http://www.rollcall.com/news/policy/congress-industry-hit-reset-health-law-repeal-fails?bt_alias=eyJ1c2VySWQiOiAiNjllMWYzZjMtOWY1Mi00OTE5LTk1MjktNDczNDA4OWFlOTBjIn0%3D&utm_source=weekendreads&utm_campaign=newsletters&utm_medium=email

House Republicans appeared divided and frustrated Friday morning about their next steps on health care legislation, hours after their Senate colleagues fell short of passing a scaled-back repeal.

House Republicans attending a conference meeting Friday morning described a disappointed mood hanging over them as Speaker Paul D. Ryan of Wisconsin read lyrics from the song “The Wreck of the Edmund Fitzgerald.” The ballad, by Gordon Lightfoot, is about a Great Lakes shipwreck that the song suggests could have been avoided if the crew had decided to keep sailing through a storm.

Earlier Friday morning, GOP Sens. Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona had voted against a “skinny repeal” amendment, forcing Majority Leader Mitch McConnell, R-Ky., to pull the bill from the Senate floor.

Some House Republicans appeared ready Friday to move on to a tax overhaul and fiscal issues, while others insisted the health care effort could be revived.

Those who were optimistic that work on health care could continue differed about the shape it would take. While moderates such as Reps. Charlie Dent, R-Pa., and Leonard Lance, R-N.J., stressed the importance of working with Democrats, more conservative members advocated continuing a Republican-only approach.

Rep. Mark Meadows, leader of the conservative House Freedom Caucus, thought the Senate would keep working out its differences. “I’m still optimistic we’ll have another motion to proceed and put something on the president’s desk,” he said. “The reconciliation process is not dead.”

Some House members vented about their frustrations with the Senate’s inability to come together on a repeal.

“It’s a huge disappointment,” said Rep. Richard Hudson, R-N.C. “How dare these senators not deliver on the promise we all made, that they all campaigned on? They can’t stop now.”

Republican Study Committee Chairman Mark Walker, R-N.C., suggested there should be some kind of consequences.

“Senate guys are part of our team so we can’t be out saying this or whatever, but there’s still a lot of frustration that exists,” Walker told reporters. “And I think at some point, accountability is not out of order for our Senate companions.”

‘More work to do’

But other Republicans suggested the need to move on to other health care priorities with the hope that aspects of repeal could be addressed at the same time.

A number of health care insurers have abandoned marketplaces in several states, citing the uncertainty in Washington as a major factor.

“We’ve got more work to do going forward, clearly, to rescue these markets,” said Rep. Greg Walden, R-Ore., chairman of the Energy and Commerce Committee.

Walden noted that a variety of legislative efforts could be vehicles for aspects of repeal legislation, including an expected renewal of expiring funding for the children’s health insurance program or reauthorization of community health centers. He thought that a repeal of the Independent Payment Advisory Board, a controversial commission the 2010 health care law called for but which has never been established, could still have traction in Congress. He noted the importance of paying the law’s cost-sharing reductions, which the Trump administration controls and insurers say are critical.

Walden did not rule out working with Democrats.

Any pieces of health care legislation also will be targets for industry groups who were disappointed along with Republicans last night. JC Scott, chief advocacy officer for the medical device trade group  Advanced Medical Technology Association, said the group is examining the calendar to see where a repeal of the medical device tax might fit in, noting that members on both sides of the aisle support the repeal.

The trade group America’s Health Insurance Plans, which has stayed largely neutral during the repeal debate, said it will continue to work with both parties going forward.

Tax legislation

Ryan indicated in a statement that the House is moving on to a tax overhaul and urged the Senate not to give up on changing the health care law.

“We have so much work still to do, and the House will continue to focus on issues that are important to the American people,” he said in a statement. “At the top of that list is cutting taxes for middle class families and fixing our broken tax code. I’m glad that members will now take time to hear directly from those they represent and make the case for historic tax reform that we intend to pursue in the fall.”

But doing tax legislation without completing a health care bill first will be tricky, Rep. Trent Franks, R-Ariz., acknowledged.The health care bill would have repealed taxes, leaving fewer tax changes to be addressed in the tax bill.

