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Happy actual Friday! We're getting a better picture of the Obamacare replacement plans the House committees will start working on after the recess. But they're still figuring out critical details, like any numbers at all, and they're nowhere close to getting all Republicans on board.

Surprise! It was "A Better Way" all along

Giphy

We've all been in suspense, chasing the details of what House Republicans will do to replace Obamacare — and now it's clear we could have been reading House Speaker Paul Ryan's "A Better Way" plan the whole time. The briefing document from yesterday's House Republican meeting sticks closely to the Ryan plan from last year, at least in the parts it includes.

The big things that are being picked up from "A Better Way":

  • Tax credits (fixed amounts, based on age, not income)
  • Health savings accounts
  • Medicaid reform (choice between per-capita caps and block grants)
  • "State Innovation Grants" (can be used for high-risk pools)

The big pieces that are left out:

  • Limiting the tax breaks for employer health coverage (Republicans are still talking about it)
  • Medicare "premium support" plan (President Trump's not interested)
The backstory: None of this should be a surprise. Ryan has been the driving force in the House on health care reform all along, and he noted yesterday that his former colleague, Health and Human Services secretary Tom Price, was "one of the primary architects" of the Better Way plan. The Senate still has to buy off on it, but the thinking among House GOP aides is that the House has more leverage because Ryan has been working on these ideas for years.

They haven't solved the Obamacare Lite problem

The big signal that House Republican leaders are sending with the Obamacare replacement plan: The Freedom Caucus doesn't get to run the show.

  • The conservatives have insisted that the law needs to be repealed before they worry about a replacement. And earlier this week, Rep. Raul Labrador said they don't want to pass anything that looks like "Obamacare Lite" — another huge overhaul of the health care system that just happens to be more conservative.
  • But House Republicans are clearly headed for an ambitious overhaul, and they even brought in Price to tell the rank and file that President Trump wants the repeal and replacement to happen at the same time.
  • Labrador made it clear the new plan didn't avoid the "Obamacare Lite" trap. "No," he said when I asked him. "So far it just sounds like Obamacare Lite."
  • He said he wanted to find out more about it, but "there were only two minutes of time for members to ask questions." Rep. Jim Jordan had the same complaint.

Why it matters: The House leadership is calling the bluff of the Freedom Caucus — but they do need their votes to pass the plan. And then they'll have to keep the conservatives on board if the Senate tries to moderate the plan.

FWIW: Caitlin Owens reports that none of the Senate Republicans she asked had read the House plan. They didn't know it was out.

Ryan on the big problem: Medicaid

Here's what Ryan said at his weekly press conference yesterday: "I think it's 32 states, if I am not mistaken, have Medicaid expansion. Mine did not. We're going to have to find a solution that accommodates each of these two concerns."

What's in the plan: States that expanded Medicaid could keep getting their extra federal funds "for a limited period of time," but they'd go back to the regular federal matching rate "at a date certain." Republicans are still figuring out what those dates will be, but the goal is to stop the states that expanded Medicaid from enrolling new people.

What's missing is what matters the most

The briefing document lays out all of the ideas but includes almost none of the specifics that really matter, like the size of the tax credit, the amount of the "state innovation grants," or the ways to pay for all of it. That's partly because Republicans are still getting official cost estimates, but those are the details that will really make a difference, according to outside analysts:

  • Harvard's John McDonough, former Senate Democratic aide and member of the Axios board of experts: "What is the size of the credit? Why so shy about this? Why the veil over the most important single item in a plan? Maybe because revealing the number will allow experts to figure out quickly how many will lose coverage."
  • Chris Condeluci, former Senate Republican aide and member of the Axios board of experts: Key questions are whether it really repeals all Obamacare taxes right away or phases some out gradually, and how to be fair to states that expanded Medicaid and the ones that didn't.
  • Zeke Emanuel of the Center for American Progress: "How much is the subsidy? We don't know their value so we cannot say what it will cover ... There is not enough information but what appears is that people will pay more and many people will find insurance impossible to buy."

How the FTC’s new competition chief could affect health care

President Trump's acting Federal Trade Commission chairwoman, Maureen Ohlhausen, is wasting no time shaking up the agency. Bob Herman reports that she named Tad Lipsky the new acting director of the FTC's Bureau of Competition yesterday — the office charged with policing mergers and acquisitions for most of the health care industry.

What this means: Potentially less oversight, but not for all health care players. Lipsky replaces Deborah Feinstein, who went after some large hospital and health system mergers. However, her group has been lax on many transactions involving drug companies, pharmacy benefit managers and retail pharmacies.

  • Former FTC staffers say Lipsky is a pro-business conservative who is less aggressive in challenging M&A, but he also is knowledgable about health care and likely won't slow down reviews on hospital mergers.
  • Former FTC antitrust attorney John Kirkwood: "This is not choosing a Steve Bannon ... This is like choosing another establishment figure to the right of Debbie Feinstein."

Key quote: Here's what Lipsky said to U.S. News & World Report in December after Trump won: "The purpose of antitrust is not necessarily to prevent firms from succeeding, even when they become very dominant in their industry."

A few big moments at the Seema Verma hearing

The Centers for Medicare and Medicaid Services nominee didn't answer all of the questions at the Senate Finance Committee hearing yesterday — especially on the new Obamacare rule, which came from the agency she'll be running. But there were a few standout moments:

  • She defended the Indiana approach to Medicaid, which requires low-income people to contribute to their health care: "It gives dignity to individuals ... We don't assume that just because someone is poor, they don't want choices about their health care."
  • She said she doesn't support what Sen. Bill Nelson called a "voucher" system for Medicare, meaning the premium support model that Ryan wants — a sign that the Trump team has given her full permission to brush it away.
  • She might actually be a fan of pharmaceutical benefit managers, which are taking a lot of grief lately for their possible role in contributing to rising drug prices.
  • She said the MACRA bill, which reformed how Medicare pays doctors, was an "important step forward" for outcomes and providers.
For more highlights, read Caitlin Owens' roundup here.

For more Obamacare replacement light reading ...

Republicans went on a tear yesterday with the bill introductions, as they unloaded more details of other pieces of Obamacare replacements. Bookmark these and make someone read them for you:

Between the lines: The pre-existing conditions bill reads a lot like Obamacare — it looks like Republicans suddenly decided to just cover all sick people. But it's supposed to be paired with a "continuous coverage" bill, which would allow people to be charged more if they didn't keep themselves insured. It's also possible that the Trump administration will take some of their own steps to promote continuous coverage, as we noted yesterday.

What we're watching next week: National Governors Association winter meeting, Washington, Feb. 24-27. Also: what's the reaction to the House GOP plan? And what will be the next Obamacare town hall video to go viral?

Have a great weekend, and tell us what you're hearing and what else we need to know: david@axios.com.

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New Trumpcare amendment would require states to define essential health benefits

(Alex Brandon / AP)

A final amendment to the American Health Care Act was introduced Thursday night by the authors of the legislation, a last-minute attempt to win conservatives over by requiring states to define what services insurers must offer enrollees.

Here's what's in the amendment, which will be voted on in the Rules Committee tomorrow before the bill heads to the House floor for a final vote:

  • Beginning in 2018, states will determine essential health benefits. There are currently 10 federal ones under Obamacare, which apply to the individual and small group markets.
  • The repeal of the Medicare payroll tax on high earners would be delayed until 2023.
  • The original bill's Patient and State Stability Fund would get an extra $15 billion to be used for maternity coverage and newborn care, as well as mental health and substance abuse disorder treatment.
Featured

Apple says flaws in latest WikiLeaks disclosure are all old

Mike Deerkoski / Flickr cc

Although much was made about a new batch of iPhone and MacBook flaws disclosed by WikiLeaks on Thursday, Apple says the issues appear to all be old, since-fixed vulnerabilities.

"We have preliminarily assessed the Wikileaks disclosures from this morning," Apple said in a statement to Axios. "Based on our initial analysis, the alleged iPhone vulnerability affected iPhone 3G only and was fixed in 2009 when iPhone 3GS was released. Additionally, our preliminary assessment shows the alleged Mac vulnerabilities were previously fixed in all Macs launched after 2013."
Apple added that it has "not negotiated with Wikileaks for any information."

We have given them instructions to submit any information they wish through our normal process under our standard terms. Thus far, we have not received any information from them that isn't in the public domain. We are tireless defenders of our users' security and privacy, but we do not condone theft or coordinate with those that threaten to harm our users.
Featured

Trump orders tougher Visa screenings

J. Scott Applewhite / AP

President Trump is ordering tougher screenings for Visa applicants as part of his "extreme vetting" policy. Last week Secretary of State Rex Tillerson sent four cables to U.S. embassies and consular officials demanding scrutiny be tightened up, as originally reported by Reuters.

The new rules don't apply to 38 countries who can be admitted using the visa waiver program, including Australia, New Zealand, Japan, South Korea, and most of Europe.

Profiling and delays: This will include "mandatory social media check" if an applicant has been in a territory controlled by ISIS. Such checks are rarely done at present, former officials told Reuters. Consular officials and immigration experts told the NYT this will make it much more common to be denied a Visa to the U.S. and they fear this might lead to profiling based on nationality. It will likely also extend Visa review times.

Context: The cables were issued to complement the travel ban that was upended by a court in Hawaii, but some provisions were remedied to abide by the temporary restraining order. Namely, questions specifically aimed at applicants from the six countries listed in the ban were rescinded.
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Trump's ultimatum: If vote fails, Obamacare stays

AP

Budget Director Mick Mulvaney has just laid down a gauntlet to House Republicans on behalf of President Trump: pass this bill, or Obamacare remains in place.

Members of the conservative Freedom Caucus want more concessions but, according to Mulvaney, Trump will not negotiate further.

The president demanded a vote tomorrow, and now it appears he will get it. He is all but daring Republicans to vote no.

Featured

Twitter is weighing whether to build a paid version of TweetDeck

Richard Drew / AP

Twitter is considering whether to build premium software geared toward power users of its service.

The company already owns TweetDeck, a program geared toward those who juggle multiple Twitter accounts and spend a lot of time on the social media service. A paid version could offer extra features and bypass advertising.

Andrew Tavani, managing editor of Women in the World, first spotted a message from Twitter about the potential service.



Still pondering: It appears the idea is still in the early stages and Twitter hasn't decided if it'll build this. "We're conducting a survey to assess the interest in a new, more enhanced version of TweetDeck," a Twitter spokesperson told Axios, adding that Twitter is "exploring several ways to make TweetDeck even more valuable for professionals."

Why it matters: Twitter acquired TweetDeck in 2011 from developer Iain Dodsworth, but hasn't done much with it since as far as expanding features and capabilities. This could be a welcome option for users for whom Twitter is a critical part of doing their job.

Featured

Here are the AHCA changes demanded by the Freedom Caucus

Alex Brandon / AP

The key changes to the Republican health care bill demanded by the conservative Freedom Caucus:

  • A repeal of ACA's Essential Health Benefits (like emergency or maternity treatment) guaranteed under Obamacare
  • An elimination of the "single risk pool," which prevents insurers from splitting the market into healthy and sick groups
  • An elimination of rating restrictions, which allow insurers to base premiums only on age, area, tobacco use and family vs individual plan
  • A repeal on lifetime or annual limits
  • A reversal of standard documentation mandates, which make it easier to compare insurance plans
  • A reversal on Medical Loss Ratio standards, which force large insurers spend at least 85% of premiums on claims

Why it matters: These changes would appease the Freedom Caucus, but could see moderates abandon the bill.

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Fox News: GOP expects 'smoking gun' proving Obama admin spied on Trump

Jack Gruber / AP

Republicans in Congress are expecting a "smoking gun" showing the Obama administration intentionally spied on Trump associates, and possibly Trump himself, Fox News reports:

The intelligence is said to leave no doubt the Obama administration, in its closing days, was using the cover of legitimate surveillance on foreign targets to spy on President-elect Trump, sources said.

A source told Fox that the surveillance left a "paper trail" indicating there was "no other plausible purpose... than to damage the incoming Trump administration." No, Trump Tower wasn't bugged, as POTUS claimed, but if the report is accurate his transition team was targeted for surveillance.

What's next: Fox says the House Intelligence Committee expects to receive the evidence this week. Trump said he felt "somewhat" vindicated by Devin Nunes' statements yesterday about "incidental" surveillance of Trump's communications. Expect him to be less restrained if this report proves accurate.




Featured

Marketo apologizes after video promo for its conference panned as sexist

Marketo, which specializes in helping companies promote themselves, apologized Thursday after one of its own promotions fell flat.

The ad, promoting an upcoming Marketo conference, featured a ditzy female newscaster and the company's male CEO, Steve Lucas. Marketo told Axios the ad, which was roundly criticized on Twitter, has been pulled down.

We sincerely apologize for the offense we caused with what was intended to be a light-hearted promotion for Marketing Nation Summit. The video was created to promote the conference, playing off our theme of engagement. Marketo has always had a steadfast commitment to championing diversity and empowering female leaders in technology and beyond.
Featured

Theranos offers shares to investors if they promise not to sue

Theranos

Theranos, the embattled blood-testing company, plans to offer additional shares to existing investors if they agree not to sue the company, according to a report from the Wall Street Journal citing anonymous sources. Theranos reportedly only has $200 million in cash left, but is already facing multiple lawsuits, including from former partner Walgreens and investor Partner Fund Management.

The deal: The shares would come from founder and CEO Elizabeth Holmes' personal stake in the company, which would result in her losing her majority ownership. According to the Journal, early investors aren't included in the deal, and weren't even informed of it.

Murdoch exit: Theranos has reportedly agreed to buy back the stake Rupert Murdoch, the executive chairman of News Corp. and 21st Century Fox, purchased for $125 million in 2015.

Featured

Valeant's ousted CEO made $72.5 million in 2016

Manuel Balce Ceneta / AP

Michael Pearson, former CEO of Valeant Pharmaceuticals, cashed in $72.5 million worth of stock and severance pay in 2016 even as he and the drug company were under federal investigation for accounting fraud and a billing scheme tied to a specialty pharmacy it secretly owned.

Pearson took home $60.5 million in stock and the rest in severance pay and other benefits, Valeant disclosed Thursday to the Securities and Exchange Commission. He also still used Valeant's corporate jet. Joseph Papa replaced Pearson last year, and Papa earned $62.7 million even though Valeant remains mired in trouble.

Valeant's stock has cratered since the middle of 2015, and it has become a pariah in the pharmaceutical industry. Pearson led Valeant since 2008, building the company up on the controversial practice of acquiring drugs and jacking up the prices.