Good morning — all set for President Trump's speech to Congress tonight? We know he's going to talk about Obamacare repeal, but now he has to satisfy two very different Republican audiences: governors who don't want anyone to lose coverage, and conservatives who don't want to create a "new entitlement."
Meantime, Cory Booker is going to have a chance to work with Bernie Sanders on drug prices — and get back in the good graces of progressive Democrats again.
It didn't take long for the Republican governors to lose the spotlight. Now everyone is back to worrying about the conservative hardliners in the House. Within a few hours of each other:
Why it may be a crisis: If the two are serious about voting against the bill, and they bring most of the members of their groups with them, that pretty much ends any chance that the House could pass an Obamacare repeal bill. Even if they succeeded in knocking the tax credits out of the bill, the Senate would never pass a repeal bill that didn't give customers another way to buy health insurance.
Why it may not be a crisis: Would they really vote against repeal when the time comes, or are they just trying to negotiate changes? Meadows and Walker want to repeal Obamacare as much as anyone else — which is why Republican leaders have been betting they wouldn't really tank the repeal effort.
What to watch: Jonathan Swan reports that Trump was still working on his speech to Congress last night — so watch to see if he tries to stare down the conservatives.
What did the governors want again? They told Trump yesterday that they don't want any of their constituents to lose health insurance — and they haven't seen any details yet that would back up his assurances, Caitlin Owens reports. "There's no specificity, and that's one of the things I want to see," Nevada Gov. Brian Sandoval told reporters after the meeting.
Speaking of the GOP tax credits, Caitlin Owens took a look at how they'd compare with the premium tax credits in Obamacare. (The big difference: the GOP version would be flat credits, based on age, rather than the income-based ones in Obamacare.) The bottom line: younger, wealthier people would do better under the GOP version, but older, poorer people would do worse. Read the story here.
The Republicans have been getting some very bad news lately about how many people would actually have insurance under their Obamacare replacement plans. But it's important to remember a couple of things:
Yes, but: The same estimate showed a long-term loss of coverage of 4 million people, mainly because the Medicaid expansion would be repealed. (Holtz-Eakin says "I do not for the life of me believe that that's what they're going to do" with the actual GOP bill.)
And: Any policy changes, especially with the tax credits, would probably have to be pretty major to make a difference. Avik Roy, a conservative health care expert, writes in Forbes that the flat tax credits in the draft plan are a "fatal flaw," because "millions of highly vulnerable people—those near the poverty line and those with poor health status—will not receive enough in tax credits to afford the coverage they need."
Cory Booker had a big political problem on his hands earlier this year after he voted against Bernie Sanders measure allowing Americans to buy cheaper prescription drugs from Canada. It was only a symbolic vote, a non-binding budget amendment that wouldn't have done anything by itself. But by voting against it, Booker — who pretty much everyone expects to run for president in 2020 — put himself on the wrong side of a big issue for progressive Democratic voters.
Now, he's about to get back on the right side. Booker and Sanders, along with a group of other Democrats, will introduce a fully developed bill today to allow the drug imports. It will include the language Booker thought was missing last time — provisions to make sure the imported drugs are safe. Problem solved!
A spokesperson with the Centers for Medicare and Medicaid Services told Bob Herman that the agency "anticipates awarding a contract" this year for a private company to audit Medicare Advantage insurers. A little-known Obamacare provision required the expansion of recovery audit contractors, or RACs, to Medicare Advantage and Part D plans, and it looks like it will finally happen.
Why this matters: The agency is currently conducting what are called "risk-adjustment data validation audits," which are reviews of Medicare Advantage insurers to see if they are overcharging Medicare. Aetna, Humana, UnitedHealth Group, multiple Blue Cross Blue Shield plans and other companies are facing the audits right now, but the results haven't been released yet.
Why insurers are nervous: Health insurers fear the reviews because they know an adverse outcome could force them to pay back a lot of money. The industry won't be thrilled the feds are adding a private auditor to the mix. It's worth noting that hospitals and doctors hate Medicare RACs, which are paid a percentage of every overpayment they find.
A new report says health care organizations in the United States are going to spend a lot more on cybersecurity — but it sounds skeptical that the money will go to the right places, especially when there's so much more use of electronic health records and other digitized personal health data.
The main points from the report by Thales and 451 Research:
What we're watching today: Trump's speech to Congress, 9:10 pm Eastern.
What we're watching this week: Senate Finance Committee confirmation vote on Centers for Medicare and Medicaid Services nominee Seema Verma, Wednesday; House Energy and Commerce health subcommittee hearing on reauthorizing the Food and Drug Administration's generic drug and biosimilar user fee programs, Thursday; MedPAC discusses Medicare premium support, Friday.
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