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September 2017


September 29, 2017

The drama over the Graham-Cassidy bill did not play out as expected heading into last weekend as it quickly became clear there were not sufficient votes to get the bill out of the Senate.  At the Republican senators’ weekly lunch, it was decided to not call up the bill and keep working on the issue.

What does “keep working on the issue” specifically mean?  Well, there appears to still be several moving parts to the puzzle.  Senators Alexander (R-LA) and Murray (D-WA) continue their discussions over a bill to stabilize the individual insurance market.  We are told they are close to an agreement, but how far that bill can move beyond the Senate HELP Committee, where they serve as Chairman and Ranking Member, remains to be seen.

Senators Graham (R-SC), Cassidy (R-LA), Heller (R-NV), and Johnson (R-WI), who wrote the amendment to the reconciliation bill, say they are going to get back to work on the language on Monday.   But it is not clear if they are going to try and come up with policy that can pass the Senate on simple majority vote and move in a future reconciliation bill or something that can gain 60 votes.

The Problem Solvers Caucus in the House continues to try and move forward the legislative solution they put together.  We are told their solution will look very close to what Senators Alexander and Murray will come up with as a solution.

Meanwhile, House committees are moving on to bipartisan legislation outside of the Affordable Care Act.  House Energy and Commerce is poised to consider a bipartisan reauthorization of the Children’s Health Insurance Program (CHIP) next week.

  • Alexander, Murray inching toward deal to stabilize Obamacare – Politico (Sep 28)
    “A pair of deal-making senators is inching toward a bipartisan agreement to fund Obamacare’s insurance subsidies and provide some certainty to health insurance markets just two days after the GOP’s latest Obamacare repeal effort failed. Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.) are moving toward a plan to stabilize Obamacare in the short term after meeting on Wednesday. Though they have not yet clinched a deal, their progress could ignite a new battle over how or whether to improve the law.”
  • Senate GOP effort to unwind the ACA collapses Monday – Washington Post (Sep 25)
    “The latest Republican effort to unwind the Affordable Care Act collapsed Monday as a third GOP senator announced her opposition and left the proposal short of the votes needed to pass. While one top Republican senator held out the possibility that the Senate might still vote on the bill, others accepted the reality that the push had sputtered out after Sen. Susan Collins (R-Maine) joined two of her colleagues in formal opposition.”
  • Here’s how the Trump administration is hurting enrollment in Obamacare – Washington Post (Sep 28)
    “…In other words, enrolling those healthy people is central to making Obamacare work. And in light of that, it’s probably not surprising to discover that the administration of President Trump is taking a number of steps that, intentionally or not, will undercut the number of healthy people who enroll. Here are a number of ways that’s happening.”
  • Trump blamed pharma’s political donations for ‘outrageous’ drug prices. The next day, those donations spiked – STAT (Sept 27)
    “Eight pharmaceutical political action committees made 134 contributions, spread over 77 politicians, on March 21. They spent $279,400 in all, showering Republicans and Democrats in both legislative bodies with campaign cash, according to FEC filings. The second-highest one-day contribution tally was $203,500, on June 20.”
  • Dems see 2018 gains in repeated Obamacare repeal tries – Politico (Sep 28)
    “To the Republicans vowing to keep their Obamacare repeal drive alive for as long as it takes, Democrats say: Please, and thank you. While Senate Republicans abandoned their last-gasp attempt to topple Obamacare before a Saturday deadline, they’re already suggesting they might try again next year. That timing — President Donald Trump said Wednesday that Congress would take up repeal again in the first quarter of next year — could keep the threat of upending the health care system front of mind in the thick of the 2018 campaign season.”

September 22, 2017

The plot has thickened as they say with respect to the so-called Graham-Cassidy bill.  We are told those two Senators are personally working extremely hard to line up the necessary votes from their colleagues.  We are also hearing that modifications to the bill are being discussed and negotiated to lock down 50 votes for the bill.

The Congressional Budget Office has announced it will release a preliminary score of the bill next week.  The preliminary score is not expected to have a lot of details and certainly will not include coverage estimates of this bill, but it will provide enough information to allow the Senate to turn to this amendment should Leader McConnell think he has the votes or is close to having the votes.

The Democratic Senators do not have many options for preventing this bill from moving forward.  The debate time on the reconciliation bill has expired so the Senate is in the vote-a-rama phase of considering the reconciliation bill which means any amendments get called up for a vote without debate.  The one tool the Democrats do have is to file as many amendments as possible under the hopes that the roll calls on those votes will not be completed before the September 30th deadline.  Yom Kippur beginning the evening of September 29th helps the Democrats if they pursue that strategy.

If the Senate does manage to pass the reconciliation bill next week, the House will not be faced with any deadline for considering the Senate-passed bill.  There was talk of including in “side car” legislation fixes for any problems/issues the House desires to be addressed.  The side car legislation would likely be included in a future must-pass measure such as supplemental funding for response to the hurricanes.

Regardless of the outcome of the Senate votes next week, these developments are likely to have a spill-over effect on other issues Congress must address such as the Dreamers and expiring provisions.


September 15, 2017

It was a big week for healthcare in Washington with two new significant bills being put forward.
Senators Graham (R-SC), Cassidy (R-LA), Johnson (R-WI), and Heller (R-NV) released a substitute amendment for the House-passed “repeal and replace” bill known as the American Health Care Act. The so-called Graham-Cassidy bill establishes a block grant to states to help individuals pay for healthcare coverage. The block grant is funded by repealing the premium and small business tax credits and pulling back the Medicaid expansion funding starting in 2020. The bill also provides $25 billion to states for transitional assistance until the new block grant programs are implemented. The individual and employer mandates are repealed in the bill as are some of the taxes introduced by the Affordable Care Act (medical device, over-the-counter medications, etc.).
We are told the sponsors of the bill are seeking a score from the Congressional Budget Office. However, it is not certain whether a score can or will be produced before the reconciliation privilege with the 2017 budget resolution expiring on September 30. It is also uncertain whether the score would produce the results necessary to meet the reconciliation instructions. Leader McConnell has said he is “all in” if they have a favorable score and the votes to pass the bill. President Trump put out a complimentary statement following the bill’s release, but did not indicate whether he would sign the bill into law if passed by Congress.
Should the Senate pass this bill, it would set up an interesting dynamic with the House given the significantly different approach the House took. As with many other issues in Washington these days, there are a lot of people taking a wait and see approach with the Senate on this issue.
The second healthcare bill was Senator Sanders’ (I-VT) single payer healthcare bill. The “Medicare for All” bill has 16 original cosponsors including Senator Baldwin (D-WI) who is up for reelection in a state Trump carried and Senators Harris and Gillibrand who are mentioned as possible candidates for President in 2020.
  • Cassidy says he’s close to having the votes to pass Obamacare repeal – Politico(Sep 15)
    “Sen. Bill Cassidy Friday sought to rally support for the last-ditch Obamacare repeal plan he co-authored, saying he believes he’s on the verge of winning the final votes needed to jam it through the Senate. Cassidy claims that as many as 49 GOP senators have expressed support but doesn’t have a hard whip count with just days left to use a fast-track process allowing the bill to pass with a simple majority. And his search for the elusive 50 “aye” votes got harder Thursday, when Sen. Rand Paul announced his opposition.”
  • GOP tries one more time to undo ACA with bill offering huge block grants to states – Washington Post (Sep 13)
    “With just 17 days left for Republicans to repeal the Affordable Care Act on a party-line vote, a quartet of GOP senators on Wednesday rolled out a plan to devolve federal health care spending into state-by-state block grants – legislation that South Carolina Sen. Lindsey O. Graham described as conservatives’ last shot at reform.”
  • Sanders’ single-payer push splits Democrats – Politico (Sep 13)
    “Bernie Sanders’ single-payer health care plan has won over most other liberal senators, including many weighing 2020 bids. The rest of the Democratic Party is another matter. As Sanders prepares to unveil his Medicare for All legislation on Wednesday, most of the party’s congressional leaders and vulnerable Senate incumbents are steering clear. Even as the left celebrates Sanders’ ability to push the Democratic agenda leftward after his primary challenge to Hillary Clinton last year, that success appears to have its limits.”
  • Governors Ask Congress to Help Stabilize Health Care Market – CQ Roll Call(Sep 11)
    “Governors are calling for multiyear funding for cost-sharing payments and for federal assistance to launch reinsurance programs as part of a bipartisan measure to stabilize the individual insurance market. The conversation among governors and senators in a Sept. 7 hearing before the Senate Health, Education, Labor and Pensions Committee echoed what insurance commissioners told the same panel earlier in the week about how to bring stability to the individual insurance market before the fifth open enrollment period.”

September 8, 2017

The Senate Committee on Health, Education, Labor and Pensions (HELP) held its first two hearings on stabilizing the individual insurance markets this week.  The first hearing featured state insurance commissioners from a cross-section of states.  Broadly speaking, the consensus from the group was that cost sharing reduction payments should be made and continued (preferably long term) and the creation of a federal reinsurance program would be helpful.  The commissioners also urged that states be given more flexibility in a streamlined way to address unique needs in their states.  The second hearing featured governors who largely agreed with the recommendations of the insurance commissioners.

HELP Chairman Alexander held bipartisan caucuses before each hearing to begin a dialogue amongst the senators about possible legislative solutions the committee can advance.  We are expecting that Senator Alexander will look to start the negotiations over a possible bill that is similar in scope to the legislative solution proposed by the bipartisan Problem Solvers Caucus in the House.

There are a number of expiring health care provisions including the Children’s Health Insurance Program in the month of September, but these provisions were not part of the deal cut by the President with Democratic leaders to process the big three issues of raising the debt limit, continuing funding for the government with a continuing resolution, and making the first payment to respond to the damage from Hurricane Harvey.  It is not clear what path the expiring health provisions will take at this point and there more provisions such as the Medicare extenders with year-end expirations.

  • Senate GOP accepting defeat on Obamacare repeal – Politico (Sep 7)
    “Senate Republicans are throwing cold water on the idea of holding another Obamacare repeal vote before their opportunity to gut the law on a party-line vote expires at the end of this month. Though President Donald Trump and some Senate Republicans are pushing a plan being devised by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) to block grant federal health care funding to the states and keep much of Obamacare’s taxes, the idea of passing the measure by month’s end appears almost impossible, according to senators and aides.”
  • State insurance commissioners under pressure in health-care drama – Washington Post (Sep 2)
    “With insurance premiums rising amid congressional Republicans’ failed attack on the Affordable Care Act, a group of bureaucrats whom few Americans can identify hold considerable power over consumers’ health plans: state insurance commissioners. Elected in 11 states, appointed in the others, they are central characters in the unfolding drama that is the nation’s health coverage.”
  • Senate’s Obamacare fixes would build on heavy lifting by states – Politico (Sep 5)
    “While Congress was busy bickering over repealing the health law, officials in red and blue states worked frantically to soothe anxious insurers, tamp down rate increases and insulate their markets from the ceaseless chaos in Washington. The result is an Obamacare system that’s still vulnerable, but far from the “disaster” President Donald Trump and his top health officials describe.”
  • Senate Appropriators Back NIH, Pell Grant Boosts in Draft Bill – CQ (Sep 6)
    “The Senate Labor-HHS-Education Appropriations Subcommittee on Wednesday approved by voice vote a bipartisan draft spending bill that would increase funding for the National Institutes of Health by $2 billion and provide more funding to low-income students attending college.”