Tag Archives: Med Device Tax

House votes to repeal medical device tax

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https://www.washingtonpost.com/politics/house-votes-to-repeal-medical-device-tax/2018/07/24/d786fa0e-8f9c-11e8-b769-e3fff17f0689_story.html?utm_term=.189b15308a2f

The House voted Tuesday to repeal the excise tax on medical devices, with nearly five-dozen Democrats joining all but one Republican in backing the bill.

The measure was approved on a 283-132 vote that comes before lawmakers leave Washington for their summer recess at the end of the week.

The 2.3 percent tax on some devices sold by medical manufacturers was created under the Affordable Care Act. It is not set to take effect until 2020, following a move by lawmakers to include its postponement as part of the deal that ended a government shutdown in January. But lawmakers of both parties have long sought to repeal the tax, arguing that its enactment could lead to higher prices for consumers as well as the loss of tens of thousands of manufacturing jobs.

Fifty-seven Democrats joined 226 Republicans in approving the measure Tuesday night. The path forward in the Senate remains uncertain.

 

 

House GOP unveils package to delay ObamaCare taxes

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http://thehill.com/policy/healthcare/364501-house-gop-unveils-package-delaying-obamacare-taxes

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House Republicans on Tuesday unveiled a package of bills to delay a range of ObamaCare taxes, which could be acted on later this month.

House Ways and Means Chairman Kevin Brady (R-Texas) led the announcement for the bills to delay ObamaCare’s tax on medical devices for five years, on health insurance for two years, and the “Cadillac tax” on high-cost health plans for one year. The package would also eliminate penalties for employers who do not offer health insurance to their workers, under the employer mandate, through 2018.

The bills are only supported by Republicans at the moment, but they come after bipartisan negotiations with Democrats on delaying the taxes, a move that has support on both sides of the aisle. The package could be attached as part of a bipartisan deal on a year-end government funding bill.

The delay of these taxes would be a victory for industries, like medical device companies and health insurers, that have pushed against the taxes. Those groups are still pushing for full repeal eventually.

The delay of the taxes is not paid for in the bills introduced on Tuesday.

The Cadillac tax has been a particular sticking point, with Democrats leading the charge to delay it. Republicans on Tuesday agreed to delay it for one year.

“Obamacare’s failures are continuing to hurt families across the country – and allowing burdensome health care taxes to continue or go back into effect would make these problems even more severe,” Brady said in a statement.

 

Five health-care fights facing Congress in December

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Five health-care fights facing Congress in December

Five health-care fights facing Congress in December

Health-care issues are at the top of Congress’s hefty December to-do list.

Republicans spent much of the year on a failed bid to repeal and replace ObamaCare. That’s left several programs and taxes hanging in the balance as the year draws to a close, in addition to the latest health-care drama thrust into the GOP tax-reform debate.

Here are five of the biggest health-care issues Congress will face next month.

Will Republicans repeal the individual mandate?

Weeks ago, Sen. Tom Cotton (R-Ark.) began to push for a repeal of the individual mandate to be added into the GOP tax overhaul. It worked, at least in the upper chamber.

To Democrats’ dismay, the Senate Finance Committee passed a tax-reform bill before breaking for Thanksgiving that included repeal of the ObamaCare mandate that Americans without health insurance pay a fee.

The House already passed a bill out of its chamber on a party-line vote — legislation that didn’t include repealing the individual mandate. But leaders have said they’re open to it if the Senate is able to muster enough votes to pass tax reform with the repeal.

It appears that the upper chamber might be able to pull it off.

Sen. Susan Collins (R-Maine) has said the repeal shouldn’t be in the bill, but hasn’t said she would vote against the tax-reform bill if it was included. Sen. John McCain (R-Ariz.) hasn’t rung any alarms that he would vote against the bill, saying he wants to see the whole package before deciding, and applauding the Finance Committee for holding hearings on the measure.

