THE PROGNOSIS

Let’s put it this way: There will be dead bodies one way or another, regardless of which way the Senate swings on its health-care bill.

After the current bill suffered a spectacular meltdown yesterday, there's a widespread expectation that Senate Majority Leader Mitch McConnell (R-Ky.) will ultimately bring some version of his health-care bill to the floor sometime in the 13 legislative days before August recess -- even if he knows it will fail. 

It’s not enough for McConnell to tell the GOP base it couldn’t get done, not after seven years of promising otherwise. He’s got to show them with dead bodies on the floor -- a morbid, insider way of describing a measure that can’t get enough votes to pass.

“It’s now or never,” Rodney Whitlock, a former longtime health staffer for Sen. Charles E. Grassley (R-Iowa), told The Health 202.

The Senate GOP quest to pass a measure replacing big parts of the Affordable Care Act and enacting steep Medicaid spending cuts came to a halt yesterday as senators kept jumping ship, forcing McConnell to suspend his plans for a vote this week and virtually guaranteeing health-care will remain front-and-center on Capitol Hill throughout July.

There were glimmers of harmony after the Republicans huddled at the White House yesterday afternoon with President Trump, but it was clear the legislation would still need changes to secure enough votes and that a vote this week is still unlikely.

“The president got an opportunity to learn all the various positions on things that we’ve been discussing,” McConnell said after the gathering. “We all agreed that, because the markets are imploding, we need to reach an agreement among ourselves here as soon as possible and then move to the floor after the recess.”

If Republicans do pass their health-care bill, it could cause 22 million fewer Americans to have health coverage a decade from now. Some of those people will voluntarily choose to forgo insurance. But others facing serious illnesses will find plans less affordable than under the ACA, fueling dramatic charges by Democrats that more people will die under the GOP approach.

A tweet by Sen. Bernie Sanders (I-Vt.):

From Senate Finance Committee ranking member Ron Wyden (D-Ore.):

Rep. Jackie Speier (D-Calif.) said the GOP bill "will guarantee that people will die" 

Hillary Clinton called Republicans "the death party" if they pass their health-care measure:

Democrats are clearly blowing up the “death” line to score political points. The available evidence suggests there will be a human toll from an increase in the number of uninsured – but that number is hard to pin down, my colleague Philip Bump writes.

“One key reason is obvious: There are serious ethical questions about running an experiment in which people are denied insurance in an effort to determine how much more quickly they might die,” Philip writes. “We’re left with a number of studies that try to approximate the answer to the question by using inadvertent experiments along those lines.”

The studies we do have suggest that health insurance does save some lives; the Annals of Internal Medicine published a meta-analysis this month concluding that the odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

Regardless, the steep coverage declines projected for the Senate GOP bill are such bad optics for the party’s moderates that McConnell may ultimately fail to bring them on board. The month of July will be a defining time for Republicans as it becomes clear whether they’ll be able to fulfill their long-standing promise of repealing much of the ACA. If the Senate passes a bill, it would then be the House's turn to approve it or reconcile it with their own version passed in May. Only at that point could it get a signature from President Trump and become law.

Health 202 would do anything to be a fly on the wall in McConnell’s office. The majority leader appears determined to hold a health-care vote but he’s given little indication of the path he sees forward for a bill filled with unpopular Medicaid cuts and less-generous insurance subsidies. Yet he's widely-regarded as one of D.C.'s most able political operatives and he may have some tricks left in his back pocket, observers say.

“He’s a political person and he’ll figure out whatever moves cause the least political damage,” Tom Miller, a health care policy fellow at the conservative American Enterprise Institute, told me.

As senators are back in their home states over the July 4th recess, negotiations will be going on in the background. There’s a strong possibility that McConnell will try to ease some of the bill’s Medicaid cuts, perhaps forgoing its slower Medicaid growth rate in 2026 or even pulling back more slowly on extra federal funding for expanded Medicaid programs. Any moves of that nature would be aimed at Sens. Dean Heller (Nev.) and Susan Collins (Maine) who are opposing the bill in its current form.

McConnell could also add in more funding to combat opioid addiction to attract Sens. Rob Portman (Ohio) and Shelley Moore Capito (W.Va)., who declared they were opposing the bill only after the vote was delayed yesterday. Portman and Capito had asked for $45 billion in funding but got only $2 billion in the measure.

It’s less clear how McConnell could tweak existing policy to get Sens. Rand Paul (Ky.), Ted Cruz (Tex.), and Mike Lee (Utah) and other conservatives on board. They want more of Obamacare repealed, but that could be hard under budget reconciliation rules governing the whole process.

But this much is clear: To get to 50 votes over the next few weeks, Senate Republican leaders will have to have heart-to-hearts with a dozen or so deeply skeptical senators, winning them over one by one.

“He has to do it on a retail basis,” said Julius Hobson, a former lobbyist for the American Medical Association. “It’s senator by senator, and that’s tough.”

