THE PROGNOSIS

House Republicans are a “heck, yeah” on repealing Obamacare’s individual mandate but still a “maybe” on funding its extra cost-sharing discounts for low-income Americans.

At least that’s what I heard on Capitol Hill yesterday, as Republicans headed into meeting with President Trump shortly before passing their tax overhaul. House conservatives were predictably thrilled at the possibility of ultimately repealing the individual mandate in a final tax bill. Even some moderates said they’re also in favor of ditching the mandate and its accompanying penalty for remaining uninsured.

“Let’s remember the mandate was called a tax by the Supreme Court,” said Rep. Tom MacArthur (R-N.J.), who let's remember was ousted as chairman of the moderate Tuesday Group after helping Trump and the Freedom Caucus craft a deal on Obamacare repeal. “Eighty percent of the people who pay that tax make less than 50,000 a year, so if we can eliminate one of the most punitive and regressive taxes in our generation, I’m open to that.”

Freedom Caucus Chairman Mark Meadows (R-N.C.) summed up why he dislikes the mandate, in a tweet:

These are the two looming Obamacare-related questions on Capitol Hill as Republicans hurtle toward the end of the year. Will lawmakers repeal the individual mandate within their tax overhaul? And will they fund the cost-sharing discounts, known as CSRs, in a separate bill to keep the government running?

While the two priorities can’t be combined into a single piece of legislation, they’re being viewed as a dual way to appease GOP conservatives and moderates, who have so often been at odds this year over how to treat the Affordable Care Act. The party as a whole is still clearly unsettled about how to approach the law, torn between trying to dismantle it or making efforts to improve its marketplaces.

Rep. Mia Love (R-Utah) appeared pragmatic. She said Congress needs to fund the CSRs – which would help insurers lower premiums for consumers – until Republicans get their health-care act together. And while she’d also like to repeal the mandate, she’s mostly concerned that the Senate passes some kind of tax overhaul so the whole effort doesn’t get mired down in partisan gridlock.

“If they’re not passing something, it was for nothing,” Love told reporters. “If they are able to get their voters in line and actually work for the American people, I’ll be satisfied with that.”

House members acknowledged adding mandate repeal into a tax overhaul – as Senate Republicans have done – injects political risk into the overall debate. And it’s infuriated Senate Democrats, who agreed to support a bipartisan plan to fund the CSRs but are now steaming that Republicans still haven’t abandoned their repeal efforts.

“Republicans who think they’ll be able to jam through a partisan bill that spikes health-care premiums and then make it all better by pointing to our bipartisan bill to reduce health costs are either fooling themselves or trying to fool their constituents,” Sen. Patty Murray (D-Wash.) said in a statement yesterday.

Murray has struck a deal with Sen. Lamar Alexander (R-Tenn.) to fund the CSR payments for two years in a measure seeking overall to stabilize the ACA marketplaces. Alexander has said he'll vote for repeal of the mandate -- even though it could jeopardize his working relationship with Murray:

My colleague Mike DeBonis:

Even though it's completely unclear whether House moderates will ultimately support repealing the ACA’s individual mandate, it’s also been unclear whether conservatives would agree to fund the CSRs, which they’ve long termed a “bailout” for insurers. House Speaker Paul Ryan (R-Wis. has previously said he wouldn’t bring such a measure to the floor, and his office didn’t respond yesterday to questions about where he currently stands on the matter.

“We shouldn’t be bailing out insurance companies,” Rep. Raul Labrador (R-Idaho), a House Freedom Caucus member, told me. “They were the ones that wanted Obamacare, and we shouldn’t be then bailing them out because Obamacare didn’t work.”

Yet some conservatives aren’t entirely ruling out such a deal, saying it depends on what a total year-end spending package looks like. Rep. Phil Roe (R-Tenn.) said he would need to see the “totality” of a bill but that CSR payments wouldn’t necessarily be a “stopper” for him.

“I’m a conservative, but I also realize there’s a greater picture out there,” Roe said.

AHH, OOF and OUCH

AHH: Quick, cover your ears, Republicans. More than six in 10 Americans say you now own the U.S. health-care system, Obamacare and all. And majorities of Democrats, Republicans and independents favor the idea of letting more people buy into Medicare -- an idea proposed by several Democrats. Here are some of the topline findings from a Kaiser Family Foundation poll released this morning:

--Half of respondents said if Obamacare enrollment is down this year, it's mainly the Trump administration's fault. There's a significant partisan divide on this question; while 78 percent of Democrats said they'd blame reduced enrollment on the administration, 73 percent of Republicans said it would be because Democrats designed a flawed law. Independents were more likely to blame Trump's actions (48 percent) than Democrats who wrote the law (36 percent).

