SIGN UP! If you’d like to continue receiving Washington Examiner’s Dailyon Healthcare newsletter, SUBSCRIBE HERE: http://newsletters.washingtonexaminer.com/
It’s here: On Thursday, Senate Majority Leader Mitch McConnell, R-Ky., unveiled a closely guarded “discussion draft” of his cambers healthcare bill. Now he’s going to have to begin in earnest the task of selling it to his caucus – and he can only afford to lose the votes of two Senators. Before digging into some of the details, it’s worth keeping in mind one big factor that is going to figure heavily in Senators calculations as to the tradeoffs in this bill, and that’s how it treats the short-term vs. the long term.
The bottom line: The bill pumps a lot of money into insurance markets in an attempt to shore them up in the coming years, but doesn’t begin enacting its major changes to existing law until the next decade. So centrists will have to ask themselves whether they’re willing to tolerate big changes to Medicaid’s long-term growth rate a decade from now in exchange for more reassurance of up front money, and a more gradual phaseout of Obamacare. On the flip-side, conservatives will have to ask whether the prospect of long-term Medicaid reform is worth swallowing short-term spending injections.
More specifically, here is how the Senate bill deals with some key areas:
Medicaid: Keeps Obamacare’s expansion intact through 2020, and starting in 2021, it starts phasing out the enhanced Obamacare payments to states, which will return to pre-Obamacare levels by 2024. Also starting in 2020, states would be able to chose either a block grant or per capita allotment for Medicaid funds and allows them to impose work requirements. Starting in 2025, the program would grow at a standard rate of inflation, which is lower than current law and than the House bill.
Tax credits: The tax credits have become more like Obamacare. Whereas the House-passed bill adjusted the value of tax credits to age, the Senate bill adjusts them to income, capping off subsidies at 350 percent of the federal poverty level rather than 400 percent.
Regulations: The bill amends Obamacare’s 1332 waivers to give states more flexibility to opt-out of some of Obamacare’s federal requirements.
Stabilization funding: The bill would pump $50 billion into Obamacare markets through 2021, and pay out Obamacare’s cost sharing reduction subsidies through 2019, including back payments. These provisions represent a big win for insurance lobbyists.
Mandates: It eliminates the penalties for individuals and insurers who do not comply with the mandate to purchase coverage.
Tax hikes: It repeals most of Obamacare’s taxes, though some of those repeals are delayed. For instance, the repeal of the Medicare surtax doesn’t take place until 2023. Obamacare’s “Cadillac tax” on high cost employer health insurance plans is repealed from 2020 to 2025, and then reinstated starting in 2026. This is to help it comply with rules governing the reconciliation which say that the law has to be deficit-reducing the second decade.
McConnell’s healthcare bill keeps eye toward 2018 midterms: One way to think about the draft Senate healthcare bill is through the political prism. It’s clear that one of McConnell’s big goals was to produce a bill that he could claim as delivering on promises made to Republican voters on repealing Obamacare, while trying to limit disruption during the upcoming election year. It’s not accident that the first bullet point in the Senate Republican summary of the bill was that it would, “Help stabilize collapsing insurance markets.”
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.
Key vote has “number of concerns” Sen. Susan Collins, R-Maine, doesn’t seem too happy with the discussion draft. Collins said in a statement that she is reviewing the bill and eagerly awaiting the CBO score expected to come by Monday. “She has a number of concerns and will be particularly interested in examining the forthcoming CBO analysis on the impact on insurance coverage, the effect on insurance premiums, and the changes in the Medicaid program,” according to a statement from her office. Collins is a key centrist vote and has complained recently of the Senate process on drafting the bill behind closed doors. CNN is reporting that another key centrist, Dean Heller of Nevada, has some serious concerns with the bill’s Medicaid cuts. Heller is up for reelection in 2018 and is widely regarded as the most vulnerable incumbent Republican.
