THE PROGNOSIS

Lawmakers, both Democrats and Republicans, tend to head behind closed doors when they're trying to craft big -- and frequently controversial -- legislation. But Senate Republicans aren’t even grasping at the pretense of transparency as they attempt to craft a bill overhauling the Affordable Care Act.

Charges of secrecy have become a big health-care attack line around the ACA. Bitter about the final legislative maneuvers Democrats went through to pass the 2010 health-care law -- and how they were shut out of final negotiations -- Republicans for years grumbled about how it all went down, repeating out-of-context the line used by top Democrat Nancy Pelosi that “we have to pass the bill so you can find out what’s in it.”

Yet when it was their turn to rewrite health-care policy, the same could be said of them -- or worse. Charges of secrecy beset the House Republican negotiations one week before the attempt to vote on their measure to replace Obamacare. Opponents of that effort dramatized their efforts to "find" the measure -- which only GOP lawmakers were allowed to access in a basement room --  and silly social media stunts such as House Democratic Whip Steny H. Hoyer (Md.) posting his search on Facebook Live: 

 

 

Kentucky Sen. Rand Paul (R) also made a show of trying to unearth the measure:

But Paul would do well to chastise his own Senate colleagues, who have not done much better now that the American Health Care Act is in their hands.

Senate Republicans have spent weeks meeting privately to hash out their own bill partially replacing Obamacare, and there’s widespread talk of bypassing the committee hearing and markup process entirely.

What’s more, some senators don’t seem to care. The feeling seems to be that health care is already such a delicate issue for Republicans that opening it up to more input (including from Democrats) would lead them down a dark alleyway from which they’d never emerge. Many feel that hashing out an agreement without the glare of television cameras -- or even many of their own colleagues -- is their only pathway to success.

 

“We know there’s not going to be bipartisan support for this,” Sen. James Lankford (R-Okla.) told me recently. “There’s not a reason to do this through a committee hearing process.”

Lankford said he’s worried that holding hearings would be counterproductive because members would be focused only on making speeches that would be aired on C-Span instead of working seriously to reach an agreement.

“Let’s work through as much as we can -- that gives us the opportunity to be able to have real dialogue and not have to worry about everyone having to make speeches for the camera,” he said.

Lankford has a point. Anyone who watches Capitol Hill committee hearings knows that members of both parties use them chiefly to land political punches that will generate applause from the crowd back home. Even Sen. John McCain (R-Ariz.), who has called for including Democrats in health-care discussions, dismissed hearings as unnecessary.

“We all know the issues -- it’s what the remedies are,” McCain said. “Will we get enough agreement on the remedies?”

Even for legislation like the ACA, for which Democrats held dozens of hearings in the year leading up to its passage in March 2010, and hours of floor debate, agreements on final bills are typically forged privately among key lawmakers.

That’s partly because Congress looks to get buy-in from the industry to ensure it has help selling the legislation to the public (Democrats got support for the ACA from most in the medical industry whereas House Republicans didn’t for the AHCA.) It’s also so lawmakers can engage in a give-and-take where members might agree to retain certain provisions in exchange for keeping or jettisoning others.

The real negotiations around the ACA occurred in private, as President Obama dispatched White House officials to meet with small groups of top Democrats in the fall of 2009 to get a sense of what kind of legislation was realistic. In the Senate, Republicans were allowed to offer hundreds of amendments to versions of the bill marked up by two committees (Finance and Health, Education, Labor and Pensions), but they were mostly technical in nature.

What’s different this time around is that Senate Republican leader Mitch McConnell (Ky.) may not even hold hearings on the chamber's measure -- assuming his colleagues come to an agreement at all --  erasing any opportunity Democrats might have to try to influence it. McConnell is expected to roll out a measure only when he is absolutely certain there are the sufficient 50 GOP votes to pass it (the GOP can afford to lose two Republican votes if it relies on Vice President Pence as a tie-breaker).

Some Republicans, the moderates, have been willing to criticize the process. “I would prefer that there be more committee hearings,” Sen. Susan Collins (R-Maine) told me.

Sen. Lindsey O. Graham (R-S.C.) tweeted his concerns with the House health-care bill, which Republicans passed before even getting a final and complete estimation of its costs and effects from the Congressional Budget Office.

Political expediency doesn’t excuse this closed-door approach of which both parties have been guilty to some extent or another. But considering the near-miss passage of the House health-care bill, it’s at least easy to understand why McConnell and his team would pull away even harder from the public eye.

However the Senate GOP crafts its health-care bill, it will almost certainly cover fewer people than the ACA -- and senators have seen the public outrage their House colleagues endured as their own messy negotiations seemed to continue on forever. The process is a political lose-lose for them on many fronts.

“I know you’re going to consider this a facetious remark and it’s not,” Sen. Charles E. Grassley (R-Iowa) told me. “We’re not going to have the public-relations debacle the House of Representatives had…they delayed it and delayed it and delayed it and they got it passed a month later.

