A lower-profile fight involving the House health-care bill and whether it can go over to the Senate is not exactly Comey vs. Trump on charges of Russian election interference. But it is critical to how -- and whether -- the Affordable Care Act gets a makeover anytime soon. It also shows just how ridiculously hard it is to replace big parts of the health-care law even with one-party Republican control of Washington.
The skirmish pits Democrats against Republicans -- of course -- and involves private emails to Hill staffers that each side interprets as favorable to its cause. It centers on $2 billion in savings required in the House-passed health-care bill known as the American Health Care Act (which the Senate wants to use as a vehicle for its own measure) and who ultimately decides that its savings are sufficient.
Under complex budget rules known as "reconciliation," the AHCA must save $1 billion in each of the committees with jurisdiction over health care: Senate Finance, and the Health, Education, Labor and Pensions committees. The Congressional Budget Office has already said the House bill saves more than enough money in total. But Democrats, trying to throw as many obstacles in the way as possible, are arguing that HELP didn't achieve its minimum level of savings and that therefore the GOP health-care bill can't be taken up in the Senate.
Who decides? That's the crux of the problem: Republicans say the call should be made by the Senate Budget Committee chairman -- in this case, Sen. Mike Enzi (R-Wyo.). They say the bill has the green light because Enzi has determined it saves the required money. Democrats say the decision is up to the Senate parliamentarian.
Much is at stake: a verdict that the House bill complies with budget rules allows Senate Majority Leader Mitch McConnell (R-Ky.) to seek approval of the package by a simple-majority vote instead of the usual 60 votes required to avert a filibuster. A call that it doesn't comply with budget rules means the House might have to re-vote on its measure, which would not be easy given the drama the first time around.
That may be why there's been such a tussle over who is the Decider. Both sides dug in yesterday to their respective positions. An Enzi spokesman said the chairman "has reviewed the House-passed legislation and found that it satisfies the instructions for both the HELP Committee and the Finance Committee." Enzi's counterpart on the other side of the aisle, Sen. Bernie Sanders (I-Vt.), said that assertion is "extremely concerning" and demanded a verdict from the parliamentarian.
"I look forward to hearing from the parliamentarian as soon as possible on the broader ruling on whether the Trump-Ryan health care bill is in compliance with the instructions contained in the budget resolution," Sanders said in a statement.
This whole dispute started Tuesday night, when Republicans first announced the AHCA complies with reconciliation rules -- but Democrats balked that the announcement was premature. The Health 202 pieced together what seems to have occurred, according to emails we obtained.
5:15 p.m.: Senate Parliamentarian Elizabeth MacDonough emails Democratic and Republicans staffers for leadership and the relevant committees. She writes that a particular provision in the House bill dealing with cost-sharing subsidies for Native Americans isn't fatal to the House bill.
5:33 p.m.: Republicans on the Senate Budget Committee fire off a press release that says the House health-care bill “complies with the budget reconciliation process.”
6:43 p.m.: MacDonough sends a follow-up email, where she clarifies she was giving the green light to only one part of the bill -- not all of it. “I was overbroad in my email but the conclusion that there is not a jurisdictional violation with respect to the instructed committees holds,” she writes.
7 p.m.: Democrats on the Senate Budget Committee send out a press release saying “it remains to be seen whether the House-passed bill qualifies for reconciliation in the Senate.” Democrats say that Republicans still must prove it meets the savings targets.
The situation led to mass confusion, as Democrats and Republicans appeared to be contradicting each other on whether the AHCA could be sent over from the House to the Senate.
Confusion as Repubs say House bill declared reconciliation worthy by Senate parliamentarian and Dems say only one narrow aspect so far has.— Billy House (@HouseInSession) June 6, 2017
Democrats are not actually seeking to challenge whether the overall savings targets in the House bill are met -- the Congressional Budget Office has already said they are – but whether the HELP Committee itself saves the required $1 billion. They’re making the case that some spending additions to the House bill for high-risk pools fall under the HELP committee’s jurisdiction and would therefore erase the savings the bill would otherwise achieve.
Bill Hoagland, former Senate Budget Committee director for Republicans and now senior vice president of the Bipartisan Policy Center, believes the bill meets reconciliation rules in this area. The House measure specifically directs the Department of Health and Human Services to implement the high-risk pools, which would put the provision within Finance’s jurisdiction. And Republican aides pointed to the Congressional Budget Act, which indicates that the leader of the Budget Committee ultimately gets to make that call.
