The Health 202: McConnell places all his chips on health care gambit

THE PROGNOSIS

Senate Majority Leader Mitch McConnell is heading down the Obamacare repeal-and-replace runway, but he's hardly cleared for takeoff. (Photo by Melina Mara/The Washington Post)

Senate Majority Leader Mitch McConnell is charging onward in his quest to pass a health-care bill reshaping Obamacare, announcing yesterday that a draft will be ready on Thursday for a potential vote next week. From his perspective, a vote can't happen fast enough.

Lobbyists and aides say the majority leader wants to move health care off his plate as quickly as possible. McConnell (R-Ky.) appears to believe the issue could be a political sinkhole, which could bury his chances of retaining the Senate majority next year. The House version is deeply unpopular, and there's little indication the Senate bill will be much more palatable to voters. McConnell feels strongly that Republicans must pass some kind of rollback after promising for seven years to do so, but he wants it done and out of the way — fast. And the majority leader is deeply aware there's a strong possibility the whole effort might lose steam if his members return to their home states for the Fourth of July recess without finishing their work on health care before then.

Staff is now putting the finishing touches on a draft bill as the GOP leadership tries behind closed doors to bring Republicans on board with it. Leaders have planned a big meeting Thursday morning to start whipping members, per Politico.

But Republicans are hardly out of the danger zone. It remains unclear exactly how McConnell will get about five to seven holdout senators to sign off on the forthcoming measure (Politico also has a useful list of senators most likely to oppose the bill and why). Some key members, including Finance Committee Chairman Orrin G. Hatch (R-Utah), don't appear at all certain they're nearing a resolution. "Didn't seem like it to me," Hatch told my colleagues Sean Sullivan, Juliet Eilperin and Kelsey Snell yesterday.

McConnell's can't-attack-what-you-can't-see approach of not holding committee hearings is deeply irking a growing chorus of members as even some Republicans join Democrats in criticizing the majority leader's methods. "The secretive effort has alarmed Senate Democrats and even some Republicans," Sean, Kelsey and Juliet write. "Some Republicans said they were confused about the bill taking shape, voicing frustration about the lack of transparency or warning against rushing."

Sen. John McCain (R-Ariz.) summed up perfectly the frustration Republicans are feeling, in a comment to Bloomberg's Laura Litvan.

"No, nor have I met any American that has," McCain said when asked if he'd seen the Senate health-care plan. "I'm sure the Russians have been able to hack in and have gotten most of it."

--Sen. Mike Lee (R-Utah), one of the conservatives whose vote is in doubt, posted a video to Facebook yesterday saying he was "frustrated" with the process thus far. Lee said he’s received numerous calls from constituents asking questions like when the health-care bill will be released to the public and why it isn't already public:

"The short answer to the question is: I haven’t seen it either," Lee says into the camera. “Even though I’ve been a member of this working group assigned to help narrow some of the focus of this, I haven’t seen the bill."

Lee was referring to an original group of 13 Republicans who started meeting to discuss an Obamacare overhaul. He expressed disappointment that the group was sidelined as leadership led the bill-writing process, and that they've not even seen text yet even though they're being pressured to vote next week on it.

"It's not being written by us — it's apparently being written by a small handful of staffers or members of the Republican leadership in the Senate," Lee said. "So if you're frustrated by the lack of transparency in this process, I share your frustration, I share it wholeheartedly."

“There’s no question that the American people need relief from Obamacare.... The big question is what we’re going to do about it and why we have to act so quickly that we necessarily have to be voting on it next week," he continued. "I’d be fine, don’t get me wrong, to be voting on something soon. But we should be able to see it first. We should have been able to see it weeks ago if we’re going to be voting on it next week.”

While Lee's support is still in question, Sen. Rand Paul (R-Ky.) will almost certainly be among the "no" votes; he trashed the measure yesterday, saying it might just be best to start over:

From Bloomberg's Sahil Kapur:

-- As for Democrats, they're pulling all sorts of publicity stunts to register their displeasure at both the process and the policy. Yesterday, Sens. Cory Booker (D-N.J.), Chris Murphy (D-Conn.) and Brian Schatz (D-Hawaii) livestreamed a visit to the Congressional Budget Office to search for the "super secret health-care bill." From Booker communications director Kristin Lynch:

“We’re actually going down to see if we can get the Republican health-care bill. Do you know anything about that?” Booker asked the cab driver at the start of his livestream.

Along their journey down the street, the senators chided the “secretive, behind-closed-doors” tactics used by Republicans in crafting the bill.

“All we’re asking ... we understand they have the majority and if they can get to 51 they’re going to be able to enact what they’re going to enact," Schatz said. "But they’re so afraid of the American people finding out what’s in this bill that they’re hiding it from everybody, including United States senators, until the very last moment."

"It’s not as if we haven’t begged our Republican colleagues to be part of the process. We wouldn’t be doing this if we hadn’t already been shut down in every way possible by the Republicans,” Murphy added.

