Health Brief: Trump Open to Changes to Health Care Bill

Washington Brief

  • President Donald Trump is open to changes to the Republican health care bill such as pushing up a freeze to Medicaid expansion enrollment, conservatives who met with him Wednesday said. (The Washington Post) The Energy and Commerce Committee is set to debate some of those changes during an ongoing markup, though it’s unclear how much support the amendment has. (Morning Consult)
  • Two lengthy House committee markups of the American Health Care Act began Wednesday morning, with the Ways and Means Committee approving the bill along party lines early Thursday morning. The Energy and Commerce Committee markup is ongoing. (Politico)
  • Governors in some battleground states weren’t thrilled with the Republican health care bill, and criticized how the bill would treat Medicaid expansion. Some GOP governors have been working on their own proposal, and suggested they would continue doing so. (The Associated Press)

Business Brief

  • Some patients with Obamacare coverage are pushing up surgeries to take place sooner, with concerns that their coverage could change if Republicans are successful in their efforts to dismantle the law. (The Wall Street Journal)
  • More medical and health care advocacy groups said they cannot support the GOP health care bill, including the American Medical Association and the American Hospital Association. America’s Health Insurance Plans, a trade company representing insurers, did not come out against the bill and praised parts of it, but raised concerns that it may not provide enough funding to Medicaid and that proposed tax credits may not be large enough. (Bloomberg News)
  • Blue Cross Blue Shield of Illinois, the state’s dominant insurer, benefits from Advocate Health Care and NorthShore University HealthSystem terminating their proposed merger. (Modern Healthcare)

Chart Review

Events Calendar (All Times Local)

Thursday
Ongoing House Energy and Commerce Markup of Health Care Bill
Friday
No events scheduled

 

General

Democrats thwart progress on Obamacare repeal
Jennifer Haberkorn et al., Politico

House Democrats on Wednesday fought to stall an Obamacare repeal bill that Republicans, still facing deep intraparty divisions over the measure, are trying to push toward the House floor and eventually the White House. The first public debates over the bill were a mirror image of the bitter 2009 debate over the passage of Obamacare, with accusations about a lack of transparency and the majority party rushing things through.

Conservatives meet with Trump, who hints that GOP ACA fix could drift further right
David Weigel and Sean Sullivan, The Washington Post

Leaders of conservative groups that oppose the House Republicans’ health care bill met with President Trump at the White House on Wednesday night, part of a high-profile effort to quiet anger from the right. In the process, the conservatives heard the president and his team express some openness to tweaks to the bill that go further than House or Senate leaders might accept.

Republican governors complain about GOP health care plan
Thomas Beaumont and Alison Noon, The Associated Press

Republican governors complain that a GOP proposal to replace former President Barack Obama’s health care law would force millions of lower-income earners off insurance rolls or stick states with the cost of keeping them covered. Governors, especially those from political battleground states, were generally cool to the bill put forth in the Republican-controlled U.S. House.

Rand stands up to Trump on Obamacare
Burgess Everett, Politico

Rand Paul is not backing down. Hours after President Donald Trump exhorted the Kentucky senator to get behind his Obamacare replacement plan, Paul reiterated his opposition in an interview with POLITICO.

In role reversal, Mick Mulvaney trying to get conservatives to back GOP establishment health bill
Emma Dumain, The Post and Courier

Mick Mulvaney was typically on the receiving end of a pitch — or plea — to give up a fight and go along with the Republican status quo. Just a few weeks since being confirmed as the White House’s director of the Office of Management and Budget, however, Mulvaney is finding himself doing the pitching and pleading.

GOP Aims to Replace Obamacare Before Opposition Grows
Alex Rogers and Daniel Newhauser, National Journal

The longer it takes to “re­peal and re­place” Obama­care, the great­er the risk that mount­ing op­pos­i­tion from in­dustry and ad­vocacy groups could de­rail the ef­fort. Re­pub­lic­an lead­ers’ health care bill has drawn poin­ted cri­ti­cism from con­ser­vat­ive act­iv­ists and ma­jor in­dustry.

