Good morning — who's excited for the next Trumpcare markup? There might be some actual drama in the House Budget Committee today, since the vote could be way closer than Republican leaders want. Meantime, they're trying harder to get those conservatives on board for the House vote — but the list of Republican opponents and skeptics doesn't seem to be getting any shorter.
And just a quick reminder to check the Axios health care news stream throughout the day for the latest. And while you're at it, please tell everyone to sign up for our newsletters and breaking news alerts here.
The White House and House Republican leaders have one urgent mission in the coming days: get those Republican holdouts back on board the Obamacare repeal train. They're trying to do it by making concessions to the conservatives — though they don't seem to be in sync on which ones they're willing to make. And some of the changes could hurt them in the Senate, but the top priority right now is to just get it through the House.
There's been a lot of movement on this in the last couple of days, so here's where it stands now.
Why it's happening: The bill has to get through the House Budget Committee today, where one conservative, Rep. Dave Brat, is already a "no" vote and others might not be far behind. Republicans can't lose more than three votes. And then, of course, they've got to start cutting back the long list of Trumpcare haters in the House and the Senate. Here's the running tally Shane Savitsky has been keeping for us.
What to watch this morning: If it appears that the bill might not have the votes to get out of the Budget Committee, don't be surprised if they go into recess until Republicans have the votes.
Trump and GOP leaders keep talking about how Obamacare replacement is going to happen in three phases — the repeal bill they're working on now, the regulations Health and Human Services secretary Tom Price will rewrite, and the other bills Congress will vote on separately. Last night, House Majority Leader Kevin McCarthy laid out the schedule for those "Phase 3" bills:
The return of drug prices: Trump also suggested in the Tucker Carlson interview that he might try to win Democrats by throwing drug prices into that set of bills — hinting it might be the bill to let Medicare negotiate drug prices, or "bidding for medicine," as he put it. He recalled his recent meeting with Democratic Rep. Elijah Cummings, who's sponsoring a bill to allow the drug price negotiations. "We're going to get drug prices so far lower than they are now your head will spin," Trump said.
New bombshell this morning: The National Institutes of Health would get a $5.8 billion funding cut in Trump's first budget — about 19 percent of its budget, per the Washington Post. That's after two years of Congress pushing for big increases.
And that's after Trump made a big issue of supporting research into new cures in his speech to Congress last month. Office of Management and Budget director Mick Mulvaney didn't tip his hand at a press briefing yesterday — he acknowledged that federal funding is needed for research into rare diseases," and our budget preserves the ability to do exactly that."
But NIH supporters in Congress have been warning that funding cuts are a real possibility. The agency got a $2 billion increase in December 2015, the biggest funding boost in a dozen years. And last year, STAT reported (oh wait, that's me!) that appropriators were looking at another $2 billion increase for the coming year. Congress hasn't finished its work on that funding package yet.
Last night's CNN town hall didn't have shouting protesters, but it did have some uncomfortable questions for Price (plus a few softballs to make him feel better). Here's how it went:
Republicans don't want government interference in health care, but the health insurance industry is aware and accepting that taxpayer-funded programs are where its growth will come from. Half of the premiums Aetna collects, for example, now come from Medicare and Medicaid.
Shawn Guertin, Aetna's chief financial officer, talked about the growth of government programs at the annual Barclays health care conference Wednesday, Bob Herman reports. He was particularly giddy about Medicare Advantage, the private alternative to traditional Medicare: "There is an awful lot of positive momentum around MA right now." The takeaway: Medicare Advantage and privatized Medicaid programs aren't going anywhere.
Also worth noting: Guertin said Aetna had to "resist the urge of M&A fatigue" following the failed buyout of Humana. Aetna still has cash to use and wants to expand its Medicare plans, so don't write off the chances for industry consolidation despite the recent setbacks.
Democratic Sen. Ron Wyden is ready to go after the pharmacy benefit managers — the middlemen in drug price negotiations. He introduced a bill yesterday that would make the benefit managers disclose how much they receive in rebates from drug companies — and after two years, they'd have to start passing on some of those rebates to health plans to start lowering costs for customers.
Why it matters: There's been a lot of talk in Congress, including from Republicans like Chuck Grassley, about drawing the benefit managers in to the legislative fights over drug prices. This one has only Democrats so far — Sherrod Brown and Heidi Heitkamp are the cosponsors. But it could be a marker that drives the discussion forward on drug prices forward in both parties, much like the bill by Cummings and Democratic Sen. Bernie Sanders to let Medicare negotiate drug prices.
Speaking of which: Sanders and Cummings fired off a letter to the Food and Drug Administration yesterday asking a lot of questions about the approval of the drug that got an $89,000 price tag from Marathon Pharmaceuticals.
The independent and influential Medicare Payment Advisory Commission, known as MedPAC, released its annual report to Congress yesterday — a whopping 483 pages that has health wonks and data nerds salivating at their computer screens (including Bob Herman). If you want to read the full tome, here it is. Otherwise, you can digest a few of these nuggets:
What we're watching today: House Budget Committee marks up the budget "reconciliation" package tying together the repeal bills, 10 a.m. Eastern. Livestream here.
What we're watching next week: House Rules Committee takes up the Obamacare replacement package ... and maybe the House will vote, maybe not. Also, Senate HELP Committee hearing on reauthorizing the Food and Drug Administration's user fee agreements, March 21.
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