The Health 202: Trump’s health care evolution can be traced in his tweets – Washington Post

THE PROGNOSIS

President Trump has showered praise upon the GOP bill to overhaul Obamacare. He threw a big Rose Garden celebration once the House passed it. He promised it would transform the nation’s health-care system into one of the world’s finest.

And yesterday, behind closed doors, he told a group of Senate Republicans it is “mean.”

Trump apparently critiqued the health-care bill passed by House Republicans in front of more than a dozen senators he hosted for lunch at the White House. The president said the senators should make their own version “more generous,” according to congressional sources who leaked to the Associated Press. That’s pretty different from what Trump said when the cameras were turned on. He had some tart words for Democrats, instead:

Of course, the GOP senators didn’t share those comments with the press, either. Conference Chair John Thune (R-S.D.), who attended the lunch, said Trump talked about “making sure that we have a bill that protects people with preexisting conditions” and how to design a tax credit for purchasing insurance that works for lower-income and elderly people in particular, my colleagues Kelsey Snell and Sean Sullivan report.

“I think he realizes, you know, our bill is going to move, probably, from where the House was and he seems fine with that,” Thune said. “He talked about making sure that we have a bill that protects people with preexisting conditions.”

It’s hardly surprising that Trump would privately feel this way about the House’s American Health Care Act, which is projected to leave 23 million more Americans without health coverage. After all, Trump was a longtime advocate of government-run health-care programs in many other developed countries. In his book “The America We Deserve,” Trump praised Canada’s single-payer system and wrote that the United States must similarly have universal health care.

But Trump has publicly bragged about the AHCA in such sweeping terms and with such outward confidence that his candid moment yesterday dramatically emphasizes the incongruity of his past personal views and the outlook of Republicans he’s trying to work with to sweep much of Obamacare aside.

Unsurprisingly, the president’s zigzag health-care evolution can be traced in his tweets. Let’s take a tour of what he’s said about the GOP health effort:

From right after the House bill passed:

Then, a strange nod to the Australian health-care system during the same time period:

And a helping hand for Senate Republicans embarking on the politically perilous process:

But suddenly, a shift (about three weeks after applauding the AHCA’s House passage):

Now — as senator struggle to pass their own version of health care — Trump has characterized the version passed in the lower chamber as “mean.”

The president may — or may not — be referring to the fact that many experts believe that allowing states to opt out of certain insurance requirements and allow insurers to charge more to cover sick people (see my colleague Glenn Kessler’s fact check on the subject). Trump could also be talking about criticism that the House bill allows insurers to charge older people (who are likely to be sicker) up to five times more than younger ones (the healthier part of the population).

Or Trump could be referring to something else entirely.

Twitter was aflame over the comment:

From CNBC’s Chief Washington Correspondent John Harwood: 

From the New York Times’s Chief Washington Correspondent Carl Hulse:

BREAKING NEWS THIS MORNING: A gunman opened fire this morning on Republican lawmakers practicing for the Congressional Baseball Game in Alexandria, Va., “possibly injuring several including at least one lawmaker, Steve Scalise, the majority whip, according to police and a congressman. Alexandria police would only confirm that a shooting had occurred and that one person was in custody,” reports Peter Hermann, Paul Kane and Patricia Sullivan. For more real-time updates, check the Post website.

AHH: One insurer is expanding into more Affordable Care Act marketplaces instead of withdrawing from them — and could help fill some holes. Health insurer Centene announced plans Tuesday to start offering coverage on exchanges in Missouri, Kansas and Nevada. It also will expand its presence in Florida, Ohio, Texas and Washington, among other states, the AP reports.

“This growth spurt could fill some big holes that have developed in the exchanges, the only place where people can buy individual coverage with help from an income-based tax credit,” according to the AP. “Currently, 25 counties in Missouri, 20 in Ohio and another two in Washington have no insurers lined up to sell coverage on the exchange in 2018.”

OOF: Mandatory new nutrition fact labels have been delayed indefinitely, the FDA announced yesterday. “The labels, championed by former first lady Michelle Obama, were supposed to add a special line for ‘added sugars’ and emphasize calorie content in large, bold text,” the Post’s Caitlin Dewey reports. “They had been scheduled for rollout in July 2018, with a one-year extension for smaller manufacturers.”