White House: Don’t call it Trumpcare
Matthew Nussbaum and Jennifer Haberkorn, Politico

He built his career in large part by plastering his name on skyscrapers, hotels, casinos, books, wines and steaks, but there appears to be one place President Donald Trump does not want his favorite five-letter word — the Republican health care bill. Before Obamacare, there was Romneycare. Back in the 1990s, there was Hillarycare.

Obamacare repeal guts crucial public health funds
Lena H. Sun, The Washington Post

The latest Republican health-care bill to repeal the Affordable Care Act would eliminate funds for fundamental public health programs, including for the prevention of bioterrorism and disease outbreaks, as well as money to provide immunizations and heart-disease screenings. As part of the ACA, or Obamacare, the Prevention and Public Health Fund provides almost $1 billion annually to the Centers for Disease Control and Prevention.

Amid federal uncertainty, states confront opioid crisis
Reid Wilson, The Hill

State lawmakers have considered about 1,000 measures in the past year aimed at confronting the mounting opioid epidemic, as heroin use spikes and overdoses claim thousands of lives across the country. At the same time, states — and members of Congress — are worried that a draft Republican bill to repeal and replace the Affordable Care Act would cut hundreds of millions of dollars from Medicaid programs aimed at addiction treatment and prevention.

The Republicans who could tell Trump to take a hike on health care
Kyle Cheney and Rachael Bade, Politico

Hard-line conservatives have threatened to upend the GOP’s drive to replace Obamacare, but the real peril may come from a quieter group of moderates.  The two dozen House Republicans who outran President Donald Trump at home — in some cases surviving even as Hillary Clinton won their districts — are now facing a vote on health care that could put their political careers on the line.

Nonpartisan Scorekeeper in Hot Seat in GOP’s Obamacare Repeal
Zachary Tracer and Anna Edney, Bloomberg News

A nonpartisan body of number-crunchers who evaluate the costs of bills for Congress has become the unlikely lightning rod in the debate over the GOP’s plan to replace Obamacare. Democrats want to delay debate until the body, the Congressional Budget Office, comes up with its analysis of the proposal — including an estimate on the number of people who could lose health coverage.

Obamacare replacement is hard to score, budget experts say
Paige Winfield Cunningham, Washington Examiner

Republicans have a point that their Obamacare replacement plan is particularly hard for the Congressional Budget Office to score, budget experts say. The bill, which Democrats are sharply criticizing for its lack of a CBO score, gives states much more leeway in how they would provide — or not provide — health insurance for people.

Dollar Extends Gain, Euro Climbs Before ECB Meets: Markets Wrap
Samuel Potter, Bloomberg News

The dollar rose and the euro strengthened as central banks dominated markets on Thursday. Metals deepened their losses, while oil gave up early gains to extend its retreat.

Payers

Patients Prepare for Life After Obamacare
Stephanie Armour, The Wall Street Journal

Theresa Bohannan is moving up her son’s surgical procedure because she is worried the push to overturn the Affordable Care Act could endanger her family’s health-insurance coverage. Ms. Bohannan, a senior policy analyst in Reno, Nev., worries insurers would again be allowed to limit how much health care they cover over a patient’s lifetime.

First House panel advances ObamaCare repeal bill
Peter Sullivan, The Hill

The House Ways and Means Committee on Thursday advanced GOP legislation to repeal and replace ObamaCare on a party line vote, moving the process forward even as the bill faces headwinds. Republican leaders are pushing forward with the process on a fast timetable, even as many conservatives strongly object to the bill, and centrists harbor their own reservations.

Doctors, hospitals and insurers oppose Republican health plan
Juliet Eilperin and Mike DeBonis, The Washington Post

Major associations representing physicians, hospitals, insurers and seniors all leveled sharp attacks against the House GOP’s plan to rewrite the Affordable Care Act on Wednesday, as some Republicans publicly questioned whether the measure can clear the House of Representatives. While industry groups warned that the proposal could leave vulnerable Americans with fewer protections than they now have, GOP leaders pressed ahead, bringing legislation before two key committees that are expected to approve the bills by week’s end.

