THE PROGNOSIS
Senate Health, Education, Labor, and Pensions Committee Chairman Sen. Lamar Alexander (R-Tenn.) accompanied by the committee's ranking Democrat, Sen. Patty Murray (Wash.), speaks on Capitol Hill. (AP Photo/Alex Brandon, File)
Sean Sullivan is our guest writer for today's Prognosis. Paige will be back next week.
Repeal and replace, meet Fix and Fine-Tune.
After spending months trying — and failing — to undo major parts of the Affordable Care Act, a growing number of Senate Republicans have turned their attention to a new goal: shoring up the insurance marketplaces under the law the GOP spent seven years fighting tooth and nail.
The effort convened in earnest yesterday when Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.) kicked off the first of four bipartisan hearings on the subject. His goal: Strike a bipartisan deal by the end of next week.
“We had 31 senators at coffee this morning with our witnesses and we had 22 out of 23 at our hearing,” Alexander said in an interview afterward. “Half the Senate met today to work together to try to get a result.”
But interest doesn’t always equal action, as Congress has repeatedly demonstrated. Although this Senate is closer than it’s ever been to striking a truly bipartisan agreement on health care, there are still several political land mines that could derail its plans.
Opening the hearing, Alexander made his give-a-little-to-get-a-little pitch: “To get a result, Democrats will have to agree to something — more flexibility for states — that some may be reluctant to support. And Republicans will have to agree to something — additional funding through the Affordable Care Act -- that some may be reluctant to support.”
He added: “That is called a compromise.”
Given the fierce warfare between Democrats and Republicans over the law known as Obamacare, it’s nothing short of remarkable to hear a leading Republican utter the word “compromise” in the context of health care. So, how did we get here? And where do we go from here?
The answer to the first question is much simpler. Republicans, given full control of Congress and the White House, were unable to overcome their own disagreements and long-standing ideological divisions to pass a repeal-and-replace bill. And that, some Republicans say, fueled a desire for something new.
“I do believe there’s much more impetus for a bipartisan bill,” said Sen. Susan Collins of Maine, one of three Republicans who effectively killed the repeal-and-replace effort.
Of course, that’s only part of the picture. Other Republican senators have not given up the goal of repeal and replace, a long-standing promise. Privately, many fear blowback — from a GOP base that heard vow after vow about taking down Obamacare — if they do not deliver.
Sen. Ted Cruz (R-Tex.) (Photo by Alex Wong/Getty Images)
Asked Wednesday whether he would support a compromise along the lines of what Alexander is proposing, Sen. Ted Cruz (R-Tex.), who is up for reelection in 2018, replied simply: “We’ll have plenty of time to debate Obamacare. And I believe we will honor our commitment to repeal it.”
So, it’s far from clear that enough Republicans will vote for any plan to stabilize the 2010 law they have so long reviled. Democrats are also a wild card, given that some are asking for more concessions than Alexander is offering.
As Amy and Juliet report, Sen. Patty Murray (Wash.), the top Democrat on HELP, “quickly reflected the Democrats’ differences with their Republican counterparts. The government should promise insurers cost-sharing payments for multiple years, she said.”
Complicating matters further, Sens. Lindsey O. Graham (R-S.C.) and Bill Cassidy (R-La.) are pushing their own repeal-and-replace plan — an alternative to the package that failed in July.
Sen. John McCain (R-Ariz.)
And it has caught the eye of Sen. John McCain (R-Ariz.), who is voicing his support. McCain voted against the July repeal-and-replace plan. "Asked if he supported [Graham-Cassidy], McCain told reporters, 'Yes. You think I wouldn't be?': He added: "If it's not through regular order then it's a mistake, but it doesn't mean I wouldn't vote for it." In a follow-up statement, McCain backed up a bit, saying, "While I support the concept of the Graham-Cassidy proposal, I want to see the final legislation and understand its impact on the state of Arizona before taking a position."
Here’s what we know: Alexander is a close ally of Senate Majority Leader Mitch McConnell (R-Ky.) — so his efforts are worth watching. He has the ear of the man who effectively controls the Senate.
Here’s what we don’t know: Given all the other things Congress has on its plate this fall, whether McConnell is prepared for another round of arm-twistingon health care — or whether he will see it as a top priority. What happens in the House is also an open question.
The fact that Republicans and Democrats are even talking to one another in earnest about health care is a major development, to be sure.
Whether those talks will lead to any tangible action, though, is what we’ll find out in the coming weeks.
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AHH, OOF and OUCH
Sen. John McCain (R-Ariz.) and Sen. Lindsey O. Graham (R-S.C.) walk near the Senate chamber. (EPA/MICHAEL REYNOLDS)
AHH: The Graham-Cassidy measure may be gaining support, although our colleague Kim Soffen says it may not deliver as billed. “If you like Obamacare, you can keep it,” Graham has said of the plan. “If you want to replace it, you can.”
The proposal would turn the sprawling health-care market over to the states by converting federal Medicaid and subsidy funding into block grants for them to implement their own health-care systems.
President Trump, in a last-ditch effort to deliver some fix to the Affordable Care Act, has been working with Graham and Cassidy on their proposal, Politicoreported Tuesday. Senior White House adviser Kellyanne Conway said Trump would be ready to sign the plan if lawmakers moved forward with it.
“The president’s ready, he’s ready with pen in hand to sign health-care reform if, say, Graham-Cassidy moves forward. A lot of the governors seem to be supportive of that, people have been working on that very strongly over the recess,” Conway said Wednesday on “America's Newsroom” on Fox News.
Beyond the tight September deadline for Republicans to fast-track the bill, Kim breaks down how some of the plan's claims may fall short.
