Good morning ... Know what Obamacare is getting for its 7th birthday on Thursday? A repeal vote in the House, that's what! Happy birthday, Obamacare. Gonna be the worst birthday party ever. Brings back bad memories of when I lost at miniature golf on my 7th birthday, and then got repealed.
This is going to be one of those weeks where you really need help de-cluttering your news, and that's what we, on the Axios health care team, are trying to do. But if you think we're missing important stuff, please let us know. And keep checking the Axios health care news stream for all the latest, and sign up for our newsletters and breaking news alerts here.
Here's what you need to know as we head into the week of the House vote:
There's still a long way to go in the House, but GOP leaders are a lot closer to nailing down the votes after President Trump struck a deal with the Republican Study Committee on Friday morning to win their support. (Caitlin Owens and Jonathan Swan give a rundown here of the Medicaid changes they've been promised.) Here's who to keep your eye on now:
The bigger problem is in the Senate, where senators are more independent and less likely to fall in line than in the House. Sens. Ted Cruz and Susan Collins were on separate Sunday talk shows discussing how they can't support the bill, but from opposite ends of the spectrum: Cruz wants to knock out the Obamacare insurance regulations, while Collins is worried about lost coverage and Medicaid cuts. Try to figure out the formula that makes both happy.
Obamacare was good for health care jobs around the country, but especially for hospitals. Now, Bob Herman reports that they're going to have a problem on their hands if repeal happens: What are they going to do with all of those expensive new hires if millions of people lose health coverage? The hiring has already slowed down because of all of the uncertainty, and if they have fewer patients who can pay for their medical care, they might have to reduce their staffs through attrition — or layoffs. Read Bob's story here.
I was all set to give you an in-depth look at all of the health care bills Republicans are lining up for "Phase 3" of Obamacare replacement — all the proposals they can't put in the budget "reconciliation" bill. Here's the list so far:
There are substantive reasons to learn about the pros and cons and all of them. But here's the problem: All of them might be able to pass the House pretty easily, but then they'd all need Democratic votes to pass the Senate, since they'd need 60 votes.
So I asked around about whether any of them could get enough Democratic votes, and here's what a Senate Democratic leadership aide told me: "No they will not. We are happy to work with Republicans to improve health care but they have to drop repeal first. If they manage to pass a repeal bill, they're on their own. There won't be a phase 3."
Cruz actually laughed at the idea on CBS's "Face the Nation" yesterday when John Dickerson asked him about it. "That ain't going to happen," Cruz said, calling it "the sucker's bucket." So, moving along ....
Steven Brill points out something for your radar: Price's long fight to let doctors charge more to Medicare patients could now be a big deal. Modern Healthcare reported that in his written responses to questions from the Senate Finance Committee considering his nomination for Health and Human Services secretary, Price didn't back down from his support for a change in the Medicare law that would allow doctors participating in the program to "balance bill" Medicare beneficiaries — meaning they could charge them more than the amount Medicare pays. (You can read the exchange here — it starts on page 8.)
Balance bills are often given to patients with private insurance, usually because they are using a doctor out of the insurance company's network. But the practice has always been banned for doctors treating Medicare patients. Under the change long advocated by Price, a former orthopedic surgeon, the doctors could have their cake and eat it, too: be in the Medicare network, but charge as much extra as they can to as many patients as they can.
Why it matters: Medicare, with about 55 million enrollees, protects about twice the number of Americans who are enrolled through the Obamacare exchanges and the expansion of Medicaid.
Some think tank is apparently warning that work requirements for Medicaid — the latest thing Republicans are about to add to the Obamacare replacement bill — won't work because "making cash assistance or food stamps contingent on work participation is one issue, denying medical care to sick, poor people is another matter."
Just gonna check and see who wrote that — guessing it's the Center for American Progress or some other lefty think tank that would never...OMG IT'S THE HERITAGE FOUNDATION. Here's what senior research fellow Robert Rector wrote: It's likely to be optional, so most governors would ignore it; the rule would be "almost impossible to administer and enforce;" and, no one's really going to deny medical care to someone who didn't do their work assignments.
Rector isn't really against work requirements in principle — he just thinks they should be applied to food stamps, which would be easier to enforce and covers a lot of the same population. But it will be interesting to see if any Republicans grapple with the practical problems when the Medicaid part of the bill is being rewritten.
What we're watching today: Trump rally in Louisville, Kentucky to build support for the GOP bill, 7:40 p.m. Eastern. Also, Trump meets with Ryan, Price, and Zeke Emanuel, 11:30 a.m. Eastern.
What we're watching this week: House Rules Committee takes up the Obamacare replacement package, probably Wednesday ... and the big House vote, Thursday. The House also votes on bills to eliminate the antitrust protection for insurance providers and to create association health plans. Also, Senate HELP Committee will hold a hearing on reauthorizing the Food and Drug Administration's user fee agreements, Tuesday.
Thanks, and let me know what you'll be drinking on repeal night: email@example.com.