Axios Vitals

A briefcase with a red cross on the front.

March 09, 2017

Good morning ... That sure was a lot of hours we'll never get back, thanks to the House committee markups of the Obamacare replacement bills. And by the way, they still don't have the votes to pass the House, and the Republicans aren't any closer to getting them.

The time-wasty Obamacare markups

If Republicans were really trying to jam the Obamacare replacement bills through the committees, as the Democrats charged, couldn't they have jammed it a little faster? Here's where things stood as of this morning:

  • The House Ways and Means Committee approved its bill shortly before 4:30 a.m.
  • The House Energy and Commerce Committee was still going at it.

What took so long? Lots of substantive amendments and serious work? Not really. Blame lots of point-scoring Democratic amendments, like trying to write President Trump's "health care for everybody" test into law, preventing cost increases for seniors, guaranteeing no job losses at hospitals, and, for some reason, releasing Trump's tax returns.

But at least Ways and Means got going on those trolling amendments during the daylight hours. In Energy and Commerce, chairman Greg Walden let the debate, and the bickering, drone on for hours before they even got to any amendments. They finally took up the first of 100 threatened Democratic amendments at 7:30 pm: trying to rename the GOP bill "The Republican Pay More for Less Care Act," just like the signs the Democrats briefly plastered all around the committee room.

It got voted down around 10:30 pm — after which Walden warned the Democrats to "buckle in" so they could work through the night. They did eventually get to more substantive Democratic amendments, like getting rid of the change to Medicaid per-capita caps. (It failed.) As of this morning, they were arguing about premiums for older people. They weren't moving any faster, but they were sounding sleepier.

Caitlin Owens stayed into the early morning hours at the Ways and Means markup, so you should definitely read her story here. Me? I went to sleep and got up early. Didn't miss a thing.

What's the game changer going to be?

The big question right now is: What would it actually take to stop the hemorrhaging of conservative support?

President Trump met with the leaders of conservative groups yesterday, and they seemed pleased to have face time with him. And Walden insists the outreach will make a difference. "I think when the president of the United States who campaigned on repeal and replace says, 'This is the repeal and replace bill' ... the dynamic changes," Walden told reporters yesterday.

That might be wishful thinking, though. As Jonathan Swan and I reported yesterday, the conservatives want such major changes in the bill that a few more Trump meetings probably aren't going to change anything. They want to get rid of the refundable tax credits and end the Medicaid expansion, and they want more in the bill that would be specifically aimed at cutting people's health care costs. "It's not going to be cosmetic fixes," a Freedom Caucus aide told me.

That was underscored by the statement FreedomWorks president Adam Brandon put out after the Trump meeting. He said his group wants to "get to 'yes' on this bill," but look at the list of objections his group raised and see how easy you think the solutions would be:

  • The tax credit
  • The continuation of Medicaid expansion (until 2020)
  • The possibility that Congress will keep delaying the end date of Medicaid expansion
  • The "continuous coverage" provision that would penalize people who don't stay insured
  • The "remaining regulations in the bill"

Yes, but: The Trump team may give it a shot: CNN's Jim Acosta reports that the White House might be willing to move up the Medicaid reform start date to 2018 to appease the conservatives.

Nice try: House Speaker Paul Ryan used one of his best arguments at a meeting with House Republicans yesterday: If they don't pass the repeal bill quickly, it will delay their other priorities, like tax reform. That didn't change anything.

Also piling on: Doctors, hospitals, insurers

Worth noting: The list of health industry groups against the bill just keeps growing. Now it includes the American Medical Association, the American Hospital Association, the Federation of American Hospitals, and several other physician groups. America's Health Insurance Plans, the trade group for health insurers, raised concerns about Medicaid and the tax credits. Oh, and AARP is livid. Bloomberg has a good rundown here.

Refundable tax credits, then and now

As we've reported before, several of the Freedom Caucus members were co-sponsors of Price's Obamacare replacement bill when he was in the House — which included refundable tax credits. So what's the difference between that version and the one they're complaining about in the House GOP bill now?

Two things we're told the Freedom Caucus is focusing on:

  • The context is different. The Price bill also repealed Obamacare's insurance regulations, including the requirement that makes insurers cover everyone regardless of health status, and the Medicaid expansion. Freedom Caucus members think those were two of the worst things about Obamacare.
  • The tax credit under Price's plan could have gone straight to a customer's health savings account — not directly to the insurance company, as it would under the House GOP plan.

Reality check: The arguments may make ideological sense to the caucus members, but they could be a hard sell to the public and the rest of Congress — because other Republicans like the Medicaid expansion and the coverage of pre-existing conditions.

The problem, in one quote

Here's what Freedom Caucus member Dave Brat told some of us on his way in to the Ryan meeting: "We've paid way too much attention to coverage. That's important, right? But we've got to design a system that works for 300 million people."

And what about the 20 million people who gained coverage under Obamacare? "The 20 million, you can handle through the safety net. We've always been a generous country."

Why it matters: Republicans do believe that Democrats have been too focused on high coverage numbers at any cost — but "too much attention to coverage" isn't the bumper sticker they've been looking for.

DeGette to GOP: Why don't we do what we did with Cures?

One Democrat who didn't spend the whole day trolling the Republicans was Rep. Diana DeGette — but that's because she has actually worked with them on major health care legislation, last year's 21st Century Cures Act. And she asked them why the two sides couldn't use that same model to work on Obamacare fixes, the way she worked with former Energy and Commerce Committee chairman Fred Upton on the Cures bill.

Later, DeGette told me she has already been approached by Republicans — from both the House and Senate — asking her to work with them. But she turned them down, she said, until the conversation moves from repeal to fixes: "If you're talking about repealing the ACA, we're not interested." DeGette says she can't tell when the conversation might shift — because she doesn't think the Republicans have a plan for what happens if repeal fails.

Brutal 2016 doesn’t hurt Humana CEO’s pay

Last year was rough for Humana CEO Bruce Broussard. The Justice Department ruled against his company's proposed marriage with Aetna, and Humana's overall profit fell by more than 50% after it got clobbered in the Obamacare markets and struggled with its Medicare Advantage plans, Bob Herman reports. (Don't forget: Humana is abandoning the Obamacare exchanges completely in 2018.) Yet Humana's annual proxy filing shows Broussard's pay package increased by more than three times.

The numbers: Broussard's total compensation (based on his actual realized stock gains, not estimated fair value of stock) in 2016 was $17 million compared with $4.8 million in 2015.

How it got there: A vast majority of Broussard's pay came from cashed-out stock. But his bonuses were weighed heavily by a juiced-up figure known as adjusted earnings per share. That number excluded Aetna merger costs and losses associated with Obamacare's risk corridors. Humana said doing so was "consistent with past practice and appropriate."

What we're watching today: The Energy and Commerce markup of the Obamacare repeal bill is still going. If you want to see who passes out first, watch the livestream here.

What we're watching this week: Senate confirmation vote for Seema Verma, likely Friday.

What we're watching next week: House Budget Committee is expected to mark up the budget "reconciliation" package tying together the repeal bills, assuming Ways and Means and Energy and Commerce approve them. It could go to the Rules Committee the same week.

What we're watching in two weeks: House vote on the Obamacare replacement package?

Thanks for reading, and let me know if you've figured out how this story ends: [email protected]