Booker noted it would take just three Republicans to halt the whole process by refusing to back the bill.

The senators — and others — tweeted about their staged hunt for the health-care bill:

-- Upon arriving at the CBO, the senators weren't able to get a copy of the bill after asking the agency's director for it. So they took a selfie instead:

From the Hill's Rachel Roubein:

"We’re trying to point out the absurd today," Booker said after the CBO wouldn't share the bill with them. "This is absolutely offensive.... It's an a-historical, a-democratic affront to the American public by not allowing them to be involved or engaged in the process."

The Onion even made fun of the "missing" Senate health-care bill:

-- Come visit us at One Franklin Square from 9 a.m. to 11 a.m. this morning for Post Live's "Addiction in America" panel discussion. Policymakers, researchers and health-care experts will explore the roots of the opioid crisis, discuss solutions for combating addiction and describe what’s being done to address the abuse of opioids as recreational drugs. 

Speakers include Reps. Diana DeGette (D-Colo.) and Greg Walden (R-Ore.), Sen. Ed Markey (D-Mass.), PhRMA research VP Anne Pritchett, former congressman Patrick Kennedy (D-R.I.) and Brandeis University professor Andrew Kolodny. Full agenda here. And watch here if you can't make it in person.

One more thing: I was at the U2 concert along with many other D.C. folks last night. Look who showed up, onstage nonetheless:

Karen Handel waves to supporters during an election party in Atlanta, Ga., 20 June 2017. (EPA/BRANDEN CAMP

AHH: Republican Karen Handel defeated Democrat Jon Ossoff yesterday, after a months-long campaign and the most expensive House race in history. Staving off a major upset in Georgia’s ruby-red 6th congressional district, Handel won with about 52 percent of the vote, retaining a seat that has belonged to a Republican since 1979 and becoming the first Republican woman elected to Congress from Georgia.

In her victory speech, Handel told supporters “we need to finish the drill on health care." Chants of “Trump! Trump! Trump!” erupted before her, my colleagues Robert Costa, Paul Kane and Elise Viebeck report.

Handel's victory "may embolden Republicans in Washington to press ahead on an ambitious policy agenda that has yielded few legislative victories since Trump’s inauguration in January," they write. "Most immediately, the election result could bring momentum to Senate Republicans’ efforts this week to craft their version of a major revision to the Affordable Care Act." More about Handel's position on health care from STAT News and from my colleague James Hohmann over at The Daily 202.

Abortion opponents said Handel's victory is a mark against Planned Parenthood, which had vociferously opposed her. Handel was famously forced out of the Susan G. Komen Foundation back in 2012, after she had advised the breast cancer charity to cut ties with the women's health and abortion provider.

From Susan B. Anthony's Marjorie Dannenfelser:

Some Democrats mourned the loss but said it means they need to dig in deeper against the GOP health-care effort:

From former Obama spokesman Tommy Vietor:

President Trump speaks during an American Technology Council roundtable in the State Dinning Room at the White House on Monday. From left, Tim Cook, Chief Executive Officer of Apple, Trump, Satya Nadella, Chief Executive Officer of Microsoft, and Jeff Bezos, Chief Executive Officer of Amazon. (Photo by Jabin Botsford/The Washington Post)

OOF: President Trump told tech executives that the Senate health-care bill needs "more heart," a source tells CNBC. The president made the comment in a Monday meeting with Apple CEO Tim Cook and other industry executives, according to the report. If true, it would be the second time Trump privately criticized GOP legislation replacing big parts of Obamacare, after telling a group of senators last week that it's "mean."

That "mean" comment dismayed congressional Republicans, especially House members who had to be cajoled into supporting the bill at all. Democrats have leapt at the political opportunity it afforded them to tar the GOP over its health-care effort. Reporters asked Republican leaders yesterday to respond to Trump's latest "heart" comment:

From ABC's social media editor Evan McMurry:

ThinkProgress editor Judd Legum tweeted the response from White House Press Secretary Sean Spicer:

Spicer's full comment, from the Post's Aaron Blake:

Journalist Al Giordano poked fun:

So did the Sierra Club:

OxyContin pills, a strong opioid painkiller. (AP Photo/Toby Talbot)

OUCH: Hospitals are absolutely swamped with patients struggling with opioid abuse. New government data shows nearly 1.3 million emergency room visits or inpatient stays for opioid-related issues in 2014 — a 99 percent jump for ER visits and 64 percent jump for inpatient care compared to 2005, the Post's Joel Achenbach and Dan Keating report. The rate of opioid-related hospitalizations were highest in Maryland, followed by Massachusetts and D.C.

"The sharpest increase in hospitalization and emergency room treatment for opioids was among people ages 25 to 44.... The data also show that women are now as likely as men to be admitted to a hospital for inpatient treatment for opioid-related problems," Joel and Dan write. 

"The broad but uneven repercussions of the opioid epidemic emerge through the data," they write. "Texas, Nebraska and Iowa, for example, have remarkably low rates of hospital admissions. So do California and Florida. It's unclear if, when and to what extent the epidemic will surge into places relatively quiet so far, at least compared to hard-hit states in New England and Appalachia."