“Obamacare was the biggest tax increase in the history of the human family,” he said. “We have to deal with that so we have a baseline to deal with the tax code. I’m afraid at this point we’re going to have to work around that, because I’m not sure there’s going to be time.”

Given the outcome on in the Senate, it seems unlikely that any health care repeal legislation could pass the Senate. Hours before the vote Thursday, McCain told reporters he would not vote for the bill, but then backtracked.

“I never voted for a bill that I didn’t want to become law,” he said.

McConnell indicated he thought Democrats would face a political pushback on their health care policy ideas.

“It’s time for our friends on the other side to tell us what they have in mind,” he said in a speech after the vote. “And we’ll see how the American people feel about their ideas.”

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President Donald Trump spent a grey and sometimes rainy Saturday at the White House on a Twitter binge, firing off a late-afternoon tweet instructing Republican senators to demand another vote on a measure that would repeal and replace the 2010 health care law.

In the morning, the president threatened lawmakers’ health insurance and attacked members of his own party, saying they “look like fools” because they cannot pass major bills.

Trump had some different advice for Republican senators later in the day, amid talk from both sides of the Senate chamber about working through the relevant committees to craft a possible bipartisan health care overhaul: Don’t be quitters. Try again.

“Unless the Republican Senators are total quitters, Repeal & Replace is not dead! Demand another vote before voting on any other bill!” the president tweeted.

A bill that would have partially done that, but mostly would have set up a conference with the House, failed in the wee hours of Friday morning when Arizona Sen. John McCain shocked the political world by joining fellow Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska in voting against a Republican “skinny” repeal bill.

Trump’s tweet was yet another new stance from him on just what he wants the next step to be on health care.

On Friday, during a speech to law enforcement officials in New York, the president — in a rambling address about a wide range of things on his mind — suggested McCain’s dramatic vote would clear the path to an idea he has long seemed to favor over all others.

“I said from the beginning, ‘Let Obamacare implode and then do it.’ I turned out to be right,” Trump said Friday.

But just over 24 hours later, the president once again appeared to have changed his mind.

Trump has been visiting his golf club in nearby Sterling, Virginia, on most weekends that he is in Washington. Saturday’s rainy weather and unseasonably cool temperatures kept him at the executive mansion, but apparently with his phone handy.

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Sen. John McCain of Arizona’s vote against the “skinny repeal” of Obamacare may have been the most dramatic, but the objections of Republican Sens. Lisa Murkowski of Alaska and Susan Collins of Maine had already put the bill’s fate in jeopardy.

The Senate’s Republican women, including Sen. Shelley Moore Capito of West Virginia, had been left out of the initial drafting process and derailed the Majority Leader’s mid-July effort to repeal Obamacare in order to replace it further down the road.

While Capito ultimately voted for the bill, Murkowski and Collins held firm on Friday morning and, along with McCain, joined with Democrats to kill the bill.

Here’s who they are.

Sen. Lisa Murkowski

Lisa Murkowski has been a U.S. Senator since 2002, when she was appointed to finish out her father Frank’s term when he was elected governor of the state. She ran for the seat in 2004 and won, but in 2010 she lost the GOP primary to a Tea Party challenger. But ultimately, Murkowski beat both the Tea Party and Democratic candidates and became the first successful write-in candidate since South Carolina’s Strom Thurmond in 1954. She won reelection in 2016.

Murkowski has been wary of the process to replace the Affordable Care Act since it began. She has said she could not support a bill that did not expand coverage and left costs high, but was largely concerned with the approach to Medicaid. She was also against including cuts to Planned Parenthood in a repeal measure. According to the Alaska Dispatch News, a quarter of Alaskans receive health coverage via the entitlement program. In July, Murkowski said that while some Alaskans had told her that she should “stick with the president,” most wanted her to put her state’s citizens first. “Almost without exception, it was, ‘Please Lisa. Protect Alaska’s interests,” the Dispatch News reports she said. “Help us with ensuring that the most vulnerable are cared for, and that when it comes to the access issues that we face, the costs that we face, that you can help us address these.'”

