stands on healthcare: Handel will replace former Republican Rep. Tom Price, who joined the Trump administration as secretary of health and human services. Handel defeated Democratic candidate Jon Ossoff in what became the most expensive House race in U.S. history, and one that many political analysts viewed as a reckoning moment for Trump. On healthcare, Handel has said she supports protections for people with pre-existing illnesses. She praised the American Health Care Act when it passed and is anti-abortion. Susan B. Anthony List, a group that opposes abortion, praised Handel’s victory. “We congratulate pro-life champion Karen Handel on her historic victory tonight. Although America’s largest abortion business, Planned Parenthood, spent six figures in support of her opponent Jon Ossoff, Karen’s record of courageous leadership won the day,” SBA List president Marjorie Dannenfelser said in a statement.

House Democrats not happy with Trump on drug prices: House Democrats who met with Trump earlier this year on high drug prices aren’t happy with the White House.

Reps. Elijah Cummings, D-Md., and Peter Welch, D-Vt., wrote a letter to Trump saying that he has done little to work with them on high prices after a meeting on March 8. They are also dismayed at reports of an executive order that could be friendly to the pharmaceutical industry.

Cummings and Welch reminded Trump that he said on the campaign trail that the pharma industry is “getting away with murder.” “Your statements and your promises gave many of us hope, but your planned executive actions suggest that you have abandoned those promises in favor of the very pharmaceutical lobby you warned of,” the letter added. Trump hasn’t endorsed Democratic-led reforms that include letting Americans buy cheaper drugs from Canada or giving Medicare the power to negotiate for lower drug prices.

Trump hits Democratic “obstruction” following special election results: “Democrats would do much better as a party if they got together with Republicans on Healthcare,Tax Cuts, Security. Obstruction doesn’t work!” Trump tweeted Wednesday. The office of Senate Minority Leader Chuck Schumer, D-N.Y., sent an email to reporters after the tweet had been sent that outlined several requests democratic leaders have made to Republicans and the Trump administration to fix Obamacare.

Schumer predicts “outcry” over GOP healthcare bill: Schumer predicted Tuesday that voters would revolt against the Senate Republican healthcare bill once it’s released this week. “I would assume that once the public sees this bill, there will be the same outcry there was against the House bill, but it may have even greater effect because the Senate Republicans have less margin for error,” Schumer told reporters at his weekly press conference.

Democratic National Committee releases digital ads on Republican healthcare bill: Ahead of the Senate’s expected vote on a healthcare bill next week, the DNC on Tuesday released ads showing Trump and House Republicans celebrating the passage of the American Health Care Act. “This is how House Republicans reacted after voting to repeal the Affordable Care Act,” the ad says. “Celebrating a bill that would kick 23 million Americans off their health insurance to provide tax breaks to millionaires. Now Senate Republicans are planning to vote for healthcare repeal, too.” The ad, which urges viewers to call their senators, will run in Nevada, Arizona, Maine, Alaska, Texas and Tennessee.

Behavioral health groups launch radio ads against GOP healthcare bill: Shatterproof, the National Council for Behavioral Health and the American Psychiatric Association launched a six-figure radio campaign this week urging Senators to reject the American Health Care Act. The bill, they argue, would reduce spending on Medicaid, which provides medical coverage for low-income people with substance abuse disorders and mental illness. The ads are running in West Virginia, Ohio and Maine.

Other ad campaigns were launched by the American Cancer Society Cancer Action Network, which said it was worried about protections for people with pre-existing illnesses and about reductions to Medicaid funding. These will run print and digital ads in Alaska, Nevada, Maine and West Virginia.

AARP goes after senators on healthcare through radio ads: They ask constituents to contact Republican Sens. Jeff Flake of Arizona, Cory Gardner of Colorado, Dean Heller of Nevada, Rob Portman of Ohio, Shelley Moore Capito of West Virginia, and Lisa Murkowski and Dan Sullivan of Alaska to ask them to vote “no” on the health care bill. It tells Senators “It’s your choice whether to stand with us, or support a bill being written in secret – a bill that could make it harder for us to afford to go to the doctor, fill our prescriptions, or get the basic medical care we depend on. Just one vote could be enough to stop this bill.”

Oscar Health will expand its Obamacare exchange presence, selling plans in Ohio, New Jersey, Texas, Tennessee and California. Company CEO and co-founder Mario Schlosser said in a blog post that he was confident the exchanges would stabilize in 2018.

