Good morning ... That House Republican health care rocket ship is still struggling to get off the ground, but they're going to keep on trying. In the meantime, watch who's picking fights over Affordable Care Act insurer payments and who isn't.
Mark your calendars for tomorrow: Axios and HBO are going to host the D.C. premiere of HBO's new documentary on the opioid addiction crisis, "Warning: This Drug May Kill You." There's going to be a discussion hosted by Axios executive VP Evan Ryan. Get the details and RSVP here.
The two big things to watch this week:
The big takeaway: It would be a mistake to write off any House Republican attempt to revive its health care bill — because the White House wants a repeal and replacement of the Affordable Care Act so badly, and the House GOP is so reluctant to give it up, that they may keep going until they win the bare minimum votes to pass it. Then it becomes the Senate's problem.
Key quote: From a GOP leadership aide: "It's hard to imagine not resolving the health care issue at this point. We are too far along to abandon the effort altogether."
Where things stand:
We've now had two analyses from two respected organizations — the Kaiser Family Foundation and S&P Global — that shoot down the narrative that the Affordable Care Act marketplaces are falling apart. Bob Herman pulls them together this morning into one of our Facts Matter features. It's not that health insurers have been doing just fine — you know that's not true. But here's what's really happening:
The Trump administration sure kept it quiet on Friday night when Vivek Murthy was fired as surgeon general and replaced with his deputy. It also wasn't really clear why, and his wife, Alice Chen, tells me they didn't give him any explanation. Yesterday, Murthy confirmed in a Facebook post that he refused to resign when asked. "My reason was simple: because I would never willfully abandon my commitment to my Commissioned Corps officers, to the American people, and to all who have stood with me to build a healthier and more compassionate America," he wrote.
The back story: HHS isn't saying anything else about why Murthy was fired, but the reality is, he has been a target for the right all along. It took him more than a year to be confirmed by the Senate after President Barack Obama nominated him.
The temporary surgeon general: Murthy did say in his Facebook post that Rear Admiral Sylvia Trent-Adams, who's now the acting surgeon general, "is the right person to step into this role" and that "her deep wealth of experience is matched only by the immense size of her heart."
David Anderson, the former health insurance official who writes a thoughtful health care blog called Balloon Juice, has a fascinating account of one reason the Iowa individual health insurance market is having problems. There's one person with a severe genetic disorder whose medical care costs about $1 million a month — $12 million a year. Last year, this person alone was responsible for 10 percentage points of a massive rate hike by Wellmark Blue Cross and Blue Shield, which is now pulling out of the Iowa marketplace for next year.
What would you do? One of the main goals of the Affordable Care Act was to make sure insurers had to cover sick people and stop separating them out into high-risk pools, which were often underfunded and didn't work well. But Anderson writes that the Iowa patient may be "the textbook case" of why the most expensive patients may have to be treated separately — either in a high-risk pool or with reinsurance money, which keeps them in a regular insurance plan but covers their costs.
The bottom line: Republicans and Democrats are going to have to grapple with this issue regardless of what happens with the ACA. (As Anderson writes in a separate post, this wouldn't be an issue if we had a single-payer health care system, but we don't and we're not about to.)
Conservative Republicans have been trying to knock out the Affordable Care Act's benefit mandates because they're convinced the benefits are making health insurance too expensive. But Julie Rovner of Kaiser Health News talked to some actuaries and found that the benefits aren't really the problem — at least, not the ones everyone wants to get rid of:
What to watch: The whole point of the Freedom Caucus' demands for changes in the health care bill was to bring down insurance costs. If benefits don't really make a difference, that puts the focus on whether the bill will separate sick people out into risk pools again — which some conservatives want, but other Republicans oppose because they don't want to give up the ACA's coverage of pre-existing conditions.
What we're watching this week: GOP health care negotiations and Affordable Care Act insurer payments, all week long. Plus, drug company earnings calls throughout the week; Universal Health Services earnings call, Tuesday after markets close; Anthem earnings call, Wednesday before markets open; Senate HELP Committee vote on FDA commissioner nominee Scott Gottlieb, Wednesday; Trump signs the executive order on veterans' health care, Thursday.
Have a swell Monday, and tell me what we should add to our health care radar: firstname.lastname@example.org.