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The Pence-Collins plan? Republicans hoping to pass a healthcare bill through the Senate are in a quandary. Among the many areas of disagreement is Medicaid, where conservatives want a quicker repeal of Obamacare’s expansion and a reformed system that gives more control to states, while centrist Senators (particularly those in states that have already expanded Medicaid) want more money for the program. One way Senate leaders may try to square the circle is to reform the program to give more flexibility to the states while funding it at a higher level than the House bill. That’s where Indiana may provide a clue.

When Vice President Mike Pence was governor of Indiana, he ended up taking Obamacare’s Medicaid expansion, but sought some cosmetic changes to the program that allowed him to argue he was really pushing a free market plan. The Indiana approach includes managed care plans as well as the requirement for enrollees to contribute to health savings accounts and was put put together by the current administrator for the Centers for Medicare and Medicaid Services, Seema Verma. A New York Times profile about Sen. Susan Collins, R-Maine, role in the healthcare debate said she supports Medicaid expansion similar to Indiana model. Given the active role that Pence has been playing in healthcare talks -- acting as a kind of liaison between the White House and Congress -- don’t be surprised if his experience in Indiana guides his thinking on Medicaid.

The big question, of course, would be whether conservatives would be able to get in line behind a bill that allowed for a higher level of Medicaid funding, especially as the only way to accomplish it (barring spending cuts elsewhere) would be to maintain more of Obamacare’s taxes, which in turn has implications for tax reform. 

Meanwhile, Pence is pressuring the Senate to act on healthcare by summer. "This Congress must repeal and replace Obamacare," Pence said during Sen. Joni Ernst's "Roast and Ride" event in Boone, Iowa. The two rode into the event riding motorcycles. Pence's comments come a day or so after Sen. Richard Burr, R-N.C., told a local radio station that he didn't think healthcare reform could get done this year, let alone before Congress' month-long August recess that starts at the end of July. Pence detailed the problems with Iowa's beleaguered individual market, which is for people who don't get insurance through work. He noted that insurers have been fleeing the individual market due to mounting financial losses. "Iowa is facing a healthcare crisis in America," he said. 

House Budget Committee Chair Diane Black, R-Tenn., says it’s “sad” Senate would consider giving up on repeal so quickly: Responding to Burr’s pessimistic comments on the prospects for a healthcare bill this year, Black said in a statement emailed to the Washington Examiner, "It's sad, honestly, that the Senate would consider giving up so quickly on saving the American people from Obamacare. The House already did the heavy lifting to repeal and replace Obamacare. If they can't pass our bill, then they should pass what they can and send it back to the House." 

Welcome to Philip Klein’s Daily on Healthcare, compiled by Washington Examiner Managing Editor Philip Klein (@philipaklein), Senior Healthcare Writer Kimberly Leonard (@LeonardKL) and Healthcare Reporter Robert King (@rking_19).  Email dailyonhealthcare@washingtonexaminer.com for tips, suggestions, calendar items and anything else. If a friend sent this to you and you’d like to sign up, click here. If signing up doesn’t work, shoot us an email and we’ll add you to our list.

Senate works to pass Obamacare repeal bill before August recess: Before lawmakers left town for the weeklong Memorial Day recess, Republican leaders said they would begin drafting legislation to repeal and replace Obamacare. This week, lawmakers will begin asking to see details on how Senate GOP leaders hope to write a measure that can attract at least 50 Republican votes. It is likely to deviate from the version that was passed by the House in May.

How Steve Scalise plans to make tax reform and a balanced budget happen: By sweet talking and arm twisting, Scalise alternately coaxes and cajoles House Republicans before each vote. Scalise sat down with Washington Examiner reporters and editors to explain how whipping Congress is like herding cats. As the muscle of leadership, Scalise recently helped talk 217 timid Republicans into fulfilling an 8-year-old promise of repealing and replacing Obamacare. He explained that second healthcare effort, detailing how he recruited Trump to help thrash conservative and centrist factions into line and what the Senate needs to do to finish the job.

