Happy markup day! We're about to start a nice, long day of Obamacare repeal action in two House committees — and no guarantee we'll be done by the end of the day. Plus, it looks like conservative support for the bill is collapsing. So sit back and watch the Republicans fight it out. Also, the Democrats will be there.
If you got dizzy from all of the Obamacare repeal news yesterday, here's the bottom line: Two House committees are about to take up the Republican repeal and replacement bills this morning with no path to the 218 votes needed to pass the House. That's because conservative Republicans are in full rebellion, even after President Trump's endorsement and an afternoon of sweet talking from their former colleague, Vice President Mike Pence.
Rep. Raul Labrador's warning last night after a meeting of the conservative Freedom Caucus: "I don't think there's any tinkering that will get us to 218."
Here's where things stand heading into today's committee markups:
The bottom line: Conservatives will get their chance to amend the bills in the House committees. But if they fail, and they're still complaining after that, Ryan has made his intentions clear: He's moving ahead anyway.
There are good reasons for Republicans to be on the defensive about their bill. For a party that used to promise to wipe Obamacare off the map, it doesn't totally do that. Caitlin Owens has a good rundown of the pieces of the Obamacare regulatory system that would be left in place: pre-existing condition coverage, young adult coverage, no lifetime or annual limits, essential health benefits, and limits on out-of-pocket costs.
That said, no one should think there would be no changes. Here are a few of the ones Republican leaders like to talk about:
And a few they don't like to talk about:
"If Congress fails to vote on a replacement at the same time as repeal, the repealers risk assuming the blame for the continued unraveling of Obamacare." — Paul in January, in Rare.
"We are united on repeal, but we are divided on replacement." — Paul yesterday, arguing for separate repeal and replacement votes.
Yesterday we wrote about how much heat the Republicans are getting about moving ahead with today's markups without waiting for the Congressional Budget Office estimates. So it's fair to look at their counterargument: that other major health care bills have moved through committees without CBO estimates too, including the original 21st Century Cures bill and the MACRA payment reform bill.
"Committees regularly go through the markup process without a formal CBO score," a House GOP aide told me. "The important thing to remember is that this is a fiscally responsible piece of legislation that will improve health care for millions of Americans and protect taxpayers." And at a press conference yesterday, Energy and Commerce Committee chairman Greg Walden noted that CBO isn't always right — its original estimates for how many people would be covered in the Obamacare exchanges were way off.
The bottom line: CBO's estimates should never be taken as the word of God — but there's more on the line for Republicans when the issue is how many people might lose health coverage.
Dr. J. Mario Molina, CEO of Molina Healthcare, was pretty candid when he told Bob Herman his thoughts yesterday on the Obamacare replacement plan: "There's not a lot of good stuff here in this bill, unless you're a budget hawk and you want to see Medicaid cut."
Big carriers like Aetna and UnitedHealth Group have been mum on the bill, but Molina's critiques are arguably more important for the fate of the individual and small-group markets since his company is far more invested in the exchanges. Molina covers more than a half million Obamacare enrollees. These are the biggest problems for Molina:
The bottom line: Molina
still won't commit
to participating in the exchanges next year. The GOP plan "doesn't reassure me that the marketplace is going to be more stable in the future," he said.
Drug company officials often point to high research-and-development costs as a reason for rising prices — but a team of researchers checked it out and said they're not high enough to explain it all. In a study posted on the Health Affaiirs blog, they estimated the "excess revenue" compared to other countries for 15 drug companies and compared it to their R&D costs. They found that the companies earned "substantially more than the companies spend globally on their research and development."
Yes, but: That's not the only factor the drug industry blames for rising prices. It's also focusing on other causes, like the role of pharmacy benefit managers, the middlemen in drug price negotiations.
What we're watching today: House Ways and Means Committee and Energy and Commerce Committee markups of the the Obamacare repeal bills, both at 10:30 am Eastern. Ways and Means livestream here, Energy and Commerce livestream here. Trump meets with conservative leaders on health care at 5:05 pm, per the White House. He also meets with Democratic Rep. Elijah Cummings at 2:30 pm — drug prices are likely to come up.
What we're watching this week: Senate confirmation vote for Seema Verma, likely Friday.
What we're watching next week: House Budget Committee is expected to mark up the budget "reconciliation" package tying together the repeal bills, assuming Ways and Means and Energy and Commerce approve them.
Hang in there and let me know what we've missed: email@example.com.