Good morning ... Did you think, after so many weeks of nonstop madness, you might be in for a brief respite? That health care would quiet down for a while, we could all catch our breath, maybe go on a little vacation, or at least get some sleep before dealing with the next crisis? WRONG. It never stops.
President Trump says the Affordable Care Act is already imploding, but insurers say there are two things that could really destabilize the already fragile markets: cut off the cost-sharing reduction payments to insurers, and weaken the individual mandate. Between Trump's Twitter account and Health and Human Services secretary Tom Price's remarks on the Sunday talk shows, the Trump administration has suggested it might do both.
What to watch:
Mark your calendar: The deadline for insurers to adjust the rates they've already filed is Aug. 16. That's when insurers who warned of additional premium increases without the CSR payments would raise their rates. America's Health Insurance Plans, the main health insurance trade group, says premiums will rise by 20% if the CSRs aren't funded.
Top priority: Bob Herman reports this morning that the CSR payments are the top priority for health insurers now that the ACA effort has fallen apart — and they were already worried that Trump would be impulsive and follow through on his past threats to cut off the payments. Now that he's been tweeting about it this weekend, they're sure to be more nervous than ever.
The struggle to repeal the ACA was the first real test of how Republicans would handle their total control of the House, Senate, and White House — and how the health care world would respond. And though the top-line effort was a failure, this won't be the last big legislative test for Republicans, and the power dynamic in Washington shifted significantly during the health care debate.
So, who came out of the health care mess stronger, and who came out weaker? Be sure to read our full analysis this morning, but here's a quick breakdown:
There's been a lot of talk that the next step after the failure of repeal should be a bipartisan effort to stabilize the health insurance markets (and Democratic leaders have tried to encourage that talk). But that's not the message Trump sent with his tweets this weekend. He spent a lot of time urging the Senate to keep trying to repeal and replace the ACA.
He even recommended what he called the "nuke option." Relax, everyone — he meant the Senate nuclear option. It's still a big deal — that's where they would eliminate the legislative filibuster so Republicans could pass a complete health care plan with 51 votes, rather than 60.
Yes, we know — Senate Republicans couldn't even get 50 votes for anything last week. But note that Trump mentioned "Cross State Lines," his shorthand for association health plans, which couldn't be done through budget reconciliation. That suggests he's also frustrated that Republicans were never able to vote on a complete repeal and replace plan, and had to throw out anything that required 60 votes.
So much for Sen. John McCain's message. Key quote from his floor speech after he returned (and before he tanked the last repeal bill): "What have we to lose by trying to work together to find those solutions? We're not getting much done apart."
That's what Tim Phillips, president of Americans for Prosperity — a conservative group aligned with the Koch brothers — said when David asked him what the next steps on ACA repeal should be. That says a lot about the state of the repeal effort, especially at a time when Trump and top administration officials aren't ready to move on.
Yes, but: Not all conservative groups are ready to hit the pause button. FreedomWorks president Adam Brandon, for example, wants Republicans to shift to a "death by a thousand cuts" strategy — including a reworked version of Cruz's "Consumer Freedom Option" and whatever steps Price can take on his own to loosen the ACA rules.
And Heritage Action wants the Senate to keep looking for ways to revive the repeal effort, according to Dan Holler, the group's vice president. What should they try that the Senate hasn't already tried? Not clear, Holler acknowledged — "but just throwing up their hands and not continuing to work on it isn't acceptable."
Don't forget the punishment: Brandon also wants Senate GOP leaders to take away Murkowski's position as chairwoman of the Senate Energy and Natural Resources Committee — to see if she'll keep voting "no" on repeal after that.
What we're watching this week: Maybe a final decision from Trump on the CSR payments. It's also a good idea to watch the Senate to see if they'll take up the reauthorization of the Food and Drug Administration's user fees, although a spokesman for McConnell says it's not clear if that will happen this week.
Also: Pfizer earnings call, Tuesday before markets open. Humana earnings call, Wednesday before markets open. Aetna earnings call, Thursday before markets open. Cigna earnings call, Friday before markets open.
Let us know what's on your health care radar, now that it can include other stuff: firstname.lastname@example.org, email@example.com.