House Health Plan Explained: How the Tax Credit Would Work
Richard Rubin, The Wall Street Journal

House Republicans’ plan to repeal and replace parts of the 2010 Affordable Care Act would seek to help households purchase health insurance with a measure called an advanceable refundable tax credit. Here’s an explanation of how that would work, and how it differs from the existing law.

HHS official bucks Trump administration, opposes healthcare plan
Robert King, Washington Examiner

A top official at the Department of Health and Human Services is publicly opposing the American Health Care Act, which repeals and partially replaces Obamacare. Andrew Ostrovsky, a medical official at the Centers for Medicare and Medicaid Services, which is part of HHS, tweeted late Wednesday that he would oppose the bill.

Why Republicans Included A Tax They Hate In Their Health Care Bill
Tierney Sneed, Talking Points Memo

Almost none of the Obamacare taxes survive in the repeal legislation that the GOP congressional leadership is pushing. But the one Obamacare tax that Republicans do retain — though it is delayed for almost a decade — is a surprising candidate. The legislation includes an implementation in 2025 of the widely loathed Cadillac tax, which imposes a 40 percent levy on the most generous of employer health insurance plans.

Providers

Health Providers Denounce G.O.P. Bill as House Panels Get to Work
Abby Goodnough et al., The New York Times

Two key House committees began formally drafting a repeal of the Affordable Care Act on Wednesday morning, even as the nation’s largest doctors’ group and a coalition of hospitals came out strongly against the Republican plan for replacing the law. Leaders of the committees — Ways and Means, and Energy and Commerce — portrayed the replacement bill in their opening statements as one that would rescue Americans from health coverage that had grown far too expensive and limited, painting a dire portrait of the nation’s health care system under the signature domestic achievement of President Barack Obama.

Doctor, Hospital Groups Line Up Against GOP Health Proposal
Zachary Tracer and Anna Edney, Bloomberg News

The Republican plan to replace Obamacare has a health problem. On Wednesday, the U.S.’s biggest advocacy group for doctors came out against House Republicans’ legislation, while the insurance lobby expressed concerns with the bill, adding to growing opposition from the country’s top trade groups for physicians and hospitals who worry that it will leave more people uninsured or with limited coverage.

Nurses join doctors, hospitals in ripping GOP health plan
Olivia Beavers, The Hill

The American Nurses Association denounced the Republican House healthcare proposal in a Wednesday letter, saying the plan to repeal and replace ObamaCare does not “improve care for the American people.” “The American Health Care Act threatens health care affordability, access, and delivery for individuals across the nation,” the ANA wrote.

GOP chairman hits back at hospitals on ObamaCare bill
Peter Sullivan, The Hill

House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) on Wednesday hit back against hospital groups that are opposing the GOP’s ObamaCare repeal legislation.  “We understand you change this thing up, there’s a pretty big medical industrial complex in America, and when you touch it, I’ve discovered it touches back,” Walden told reporters.

The big winner in Advocate, NorthShore breakup? Blue Cross
Kristen Schorsch and Brigid Sweeney, Crain’s Chicago Business

Now that merger candidates Advocate Health Care and NorthShore University HealthSystem have split just shy of the altar, Blue Cross and Blue Shield of Illinois is playing the role of the relative who breathes a sigh of relief. The dominant insurer in the state didn’t support the merger even when some of its rivals did, including national players UnitedHealthcare and Aetna.

Pharma, Biotech and Devices

Cummings: Trump commits to strong push for Medicare drug price negotiation
Mike Lillis, The Hill

President Trump is vowing to join forces with Democrats to grant the federal government more power when it comes to negotiating drug prices, Rep. Elijah Cummings (D-Md.) said Wednesday after meeting with the president. Such a push sets the stage for a clash between Trump and Republicans on Capitol Hill, who have long opposed the Democrats’ efforts to allow Medicare to haggle directly with pharmaceutical companies for lower prescription drug prices — a power barred under current law.

