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Trump poised to punt on Obamacare subsidies: Republicans and Democrats were bracing for the latest battle in the ongoing healthcare wars in Washington, as the Trump administration and the House must give a status report to a federal court on an appeal of a lawsuit over insurer subsidies. But the Washington Examiner’s David Drucker broke news this morning that the administration is prepared to ask for a 90-day stay as Trump and House Republicans explore their options — and in the meantime, the payments will continue to flow.  ”We feel payments should continue while we figure out a solution,” a GOP source said. “The Justice Department is working with House Republicans in good faith to achieve this.” The move buys some time to watch the healthcare negotiations over repealing and replacing Obamacare play out in the Senate.

While the filing seems innocuous, it became the latest major standoff in Washington, because it was an opportunity for Trump to effectively end the insurer subsidies by choosing not to defend them against a House Republican lawsuit that originated during the Obama era. Republicans argued that the subsidies, meant to help lower income Obamacare enrollees cover insurance costs, were being illegally used to prop up the exchanges because the money was never appropriated by Congress. If the subsidies are removed, it could trigger a spike in premiums and an exodus of insurers from the markets. Democrats have been gearing up to portray ending the subsidies as an act of sabotage by the Trump administration against Obamacare, whereas Republicans were ready to argue that the exchanges were collapsing on their own and illegally funneling money to insurers is not the answer. On a number of occasions, Trump himself has argued that if Obamacare were to collapse, it would force Democrats to the negotiating table, but leading Democrats have said that such a tactic won’t work, because they’ll maintain the position that he owns any problems with the healthcare system.

Uncertainty still remains: Major insurer, doctor and hospital groups and the U.S. Chamber of Commerce have been pleading with Congress to keep paying Obamacare insurer subsidies. In a letter, spearheaded by America’s Health Insurance Plans, the groups wrote, “There is now clear evidence that this uncertainty is undermining the individual insurance market for 2018 and stands to negatively impact millions of people.” Though Trump has not stripped the subsidies, he hasn’t yet given the industry a clear indication of what his long-term intentions are, as insurers have to make decisions soon about premiums and participation in Obamacare for next year.

Senate Minority Leader Chuck Schumer’s blasts Trump for “kicking the can down the road”: “Clearly by today’s action and their decision to make the next payment, the White House realizes that eliminating cost sharing reduction payments would cause chaos in the markets, and they would get the blame. Unfortunately, by kicking the can down the road once again, the administration is continuing to sow uncertainty in the markets that will hurt millions of Americans. Instead of hemming and hawing, they ought to step up to the plate and say once and for all that they will make these payments permanently, which help millions of Americans pay less for their health care.”

Welcome to Philip Klein’s Daily on Healthcare, compiled by Washington Examiner Managing Editor Philip Klein (@philipaklein), Senior Healthcare Writer Kimberly Leonard (@LeonardKL) and Healthcare Reporter Robert King (@rking_19).  Email for tips, suggestions, calendar items and anything else. If a friend sent this to you and you’d like to sign up, click here. If signing up doesn’t work, shoot us an email and we’ll add you to our list.

Alcohol-related deaths are rising. Will new state rules help? Our magazine feature, out this morning, examines the impact that alcohol misuse has had on mortality rates among middle-aged whites, and the policy proposals that have occurred, here and around the world, to reduce the health effects of drinking. To members of the alcohol industry, the proposed policies, such as taxes and restrictions on where and when alcohol is sold, is an attack on their product that would affect even those who consume only moderate amounts of alcohol. But public health experts say alcohol is still a harmful drug that can impede decision-making and argue restrictions are necessary. Read the full feature, by Kimberly Leonard, here.

Blue Cross Blue Shield writes healthcare policy wish list … and it sounds a lot like Obamacare: In a message to its customers, the company indicated that it would like to keep portions of Obamacare, such as protections for people with pre-existing illnesses, but also that it wanted a plan that would more heavily push people to enroll and stay in coverage, so as to bring in more young, healthy enrollees. “In order to have a health insurance system in which everyone can obtain coverage regardless of their health status, there must be a balance among those enrolled that includes healthier individuals along with those who need significant care,” the company wrote. “To achieve this, we need strong incentives for younger, healthier people to obtain coverage and for everyone to stay covered year-round.” Some tangible ideas that would be consistent with this line of thinking would be auto-enrollment, shorter enrollment periods and more limited special enrollment.

The World Health Organization spends more than $200 million a year on travel expenses, according to an investigation conducted by the Associated Press. The amount is more than is spent on programs to combat AIDS, tuberculosis and malaria, and the investigation comes at a time when the agency is asking for more funding to combat global disease outbreaks. According to the report, several top officials are booking first-class flights and rooms at five-star hotels. Earlier this year, WHO sent a memo to staffers asking them to make changes. Travel would always be necessary, the memo said, but “as an organization we must demonstrate that we are serious about managing this appropriately.”

Get ready for the busy week ahead: The lawsuit deadline or the release of Trump’s budget aren’t even the biggest healthcare items on the docket for this week. That honor belongs to the Congressional Budget Office’s updated estimate for the American Health Care Act. The estimate looks at major changes to the House’s Obamacare repeal bill that helped get it narrowly approved earlier this month by a 217-213 vote. The updated score will look at the MacArthur amendment that lets states opt out of key Obamacare insurance regulations. Other changes include adding $23 billion for high-risk pools Republicans say will act as a safety net for people with pre-existing conditions in states that get the waiver. The CBO score will have a major impact on the debate surrounding the AHCA, even though the Senate plans to scrap most of it and start from scratch on its own version.

Senate Minority Leader Chuck Schumer on rumored cuts to Medicaid in Trump’s budget: “In yet another broken promise to working people, President Trump’s budget pulls the rug out from so many who need help: those suffering from opioid and heroin addiction, people in nursing homes and their families who may now have to care for them, the elderly, the disabled and children. This budget continues to reveal President Trump’s true colors: His populist campaign rhetoric was just a Trojan horse to execute long-held, hard-right policies that benefit the ultra-wealthy at the expense of the middle class. This budget is taking the fast lane to rejection by the American people and both parties in Congress.”

Freedom Partners and Americans for Prosperity send letter to members of Senate healthcare working group. “The American Health Care Act, recently passed by the U.S. House of Representatives, takes some positive steps toward rolling back some of Obamacare’s worst elements, but much more must be done to drive down costs, create more affordable options, and expand access to quality care for everyone – especially those most in need,” they wrote. On the auto-enrollment proposal that some centrist Republicans have floated as a replacement for the individual mandate, they said: “Enrolling people without their consent is a giveaway to insurers that inflates prices, drives up costs for taxpayers, and keeps Washington at the center of health care.”

They laid out several points they believed should guide the Obamacare repeal and replace bill:

  • Repeal as much of Obamacare as possible under budget reconciliation, including the law’s harmful insurance regulations and mandates that drive up healthcare costs and reduce choices for patients.
  • End Medicaid expansion, freeze enrollment in the expanded program, and move funding and control of program design to the states.
  • Stop subsidizing unaffordable care and instead fix the problems that put quality and affordable care out of reach for so many Americans. Continuing to subsidize Obamacare with tax credits locks in artificially higher costs, while ignoring the fundamental problems with our healthcare system.
  • Provide state block grants to help people with pre-existing conditions gain and maintain access to coverage.

Democrats angry at CMS director: The top Democrats on four House and Senate committees are demanding answers from the Trump administration on reports of quid pro quo on insurer subsidies. The Democrats want Centers for Medicare and Medicaid Services Administrator Seema Verma to answer media reports that she told insurers the Trump administration would continue paying cost-sharing reduction payments. However, to get the payments the insurers had to come out in favor of the American Health Care Act, the bill that partially repeals and replaces Obamacare. “Your reported actions suggest you are using the operation of the American healthcare system as a tool to gain leverage in political negotiations,” the top Democrats on the Senate Finance Committee; Senate Health, Education, Labor and Pensions Committee; House Energy and Commerce Committee and House Ways and Means Committee. CMS previously denied that Verma made such a proposal to insurers.

I’m telling ya’ll it’s SABOTAGE: At least that is the message from the Obamacare advocacy group Save My Care. The group is out with an ad Monday detailing Trump’s actions to derail Obamacare’s exchanges. The digital ad is part of a larger offensive from Obamacare supporters and Democrats who are aiming to tie high premiums to Trump. The ad shows Trump saying that the best thing for him to do politically is to let Obamacare “explode.” Trump made the comment after the American Health Care Act, which partially repealed Obamacare, failed to get enough votes in the House in March. The House later passed the bill by the slim margin of 217-213. The Senate is working on its own version, however.

Tom MacArthur’s trial by fire New Jersey:  The centrist Republican catapulted into notoriety when he negotiated a key amendment that resuscitated the party’s Obamacare repeal. When he came back to his southern New Jersey district for a town hall meeting in the Democratic part of town, he spent five hours fielding questions from a mostly hostile crowd. MacArthur discussed the experience during an interview with the Washington Examiner’s David Drucker.

ICYMI: With the burgeoning vaping industry facing crushing potential fees, supporters of e-cigarettes in Congress are stepping up their push on the administration to completely knock out former President Barack Obama’s bid to kill the product some see as a safer alternative to cigarettes.


Incidental Economist Taking the nuclear option off the table
The Federalist
: Don’t let health insurers hold Americans hostage for cost-sharing payments
New York Times
A vital drug runs low, but its base ingredient is in many kitchens
Kaiser Health News
Republicans race against the clock on healthcare reform, but calendar not helping
Associated Press
Texas House approves new limits on abortion
Factory farming becoming public health issue
First-try antibiotics now fail in 1 in 4 adults with pneumonia
Blame for Obamacare’s next rate hike shifts to Trump and GOP
A bipartisan way to solve high drug prices



Trump administration must provide the D.C. Circuit Court of Appeals an update in the case House v. Price on cost-sharing reduction subsidies.

Health and Human Services Secretary Tom Price in Geneva for a meeting of the World Health Assembly. The meeting begins Monday and ends next Wednesday. Details.

May 22 to 24. Atlanta Marriott Marquis. 2017 Spring Hospital & Healthcare I.T. Conference. Details.


The president’s full budget proposal for fiscal 2018  is expected.  

10 a.m. Bipartisan Policy Center. 1225 I St. NW, Suite 1000. Roundtable on “Patient Safety and Information Technology,” including Former Senate Majority Leader William Frist, former Rep. Bart Gordon from Tennessee; former Health IT National Coordinator Karen DeSalvo and former FDA Commissioner Andrew von Eschenbach. Details.  

10 a.m. 2123 Rayburn. House Energy and Commerce committee hearing on “U.S. Public Health Response to the Zika Virus: Continuing Challenges.” Details.


9:30 a.m. 1334 Longworth. House Budget Committee hearing on the president’s fiscal 2018 budget. Details.

11 a.m. Kaiser Permanente Center for Total Health. 700 2nd St NE. Council of Accountable Physician Practices and the American Cancer Society to hold a press briefing on the “The State of Cancer Care Today.” Will include experts from the Biden Foundation and the CDC, as well as Dr. John Fleming, deputy assistant secretary for health technology at HHS. Details.

1 p.m. 2007 Rayburn. House Appropriations Committee budget hearing on Indian Health Service. Details.

1: 30 p.m. Alliance for Health Reform webinar on “Where Medicaid Stands: From the AHCA to State Waivers.” Details.

2 p.m. 1100 Longworth. Hearing on the president’s proposed fiscal 2018 budget with Treasury Secretary Steven Mnuchin.

6 p.m. National Press Club. 529 14th St. NW. Documentary premier and discussion of “Your Health: A Sacred Matter.” Details.

CBO report on the American Health Care Act expected.


9:45 a.m. 608 Dirksen. House Budget Committee hearing on the president’s fiscal 2018 budget with OMB Director Mick Mulvaney. Details.

10 a.m. 2362-A Rayburn. House Appropriations Committee budget hearing on the Food and Drug Administration with FDA Commissioner Scott Gottlieb. Details.