A tense meeting this morning The GOP conference got their first look at the healthcare reform bill during a closed-door meeting on Thursday and one account says it wasn’t pretty.
“It was an interesting morning, a little tense,” said Sen. Tim Scott, R-S.C., after leaving. He wouldn’t elaborate on what was creating the tension.
Other senators said that they liked parts of the bill but still want some changes, a reminder that nothing is final yet. Sen. Mike Rounds, R-S.D., said that he wants tax credits for the group insurance markets. He added that there will still be informal talks on healthcare, even though a vote is expected by next week. McCain gave a more comical response to how the meeting went. “Terrible. Bunch of jerks,” he told reporters sarcastically.
Cassidy has no regrets At the onset of the healthcare debate this year, Sens. Bill Cassidy of Louisiana and Susan Collins of Maine released a bill that let states keep Obamacare if they wanted. It didn’t really fly and the Senate put out a healthcare reform bill that doesn’t have the optional parts of Cassidy-Collins. However, Cassidy has no regrets. “There are a lot of elements that would be in the bill or what they would do through a waiver process [with Health and Human Services],” he told reporters Thursday. “I think Cassidy Collins absolutely influenced this product.”
Speaking of Cassidy, does the bill meet his “Kimmel test?” Cassidy said that he believes it does but still needs to look at the draft, which wasn’t presented apparently at the closed-door meeting. “If your loved one gets sick will they have adequate coverage, as best as I can tell it does but again I need to read the text,” he said. Cassidy said earlier this year any Senate healthcare bill needs to meet that test, a reference to a monologue from late-night comedian Jimmy Kimmel recounting the struggles his child had faced getting care for a congenital heart defect.
Trump: GOP healthcare bill ‘is going to be negotiated.’ “But it’s going to be very good,” Trump told reporters at the White House on Thursday. “We’ve had a thing called healthcare that is… percolating. Obamacare is dead and we’re putting a plan out today that is going to be negotiated,” Trump said. “We’d love to have some Democrats’ support but they’re obstructionists.”
Paul Ryan ‘eager’ for Senate to pass healthcare bill. The house speaker said Thursday that he hopes the Senate can quickly pass its version of the healthcare reform bill moments after the bill was released, but admitted that he has not seen the details of the plan. “I have not. I’ve been briefed on the Senate version,” Ryan said. “Believe me, I know how hard this process is from personal experience. From what I understand, their bill tracks in many ways along the lines of the House bill. I think that’s very good.” Ryan declined to comment on the Senate’s process of drafting a bill, which many panned as secretive after Republican senators complained that they had not seen the legislation prior to its release. “I’m very happy that the Senate has gone through the work of putting together a bill that keeps that promise, so yeah, I’m eager for them to pass it,” Ryan said. “But I’m not going to opine on the details as they go along.”
Despite Byrd rule warning, Senate bill includes anti-abortion language. The draft creates a new set of tax credits for individuals to purchase insurance that included Hyde Amendment language, a spending rider that prohibits federal funding from going towards most abortions. It also cuts off federal family planning funds for birth control, STD testing and cancer screenings from going to organizations that also provide abortions, a provision that would result in federal funding being cut off from organizations like Planned Parenthood. The Senate is passing the bill through reconciliation, which carries a number of restrictions, including that provisions must be primarily budgetary in nature. The Senate parliamentarian is tasked with advising the Senate on whether any part of the bill meets the reconciliation rules, and reportedly has advised against some of the language.
Dems to GOP: Burn bill and start over with us. Lawmakers on Thursday clashed in the Senate chamber over the new GOP health care draft after the Republican majority refused a request by Democrats to allow a three-day review and committee consideration of the proposal. “We won’t see the real bill, apparently, until next week even though we were told we would see it this morning,” Sen. Patty Murray, D-Wash., said on the senate floor. “Thirteen men in a private room wrote this discussion draft that is not a bill. Even the other side doesn’t know what we have. This is deplorable.” Senate Minority Leader Chuck Schumer, D-N.Y.,in a heated exchange with GOP leaders in the Senate chamber, asked the GOP to toss out their plan and start over with Democrats. “Let us right now, Democrats and Republicans, sit down right now and try to come up with a bipartisan bill,” Schumer, D-N.Y., said. “We are willing to do it right now this minute. Will you accept the offer?”