Obamacare insurer payments go out in June, with no promise of future: Sources in the administration confirmed that the payments had been given to insurers for June. “We are weighing our options and still evaluating the issues,” a White House spokesperson said in an email. “Congress could resolve any uncertainty about the payments by passing the AHCA and reforming Obamacare’s failed funding structure.” The Department of Health and Human Services issued a similar response. “The June payment has been made. We are weighing our options and still evaluating the issues,” said HHS press secretary Caitlyn Oakley. “Congress could resolve any uncertainty about the payments by passing the AHCA and reforming Obamacare’s failed funding structure.”

Ivanka Trump meets with nine conservative lawmakers about childcare and paid family leave: During the meeting she discussed issues affecting “working families” including childcare and paid family leave. “Just left a productive meeting on the Hill to discuss issues affecting American working families, including childcare & paid family leave!” Trump tweeted. She added: “Childcare is a major expense for American working families. This Admin. is focused on creating policy solutions to enable them to thrive!” Ivanka Trump was behind the president’s inclusion in his budget of a mandatory six weeks of paid leave to families after the birth or adoption of child, a government mandate conservatives have not embraced. She was invited to Capitol Hill by Florida Republican Sen. Marco Rubio. Utah Sen. Mike Lee, Iowa Sen. Joni Ernst, Nebraska Sen. Deb Fischer, Montana Sen. Steve Daines, South Carolina Sen. Tim Scott, Arizona Rep. David Schweikert, Arizona Rep. Trent Franks and Texas Rep. Lamar Smith also met with Trump. Rubio’s office said they spoke about the Child Tax Credit, eliminating marriage penalties in the tax code and promoting paid family leave. “Sen. Rubio was glad to see strong support for pro-family policies that empower parents to make decisions that are best for their children, and he looks forward to working with his congressional colleagues to make tax relief for working families an essential piece of comprehensive tax reform,” his office said.

Trump’s nomination of Lance Allen Robertson has been sent to the Senate to be Assistant Secretary for Aging at the Department of Health and Human Services.

GOP healthcare bill doesn’t get any love in new poll: Half of all registered voters don’t like the American Health Care Act, which is the highest level of nonsupport in the bill’s short history.

The poll from Morning Consult and Politico released Tuesday found that 50 percent of people don’t support the bill and 35 percent do. The disapproval ratings are the lowest since the bill was first tracked in late April, when it was supported by 42 percent of voters and disliked by 37 percent. The bill, which guts Obamacare and passed the House last month, is expected to change significantly in the Senate. A vote is tentatively planned for next week.

The poll also found that congressional Democrats were better suited to reform healthcare. It found 47 percent of respondents trust democrats compared to one-third that picked Republicans. The poll had a sample of 2,051 voters and had a two-point margin of error.

RUNDOWN
 

Roll Call GOP might buck Senate rules to pass healthcare overhaul

Politico How McConnell gets to 50 votes on healthcare

The Hill Insurer startup to enter five Obamacare exchanges

Axios Why a cutoff of insurer payments could hurt the middle class

Associated Press GOP Medicaid cuts would hit states fighting the opioid epidemic

NPR Survivors of childhood disease struggle to find care as adults

Reuters Missouri attorney general sues opioid manufacturers

LA Times Fears mount that Obamacare repeal will put life-saving treatments for opioid epidemic out of reach

Health Affairs Building sustainable partnerships to improve access to breast cancer treatment for uninsured women

Calendar

WEDNESDAY | JUNE 21

June 19-22. San Diego Convention Center. 111 W Harbor Dr. Biotechnology Innovation Organization annual convention. Details.

Deadline for filing health insurance rates in states that use the federal exchange, healthcare.gov.

2:30 p.m. Dirksen 124. Senate appropriations hearing on VA budget. Details.

THURSDAY | JUNE 22

Mylan annual shareholder meeting.

10 a.m. Dirksen 138. Senate Appropriations committee hearing on NIH’s budget. Details.

FRIDAY | JUNE 23

9 a.m. 2123 Rayburn. House Energy and Commerce Committee hearing on CHIP reauthorization. Details.

TUESDAY | JUNE 27

6:30 p.m. Newseum. 555 Pennsylvania Avenue 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.