Get this: I may soon be able to use the words “bipartisan” and “Obamacare” in the same sentence.

Republicans crashed and burned on their one-sided repeal-and-replace effort, but a pair of senators are cruising toward a limited agreement to stabilize the Affordable Care Act’s online insurance marketplaces. There’s a decent chance they could arrive at a deal this week, although actually getting it through the Senate and the more conservative House would still be a tall, tall order.

A rather vague possible framework circulated late last week by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) would fund extra Obamacare subsidies through the end of 2019 and somewhat expand the range of health plans that individual shoppers can buy, according to a draft seen by multiple lobbyists. Under the limited list of ideas — which staffers emphasize are not final and could very well change — insurers would be guaranteed two years of federal payments covering cost-sharing discounts they’re required to provide, something members of both parties acknowledge are important to keeping down monthly premiums for health plans that about 11 million Americans buy every year.

The draft contains a few nuggets Republicans demanded, allowing insurers to sell extremely lean “copper” plans covering just catastrophic medical needs (right now only those under 30 can buy such plans without a special exemption) and somewhat expanding the ability of states to structure their marketplaces in alternative ways.

But the framework stops far short of what the GOP would ideally like to pass, reflecting Democrats’ upper hand in these discussions. It would maintain the “essential health benefits” -- or services insurers are required to cover -- a mandate Democrats have insisted on retaining because it guarantees access to a basic set of covered services.

Staffers for both Alexander and Murray stressed that negotiations were ongoing, and that no details have been finalized. Yet they said the senators remain optimistic about the prospects for a bipartisan deal.

“Sen. Murray is very hopeful that final details can be ironed out quickly on a deal reflecting the substantial common ground identified in the health committee process,” spokeswoman Helen Hare said.

In the end, the Democrats really hold the reins of power here. If Congress can’t ultimately agree on funding these extra subsidies known as cost-sharing reductions and they eventually stop flowing to insurers, resulting in even higher marketplace premium hikes, the public is likely to blame Republicans because they control Congress and the presidency.

It’s nearly too late for Alexander and Murray to affect 2018 premiums. Enrollment for and a dozen or so marketplaces run by states themselves starts in just 28 days. Insurers have blamed about 20 percent of their premium hikes on uncertainty about whether the subsidy payments will continue.

At the heart of all this is the GOP's rift over whether to keep trying to repeal and replace Obamacare — or cut their political losses and move on to fixing the longtime political punching bag.

Alexander has been working hard to craft the type of bipartisan deal that his Republican colleagues in the Senate would accept. But it’s a lot less likely that House Republicans would stomach a bill they view as propping up President Obama’s health-care law. House Speaker Paul Ryan (R-Wis.) and the White House have reportedly poured cold water on the prospect.

Still, a bipartisan deal — no matter how far it gets in Congress — would represent the first time Democrats and Republicans have come together in the ACA’s seven-year-lifespan to significantly improve the marketplaces. 


THE LATEST ON THE LAS VEGAS SHOOTING: The toll is up to 59 people killed and more than 500 injured when a gunman opened fire from a perch at a high rise hotel down into a country music festival on the Las Vegas Strip late Sunday.

Police do not yet have a motive for what is the deadliest mass shooting in modern American history, report The Post’s Lynh Bui, Matt Zapotosky, Devlin Barrett and Mark Berman. Stephen Paddock, the 64-year-old shooter, had smuggled 23 guns inside his 32nd floor hotel room at the Mandalay Bay Resort and Casino. More firearms were found at his home.

Authorities say Paddock had no known previous run-ins with police and, despite a claim of responsibility from the Islamic state, no connection was found with terrorist groups. In the hours after the shooting, area blood donation centers were packed with lines stretching around blocks. Several vigils were held Monday night in Las Vegas, Reno, the Nellis Air Force Base and at the University of Nevada, Las Vegas campus in honor of the victims of the shooting. Here’s what we know about the lives lost in Las Vegas.  

--All sorts of questions remain about how Paddock, a man with no criminal background, history of mental illness or problems with drugs or alcohol, could have brought two dozen weapons into a hotel suite undetected and rained bullets down into the crowd.

"The attack, at least initially, was as inexplicable as it was horrifying. Law enforcement officials said they could not immediately tell what drove Stephen Paddock to fire at thousands of unsuspecting concertgoers from the 32nd floor of the Mandalay Bay Resort and Casino before killing himself," The Post's Lynh Bui, Matt Zapotosky, Devlin Barrett and Mark Berman report from Las Vegas ... 

'I can’t get into the mind of a psychopath,' said Joseph Lombardo, the sheriff of the Las Vegas Metropolitan Police Department, which is leading the investigation.

--"If you told me an asteroid fell into Earth, it would mean the same to me. There’s absolutely no sense, no reason he did this,” his brother Eric Paddock said in an interview outside his home in Orlando. “He’s just a guy who played video poker and took cruises and ate burritos at Taco Bell. There’s no political affiliation that we know of. There’s no religious affiliation that we know of.”

Some of the scenes at medical centers where victims were taken:

From the account of the Mandalay Bay Resort: 

Lines of people volunteering blood stretched for blocks. From CBS Radio's Dave Farra: 

--House Majority Whip Steve Scalise (R-La.), who spent the past three months recovering from a shooting attack in June and just returned to Congress last week, called the Vegas attack "unspeakable evil."

“In this tragic moment, I encourage people across America to stand together in solidarity, and to support the Las Vegas community and all of those affected, especially by giving blood and encouraging others to do the same,” Scalise said in a statement. “In the face of unspeakable evil, our whole nation must respond with countless acts of kindness, warmth and generosity."

--In Washington, the perennial issue of gun control surfaced again. The American Academy of Pediatrics issued a statement noting Nevada's loose gun control laws and calling on Congress and state governments to pass "meaningful gun safety legislation."

"We will learn more about this tragic event in Las Vegas as authorities continue their investigation, but we already know the irrevocable ways that gun violence destroys communities and families every day, and we must do more to prevent it," the AAP wrote. "We can start by working to advance meaningful gun safety legislation that keeps children safe. State laws vary widely; in Nevada, firearms owners are not required to have licenses or register their weapons, or to pass a waiting period before purchasing a firearm. There is no limit on the number of firearms an individual may own. Assault weapons and large capacity ammunition magazines are legal."

--The American College of Physicians called for a ban on the sale and ownership of automatic and semiautomatic weapons. "These are military-style 'assault' weapons that were designed to kill as many people as possible as quickly as possible," the group said in a statement, saying it's time to acknowledge that the "lack of a U.S. policy to address gun violence is the reason we have much higher rates of injuries and deaths from firearms violence than other countries."

A tweet from the American Medical Association:


AHH: Minnesota, we applaud you. The state announced yesterday that many of its customers will actually pay less next year for their premiums, which are expected to range from a 3 percent increase to a 38 percent decrease. Mike Rothman, Minnesota's Department of Commerce commissioner, attributed the lower rates to a $549 million reinsurance program paid for by the state that will help cover the costs of sicker customers over the next two years. 

OOF: Nevada, not so much. That state announced yesterday its average marketplace rates are expected to increase by nearly 37 percent next year, the Washington Examiner reports. The average increase for rates sold on the exchange will be 36.8 percent above this year's rate, but the increase is slightly lower -- 31.6 percent -- when individual plans sold off-marketplace are taken into account.

OUCH: Yesterday at Sen. Bob Menendez' (D-N.J.) corruption trial, a former Medicare official shared details of several punchy interactions between the New Jersey Democrat and the Obama administration, the New York Times reports. A “visibly angry” Menendez grew increasingly “hostile” during a phone call with a top official from the Centers for Medicare and Medicaid Services in 2009, eventually hanging up on the official. The senator maintained a similar angry disposition during a meeting in 2012 with Sen. Harry Reid (D-Nev.) and Kathleen Sebelius, who at the time was the secretary of Health and Human Services.

The testimony from Jonathan Blum, a former principal deputy CMS administrator, offered a window into direct action taken by Menendez on behalf of his friend and co-defendant, Dr. Salomon Melgen, a wealthy ophthalmologist, who was involved in a dispute over whether he had overbilled Medicare by roughly $8.9 million. Menendez is accused of using the power of his office to benefit Melgen in exchange for luxurious gifts and political donations. 