AHH, OOF and OUCH

AHH: Replacing Obamacare used to be the GOP's great unifier. Now it has become their albatross, the Post's Dan Balz writes

"In a worst-of-all-worlds environment, Republicans continue to struggle with what they’re selling, beyond the stated goal of repealing or revising the Affordable Care Act," Dan writes. "Whatever overarching arguments they hope to make on behalf of their legislation have been lost in a welter of competing claims and demands among senators with different priorities and dissimilar ideological viewpoints."

"The Republicans’ major selling point is that Obamacare is collapsing," he continues. "Even Democrats acknowledge weaknesses with the current law, though some Democrats have accused Trump and Republicans of deliberately trying to make those problems worse. McConnell said Tuesday that a Republican solution will be superior to the status quo. Exactly how, Senate Republicans haven’t been able to say. But in terms of corralling the votes, McConnell should not be underestimated."

OOF: Maybe don't attack your own if you're trying to build support for a health-care bill. Heller, one of the moderates skeptical of the Senate bill who is facing a tough reelection next year, reportedly complained to Trump yesterday about attack ads coming from America First Policies, a nonprofit run by a former White House aide and Trump campaign veterans. The group targeted Heller over the weekend with a TV and radio ad campaign for denouncing the Senate plan as written, pressuring him to vote for it and even roping him to House Minority Leader Nancy Pelosi (D-Calif.)

"McConnell told White House Chief of Staff Reince Priebus over the weekend that the group’s attacks were 'beyond stupid,' according to a Republican with knowledge of the exchange," the AP reports. "McConnell allies argued that the approach alienated Heller and other Republicans rather than making it easier to get their votes."

Shortly after Heller himself complained about the ads in the White House meeting yesterday, America First Policies said it decided to take down its Heller ads because “he has decided to come back to the table to negotiate with his colleagues on the Senate bill,” spokeswoman Erin Montgomery said.

But America First Policies didn't apologize for its aggressive strategy. And one of its leaders, former Trump campaign spokesman Katrina Pierson, tweeted that it's not the group's task to preserve GOP seats in Congress:

OUCH: Members of Congress are skilled at giving answers that really aren't answers at all, as my colleague Sean Sullivan noted yesterday. His conversation with Sen. Patrick J. Toomey (R-Pa.) on whether delaying the health-care vote until July is good or bad:

TRUMP TEMPERATURE

--Trump attempted a heart-to-heart with the entire Senate Republican Conference at the White House yesterday afternoon, where senators got a chance to air their grievances about the health-care bill and the whole closed-door process of writing it, Sean Sullivan, Juliet Eilperin and Kelsey Snell report.

The president sat between two of the bill's holdouts — Sens. Lisa Murkowski (Alaska) and Susan Collins (Maine) — and said Republicans are “getting very close” to securing the votes they need even as he acknowledged that they might fail. He told the room we have “no choice but to solve this situation” because Obamacare is a “total disaster.”

“This will be great if we get it done,” Trump said. “And if we don’t get it done, it’s just going to be something that we’re not going to like — and that’s okay. I understand that very well.”

Collins described the meeting as productive, and said Trump was “really in listening mode.” “He was taking in all of the comments. There were many senators who raised issues, and, as you can imagine, the issues really run the ideological gamut," she added.

McConnell also emerged from the meeting praising Trump's interventions, according to my colleague Ed O'Keefe:

A telling photo of Collins and Heller (the two moderates who have said they won't vote for the health-care bill unless it's changed). From former Hillary Clinton press secretary Tim Hogan:

Another visual of the meeting tweeted by the New York Times' Doug Mills: 

Nevada Independent editor Jon Ralston poked fun:

--But does Trump have enough clout with congressional Republicans? Maybe not. "Republican fixtures in Washington are beginning to conclude that Trump may be neither, despite his mix of bravado, threats and efforts to schmooze with GOP lawmakers," the Post's Philip Rucker, Ashley Parker and Robert Costa write.

Case in point: Trump got on the phone Monday with conservative Sen. Mike Lee (R-Utah) and urged him to back the measure, but a day later Lee said he would vote against the bill.

"Trump had hoped for a swift and easy win on health care this week. Instead he got a delay and a return to the negotiating table — the latest reminder of the limits of his power to shape outcomes at the opposite end of Pennsylvania Avenue," Ashley, Robert and Philip report. "History suggests that presidents who have governed successfully have been both revered and feared...The president is the leader of his party, yet Trump has struggled to get Republican lawmakers moving in lockstep on health care and other major issues, leaving no signature legislation in his first five months in office. The confirmation of Supreme Court Justice Neil M. Gorsuch is his most-cited achievement to date."

A Post video about the White House meeting:

--Unlike most congressional leaders, McConnell has managed so far to escape Trump’s wrath, my colleagues Robert Costa and Sean Sullivan report. “He’s never, as far as I can tell, gotten angry at me — in my presence, anyway,” McConnell said of the president last month.

"That fragile peace between a taciturn insider and a brash newcomer has helped both men pursue Republican priorities, but it faces an uncertain future this week as a major rewrite of the nation’s health-care laws falters in the Senate. McConnell and Trump are both hungry for a win," Robert and Sean write. "Their understanding, built to score legislative victories, does neither of them any good if victories remain out of reach."

