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Healthcare Today

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March 22, 2017

House Energy and Commerce Chairman Walden and House Ways and Means Chairman Brady filed second degree amendments to their Manager’s Amendment last night. It should be noted that those second degree amendments are purely technical in nature; this suggests the Chairmen and Republican leadership believe they have the right policy mix in the bill to pass it in the House.

We are hearing that the Republicans are short on the necessary votes to pass the bill but the number of votes they need to get is probably in the single digits now. Republicans can lose 21 votes assuming 100 percent attendance in the House. Our experiences have been that when leadership is close to having the necessary votes they will often proceed with the vote knowing that the live vote will put some additional pressure on the Members.

The next big development to watch is whether the House Rules Committee issues and files a rule in the House of Representatives. A hearing on the bill was held today and filing a rule is a leading indicator that the leadership is confident of the vote. If the Rules Committee issues a rule for consideration of the bill and a so-called same day rule that would allow the House to consider a rule the same day it is filed, then that would suggest there is sufficient concern from leadership that they will need to make further changes in the bill in order to pass it.

Below are some highlights from the press about recent developments in healthcare policy:

  • Health groups blast away at ObamaCare repeal bill – The Hill (Mar 21)
    “Healthcare groups are ramping up their opposition to the ObamaCare replacement bill ahead of a House vote this week. The American Hospital Association is running TV ads against the American Health Care Act, warning that millions of people would lose coverage if it becomes law. The AARP says it will be alerting its 38 million members to how their representatives voted on the legislation. And the American Medical Association is calling on Republicans to go “back to the drawing board.”
  • House health-care plan faces key hurdle before floor vote, as its fate remains doubtful – Washington Post (Mar 22)
    “The Republican health-care overhaul spearheaded by House Speaker Paul D. Ryan (Wis.) and backed by President Trump began navigating its final procedural hurdle Wednesday, even as it appeared it might lack sufficient votes to pass the House. On a party-line vote of 7 to 2 Wednesday morning, the House Rules Committee rejected a Democratic motion to adjourn because the Congressional Budget Office has not yet calculated the impact of a set of changes meant to mollify various blocs of House Republicans and improve the measure’s chances of passing.”
  • Why the Trumpcare vote could hurt Republicans no matter how they vote – Axios (Mar 22)
    “President Trump didn’t sugarcoat the political consequences of a vote against the House Obamacare replacement bill on Thursday. “I honestly think many of you will lose your seats in 2018 if you don’t get this done,” he told House Republicans, per a source in the room. True enough, but these members also could lose their seats and the House majority if they do vote to pass the bill currently being considered. So they’re left with a terrible choice: Vote against Obamacare repeal after campaigning on repeal for seven years, or vote to cover 24 million fewer people and potentially raise premiums for senior citizens.”
  • Eight Senate Republicans still dissatisfied with House bill — enough to sink it – Washington Examiner (Mar 22)
    “The national spotlight is trained on House Republicans’ furious efforts to pass a healthcare bill this week, but the measure faces an even more difficult path in the Senate, where just three GOP senators could sink it. As it stands, there are eight senators who have expressed serious reservations about the revised House bill aimed at repealing and replacing Obamacare – more than enough to torpedo its passage in the closely divided, 52-48 GOP majority Senate.”
  • White House Health Care Full-Court Press Changes Few Minds – Roll Call (Mar 22)
    “A White House in full-court press mode deployed President Donald Trump and Vice President Mike Pence to Capitol Hill on Tuesday to call out and fire up Republican members about the party’s health care overhaul bill, but there was scant evidence it worked. Trump made a rare morning trek to the Capitol’s basement in his quest for the 216 Republican votes, where he addressed the GOP House caucus with his signature brashness: Members present said he called out reluctant members, including Freedom Caucus Chairman Mark Meadows, by name. A few hours later, Pence tried to keep skeptical GOP senators in the loop about what kind of bill they might soon receive.”
  • Don’t count on ‘third prong’ of GOP health overhaul – Politico (Mar 21)
    “House Republicans chasing the final votes to repeal much of Obamacare are promising hard-liners they’ll fix the rest of the health care system with another batch of conservative bills down the road. The hitch is those bills would almost certainly die in the Senate — as several of them have done before.”

March 20, 2017

President Trump is scheduled to speak at the House Republican Conference meeting tomorrow morning. Speaker Ryan has been referring to the president as the “closer” or the “ultimate closer” as they work to secure the necessary 216 votes for passage in the House of Representatives.

A significant development occurred this morning when Chairman Mark Walker (R-NC) of the Republican Study Committee (RSC) announced his support of the bill. This announcement comes after Walker led a group of more than a dozen RSC members to the White House on Friday to meet with President Trump, Vice President Pence, Secretary of Health and Human Services Price, and Office of Management and Budget Director Mulvaney to discuss changes to the bill. Congressman Walker reported that the President agreed to some of the changes the RSC sought.

