Good morning … Sen. John McCain is headed back to Washington, putting Majority Leader Mitch McConnell in a much better position to at least open the gates on a wild, unpredictable vote-a-rama.
You should always stay tuned to Axios' health care stream, but today especially. If past is prologue, this story is going to change dramatically, oh, maybe 10,000 times, give or take, before the sun sets.
It's impossible to overstate how incredible this is: The Senate is planning to vote today to begin debate on a health care bill, but no one knows which one. Would it fundamentally restructure Medicaid? Would it send individual insurance markets across the country into a tailspin? The lawmakers themselves don't know which version will make it to the top.
But their chances of getting there seem to be improving:
All the options have major shortcomings:
Key caveat: A successful motion to begin the voting process doesn't necessarily mean any of the underlying health care bills will pass. But this has been leadership's message so far: Just let us get on the bill. Each incremental victory puts another one within reach.
Senate aides tell us this is how the process will likely unfold:
How insane could all this get? Completely, wildly, utterly, spectacularly insane:
Caitlin Owens has a good reminder this morning of what's at stake with the Senate bill. The Medicaid spending reductions would force states to choose between multiple unpleasant options when it comes to covering even traditional enrollees like the aged and disabled.
The bottom line: The bill's per-capita caps reduce the amount the government spends on Medicaid by about $180 billion compared to current law, according to the Center on Budget and Policy Priorities. That means states — which must balance their budgets — will be forced to choose between three main options: raise taxes, cut spending elsewhere (like education), or cut Medicaid eligibility, benefits, or provider payments. The best case scenario is that some states may be able to make their programs more efficient.
Reality check: Per Diane Rowland of the Kaiser Family Foundation: "Why do you have to cut services to the elderly and disabled? Because those are where the big dollars are."
Lobbying disclosures for the second quarter of 2017 have been pouring out. Bob Herman put on his galoshes and waded through the health care deluge:
PhRMA + member companies:
No health care group spent more in the second quarter than, you guessed it, big pharma. The Pharmaceutical Research and Manufacturers of America had lobbying expenses of $6 million, less than what it spent in the first quarter of this year but $120,000 more than in the same period of 2016. PhRMA also paid more than a dozen other lobbying shops to push its agenda.PhRMA member companies similarly played fast and loose with their wallets. Amgen spent $3.6 million, the most of any individual health care company. Bayer, Eli Lilly, Merck, Pfizer, Novartis and Johnson & Johnson each spent more than $1 million.AMA + AHA: Among the trade groups, right behind PhRMA was the American Medical Association ($5.28 million) and the American Hospital Association ($3.82 million). Both groups have opposed the Republican health care bills, which would result in doctors and hospitals treating more uninsured people.Not-for-profit hospitals: Fifteen individual not-for-profit hospital systems spent more than $100,000 lobbying Washington on everything from opposing the Republican health care bills to boosting Medicare payments to tax rules around uncompensated care. The biggest spenders, each doling out more than $200,000, were Children's Hospital of Philadelphia, Mayo Clinic, Ascension, Advocate Health Care, Cleveland Clinic, and BayCare Health System.Large companies:Don't forget that the nation's largest companies subsidize their employees' health insurance and have a lot at stake in any reform. Google, Boeing, FedEx, General Motors, Coca-Cola, UPS, MillerCoors and General Electric were just a sample of the many, many names that lobbied Congress on health care.
Think rising drug prices are bad enough that they should get their own federal agency? The Democrats may have just the plan for you. Their "Better Deal" plan released yesterday has a drug prices proposal that would create a new "price gouging enforcer" — an independent official, to be confirmed by the Senate, who would lead a new agency created to investigate "unconscionable" price increases and fine drug companies that impose them.
Reality check: Democratic leaders say there's no agency right now that has this kind of authority, and that lowering drug prices should be the sole mission of a new entity. But the proposal won't help Democrats shed their image as a party that wants a new bureaucracy for every problem. When Maryland took on price-gouging, they just put the power in the hands of the state attorney general.
The FDA's role: FDA commissioner Scott Gottlieb won't go after drug companies in that way — and he doesn't have the power anyway — but he told Bloomberg about some smaller steps he's thinking of taking:
Turns out there's one company behind a lot of the high emergency room bills that are making patients miserable. The New York Times reports that EmCare, a company that helps hospitals staff their emergency rooms with physicians, is charging a lot of the higher billing codes that result in big bills for patients.
Why it's happening: EmCare physicians aren't part of the insurance networks hospitals use, so patients get charged out-of-network rates. The Times cites a study by Yale researchers that found one insurer's out-of-network doctor's bills shot up when EmCare entered a hospital. (EmCare said the study was "fundamentally flawed and dated.")
Why it matters: Hospital patients are understandably angry when they get the surprise bills. But the story suggests that hospital executives who use physician-staffing companies like EmCare aren't always aware that it's happening.
What we're watching today: The Senate votes to start the health care debate. Or not. Also, HCA earnings call, 10 a.m. Eastern.
What we're watching this week: Senate Aging Committee hearing on progress toward a cure for Type 1 diabetes, Wednesday. House Energy and Commerce health subcommittee hearing on Medicare Advantage Special Needs Plans, Wednesday.
Lots more earnings calls: Anthem, Wednesday before markets open; Gilead Sciences, Wednesday after markets close; Zimmer Biomet, Thursday before markets open. And Biogen and Alexion Pharmaceuticals will have "strategic updates" in addition to earnings.
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