Murkowski vocalized her displeasure with the secretive Obamacare repeal process in late June, telling an Independent Journal Review reporter that she had not seen a draft of the bill because she is “not a reporter and I’m not a lobbyist.” She, along with Sens. Collins and Capito of West Virginia, later came out against Majority Leader Mitch McConnell’s plan to immediately repeal the Affordable Care Act, but hold off on replacing it, effectively killing that effort.

Her opposition to the health care plan made her a target of President Donald Trump, who tweeted that she had “really let the Republicans, and our country, down” when she voted against a motion that led to the Friday morning vote. The administration also reportedly called Murkowski and Alaska Sen. Dan Sullivan threatening that there would be consequences over her position on the repeal.

Sen. Susan Collins

Susan Collins, of Maine, was first elected to the U.S. Senate in 1996 and was last reelected in 2014. She will be up for reelection again in 2020, though she is said to be seriously considering a run for governor of Maine. It would be her second time vying for the governorship—she lost to independent Sen. Angus King in 1994.

Collins has said she could not support the Obamacare repeal because of the impact it would have had on Americans seeking coverage. “I can’t support a bill that will greatly increase premiums for our older Americans,” Collins told MSNBC in June. “I cannot support a bill that is going to result in tens of millions of people losing their health insurance.”

The Maine Republican was also dismayed by the deep cuts to Medicaid that had been proposed under the repeal legislation and the impact it would have on vulnerable citizens including disabled children and poor seniors.”We should not be making fundamental changes in a vital safety net program that’s been on the books for 50 years … without evaluating what the consequences will be,” she said on CNN‘s State of the Union.

In a lengthy statement issued Friday, Collins explained the many reasons why she voted against the measures, including her opposition to proposals that would have stripped funding from Planned Parenthood. “Let me be clear that this is not about abortion,” she said. This is about interfering with the ability of a woman to choose the health care provider who is right for her. This harmful provision should have no place in legislation that purports to be about restoring patient choices and freedom.

Like Murkowski, Collins faced threats as a result of her position on the repeal. The Associated Press reported Texas Rep. Blake Farenthold complained about the opposition the repeal effort had faced from “some female Senators from the northeast.” During a radio interview, he reportedly said, “if it was a guy from south Texas, I might ask him to step outside and settle this Aaron Burr-style.”

She was later caught on a hot mic discussing the threat, with a Senate colleague telling her he thinks she could “beat the s–t” out of the Representative. “Well, he’s huge,” she said in response. “And he — I don’t mean to be unkind, but he’s so unattractive it’s unbelievable.”

http://www.rollcall.com/news/white-house-health-care-implode

Amid pleas from Republicans and Democrats for the parties to begin work on a bipartisan health care bill, President Donald Trump and White House officials on Friday doubled down on his call to put off any action until Barack Obama’s 2010 law fails.

Ailing Arizona Republican Sen. John McCain shocked senators from both parties early Friday morning when he voted against a GOP leadership-crafted measure that amounted only to a partial repeal of the Affordable Care Act. Back in Washington after a brain tumor diagnosis, McCain made clear his vote was a shove for the entire Senate to get back to “regular order” — meaning hearings and floor debate — on health care and every other issue.

Following McCain’s dramatic vote on the Senate floor, several senators reported that Health, Education, Labor and Pensions Chairman Lamar Alexander of Tennessee is planning for just that. And Senate Minority Leader Charles E. Schumer, D-N.Y., said he saw Alexander and the committee’s ranking Democrat, Patty Murray of Washington, already talking in the wee hours of Friday morning.

“Now Republicans have a choice to make,” Murray said. “They can continue to try to bring Trumpcare back just to score political points and give special interests a massive tax break, or they can engage in the open, transparent, bipartisan process that many Democrats and Republicans agree is the right way to actually make our health care system work better for the people we serve.”

The list of committees that could begin health care-related work also includes the Homeland Security and Governmental Affairs panel. Its chairman, Ron Johnson of Wisconsin, at times has been very critical of the Senate GOP leaders’ process — which included no committee work and various bills crafted behind closed doors — despite his vote in favor of the so-called “skinny” repeal amendment.

“In the coming weeks, my committee will hold hearings to lay out the realities of our health care system, and I am committed to working with anyone who is serious about addressing these issues,” Johnson said in a statement that appeared to extend and olive branch to Democrats. “Americans deserve far better than their elected officials have delivered to this point.”

