By Dan Diamond
TOM PRICE: 'NOBODY WILL BE WORSE OFF FINANCIALLY' UNDER AHCA — The HHS secretary said on NBC's "Meet the Press" that he thinks coverage will expand and financial burdens will decrease under the American Health Care Act, the Republican bill to repeal and replace large parts of the Affordable Care Act.
"I firmly believe that nobody will be worse off financially in the process that we're going through," Price said, blasting the ACA's coverage and provider lists as too expensive or insufficent for many Americans. See 75-second video. He added that the bill is only the first step in the GOP agenda to reshape health care, adding that there would be additional legislation and deregulation. More for Pros.
— Breitbart's headline: 'Upcoming lie of the year?' The website formerly run by Steve Bannon, which backed President Donald Trump throughout his campaign but has repeatedly attacked Republicans' health plan, wasn't impressed with Price's comments. See screenshot. Breitbart also continues to refer to AHCA in its headlines as "Paul Ryan's plan."
PAUL RYAN: 'I CAN'T ANSWER' IF THERE WILL BE COVERAGE LOSSES — The House speaker told CBS's "Face the Nation" that he can't predict how many would lose coverage.
"I can’t answer that question. It’s up to people," Ryan said. "People are going to do what they want to do with their lives because we believe in individual freedom in this country."
However, Ryan allowed that CBO — which is expected to soon release its estimates about the impact of AHCA — will predict fewer people would be covered by the bill, which repeals the ACA individual mandate.
"The one thing I’m certain will happen is CBO will say, ‘Well, gosh. Not as many people will get coverage,'" he said. "You know why? Because this isn’t a government mandate … there’s no way you can compete with on paper a government mandate with coverage."
DEAN HELLER DOESN'T LIKE THE BILL — In remarks obtained by POLITICO, the Nevada senator told constituents that he wasn't happy with key provisions of AHCA, Burgess Everett reports.
"My argument with the Republicans is if we’re going to make the changes, don't repeal the Affordable Care Act so you can keep all the taxes," the GOP senator said. "I think that's unfair and I don't think that’s a responsible way to move forward." More.
Heller — the most vulnerable Republican senator on the ballot for 2018 — also credited the health law for some of its protections. "Not everything in the Affordable Care Act is bad,” Heller told the crowd. More than 300,000 previously uninsured Nevadans can trace their coverage to Medicaid expansion or other ACA provisions.
— Heller's at least the 11th GOP senator to raise questions about AHCA. To get the bill through the Senate, Republicans can afford to lose only two.
AND CONSERVATIVES CONTINUE THEIR PILE-ON — Conservative Hill leaders warned on Sunday that they won’t support the House GOP Obamacare alternative as it’s written, saying that they’ll let the bill fail if they don’t get concessions, POLITICO's Rachael Bade reports.
“Seems to me the ‘binary choice,’ if there is one here, is to say … ‘Either work with us or you don’t end up getting the votes,’” Rep. Jim Jordan told Chris Wallace on “Fox News Sunday.” More.
— Heritage Action: AHCA 'keeps the architecture of Obamacare.' The "fundamental problem" of the bill is that it doesn't strike down the ACA's insurance market provisions and other regulations, the advocacy group warns — an argument that they're going to ramp up across the week.
"If Republicans leave the architecture of Obamacare in place and if we have death spirals and premiums going up under Ryancare, what do you think the 2020 election is going to look like? What’s the 2024 election look like?" Heritage Action CEO Mike Needham asked on "Fox News Sunday."
— Sarah Parlin blasts AHCA as 'RINO-care.' The former Alaska governor, who was among the first major Republican figures to endorse Trump, also says the premium surcharge for those who don't maintain uninterrupted coverage is ill-intended and will hurt average consumers.
"It makes you wonder who’s lobbying hardest for aspects of this new bill because obviously there are special interests involved," Palin told Breitbart Radio. More.
ONE PERSON WHO LIKES THE BILL: DOUG HOLTZ-EAKIN — The former CBO director under President George W. Bush and American Action Forum president is the rare economist who’s publicly optimistic about AHCA. “It’s a personality flaw,” he joked to PULSE.