"On its surface, the health-care effort is about fulfilling a GOP pledge," they continue. "But Republicans said it is also a test of whether McConnell and Trump can stitch together winning coalitions on any big-ticket item this year — and reassure business leaders and activists eager for action."

REPRODUCTIVE WARS

--Hundreds of activists protesting the Senate health-care bill hooted and cheered from their stakeout in the "Senate swamp" as the news broke yesterday that the Senate was delaying a vote on its health-care bill. "Hundreds of activists from Planned Parenthood, AFSCME, and smaller progressive groups were hooting and cheering their latest mini-victory," the Post's Dave Weigel reports.

"For some Democrats, it was the fifth or six protest of the Better Care Reconciliation Act in 24 hours," Dave writes. "Some of the protesters had done even more, with the progressive group Ultraviolet tailing Republican senators as they left their offices, the most aggressive of dozens of tactics to slow down or stop BCRA. More had been cycling in and out of Capitol office rooms for news conferences, where Democrats sat back and let Medicaid beneficiaries take over the microphone."

--Among the protesters were dozens of women dressed in “The Handmaid’s Tale”-like costumes to protest the bill's restriction on Medicaid dollars for Planned Parenthood clinics. “It would be the worst bill for women in generations and decimate women’s healthcare,” said Planned Parenthood spokeswoman Fern Whyland, according to the Hill. “It’s a healthcare bill with no healthcare.” 

From The Hill's Taylor Lorenz:

MALPRACTICE

--A meme about how McConnell received his polio treatment as a child has been shared hundreds of thousands of times on the Internet by activists opposing the Obamacare overhaul he's shepherding through the Senate.

“As a kid, Mitch McConnell had polio, and the government paid for ALL of his care and rehabilitation,” says a text below an apparent picture of a young McConnell, adding that McConnell wants to take away the government-funded care that once helped him. The meme was originally posted to Facebook by the group Occupy Democrats.

The problem is, that story is false, the Post's Kristine Phillips reports.

The facts: After McConnell was struck with polio at the age of 2 in 1944, he received treatment at the polio treatment center that President Franklin D. Roosevelt founded in Warm Springs, Ga. The funds for the treatment center were raised by the National Foundation for Infantile Paralysis, a nonprofit that collected private donations -- not government funding.

"Shortly after the foundation was created in 1937, comedian Eddie Cantor spearheaded a fundraising campaign that he called March of Dimes," Kristine writes. "Its goal was simple: Use radio and the president's Birthday Ball to encourage people to donate at least one dime to the cause of fighting polio...The result was an 'avalanche of donations' in the form of 80,000 letters containing dimes and dollars that inundated the White House mail room, according to the March of Dimes website."

"It's likely that the stories by Occupy Democrats and others relied on a misunderstanding of what public money is and falsely concluded that dollars donated by members of the public to a private organization are the same as taxpayer dollars that fund government programs," Kristine continues. "McConnell's staff did not respond to a request for comment. Colin Taylor, who wrote the Occupy Democrat story, also did not respond."

INDUSTRY RX
The Food and Drug Administration said it’s taking steps to boost the number of generic prescription drugs on the market in an effort to make medicines more affordable and to prevent price gouging.
Associated Press
Officials credit drugs and prevention programs, including condom giveaways and needle exchange, for 73 percent drop in new cases since 2007.
Rachel Chason
A mother says her son is the poster child for Obamacare, and she's using his story as a message to Republicans attempting to change the health-care law.
Cleve R. Wootson Jr.
SECOND OPINION
States do not have some magic way to cover millions of Americans with far less federal support.
Drew Altman
It’s past time to ensure Medicaid works for those it was designed to serve.
Seema Verma
MEDICAL MISSIVES
The earnest statement from the White House was technically accurate, apolitical and struck just the right notes.
Ariana Eunjung Cha
STATE SCAN
Jobs in health care and nursing homes are growing far more rapidly than in other areas
Danielle Paquette
DAYBOOK

Today

  • The Bipartisan Policy Center will hold an event  on cybersecurity and medical devices.
  • The Cato Institute will hold a briefing  on Capitol Hill on how the federal government should address the opioid crisis.

Coming Up

  • The Bipartisan Policy Center will hold an event on Thursday on balancing Medicaid cost and coverage.
  • American Enterprise Institute will hold an event on Thursday on the government’s role in medical innovation.
SUGAR RUSH

Here's what happened after Senate leaders postponed the health-care vote:

Senate Minority Leader Charles E. Schumer (D-N.Y.) on health care: 'We're going to fight the bill tooth and nail'

Sen. Ted Cruz (R-Tex.) on health-care bill: ‘We still got a way to go’:

Sen. Jeanne Shaheen (D-N.H.) said she wants Republican and Democratic senators to “work together” to “improve on the Affordable Care Act.”: 

House Speaker Paul D. Ryan (R-Wis.) weighs in on the health-care bill: 

White House deputy press secretary Sarah Huckabee Sanders says Trump remains 'optimistic' on health care and criticizes CBO report:

A mother’s response to the health-care debate: Her 3-year-old son’s $231,000 hospital bill:

And Stephen Colbert says "'Repeal And Replace' Is Being 'Delayed And Postponed'":