“The delay is the latest reversal of the Obama administration’s nutrition reforms under Trump,” Caitlin writes. “On April 27, the FDA also delayed rules that would have required calorie counts on restaurant menus. A week later, the Department of Agriculture loosened the minimum requirements for the amount of whole grain in school lunches and delayed future sodium reductions….Consumer groups are already slamming the Nutrition Facts delay as an attack on public health. The largest groups in the food industry, meanwhile, is celebrating what it calls a win for ‘common-sense’ regulation.”

OUCH: Attorney General Jeff Sessions is asking congressional leaders to undo federal medical-marijuana protections that have been in place since 2014, according to a May letter that became public Monday, my colleague Christopher Ingraham reports. The protections, known as the Rohrabacher-Farr amendment, prohibit the Justice Department from using federal funds to prevent states from implementing their own laws authorizing the use, distribution, possession or cultivation of medical marijuana.

In his letter, Sessions cited a “historic drug epidemic” to justify a crackdown on medical marijuana. But that’s at odds with what researchers know about current drug use and abuse in the United States. The epidemic Sessions refers to involves deadly opiate drugs, not marijuana, Chris writes.

–Several top Senate Republicans sought to temper expectations yesterday that they can produce a final health-care draft by the end of the week — or even by the end of the month. Finance Committee Chairman Orrin G. Hatch (R-Utah) chuckled quietly when we asked if they’ll be ready to vote on a bill before the July 4 recess.

“I think we’re a ways away,” Hatch said. Asked when legislation might be done, he laughed again. “When we get it done,” he said.

–Other Republicans emerging from their health-care huddle said there’s an openness to retain some of the ACA’s taxes in order to pay for more generous benefits. Sen. Mike Rounds (R-S.D.) said that’s the big question. “It depends on what it’s going to take to get to 50 [votes],” he said. “So that’s really the timing and that’s the deciding factor.” Conservatives would not be happy, as I wrote yesterday.

But Hatch said he would prefer to repeal all of the ACA’s taxes. “I’d like to have no taxes,” he said.

–But as senators downplayed their rate of progress, a top House Republican dialed up expectations. House Energy and Commerce Chairman Greg Walden (R-Ore.) predicted to the Wall Street Journal’s CFO Network meeting yesterday that a final bill will pass the Senate and land on the president’s desk before August. Walden added that there’s been “radio silence” from his Senate colleagues as they’ve been drafting their own bill.

–The effort has grown increasingly dependent on the fragile alliance between Senate GOP leaders and a man they have clashed bitterly with for years: Sen. Ted Cruz (R-Tex.), Kelsey and Sean report.

“Senate leaders are struggling to build conservative support for their emerging bill, with GOP aides and senators voicing growing skepticism that hard-right Sens. Rand Paul (R-Ky.) and Mike Lee (R-Utah) can be convinced to back it,” they write. “Conservative organizations, meanwhile, are complaining that Majority Leader Mitch McConnell (R-Ky.) is offering proposals that would not sufficiently dismantle the law known as Obamacare.”

“But Cruz, after building a national brand stoking tensions with McConnell and his top deputies, is, in his own words, trying to “get to yes.’ The former presidential hopeful has spoken positively about the negotiations, which he helped kick-start. His investment in the talks has generated cautious optimism among many Republicans that he won’t walk away from a delicate effort from which McConnell, with a 52-seat majority and Vice President Pence as a potential tiebreaking vote, can afford only two defections,” my colleagues report.

–Democrats had an unexpected opportunity yesterday to press even harder on their criticisms of Republicans for writing their health-care bill behind closed doors when television reporters covering the Capitol were told midday Tuesday to stop recording interviews in Senate hallways. What would have been a dramatic and unexplained break with tradition that was soon reversed amid a wide rebuke from journalists, Democratic lawmakers and free-speech advocates, my colleague Elise Viebeck reports.

“The controversy started Tuesday around noon, when staffers from the Senate Radio and Television Correspondents Gallery, which operates workspace for networks in the Capitol, told reporters from major television networks, with no warning, to stop recording video in the hallways,” Elise writes.