A closer look at possible solutions to Obamacare’s multimillion-dollar patient in Iowa: Insurers are planning or considering fleeing the Obamacare exchange in Iowa, a move that is driven by an overly sick, costly risk pool that includes a patient whose medical bills total $1 million a month. The state and federal governments have some options for stabilizing the exchange for next year, such as reinsurance or the introduction of a more expansive high-risk pool. Medica, one of the insurers that has not decided whether it will participate in the state, has issued such proposals. Read more.

Wellmark: How we can re-enter Iowa's individual health market in 2018: The chairman and CEO of Wellmark Blue Cross and Blue Shield lays out the policy changes he’d want to see before offering individual insurance in Iowa again. His suggestions include a continuous coverage provision, more limited special enrollment, and subsidies based on both age and income.   

Missouri looks to ease doctor shortage with 'assistant physicians.' Republican Rep. Lynn Morris introduced legislation to ease qualification standards for medical school graduates who would be unable to practice unless they complete their residency. Under the bill, all legal U.S. residents who have graduated from medical school within the last three years and have passed their medical licensing exams within the past two years could apply for an "assistant physician" license. The assistant physicians , different from physician assistants,​ would have to practice alongside a licensed physician in one of the state's "healthcare shortage areas," where 98 of its 101 rural counties don't have enough primary care providers, according to U.S. Department of Health and Human Services data.

Keep your eye on Scott Walker in Wisconsin: “My approach is a simple principle. I believe we are good and decent people, particularly here in Wisconsin, and we want to help people who are down and out,” Wisconsin Gov. Scott Walker tells Salena Zito in an interview. “But public assistance, as I've often said, should be more like a trampoline than like a hammock.” In his newest budget, Walker wants to require childless adults in the state's Medicaid program either to be working or to accept job training of 80 hours a month. In addition, the proposals would include a required drug test.

FDA takes bigger role in lowering drug prices. In a major shift, new Commissioner Scott Gottlieb is creating an action plan to spur more competition and lower prices. The plan comes as the Republican-controlled Congress is looking to make changes at the FDA to address high prices by getting cheaper generics to the market faster. The decision by the GOP to focus on FDA changes is the latest rebuke to Democratic-proposed reforms, such as giving Medicare the power to negotiate lower drug prices and allowing people to buy cheap drugs from Canada.

Sen. Ron Johnson: Tax reform an easier lift than healthcare. The Wisconsin senator is the latest lawmaker to cast doubt on the prospects for getting Obamacare repeal done in the Senate quickly. "I think tax reform is an easier lift," he told the radio station AM 970 The Answer. "There are a number of pretty good proposals out there." Johnson speculated that getting Obamacare passed is going to be harder than it looks. Johnson has been pushing for a short-term bill to stabilize Obamacare's exchanges while working on long-term reform."We may have to break this into two pieces," he said. He said the Senate should take its time to put together a healthcare bill that "restrains the cost of healthcare."

Rep. Darrell Issa faces angry town hall questions on healthcare. Issa at one point ignited a testy exchange with town hall attendees when he discussed the American Health Care Act's penalty on not getting continuous coverage. He Issa appeared to veer off to comment on the attendance at the town hall. "Sometimes you see 200 of your constituents, 500 of your constituents and see the same ones again and again," Issa said. "And many of you are that 500 constituents." "How rude!" someone yelled in response to his comments. One constituent said that Issa's vote for the AHCA goes against promises that people with pre-existing conditions should be protected. The AHCA, which partially repeals Obamacare, does keep Obamacare's mandate for insurers to guarantee coverage for people with pre-existing conditions. However, it does let states opt out of a mandate that prevents insurers from charging people with pre-existing conditions more. Issa downplayed the AHCA, saying that there is a lot more to do on the bill. "I voted for it that moves a process that includes penalties for those that choose not to be insured and I stand by that," he said, referring to the AHCA's penalty for people who don't get continuous insurance coverage.