--House Energy and Commerce Republicans are proposing to send $1 billion in extra Medicaid funding to Puerto Rico as it deals with severe hurricane damage. The cash would be part of a five-year plan to fund the federal health insurance program for children. They're also including specific funding details in the proposal, taking it a step further than a parallel measure in the Senate.

It’s the first request from a group of Republicans in Congress to direct extra Medicaid dollars to Puerto Rico, where Hurricane Maria recently caused widespread wreckage. Democrats have demanded a disaster aid package, but the White House has yet to propose one and Trump has defended his administration’s slow response in the territory (the president visits Puerto Rico today). Even before the hurricane, the island was facing a Medicaid funding cliff when extra dollars provided to it through the ACA expire at the end of this year.

The proposal, which I first reported last night and is scheduled for a markup on Wednesday, would be paid for with the following bucket of items:

— Charging higher Medicare premiums to seniors earning more than $500,000: $6 billion.

— Allow states to dis-enroll lottery winners from Medicaid: $400 million.

— Shorten the grace period for ACA enrollees who don’t pay their marketplace premiums from 90 days to 30 days: $5 billion.

— Redirect money from the ACA’s prevention and public health fund to community health centers: $5.5 billion.

— Strengthen Medicaid’s third-party liability policy by making it easier for state programs to avoid some medical costs if they’re already covered by private plans or other government programs: nearly $4 billion.

--The GOP-led House will vote today on a measure banning abortions about midway through pregnancy. Under the bill, dubbed the Pain-Capable Unborn Child Protection Act, providers who perform abortions after 20 weeks would face a fine, up to five years in prison or both. The legislation contains the federal Hyde Amendment exemptions for rape, incest or if the woman's life is at stake.

The House passed a similar measure back in 2015, but it was blocked by Democrats in the Senate, where it would need 60 votes. The same situation is expected this year, but the White House said yesterday that President Trump would sign it should the bill make it to his desk. "The bill, if enacted into law, would help to facilitate the culture of life to which our nation aspires," the statement of administration policy says.


--The watchdog agency overseeing HHS has calculated that seven faulty cardiac devices cost Medicare an extra $1.5 billion in additional care (such as additional surgeries) for patients who had them implanted. These patients also had to pay $140 million out of pocket, according to the report released yesterday by the HHS inspector general.

To help avoid these additional costs in the future, the IG is recommending that HHS add medical device identifiers onto the insurance claims that hospitals submit to Medicare and private insurance companies so researchers could gather better data on how devices are performing.

"This could help reduce Medicare costs by identifying poorly performing devices more quickly, which could also protect beneficiaries from unnecessary costs and improve their chances of receiving appropriate followup care more quickly," the report says.

More news from The Post and around the Web:

The injured survivors of the Las Vegas shooting will benefit from surgical lessons learned on the battlefield.
Jeffrey C. Hall, Michael Rosbash and Michael W. Young identified genes responsible for circadian rhythms. Misalignments in this clock may result in medical conditions and disorders, as well as jet lag.
Ariana Eunjung Cha
Our aversion to gun control is out of line with our values.
Sen. Chris Murphy (D-Conn.)
The Food and Drug Administration will take action to deal with the rising cost of prescription drugs, the agency’s head said on Monday.
The Hill


  • The House Energy and Commerce Subcommittee on Health holds a hearing on patient access to investigational drugs.

  • The Atlantic holds an event on prescription drugs.

  • Politico holds an event on Medicaid.

  • The Center for American Progress holds an event with former FEMA administrator Craig Fugate on preparation and recovery for extreme weather.

Coming Up

  • The S&P Global Ratings’ Health Care Conference is set for Wednesday.

  • The Brookings Institution holds an event on 21st century medicine on Wednesday.

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the federal response to the opioid crisis on Thursday.


Fact Check: Are most Planned Parenthood in urban areas without doctor shortages?:

Politicians react to Las Vegas shooting:

How Trump is responding to mass shootings as president:

An emotional Jimmy Kimmel asks for gun control. He wasn't the only late-night host to do so:

Watch Stephen Colbert address the shooting in Las Vegas:

Seth Meyers responds to the shooting and calls on lawmakers to address gun control:

On The Tonight Show with Jimmy Fallon, Miley Cyrus and Adam Sandler open with a performance of "No Freedom" to honor the victims:

Maren Morris dedicates a song to victims: