Good morning ... Graham-Cassidy doesn't have 50 votes yet, but a vote is still — for now — planned for next week. So we have a few more days to keep digesting the policy. If you spot anything interesting, let me know: email@example.com.
If your list of predictions for 2017 included "multi-round battle between Jimmy Kimmel and Sen. Bill Cassidy over federal protections for people with pre-existing conditions," congratulations. If you also predicted that Kimmel would win that argument, you should go buy some Powerball tickets. Because policy experts tell Axios' Caitlin Owens that Kimmel has the upper hand.
Here's the juice: The bill Cassidy introduced with Sen. Lindsey Graham would not repeal the section of the Affordable Care Act that requires insurance companies to cover people with pre-existing conditions, nor could states seek a waiver from that provision.
Go deeper: Because the bill gives states so much control, a more liberal state like California might want to preserve more of the ACA's regulations. But those states would take the biggest hit from Graham-Cassidy's funding cuts — making more aggressive waivers a necessity.
A quick summary of what you might have missed yesterday:
News: Majority Leader Mitch McConnell confirmed he intends to hold votes on the bill next week. That doesn't mean he has the votes. "Intends" is doing a lot of work. And none of the wavering senators came off the fence publicly.
Why it matters: If you're thinking to yourself, "Well, come on, most of this stuff is from the bill's critics," you are correct. An analysis from the Congressional Budget Office would have been much more authoritative. Also, who are this bill's allies?
Outside advocacy groups have kept up the pressure on congressional Republicans for years to repeal the ACA. But none of them seems too excited about Graham-Cassidy.
Context: These groups are part of the reason ACA repeal is such a high priority for congressional Republicans, and why so many of them are worried about primary challenges if they don't deliver. Together, these organizations hold a good deal of sway with the conservative grassroots, and could still help gin up support for Graham-Cassidy if they want to, as the bill changes.
Yes, but: The conservative grassroots aren't a huge threat to any of the senators who are in the mix here. Sen. John McCain was just reelected in 2016. So was Sen. Lisa Murkowski, and remember, she won a write-in campaign before that. Sen. Susan Collins is safe. Space to the right of Sen. Rand Paul, like the multiverse, exists only in theory.
Another hit: Conservative policy analyst Chris Jacobs raised a new objection in the Federalist yesterday: He says the bill would give the Health and Human Services Department too much authority over the law's funding formula, calling it "a trillion-dollar loophole that leaves HHS bureaucrats with the ultimate say over how much money states will receive."
Caitlin also flagged one of the under-appreciated parts of Graham-Cassidy: The tight timeline for states to decide what kind of new health system they want, and to implement it. States would have to do both by the beginning of 2020, when federal premium subsidies and Medicaid expansion funding would become part of a block grant.
What this means: While there's nothing in the bill that explicitly requires states to pass legislation as part of the transition process, it almost certainly would have to happen.
The details: States might need legislation to:
"Graham-Cassidy doesn't require states to pass a law in order to ask for a waiver," Nicholas Bagley, a health law professor at the University of Michigan, told Caitlin. "As a practical matter, a state that wants to create the infrastructure to allow it to parcel out and spend the block grants will probably have to secure legislation allowing it to do so."
HHS secretary Tom Price and Centers for Medicare and Medicaid Services administrator Seema Verma put out a notice yesterday that they want to overhaul the direction of the Center for Medicare and Medicaid Innovation — an agency created by the ACA to test different ways to pay for and deliver health care. The goal: Roll out conservative, "market-driven" health policy ideas.
Why it matters: The Innovation Center, unknown to most Americans, holds a lot of power in trying new health care experiments that attempt to lower costs and improve quality. But some health policy observers told Axios' Bob Herman they're worried the Trump administration is changing course with minimal transparency and eyeing radical changes to Medicare and Medicaid.
What they're saying: "There's some very industry-friendly ideas in this (request for information)," said Aisling McDonough, a former CMS staff member who worked during the Obama administration.
Bob has the full rundown of what Price and Verma have in mind — and what's not going to change.
What we're watching today: The most important show in health policy, "Jimmy Kimmel Live."
Also, of course any action on Graham-Cassidy, and insurers' last-minute moves before finalizing their contracts for the next open enrollment period.
What's on your mind? firstname.lastname@example.org