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Don’t bet on a Trumpcare re-vote: On Thursday afternoon, as many Washington folks were glued to Twitter bracing for another bombshell story to emerge about President Trump and James Comey, the healthcare world was rattled a bit by a Bloomberg story raising the possibility that Republicans may be forced to re-vote on the American Health Care Act, which barely squeaked through the House just a few weeks ago. The story is that the House has not formally sent the bill to the Senate as leaders await a Congressional Budget Office score next Wednesday — an adverse one could theoretically force them to make tweaks and re-vote before sending it to the Senate. The concern is that to be eligible for passage by a simple majority in the Senate through the process of reconciliation, it has to meet a number of budget targets — reducing deficits by $1 billion in each of the two relevant committees, and reducing deficits in the second decade after enactment. The question is whether the late changes to the bill would mean that the version as passed did not clear this threshold. In reality, this should be treated as a very remote possibility.

The most recent version of the bill evaluated by the CBO found $150 billion in deficit reduction. Some analysts have argued that if a lot of states choose to waive Obamacare regulations, it would lower premiums in those states for younger and healthier Americans, and thus increase the number of people taking advantage of the AHCA tax credits. That would increase the cost of the bill. At the same time, however, the latest changes delayed the repeal of the Medicare surtax on high income earners, so it will raise more revenue than previous iterations of the bill. Even an analysis by the Committee for a Responsible Federal Budget, which a number of people have been pointing to, shows the bill would still reduce deficits by $35 billion even if 5 million more people enrolled in plans as a result of states taking waivers. Also, while the bill delays the implementation of the “Cadillac tax” on expensive employer plans, it still keeps it on the books, which should make sure the bill meets deficit targets for the second decade. While gaming out how the spending would break down by individual committee would get more complicated, it’s important to keep in mind that Republicans have some wiggle room, and they were regularly in touch with the CBO as the bill was crafted, so they have some sense of how analysts are going to approach scoring the waivers and assuming how many states adopt them. The stakes are too high for them to have simply flown completely blind.

That’s likely why House Speaker Paul Ryan  was so dismissive of the idea this morning: "It's a technical non-issue,” the Wisconsin Republican told Hugh Hewitt. “We're just, out of an abundance of caution, we're waiting to send the bill to the Senate." That said, no matter how remote the possibility, because there’s still a non-zero chance the GOP could have massively miscalculated, it will add an extra dose of drama to the release of the CBO score on Wednesday — during a week that is not lacking of drama with Trump’s foreign trip, his budget expected, and the deadline for the FBI to respond to Congress over releasing the Comey memos.  

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.

CBO score coming Wednesday: The Congressional Budget Office said it will release an updated score on the House healthcare bill on Wednesday. The updated score will reflect major changes to the House bill that was narrowly approved earlier this month. Those changes include a waiver system to let states opt out of certain insurance mandates and adding more money for high risk pools.

Democrats playing offense on rate hikes: Democrats have largely been on the defensive in the past when news of major Obamacare rate hikes have emerged. But now they are using proposed hikes in 2018 to prove that President Trump is sabotaging the exchanges. Last year, for instance, Obamacare insurers called for major rate hikes of an average of 25 percent for the most popular plan. Democrats said the rate hikes weren't bad because tax credits would rise alongside any premium hikes and most Obamacare customers won't be affected.

Now with Trump as president, Democrats are playing up the impact of the hikes. They say that the hikes are proof of uncertainty that Trump has created in insurance markets through the efforts to repeal Obamacare and by not committing yet to pay insurance subsidies for 2018.

HHS says Dems are performing healthcare policy gymnastics: Spokeswoman Alleigh Marré says, “It requires impressive mental gymnastics to make the case that Obamacare is working while Americans living in one-third of our nation’s counties have only one option for healthcare coverage and premiums and deductibles continue to rise. Obamacare has failed. For this reason, Republicans are reforming healthcare so it delivers access to quality, affordable coverage to the American people.”

Senate working group now more like a working army: Sen. Bill Cassidy, R-La., has been on the outside looking in for most of the healthcare reform debate in Washington this year. But now he has a seat at the table. Or more specifically at the small table of a dozen or so senators. Cassidy was spotted heading into the Senate healthcare working group's latest meeting on Thursday. He told reporters the working group of about 14 senators is now open to all members. His own Obamacare repeal plan released earlier this year with Sen. Susan Collins, R-Maine, didn't get any traction. The bill lets states keep Obamacare or choose two other options.

States want to join Obamacare subsidies lawsuit A collection of 15 states and the District of Columbia want to take up the fight over Obamacare's insurer subsidies if Trump doesn't want to.

The states filed a motion to intervene in a federal lawsuit between the House and Trump administration over the cost-sharing reduction payments to insurers. Obamacare requires insurers to lower copays and deductibles for low-income Obamacare customers, and the government reimburses them. But the House sued a few years ago saying that the Obama administration bypassed Congress for the payments and they require a congressional appropriation. A federal judge sided with the House but delayed her ruling until appeals were exhausted. Then the White House changed hands and it is not clear if Trump wants to continue the appeal. He has been pretty dodgy about whether to keep the insurer subsidies for 2018, and insurers need to know ... now.