GOP Speaker Paul D. Ryan of Wisconsin reacted to the party’s failed Senate vote by putting the health care onus on the shoulders of his Senate colleagues, urging them to “continue working toward a real solution that keeps our promise.” The House, he said Friday, having passed a health overhaul measure, will move on to issues like taxes.

But there is no guarantee Senate Republicans and Democrats, long ideologically divided on the details of health care, can find enough common ground to craft a bill — or that Ryan would bring it to a vote.

“I can’t speculate about a bill that doesn’t exist,” a Ryan aide said Friday when asked if the speaker put a Senate-passed bipartisan health bill on the floor.

And the White House, the person whose opinion matters most, Trump, appears just fine with both chambers moving on to crafting a sweeping tax overhaul push.

White House officials initially were uncharacteristically quiet following the Senate failure. There was no paper statement issued signaling the president’s preferred next move on an issue that was central to his 2016 campaign message. But Trump weighed in during the wee hours of Friday morning — and endorsed only one path for addressing health care.

“As I said from the beginning, let ObamaCare implode, then deal,” Trump tweeted at 2:25 a.m. Friday. He then ended the tweet with what seemed like a guarantee: “Watch!”

Likely to the chagrin of Republican and Democratic lawmakers, a White House official early Friday afternoon said the president’s tweet represents the administration’s preferred path ahead on health care.

“I’d stick with the tweet,” the White House official told Roll Call, adding a more nuanced description could be coming at some point. (One had not been provided by the time this article was published, however.)

About an hour later, Trump doubled down on his call during remarks in New York state.

“I said from the beginning, ‘Let Obamacare implode and then do it.’ I turned out to be right,” Trump said.

Trump may find some allies on Capitol Hill on the path to a possible implosion.

“I believe it may take Obamacare’s collapse before the parties are willing to work together in a bipartisan manner. The collapse and replace of Obamacare may prove to be the most effective path forward,” Sen. Lindsey Graham, R-S.C., said in May. On Thursday evening, Graham reiterated that stance, saying he would rather “get out of the way” and let the 2010 law fail rather than pass a flawed GOP replacement.

Over an hour after Trump said he was “right” about his implode-and-repair idea, the White House official sent an emailed statement saying the administration “will continue to fight to repeal and replace the Obamacare disaster and to ensure all Americans have access to affordable healthcare, making good on an unwavering promise to the American people.”

“President Trump and his administration will not rest until he can sign a bill that fulfills the shared promise to repeal and replace Obamacare,” the official added after Trump spoke.

That statement, notably, applies to the implode-and-repair scenario of which the president is so fond.

Pitching a scenario under which GOP lawmakers and the White House would stand by and let the 2010 law to continue sputtering — forcing Democrats to beg him to cut a deal to fix it — has been a steady drumbeat for Trump. And, just like early Friday morning, the president always brings it up without being prompted — suggesting that has been his Plan A even as Senate Republican leaders struggled to find one of their own.

For months, and especially since the Senate took up the health overhaul baton in early May, Trump has bounced from one preferred approach to another. And after McCain sent ripple waves across the political world, the president again pitched allowing Obama’s law to, as he often puts it, “fail.”

The president has more than one way to nudge Obama’s law toward failure: Trump could opt to stop paying subsidies to insurance companies; he can order agencies to cease enforcing its requirement for most Americans to obtain health insurance; and he could undermine its markets by stopping all federally financed advertising urging folks to enroll under the law.

But lawmakers, at least before the smoke cleared and the sun rose Friday morning, seemed willing to try a new approach. The first real action may come in connection with the looming reauthorization of the children’s health insurance program.

While many Republicans were not in a mood to discuss next steps on health care policy as they left the Capitol in the middle of the night, Sen. Bill Cassidy of Louisiana was an exception.

Cassidy spoke to reporters outside the Capitol at about 2:30 a.m. Friday, and with Democratic senators and other supporters of the 2010 health law cheering across the lawn, he was already talking about the CHIP legislation as a vehicle for interim changes.