HEALTH ON THE HILL:

 Sen. Rob Portman (R-Ohio) testifies about the impact of heroin and prescription drug abuse and deaths in his state during a Senate JudicIary Committee hearing in January. (Photo by Chip Somodevilla/Getty Images)

The GOP rift over funding to address the opioid crisis could imperil getting to the 50 necessary votes on health care, The New York Times's Robert Pear and Jennifer Steinhauer report. GOP Sens. Rob Portman (Ohio) and Shelley Moore Capito (W.Va.) are lobbying for more funding and their votes seem like they'll be absolutely necessary for McConnell to get the bill over the finish line. Here's the calculus: "Republican senators from states that have been hit hard by the opioid drug crisis have tried to cushion the Medicaid blow with a separate funding stream of $45 billion over 10 years for substance abuse treatment and prevention costs, now covered by the expansion of Medicaid under the Affordable Care Act. But that, too, is running into opposition from conservatives. They have been tussling over the issue with moderate Republican senators like Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Susan Collins of Maine. Without some opioid funding, Mr. Portman cannot vote for the bill, he said, adding, “Any replacement is going to have to do something to address this opioid crisis that is gripping our country.”

The Associated Press does a good job of explaining how the health-care overhaul dovetails with the opioid crisis, in a bad way: "The central issue is that the House health care bill would phase out “Obamacare’s” expanded Medicaid, which allows states to provide federally backed insurance to low-income adults previously not eligible. Many people in that demographic are in their 20s and 30s and dealing with opioid addiction. Dollars from Washington have allowed states to boost their response to the crisis, paying for medication, counseling, therapy and other services."

The key and eye-popping graph that explains why some GOPers are so worried: "According to data compiled by The Associated Press, Medicaid expansion accounted for 61 percent of total Medicaid spending on substance abuse treatment in Kentucky, 47 percent in West Virginia, 56 percent in Michigan, 59 percent in Maryland, and 31 percent in Rhode Island. In Ohio, the expansion accounted for 43 percent of Medicaid spending in 2016 on behavioral health, a category that includes mental health and substance abuse."

Keith Hall. (Andrew Harrer/Bloomberg)

The NYT also has a good piece on Keith Hall, the director of the non-partisan Congressional Budget Office, who has been the target of GOP attacks on his estimates for how much the House health-care legislation will cost and how many people are estimated to lose insurance under it. From Alan Rappeport: "Staying out of the political fray while working in its epicenter can be daunting, and Mr. Hall inevitably gets thrust into a spotlight that he does not crave. 'We’re a nonpartisan place and we’re working in a partisan world and we get treated as if we’re partisan,' Mr. Hall, 60, said in an interview ...  'That’s unfortunate.'"

Draft Order on Drug Prices Proposes Easing Regulations

A draft of an executive order obtained by The Times appears to give the drug industry what it wants with no guarantee that consumer costs will fall.

https://www.nytimes.com/by/katie-thomas

Today is the deadline for insurers to declare whether they’ll sell plans on the Obamacare state marketplace in 2018 – and submit bids for the premiums they want to charge.

It’s an important date, because several dozen insurance counties are in danger of having no insurer at all next year unless more enter. Washington state announced earlier this week that an insurer is entering the market in one of its two endangered counties, but large portions of Iowa, Ohio and Missouri may lack marketplace options.

The Obama administration had originally proposed a May 3 deadline for insurers to submit bids, but the Trump administration pushed that back to June 21. The bids won’t be finalized until August or September, but they’re initial indicators of the premium hikes – or decreases – insurers are envisioning for next year.

Big insurers, however, entered the marketplace in Tennessee:

BCBST, Cigna on tap to sell Obamacare plans in 2018

BlueCross BlueShield of Tennessee, Cigna are lined up to sell individual insurance in Tennessee for 2018.

https://www.facebook.com/byhollyfletcher

SBA List seizing its moment

After eight years of essentially being locked out of the White House, Marjorie Dannenfelser, president of the Susan B. Anthony (SBA) List, has high hopes for the Trump administration — and the 2018 midterms.

The Hill

Today

• The Ninth Annual Congressional Women’s Softball Game is tonight.
• FleishmanHillard is holding an event on health care in the Trump era.
• The Biotechnology Innovation Organization’s International Convention continues through Thursday.

Coming Up

• The Senate Appropriations Subcommittee on Health and Human Services, Education and Related Agencies holds a hearing on the budget request for the National Institutes of Health on Thursday.

Senate Minority Leader Charles E. Schumer (D-N.Y.) accuses the GOP of "sabotaging the health-care system":

Democrats protest closed-door efforts to draft an Obamacare replacement:

McConnell says Americans will have "plenty of time" to look at health-care bill: 

Late-night hosts talked about the Georgia special election last night before polls were closed. Stephen Colbert said President Obama was dragged into the race via an attack ad: