THE PROGNOSIS

Republicans took a swing at Medicaid spending in their Obamacare rollback bills this year — and missed badly. Yet they’re taking another whack as part of a tax code rewrite.

Yes, you read that right. Health care is such a huge chunk of the federal budget that it’s part of virtually any spending conversation on Capitol Hill. That’s likely to hold true as Republicans launch their next big, partisan legislative goal: overhauling the U.S. tax code.

This morning, the Senate Budget Committee will consider a resolution that instructs lawmakers to find ways to reduce Medicaid spending by $1 trillion (and Medicare spending by $473 billion) over the next decade, according to supporting documentation that Democrats are publicizing. The idea is to clear the way for tax cuts by trimming from the two entitlement programs, which together consume a quarter of the federal budget.

Republicans have moved on from their failed health-care attempts with high hopes that they’ll be able to make their mark on taxes — the second major priority that House and Senate leaders have set their sights on. The two chambers have each rolled out their own tax outlines, which they’d have to eventually merge.

But Senate Republicans are opening the door to even deeper Medicaid cuts than in the health-care bills conceived over the spring and summer. And the GOP could barely advance those bills.

The House’s American Health Care Act would have reduced Medicaid spending by $880 billion and the Senate’s Better Care Reconciliation Act would have chopped off about $750 billion over 10 years.

Although conservative Republicans were fine with those reductions — arguing that the current spending trajectory is unsustainable, anyway — moderates balked. The House barely scraped together enough votes for its bill after multiple attempts, and after falling several votes short in July the Senate eventually gave up.

Republicans learned this hard lesson: Cutting entitlement programs is almost impossible if you don’t want to risk losing seats in the next election. Multiple polls showed that both the House and Senate health-care bills were deeply unpopular. Moderate senators publicly griped about the Medicaid reductions and enough refused to support them. It's just really, really hard to take free stuff away from voters, especially if they don't earn much.

And there’s another catch: President Trump promised multiple times during his campaign that he wouldn’t cut Medicare. The president hasn’t commented specifically on the potential entitlement cuts that his party appears to be exploring as part of tax reform.

In defense of their strategy, Republicans are stressing the same points they did with the health-care bills. Medicaid and Medicare spending would still grow in absolute terms over the next decade, just more slowly, the office of Senate Budget Chairman Mike Enzi (R-Wyo.) stressed to me. The reductions are spread over a 10-year period, not all at once.

And the proposed reductions could change, too, as the committees with jurisdiction would have to formally propose them and decide how to achieve them. This could be done in several ways, by reducing provider reimbursements or increasing patient contribution or cutting benefits or some combination. 

Yet it’s still hard to see how Republicans don’t risk the same kind of political fallout on taxes, which they’re also trying to cut without any Democratic support through a budget reconciliation bill that needs just 51 votes, not 60, in the Senate. Of course, Democrats are working hard to capitalize on all this, fresh off their victory in the health-care arena.

“Republicans used their Trumpcare bill to stick in tax cuts for the rich while they were officially desiccating Medicaid,” Senate Minority Leader Chuck Schumer (D-N.Y.) told reporters yesterday. “Now they’re using their tax-cut plan and sneaking in cuts to Medicaid and Medicare, but it’s the same playbook.”

Here's what other Democrats had to say:

From Sen. Tammy Baldwin (D-Wis.):

Sen. Debbie Stabenow (D-Mich.):

Budget Committee ranking member Bernie Sanders (I-Vt.):

From the Senate Democrats account: 

Sen. Jeff Merkley (D-Ore.):

 

AHH, OOF and OUCH

AHH: Wondering how Politico's Rachana Pradhan and Dan Diamond landed the scoop which led to HHS Secretary Tom Price's resignation last week? It started with a tip that prompted months of investigations which culminated in a top-secret outing to Dulles Airport, The Post's media reporter Erik Wemple writes after a chat with the two reporters.

"The tip about the charter-flight reliance of former health and human services secretary Tom Price came to Politico’s Rachana Pradhan in May," Erik writes. "A reporter for the site’s subscription service, Politico Pro, she started work on the story and later invited her colleague Dan Diamond to team up on a monster reportorial task: Price’s department didn’t release previews of the secretary’s travel schedule; charter flights are tricky to track and price; they were working on a story that the authorities didn’t want to see published."

Over the course of the summer, the duo moved the story forward, though haltingly. “There were periods of probably a week or two where we just couldn’t get any more,” Pradhan said.

Then came Sept. 15, when Pradhan and Diamond knew enough to head over to Dulles Airport. Working as a team, Diamond counted down to Pradhan as Price's private jet landed, while she drove a car along the road that hugs the airport's charter-flight area of Dulles. Pradhan was able to spot the secretary for a few seconds as he headed off the plane. Over the following days, Politico published its damaging series of reports detailing Price's use of taxpayer-funded jets instead of flying commercial.

OOF: Rep. Tim Murphy (R-Pa.) has announced he won't seek reelection, a day after a news report claimed he'd asked a woman with whom he'd been having an extramarital affair to get an abortion, my colleagues Mary Hui and Mike DeBonis report. Murphy was a co-sponsor of the 20-week abortion ban the House passed on Tuesday.