“The Medicaid expansion and subsidy funding would be cut sharply compared to current spending, going to zero in a decade,” she writes. Read more of her explainer with graphics breaking down key elements of the Cassidy-Graham proposal compared with the Republicans' initial failed Senate bill here.
Florida Gov. Rick Scott gives an update to the media regarding Hurricane Irma. (Photo by Mark Wilson/Getty Images)
OOF: In preparation for the Category 5 storm that could hit the area this weekend, hospitals in the Florida Keys have begun evacuating. Lower Keys Medical Center, Mariners Hospital, and Fishermen’s Community Hospital discharged mobile patients and began planning for the transport of about 20 other patients who are still at the facilities, STAT News reported.
Gov. Rick Scott (R) ordered visitor evacuations from the Keys to start early Wednesday.
“This storm is much more powerful than any storm that’s threatened the Keys since 1935,” Wayne Brackin, chief operating officer of Baptist Health South Florida, told STAT News. “People in the Keys, by and large, are rugged individualists and, historically, it’s been difficult to motivate people to evacuate. The fact this storm is such a monster, and given what they witnessed during Harvey, people are getting out.”
Inpatients from Keys facilities are being transferred to hospitals to Miami and to a facility in Alabama, according to the report.
Sen. Claire McCaskill (D-Mo.) speaks on Capitol Hill in Washington. (AP Photo/Alex Brandon, File)
OUCH: Sen. Claire McCaskill (D-Mo.) released a report yesterday detailing explosive findings about how pharmaeutical companies have allegedly misled doctors about opioids, leading to an increase in inappropriate prescriptions by doctors and subsequent abuse by patients.
The report -- which the senator said was the first in a round of investigations into drug-makers' practices -- zeroed in on drug manufacturer Insys Therapeutics and its fentanyl drug product Subsys, writes Vox's German Lopez. "According to the report, Insys misrepresented Subsys to get insurers to pay for it, letting the company sell its product to people who didn’t need and shouldn’t have access to such a powerful drug," Lopez writes. "In 2012, Insys found that Subsys got reimbursement approval from insurers in only about 30 percent of cases — a pretty low rate. So the company set up a special unit, known as the Insys Reimbursement Center (IRC), to try to get that number up."
The bottom line: “McCaskill’s report provides a grim snapshot of how the opioid epidemic became the deadliest drug overdose crisis in US history: Driven by a quest for profit, opioid makers and distributors misled doctors, insurers, patients, and the general public about their drugs — claiming that they are safe and effective for conditions that they would turn out to be neither safe nor effective for."
Vox reported that Insys told McCaskill’s office that it has “completely transformed its employee base over the last several years,” and has “actively taken the appropriate steps to place ethical standards of conduct and patient interests at the heart of [its] business decisions.”
HEALTH ON THE HILL
Testying before the Senate HELP Committee yesterday: Tennessee Department of Commerce and Insurance Commissioner Julie Mix McPeak; Washington State Insurance Commissioner Mike Kreidler; Alaska Division of Insurance Director Lori Wing-Heier; former Insurance Commissioner of Pennsylvania Teresa Miller and Oklahoma Department of Insurance Commissioner John Doak. (AP Photo/Manuel Balce Ceneta)
HELPing out: Post reporters Amy Goldstein and Juliet Eilperin have the download for you on yesterday's ACA hearing at the Senate HELP panel, where Alexander and Murray are trying to find a way to stabilize insurance marketplaces that flies with both parties.
The star witnesses were five former and current state insurance commissionersfrom Alaska, Oklahoma, Pennsylvania, Tennessee and Washington were invited to advise on how their state marketplaces could be stabilized. The series of four HELP hearings on the subject continue today with appearances from five governors: GOP Govs. Charlie Baker (Mass.); Bill Haslam (Tenn.); Gary Herbert (Utah); and Democratic Govs. Steve Bullock (Mont.) and John Hickenlooper (Colo.).
At yesterday's hearing, the insurance officials voiced support for extending the much-debate cost-sharing reduction subsidies the federal government provides to enable low-income Americans to enroll in the Obamacare marketplaces. President Trump has frequently threatened to withhold the subsidies, and has settled on a pattern of deciding whether to disburse them on a month-to-month basis.
"The commissioners urged senators to guarantee at least two more years of funding for subsidies to insurers that President Trump has repeatedly threatened to abolish," Amy and Juliet wrioe.
They wrote: “While President Trump has repeatedly threatened to end the cost-sharing payments, and his administration has each month left their status mystery until just before they are paid, senators and commissioners of both parties endorsed them on Wednesday. The lingering dispute is over how long, with Republican and Democratic commissioners calling for an extension at least through 2019 to reassure a jittery insurance industry.”
"They also said the government should gives states more flexibility to bypass certain ACA insurance requirements and should recreate a pool of money the law originally provided to help buffer health plans from the expense of covering customers with unusually high medical costs."
Here are some specifics:
- Julie McPeak, commissioner of the Tennessee Department of Commerce and a Republican testified that the state’s marketplace are “very near collapse.” McPeak said that 78 of Tennessee’s 95 counties will have only one insurer selling ACA health plans next year.
- Mike Kreidler, Washington’s insurance commissioner and a Democrat, said the state had seen a “serious jolt to the system” over “the growing uncertainties and actions of the administration. Our individual insurance markets are in serious peril.”
- Teresa Miller, Pennsylvania's acting health and human services secretary and former insurance commissioner, suggested there should be changes to the waiver process for states to change the individual insurance markets: “The current waiver process is very cumbersome… the more we can streamline the process, the better it would be,” said Miller, who works under the state’s Democratic Gov. Tom Wolf.
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