In a boost to the effort, Sen. Lisa Murkowski (R-Alaska) wrote in the Fairbanks Daily News-Miner Tuesday that she backs repealing the individual mandate. All three senators voted against a scaled-down version of an ObamaCare repeal bill in late July, effectively sinking the measure.

GOP leaders have signaled that a bipartisan stabilization bill from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) could pass if the individual mandate is repealed. On Sunday, Collins said she would like the Alexander-Murray bill, along with a bipartisan bill to provide funding for high-cost enrollees she introduced, to pass before tax reform does.

Sen. John Cornyn (Texas), the Senate’s No. 2 Republican, said that the deal is “likely” to be included in an end-of-the-year package.

But that effort could face resistance from Democrats, who have balked at repealing the individual mandate, and say that runs counter to the bipartisan spirit that Alexander-Murray was crafted under.

Will Congress reauthorize critical health programs it let lapse?

It’s been nearly two months since funding for the Children’s Health Insurance Program (CHIP) and community health centers expired. Advocates are holding out hope that lawmakers will reauthorize both before the new year, but are frustrated that Congress failed to reauthorize the dollars by a Sept. 30 deadline.

Roughly 9 million low- and middle-income children rely on CHIP for health coverage. Some states have asked the Centers for Medicare and Medicaid Services for funding to hold them over in the interim, and the agency has awarded about $607 million in redistributed funds to states and U.S. territories.

Community health centers have been crafting contingency plans as they wait for Congress to reauthorize a fund that amounts to 70 percent of their federal funding. These centers are a large source of comprehensive primary care for over 26 million of the nation’s most vulnerable people.

Some have already instituted hiring freezes. Others are examining which services they could cut or scale back. If the funding lapses, staff could be laid off, facility renovations or expansions could be canceled or delayed and hours of operation could be reduced.

Though the uncertainty has caused angst for health centers, they haven’t yet seen a monetary impact. But that impact could come on Jan. 1 for 25 percent of centers and on Feb. 1 for another 17 percent, because that’s when their new grant periods begin.

The Health Resources and Services Administration plans to help out on a prorated, monthly basis, according to a spokesperson.

But advocates hope it won’t come to that. The House passed a bill to fund CHIP for five years and community health centers for two. It passed on a party-line vote, as Democrats criticized how Republicans planned to pay for the bill.

The Senate Finance Committee passed a bipartisan, five-year CHIP extension, but hasn’t yet released offsets. Sens. Debbie Stabenow (D-Mich.) and Roy Blunt (R-Mo.) have introduced a bipartisan bill to extend community health center funding for five years.

Will Congress fund the opioid response?

In late October, President Trump declared the opioid epidemic a national public health emergency.

But the move didn’t come with millions of new dollars to combat the crisis, nor did it include a funding ask to Congress. This has frustrated Democrats and many advocates, who say a significant infusion of federal funds is needed to make an emergency declaration effective.

It’s not clear if money will come.

Senate Democrats introduced a bill to provide $45 billion over 10 years to address the crisis — a nod to a similar amount of funding Republicans included in an ObamaCare repeal bill, in part to attempt to offset changes to Medicaid.

But Republicans haven’t named a dollar figure. With a jam-packed December, advocates worry the new year could begin without more money to help curb the crisis of prescription painkillers and heroin that’s ravaged the country.

As for the administration, Hogan Gidley, White House deputy press secretary, said in a statement that “we will continue discussions with Congress on the appropriate level of funding needed to address this crisis” but didn’t say how much that would be.

What does Congress do on ObamaCare taxes?

Behind the scenes, industry lobbyists are working hard to ensure several ObamaCare taxes won’t kick in come January.

The medical device industry wants a full repeal of a 2.3 percent tax on the sale of certain medical devices, such as pacemakers and MRI machines.

“We feel we’re very much in play and that is for full repeal,” said Greg Crist, a spokesman for the medical device trade association AdvaMed. “We’re talking with staff and leadership for the right vehicle.”