“After discussions with my family and staff, I have come to the decision that I will not seek reelection to Congress at the end of my current term,” Murphy said in a statement. “I plan to spend my remaining months in office continuing my work as the national leader on mental health care reform, as well as issues affecting working families in southwestern Pennsylvania."

OUCH: Stephen Paddock, the man who killed at least 58 people and wounded hundreds more in Las Vegas on Sunday, was prescribed an anti-anxiety drug in June that can lead to aggressive behavior, the Las Vegas Review-Journal reports.

Records from the Nevada Prescription Monitoring Program show Paddock was prescribed 50 10-milligram diazepam tablets (the brand name is Valium), and purchased them without insurance at a Walgreens store in Reno. He was supposed to take one pill a day. Diazepam is a sedative-hypnotic drug in the class of drugs known as benzodiazepines, which studies have shown can trigger aggressive behavior. Chronic use or abuse of sedatives such as diazepam can also trigger psychotic experiences, reporter Paul Harasim writes.

HEALTH ON THE HILL

--House Majority Whip Steve ­Scalise may be a different man after his near-fatal wound from the ballpark shooting in Alexandria, Va. in June, but not in the ways his political foes might wish. The Louisiana Republican remains a strong proponent of gun rights, telling my colleagues Paul Kane and Mike DeBonis in an interview yesterday that those who thought that his shooting would prompt a conversion on the issue are sorely mistaken.

“That usually comes from people on the far left who already want gun control on their own, and they want somehow some transformational event to happen that’s going to convert somebody’s political viewpoints that are based in decades of understanding and studying the history of our country,” Scalise said.

“Anybody that wants to say, ‘Okay, somehow the idea of taking away people’s guns is an answer to this’ . . . they don’t understand, number one, what the Second Amendment stands for and why it’s in our Bill of Rights,” he added.

Scalise is still convalescing from a shot to his hip, prompting immense blood loss that would have killed him had it not been for an emergency tourniquet applied by fellow lawmaker and retired combat surgeon Rep. Brad Wenstrup (R-Ohio), a swift helicopter evacuation to MedStar Washington Hospital Center and the efforts of trauma surgeons there.

"In his office Wednesday morning, Scalise sat amid reminders of that day — the motorized scooter he now relies on, a personalized Army jacket gifted by Wenstrup, a painting of his colleagues kneeling in prayer for him — and reflected on his rehabilitation and his life ahead while sipping a cup of chicory coffee," Paul and Mike write.

"During the nearly 40-minute interview, he expanded on a theme of his speech last week: the bottomless font of generosity and goodwill he received from the public after the shooting. Particularly in the past six weeks, as he focused more and more on his return to the Capitol, Scalise said that he came to realize that a key problem for the institution is the way members disparage it."

“If you had a job and every day you’re going back home and telling all your friends how horrible your job is and how horrible your employer is, after a while, they’re going to start believing you,” he said. “And then at some point, they’re going to start questioning you and say, ‘Why, if it’s so bad, are you doing it?’ ”

--Yesterday, Republicans on the House Energy and Commerce Committee passed a bill 28-23 extending financing for the popular Children's Health Insurance Program, but partisan divisions over how to pay for it suggest that congressional approval will take time despite growing pressure on Congress to act, the AP reports.

Lawmakers are ultimately likely to fund CHIP, even though the deadline officially passed last weekend, but Energy and Commerce Democrats oppose GOP plans for financing the extension and a related community health center bill. Ranking member Frank Pallone said the dispute could delay congressional action until the end of the year and accused the GOP of trying to “continue their ongoing sabotage of the Affordable Care Act."

“While some have called these offsets partisan, we would call them reasonable,” said Chairman Greg Walden (R-Ore.).

Some other good reads from The Post and beyond:

A new campaign will try to make up for at least some of the Trump administration’s outreach cuts.
Axios
The FDA commissioner has quickly won over some skeptics and is now seen as a front-runner to succeed his old boss, Tom Price, as health secretary.
STAT News
MEDICAL MISSIVES
Altruism in times of crisis is about connecting with others. It happens after every disaster, whether natural or human-made. Before the floods recede or the crime tape is removed, hundreds will line up to donate their blood.
Amy Ellis Nutt
President Barack Obama's surgeon general wants to do something about the emotional well-being of American workers.
Jena McGregor
INDUSTRY RX
One New England bakery learned the hard way.
Travis M. Andrews
DAYBOOK

Today

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

  • Sen. Lindsey Graham (R-S.C.) will hold a news conference to introduce the Pain-Capable Unborn Child Protection Act.

Coming Up

  • Kaiser Health News hosts a Facebook Live on how hurricanes affect your health on October 11.

SUGAR RUSH

‘A nation in mourning’: President Trump visits Las Vegas:

President Trump says Americans ‘will all have to wrestle with the horror’ of Las Vegas shooting:

President Trump: Medical staff in Las Vegas did a ‘job that’s indescribable:’

Survivors return to the scene of the mass shooting to gather belongings:

Las Vegas mass shooting survivor recounts story:

7 talking points that are repeated after every mass shooting:

Late-night reactions: The gun control debate:

From the Late Show with Stephen Colbert: "Did Rex Tillerson Call Trump A 'Moron' Or A 'F***ing Moron'?:"