Good morning ... Health care bill is put on hold, rewritten, steered to the right, and reintroduced. Moderates will be blamed if the bill goes down. Where have we seen this before?
For a fun way to follow all this, be sure to check the latest "Axios Sourced" video, featuring our own Caitlin Owens. She took a few minutes yesterday to walk through the policy, the politics, and the behind-the-scenes madness of covering this process.
If the Senate's health care bill dies, moderate Republicans will likely be the ones who kill it. And the changes released yesterday won't do much to allay their biggest concerns.
Conservatives won some major policy changes yesterday, in the form of Ted Cruz's consumer-choice proposal. Moderates didn't: The bill's Medicaid cuts are just as deep, and the latest version didn't do much to cover more people or make coverage more affordable to older, sicker consumers.
So, what did the moderates get? Money:
"We're making it rain on them," one senior GOP aide told Axios' Caitlin Owens.
This is what worked in the House: Conservatives won structural changes to the Affordable Care Act's insurance regulations, and some additional money for states brought moderates on board. Will it work in the Senate?
What's next: We're expecting that CBO score early next week, though it may not include the biggest changes announced yesterday — Cruz's consumer-choice proposal (more on that in a minute). Even so, GOP leaders say the plan is still to hold a vote next week. Just like the plan from two weeks ago. Either way, expect plenty more haggling and last-minute changes over the next few days.
If the Senate takes up the bill: Watch Sen. John McCain. He says he's not happy because he didn't get his amendments to protect the Arizona Medicaid program. He'll try to change that.
In a March letter to McConnell, four Senate Republican moderates — Rob Portman, Shelley Moore Capito, Cory Gardner, and Murkowski — opposed the House bill because "we will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states."
Now, here's what they're saying about the Senate bill, which has tighter long-term Medicaid spending limits than the House bill:
Republicans might rely on the Trump administration — not CBO — to evaluate the effects of Cruz's consumer-choice policy, which was by far the biggest change released yesterday.
But wait, you might say, because we're all Senate procedural experts now — don't the Senate budget rules require a CBO score before a vote? We talked to two experts on Senate procedure, and it turns out, the chamber's rules only require a score, not necessarily a CBO score.
"Is it forbidden under the law or Senate rules? Nope. Do I recall the Senate in the past using a different scorekeeper than CBO? Nope," George Washington University professor Sarah Binder told us.
Why it matters: The Senate typically relies on CBO because, well, that's the whole reason Congress created CBO: So it wouldn't be beholden to the executive branch's agenda when it wanted to know what a bill would do. "CBO was established precisely to avoid having to rely on the administration," Binder said.
Why it doesn't: Per Sen. Ron Johnson, yesterday: "It will be beneficial to America. So on the whole, I mean, I don't need a score to tell me that is a good thing."
It's Marco Rubio. He went on a mini-tweetstorm on Wednesday night, saying he needed things like more hospital money for Florida and the ability to waive Medicaid spending limits if there's another outbreak like the Zika virus. Yesterday, he told reporters he got some of what he needed, but he claimed he was still undecided on the bill.
Reality check: Rubio is not going to be the vote that kills ACA repeal. But if you're a senator who wants maximum attention for your priorities, now's the time to get it.
Remember how health insurance companies posted record profits in the first quarter this year? Wall Street is expecting a lot more of the same.
Bob Herman combed through financial analyst reports and found that pretty much all of them were drooling over the upcoming second-quarter results for Aetna, Anthem, Cigna, Humana, UnitedHealth Group, and other large health insurers, which start rolling out next week.
Here's why: People are not getting admitted to the hospital as much, are putting off care, and are not filling as many prescriptions. Data and surveys from Citi, Credit Suisse, and Leerink Partners all show slow growth in hospital visits and drug prescriptions ("utilization" in wonk parlance). If people aren't going to the hospital and aren't picking up their drugs, that's money that stays in the pocket of the insurer.
Go deeper: This is happening partially due to the continued rise of high-deductible health plans — a trend that spans well before the ACA.
Other stuff that happened while you were distracted with the Senate bill:
One goof: In yesterday's Vitals, we quoted a statement from Dan Hilferty, CEO of Independence Blue Cross, that we said was from this week. It was actually from June 27.
What we're watching next week: CBO score of most of the new bill, though probably not the Cruz provision. Expected Monday. And then the motion to take up the bill — which could end the whole effort if it doesn't succeed. Likely Tuesday.
Also, UnitedHealth Group and Johnson & Johnson kick off second-quarter earnings season, Tuesday, July 18. House Energy and Commerce oversight subcommittee hearing on the 340B drug discount program, Tuesday, July 18.
What else do you want to know about the bill? Give us a shout: firstname.lastname@example.org, email@example.com.