THE PROGNOSIS

Senate Republicans want to start Act Two in the Obamacare overhaul saga, but they’re in danger of getting upstaged by the unfolding White House drama.

The latest twist had the Justice Department naming last night former FBI Director Robert Mueller as a special counsel to investigate Russia's meddling in the 2016 elections and alleged links between Trump aides and the Kremlin. That news came one day after a bombshell report that President Trump asked ousted FBI Director James B. Comey to call off his investigation of former national security adviser Michel Flynn.

Oh, and then there was the Post's scoop last night from Adam Entous in which House Majority Leader Kevin McCarthy (R-Calif.) said in June 2016 that Trump could be the beneficiary of payments from Vladimir Putin. House Speaker Paul D. Ryan (R-Wis.) swore those in attendance to secrecy, according to a taped conversation heard by the Post (a House GOP leadership aide, after initially denying the reports, said the whole exchange was "clearly an attempt at humor.").

But what concerns us here at The Health 202 is how all of this affects health care. Does it make Senate negotiations easier or harder? On one hand, nothing else can gain any oxygen with the happenings on the other end of Pennsylvania Avenue. But on the other, a little less of the spotlight could help intransigent lawmakers come to terms on the thorniest legislative issue before them.

Senate Republicans are driving hard toward coming up with their own proposal to replace much of the Affordable Care Act. The Senate Finance Committee is currently drafting several different versions of a health-care bill, with the goal of having a menu for moderate and conservative senators to chew over and decide where they might be able to compromise.

Republicans met Tuesday and Wednesday – and are meeting again today – to specifically discuss insurance premiums and how to stabilize the individual market in 2018 and during a transition away from Obamacare.

And Majority Leader Mitch McConnell (R-Ky.) has opened up the original 13-member working group to include any senator who wants to attend its meetings – since he’ll have to bring all but two Republicans on board anyway to pass anything.

"Health-care discussions are open to the entire caucus — everyone has an opportunity to be at the table as members work to get a consensus to rescue Americans from a health care law that is currently in collapse," a Senate Republican aide told The Health 202.

McConnell is pretty darn determined to ultimately hold a vote on a health-care bill, members, aides and lobbyists have told me. Dissension among the Republican ranks would have to be virtually insurmountable to deter the majority leader from his quest to bring legislation to the floor, allowing Republicans to say they’ve fulfilled their Obamacare repeal promises.

—But as Republicans try to accelerate toward some kind of credible measure, the Trump controversies are getting in the way. On Wednesday, members insisted they can keep moving forward on health care and other policy goals. But many admit White House blunders are dampening the entire effort, especially as lawmakers fear what new, troubling news report could be coming next.

“I think policy initiatives are sort of parked right now until we get the Comey thing dealt with,” said Lindsey Graham (R-S.C.).

Sen. Susan Collins (R-Maine) said the Senate is “certainly able to handle more than one issue at a time” but acknowledged news surfacing in rapid succession about Trump makes things harder.

“We’ve been discussing health care in lunches and private meetings and so that work continues, but obviously as there’s new revelations every day coming in the press concerning the White House it makes it more difficult for us to pursue an agenda here,” she said.

—Trump did contribute in a very general way to the health-care bill the House passed last month. He put major pressure on Ryan to get it done after an initial legislative meltdown in March, and dispatched Vice President  Pence to the Hill on multiple occasions to sweet talk conservatives in the Freedom Caucus.

But the president doesn’t have a great track record on legislation overall, and particularly health care. He was mostly ineffective as the House struggled toward consensus, and even aggravated tensions with some ill-timed and misinformed tweets. So it was already highly questionable whether the president would have been helpful at all in bringing senators together on tricky questions of how quickly to phase out Medicaid expansion (or whether to do so at all), how to structure insurance subsidies and how much of the ACA’s insurance regulations to try to repeal.

Now Republicans are downplaying any role the White House might play in a Senate health-care bill, as they get increasingly annoyed at the administration and its seeming inability to get its act together.

“We’re working on it as a Senate, not working with the president,” said Sen. John McCain (R-Ariz.).

Other Republicans worry the high drama is distracting Americans from the efforts to replace Obamacare, especially at a time when marketplace insurers are again seeking big rate hikes for next year. Sen. Mike Rounds (R-S.D.) said senators are focusing on health care in “nearly every meeting” lately, but fears that’s getting lost on the public.

“That really gets waylaid by the day-to-day issue of the hour,” Rounds said.

AHH, OOF and OUCH

AHH: Here's an enlightening tweet about being a reporter these days:

OOF: The more extensive budget proposal the Trump administration is expected to release next week may propose a 10 percent cap in the overhead budget for the National Institutes of Health, The Atlantic reports. That would mean grantees get less money to support administration, equipment, libraries, IT, lighting, heating and electricity. 

The White House denies a final decision has been made, but the proposal wouldn't be a huge surprise since Health and Human Services Secretary Tom Price has argued that such "indirect costs" represent inefficiencies. He's got a point -- overhead spending has long been controversial -- but defenders of NIH funding argue that the agency's grants are already too small to cover all the costs of running a research lab.

OUCH: Republicans may not go for NIH cuts. In a House Appropriations subcommittee hearing yesterday, they pushed back against an 18 percent cut the Trump administration already proposed earlier this year in its "skinny budget," The Hill reports. Chairman Tom Cole (R-Okla.) said he was "disappointed" to see the recommendation because it could "stall progress" made by recent budget boosts under the Obama administration.

HEALTH ON THE HILL

--A top GOP influencer on health care -- Finance Committee Chairman Orrin G. Hatch -- told Morning Consult that he's open to delaying the repeal of the so-called individual mandate to buy insurance -- yes, that part of the Affordable Care Act that Republicans have lambasted for years. Hatch also didn't rule out keeping the mandate indefinitely, although he would prefer getting rid of it.

The House bill technically doesn't repeal the individual mandate, because that might run up against procedural rules in the Senate, but it does remove the mandate's teeth by erasing the penalty for lacking coverage. Despite Hatch's comments, other senators said there's no conference-wide talk of leaving the mandate in place in a Senate version.

--Here's what the most serious talks are centered on: Providing more generous insurance subsidies that are pegged to income more than age and phasing out Medicaid expansion more slowly than under the House bill, which would cut off extra federal payments in 2020. Lobbyists say there appears to be little appetite at the Senate Finance Committee, which is drafting sample legislation, for a bill that would cause the steep reductions in coverage estimated under the House version.

--Sen. Bob Corker told The Hill this: "What I want to ensure is that the subsidies or tax credits are enough so that lower-income, middle-income people have the ability to actually purchase health care. The way the subsidies were in the House bill, it really wasn’t enough to help people who were on the lower end of the economic spectrum to be able to actually purchase it."

INDUSTRY RX
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MALPRACTICE

--The House's Democratic Leader, Nancy Pelosi, made the following claim about the GOP health-care bill earlier this week when she was speaking at a conference hosted by the liberal Center for American Progress:

“Seven million veterans will lose their tax credit for their families in this bill."

 

 

--But is that true? One of our stellar fact-checkers, Michelle Ye Hee Lee, investigated. Here's what she found:

The facts: The original American Health Care Act (the GOP health bill) contained a provision protecting tax credits for veterans, regardless of whether or not they were enrolled in the Department of Veterans Affairs health-care system. The version of the bill that was passed in May omitted this provision, meaning some veterans may no longer have access to subsidized private insurance.

Where it's complicated: Since Obamacare subsidies aren't specifically for veterans, the Obama administration had issued a rule allowing them to either get VA coverage or enroll in the marketplaces where they could get the tax credits. To maintain that policy, the IRS would likely have to issue a new rule but could probably use the same language in effect now.

Sooo: The 7 million figure Pelosi cited isn't so certain. Republicans have stressed that they want current protections to remain and they're now taking steps to turn the current IRS protections into law. And even if current regulations don’t carry over, the universe of people affected by this change likely is not the full 7 million. There already are people within that 7 million population who don’t qualify for the tax credit because they have another form of insurance.

REPRODUCTIVE WARS
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SUGAR RUSH

Here's a mashup of late-night comedians on Trump's current dilemma:

And here's Donald Trump vs. The Rock: