Good morning ... Best wishes for a speedy recovery to Sen. John McCain, whose unanticipated need for some health care has delayed the Senate health care vote. Looks like Sen. Dean Heller is going to have some time to make himself comfortable in all the backdoors and quiet detours he's been using to avoid reporters lately.
The Senate health care vote is off for at least a week, maybe more, as Republicans wait for McCain to come back from eye surgery. That gives the bill's critics more time to put pressure on the moderate holdouts — and more time for damaging studies to come out.
Yes, but: It also gives the Trump administration and GOP leaders more time to try to convince the moderates that the $70 billion they've added in "stabilization" money can take care of their concerns about Medicaid spending limits — though that pitch didn't go over so well with the governors at the National Governors Association meeting this weekend.
Here is what's going to change because of the delay, and what's not.
Bob Herman has a deep dive this morning into the story behind the latest Medicare payment rules. There's usually a lot of lobbying that goes into these rules, and the rest of us don't see it. The 2018 proposals are no different: There are victories for clinical laboratories, outpatient heart labs, and a bladder cancer drug.
Why it matters: Medicare's annual payment rules are buried in bureaucratic and complex language. But that's where a lot of policy action is, and companies spend a lot of time and money influencing the process, often to get higher Medicare payouts.
Read more here.
Senate Republicans are starting to talk more about how their bill would fill the "coverage gap" in states that didn't expand Medicaid. That's what Senate Majority Whip John Cornyn was referring to yesterday when he said: "In my state alone, 600,000 low-income Texans will get access to private insurance which they don't currently have. That represents progress."
The back story: The "coverage gap" refers to the fact that more than 2.6 million low-income people can't get either Affordable Care Act subsidies or Medicaid coverage in non-expansion states. That's because they earn too much for Medicaid, but too little for the ACA tax credits. (The tax credits are available between 100% and 400% of the federal poverty line, because the assumption was that everyone below that would get expanded Medicaid).
What would change: The Senate bill changes the tax credits to be available at all income levels up to 350% of the poverty line — including those in the gap. Cornyn's office pointed David to this Kaiser Family Foundation report on the issue, which estimates that 684,000 Texans are in the coverage gap.
Yes, but: As we and others have noted, low-income people would still have to cover more costs on their own because of other changes in the bill.
Here's one thing you can do with the extra time: Study up on the "Byrd rule" — the rule that says the bill can only make changes to the ACA that have a budget impact. It's going to matter when the Senate gets back to the bill, if Republican senators bring up amendments (spoiler: they will). And it matters if Democrats try to strip out provisions that are already in the bill (another spoiler: they will, too.)
Here's a good one-stop guide: a report by the Congressional Research Service that tells you everything you'd ever want to know about the Byrd rule, and more. Skip most of it and just read pages 3-5. That's the part about how senators can use the rule to knock out stuff.
The bottom line: A provision or amendment can be considered "extraneous" if it doesn't affect spending or revenues, or if it only has an "incidental" effect, or if it increases the deficit in the long term, etc.
What to watch: Cruz's provision could get knocked out. If so, he and other conservatives might not vote for the bill — and that would sink it.
The ACA requires most taxpayers to either buy insurance or pay a penalty. So, who's been paying the penalty? Sen. Steve Daines' office worked through the IRS' data from 2014 (the most current year available, and the first year the policy took effect), and came up with some interesting results:
Why it matters: These numbers are somewhat surprising because people at these income levels could have gotten a pretty healthy subsidy to help make coverage more affordable. Still, this analysis suggests there's a reasonable point to be made that the mandate penalty is a tax borne mostly by lower-income families.
What we're watching today: Guess it won't be a CBO score, now. So we'll settle for watching for any more Republican defectors.
What we're watching this week: Same. Also, UnitedHealth Group and Johnson & Johnson kick off second-quarter earnings season, Tuesday. House Energy and Commerce oversight subcommittee hearing on the 340B drug discount program, Tuesday.
As always, let us know what we're missing: firstname.lastname@example.org, email@example.com.