April 27, 2017

Happy Friday! Do you like how we're avoiding those health care cliches when we bring you the news? Like, "the GOP health care bill is on life support"? Or, "the patient is crashing"? Or, "do no harm"? You're welcome.

That was almost an amazing health care comeback

So it looks like winning the Freedom Caucus wasn't really enough to bring the Republican health care bill back to life. House GOP leaders are still going to need some moderates, and they're probably going to have to give them something, and the search is on for that "something." Until then, don't expect the House to call the vote, because they don't want to fall on their face again.

Bottom line: No vote this week, House Majority Leader Kevin McCarthy told reporters after a leadership meeting last night. A GOP aide said they're "trending in a decent direction but no need to rush."

How short? Plugged-in lobbyists tell Caitlin Owens Republicans appear to be short somewhere around 15 votes. CQ-Roll Call said that at least 18 Republicans were solid "no" votes, not counting undecideds. Republicans can only lose 22 of their members.

What they're saying: The holdouts are mainly worried about weakening coverage for sick people. Rep. Ryan Costello of Pennsylvania: "Protections for those with pre-existing conditions without contingency and affordable access to coverage for every American remain my priorities for advancing healthcare reform, and this bill does not satisfy those benchmarks for me."

How you know they're short: House Speaker Paul Ryan was still in we'll-vote-when-we're ready mode yesterday: "We want to go when we're ready to go."

What's next: Caitlin reported that Republicans are talking about adding more money for high-risk pools to win support from the moderates.

Price concerns aren't hurting drug industry profits

President Donald Trump's rhetoric around price controls and public outrage over high drug costs have forced the industry to ease up on drug price increases. So does that mean the drug industry will lose a lot of money? Not really, Bob Herman reports. First-quarter reports show many of the largest pharmaceutical companies increased their profits compared with the same period last year.

Sales of some drugs lagged, but companies still hiked list prices by high single digits — well above general inflation. Read Bob's story here, including a sampling of the major pharmaceutical firms that reported higher first-quarter earnings this week.

Ryan's bold promise on pre-existing conditions

Pretty sure you're going to see this clip a lot if the House health care bill passes: Paul Ryan promised yesterday that "People will be better off with pre-existing conditions under our plan." Why? He didn't really talk about what's concerning all of the critics — the state waivers that would let insurers charge higher rates to some sick people. Instead, he talked about how many more health insurance options everyone would have.

But Ryan also talked about high-risk pools, and how the GOP bill would improve on past programs by adding federal funds on top of state funds. And he said the high-risk pool in his home state of Wisconsin was "pretty darned good" in pre-Affordable Care Act days.

Bottom line: He thinks the solution is to subsidize people with health problems directly "so that everybody else doesn't have to bear those costs in their insurance pools."

About Wisconsin: The one quote that that sums up the state's high risk pool, from the Wisconsin State Journal's deep dive in February: "It worked well for 21,000 people," Donna Friedsam, health policy programs director at UW-Madison's Population Health Institute, said. "But it did not solve the problem of getting most of the people in our state connected to affordable coverage."

Why some might quibble with the "better off" part

Here's what Jeanne Lambrew, a former health care adviser to President Barack Obama and now a senior fellow at the Century Foundation, had to say when I asked about Ryan's promise on pre-existing conditions:

  • There is "zero evidence" that more insurers will enter the market under the GOP bill.
  • In fact, she writes, "low deductible gold plans would likely disappear and the bill would, in CBO's words, make 'shopping for a plan on the basis of price more difficult.' "
  • "People don't have choices when then can't afford them."
  • The end of the Medicaid expansion, limits on federal Medicaid spending, and state waivers of the Affordable Care Act's essential benefit requirements would leave people with pre-existing conditions "worse off," not better off.

There's also a new analysis by the Brookings Institution that suggests the state waivers from the Affordable Care Act's pricing rules might have a runaway effect and raise premiums for all sick people. Here's why:

  • The amendment would create two separate premium options: one for people who stay insured where healthy people and sick people pay the same rates, and, one for people who do not keep themselves insured where sick people could be charged more.
  • Healthy people would have an incentive to choose the second one, since they could be charged less because they're healthy.
  • That would leave the sick people in the first one — and their premiums would get more and more expensive because all of the healthy people would be gone.

Remember this stat on lapses in coverage

Republicans aren't really trying to make life harder for sick people, of course. Their goal is to keep people from gaming the system by waiting to buy health insurance until they're sick. That's why the new GOP amendment only lets states allow higher premiums for people with health conditions who had more than a 63-day lapse in coverage.

But here's what the liberal Center on Budget and Policy Priorities said about that in a report yesterday: "Nearly one-third of people with pre-existing conditions experience a gap in coverage over a two-year period due to job changes, other life transitions, or periods of financial difficulty."

Trump's not ready to commit on insurer payments

Here's his latest, from an interview with the Washington Examiner: He won't decide whether to cut off the Affordable Care Act insurer payments or push Congress to fund them until the fate of the repeal bill is decided. "I want to see what happens with our bill first," Trump told the Examiner.

Between the lines: That's a step back from withholding the payments as negotiating leverage, but it still suggests that Trump wants to link the payments to whatever happens with the health care bill.

Ryan's not stepping up either: He doesn't want to fund the payments until there's a resolution of the House GOP lawsuit against the subsidies. "I won't speculate because I don't know what the outcome of the lawsuit is going to be," he said at yesterday's press conference.

Clarity, please: The insurance trade group America's Health Insurance Plans, along with several big-name physician and business groups, gave their response yesterday to the White House promise to keep making the payments "for now": They want a two-year commitment.

Where people would get hit if the payments stop

If Trump stops the payments, take a look at this map — that's where low-income Affordable Care Act customers would be hit the hardest. The highest percentage of low-income customers are in the red states, and a lot are in the south.

What we're watching next week: Same as always: Will we ever get a health care vote?

Thanks for reading, happy weekend, and tell us some important health care stuff that we missed: [email protected].