“Gallery staffers blamed the shift on the Senate Rules Committee, which has official jurisdiction over media access in the upper chamber, according to journalists who shared detailed accounts of the developments on Twitter….The directive touched off a day of confusion as the Rules Committee denied issuing new restrictions and gallery staffers refused to explain their part in the drama.”

Rules Committee Chairman Richard C. Shelby (R-Ala.) eventually issued a statement saying there will be no policy shift on where reporters can go on the Senate side of the Capitol building. But that was after many Democrats tried to link it to how Republicans aren’t being transparent on health care:

Hillary Clinton even chimed in yesterday:

–Republicans who have been trashing the Congressional Budget Office lately for its unflattering score of their health-care bill might be more pleased with an estimate out from the actuary for the Centers for Medicare and Medicaid Services. The actuary says the House-passed bill would strip health coverage from 10 million fewer people than projected by the CBO — and estimates it will save the federal government $328 billion instead of $119 billion the CBO estimated.

 

The New York Times’ Margot Sanger-Katz took note:

Why are the estimates so different? Politico’s Paul Demko explains that CMS and CBO made some different assumptions:

“The disparity is a result of differing assumptions about whether cost-saving measures in the House bill will work,” Paul writes. “The CMS actuary and CBO have disagreed in the past on the budgetary effects of legislation, including surrounding the enactment of Obamacare. The new actuary’s analysis does not estimate the effects of taxes repealed.”

–Vice President Pence pulled a Paul Ryan yesterday when he used a chart to reinforce his arguments against the ACA in a speech at the Department of Health and Human Services. Here’s what Pence said (while gesturing to his chart):

“Back when Obamacare was first passed, just over seven years ago, the Congressional Budget Office estimated that 23 million Americans would be covered by now. That’s the blue line on the far left. It quickly became apparent that this was far-fetched — to put it mildly.”

But Pence’s chart didn’t tell the full story, according to a fact-check from the AP’s Ricardo Alonso-Zaldivar.

The facts: It’s true that only 10.3 million people are enrolled this year in the subsidized health-insurance markets, not the 23 million the Congressional Budget Office had originally projected.

The details: The chart omitted this relevant information: Of the new enrollees, 12 million were supposed to get coverage through the law’s Medicaid expansion. But 19 states have refused to expand Medicaid because of opposition from Republicans, a big contributor to why enrollment fell so short of the CBO’s initial projection. “Together, the Medicaid expansion and subsidized private health insurance have reduced the number of uninsured by about 20 million people, bringing the uninsured rate to a historic low of about 9 percent, according to the government,” Ricardo writes.

Today         

  • The House Energy and Commerce subcommittee on Health will hold a hearing on safety-net health programs.
  • Axios is hosting an event in Los Angeles on the “impact and possibilities of artificial intelligence, virtual reality, biopharmaceuticals and research for the brain.”
  • The Brookings Institution will host an event on the pharmaceutical distribution chain.
  • The Manhattan Institute and U.S. Chamber of Commerce co-sponsor a forum on solutions to high drug prices.
  • The Senate Finance Committee will hold a confirmation vote on Eric D. Hargan to be deputy Health and Human Services secretary.

Coming Up

  • Bloomberg Law is hosting an event on the future of the Affordable Care Act on Thursday.
  • The Senate Appropriations’ subcommittee on Labor, Health and Human Services, Education and Related Agencies will hold a hearing with HHS Secretary Tom Price on Thursday on the department’s 2018 fiscal year budget request.
  • Mylan, the company that makes the EpiPen, is scheduled to have its annual shareholder meeting on June 22. A major advisory firm is reportedly recommending Mylan shareholders vote to remove nearly all the company’s board members.

Watch President Trump’s full remarks about health care in Milwaukee:

Attorney General Jeff Sessions said during his testimony before the Senate Intelligence Committee that the “suggestion that I participated in any collusion . . . is an appalling and detestable lie”:

Here’s a fact check on President Trump’s claim that his nominees faced “record-setting long” delays:

And on The Late Show with Stephen Colbert, a First Lady Melania Trump got emotional about finally moving into the White House: 

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