Meanwhile, McConnell took his own procedural steps forward yesterday, beginning a process under what is known as Rule 14 to allow a health-care bill to be put directly on the Senate calendar so a vote can be held when a final bill is ready.
It begins: McConnell initiates the "Rule 14" process of putting the House-passed AHCA on the Senate calendar for fast-track consideration.— Sahil Kapur (@sahilkapur) June 7, 2017
Are you dizzy yet? We are. So, go ahead and turn on the Comey hearings or head to Shaw's Tavern for the "Comey hearing covfefe." It might make a little more sense.
|You are reading The Health 202, our must-read newsletter on health policy.|
|Not a regular subscriber?|
AHH: From an airport tarmac in Cincinnati on Wednesday, President Trump disparaged and undercut the health-care law his administration must officially must carry out, the Post's Juliet Eilperin and Abby Phillip report. "Standing in front of Air Force One along with two small-business owners, President Trump recounted how they 'have had their lives completely upended by the disaster known as Obamacare,'" my colleagues write.
“The coverage is horrendous,” Trump said, noting insurers’ recent decisions to pull out of federal marketplaces in Ohio, Kentucky and elsewhere. “Obamacare is in a total death spiral. The problems will only get worse if Congress fails to act.”
OOF: A new set of documents released Wednesday show that six former lobbyists have been tapped by the Trump administration to serve at HHS, Juliet and Matea Gold report. One of them -- HHS chief of staff Lance Leggitt -- received an ethics waiver addressing his previous lobbying work. An executive order from Trump allows former lobbyists to enter the administration but prohibits them for two years from working on a specific issue that they lobbied on during the previous two years (under Obama, former lobbyists had to wait two years before even entering the agency they'd lobbied).
"Leggitt is among a half dozen officials across the federal government who have been granted special waivers to disregard ethics rules," Juliet and Matea write. "He previously headed the federal health policy group for the law firm Baker Donelson, where he lobbied for hospitals and other medical clients...Leggitt’s waiver allows him to work on issues on which he lobbied, though he still is barred from participating in matters involving former clients."
Seema Verma, a former Medicaid consultant to states who now heads the Centers for Medicare and Medicaid Services, also got an ethics waiver allowing her to weigh in on decisions affecting her former state clients.
"In an ethics waiver dated March 20, Health and Human Services Secretary Tom Price determined that Verma should be allowed to weigh in on decisions affecting her former state clients, saying that excluding her expertise 'would unduly disadvantage the citizens of your former state clients,'" the Post story says. "However, the waiver does not apply to specific matters that she personally worked on for Kentucky, Indiana and Iowa. Verma has recused herself from those issues."
OUCH: Speaking of Trump, his proposed cuts to Medicaid would most affect the small town and rural Americans often credited with his 2016 election victory, the Post's Jose DelReal reports.
"The Affordable Care Act's Medicaid expansion disproportionately benefited rural Americans over their urban counterparts, according to a new report," Jose writes. The ACA "led to an 11 percent decrease in the number of uninsured rural Americans in states that chose to participate in Medicaid expansion, a linchpin of the law...That improvement was higher than in urban areas, which saw the uninsured rates drop by 9 percentage points. In states that did not participate in the Medicaid expansion, the decrease in uninsured rates in rural areas and small towns was smaller, at 6 percent."
--This week brought a fresh surge of optimism from Senate Republicans that they'll be able to vote this summer on a bill overhauling the Affordable Care Act. The Health 202 is hearing that a legislative draft may be circulating among members next week. Budget Committee Chairman Mike Enzi (R-Wyo.), who is heading up the process, left open the possibility of releasing a draft by the end of this week, Politico reports.
--Here's a reality Senate Republicans are bumping up against: If they want their health-care bill to contain more federal assistance for people, rather than less, they have to pay for it somehow. They want a more generous version than the House bill, but they're struggling with how to pay for it -- so they're considering keeping some Obamacare taxes for a few more years.
"Repealing Obamacare’s taxes should have been a no-brainer for the GOP," Politico's Jen Haberkorn, Burgess Everett and Adam Cancryn write. "Republicans have railed against the litany of new levies since the Affordable Care Act was signed into law, blaming them for killing jobs and driving up prices. The law imposed new taxes on many health sectors, including medical device makers, insurance companies, high-cost health insurance plans and even tanning salons....But the party's orthodoxy on taxes is crashing against its accounting books: keeping the taxes around for even a few years raises money to pay for other parts of the bill."