Below are some highlights from the press about recent developments in healthcare policy:

  • Ryan Plans Tweaks to Health-Care Bill to Help Older People – Bloomberg (Mar 19)
    “House Speaker Paul Ryan said he would “most likely” bring a health-care bill forward for a floor vote on Thursday, even as he seeks to increase tax credits to help older people buy insurance to tamp down concerns about moderate Republicans. “We believe that we do need to add some additional assistance to people in those older cohorts,” Ryan said of the bill, known as the American Health Care Act, on “Fox News Sunday.” “That’s one of the things we’re looking at.””
  • Ryan puts speakership on the line with Obamacare blitz – Politico (Mar 20)
    “The success of the new president’s legislative agenda will hinge in large part on Thursday’s vote in the House on the American Health Care Act, already being dubbed “Ryancare” or “Trumpcare.” Failure would be a real blow to Trump, who has vowed over and over again to “repeal and replace horrible, disastrous Obamacare.” It would damage the prospects of getting his other top priorities — from tax reform to funding his “beautiful wall” — through a GOP-controlled Congress.”
  • Trump’s budget adds funds to addiction treatment, but health bill cuts access to it – Fierce Healthcare (Mar 17)
    “One hand giveth, the other taketh away. So it might seem for advocates who hope to increase access to health services for people with addiction. In the midst of the country’s opioid epidemic, President Donald Trump’s proposed federal budget contained good news with the promise of additional money for opioid prevention and treatment. On the other hand, the proposed Republican health plan supported by Trump has those same advocates worried that repeal of the Affordable Care Act (ACA) will cut access to addiction treatment.”
  • Hospitals have a labor problem – Axios (Mar 20)
    “Hospitals across the country have benefited from Obamacare’s insurance expansions, and they hired physicians, nurses, technicians and others in droves to handle the influx of newly insured patients. But now hospitals face tough choices about what they should do with their increasingly expensive staffs if millions of Americans lose health coverage under the Republican Obamacare replacement. The latest federal data reinforce what hospital officials say is happening: Hiring is slowing down in the face of the political uncertainty.”
  • On Medicaid Money, GOP Has Win-Or-Lose Proposition For States – Kaiser Health News (Mar 20)
    “Per-capita caps would limit the government’s Medicaid spending because it would no longer be on the hook to help cover states’ rising costs. But caps also would shift costs and financial risks to the states and could force them to cut benefits or eligibility to manage their budgets. “It would present a huge problem,” said Adam Fox, a spokesman for the Colorado Consumer Health Initiative, an advocacy group.”

March 17, 2017

The House Budget Committee combined the legislative texts from the Energy and Commerce and Ways and Means Committees without making any changes to their reported bill language on March 16.  The House is expected to vote on the bill next Thursday, though some reports are indicating the vote may slip to Friday. We are hearing that there is a manager’s amendment in the works to address concerns in the bill that will likely be addressed at the Rules Committee.  Specific details of the manager’s amendment have not yet emerged, but AP is reporting a source has informed them of three amendments to be added: an option for states to receive a Medicaid block grant; an option for Medicaid work requirements for able-bodied people; and the prevention of non-expansion states from expanding Medicaid during the expansion phase-out.

We are also expecting the House to take action soon on the association health plan bill reported from the Education and Workforce Committee on March 8.  This suggests the second and third phases of the repeal and replace efforts are not waiting for the first phase to be completed. Recent announcements about senior officials at the Department of Health and Human Services suggest administrative actions are likely to begin soon. Secretary Price has been spending a lot of his time with Members of the House working to get the necessary votes for the reconciliation bill including attending this morning’s meeting of the House Republican Conference.

Below are some highlights from the press about recent developments in healthcare policy:

  • Trump backs changes to GOP health bill as House leaders eye vote next week – Washington Post (Mar 17)
    “President Trump signed on to a pair of changes to the House Republican health plan and declared “100 percent” backing for it Friday, moving to consolidate support among GOP lawmakers in hopes of moving it through the House next week. In a meeting with members of the conservative Republican Study Committee, Trump endorsed two provisions affecting Medicaid, the federal health program for the poor and disabled that would see $880 billion in cuts over the next decade under the current GOP plan.”
  • Republicans’ Obamacare repeal fight turning into battle over Senate procedure – Washington Examiner (Mar 16)
    “Frustrated conservatives are complaining that Congressional leadership isn’t being straight about the latitude that exists to repeal and replace Obamacare, which is quickly turning the GOP’s intraparty healthcare policy debate into a battle over the complex procedural rules governing the Senate.”
  • Freedom Caucus aligns with Bannon in risky Obamacare gambit – Politico (Mar 17)
    “The Freedom Caucus, however, has clearly found a sympathetic ear in Trump’s right-hand man Bannon, who wants conservatives to be included in the legislative process instead of twisting their arms to vote yes. The fledgling alliance has given the group newfound hope that they can win the White House over to their side — or, at least, that Trump won’t blame them if Obamacare repeal implodes.”
  • Trio of GOP proposals would overhaul Medicaid dramatically, starting with job requirement – Washington Post (Mar 17)
    “A contingent of House Republicans is trying to push the nation’s health insurance program for poor and vulnerable Americans deep into conservative territory, past a firewall that the Obama administration maintained for eight years. A partisan vote Thursday afternoon by the House Budget Committee would require able-bodied adults to hold a job in order to qualify for Medicaid. That profound change has long been popular on the far right as a way to promote personal responsibility but opposed by Democrats who fear it would deny health care to many people who need it the most.
  • Four Republican Governors Come Out Against Obamacare Replacement Plan – Bloomberg (Mar 17)
    “Four Republican governors told top lawmakers in the U.S. House and Senate that they oppose the current GOP plan to repeal and replace Obamacare, and that they want Congress to preserve an expansion of the Medicaid health program for poor Americans.”
  • Report: Fired US attorney was investigating HHS chief Tom Price – Washington Examiner (Mar 17)
    “Preet Bharara, the U.S. attorney who refused to step down and was fired by President Trump last week, was investigating Health and Human Services Secretary Tom Price’s stock trades, according to a report. ProPublica reported Friday that Bharara was investigating Price’s controversial trades that landed him in hot water during his confirmation hearings. When he was a House member, Price traded hundreds of thousands of dollars worth of stock in health-related companies while he was voting on and sponsoring legislation about the health industry.”

See All March 2017 Updates

See All February 2017 Updates 

See All January 2017 Updates 

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 a Client Executive at Prime Policy Group, where he is an integral member of the Firm’s research team.