Good morning ... In a few minutes yesterday, President Trump managed to overrule his HHS secretary on opioids, smack down Mitch McConnell again, and make a ton of non-health-care news that you can catch up with here. But first, Nevada Sen. Dean Heller has a serious health care dilemma — and so does the Republican Party.
Dean Heller's newest health care dilemma
The Nevada senator's torturous rendezvous with health care politics isn't over, Caitlin Owens reports. Of the 17 counties listed in the latest Centers for Medicare and Medicaid Service map that might have no Affordable Care Act insurers at all next year, 14 were in — you guessed it — Nevada.
Context: Sen. Lamar Alexander, chairman of the Senate health committee, and Democratic Sen. Patty Murray are pushing hard for a bipartisan short-term stabilization package in September. Conservative groups have all but already branded such a package an "insurer bailout."
Heller — up for re-election next year — is just two weeks removed from the debacle of the GOP's health care bill, where he started as an opponent but ended up not taking much of a firm stance on anything.
What's next: Nevada is a purple state that went for Hillary Clinton, and two different former GOP Senate aides told Caitlin without hesitation that Heller should make sure he's part of any individual market stabilization effort. But Heller has a primary opponent from the right, and it's already become a given that he misplayed his hand over the last few months.
The lesson from the past is that Nevada's bare counties don't necessarily indicate how Heller will behave next month.
"It appears that the Alexander-Murray duo is going to come up with something, and I would work pretty hard to make sure I was in the middle of that and getting as much public attention for my work on that as I could if I was Dean Heller," said one of the former aides. "He needs to be seen as part of the solution."
The big divide on health care's next steps
One major problem Republicans have had on health care all year isn't going away: There's a huge disconnect between what their voters want and what Democrats and independents want. Look at the differences between the parties in new Kaiser Family Foundation poll out this morning:
- Large majorities of Democrats and independents want President Trump and Republicans to work to fix the Affordable Care Act now that repeal has failed.
- Overall, that's the verdict of roughly seven out of 10 Americans.
- But six out of 10 Republicans, and Trump supporters, want them to keep working on repeal.
Why it matters: It's hard to dismiss what your own voters want — which is why it's tough to see how Republicans avoid the temptation to expand a bipartisan ACA stabilization bill this fall into yet another repeal exercise.
Yes, Trump and GOP will own ACA problems
From the same Kaiser poll — on who's responsible for any ACA problems from now on:
- President Trump and Republicans in Congress: 60%
- Former President Barack Obama and Democrats in Congress: 28%
- President Trump and Republicans in Congress: 74%
- Former President Barack Obama and Democrats in Congress: 16%
- President Trump and Republicans in Congress: 62%
- Former President Barack Obama and Democrats in Congress: 24%
- President Trump and Republicans in Congress: 36%
- Former President Barack Obama and Democrats in Congress: 56%
Why it matters: Other polls have found similar results, but Trump said after the failure of the Senate repeal efforts that it was time to "let Obamacare fail ... I'm not going to own it. I can tell you, the Republicans are not going to own it."
A new deadline for insurers
Good news, health insurers! You've got a few more weeks to decide if you're going to raise your ACA rates some more. The Centers for Medicare and Medicaid Services has announced that the deadline for insurers to lock down their rates for next year is being pushed back to Sept. 5. (It was supposed to be next week.)
The fine print: It's all about those cost-sharing reduction payments Trump wants to cut off. CMS says it's doing that to allow for some risk adjustment formula changes for insurers that might face "uncompensated liability" for those subsidies. So ... hooray?
What a national opioids emergency would mean
Trump told reporters yesterday that he's ordering up the paperwork to declare the opioids crisis a national emergency — but he didn't give a lot of specifics on what that would mean. It's clear, though, that he was taking the recommendations of New Jersey Gov. Chris Christie's opioids commission seriously.
The Christie commission's report didn't lay out a ton of details either, but here's what it said a national emergency could do:
- Give the Trump administration leverage to pry more money and power out of Congress. "Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the Executive Branch even further to deal with this loss of life."
- Allow the federal government to push for cheaper access to naloxone, the drug that can help reverse opioid overdoses. "By declaring a national emergency, you can empower the HHS Secretary to negotiate reduced pricing for all governmental units."
Deeper dive: Vox has a good look at what else an emergency declaration might mean — including mobilizing federal and state agencies, tapping disaster relief funds, or sending medical staff to underserved areas, depending which of two federal laws he uses to declare the emergency. (Trump didn't say, and the statement the White House released last night didn't, either.)
Price vs. Trump
Health and Human Services secretary Tom Price, at a Tuesday press briefing:
"Most national emergencies that have been declared in the area of public health emergency have been focused on a specific area, a time-limited problem ... So we believe that, at this point -- that the resources that we need or the focus that we need to bring to bear to the opioid crisis, at this point, can be addressed without the declaration of an emergency, although all things are on the table for the president."
Trump, yesterday, 2:25 pm Eastern:
"We're going to draw it up and we're going to make it a national emergency. It is a serious problem the likes of which we have never had ... This is happening worldwide. But this is a national emergency, and we are drawing documents now to so attest."
Price, yesterday, 9:19 pm Eastern:
"President Trump is taking strong, decisive action in directing the Administration to use all appropriate emergency and other authorities to respond to the crisis caused by the opioid epidemic.”
It's never a slow time for cancer hospitals
Hospitals have had a rough first half of 2017. Fewer people are going to the hospital, in large part because they don't want to face their high deductibles, or they are going to outpatient centers where care costs less. But that's not the case for at least one specialty hospital, Bob Herman reports.
The operating margin at Memorial Sloan Kettering Cancer Center increased from 6% in the first half of 2016 to 7% this year. The $4 billion hospital in New York City recorded "strong demand for patient services and increased capacity," according to documents filed for municipal bondholders.
Yes, but: Memorial Sloan Kettering had one noticeably higher expense: pharmaceuticals, which rose almost 28% from the same time a year ago due to "costs for newly approved drugs and market price increases."
- People are still going to get cancer treated.
- Cancer care costs significantly more than annual deductibles, so cancer hospitals don't have to worry as much about patients putting off treatment, since they know they'll be covered once they've blown through their deductible anyway.
- But cancer hospitals are still stomaching huge costs from pricey oncology medications, yet another reminder that the country's drug pricing problem hasn't really been addressed.