Good morning ... There's still a path for the Obamacare replacement to get to President Trump's desk, even after those disastrous Congressional Budget Office estimates. But don't try to memorize this bill, because it's going to change. Keep an eye on John Thune's effort to change the tax credits, and look for a lot more plot twists before this is over.
It's going to be tough to satisfy all of the Republicans who have problems with the House Obamacare replacement bill — conservatives who want a faster end to Medicaid expansion, Republicans from states that want to keep their Medicaid expansion, and especially moderates who are rattled by the massive health coverage losses predicted by the Congressional Budget Office.
But don't assume that's the end of the road. Smart Republicans who were around for the passage of Obamacare, the mirror image of what Republicans are going through now, tell me there's probably still a path to President Trump's desk for something they can call repeal. Just don't assume it's going to look like this bill.
The bottom line: Republicans have to press forward with the current bill and drive it as far as they can. But there could be a pretty big pivot point in the Senate — and the final version of Trumpcare could look very different from this version.
That didn't take long: Just hours after Seema Verma was sworn in yesterday as the new head of the Centers for Medicare and Medicaid Services, she and Health and Human Services secretary Tom Price sent a letter inviting states to apply for lots and lots of Medicaid waivers. The themes of the waivers they want to grant are pretty much the ones you'd expect from Verma's career in Indiana: work requirements, premium contributions, and health savings accounts.
Judging from the Kaiser Family Foundation's new poll this morning, the Republicans have a bit more selling to do on that Obamacare replacement bill. Here's what the poll, which was done after the bill's release but before the CBO estimates on Monday, found that people expect from the plan:
On the bright side: 45 percent believe pre-existing condition coverage would stay about the same — suggesting they're not buying Democratic attacks that suggest those protections would go away.
Sen. John Thune is working on his own proposal to means-test the tax credits for low-income people, hoping the House will snatch it up but suspecting it'll really have to be dealt with in the Senate. Thune sat down with Caitlin Owens yesterday to explain his proposal, which would base the credit for people under 250 percent of poverty on both age and income (as opposed to the House bill's age-adjusted-only approach).
Why the change? First of all, he thinks low-income people need more help. And secondly, he wants to avoid "creating a new middle class entitlement." More here.
The House Budget Committee markup of Obamacare replacement on Thursday was supposed to be a pretty cut-and-dried affair, but McClatchy points out that it might not go as smoothly as everyone thought. That's because the committee includes three members of the Freedom Caucus, including Rep. Mark Sanford, who's sponsoring a more conservative replacement bill, and Rep. Dave Brat, who's been a vocal critic of the GOP leadership version. Other Republicans on the committee have been noncommittal.
Why it matters: If Republicans lose four votes, the bill won't get out of committee, since no Democrats will vote for it.
Reality check: A close vote is a real possibility, especially after the CBO estimates — but a defeat seems farfetched, given all of the pressure we described above for Republicans to live up to their repeal promises. A Budget Committee aide's prediction: "It'll pass."
One thing's for sure: the CBO estimates have made the CNN town hall with Tom Price way more interesting than it was going to be. He's already said CBO "defies logic," that coverage will actually go up if people have more choices of health plans, and that CBO didn't look at the GOP's entire replacement strategy. But will the audience members buy it? Or will they go all "congressional town hall" on him? Tune in at 9 pm Eastern to find out!
The so-called "Bay State boondoggle" is back, Bob Herman reports. The hospital payment policy, based on a provision then-Sen. John Kerry slipped into Obamacare, makes Massachusetts hospitals look bad. And it's sure to create more in-fighting among hospitals — especially since it has continued to create a chain reaction that affected hospital payments around the country.
We'll let Bob explain what the boondoggle is in his story this morning, but here's the new twist: a report from the HHS Office of Inspector General says that because Nantucket Cottage Hospital miscalculated wages and costs in 2015, it led to Medicare overpaying all other Massachusetts hospitals by $133.6 million. That caused underpayments to hospitals in other states. Some state hospital associations have compared it to a "bank robbery."
What we're watching today: Vice President Mike Pence speaks to the Republican Study Committee, 12:45 pm Eastern, and the GOP Conference, 6 pm Eastern; CNN town hall with Tom Price, 9 pm Eastern. Also, Barclays annual global health care conference in Miami; speakers include Bristol-Myers Squibb CFO Charles Bancroft, Aetna CFO Shawn Guertin.
What we're watching this week: House Budget Committee marks up the budget "reconciliation" package tying together the repeal bills, Thursday (rescheduled from Wednesday).
What we're watching next week: House vote on the Obamacare replacement package. Also, Senate HELP Committee hearing on reauthorizing the Food and Drug Administration's user fee agreements, March 21.
Thanks for reading, and keep the feedback and tips coming: firstname.lastname@example.org.