Good morning ... Well, that was awfully dramatic for a Monday night. Let's just get into it.
The current version of the Senate health care bill is dead, following last night's opposition from Sens. Mike Lee and Jerry Moran — and Majority Leader Mitch McConnell's subsequent admission that the Senate's repeal-and-replace bill "will not be successful." He said the Senate will instead vote on straight repeal with a two-year delay.
It'll be a tough vote for McConnell's caucus, but holding it is probably the only way he can declare health care dead for good and move on.
What killed the bill: The biggest, most consistent obstacle was that the complaints within the GOP caucus were diverse, and a big part of that caucus was not especially invested in reconciling them.
Who's breathing a sigh of relief, and who's breathing into a paper bag?
In the "don't call it dead yet" category...the House is releasing its fiscal 2018 budget resolution this morning, and it assumes that all of the policies in the House-passed repeal bill, the American Health Care Act, will become law.
And that's not all. It also revives the GOP proposals for Medicare premium support — the overhaul Ryan has been championing for years, but also the one Trump has said he doesn't want to do.
Reality check: It may not sound realistic, but everything about the budget is a negotiation — and House Republicans are loading up their budget with as many conservative priorities as they possibly can. It also calls for Medicaid work requirements, additional state flexibility beyond the House bill's Medicaid changes, and medical liability reform.
Here's the latest thing the Congressional Budget Office wrote about straight repeal — a January report estimating what would have happened under the version Congress passed in 2015. Then-President Obama vetoed it, and it's going to be the model for this year's effort:
Important: Even this wouldn't be complete repeal of the ACA. It would just wipe out everything they can get at through budget "reconciliation" rules. One part that wouldn't be repealed: all of the insurance regulations conservatives say they hate.
Back in May, we told you how four health insurance companies control more than half of the membership market for Medicare Advantage, the narrow-network version of Medicare. Well, the market is arguably even more consolidated for Medicare Part D, the privately run program that covers prescription drugs for seniors and the disabled.
Who's in control: The federal government just released updated data on Medicare Part D enrollment, and Bob Herman found that five insurers and pharmacy benefit managers enroll 83% of Medicare's 25 million prescription drug plan consumers. These companies have controlled Part D for a while, but it's still worth spelling out:
CVS Health: 5.5 million members (22%)UnitedHealth Group: 5.4 million members (21%)Humana: 5.1 million members (20%)Express Scripts: 2.8 million members (11%)Aetna: 2.1 million members (8%)Why it matters: High drug prices remain top of mind for the public, and Part D costs have risen by 8.3% on average annually over the last five years, according to recent Medicare trustees' report. That rate is well above the spending growth rate of regular Medicare and the economy, raising questions if the dominant companies running Part D are doing enough to keep costs under control.
This was a pretty dramatic followup to a Boston Globe investigation: VA secretary David Shulkin got rid of the top two officials at the Manchester VA Medical Center yesterday and called for a "top-to-bottom" review, the Globe reports. This was a day after a Spotlight investigation that found the hospital's operating room was filled with flies and the surgical instruments were often unsterile — with the chief of medicine saying he had "never seen a hospital run this poorly."
Why it matters: The hospital director and chief of staff have been reassigned, not fired from the VA. But it's a sign that Shulkin wants to send a message that poorly performing VA officials aren't safe, especially in a case this bad.
Trump's tweets about health care are not particularly substantive, and aren't always accurate, per an analysis from Philip Bump at The Washington Post. Trump has tweeted a lot about health care since the House first introduced its bill — more than he has tweeted about "fake news," even — but only five times in that span has he said anything you might refer to as policy.
Why it matters: It's been six months — no one should be surprised that Trump isn't a policy wonk. All the same, building support for a bill usually involves giving the public some sense of how it would benefit them. And that requires talking at least a little bit about what it would do.
What we're watching today: Today's Senate Republican lunch should be interesting. (Vice President Mike Pence will be there.) Also, House Budget Committee Republicans release the fiscal 2018 budget resolution, 10:30 a.m. Eastern.
Plus: UnitedHealth Group and Johnson & Johnson kick off second-quarter earnings season before markets open. House Energy and Commerce oversight subcommittee hearing on the 340B drug discount program, 10:15 a.m. Eastern. Livestream here. Senate Appropriations subcommittee marks up the funding bill for the Food and Drug Administration, 10:30 a.m. Eastern. FDA hearing on innovation vs. access, 9 a.m. to 5 p.m. Eastern. Details here.
What we're watching this week: House Budget Committee marks up budget resolution, Wednesday. House Appropriations Committee marks up funding bill for HHS, Wednesday. Senate Appropriations Committee marks up FDA funding bill, Thursday. Athenahealth earnings report, Thursday after markets close.
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