Holtz-Eakin points to previous analyses of GOP bills done by the Center on Health and Economy, a nonpartisan think tank that includes big names like Uwe Reinhardt and Mark Pauly. For instance, the center found favorable short-term coverage and budget effects from Ryan’s “Better Way” plan.
The Republican bill “looks to be a bit different in that, the Medicaid expansion phases out slower,” Holtz-Eakin allows. AHCA also doesn’t contain as many regulatory reforms (because it’s being done through budget reconciliation) and its $100 billion state stabilization fund is a “huge wild card” because states will take different paths. But “my take on the bottom line is roughly in the same ballpark,” Holtz-Eakin concludes.
… Despite the conservative pushback, Holtz-Eakin also predicts AHCA will pass with the slimmest of majorities — “218 votes in the House and 51 in the Senate, with maybe Pence being the [tiebreaker], because it has to,” he says. But he added, “It’s going to be ugly.”
THIS IS MONDAY PULSE — Where we're still wincing at SNL's riff on the AHCA. Republicans may never win over New York City comedians — but it's not often that a single piece of legislation produces more than two minutes worth of punchlines.
Your PULSE author tries to be funny, but he's seriously interested in your takes on AHCA. Send tips and quips to ddiamond@politico.com or @ddiamond on Twitter.
SEEMA VERMA FACES CONFIRMATION VOTE TODAY — Trump's pick to run CMS is likely to be confirmed in the vote, which is currently scheduled for 5:30 p.m.
The Indiana health policy consultant would be the agency's first confirmed administrator since Marilyn Tavenner, who was backed in a 91-7 vote in May 2013 and served until January 2015.
SCOTT GOTTLIEB TAPPED FOR FDA
Broad praise pours in. Leaders on the Hill, in industry and some in public health praised Trump's pick of Gottlieb — a former FDA and CMS official, who's also a physician and a prominent health policy commentator — to run the agency.
Gottlieb "has impressive qualifications helping American patients as both a physician and in his previous roles at the FDA," Senate HELP Committee Chair Lamar Alexander said in a statement. "He understands the FDA’s vital in assuring public safety while allowing patients to benefit from cutting-edge medical discoveries," added AEI president Arthur Brooks.
"The reason I voted through my objections with Trump is that a presidential election selects a team, not one person," said Tom Giovanetti, head of the conservative Institute of Policy Innovation. "Scott Gottlieb is another example."
— Gottlieb, long rumored to be a finalist for the job, benefited from an unusual beauty pageant. Trump's other rumored finalist, Jim O'Neill, would have been non-traditional (he's not a doctor) and had argued for making dramatic changes that would have weakened drug safeguards — a stance that had alarmed the industry.
That's one reason why Democrats who have been largely critical of Trump's picks were more muted on Gottlieb's selection — although Sen. Patty Murray, the ranking member on the HELP Committee, said she'd look into Gottlieb's potential conflicts of interest.
— How Gottlieb thinks about health care. Unlike Seema Verma, who had a low public profile, Gottlieb has written and spoken extensively about the industry and federal regulations.
Here's a roundup of Gottlieb's top posts at Forbes.
Here's are three Health Affairs blog posts he's written, including one from last year on reducing drug prices.
MORE AHCA
White House continues war on CBO. Budget chief Mick Mulvaney told ABC's "This Week" that he wasn't sure if the non-partisan budget office was up to the task of analyzing the health bill — the latest, if most direct attack, on the CBO by top Republicans.
"I love the folks at the CBO, they work really hard. They do," the OMB chief said. But "sometimes we ask them to do stuff that they're not capable of doing." See 23-second video.
CBO, of course, was created specifically to analyze major legislation and is staffed by professional economists. "The former OMB and CBO director in me is speechless," tweeted Peter Orszag.
In Sunday morning appearances, Price and Ryan also took swipes at the budget office.
… Paul Winfree, the deputy director of the Domestic Policy Council and director of budget policy, took a more nuanced but critical view in a series of Twitter posts.
