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Senate bill faces early headwinds: Senate Majority Leader Mitch McConnell, R-Ky., has his work cut out for him. Hoping to vote on the healthcare bill next week, enough Republicans have already come out against the bill to sink it – and both from the right and left flanks, which complicates efforts to satisfy one faction without alienating the other. Any combination of three Republicans could vote down the bill, because no Democrats are expected to vote in favor of it. Yet hours after the bill was released, four conservatives (Sens. Rand Paul, Mike Lee, Ted Cruz, and Ron Johnson) said they could not support the bill in its current form because it didn’t go far enough in repealing Obamacare and bringing down premiums. Meanwhile, centrist Sens. Susan Collins, Dean Heller, and Shelley Moore Capito all expressed concerns about the cuts to projected Medicaid spending. The problem with pumping more money into Medicaid is that the spending restraint on Medicaid the bill imposes in the long-run – specifically capping growth at standard inflation – is one of the elements that make the bill most attractive to conservatives as entitlement reform.
More from the Examiner team on the state of play:
Healthcare plan won’t pass without changes
Senate conservatives hope to have Obamacare impact similar to Freedom Caucus
Key Republicans have early problems with Senate healthcare bill
Susan Collins elaborates on her concerns
Washington Examiner’s Whip List: The GOP Senate will need at least 50 votes for the Better Care Reconciliation bill to pass. Here’s where they stand now.
A surprising omission: As health policy analysts dug into the Senate healthcare bill, they found one thing surprisingly missing: any sort of provision incentivizing individuals to maintain continuous coverage in place of the individual mandate. The House bill, for instance, includes a 30 percent surcharge for those who don’t maintain continuous coverage and then seek insurance. The Senate bill was expected to include some version of this, perhaps a waiting period to purchase insurance. But it did not. Insurers are likely to want to see some sort of provision like this to give them more confidence that young and healthy individuals won’t simply wait until they get sick to purchase coverage, given that the Senate bill does not scrap Obamacare’s requirement that individuals purchase insurance. Senior Republican aides, however, have suggested that the provision is still being considered so that people “don’t game the system.” A senior Republican aide suggested that tax credits might be enough of an impetus to compel people to buy coverage. “Everybody wants insurance,” a senior Republican aide said on a call with reporters shortly after the bill was released to the public. “The benefit of what we are doing is that we are able to make more people eligible for tax credits.”
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.
Trump is ‘very supportive’ of Senate Republican healthcare bill. The president, who told Senators in a private meeting earlier this month that he thought the House bill was too “mean,” praised the Senate bill right out of the gate. “I am very supportive of the Senate #HealthcareBill,” Trump said on Twitter. “Look forward to making it really special! Remember, ObamaCare is dead.”
Trump worried about ‘final product’ rather than timeline of healthcare bill: “I don’t think we’re as focused on the timeline as we are on the final product,” White House deputy press secretary Sarah Sanders told reporters at the White House. When asked about Trump’s promises during the presidential race to avoid changes to Medicaid in light of the changes laid out in the GOP’s healthcare bill, Sanders replied: “I don’t believe that the president has specifically weighed in that it’s right to cut Medicaid.” She slammed Democrats for their refusal to work with Republicans on healthcare reform. “If Democrats really cared, they would try to be involved in the process,” Sanders said. “I think that it’s sad that they’ve tried to played partisan politics instead of trying to have a seat at the table.”
Says conservatives will get there: Trump did say on Friday morning he believes that Republican senators opposing the healthcare bill will eventually come on board. “Well, they’re also four good guys and they’re four friends of mine. And I think that they’ll probably get there,” Trump told Fox News. “It’s that very, very narrow path, but I think we’re going to get there. We have four very good people that — it’s not that they’re opposed, they’d like to get certain changes and we’ll see if we can take care of that.”
Seema Verma, administrator for the Centers for Medicare and Medicaid Services, commended the Senate: “I appreciate the work of the Senate as they continue to make progress fixing the crisis in healthcare that has resulted from Obamacare,” she said in a statement. “Skyrocketing premiums, rising costs and fewer choices have caused too many Americans to drop their insurance coverage … The Senate proposal is built on putting patients first and in charge of their healthcare decisions, bringing down the cost of coverage and expanding choices. Congress must act now to achieve the president’s goal to make sure all Americans have access to quality, affordable coverage.”
Former President Barack Obama slams the healthcare bill, calling on Congress to work in a bipartisan way to fix his signature achievement and constituents to urge their senators to halt the process. The legislation, he said, was “not a healthcare bill.” “It’s a massive transfer of wealth from middle-class and poor families to the richest people in America,” he wrote in a Facebook post. “It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else.” Obama slammed what he called the “rushed” process that Republicans were using to advance their legislation and said that it would undo the protections that his law created. “I recognize that repealing and replacing the Affordable Care Act has become a core tenet of the Republican Party,” he said. “Still, I hope that our senators, many of whom I know well, step back and measure what’s really at stake, and consider that the rationale for action, on healthcare or any other issue, must be something more than simply undoing something that Democrats did.” Full post.