“Insurers will continue to leave markets. People will continue to get quotes they cannot afford, and as folks celebrate in the background, they will be bitter because they will feel like they’ve lost an opportunity for something better,” Cassidy said. “Procedurally, CHIP reauthorization will come up, so perhaps there’s some things that can be done”

https://www.medpagetoday.com/Washington-Watch/repeal-and-replace/66962?xid=nl_mpt_DHE_2017-07-29&eun=g885344d0r&pos=0

Following Republicans’ many attempts to kill the Affordable Care Act this week, culminating in last night’s surprising failure of a “skinny” repeal bill, MedPage Today asked physicians outside the Beltway how they and their patients have been reacting to the drama.

“I think people sort of feel that the whole system is just an angry mess,” said Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates in New York City, and weekly blogger for MedPage Today.

In Manhattan, he sees patients of all kinds.

Throughout this process of “dredging up” different repeal bills, instead of patients being relieved that one or another didn’t pass, “there’s a lot of throwing up their hands,” he told MedPage Today in a phone call.

Even those patient who don’t like the Affordable Care Act felt this wasn’t a good process, Pelzman added.

For his own perspective, Pelzman believes that the ACA was a good start but the country should move towards Medicare-for-all (or “god forbid, socialized medicine,” he joked), but he acknowledged that it may not be realistic right now.

“My hope for the future of the healthcare system in this country is that we figure out what that baseline of access and preventive and chronic care that every member of society should have is, and then if people want some platinum policy and want to pay more for this or that, I think the private insurers would be more than happy to provide that.”

“This country needs a safety net that is a little less exclusive … You should be able to get the care you need and if you want to see the world’s greatest heart surgeon, you figure that out.”

“Why should someone who has a child with leukemia … worry that they’re going to have to give up food or their house in order to get their child treatment?” he asked.

“When you hear people like [Sen. John] McCain standing up and saying it’s time to stop making it all what the Democrats want or what the Republicans want, it’s got to be what the people who sent us to Washington want, I think that’s the right message.”

Self-Described Conservative

Daniel Edney, MD, an internist in Vicksburg, Miss., who characterizes his political views as “left of the Tea Party but to the right of most moderates in Washington,” said he isn’t against repealing the ACA as long it can be replaced with something better.

“In the absence of seeing something better, I personally am in favor of fixing what we have,” he said.

He was disappointed that Mississippi’s governor chose not to expand Medicaid.

“If any state in the union needed Medicaid expansion it was Mississippi,” Edney said, adding that it was “absolutely foolish” to give up $2 billion in funding over a political statement.

However, the governor did say he would accept funding through a block grant, an idea that Edney is not opposed to. “It’s not about ideologies, it’s about doing the right thing to help our folks,” he said.

The ideal is “to make healthcare decisions as local as possible,” Edney said.

He’s not hopeful about the prospects of a bipartisan agreement. However, “currently the leadership in Mississippi has a good relationship with the administration,” he said. “Maybe things will improve for us whether there’s a repeal and replace or not.”

Single-Payer Advocate

“People have healthcare and they need healthcare. To take it away from them, that’s just cruel,” said Pamella Gronemeyer, MD, of SEMC Pathology in Highland, Ill., and co-president of her state’s chapter of Physicians for a National Health Program.

Gronemeyer said she fell asleep watching the debate last night but woke up on time to catch the vote.

“I was glad that John McCain voted no and killed it,” she said. “The majority of people I know supported the ACA and did not want it to be repealed.”

“I realize it was a ‘skinny repeal’ but once you get rid of those mandates, it will help break the system,” Gronemeyer added.

The biggest concern Gronemeyer had with repeal was its impact on the critical access hospitals in her state.

“Without the ACA those hospitals are going to close and the rural areas are going to suffer. It’s going to take people an hour or an hour-and-a-half to get to the hospital,” she said.

She also worried about repeal’s impact on Medicaid, noting that southern Illinois has been struggling economically and many people now rely on Medicaid.

Looking ahead, Gronemeyer said, “I’d like to go to single payer … but they keep telling me its not going to happen.”

So, she’s prepared to compromise for the moment.

“We need to fix the ACA. We need to make the markets more competitive, make the premium more affordable” and ensure that deductibles are within reach.