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Healthcare Today

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Jacob Beaver

July 21, 2017

All eyes are on the Senate where they are on track to have a vote on the motion to proceed to the House-passed American Health Care Act (AHCA).  The motion to proceed is not debatable and is a simple 50-vote test. While Majority Leader McConnell will need to tell senators what he intends to do should the Senate proceed to the bill, the motion itself is not tied to any specific proposal.

Leader McConnell was planning to offer a version of the Better Care Reconciliation Act (BCRA) as a substitute amendment but there is not sufficient support for that proposal. There was some talk about having Senator McConnell instead offer the reconciliation bill that passed in the last Congress to just repeal the Affordable Care Act (ACA) but similarly, it is not clear there are sufficient votes.

Senator McConnell has the option of just offering a more modest proposal such as just repealing the individual and employer mandates, thus achieving the necessary savings to meet the reconciliation instructions. But it is not clear whether an approach like that would win over 50 Republican senators.

We hear that if the motion to proceed fails there are a significant number of Democrats who are willing to work with Republicans on a bill to fix the ACA but it is not clear if that approach would be acceptable to Leader McConnell.

Trying to predict Senate actions is feeling a lot like forecasting the weather in Washington, where even conservative estimates can be way off base.

  • Cloud of confusion hangs over health-care bill – Washington Post (Jul 20)
    “Senate Republican leaders’ latest attempt to salvage support for a GOP health-care bill floundered Thursday as leaders struggled to explain to rank-and-file members what exactly they would be voting on next week. Senators left town for the weekend under a cloud of confusion after Senate Majority Leader Mitch McConnell (R-Ky.) reopened talks on a discarded plan to repeal and replace the Affordable Care Act under heavy pressure from President Trump. The White House intervention sparked a flurry of meetings and activity, but the rush produced no new evidence that the bill can pass.”
  • Senate ‘repeal only’ bill would leave 32 million more uninsured, CBO says – Politico (Jul 19)
    “A revived bill that would dismantle large parts of Obamacare without an immediate replacement would leave 32 million more people uninsured and double premiums over a decade, the Congressional Budget Office said in a report Wednesday.”
  • With collapse of GOP health care effort, Congress faces a long ‘to-do’ list for health policy – Stat (Jul 18)
    “But the abrupt change of plans brings to the fore a laundry list of other health policy bills that remain on Congress’ agenda for the coming months. Some are must-pass items with rapidly approaching deadlines: agreements that represent about $1 billion in private funding for the Food and Drug Administration, as well as the authorizations for federal funding for the Children’s Health Insurance Program and several Medicare programs, all of which expire in September.”
  • Medicaid shows its political clout – Politico (Jul 19)
    “Medicaid may be the next “third rail” in American politics. Resistance to cutting the health care program for the poor has emerged as a big stumbling block to Obamacare repeal, and Republicans touch it at their political peril.”
  • Trump threatens to gut Obamacare markets – Politico (Jul 18)
    “Donald Trump holds a fuse in his hands — and he could decide to light it and blow up Obamacare insurance markets as soon as Thursday. That’s the deadline for sending out the next monthly Affordable Care Act subsidies to health plans to defray the cost of care for individuals with low incomes. The president has toyed for months with the idea of stopping the payments to force Democrats to the negotiating table to avoid the prospect of millions of vulnerable Americans losing access to health coverage.”

July 14, 2017

There are enough Republican Senators who are holding out their support for the Better Care Reconciliation Act (BCRA) that is outlook remains very murky.  We are told there are continued negotiations and further changes are very likely to be made to the bill before it reaches the Senate floor.

If Leader McConnell is unable to get sufficient votes for BCRA, he could use the House passed bill as a shell to pass a tax bill in September so long as the bill includes $1 billion in savings from the Senate and HELP Committees’ jurisdiction.  Under this scenario, Congress would not need to wrestle with a fiscal year 2018 budget resolution.  There is not much speculation looking beyond health care but that certainly is an option for the leader.

  • Senate Republicans one vote away from Obamacare repeal failure – Politico (Jul 11)
    “Senate Republican leaders are praying that their fragile whip count holds over the weekend, as just one more “no” vote would doom the party’s Obamacare repeal effort from evencoming up for debate. Two GOP senators, Susan Collins of Maine and Rand Paul of Kentucky, said Thursday afternoon they will oppose a procedural vote next week to bring the bill to the floor. GOP leaders are putting immense pressure on about half a dozen other Republican senators not to join them and topple the entire effort. Another “no” is enough to kill the bill, and would also likely lead to mass defections.”
  • The new things in the Senate health bill – Axios (Jul 13)
    “Here’s what Senate Republicans have added to the latest version of their health care bill (summary here, text here)”
  • Insurance experts question Cruz’s assertion about single risk pool – Politico (Jul 13)
    “ Ted Cruz emphatically told fellow Republicans Thursday that his amendment to the Senate’s Obamacare repeal legislation would not split up healthy and sick people into two different risk pools,eliminating concern that an earlier version of his plan would drive up costs for sick people. But insurance experts say that’s not the case.
  • Medicaid Still Key Sticking Point in GOP Health Debate – CQ Roll Call (Jul 13)
    “Just hours after Senate Majority Leader Mitch McConnellunveiled an updated bill to overhaul the U.S. insurance system, lawmakers hesitant about the proposed changes to Medicaid huddled in the Kentucky Republican’s office in search of a solution. The members, which included Sens. Lisa Murkowskiof Alaska, John Hoeven of North Dakota, Shelley Moore Capito of West Virginia and Rob Portman of Ohio, were also joined by Centers for Medicare and Medicaid Services Administrator Seema Verma.”
  • Half a million Medicare recipients were prescribed too many opioid drugs last year – Washington Post (Jul 13)
    “Nearly 70,000 people on Medicare’s drug plan received “extreme” amounts of narcotic painkillers in 2016 and more than 22,000 others appeared to be “doctor shopping” for drugs, patterns that put both groups “at serious risk of opioid misuse or overdose,” a government watchdog reported Thursday. In all, about half a million people on the drug plan took amounts of the powerful drugs considered too large under standards set by the Centers for Disease Control and Prevention, according to the Inspector General’s office of the U.S. Health and Human Services Department. That number excludes people who had cancer or were in hospice, who may require large doses of painkillers.”

July 13, 2017

Senate Republican leadership just released an updated draft of the Better Care Reconciliation Act (BCRA). The most significant changes in the new bill include: leaving in place the Affordable Care Act’s (ACA) lifting of the limit on Medicare payroll taxes and the tax on passive income; allowing the purchase of health insurance from a health savings account (HSA); changing the inflation factor for the Medicaid Per Capita Cap program from the medical care component of the consumer price index for all urban customers to just the consumer price index for all urban customers; including $45 billion instead of $2 billion to fight the opioid epidemic; and providing additional funding to help vulnerable populations purchase insurance.

It is yet to be seen whether these changes will allow Senate Majority Leader Mitch McConnell (R-KY) to get the necessary votes to proceed to the bill where further changes could be made on the Senate floor if necessary to garner 50 votes for passage. We are hearing multiple senators are exploring further policy options, negotiating both individually and in groups.

The section-by-section summaries of the updated bill, as prepared by committee staff, are available here (Titles I & II) and here (Title III).

July 7, 2017

The Senate returns next week to see if they can find the right policy options to adjust the Better Care Reconciliation Act (BCRA) to garner the necessary 50 votes for passage. We had heard that Senate Majority Leader Mitch McConnell (R-KY) had sent several policy options for scoring to the Congressional Budget Office (CBO), but is not clear whether all or any of those options put forward will wind up in the bill.

Among them was an idea being promoted by Senator Ted Cruz (R-TX) to allow insurance companies to offer plans that do not comply with the Affordable Care Act (ACA) so long as they offer one ACA-compliant plan. There was also talk of leaving in place the Medicare tax and the tax on unearned income as a way to fund more subsidies for vulnerable population.

Senate GOP leadership is aiming to have BCRA on the floor the week of July 17th. However, it is possible the bill will slip to the following week leaving it very close to the August recess.

A draft of the executive order addressing drug prices was leaked this week. The document outlines a wide number of possible regulatory reforms for several agencies to take action upon including: the Food and Drug Administration; the Centers for Medicare and Medicaid Services; Health Resources and Services Administration; the United States Trade Representative; the Patent and Trademark Office; and the Internal Revenue Service. The document also includes a number of legislative options for discussion. Critics lambasted the leaked order, suggesting it was too favorable to the pharmaceutical industry.

Below are some highlights from the press about the past week’s developments in healthcare policy:

  • McConnell: If we can’t repeal Obamacare, we’ll fix it – Politico (Jul 6)
    “Senate Majority Leader Mitch McConnell said Thursday that if the chamber’s fledgling Republican Obamacare repeal effort falls short, Congress will have to pass a more limited bill to shore up health insurance markets. “If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur,” McConnell said at a Rotary Club luncheon in Glasgow, Ky., the Associated Press reported. “No action is not an alternative. … We’ve got the insurance markets imploding all over the country, including in this state.””
  • How the GOP and Democrats might begin to compromise on health care – Stat News (Jul 5)
    “Senate Majority Leader Mitch McConnell warned last week that Republicans’ failure to pass comprehensive health care reform could have dire consequences. He even warned of one scenario rarely seen here lately: bipartisanship. There’s no guarantee that a holistic, bipartisan health care bill could succeed should McConnell’s nearly single-handed effortto repeal much of the Affordable Care Act fail. But Democrats at least claim they are willing to compromise.”
  • The biggest winner in the current health-care debate: Single-payer – Washington Post (Jul 1)
    “No, single-payer isn’t going to happen at the end of this debate — or even the end of this year or this decade, necessarily. But the logical foundations for it are being laid in our political debate just about every single day. And when you pair that with the rising public support for government-run health care, it’s clear in which direction this whole debate is trending.”
  • How the GOP Medicaid overhaul could become the next fiscal cliff – Politico (Jul 3)
    “The Senate health care bill, if it becomes law, would set in motion a massive rollback of Medicaid funding beginning in three years. But even some Republican supporters acknowledge the full cuts might never happen. Instead, they say it could become another Washington fiscal cliff, where lawmakers go to the brink of radical spending changes only to pull back — or have their successors pull back — just before the point of inflicting real pain in the face of intense pressure.”
  • Kasich: Opioid money in Obamacare bill ‘like spitting in the ocean’ – Politico (Jul 2)
    “An additional $45 billion to help combat opioid addiction in the Senate Republican Obamacare repeal and replacement bill isn’t enough, Ohio Gov. John Kasich said Sunday. In an interview on ABC’s “This Week,” Kasich, who was a contender for the 2016 Republican presidential nomination, called the extra money, which would be spent over a decade, “not enough” to stem the opioid crisis.”
  • The Heroin Crisis in Trump’s Backyard – Politico Magazine (Jul 4)
    “Across the bridge from Palm Beach’s oceanfront mansions and Mar-a-Lago, the private club owned by President Donald Trump, where he spent seven weekends this past winter golfing and entertaining visiting heads of state, it’s not uncommon to see teenage junkies nodding off on coffee shop couches or to come upon them shooting up in supermarket bathrooms. Palm Beach heroin addicts like to get high in public places because if they accidentally overdose, there’s somebody around to call an ambulance. Heroin’s cocoon-like embrace is a national affliction, but here, in the shadow of some of Florida’s priciest real estate, paramedics responded to 5,000 overdose calls last year, nearly 600 of them fatal.”

See All June 2017 Updates

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Rich Meade

Rich Meade, a Vice Chairman at Prime Policy Group and Chair of the firm’s Healthcare Practice has over 25 years of experience in legislative, regulatory, political and public relations strategy. He previously served as Chief of Staff to the House Budget Committee. Rich has helped his clients navigate many complex regulatory and legislative landscapes to achieve many public policy successes including transitioning to a new Medicare payment and quality system, and developing, with the Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC), a health information exchange (HIE) on the Nationwide Health Information Network (NwHIN).


Vickie Walling

Vickie is Co-Chair of Prime Policy Group’s Healthcare Practice and also works with a variety of the firm’s clients, including domestic businesses, multinational corporations and trade associations on federal legislative and regulatory issues. She has over 40 years of legislative and political experience and is widely recognized for her assistance and guidance in the creation of the Blue Dog Coalition, a coalition of moderate Democrats where she provided strategic, legislative and fundraising counsel for 15 years.


Mitchell Vakerics

Mitchell has been delivering trusted counsel across a diverse practice of legislative, policy and political issues for more than a decade. During his long-standing tenure both in Congress and throughout the political and policy sphere of Washington, he has tackled some of the largest healthcare, energy and regulatory issues presented before the federal government. He has a massive range of relationships and strategic congressional partnerships has paid dividends for consecutive congressional sessions. Mitch is a member of Prime Policy Group’s healthcare practice.


Jacob Beaver

Jacob is an Associate at Prime Policy Group, where he is an integral member of the Firm’s research team.