The insurance industry is pushing for at least a one year delay of the health insurance tax. Both taxes were delayed in a 2015 spending bill, though for different durations; the medical device tax was paused for two years, and the health insurance tax for just 2017.

Ways and Means Chairman Kevin Brady (R-Texas) addressed the ObamaCare taxes during a marathon hearing on House Republican’s tax-reform bill, saying the legislation wasn’t the right vehicle to repeal or delay them. But, he added, he is working to do so by the end of the year.

“As the ranking member and members on both sides of the aisle know — we have been working with them over the past month to find a path forward,” Brady said. “We are working on common-sense temporary and targeted relief from many of these taxes to be acted on in the House before the end of the year.”

Employer groups are also pushing for a delay of the so-called Cadillac tax, a 40 percent fee levied on pricey employer-sponsored plans slated to begin in 2020. Critics of the tax argue a delay is needed now because employers will begin planning for 2020 next year.

Will Congress help Puerto Rico fund its Medicaid program?

The storm-ravaged island territory could be out of federal dollars for its Medicaid program in a matter of months.

Federal disaster funds haven’t been earmarked to go to the joint state-federal health insurance program for low-income and disabled Americans. On Nov. 17, the White House asked Congress for $44 billion for disaster relief. The notice mentioned Puerto Rico’s Medicaid program, but didn’t put a dollar amount on it.

“Though the Administration expects to work with Puerto Rico and the Congress on medium-term liquidity issues through a future request, the Administration is aware of legislation being considered to address Medicaid sooner,” the letter stated.

Puerto Rico Gov. Ricardo Roselló has asked for $1.6 billion annually for five years. Democratic lawmakers and advocates have been pushing to fulfill that request.

 

5 Ways the Graham-Cassidy Proposal Puts Medicaid Coverage At Risk

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5 Ways the Graham-Cassidy Proposal Puts Medicaid Coverage At Risk

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The Graham-Cassidy proposal to repeal and replace the Affordable Care Act (ACA) is reviving the federal health reform debate and could come up for a vote in the Senate in the next two weeks before the budget reconciliation authority expires on September 30. The Graham-Cassidy proposal goes beyond the American Health Care Act (AHCA) passed by the House in May and the Better Care Reconciliation Act (BCRA) that failed in the Senate in July. The Graham-Cassidy proposal revamps and cuts Medicaid, redistributes federal funds across states, and eliminates coverage for millions of poor Americans as described below:
  1. Ends federal funding for current ACA coverage and partially replaces that funding with a block grant that expires after 2026. The proposal ends both the authority to cover childless adults and funding for the ACA Medicaid expansion that covers 15 million adults. Under Graham-Cassidy, a new block grant, the “Market-Based Health Care Grant Program,” combines federal funds for the ACA Medicaid expansion, premium and cost sharing subsidies in the Marketplace, and states’ Basic Health Plans for 2020-2026. Capped nationally, the block grant would be lower than ACA spending under current law and would end after 2026. States would need to replace federal dollars or roll back coverage. Neither the AHCA nor the BCRA included expiration dates for ACA-related federal funds or eliminated the ability for states to cover childless adults through Medicaid.
  2. Massively redistributes federal funding from Medicaid expansion states to non-expansion states through the block grant program penalizing states that broadened coverage. In 2020, block grant funds would be distributed based on federal spending in states for ACA Medicaid and Marketplace coverage. By 2026, funding would go to states according to the states’ portion of the population with incomes between 50% and 138% of poverty; the new allocation is phased in over the 2021-2025 period. The Secretary has the authority to make other adjustments to the allocation. This allocation would result in a large redistribution of ACA funding by 2026, away from states that adopted the Medicaid expansion and redirecting funding to states that did not. No funding is provided beyond 2026.
  3. Prohibits Medicaid coverage for childless adults and allows states to use limited block grant funds to purchase private coverage for traditional Medicaid populations. States can use funds under the block grant to provide tax credits and/or cost-sharing reductions for individual market coverage, make direct payments to providers, or provide coverage for traditional Medicaid populations through private insurance. The proposal limits the amount of block grant funds that a state could use for traditional Medicaid populations to 15% of its allotment (or 20% under a special waiver). These limits would shift coverage and funds for many low-income adults from Medicaid to individual market coverage. Under current law, 60% of federal ACA coverage funding is currently for the Medicaid expansion (covering parents and childless adults). Medicaid coverage is typically more comprehensive, less expensive and has more financial protections compared to private insurance. The proposal also allows states to roll back individual market protections related to premium pricing, including allowing premium rating based on health status, and benefits currently in the ACA.
  4. Caps and redistributes federal funds to states for the traditional Medicaid program for more than 60 million low-income children, parents, people with disabilities and the elderly. Similar to the BCRA and AHCA, the proposal establishes a Medicaid per enrollee cap as the default for federal financing based on a complicated formula tied to different inflation rates. As a result, federal Medicaid financing would grow more slowly than estimates under current law. In addition to overall spending limits, similar to the BCRA, the proposal would give the HHS Secretary discretion to further redistribute capped federal funds across states by making adjustments to states with high or low per enrollee spending.
  5. Eliminates federal funding for states to cover Medicaid family planning at Planned Parenthood clinics for one year. Additional funding restrictions include limits on states’ ability to use provider tax revenue to finance Medicaid as well as the termination of the enhanced match for the Community First Choice attendant care program for seniors and people with disabilities. Enrollment barriers include the option for states to condition Medicaid eligibility on a work requirement and to conduct more frequent redeterminations.
Much is at stake for low-income Americans and states in the Graham-Cassidy proposal. The recent debate over the AHCA and the BCRA has shown the difficulty of making major changes that affect coverage for over 70 million Americans and reduce federal funding for Medicaid. Medicaid has broad support and majorities across political parties say Medicaid is working well. More than half of the states have a strong stake in continuing the ACA Medicaid expansion as it has provided coverage to millions of low-income residents, reduced the uninsured and produced net fiscal benefits to states. Graham-Cassidy prohibits states from using Medicaid to provide coverage to childless adults. With regard to Medicaid financing changes, caps on federal funding could shift costs to states and result in less fiscal flexibility for states. States with challenging demographics (like an aging population), high health care needs (like those hardest hit by the opioid epidemic), high cost markets or states that operate efficient programs may have the hardest time responding to federal caps on Medicaid spending. Faced with substantially reduced federal funding, states would face difficult choices: raise revenue, reduce spending in other areas, or cut Medicaid provider payments, optional benefits, and/or optional coverage groups.

Last-Ditch Effort By Republicans To Replace ACA: What You Need To Know

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http://khn.org/news/last-ditch-gop-effort-to-replace-aca-5-things-you-need-to-know/

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Republican efforts in Congress to “repeal and replace” the federal Affordable Care Act are back from the dead. Again.

While the chances for this last-ditch measure appear iffy, many GOP senators are rallying around a proposal by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), along with Sens. Dean Heller (R-Nev.) and Ron Johnson (R-Wis.)

They are racing the clock to round up the needed 50 votes — and there are 52 Senate Republicans.

An earlier attempt to replace the ACA this summer fell just one vote short when Sens. Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and John McCain (R-Ariz.) voted against it. The latest push is setting off a massive guessing game on Capitol Hill about where the GOP can pick up the needed vote.

After Sept. 30, the end of the current fiscal year, Republicans would need 60 votes ­— which means eight Democrats — to pass any such legislation because special budget rules allowing approval with a simple majority will expire.

Unlike previous GOP repeal-and-replace packages that passed the House and nearly passed the Senate, the Graham-Cassidy proposal would leave in place most of the ACA taxes that generated funding to expand coverage for millions of Americans. The plan would simply give those funds as lump sums to each state. States could do almost whatever they please with them. And the Congressional Budget Office has yet to weigh in on the potential impact of the bill, although earlier estimates of similar provisions suggest premiums would go up and coverage down.

“If you believe repealing and replacing Obamacare is a good idea, this is your best and only chance to make it happen, because everything else has failed,” said Graham in unveiling the bill last week.

Here are five things to know about the latest GOP bill: 

1. It would repeal most of the structure of the ACA.

The Graham-Cassidy proposal would eliminate the federal insurance exchange, healthcare.gov, along with the subsidies and tax credits that help people with low and moderate incomes — and small businesses — pay for health insurance and associated health costs. It would eliminate penalties for individuals who fail to obtain health insurance and employers who fail to provide it.

It would eliminate the tax on medical devices. 

2. It would eliminate many of the popular insurance protections, including those for people with preexisting conditions, in the health law.

Under the proposal, states could “waive” rules in the law requiring insurers to provide a list of specific “essential health benefits” and mandating that premiums be the same for people regardless of their health status. That would once again expose people with preexisting health conditions to unaffordable or unavailable coverage. Republicans have consistently said they wanted to maintain these protections, which polls have shown to be popular among voters.

3. It would fundamentally restructure the Medicaid program.

Medicaid, the joint-federal health program for low-income people, currently covers more than 70 million Americans. The Graham-Cassidy proposal would end the program’s expansion under the ACA and cap funding overall, and it would redistribute the funds that had provided coverage for millions of new Medicaid enrollees. It seeks to equalize payments among states. States that did not expand Medicaid and were getting fewer federal dollars for the program would receive more money and states that did expand would see large cuts, according to the bill’s own sponsors. For example, Oklahoma would see an 88 percent increase from 2020 to 2026, while Massachusetts would see a 10 percent cut.

The proposal would also bar Planned Parenthood from getting any Medicaid funding for family planning and other reproductive health services for one year, the maximum allowed under budget rules governing this bill. 

4. It’s getting mixed reviews from the states.

Sponsors of the proposal hoped for significant support from the nation’s governors as a way to help push the bill through. But, so far, the governors who are publicly supporting the measure, including Scott Walker (R-Wis.) and Doug Ducey (R-Ariz.), are being offset by opponents including Chris Sununu (R-N.H.), John Kasich (R-Ohio) and Bill Walker (I-Alaska).

On Tuesday 10 governors — five Democrats, four Republicans and Walker — sent a letterto Senate leaders urging them to pursue a more bipartisan approach. “Only open, bipartisan approaches can achieve true, lasting reforms,” said the letter.

Bill sponsor Cassidy was even taken to task publicly by his own state’s health secretary. Dr. Rebekah Gee, who was appointed by Louisiana’s Democratic governor, wrote that the bill “uniquely and disproportionately hurts Louisiana due to our recent [Medicaid] expansion and high burden of extreme poverty.”

5. The measure would come to the Senate floor with the most truncated process imaginable.

The Senate is working on its Republican-only plans under a process called “budget reconciliation,” which limits floor debate to 20 hours and prohibits a filibuster. In fact, all the time for floor debate was used up in July, when Republicans failed to advance any of several proposed overhaul plans. Senate Majority Leader Mitch McConnell (R-Ky.) could bring the bill back up anytime, but senators would immediately proceed to votes. Specifically, the next order of business would be a process called “vote-a-rama,” where votes on the bill and amendments can continue, in theory, as long as senators can stay awake to call for them.

Several senators, most notably John McCain, who cast the deciding vote to stop the process in July, have called for “regular order,” in which the bill would first be considered in the relevant committee before coming to the floor. The Senate Finance Committee, which Democrats used to write most of the ACA, has scheduled a hearing for next week. But there is not enough time for full committee consideration and a vote before the end of next week.

Meanwhile, the Congressional Budget Office said in a statement Tuesday that it could come up with an analysis by next week that would determine whether the proposal meets the requirements to be considered under the reconciliation process. But it said that more complicated questions like how many people would lose insurance under the proposal or what would happen to insurance premiums could not be answered “for at least several weeks.”

That has outraged Democrats, who are united in opposition to the measure.

“I don’t know how any senator could go home to their constituents and explain why they voted for a major bill with major consequences to so many of their people without having specific answers about how it would impact their state,” said Senate Minority Leader Chuck Schumer (D-N.Y.) on the Senate floor Tuesday.

CBO: 16 million more uninsured under GOP ‘skinny’ repeal

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http://thehill.com/policy/healthcare/344264-cbo-16-million-would-lose-coverage-under-gop-skinny-repeal

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The GOP’s newly released “skinny” repeal of ObamaCare would result in 16 million additional people without insurance by 2026, according to a report by the Congressional Budget Office (CBO) released Thursday night.

The bill, released just hours before its vote Thursday night, would repeal ObamaCare’s individual insurance mandate permanently and its employer mandate for eight years.

The CBO also estimated that premiums in the individual market would increase by 20 percent compared to current law in all years between 2018 and 2026.

The bill would lower the deficit by $135.6 billion in ten years, the CBO estimates. 
The Senate’s scaled-down ObamaCare repeal bill, the Health Care Freedom Act, would also defund Planned Parenthood for a year, repeal the medical device tax for three years and increase contribution limits to Health Savings Accounts for three years.

A vote on the bill is expected after midnight. Lawmakers could then offer amendments to the legislation.

‘Skinny’ Obamacare repeal still lacks votes to pass

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http://www.politico.com/story/2017/07/26/obamacare-repeal-republicans-minimum-240982

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A bare-bones plan picks up some key GOP support, but centrists and conservatives are skeptical.

Even a bare-bones repeal of Obamacare is no sure thing in the Senate.

A handful of key Republican senators who had spurned earlier overtures from GOP leadership endorsed the latest plan to gut Obamacare’s individual and employer coverage mandates and its medical device tax. But several centrists said they’re undecided on the so-called skinny repeal, leaving the GOP in limbo through at least the end of the week.

Jockeying on the scaled-back approach came as the Senate rejected a straight repeal of Obamacare in a 45-55 vote Wednesday. The night before, senators turned aside a comprehensive replacement plan that had been crafted by Senate Majority Leader Mitch McConnell. The roll calls were the latest reminders that GOP leaders’ best hope at this point is just to get something — anything — through the chamber with a bare majority and into a conference with the House.

“Sure. There’s plenty we agree on,” said Senate Majority Whip John Cornyn (R-Texas) late Wednesday when asked whether he can get 50 votes. One challenge for GOP leaders is “trying to explain the concept that we need to do it this way, as opposed to solving all the problems in a Senate bill now.”

Cornyn said broader negotiations on Medicaid reforms and other divisive issues would likely re-emerge in bicameral negotiations with the House. But some Republicans are worried that those talks would revive efforts to wind down a Medicaid expansion that’s benefited their states.

Centrist GOP Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia were undecided on the so-called skinny repeal Wednesday. Another Republican from an expansion state, Sen. Dean Heller of Nevada indicated he would back it.

“We’ll see at the end of the day what’s in it, but overall I think I’d support it,” Heller said. He said slashing Obamacare’s Medicaid expansion or its growth rate should be a nonstarter.

Conservatives could be another matter.

“I don’t like it,” Sen. David Perdue of Georgia said of the process. “Because I don’t know where we end up. This whole [health care system] holds together or falls apart in totality. We’ve got a system that is collapsing.”

South Carolina Sen. Lindsey Graham on Tuesday called the possibility of a skeletal plan a “political punt,” but it may be able to clear the narrowly divided chamber. Graham said he would vote for the slimmed-down plan only if House and Senate lawmakers use it to go to conference and come up with a fuller replacement.

Sen. Jeff Flake of Arizona also indicated that he could get on board with the skinny option.

“In Arizona, you have 200,000 people who were paying the [Obamacare insurance mandate] fine and can’t afford insurance,” Flake told reporters. “We gotta have relief to those who, one: can’t find affordable insurance so they have to pay the fine; and, two: even those that can afford to pay the premium, generally can’t afford to utilize the coverage because the deductibles are so high.”

Whether Sen. Mike Lee of Utah can back a trimmed-down proposal “depends how skinny it is,” a spokesman said. But Sen. Rand Paul of Kentucky signaled he could live with the minimalist approach.

“I’ve always said I will vote for any permutation of repeal. Obviously, I want as much as I can get, but I’ll vote for whatever the consensus can be. It’s what I’ve been saying for months: Start on what you can agree on,” Paul said in an interview Wednesday. “Starting small and getting bigger is a good strategy.”

That would leave out the divisive issues of cuts to Medicaid spending and efforts to create a new tax credit system for the individual markets. Republicans can afford to lose just two votes to pass whatever they come up with in the end.

Many Republicans are in the dark about the emerging proposal. And aides said senators were still focused on amendment votes, floor tactics and the chaotic atmosphere, making it difficult to tell what can clinch 50 votes.

“I don’t know what would be in the skinny repeal,” said Sen. Susan Collins of Maine. “Until I see what’s in it, I’m not ruling it out because I don’t know what it would be.”

The Senate also rejected on Wednesday an attempt to send their repeal effort to congressional committees for several days.

Republicans need a score on any proposal from the Congressional Budget Office to vote at a 50-vote threshold. They are aiming for a vote on Friday on their final plan after the unlimited amendment process known as vote-a-rama, which is expected to begin sometime Thursday.

In the final bill, Republicans could try to add more elements than repealing the mandates and device tax, but that could complicate efforts to get a quick CBO score.

“Look for victories where we should find them. In my opinion, the victory will always include: individual mandate repeal, employer mandate repeal and [eliminating] the medical device tax,” said South Carolina Sen. Tim Scott. “If we can add to it, we should … as much as you can repeal, let’s get it done.”

The CBO has scored those three pieces of the proposal in the past and could deliver an analysis of the “skinny repeal” more speedily than of a more wide-ranging effort, GOP senators said. Still, Republicans will have to add additional Obamacare provisions to the bill to meet minimum savings requirements required under reconciliation, the budget mechanism that allows for a bare majority instead of 60-vote threshold.

Republicans are likely to cut the Prevention and Public Health Fund, for instance. The goal would be to increase the bill’s scope enough to meet Senate savings targets without losing political support, according to Republican sources. They may be able to do so because slashing the mandates means millions would drop insurance coverage — and the subsidies that come with it.

In the end, Senate leaders would want the House to either take up their bill or go to conference and hammer out a compromise that can pass both chambers.

“I can’t imagine at the end of the process that we haven’t agreed on something,” said Sen. Roy Blunt (R-Mo.). “And all we have to do is agree on something that keeps this going.”

But conservatives are wary of a House-Senate negotiation.

“I would [be in] favor if we have a skinny repeal, just sending it over to the House and seeing if they can pass it rather than going to conference,” Paul said. “Conference committee to me means Big Government Republicans are going to start sticking in those spending proposals.”

Bad Hombres, Russian Hackers And … A Medical Device Tax?

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http://khn.org/news/bad-hombres-russian-hackers-and-a-medical-device-tax/

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In an election season in which the presidential campaign “issues” have ranged from “hot mics” to emails, some down-ballot campaign ads highlight a wonky, far less racy topic: a tax on medical devices.

Really? Why?

The tax taps into voters’ feelings about placing such levies on businesses and into opinions about the Affordable Care Act’s future. A provision of the federal health law, it was designed to tax manufacturers of some of the most expensive items on medical bills — from pacemakers to artificial joints. Revenues from the tax were meant to help finance the act, so to some it became a proxy for the act itself. Congress voted to suspend it for two years — until 2018 — after intense lobbying by the medical device industry, and, in states with a heavy industry presence, candidates are being asked to take a stand on whether they’ll push to have the tax repealed.

Where is the tax becoming campaign fodder?