How do you solve a problem like Rand Paul? Sen. John Thune, R-S.D., was talking with reporters about how the healthcare bill can still be tweaked to meet their needs and that there isn’t a final product yet. The Washington Examiner then reminded him that Rand Paul is not asking for any mere tweak. Paul wants to scrap most of the bill which he says doesn’t do nearly enough to repeal Obamacare. Thune contemplated the question for a moment then said “right, yeah.” “I think that is gonna be challenging,” he added. “I am not sure that Rand will ever be there. We are not voting yet.”
Paul uses Lasik surgery to prove his point: Kentucky Senator Rand Paul’s key reason for opposing the Senate bill is that it doesn’t do enough to lower prices for consumers.
The eye surgeon used an example of Lasik surgery as how people can drop when consumers are more involved. “Lasik surgery, when you want to get surgery to get rid of glasses, everybody asks the price,” Paul said on MSNBC Friday. “The average consumer calls four different doctors. It’s a very sophisticated laser, million dollar laser, and yet the price has gone down by three-quarters over 15 years.” “When you connect the consumer and the consumer cares about the price, guess what? The consumer will shop, and when the consumer shops, competition works,” he said.
To arrive at compromise, Cruz pushes for changes to insurer mandate: One of the compromises he is floating would let insurers offer plans that don’t meet Obamacare’s insurer mandates such as essential health benefits like maternity care or hospitalization. “We need common sense reforms to reduce the cost of premiums,” Cruz told reporters Thursday. The idea, which began with a 2015 opinion piece from former Sen. Phil Gramm, would force insurers to sell one plan on Obamacare’s exchanges that met the law’s mandates. That same insurer could then sell plans in the same state that don’t meet the mandates. “It leaves existing plans on the market but it gives new options so that people can purchase far more affordable health insurance,” Cruz said.
Sen. Lindsey Graham: 50 percent chance Senate GOP passes healthcare bill: “It’s 50/50 we get to 50,” Graham, R-S.C., said at the annual congressional picnic at the White House, according to CNN’s Steve Brusk. Earlier in the day Graham tweeted that he would “carefully review” the legislation before making a decision.
Congressional Budget Office score expected early next week: The report will impact how senators feel about supporting the bill and the attacks Democrats make against it. CBO released a statement saying it was working to evaluate the bill with the staff of the Joint Committee on Taxation to release an estimate, which would be released on the agency’s website. It did not specify what day to expect the report.
Republican wary of conference with House on Senate health bill: Rep. Tom MacArthur, R-N.J., hopes that there isn’t a conference to reconcile the differences between the House and Senate. “A conference is just a more difficult, challenging process and a lot more negotiations sent back and forth,” said MacArthur, who helped craft a key provision to gain consensus in the House. Rep. Mark Sanford, R-S.C., a member of the conservative Freedom Caucus, said there are parts of the Senate bill that “give conservatives pause, whether that is a further expansion of Medicaid in contrast to where the House was on Medicaid.” He was also worried about the changes to the waivers. “Those kinds of things that are ingredients on the Senate side that weren’t ingredients on the House side,” he said.
Protesters in wheelchairs removed from protest outside McConnell’s office: Capitol Police said in a statement that 43 people were arrested at the Senate Russell Office Building after the Senate Republicans healthcare bill became public. Prior to the arrests, many protesters in wheelchairs lined up outside McConnell’s office chanting “no cuts to Medicaid, save our liberties.” Capitol Police, charged with the task of keeping the hallways clear, began to remove protesters. A statement from Capitol Police said that “officers warned the demonstrators to cease their unlawful activity or be faced with arrest” but some “did not cease their demonstration activities and were arrested.” One woman had a simple message as she was escorted out: “With this bill, people will die.” Those arrested were charged with Crowding, Obstructing or Incommoding and were sent to U.S. Capitol Police headquarters for processing, a statement said.
GOP governors skeptical about Senate healthcare plan: Some governors are warning the legislation falls short of their expectations. “I have deep concerns with details in the U.S. Senate’s plan to fix America’s health care system and the resources needed to help our most vulnerable, including those who are dealing with drug addiction, mental illness and chronic health problems and have nowhere else to turn,” Ohio Gov. Kasich said in a statement. Republican Gov. Charlie Baker of Massachusetts echoed Kasich’s sentiments on the Senate’s plan, and a spokeswoman for the governor said the health care bill would cause Massachusetts to lose money.
Democrats borrow from Trump to criticize Senate healthcare bill: In what was undoubtedly a preview of their party’s 2018 advertising, House and Senate Democrats in a series of floor speeches tarred the Better Care Reconciliation Act as “even meaner” than the American Health Care Act. “You can put a lace collar on a Pit Bull, and it’s still a mean dog. What we have with the Republicans in the Senate here is an attempt to dust off the edges of the House bill and say this is not as mean,” Senate Minority Whip Dick Durbin, D-Ill., said. “This is still a mean dog.”