Republicans face pressure at home to repeal Obamacare quickly: Senate Republicans are moving swiftly to partially repeal Obamacare, driven by political pressure from an impatient conservative base that is outweighing concerns about transparency and process.
Top GOP Senator explains why Republicans aren’t seeking input from Democrats: “We’re not trying to give the impression that we’re going to listen to them,” Senate Budget Committee Chairman Mike Enzi, R-Wyo., told the Washington Examiner’s David Drucker. “They never listened to us,”
GOP senators: Parliamentarian says anti-abortion language in healthcare bill violates Senate rules: This has forced Republicans to come up with a new way to structure tax credits for the purchase of insurance.
Anthem to pull out of Obamacare exchanges in Wisconsin and Indiana: Health insurer Anthem, part of the Blue Cross Blue Shield brand, announced Wednesday that in 2018 it would no longer be participating in the Obamacare exchanges in Indiana and Wisconsin. The company will still sell plans off the exchanges in one county in Wisconsin and five counties in Indiana, but people who purchase them cannot use tax subsidies to lower their costs.
White House launches website on repealing and replacing Obamacare: “Obamacare has led to higher costs and fewer health insurance options for millions of Americans. The 2010 health care law has brought the American people rising premiums, unaffordable deductibles, fewer insurance choices and higher taxes,” the website states. “President Donald J. Trump promised to repeal and replace this disaster, and that is exactly what he is working with Congress to achieve.”
Democratic Super PAC launches digital ad campaign called “Don’t Gut our Healthcare.” American Bridge 21st Century Foundation, founded by David Brock, a former conservative journalist who now leads liberal nonprofits, is targeting six Republican senators in Alaska, Arizona, Maine Nevada and West Virginia over the healthcare bill. The ad blasts Republicans for writing the bill in secret and warns that it would have devastating effects on people with pre-existing illnesses. View the ad.
OPINION Can Mitch McConnell defuse the ticking Obamacare time bomb? President Trump once compared Obamacare to a ticking time bomb, suggesting his predecessor set it to detonate after he left office. Now it’s Senate Majority Leader Mitch McConnell’s turn to oversee the bomb squad.
OPINION Youth smoking is down, but thanks to what? “Despite substantial evidence in federally-sponsored surveys in the U.S. and abroad showing that remarkable reductions in teen and adult smoking have been concurrent with the increasing popularity of e-cigarettes, the FDA announcement makes no reference to the possibility that much, if not most, of the recent reductions in teen smoking may be attributable to the availability of e-cigarettes,” writes Joel Nitzkin.
RUNDOWN
Associated Press Government health insurance markets holding up, albeit barely
STAT News Mylan offered EpiPen discounts to state in exchange for privileged status, documents show
Kaiser Health News FDA ruling on Aussie biotech could boost Congressman’s investment
Washington Post Not quite half of American teens have had sex by 18, which is actually low
Roll Call Activists applaud Senate Democrats’ hard line on GOP healthcare bill
Bloomberg How Republican Medicaid caps could hurt millions
Axios Opioids kill as many Americans as three wars combined
THURSDAY | JUNE 22
Mylan annual shareholder meeting.
Aspen, Colorado. Aspen Ideas Festival. Health Programs.
10 a.m. Dirksen 138. Senate Appropriations committee hearing on NIH’s budget. Details.
FRIDAY | JUNE 23
CBO score expected for GOP Senate healthcare bill.
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.
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 Avenue NW. Event on “Sensible Regulation of E-Cigarettes: Opportunities for Reform.” Details.
Calendar