Pfizer hikes price on nearly 100 drugs, report says: Pharmaceutical giant Pfizer raised the U.S. price of nearly 100 drugs by about 20 percent so far this year, according to a new report. The price hike comes as Pfizer and the rest of the pharmaceutical industry get heat from Congress over high drug prices. The Financial Times reported Friday that the drug maker raised the prices of 91 drugs on June 1 from 5 to 13 percent. The U.S. drugmaker also raised prices in January, bringing the full average of the increases up to 20 percent per drug. Pfizer responded that it has "very comprehensive and extensive access programs for those that cannot afford or do not have good insurance."

EDITORIAL: The Congressional Budget Office needs to open its books: The CBO is mostly opaque. It keeps its models basically secret. It doesn't show its work. And while it is forecasting incredibly complex questions with complex interactions for many years into the future, it always arrives at a very specific answer: 23 million uninsured, or a deficit reduction of $119 billion over 10 years,” writes the Washington Examiner editorial board.

RUNDOWN

Healthcare Informatics HHS task force report: Healthcare cybersecurity is in critical condition
NPR A botched vaccine campaign for measles killed 15 children in south Sudan
CQ Magazine
Obamacare in Alaska: Cost-control plan is challenging cut working
The Hill
States scramble to prevent Obamacare exodus
Pittsburgh Post-Gazette
Bill would require time limits and work for Medicaid recipients in PA
New York Times
Drug deaths in America are rising faster than ever
Axios
Blue Cross Blue Shield insurers are making money on the ACA
Stat News
The Real World, Diabetes: As cameras roll at a Jamaican resort, desperate patients seek healing 

Calendar

MONDAY | JUNE 5

Senate back in session.

TUESDAY | JUNE 6

House back in session.

June 6-9. New York. Jefferies 2017 Global Healthcare Conference. Details.

Facebook hosting a Health Summit for drug companies. Details.

9 a.m. American Enterprise Institute. 1789 Massachusetts Ave. NW. Discussion on report from AEI and the Brookings Institution on the “Project on Paid Family Leave.” Details.

10 a.m. 2226 Rayburn. Information Technology and Innovation Foundation discussion on “Speeding Cures for Patients: How Congress Can Update the Prescription Drug User Fee Act to Spur Biopharmaceutical Innovation.” Details.

WEDNESDAY | JUNE 7

June 7-9. Austin, Texas. America’s Health Insurance Plans Institute and Expo. Agenda.

8 a.m. Newseum. Atlantic event on “The Next Drugs: An Atlantic Policy Update on Biosimilars.” Details.

10 a.m. 1300 Longworth. House Committee on Agriculture hearing on “The Next Farm Bill: The Future of International Food Aid and Agricultural Development.” Details.

10 a.m. Bipartisan Policy Center. 1225 I St. NW. Discussion on “Preparing Healthcare Providers for Obesity Care.” Details.

10:30 a.m. American Enterprise Institute. 1789 Massachusetts Ave. NW. Discussion on policies around “Deaths of Despair: Opioid, Community and the Economy.” Details.

2 p.m. 1100 Longworth. House Ways and Means subcommittee on Health Medicare Advantage hearing on “Promoting Integrated and Coordinated Care for Medicare Beneficiaries.” Details.

THURSDAY | JUNE 8

June 8-June 11. Boston. Annual scientific meeting for the American Headache Society. Webcast.

8 a.m. Patient Safety Forum. Jacksonville University. Includes presentations by Florida Blue Foundation.

9 a.m. Reserve Officers Association. 1 Constitution Ave. NE. Health Affairs media-only briefing on the future of the Affordable Care Act with Texas Republican Reps. Michael Burgess and Gene Green.

10 a.m. 215 Dirksen. Senate Finance Committee hearing on President Trump’s budget with Health and Human Services Secretary Tom Price. Details.

10 a.m. 1100 Longworth. Joint Economic Committee holds hearing on “Economic Aspects of the Opioid Crisis.” Details.

10:15 a.m. 2322 Rayburn. House Energy and Commerce Hearing on “Examining the Role of the Department of Health and Human Services in Healthcare Cybersecurity.” Details.

1 p.m. 1100 Longworth. House Ways and Means Committee hearing on budget for the Department of Health and Human Services. Details.

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