Health Brief: 4 GOP Senators Say They Will Vote Against Taking Up Health Bill

Washington Brief

  • The Senate health care bill is in jeopardy after the Congressional Budget Office released a cost estimate projecting that 22 million more Americans would be uninsured by 2026 compared to under current law. After the report was released, at four Republican senators said they would even vote against taking up the legislation. (The Hill)
  • White House and Senate officials are exploring potential deals to secure votes for the measure. Senate GOP leaders have about $188 billion in savings that they can use to address individual senators’ priorities. (Politico)
  • Sen. Bernie Sanders (I-Vt.) has been holding rallies in Rust Belt states that President Donald Trump won in 2016 in an aggressive, last-ditch effort to stop the Senate health care measure. (The Washington Post)

Business Brief

  • Anthem Inc. said it believes the Senate bill would improve the stability of the individual marketplaces, counter to the view of many other insurers who have suggested it would undermine the exchanges created by the Affordable Care Act. (The Wall Street Journal)
  • The American Medical Association announced its opposition to the Senate legislation, saying it is unhappy with its changes to the insurance marketplaces and restructuring of Medicaid. (Vox)
  • GOP efforts to repeal Obamacare and severely cut spending to Medicaid could make it harder for hundreds of rural hospitals already at risk of closing to stay afloat. (Side Effects Public Media)

Chart Review

Events Calendar (All Times Local)

No events scheduled
C-TAC event on transforming advanced care 8:30 a.m.
Bipartisan Policy Center event on cybersecurity of medical devices 10 a.m.
Cato Institute event on the opioid crisis 12 p.m.
PCORI and MHN briefing on prostate cancer 12 p.m.
Urban Institute event on stabilizing the exchanges 12 p.m.
Personalized Medicine Coalition et al., conference on cancer and medical innovation 8:30 a.m.
Bipartisan Policy Center event on Medicaid 10 a.m.
American Enterprise Institute event on regulating e-cigarettes 10:30 a.m.
American Enterprise Institute event on government role in medical innovation 4 p.m.
No events scheduled



Four GOP senators will vote against taking up healthcare bill without changes
Jordain Carney, The Hill

Four GOP senators are warning they will vote against taking up the current version of a bill to repeal and replace ObamaCare, imperiling leadership’s push to pass the legislation before the July Fourth recess. “On the current bill I’m not voting to get on it unless it changes before we get to it,” Sen. Rand Paul (R-Ky.) told reporters on Monday.

Senate Health Bill Reels as C.B.O. Predicts 22 Million More Uninsured
Thomas Kaplan and Robert Pear, The New York Times

The Senate bill to repeal the Affordable Care Act was edging toward collapse on Monday after the nonpartisan Congressional Budget Office said it would increase the number of people without health insurance by 22 million by 2026. Two Republicans, Senators Susan Collins of Maine and Rand Paul of Kentucky, said Monday that they would vote against even debating the health care bill, joining Senator Dean Heller of Nevada, who made the same pledge on Friday.

Republicans eye billions in side deals to win Obamacare repeal votes
Josh Dawsey and Burgess Everett, Politico

White House and Capitol Hill officials are exploring potential deals to divvy up billions of dollars to individual senators’ priorities in a wide-ranging bid to secure votes for the imperiled GOP health care bill. A Congressional Budget office score that projected 22 million fewer Americans would have insurance under the plan sent some members fleeing Monday and left the bill in jeopardy of failing to have enough votes to even be called to the Senate floor this week.

Bernie Sanders hits road to lead charge against Senate health-care bill
David Weigel, The Washington Post

Sen. Bernie Sanders took the stage and got right to it, warning 2,200-odd Ohioans that their lives are at risk if Senate Republicans push through their health-care bill. “Put yourself into someone else’s shoes,” Sanders (I-Vt.) said Sunday at Columbus’s ExpressLive concert hall, where large screens that usually play bar specials were showing CBO scores. “What does it mean today if you are struggling for your life, dealing with cancer, dealing with heart disease, dealing with diabetes, dealing with some chronic illness threatening your existence? What does it mean when you read in the paper that Republicans might take away your insurance?”

Senate Democrats rally against GOP health-care bill
Seung Min Kim, Politico

It’s time again for Senate Democrats to burn the midnight oil. Senate Democrats launched yet another night of floor speeches on Monday night castigating the GOP’s plan to repeal and replace Obamacare — a talk-a-thon led by Sens. Patty Murray of Washington and Mazie Hirono of Hawaii that ran several hours after the Senate’s 5:30 p.m. votes.

Heller’s hesitance on Obamacare repeal opens Dem divide
Kyle Cheney and Elana Schor, Politico

Sen. Dean Heller’s harsh critique of the Republican effort to kill Obamacare has broken open a Democratic divide — between those who want to unseat him and those who prefer to lock in his “no” vote first to save the health care law. The Nevada Republican gave Democrats a gift on Friday when he issued a stinging analysis of the Senate’ GOP health plan and signaled he may vote against it.

Conservative groups hammer Senate healthcare reform bill
Alexander Bolton, The Hill

Conservative advocacy groups that provide much of the political muscle for Tea Party-friendly lawmakers and candidates are coming out against the Senate healthcare reform bill, panning it as a disappointment. These critics on the right say the legislation falls well short of the Republican promise to repeal ObamaCare despite Senate Majority Leader Mitch McConnell’s (R-Ky.) argument that it will fix an “unsustainable” status quo.

Republican Sen. Ron Johnson slams Senate GOP Obamacare repeal legislation
Craig Gilbert, Milwaukee Journal Sentinel

In a series of interviews and an op-ed Monday, Senate Republican Ron Johnson of Wisconsin bluntly laid out his objections to the GOP Senate health care bill and to his party’s hurried push to get it passed this week. In a New York Times op-ed, Johnson offered a sweeping, conservative critique of the measure, saying it’s “throwing money at the problem” and “doesn’t appear to come close” to delivering “better, less expensive care” for working people.

Stocks Drop, Commodities Rise; Draghi Spurs Euro: Markets Wrap
Samuel Potter, Bloomberg News

A mood of caution was evident in equity markets Tuesday, with European stocks falling in a broad-based retreat. The euro jumped and the dollar fell as Mario Draghi said headwinds to inflation in the region are temporary.


Anthem Says Senate Health Bill Will Bolster Individual Insurance Market
Anna Wilde Mathews, The Wall Street Journal

Anthem Inc. said it believes that the Senate Republicans’ health bill will bolster the individual insurance market, an endorsement for the legislation as many other insurers have suggested it could undermine the marketplaces created by the Affordable Care Act. In a statement, Anthem said it believed the bill “will markedly improve the stability of the individual market and moderate premium increases,” because it allots billions to help stabilize the markets, eliminates a tax on health insurance plans and works on “aligning premium subsidies with premium costs.”

Medicaid mission creep threatens GOP’s ‘Obamacare’ repeal
Ricardo Alonso-Zaldivar, The Associated Press

Somewhere along the way, the Republican crusade to repeal “Obamacare” also turned into an effort to limit the future growth of Medicaid. That bit of mission creep is complicating prospects for the GOP, and could lead to deadlock.

Hate the Individual Health Mandate? The G.O.P. Tries a ‘Lockout’
Margot Sanger-Katz, The New York Times

Senate Republicans made only one big change in a new version of their Senate health bill released Monday: They added a penalty for Americans who let their insurance lapse for 63 days or more. Under the new provision, those who go without insurance will be locked out of getting coverage for at least six months after they sign up.

Draft executive order would enhance high-deductible coverage for chronic disease care
Shelby Livingston, Modern Healthcare

While all eyes were on Senate Republicans last week as they rushed to assemble their bill to repeal the Affordable Care Act, a draft version of a White House executive order surfaced that would allow patients enrolled in high-deductible health plans to access care for chronic conditions before they meet their deductible. Patients enrolled in high-deductible plans linked to tax-exempt health savings accounts must spend hundreds or often thousands of dollars to meet their annual deductible before benefits kick in.


American Medical Association: Republican health bill violates “do no harm” standard
Andrew Prokop, Vox

The biggest doctors’ lobby in the United States came out strongly against Senate Republicans’ health care bill on Monday. The American Medical Association declared its opposition to the bill in a letter from its executive vice president and CEO, James Madara.

Deep cuts to Medicaid put rural hospitals in the crosshairs
Bram Sable-Smith, Side Effects Public Media

For the hundreds of rural U.S. hospitals struggling to stay in business, health policy decisions made in Washington, D.C., this summer could make survival a lot tougher. Since 2010, at least 79 rural hospitals have closed across the country, and nearly 700 more are at risk of closing.

House Seeks To Cap Malpractice Awards As Part Of Health Care Update
Michelle Andrews, Kaiser Health News

Last week, a jury awarded a Pennsylvania man $620,000 for pain and suffering in a medical malpractice lawsuit he filed against a surgeon who mistakenly removed his healthy testicle, leaving the painful, atrophied one intact. However, if a bill before the House of Representatives passes, the maximum he would be able to receive for such “non-economic” damages would be $250,000.

Pharma, Biotech and Devices

What You Don’t Know About Generic Drugs, and How It Can Hurt You
Anna Edney, Bloomberg News 

To keep his anxiety under control, Peter, a 35-year-old government employee, relied for nine years on a blue-and-white pill he popped every night before bed: Cymbalta, made by Eli Lilly & Co. When a generic version came on the market, offering the chance to save money, he switched.

OxyContin maker urges judges to stop release of secret marketing records
David Armstrong, Stat News

A state appeals court Monday heard arguments over whether secret records regarding the marketing of the powerful prescription opioid OxyContin should be released to the public. A three-judge panel of the Kentucky Court of Appeals is considering a request from OxyContin maker Purdue Pharma to overturn a lower court ruling ordering the release of the documents — the result of a motion filed by STAT.

Health IT

How Apps Can Help Manage Chronic Diseases
Laura Landro, The Wall Street Journal

Technology is offering a new fix for one of the most confounding health-care challenges: getting patients with chronic disease to take better care of themselves. About half of all adults suffer from one or more chronic diseases, which account for seven of 10 deaths and 86% of U.S. health-care costs. But preventing and treating such ailments requires time that doctors don’t have in brief office visits, and a degree of daily self-management that many patients have been unable to handle.

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Opinions, Editorials and Perspectives

Want to Protect Women’s Rights? Preserve 340B
Jessica Grossman, Morning Consult 

Women have fared poorly at the hands of Washington policymakers in recent months. Recently, leaked proposals revealed Trump administration plans to significantly roll back birth control coverage. That’s on top of recent congressional health care proposals that would defund Planned Parenthood, waive maternity care as an essential health insurance benefit and give states the leeway to charge women more for health insurance.

Want to know the worst thing about the GOP’s health-care bill?
The Editorial Board, The Washington Post

The Official numbers on the Senate health-care bill are in, and they are grim: The Congressional Budget Office (CBO) found Monday that the Better Care Reconciliation Act would result in 22 million fewer people with health-care coverage in a decade. “By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law,” the experts concluded.

The Senate’s Health-Care Hour
The Editorial Board, The Wall Street Journal

Senate Republicans are headed for a vote on their health-care bill as soon as this week, and Majority Leader Mitch McConnell is still scrambling for 50 votes. What the holdouts should understand is that this is a defining political moment.

The Defenses of the Senate Health-Care Plan Are Pathetically Dishonest
Jonathan Chait, New York Magazine

There is one solid, coherent argument for the Senate health-care bill: If you believe the government redistributes too much money from the medically and financially fortunate to the unfortunate, then Trumpcare is a huge step forward. Its large regressive tax cuts and even larger cuts to low-income health-care subsidies would rebalance the tax-and-transfer system in a way that’s more fair, from a certain moral perspective.

The Senate’s Secretly Bipartisan Health Bill
Avik Roy, The New York Times

In 2010, when Democrats passed the Affordable Care Act, Republicans complained that they did so with no Republican support. Democrats responded by pointing out that the centerpiece of their plan — tax credits to buy private insurance — came from a Republican governor, Mitt Romney of Massachusetts.

Who will pay for CRISPR?
Jim Kozubek, Stat News

The ruckus over the CRISPR gene-editing system hides a dark reality: its high cost may make it unaffordable and questions remain whether most insurance companies will pay for it. As CRISPR begins to move forward in clinical trials, there are some signals about how it may — or may not — be received commercially.

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Research Reports

H.R. 1628, Better Care Reconciliation Act of 2017
Congressional Budget Office

The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of the Better Care Reconciliation Act of 2017, a Senate amendment in the nature of a substitute to H.R. 1628. CBO and JCT estimate that enacting this legislation would reduce the cumulative federal deficit over the 2017-2026 period by $321 billion.

The Downstream Consequences Of Per Capita Spending Caps In Medicaid
Timothy Layton et al., Health Affairs

Medicaid, the government program that provides health insurance coverage to low-income and disabled Americans, is the largest payer for health care in the United States in terms of enrollees and the second-largest payer (behind only Medicare) in terms of spending. Escalating health care costs, a growing federal budget deficit, and fiscal challenges in many states have led to calls to reform the program to decrease spending growth.

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