Umm ... no: Sen. John Thune, R-S.D., acutely summed up the divisions in the Senate over whether to keep the individual mandate for a few years. The idea has been toyed with in the Senate healthcare working group that has been meeting biweekly. When asked if he favors keeping the mandate around temporarily, Thune hemmed and hawed and then quickly answered "probably not" before getting into an elevator to the Senate floor.

CMS slams report it offered CSR trade The Centers for Medicare and Medicaid Services is denying an LA Times report that it offered to pay insurer subsidies in exchange for insurer support of Trump's healthcare bill. CMS told the Washington Post it is "absolutely false" that director Seema Verma suggested at an April industry meeting that insurers could get cost-sharing reduction payments in exchange for supporting the bill.

Planned Parenthood axes clinics in Iowa: Planned Parenthood will close four of its 12 clinics in Iowa due to massive state budget cuts. An estimated 30 people will be laid off as a result of the move by the Republican-led legislature to block state money for family planning services to abortion providers. Several states have aimed to cut off Medicaid funding for the women's health and abortion provider but have been blocked by the courts. The Republican-controlled Congress is also working to defund Planned Parenthood in an Obamacare repeal bill. The provider gets roughly $500 million a year in federal funds, but is prohibited under federal law from using any federal funds for providing abortions.

Journalists no think good due to booze and coffee At least that is what a small London study says. The study found that journalists' brains function on a subpar level due to too much alcohol, caffeine and sugar. We consume so much of this stuff to deal with the pressing deadlines and stress of our jobs (just going to leave this here for my editors). The study was pretty small, comprising of only 31 reporters in London who answered a questionnaire about their habits. However, even though we self-medicate via sugar and alcohol, all of the journalists say they love their jobs.

RUNDOWN

STAT News Tennessee rural hospital turns to crowd-funding to stay afloat
Bloomberg News
That time Trump wanted to cut science and got a portrait instead
Washington Post
Nearly 700 vacancies at CDC because of Trump’s hiring freeze
Modern Healthcare
House lawmakers push back on MEDPAC’s proposed Medicare reforms
Axios
Here’s how much NIH spends on indirect costs, which were subject of GOP criticism
Morning Consult
Senate panel approves bill revamping Medicare for chronically ill patients
The Hill
Senate GOP short on ideas for stabilizing Obamacare markets
New York Times
GOP highlights alternate legislative universe as Trump’s woes pile up

Calendar

FRIDAY | MAY 19

Berlin. G20 health summit. 

House Energy and Commerce Committee hearing on Drinking Water System Improvement Act and Related Issues of Funding Management and Compliance Assistance under the Safe Drinking Water Act. Began 9:30 a.m. Details.

MONDAY | MAY 22

CBO report on the American Health Care Act expected this week.

Trump administration must provide the D.C. Circuit Court of Appeals an update in the case House v. Price on cost-sharing reduction subsidies.

May 22 to 24. Atlanta Marriott Marquis. 2017 Spring Hospital & Healthcare I.T. Conference. Details.
 

TUESDAY | MAY 23

The president’s full budget proposal for fiscal 2018 is expected.  

10 a.m. Bipartisan Policy Center. 1225 I St. NW, Suite 1000. Roundtable on “Patient Safety and Information Technology,” including Former Senate Majority Leader William Frist, former Rep. Bart Gordon from Tennessee; former Health IT National Coordinator Karen DeSalvo and former FDA Commissioner Andrew von Eschenbach. Details.

10 a.m. 2123 Rayburn. House Energy and Commerce committee hearing on “U.S. Public Health Response to the Zika Virus: Continuing Challenges.” Details.

2:30 p.m. 253 Russell. Consumer Protection Subcommittee to Hold Hearing on Pool Safety. Details.

WEDNESDAY | MAY 24

8:15 a.m. AJAX. 1011 4th Street NW. Axios discussion with House Speaker Paul Ryan.

11 a.m. Kaiser Permanente Center for Total Health. 700 2nd St NE. Council of Accountable Physician Practices and the American Cancer Society to hold a press briefing on the “The State of Cancer Care Today.” Will include experts from the Biden Foundation and the CDC. Details.

1 p.m. 2007 Rayburn. House Appropriations Committee budget hearing on Indian Health Service. Details.

1: 30 p.m. Alliance for Health Reform webinar on “Where Medicaid Stands: From the AHCA to State Waivers.” Details.

2 p.m. 1100 Longworth. Hearing on the president’s proposed fiscal 2018 budget with Treasury Secretary Steven Mnuchin. Details.

THURSDAY | MAY 25

10 a.m. 2362-A Rayburn. House Appropriations Committee budget hearing on the Food and Drug Administration with FDA Commissioner Scott Gottlieb. Details.

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