Health IT

Price breaks public silence on health IT policy
Joseph Conn, Modern Healthcare

HHS Secretary Dr. Tom Price missed two high-profile opportunities to take a stand on health information technology policy Tuesday, but used a third communication to assure that the federal government will continue to push health IT interoperability. At a White House news conference, he spent the bulk of his time speaking in support of a House bill to repeal Obamacare.

A Message from PhRMA:

Myth About Importation: Importation helps U.S. trade.

Fact About Drug Importation: Importation is contrary to free market principles that drive American innovation. It would cede U.S. sovereignty to other countries and import harmful price controls. Get the facts at PhRMA.org/Importation.

Opinions, Editorials and Perspectives

Potential of Biosimilars Can be Realized With a Strong,
Well-Resourced FDA

Juliana M. Reed, Morning Consult

Americans’ lives are impacted by the work of the Food and Drug Administration each and every day, whether they realize it or not. In countless homes, workplaces and health care settings, there is little understanding of the heroic efforts of a dedicated group of scientists, physicians and regulators pursue to ensure the safety of the food we eat, the medicines we take and health care procedures we undergo.

Conservative Repeal and Replace Is Here
Kevin McCarthy and Diane Black, National Review

Our health-care system is broken. It was inefficient before Obamacare, and Obamacare’s Washington-knows-best-mandates made it many times worse. The American people have suffered as a result.

Republicans wave a white flag on health care
Charles Lane, 
The Washington Post

Democrats denouncing the new House GOP health-care bill should actually be dancing in the streets. Perhaps, in the privacy of their own homes, the savvier ones are popping the champagne corks. The true meaning of the proposed legislation is that, after eight years of all-out political and ideological struggle against Obamacare, Republicans have surrendered — pretty much on all fronts.

What Are the GOP Alternatives?
The Editorial Board, The Wall Street Journal

Progressives are lining up to assail the GOP’s health-care bill, though many on the political right seem to be even more unhappy. A little internal division is inevitable in any reform campaign worth fighting for, but the alternative strategies these conservative critics are suggesting are less than persuasive.

A Message from PhRMA:

Allowing the importation of drugs from other countries into the U.S. would lead to potentially dangerous outcomes for patients and increase the burden on law enforcement to prevent unregulated medicines from harming Americans. Get the facts on the dangers of importation.

Research Reports

Essential Facts About Health Reform Alternatives: High-Risk Pools
The Commonwealth Fund

Republican health reform proposals commonly seek to provide insurance coverage to people with high-cost medical conditions through high-risk pools. Intended for the “uninsurable” in a future deregulated private market, high-risk pools would compensate for the weakening or elimination of Affordable Care Act (ACA) rules prohibiting insurance plans from discriminating against applicants based on their health status.

Briefings

Health Brief: Week in Review & What’s Ahead

Speaker Paul Ryan (R-Wis.) pulled legislation to repeal and replace the Affordable Care Act on Friday afternoon after GOP leaders and the White House failed to cobble together enough support from the conservative and moderate wings of their party. In an astounding moment, the Wisconsin Republican conceded that Obamacare, which Republicans have campaigned on repealing since its inception, would remain the law of the land for the “foreseeable future.”

Health Brief: GOP Announces Changes to Health Care Bill

House GOP leaders made tweaks to their Obamacare replacement legislation aimed at bolstering Republican support, but many skeptical conservatives remain opposed to the plan. The changes include giving states more flexibility with their Medicaid programs, phasing out Obamacare taxes sooner and increasing tax credits to help older Americans afford health insurance.

Health Brief: Week in Review & What’s Ahead

Speaker Paul Ryan’s Obamacare replacement plan got a boost Friday when leaders of the Republican Study Committee, the largest caucus in the House GOP, announced their support after the White House agreed to an amendment package that would give states the choice to block grant Medicaid rather than receive a per capita cap, and maintain work requirements for some program enrollees.

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