"There are just two dials here,” Sen. Roy Blunt (R-Mo.) said. “You have to keep turning [them] until you get a majority who says, ‘I like that dial and that dial set right there.’ And that’s a big part of how this has to come together.”
--Other Republican senators emerged from yesterday's meeting with more details of discussions about phasing out Medicaid expansion more gradually and pegging Medicaid financing to a different growth formula. The Hill's Peter Sullivan tweeted that he heard from Sens. Rob Portman (R-Ohio) and John Cornyn (R-Tex.):
Portman says there is a proposal for a seven year Medicaid expansion phase out— Peter Sullivan (@PeterSullivan4) June 7, 2017
Cornyn says the Medicaid cap growth rate was marked "TBD" on yesterday's presentation— Peter Sullivan (@PeterSullivan4) June 7, 2017
--If only passing everything was this easy. House Majority Leader Kevin McCarthy (R-Calif.) said yesterday the House will vote on the Department of Veterans Affairs Accountability and Whistleblower Protection Act next week, after Trump tweeted this demand Tuesday evening:
Senate passed the VA Accountability Act. The House should get this bill to my desk ASAP! We can’t tolerate substandard care for our vets.— Donald J. Trump (@realDonaldTrump) June 7, 2017
The bill is aimed at making it easier for the VA to fire bad employees, lowering the evidentiary standards and streamlining the termination and appeals process, and creates an "Office of Accountability and Whistleblower Protection," my colleague Mike DeBonis reports. "For now, barring breakthroughs on bigger agenda items, Congress is left to play “small ball” on items like the VA bill that can garner at least some bipartisan support," Mike writes. "It passed the Senate on a voice vote Tuesday."
--We in the press spend a lot of time tracking Trump's every move and chasing (literally) members of Congress. But it's a lot harder to follow administrative appointees, who operate quietly within federal agencies but hold immense power to influence policy. The Atlantic's Emma Green has a fascinating profile of Roger Severino, the newly appointed head of the Office of Civil Rights (OCR) for the Department of Health and Human Services.
"Under Trump, HHS may see more changes than any other agency, in part because the president’s predecessor left his biggest mark here," Emma writes. "As Congress stalls on passing a new health-care bill, the Trump administration can still fight Obamacare with revised regulations, rejiggered budgets, and lackluster enforcement."
"...Severino leads the office that could shape the future of two of the most high-stakes aspects of the health-care debate: abortion and contraception access and LGBT rights," Emma writes. "OCR, as it’s known, is responsible for investigating civil-rights violations in health-care settings, including discrimination on the basis of race, sex, religion, and national origin....Severino has been an outspoken advocate against abortion and same-sex marriage. When he was appointed, liberal advocacy groups were in an uproar...Severino spent seven years in civil-rights enforcement at the Department of Justice; before that, he litigated religious-liberty cases. He has experience. He just doesn’t share the ideological convictions of many who work in his field."
--The Health 202 wishes Vice President Mike Pence a belated happy birthday -- he turned 58 yesterday. Planned Parenthood did too, by re-upping a humorous stunt they pulled last November when they encouraged supporters to make donations in Pence's name.
Here are some more reads on reproductive rights and health-care issues in the states:
- Health and Human Services Secretary Tom Price will testify before the Senate Finance Committee and the House Ways and Means Committee 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.
- The House Energy and Commerce subcommittee on Oversight and Investigations holds a hearing on the role of the Department of Health and Human Services in health-care cybersecurity.
- President Trump is reportedly hosting a fundraiser at his Trump National Golf Club in New Jersey for a Republican lawmaker who played a role in pushing the Republican health-care effort through in the House after a failed first bill. Trump will hold the event for Rep. Tom MacArthur on June 11 in Bedminster, N.J. The Associated Press reported donations are suggested between $5,400 and $100,000.
- The Hill is hosting an event on creating “a more value-driven health-care system” on June 13 with Sen. Bill Cassidy (R-La.) and Rep. Doris Matsui (D-Calif.)
- The Senate Health, Education, Labor and Pensions committee will hold a hearing June 13 at 10 a.m on the cost of prescription drugs.
During his address in Ohio, Trump charged that Democrats have "really been obstructionists" and warned "we won't get one Democrat vote" on the Republican health-care plan.
Are you planning to watch Comey's testimony? It appears all the late-night hosts will be. Here's Jimmy Kimmel on the former FBI Director's written testimony:
Stephen Colbert did two monologues about the Comey testimony last night, starting with the prepared statements:
And then Colbert poked fun at the attack ads running against Comey ahead of the hearing: