Axios

There's still a black cloud hanging over the individual and small-group health insurance markets next year even though Republicans and President Trump failed to vote on and pass their health care bill:

Health insurance companies looking to sell Obamacare plans in 2018 need to know the fate of the law's cost-sharing subsidies for low-income enrollees, which are the target of a pending House lawsuit, and if the Trump administration will make any of its own regulatory changes. Insurers have until June or July to file their 2018 proposed rates and health plan designs.

A lack of clear rules could still drive insurers out. "Rather than play pin the tail on the donkey with nine-figure decisions, most would probably opt not to participate," said John Gorman, a health insurance consultant and former official with the Centers for Medicare and Medicaid Services.

President Trump delivered remarks nearly an hour after he called off the vote on the Obamacare repeal and replace plan. Next on the agenda following the GOP's health care failure is tax reform, said Trump.

Trump said the votes were "very close": "Maybe 10-15 votes." Added, "We had no support from the Democrats. They weren't going to give us a single vote."

Open to a new health care bill: "I'd be totally open" to getting together with the Democrats to create a new health care bill, said Trump. "Whenever they're ready we're ready."

The losers: "I think the losers are Nancy Pelosi and Chuck Schumer. Now they own it... Obamacare will unfortunately explode it's going to be a very bad year."

Trump's role in the failure: "I worked as a team player... and I would've loved to have seen it passed... I think this was a very good bill, but I think [the next one] will be even better."

Here's the basic dynamic in the healthcare fight: the White House wants to force a vote on the floor, and House GOP leaders want to pull the bill.

Asked what message the White House gave to GOP leaders today, a senior administration official gave Axios a one word response: "vote."

Speaker Paul Ryan and Majority Leader Kevin McCarthy know they're short on the vote count and would rather pull the bill than face a potentially humiliating legislative defeat, according to multiple sources familiar with their thinking. Referring to the White House's demands, a source close to leadership said, "Is Trump Speaker?"

The prospect of pulling the Obamacare replacement bill is now a matter of discussion among House leaders, according to sources familiar with the conversations. As House Speaker Paul Ryan heads to the White House to brief the president, multiple sources close to leadership say the whip team is still short on votes and is pessimistic about bringing this home today. Some usually chatty aides in the White House and leadership didn't respond to questions about whether they were discussing pulling the bill.

Our thought bubble: What leadership keenly understands is that the bottom falls out on a vote like this. It's not like Trump will get a clear read on who is with him and who's against. Members that are currently in the "yes" column will not vote for a bill that is going down and will have the negative implications hung around their neck in the fall of 2018. If GOP leaders put the bill on the floor without the votes to win, it won't lose by a handful, it will lose badly.

The Democratic super PAC Priorities USA is shining a spotlight on the GOP health care bill's terrible polling. With a House vote imminent, it polled voters in 20 congressional districts (11 went for Hillary Clinton; 9 for Donald Trump) with a Republican member of Congress …

• After being told that their member of Congress supports the GOP bill, net voter support dropped from +12 to -21.
• The number that should terrify Republicans: voters generally said they'd reelect their member of Congress 44-38, but after being told about their member's support for the health care bill, that shifted to 45-38 in favor of a Democratic challenger.

The fate of the healthcare bill is unknowable after yesterday's embarrassing delay and President Trump's strong-arm gamble of demanding a vote today. "Failure is an option," Axios' David Nather writes.

But lessons from the debacle are already apparent:

Here's the reality that President Trump and Republican leaders are facing: They want to repeal Obamacare, but not the popular parts of Obamacare. But to the most conservative Republicans, and their supporters, repeal means repeal — which includes everything, whether it's popular or not.

That's why Trump and GOP leaders haven't been able to close the deal with the Freedom Caucus, and will have to try to steamroller them with today's vote. It's why they have the Koch brothers after them. And it's why, barring a miraculous turnaround, they're not getting any closer to a deal that can survive the Senate as well as the House.

The Food and Drug Administration on Thursday approved Bavencio, a drug that treats a rare form of skin cancer called Merkel cell carcinoma. The breakthrough drug also received orphan drug status from the FDA, meaning it has seven years of market exclusivity.

Bavencio's list price: $13,000 per month, or $156,000 per year. A spokeswoman for EMD Serono, the maker of the drug, confirmed the list price to Axios. However, that price does not reflect rebates or discounts. The amount patients will pay depends on their health insurance.

In 2014, Pfizer and EMD Serono's parent company, the German-based Merck KGaA, agreed to jointly develop and sell the drug.

Michael Pearson, former CEO of Valeant Pharmaceuticals, cashed in $72.5 million worth of stock and severance pay in 2016 even as he and the drug company were under federal investigation for accounting fraud and a billing scheme tied to a specialty pharmacy it secretly owned.

Pearson took home $60.5 million in stock and the rest in severance pay and other benefits, Valeant disclosed Thursday to the Securities and Exchange Commission. He also still used Valeant's corporate jet. Joseph Papa replaced Pearson last year, and Papa earned $62.7 million even though Valeant remains mired in trouble.

Valeant's stock has cratered since the middle of 2015, and it has become a pariah in the pharmaceutical industry. Pearson led Valeant since 2008, building the company up on the controversial practice of acquiring drugs and jacking up the prices.

House leadership has been hoping that President Trump would turn the screws on the Freedom Caucus. They'd love nothing more than for Trump to threaten Freedom Caucus members like Mark Meadows with primary challenges. In fact, they were banking on Trump doing that. They thought he could break the Freedom Caucus.

The emerging reality: Trump is doing nothing of the sort. He was joking when he told Meadows in the GOP conference meeting earlier this week that he'd come after him. And in today's White House meeting Trump did not brow-beat the Freedom Caucus members or make a hard sell on a "final offer."

According to three sources in the room for the meeting, Trump didn't demand loyalty tests, and there was lots of laughing, jokes, and stories.

"He is not being heavy handed," said a White House official. "[The House Freedom Caucus] made clear all week they appreciate respect and engagement from the White House but are upset that they feel leadership excludes them."

The House will not hold a vote on the American Health Care Act today.

However there will be procedural votes tonight, and the GOP will hold a conference meeting at 7 pm to discuss the next steps.

The White House has expressed confidence the bill will pass tomorrow morning, and claims the delay was because they wanted to hold the vote "in the light of day." However, GOP members say there's been no decision on whether to hold a vote tomorrow.

House Minority Leader Nancy Pelosi ripped into GOP's Obamacare replacement vote at her presser on Thursday, calling it a "moral monstrosity that will devastate Seniors and hard-working Americans," adding:

Stripping guaranteed maternity care is a pregnancy tax pure and simple.

Pelosi rounded out her argument by warning Trump about how the red states that voted for him will experience hardship in affording healthcare under this bill.

The Obama-Trump factor: Pelosi called the vote on Trumpcare on the 7th anniversary of Obamacare a "rookie's error," saying "you're clearly not ready."

President Trump and Paul Ryan can lose no more than 22 Republican votes in order for the American Health Care Act to pass the House tonight. But every whip count out there this morning spells bad news.

As of this morning, the AHCA looks dead. But there's still a House Freedom Caucus meeting with Trump before lunchtime. That meeting, and additional changes to the bill, could significantly change these counts.

Axios counts 28 "no" votes right now. Some other whip counts:

The health care deals that grab the most attention involve pharmaceuticals, insurance or hospitals. But there's quietly been massive consolidation among ambulatory surgery centers — outpatient facilities where physicians perform routine procedures, such as elbow or cataract surgeries, and get patients back home in less than a day.

Why there's been a buying spree: More care is being done in the outpatient setting, since it's less expensive than getting the same care inside a hospital. Yet, surgery centers are very lucrative because they don't handle emergency procedures. The business model resembles a high-profit assembly line: Schedule as many quick, elective surgeries as possible, mostly for people who have better-paying commercial health insurance. Here are some telling 2016 figures from the biggest surgery center chains, according to each company's latest financial filing: