Happy Monday ... We're bringing you a look at how an Obamacare marketplace meltdown might actually look, and we'll help you keep track of all of the political risks Republicans are taking with Trumpcare. Meantime, get ready for Seema Verma's confirmation vote tonight — and maybe the Congressional Budget Office estimates for Trumpcare, which could set off a new political firestorm and some really boring Twitter fights.
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We've all heard a lot of talk about the worst-case scenario: more and more health insurers pull out of the Obamacare marketplaces, just like Humana did, and eventually the individual insurance market collapses. It could be a vote of no confidence in the Republican repeal and replacement plan, or it could happen because they already don't like the way things were headed. Either way, if it happens, it doesn't matter how many times Republicans promise that Obamacare customers won't lose coverage — it will just happen.
Today, Bob Herman takes a detailed look at what that scenario might look like. He got the Robert Wood Johnson Foundation's help in mapping out what would happen if other insurers that have been on the fence decide to pull out. The biggest disruption would happen if Anthem leaves, although that may have become less likely now that the insurer has praised parts of the GOP bill. But other states would be devastated if insurers like Centene and Highmark bail out. Read his story here.
It was never a secret that Republicans would take a risk by repealing Obamacare, as unpopular as it was, and taking ownership of what happens next. But it's striking just how many political dangers they're putting themselves in — and how they're ignoring pretty much all of them. Democratic operatives are already testing which ones resonate the most in swing districts, I'm told.
Here are the one to watch:
OTOH: Ryan said he agrees with Trump that there will be a "bloodbath" in 2018 if Republicans don't follow through on their repeal promises.
The next big event for the GOP health care bill is the release of the Congressional Budget Office cost and coverage estimates — which could be devastating. (The Brookings Institution predicted that CBO will estimate that 15 million people would lose coverage.) They're probably coming either today or tomorrow, so while we wait, here are the political realities:
It's also worth a review of how CBO actually works. In his book "America's Bitter Pill," Steven Brill describes how much the budget office frustrated Democrats during the writing of the Affordable Care Act. Its process was "more a game to be played than it was a precise measuring device to be read like a thermometer," Brill writes, and its estimates were "unpredictable and often maddening." Its estimates were always cautious, and if it was wrong, it wanted to guess that an initiative would cost more than it really did, or a tax change would bring in less revenue than it actually did.
The bottom line: "In short, CBO was an only-in-Washington institution—an independent body whose only virtue was its independence. Which meant not only freedom from political influence but also freedom from having to do its job the way people in the real world did."
We already knew that Vice President Mike Pence was playing a big role in selling the Obamacare repeal and replacement plan — but mostly it's been a public role, making speeches where he has a tendency to repeat his best lines in every speech. Now, though, we're getting a better picture of his behind-the-scenes role in building support among conservatives — and it's a big one.
On Friday, he held a "listening session" with just about every major conservative group. One of their main messages was that Republicans have to go after Obamacare's insurance regulations, not just the other pieces — even if they have to push harder to convince the Senate parliamentarian to let them do it. Chris Jacobs, a health care analyst who was in the meeting, said his message was that those regulations are driving up costs — everything from guaranteed coverage to restrictions on the rates insurers can charge, required benefits, and rules about the value of the coverage.
On the bright side: "The White House and Administration are listening to conservatives — and that's a good thing."
Trump finally ended the suspense on Friday and nominated Scott Gottlieb to be the next Food and Drug Administration commissioner. You could save yourself some time and read my "what you need to know" from Friday, but the bottom line is that he has a ton of experience and Republicans and Democrats all seem to like him.
His American Enterprise Institute colleague Joe Antos, a member of the Axios board of independent experts, says the most important thing to know about him is his depth of experience, including past jobs at FDA and the Centers for Medicare and Medicaid Services. "The combination of medical, scientific, administrative ... and market expertise that Scott brings to the job is unique — and that's not hype," Antos said.
It's not that he's free of potential conflicts of interest — the Washington Post noted his "deep ties to the pharmaceutical industry." But that's probably not going to be enough to trip up his nomination, given all of the bipartisan gushing about him. It's one of the rare cases where Trump nominated the least provocative candidate in the mix.
"Right now, the date that's in the bill is what the president supports." — White House press secretary Sean Spicer, Friday, on moving up the end date for Medicaid expansion.
"Those are great ideas that would improve the bill. If the House sees fit to make the bill better, they'd certainly have the support of the White House." — Office of Management and Budget director Mick Mulvaney, Sunday, on moving up the Medicaid expansion end date and adding work requirements.
What we're watching this week: CBO score for the Obamacare replacement bill, today or Tuesday. Also: Senate confirmation vote for Seema Verma, today, 5:30 pm Eastern; House Budget Committee marks up the budget "reconciliation" package tying together the repeal bills, Wednesday.
What we'll watch this week as long as we can mute Wolf Blitzer: CNN town hall with Tom Price, Wednesday.
What we're watching next week: House vote on the Obamacare replacement package.
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