The Democratic attack was ripped directly from Trump’s slam on the AHCA. During a recent White House meeting with Republican senators, the president called the House bill “mean, mean, mean,” saying the final product that he signs needs to be “more generous and kind.”
Susan B. Anthony List and Family Research Council support bill’s draft but worried anti-abortion provisions will be stripped: The expectations of the pro-life movement have been very clear: The health care bill must not indefinitely subsidize abortion and must re-direct abortion giant Planned Parenthood’s taxpayer funding to community health centers,” SBA List President Marjorie Dannenfelser and Family Research Council President Tony Perkins said in a statement. “The Senate discussion draft includes these pro-life priorities, but we remain very concerned that either of these priorities could be removed from the bill for procedural or political reasons. We are working closely with our pro-life allies in the Senate to prevent this from happening as it could result in our opposition. We are confident that the pro-life Senate will ultimately move forward with our pro-life priorities intact.”
AARP warns senators against supporting GOP healthcare bill: AARP doesn’t want any senator to support the Republican healthcare proposal introduced on Thursday. AARP “The Senate bill would hit millions of Americans with higher costs and result in less coverage for them,” Executive Vice President Nancy LeaMond said in a statement. “AARP is adamantly opposed to the Age Tax, which would allow insurance companies to charge older Americans five times more for coverage than everyone else while reducing tax credits that help make insurance more affordable.” The group also complained that the bill would make cuts to Medicare and Medicaid. “AARP is also deeply concerned that the Senate bill cuts Medicaid funding that would strip health coverage from millions of low-income and vulnerable Americans who depend on the coverage, including 17 million poor seniors and children and adults with disabilities,” LeaMond said. “The proposed Medicaid cuts would leave millions, including our most vulnerable seniors, at risk of losing the care they need and erode seniors’ ability to live in their homes and communities.”
Industry has mixed reactions:
America’s Health Insurance Plans, which represents insurers, hasn’t taken a formal stance yet. We continue to analyze the bill, consistent with our previous positions,” said Kristine Grow, spokeswoman for the group. Previous positions outlined here.
American Hospital Association urges Senate to go back to the drawing board: “The Senate proposal would likely trigger deep cuts to the Medicaid program that covers millions of Americans with chronic conditions such as cancer, along with the elderly and individuals with disabilities who need long-term services and support,” said Rick Pollack, AHA president and CEO. “Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance.” America’s Essential Hospitals accused senators of putting “ideology ahead of lives.“ The American Academy of Pediatrics said the bill “fails to meet children’s needs.” “The bill fails all children by leaving more families uninsured, or without insurance they can afford or that meets their basic needs,” Dr. Fernando Stein, AAP’s president, said in a statement. “This bill fails children living in or near poverty, children in foster care and children with complex health care needs whose parents have private insurance – all of these children depend on Medicaid, and if this bill passes, Medicaid will no longer be there for them. The American Psychiatric Association called the bill “troubling and harmful.”
The Alliance for Aging Research and more than 30 other provider, patient, aging, disability and health education nonprofit organizations sent a sign-on letter urging senators to oppose any changes to Medicaid and instead build on expansion. The National Association of County and City Health Officials “strongly disavows” the bill because it “eliminates the funding that provides essential resources to governmental public health at the federal, state and local levels.” The American Public Health Association also strongly opposes it, calling it “legislative malpractice.”
The Stop The HIT Coalition, which represents small businesses and employees and is working to repeal the health insurance tax, applauded the legislation for including repeal of the tax. This is a welcome and much-needed first step in providing relief from a sorely misguided tax that has plagued small businesses for far too long,” the group said in a statement. The National Retailer’s Association also welcomed the draft, saying it “steers health care reform back in the direction of strengthening the competition-driven private insurance market.”
RUNDOWN
CNN Kellyanne Conway: Medicaid cut isn’t an actual cut
Politico Inside McConnell’s plan to repeal Obamacare
The Hill Spicer on healthcare: When Trump wants to get something done, “it’s going to get done”
Associated Press GOP’s challenge is finding votes for healthcare bill
New York Times McConnell’s calculation is he may still win by losing
Des Moines Register Nursing home workers still posting vulgar photos of residents on Snapchat
Vox The obscure Senate rule that could still save Obamacare
Washington Post Republicans’ new Obamacare repeal bill has a lot for insurers to like and hospitals to hate
Roll Call Senate Obamacare repeal bill largely an entitlement overhaul
FRIDAY | JUNE 23
House Energy and Commerce Committee hearing on CHIP reauthorization. Began 9 a.m. Details.
SUNDAY | JUNE 25
12:20 p.m. EST. Aspen, Colorado. Secretary of Health and Human Services Secretary Tom Price interview with The Atlantic’s Editor-in-Chief Jeffrey Goldberg at Spotlight Health. Stream Live.
MONDAY | JUNE 26
CBO score on Better Care Reconciliation Act, the GOP healthcare bill, expected early in the week.
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.
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, California. Annual conference for the National Association of School Nurses. Details.
Calendar
