Good morning ... One more week of this, folks. One more week. Then it's likely back to the calm waters of premium hikes, continued cost-sharing uncertainty, the nascent bid for more Affordable Care Act stabilization ... we'll never sleep again. Have a great weekend.
When Congress writes a bill, it often makes some mistakes. The bigger the bill, the more there tend to be. They're like legislative typos — some unclear phrasing, provisions that don't line up from one part of the bill to the next, even some policy glitches.
What's happening: Policy analysts, Hill staffers, industry experts, and journalists are already starting to find some in the Graham-Cassidy bill. And though Republicans aren't sweating the small stuff, those little mistakes can have big consequences if a bill actually becomes law. Just ask the people who implemented the ACA.
Why it matters: These little things can become big things.
There was a time when Congress would simply and easily pass technical corrections to clean up its work on big bills. But Republicans wouldn't pass such a bill for the ACA, and that makes it hard to envision Democrats doing so for Graham-Cassidy (if it comes to that, of course).
The bottom line: Graham-Cassidy has come together so quickly, and its effects would be so sweeping, that it's almost certain to run into a lot of these problems. And they're a whole lot easier to address in a bill than in a law.
Axios rock star Caitlin Owens got her hands on the figures the Trump administration has been providing to Senate Republicans about the Graham-Cassidy bill. They are, not surprisingly, a lot sunnier than almost every independent estimate of the law's effects.
Yes, but: Even CMS' projections still anticipate severe cuts in Alaska and Arizona — the states whose senior senators (Lisa Murkowski and John McCain, respectively) will likely decide Graham-Cassidy's fate.
According to the latest Kaiser Family Foundation tracking poll, most Republican voters want Congress to focus on repealing the ACA rather than fixing it. That's not surprising. But the same poll found that only a small majority of Democrats — 52% — want Congress to focus on fixing the ACA, while 43% say moving on to "national health care" should be the higher priority.
The bottom line: Overall, the group that wants to fix the status quo is the biggest — but it's held together by a bare majority of Democrats and a tiny minority of Republicans, while the rest of both parties want to pull harder toward the extremes.
Flashback: A lot of people in Washington rolled their eyes last Wednesday at the polarization on display when Graham and Cassidy introduced their bill on the same day Sen. Bernie Sanders launched his latest single-payer measure — all while the HELP Committee toiled quietly to try to fix the system we have. But maybe Congress represents its constituents better than we thought.
The Independent Journal Review yesterday reported the outlines of a draft proposal, circulating on Capitol Hill, designed to win Murkowski's vote. And … wow.
The details, per IJR:
My thought bubble:
This seems like a weird offer. On the one hand, it would be a
of money. But it's basically an exemption from Graham-Cassidy — which, for starters, is not a great way to persuade other wavering senators that the bill is good. And if Murkowski thinks this is a better outcome than Graham-Cassidy, why not just vote against Graham-Cassidy?
Get ready for this one: The Trump administration is getting its first chance to put its stamp on the actual structure of the ACA's health insurance marketplaces, Axios' Bob Herman reports.
The gritty details: The White House this week started reviewing the annual rule, called the "Notice of Benefit and Payment Parameters," that will detail how the ACA exchanges will function in 2019. Past rules have tinkered with risk adjustment and plan designs, and they are closely watched by the industry. The proposed rule usually is released in November.
Looking ahead: Sabrina Corlette, a research professor at the Georgetown Center of Health Insurance Reforms, told Bob there's two things she'll be looking for:
What we're watching today: Any movement toward a revised version of the bill, or new accommodations for Alaska or Arizona.
What we absolutely will not watch unless we are tortured and/or compensated handsomely: CNN's health care debate Monday featuring Graham, Cassidy, Sanders, and Sen. Amy Klobuchar. This feels like it's already gone off the rails.
Reach out. I'll be there: firstname.lastname@example.org