Happy Friday ... You thought we were heading into a quiet couple of weeks? Maybe, but the lesson of this week is, you never know when Trumpcare might rise again because they found a couple more votes. Happy recess!
And one goof I made yesterday: Michael Needham is the CEO of Heritage Action, not Heritage Foundation. Knew that, but didn't type it. It matters. So, moving on ...
Here's the big problem Republicans are facing on Trumpcare: They're facing so much pressure to pass a bill — any bill — that the changes have stopped being about improving the policies, or steering toward a broader, coherent vision of conservative health care reform. It's all about chasing votes now, and the more they try, the more the changes leave health care experts scratching their heads.
The latest as we head into the congressional recess:
What the experts are saying: Conservative health care analyst Avik Roy says the risk-sharing fund shows "considerable progress" in improving the bill — though he says it needs more work on regulatory reform and aid to the low-income elderly. But Chris Jacobs, another conservative analyst, wonders why the fund wasn't tied to the state waivers the GOP also wants: "I could be missing something, but I don't see a coherent policy vision."
What's next: GOP leaders are under intense White House pressure to bring everyone back from recess to vote on the bill, but they won't do it unless there are signs that they're actually picking up votes. Ryan spokeswoman AshLee Strong: "Should a path toward 216 votes emerge, the speaker wouldn't hesitate to bring members back to fulfill our promise to repeal and replace Obamacare."
Bottom line: It's not likely right now — but don't make any travel plans you can't change.
Despite all the hype, the $15 billion over 10 years proposed for the high-risk fund really isn't all that much money and would probably have only a small impact on premiums, Caitlin Owens reports after running the idea by some experts. Here are a couple of comparisons:
Here's the most striking paragraph from the Des Moines Register's story on Aetna's decision to stop selling Obamacare plans in Iowa next year — the second pullout of a major insurer in one week:
"Only one other insurer, the relatively small Minnesota carrier Medica, currently sells individual policies in most Iowa counties....If Medica pulls out, many Iowans could have no options for individual coverage, either on or off the Affordable Care Act's 'exchange' marketplace."
So what's the verdict? Medica spokesman Greg Bury tells the Register the company is "currently evaluating the situation and our options."
Health insurance companies that predominantly cover low-income people face a difficult decision for 2018: Drop out of the Obamacare marketplaces and ignore their missions, or stay in and raise premiums a lot to account for the uncertainty created by the Trump administration's repeal efforts.
Bob Herman reports that one safety net plan in New York, Affinity Health Plan, is hanging around for 2018. However, "the rate increases are going to be significant," said Michael Murphy, the new CEO of Affinity, which covers about 33,000 New Yorkers in traditional Obamacare plans as well as Obamacare's "Basic Health Program" plans. "Everybody's looking to at least get their head above water."
Why this matters: The mentality of local safety net plans is a lot different than the national for-profits. Aetna, Humana and UnitedHealth Group had no qualms leaving Obamacare marketplaces because they are tiny slivers of their business. Companies that didn't invest in Obamacare or were late entrants, like Wellmark in Iowa, similarly find it easier to bail. But local not-for-profits may feel more compelled to stay.
There was a pretty clear message from a Kaiser Family Foundation poll earlier this week: If Obamacare collapses, it's President Trump and congressional Republicans who will get blamed, not the Democrats. Today, Kaiser's Drew Altman explores exactly what that means. The blame will stick to the GOP if they try any of these things:
They're all tempting for a party that doesn't believe in the law, but they'd all cause serious damage that would be easily traced back to the GOP. Read the piece here.
Couple of telling nuggets from the Washington Post's look at the political troubles of Trump's chief strategist:
The DNA testing company is making a slow comeback from its big Food and Drug Administration smackdown a few years ago, CNBC reports. It's now offering a $199 FDA-approved test for several genetic diseases, and the company says the most popular one, by far, is for a gene that indicates a risk of Alzheimer's disease. That's not the full range of tests 23andMe used to offer, but it's something of a turnaround for the company, which got slapped by the FDA in 2013 for not being able to prove its tests were accurate.
Have a great weekend, and let me know who we should heckle while Congress is gone: email@example.com.