--Sixty-one percent of all respondents view Trump and Republicans as now responsible for any future ACA problems, since they control the White House and Congress. Just four in 10 respondents said Democrats are responsible for problems.

--Public opinion about the ACA remains divided, with 50 percent viewing the law favorably and 46 percent viewing it unfavorably.

--Which political party you belong to hugely affects how much you trust Trump on health care (shocker). Eight in 10 Republicans said they trust Trump at least a fair amount, while just four in 10 independents and one in 10 Democrats said they trust the president.

--Democrat or Republican, Americans love Medicare. Eighty percent of respondents said they're fans of the program for seniors.

--Majorities of voters in both parties also like an idea advanced by some Democrats of allowing younger Americans to participate in Medicare, although there's slightly higher support for expanding it only to people between ages 50 and 64 (77 percent support) than expanding it to everyone (72 percent support).

--A significant portion of the public has seen ads this month for marketplace coverage from insurance companies trying to sell plans (41 percent said they've seen these types of ads) or from another source trying to educate them about coverage opportunities (32 percent).

OOF: Yesterday, Sen. Bob Menendez’s months-long corruption case ended in a mistrial after a jury declared it was deadlocked and not “willing to move away from our strong convictions,” The Posts's Alan Maimon and Devlin Barrett report. Teary-eyed, the New Jersey Democrat declared outside the courthouse it was “Resurrection Day.” “Anyone who knows me knows I never seek to fight, but I never shy away from one either. This was not a fair fight,” he said.

Menendez was accused of corrupt bargaining with Florida eye doctor Salomon Melgen by failing to disclose gifts such as a hotel stay, private flights and campaign donations from Melgen. Menendez’s lawyers said the government was trying to criminalize a longtime friendship between the two men, and there was nothing corrupt about Menendez’s acts on Melgen’s behalf or Melgen’s financial support.

One of the jurors, Ed Norris, said Menendez and Melgen came close to an acquittal, Devlin and Alan write. Ten jurors believed Menendez was not guilty, with just two in favor of finding him guilty. The jury of seven women and five men twice sent notes to the judge saying it was deadlocked. “We cannot reach a unanimous decision,’’ the jury said in the second note just before noon Thursday. “Nor are we willing to move away from our strong convictions.”

But it might not be over for Menendez. Justice Department officials said they would review the case to decide whether to retry the senator, and top Senate Republican Mitch McConnell (R-Ky.) called for a Senate ethics probe based on the charges.

“Left unclear Thursday was whether Menendez would be able to return to his perch as top Democrat on the Senate Foreign Relations Committee," Devlin and Alan write. "Senior Democratic aides would not comment Thursday on any potential change in committee assignments, signaling no final decision would be made until after the Justice Department determines whether to retry Menendez."

Menendez also fired his own warning shot yesterday. “For those who were digging my political grave so they could jump into my seat, I know who you are and I won’t forget it,” he said. 

OUCH: Is the Drug Enforcement Administration intentionally blocking its top judge from speaking to Congress about a law curbing the DEA's enforcement powers against the opioid industry? That's the charge Sen. Claire McCaskill (D-Mo.) is levying against the agency, saying she's dismayed DEA Chief Administration Law Judge John J. Mulrooney II won't be permitted to attend a roundtable discussion she is hosting Nov. 28.

“The decision to muzzle a critic of this law is unacceptable while the U.S. opioid epidemic rages out of control,” McCaskill wrote to the acting DEA administrator Robert W. Patterson, our colleagues Scott Higham and Lenny Bernstein report.

Asked about McCaskill's charges, DEA spokeswoman Mary Brandenberger told The Post: “We cannot speak to this.”

All this follows a joint investigation by The Post and “60 Minutes” revealing an early version of the law, sponsored by Rep. Tom Marino (R-Pa.), was written by a drug-industry lawyer. Marino withdrew from consideration to be Trump’s drug czar following the reports. McCaskill and some other lawmakers have called for the law to be repealed.

The Missouri Democrat is scheduled to hold a roundtable discussion later this month, to which she'd invited Mulrooney. Following passage of the bill last year, Mulrooney penned a law review article criticizing the measure. “If it had been the intent of Congress to completely eliminate the DEA’s ability to ever impose an immediate suspension on distributors or manufacturers, it would be difficult to conceive of a more effective vehicle for achieving that goal,” Mulrooney wrote at the time.