The Senate timeline is still very much in doubt, but things appear to be moving forward -- committee staff have been preparing legislative text for senators to consider when they return to Washington this week. Last week, No. 2 Senate Republican John Cornyn (Texas) told a radio show that the Senate will “absolutely” pass a bill by the end of July “at the latest.”

The key, according to Grassley, is allowing just enough time between the bill’s rollout and bringing it to the floor so that senators are protected from charges tthey passed it too quickly -- without giving their colleagues time to read and digest it.

“We’re going to bring this bill up when we get 51 votes,” Grassley said. “The only thing is [giving] enough time for people to study it so they can’t say we’re ramming it down there.”

Democrats will make the “ramming it down there” charge, regardless. They’re eager to dish out criticism to Republicans after enduring accusations of secrecy for so long.

“They’re rushing this bill, you know why?” Senate Democratic Leader Charles E. Schumer (N.Y.) said last month. “They know if the American people even had a couple of days to see what they’ve done -- the protests at the offices…the emails, the calls, the letters would be so overwhelming that Trumpcare 2 would meet the same fate that Trumpcare 1 has met.”

AHH, OOF and OUCH

AHH: A moderate Senate Republican, whose vote could prove crucial in passing an Obamacare overhaul, is embracing Medicaid expansion to some extent. Sen. Susan Collins of Maine told the New York Times that she wishes her state would expand the program using a more conservative approach, as Indiana did.

But Collins also outlined a big problem she sees with the ACA: That people suddenly lose subsidies in a so-called "wage cliff" if their income fluctuates a single dollar above the threshold. She's among a group of moderates who would prefer to enact fixes to the ACA instead of just eliminating it, potentially frustrating McConnell's quest to erase big parts of the law, Jennifer Steinhauer writes.

"Ms. Collins’s résumé (she once oversaw Maine’s insurance bureau), her relentless practicality and her state’s particular vulnerability within the health care debate — its population is old and largely poor, with a sizable part-time workforce — have placed her at the center of an issue that conservatives have tried to dominate in Congress," Steinhauer writes.

"There is no denying that the Affordable Care Act has made insurance available to millions of Americans and allowed people to leave corporate jobs and start businesses,” Collins told NYT. “We are disproportionately affected, which is one reason I’ve spent so much energy on this issue.”

Jesse Ferguson, former spokesman for Hillary Clinton's campaign and the Democratic Congressional Campaign Committee, seized on Collins's Medicaid statement to criticize a 13-member working group the majority leader originally convened to work on a health-care bill (the group has since been opened to anyone who wants to attend):

A tweet from the House Republican leadership illustrated the big divide within the party on how many people Medicaid should cover:

The health-care bill Republicans just passed would dramatically spike what older people would have to pay while rolling back the Medicaid program, University of Chicago professor Harold Pollack noted:

OOF: A pair of Republican senators voiced considerable skepticism last week about the prospect of passing a health-care bill, despite the assurances Senate leadership is giving that it will happen this summer. Sen. Richard Burr (R-N.C.) told a local station last week that it's “unlikely that we will get a health-care deal.” And earlier in the week, Sen. Jeff Flake (R-Ariz.) said he doubted a bill could pass before the August recess, my colleague Sean Sullivan reports.

"The show of doubt in their home states during the one-week Memorial Day recess came as other Republican senators sought to temper expectations among constituents about how aggressively the Senate can go after the Affordable Care Act, known commonly as Obamacare," Sean writes. "With senators returning to Washington next week to resume work on health care, there are growing concerns among Republicans that political and policy differences among GOP senators could prevent a bill from ever winning passage."

OUCH: The Trump administration, particularly Attorney General Jeff Sessions's Justice Department, steadily ratcheted up its tough-on-crime rhetoric last month and put in place some policies that give that rhetoric some real-world bite, the Post's Christopher Ingraham writes. Mandatory minimums are back, federal marijuana policy is being reviewed and leading law enforcement figures have been deploying some of the apocalyptic anti-drug rhetoric that characterized much of federal drug policy in the ’80s and ’90s, he writes.

 

 

STATE SCAN

--These days, Democrats have no hope of furthering their health-care goals on Capitol Hill. So they're seeking political redemption at the state level, where they're embracing an unlikely-seeming cause: An actual government takeover of health care, the New York Times reports. The party's liberal base, inspired by Sen. Bernie Sanders's (I-Vt.) advocacy last year of government-run health-care, is increasingly unsatisfied with the ACA and is demanding a more drastic change to the system. For example, the California Senate last Thursday approved a preliminary plan for enacting a single-payer system.

"At rallies and in town hall meetings, and in a collection of blue-state legislatures, liberal Democrats have pressed lawmakers, with growing impatience, to support the creation of a single-payer system, in which the state or federal government would supplant private health insurance with a program of public coverage," Alexander Burns and Jennifer Medina report.