"I've always held that the real problem is with policymakers who (1) read too much into CBO analysis," Winfree posted, "and (2) use CBO analysis (rather than principles) to justify their votes." More.
Mike Pence: Kentucky is grappling with 'Obamacare nightmare.' The vice president hit the Bluegrass State over the weekend, appearing with Gov. Matt Bevin and telling residents that Republicans' health plan would allow for more "freedom and flexibility."
… However, Pence didn't point to any specific way that Kentucky voters would benefit from ACA repeal. One reason: He couldn't. No reputable analysis exists yet that shows how AHCA would lower premium costs and improve coverage. Instead, the Center on Budget and Policy Priorities and other groups have found that ACA provisions have led to financial and public health gains in the state, where nearly 500,000 people have gained coverage since the ACA took effect.
Democrats hope to win back older supporters on health care. The party's operatives are already rattling off the ways the GOP health care proposal would hit the 50-and-over crowd, POLITICO's Kevin Robillard reports.
“I wish I could’ve run ads () said Republicans want to charge seniors five times as much for health care," said Jesse Ferguson, an operative who worked for the Clinton campaign and ran House Democrats’ independent ad unit in the last midterm election. "You don’t need to be a good ad-maker to know that’s an effective attack." More
How good is salesman Trump? Unpopular health bill may be the test. Republicans haven't won over the health care industry, which seemingly violates a cardinal rule of writing health reform.
"Once there are two or three or four groups that oppose [reform], support for it starts to collapse," former Sen. Max Baucus said. That's why back in 2009 and 2010, when Baucus led the effort to write his chamber's bill, "I was constantly saying, 'Don’t walk, hey, everything’s on the table,'" he added.
But it's evocative of Trump's unconventional presidential campaign, where the businessman candidate flouted norms and alienated traditional players before his upset victory. This time he must convince well-heeled Washington lobbyists — whose industries stand to lose billions of dollars — to go along. More for Pros.
… Some Republicans have argued that not engaging industry was intentional. "Unlike the #ACA our #healthcare reform bill was not written by lobbyists & special interests to protect their own $," Florida Rep. Carlos Curbelo tweeted.
AROUND THE NATION
STATE WEEK: Price promises states Medicaid flexibility. The HHS secretary is vowing to use the department’s regulatory authority to give states more flexibility to manage their Medicaid programs amid concerns from Republican governors over the House's Obamacare replacement plan, Pro's Brianna Ehley reports. More for Pros.
Better Medicare Alliance makes major ad buy. The multi-million dollar campaign, which includes a mix of digital and TV ads, avoids the current health reform fight and pushes Medicare Advantage as a public-private solution for the industry's challenges. "While everyone discusses the future of health care, 18 million seniors are already choosing it," a narrator intones. See ad.
The Americans worried about how the GOP plan will affect them. A slew of news stories this weekend focused on the effect of repealing the ACA.
— Medical bills made him refinance the farm once. Now this Missouri farmer is worried that he'll have to do it again under the GOP plan, KBIA's Bram Sable-Smith reports. More.
— Poor, sick West Virginians who voted for Trump are now worried about what happens if the ACA goes away, WaPo Jessica Contrera writes in a deeply reported story. More.
— A 33-year-old man with early-onset Parkinson's in Kansas grapples with the uncertainty, Alex Smith reported for All Things Considered. More.
NAMES IN THE NEWS
Erin Richardson lands at the Federation of American Hospitals. Richardson, who most recently served as a senior policy adviser for the White House's Domestic Policy Council in the Obama administration, will be vice president and associate general counsel at FAH.
WHAT WE'RE READING
Republicans' health bill "could create a powerful incentive for Americans to remain in poverty instead of climbing up the economic ladder," argues prominent conservative wonk Avik Roy. More.
Fellow conservative wonk Chris Jacobs is pessimistic about whether the bill will even survive the Senate parliamentarian's review, at least in its current form. More.
Nick Gerhart, a Republican who stepped down as Iowa's insurance commissioner this year, offers six suggestions for the GOP to focus on when attempting to fix insurance markets. More.
For Brazil families touched by Zika, the disease has broken relationships and brought some partners closer together. More.