May 02, 2017

Good morning ... Looks like the House is going to keep us in suspense until they're sure they have the votes to pass their health care bill. When will that be? Let's just say it doesn't look like it's getting any closer.

The House is still teasing us on health care vote

This is one of those situations where there's a ton of noise and not a lot that's worth following. So let's get to the bottom line on the House Republican bill to repeal and replace the Affordable Care Act:

  • If they had the votes to pass it, they would have scheduled the vote by now.
  • The Wednesday vote Republicans had wanted is looking less likely, purely because time is running out, so keep your calendar open on Thursday too. After that, they leave for another recess.
  • Realistically, we may not know until the night before the vote, because Republican leaders won't call it until they're pretty sure it will pass. One top GOP aide says the most likely scenario is a Rules Committee meeting that would be called on short notice to prepare the latest amendments, followed by a House vote the next day.
  • Vice President Mike Pence and GOP leaders spent a lot of time on the Hill yesterday trying to lock down votes, without a lot of apparent success.
  • Don't spend a lot of time trying to follow every media organization's whip counts. Just read this compilation by the New York Times. They all show the same thing: Republicans are awfully close to losing 23 votes, which would sink the bill.
  • Rep. Mark Walker, chairman of the conservative Republican Study Committee, summed it up in this comment to Caitlin Owens: "I'm very confident we will have a vote on it, fairly confident it will pass."

The "You're Not Helping" award: Trump showed a bit of defensiveness yesterday when he suggested to Bloomberg that the bill is "not in its final form" on pre-existing conditions: "I want it to be good for sick people ... It will be every bit as good on pre-existing conditions as Obamacare." For Republicans who want to make sure the bill is already good for sick people, that wasn't a confidence builder.

The Senate mulls over early plans for health care

We're already bored with the House, so let's move on to the Senate, where Caitlin Owens has been asking how they can get this health care bill through without massive rewrites. The Senate will have its own version of the House conflict — moderates and conservatives have reasons to be unhappy, and Republicans can only lose two votes. But Senate Republicans have already been thinking about it, Caitlin reports, and it's not an impossible task.

The strategy: Rework the tax credit to give more help to low-income and older people, design a less abrupt end to Medicaid expansion, and throw in some extra state flexibility so conservatives like Ted Cruz and Mike Lee don't jump ship. Oh, and add some help for key senators' states — kind of like Democrats did when they passed the Affordable Care Act. Read Caitlin's story here.

No partisan battles over drug prices

Sure, Republicans and Democrats fight about everything else in health care, but the Kaiser Family Foundation's Drew Altman points out that there's one issue that unites them: Everyone wants the government to do something about drug prices. In his latest column this morning, Altman walks through some of the most surprising findings from a new Kaiser poll: Republicans are more likely to list lower drug prices as a priority than reducing the government's role in health care.

And look at these numbers for public support for some of the leading options:

  • Allow the federal government to lower drug prices: 92%
  • Make it easier to bring generic drugs to market: 87%
  • Require drug companies to disclose how they set their prices: 86%
  • Limit prices for high cost drugs: 78%

The takeaway: Republicans in Congress are still going to be reluctant, because they prefer market-based solutions — but polls like these will make it way easier for President Donald Trump to demand action.

The electronic health record marketplace under Trump

The health IT industry has been swimming in cash since 2009, when a federal program reimbursed hospitals and doctors for buying electronic health record technology. But two large health IT vendors had wildly different experiences in the first quarter of Trump's presidency, Bob Herman reports.


Stock crashed 19% after slashing profit expectations for the rest of the year.Doctors submitted fewer claims and collections through Athenahealth's technology.On a conference call, CEO Jonathan Bush attributed that to providers waiting to buy technology because of the "national breath-holding around what's Trumpcare going to be," and the fact that people with high deductibles avoid doctor visits at the beginning of the year when they'd owe the full deductible.


Stock went up 8% after a healthy first quarter.Many hospitals updated their electronic health record and billing systems to Cerner.President Zane Burke told investors that the company's main competitor, Epic, has been in a "more defensive stance" due in part to Epic's high-cost and publicly messy rollouts of its electronic health records.

Between the lines: Hospitals and doctors are still spending a lot of money on health care technology. Cerner and Epic have pretty entrenched seats at the table, but the uncertainty of health care reform has hurt companies like Athenahealth that mostly work with individual doctors and group practices with smaller tech budgets.

Tom Price's next mission: "Reimagine HHS"

The Health and Human Services secretary is giving a speech this morning to launch a "Reimagine HHS" initiative. He'll be talking to HHS staff, but you can watch the livestream if you wish. It's billed as "a vision for how the team at HHS can utilize its many talents, enthusiasm, and commitment to the mission of the department to improve how we promote and support the health and well-being of the American people."

No, the ACA didn't make us fight over doctors

For all of the Affordable Care Act's real problems, including those double-digit premium hikes and fleeing insurers, here's one that didn't come true: People who were already insured didn't have more trouble getting medical care because of all those newly insured people.

That was a real concern when Congress passed it, because some health care experts worried there wouldn't be enough doctors and other health care providers to go around. But a new study in yesterday's Health Affairs journal found no evidence that insured people had any less access to care between 2013 and 2014, when the ACA's main expansions of health coverage began. No extra delays in getting necessary medical care, getting doctors' appointments, etc.

The Medicaid "brain drain”

The Government Accountability Office put out a report yesterday that essentially made the case for paying state Medicaid directors more money if states want qualified people running their ever-expanding Medicaid programs, Bob Herman reports. The average salary for Medicaid chiefs in 10 states was $152,439 in 2015 versus more than $236,000 for the average Medicaid insurance executive.That's not all: In addition to the lower pay, former Medicaid directors interviewed by the GAO said their jobs were more complex and time-consuming than their roles with an insurance company. Those are the major reasons why many veteran Medicaid wonks have left public service for the private sector.

What we're watching today: Whip counts. HHS secretary Tom Price's speech on "Reimagining HHS," 11 a.m. Eastern. Livestream here. Also, lots and lots of earnings calls. CVS, Pfizer, Aetna, Merck and HCA before the markets open, Gilead after the markets close.

What we're watching this week: Pence speaks at the Susan B. Anthony List's Campaign for Life Gala, Wednesday.

What we're watching next week: FBI director James Comey gives keynote address on health care cyberthreats at the American Hospital Association annual membership meeting, Monday, May 8; Senate HELP Committee marks up FDA user fees reauthorization bill, Wednesday, May 10 (tentative).

Thanks for reading, and tell us if you hear any more Republicans changing their health care votes: [email protected].