"With Republicans in full control of the federal government, there is no prospect that Democrats can put in place a policy of government-guaranteed medicine on the national level in the near future," they write. "Yet as Democrats regroup from their 2016 defeat, leaders say the party has plainly shifted well to the left on the issue, setting the stage for a larger battle over the health care system in next year’s congressional elections and the 2020 presidential race."

INDUSTRY RX

Post reporter Laurie McGinley staked out the American Society for Clinical Oncology in Chicago over the weekend, where she interviewed a cancer doctor running for Congress.

"Jason Westin is an oncologist and lymphoma researcher at MD Anderson Cancer Center in Houston. But now he wants a seat in Congress — the one held by longtime Republican congressman John Abney Culberson," Laurie writes. "Westin, 40, says he was bitten by the politics bug when, before medical school, he worked as an intern for former Florida senator Bob Graham (D). And now, he argues, with health-care science under assault in the nation's capital, it's important for scientists and physicians like him to get involved. He's one of several Democratic physicians who have their eyes on Congress."

Laurie also wrote about some interesting new research presented at the conference:

--Many colon cancer patients can cut their chemotherapy regimen in half, improving their quality of life and reducing their chances of having debilitating side effects, according to a major international study released Sunday.

"The goal of the research, eagerly awaited by oncologists, was to determine whether a three-month course of chemo was as effective as six months of treatment in staving off a recurrence in people with Stage 3 colon cancer," Laurie writes. "The study found that the shorter treatment was almost as effective as the longer treatment; the results were so close that the three-month regimen is likely to become the new standard of care, especially for patients with lower-risk malignancies, researchers said. In addition, the shorter schedule resulted in fewer side effects, such as nerve damage."

--Chemotherapy patients with advanced cancer who use a simple online tool to report their side-effects in real time lived a median of five months longer than those who waited to mention problems during office visits, another new study found. Doctors often don't hear about the serious side effects of chemotherapy because patients are reluctant to complain or don't have enough time to talk about such problems during jam-packed office visits.

--Women who have had early-stage breast cancer and become pregnant do not have a greater chance of recurrence and death than those who do not get pregnant, according to results from the largest study to ever explore the issue. "The study is the first to focus specifically on the safety of pregnancy for women whose cancers are fueled by estrogen," Laurie writes. "Researchers said their conclusions should allay concerns among some doctors and patients that pregnancy, which results in a surge in estrogen levels, could put these women at risk by encouraging the growth of any cancer cells that might remain in the body after treatment."

HEALTH ON THE HILL
Issues over Medicaid and the flight of health-insurance companies show the stakes for Iowa and other states—and their senators—as the GOP works on an overhaul of health care.
Wall Street Journal
Reed was met with a very critical crowd on Saturday, where constituents criticized him for voting for the GOP health-care bill. “You made your decision in spite of your constituents. And not based upon what your constituents need," one attendee said.
WHEC
After driving past health care debates, the typically powerful lobby is playing a smaller role this time.
Politico
DAYBOOK
 

 

Today

  • Lawmakers return to Washington after a week-long Memorial-Day recess. The Senate will reconvene Monday at 3 p.m.
  • The annual meeting for the American Society of Clinical Oncology continues today in Chicago. The conference continues through Tuesday.

Coming up

  • The House will reconvene Tuesday at noon.
  • Investment banking firm Jeffries will host its Global Health Care Conference in New York City starting on Tuesday. The conference will run from June 6-9.
  • Facebook will host an invitation-only health summit in New York on Tuesday for pharmaceutical marketers, CNBC reported, as it attempts to garner ad interest from pharmaceutical companies.
  • The Bipartisan Policy Center will host a discussion on obesity care. The event begins at 10 a.m. on Wednesday.
  • American Enterprise Institute will host a panel discussion on opioids, community, and the economy. The discussion will begin at 10:30 a.m. on Wednesday.
  • The House Ways and Means Health Subcommittee will hold a hearing Wednesday on Health Medicare Advantage on “Promoting Integrated and Coordinated Care for Medicare Beneficiaries.”
  • The Atlantic will host a discussion on Wednesday at the Newseum in Washington, D.C. on biosimilars and “the policy and regulatory debates surrounding these complex large-molecule drugs.” The event begins at 8 a.m.
  • Health and Human Services Secretary Tom Price will testify Thursday before the Senate Finance committee and the House Ways and Means committee to testify on the administration’s budget for the 2018 fiscal year. The department’s budget as proposed includes more than $600 billion in cuts from Medicaid over the next decade, on top of more than $800 billion proposed in the AHCA. Dems are likely to grill Price about these numbers during Thursday’s hearings.
SUGAR RUSH

See Ariana Grande sing "Somewhere Over the Rainbow" to close out her concert for the victims in Manchester, United Kingdom (and London):

See other pop stars perform there:

Go behind the scenes of Conan's workout with Gal Gadot, who trains him to be Wonder Woman: