United States: Capitol Hill Healthcare Update - March 13, 2017

GOP leaders face pushback on new health plan

Republican leaders on Capitol Hill face growing cross pressures from different factions of GOP lawmakers over their emerging legislation to replace the Affordable Care Act (ACA).

Conservatives in the House and Senate want the legislation to speed up the phase-out of the ACA's Medicaid expansion – as soon as next year – and also dial back the refundable tax credit, which some lawmakers believe represents a new entitlement program. Other Republicans, mostly in the Senate, are worried about ending Medicaid's expanded coverage, which in some states benefits families of four earning up to 138 percent of the federal poverty level, or $33,948 annually.

GOP leaders also are bracing for an announcement as soon as today from the Congressional Budget Office (CBO) on how the American Health Care Act would impact federal spending. CBO is expected to say the Republican bill would cover millions fewer Americans than the ACA does, although Republicans counter that the refundable tax credits would give people the choice to purchase coverage if they want it.

Two House committees – Energy and Commerce and Ways and Means – last week approved sections of the GOP legislation on Medicaid and repeal of most of the ACA taxes. The House Budget Committee on Wednesday is scheduled to merge those two bills into one (an impending snowstorm in Washington could delay the committee's action until later in the week).

Republicans want the bill on the House floor before the end of the month to give the Senate time to approve the legislation ahead of the planned early-April recess for Easter and Passover.

While conservatives' opposition in the House is loud, it's not clear that it's enough to force GOP leaders to change the text of their bill. Republicans need 216 votes to approve the repeal-replace legislation (there are five vacancies in the House), meaning they can't afford to have more than 22 Republicans vote against the bill.

House Majority Leader Kevin McCarthy (R-Calif.) last week criticized conservatives' call for speeding up the phase out for the Medicaid expansion, saying such a plan would be unworkable.

If House leaders need to make changes to accommodate conservatives, they risk alienating Republican senators who have expressed concerns about the bill's Medicaid changes. There's also a faction of Senate conservatives who have come out against the legislation or are calling for significant changes.

These policy cross-currents create a challenge for GOP leaders, who nonetheless are confident the legislation – likely with some changes – will pass the House and Senate in the coming weeks. They say too much is riding on the bill's passage, including the political consequences of failing to repeal the ACA and the follow-on disruption of other GOP policy priorities, particularly tax reform. House Speaker Paul Ryan last week said that if the ACA repeal bill stalls, it would be a "momentum-killer" for Republicans' agenda.

Gottlieb's FDA selection wins GOP, stakeholder praise

Congressional Republicans and pharmaceutical and medical technology manufacturers are praising President Donald Trump's nomination of Scott Gottlieb to lead the Food and Drug Administration (FDA).

Senate HELP Committee Chairman Lamar Alexander (R-Tenn.) praised Gottlieb's "impressive qualifications" and promised quick hearings to review his nomination. Stakeholders like PhRMA and AdvaMed also praised Gottlieb's nomination.

Gottlieb, a physician, previously served as FDA deputy commissioner and in several other senior roles at the agency. He also is a fellow at the conservative think tank American Enterprise Institute and a partner in a venture fund that invests in life science companies.

Democrats criticized Gottlieb for being too close to the industries he would regulate and also used the announcement to criticize Trump's plans to streamline FDA regulatory approval.

White House cautions on Cummings' drug-price statements

A House Democrat's meeting with Trump last week alarmed pharmaceutical manufacturers about the White House's position on prescription drug prices.

Rep. Elijah Cummings (D-Md.) emerged from his White House meeting saying the president was "enthusiastic" about a legislative proposal to allow Medicare to negotiate with manufacturers over prescription drug prices. Cummings is the top Democrat on the House Oversight and Government Reform Committee.

But Trump aides cautioned that Cummings overstated what was discussed in the meeting. They pointed stakeholders to a White House readout of the meeting that said Trump pledged only to work with Cummings "in a bipartisan fashion to ensure prescription drug prices are more affordable" and that the president supports reforming the FDA to reduce "the regulatory burdens on drug manufacturers so as to enhance competition."

Still, Trump has been all over the map on the issue. He's repeatedly said he wants to allow Medicare to negotiate prices directly with manufacturers, a move that would require congressional approval. But during a meeting with industry executives last month, Trump seemed to focus more on ensuring there's competition among generics manufacturers and speeding FDA approval of applications for generic drugs.

Senate expected to approve Verma today

The Senate this evening is expected to confirm Seema Verma as Trump's nominee to head Centers for Medicare & Medicaid Services.

In a procedural vote last week, Republicans won a test vote on Verma's confirmation that largely fell along party lines, indicating that the Senate is likely to give her final confirmation.

Verma founded a health policy consulting firm and worked with Vice President Mike Pence on Indiana's Medicaid expansion plan when he was that state's governor.

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