MALPRACTICE

--Many Democrats have been levying this charge at the GOP Senate tax measure, which would repeal the ACA's individual mandate: namely, that doing so would cost the health coverage of 13 million Americans. “We’re kicking 13 million people off health insurance to give tax cuts to the wealthy," top Senate Democrat Chuck Schumer (N.Y.) said from the chamber floor this week. No. 2 Senate Democrat Dick Durbin tweeted this:
 

--The Post's fact-checker Glenn Kessler ran this claim through his super-duper truth machine and guess what? It didn't compute. The Democrats are using inaccurate language, misrepresenting why fewer people would have coverage in the absence of the individual mandate, Glenn writes. He explains:

Where Schumer and Durbin are wrong: The senator's 13 million figure comes from a Congressional Budget Office estimate on the impact of repealing the individual mandate. CBO estimated by 2025, there would be 5 million fewer people on Medicaid, 5 million fewer people in the marketplaces and 3 million fewer people getting health insurance coverage from their employers. That adds up to 13 million, but CBO says the action would be voluntary. In other words, people would not be forced to give up their insurance as Schumer claims.

Where Schumer and Durbin are mostly right: As for the changes helping mostly the wealthy, Schumer is on more solid ground. Glenn has frequently noted that because the wealthy pay the largest share of income taxes, it’s natural to expect they would reap most of the benefits of a broad-based tax cut. But Senate Republicans may have thought they inoculated themselves against the charge they altered the health-care law to benefit the wealthy because they also added elements attractive to the middle class.

The conclusion: The first part of Schumer’s statement remains problematic. CBO, in estimating the impact of repealing the individual mandate, is mostly describing a voluntary decision by people choosing not to buy health insurance. That’s not the same as “kicking off” 13 million people. Granted, some people may feel they don’t have a choice because their premiums increased, but that’s not the majority of the people affected under CBO’s analysis. 

TRUMP TEMPERATURE

--Trump repeatedly vowed on the campaign trail to fight the pharmaceutical industry and work to lower drug prices, but his appointment of Alex Azar to lead the Department of Health and Human Services underscores a pattern of picking drug industry executives to fill the ranks in his administration, Stat’s Erin Mershon reports. Many in his administration have worked in the very companies Trump criticized. Take a look at some of his nominees to top health posts:

  • Azar spent more than a decade at pharmaceutical giant Eli Lilly.
  • FDA chief Scott Gottlieb was an adviser to GlaxoSmithKline and Bristol-Myers Squibb and was a longtime industry investor.
  • Keagan Lenihan, a top adviser at HHS was previously running a lobby shop for McKesson.
  • Joe Grogan, who reviews health-care regulations at the Office of Management and Budget, is a former Gilead lobbyist.
  • Lance Leggitt, the chief of staff at HHS, lobbied for drug clients prior to joining the administration.

This list shows “just how reliant Trump is on the industry he has promised time and again to rein in,” Erin writes.

“The trends in pharmaceuticals kind of run in parallel to the trends in the financial sector and Wall Street — you have an industry that Trump ran against pretty aggressively, with pretty strident language in 2016, and he is now seeing those industries as essentially farm clubs,” Jeff Hauser, who runs the Revolving Door Project at the Center for Economic and Policy Research told Stat. “He’s going to bring them up to the major leagues of his administration. It’s unusually stark and unapologetic.”

--Yet we should also note some of these officials have extensive government experience as well. Both Azar and Gottlieb worked under former president George W. Bush, as did Leggitt and Grogan, as Erin notes.

It's Friyay! A few more great reads from The Post and beyond as you head into your weekend:

HEALTH ON THE HILL
Republicans have added a tax credit to a modified version of the Senate tax bill, which aims to incentivize businesses to offer paid family and medical leave. 
The Hill
MEDICAL MISSIVES
More than a dozen gene manipulation clinical trials are underway for conditions like hemophilia and sickle cell disease.
Ariana Eunjung Cha
Drugs users generally don’t know when their heroin is laced with fentanyl, so it's easy for them to inadvertently take a deadly dose of the substance.
STAT News
INDUSTRY RX
The famed medical center builds a grand main campus while consolidating services elsewhere.
Politico
STATE SCAN
In Virginia, premiums on policies sold under the Affordable Care Act are pushing health coverage out of reach, and customers see political forces at work.
New York Times
DAYBOOK

Today

  • The Center for American Progress holds an event on "Women of Color and Mental Health."
SUGAR RUSH

Fact Check: Are poor Americans carrying the tax burden of the individual mandate?:

Here’s what Sen. Al Franken (D-Minn.) has said about sexual violence:

Late-night comedians Stephen Colbert, Trevor Noah and others addressed the allegations against Sen. Al Franken:

Meryl Streep spoke out about her own experiences with violence at an annual award show by the Committee to Protect Journalists: