AMID STORM, ALEXANDER THROWS HEALTH CARE HAIL MARY

Back-to-back storms tied to health care blew gale-force winds in recent weeks — strong enough to topple two Trump appointees and place the insurance coverage for millions in critical condition.

Trump’s nominee as the nation’s drug czar, Rep. Tom Marino, R-Pa., withdrew his name from consideration to lead the Office of National Drug Control Policy on Tuesday after “60 Minutes” and The Washington Post revealed Sunday that he and Tennessee Republican Rep. Marsha Blackburn’s legislation and bullying had gutted DEA efforts to fight Big Pharma’s role in expanding the opioid crisis.

Between tMarino and Blackburn, they’d taken more than $200,000 in industry contributions, investigations revealed.

Just weeks before that, Heath and Human Services Secretary Tom Price, a former Georgia representative tapped by Trump, was forced to resign because he’d spent hundreds of thousands of taxpayer dollars on charter and government flights rather than travel commercially with America’s unwashed — even while he and the Trump administration worked to peel away insurance coverage from 20 million of those unwashed masses.

The ill winds smell of two popular political swamp dwellers: Congress and the pharmaceutical industry.

Add to this gloomy setting, President Donald Trump’s own tone-deaf timing.

Right in the middle of those two storms, Trump signed an executive order ending the cost-sharing reduction payments that helped the Affordable Care Act be affordable — the subsidies that offset deductibles and other out-of-pocket costs for low-income working consumers who buy insurance under the ACA.

Pundits far and wide heralded our president’s move as the nail in the coffin of Obamacare. Some also hailed it as the nail in the coffin of the GOP’s continued majority in Congress.

But as with all good drama, there is a twist. Enter Tennessee Sen. Lamar Alexander, a Republican, and Washington Sen. Patty Murray, a Democrat.

The two restarted a dialogue they’d tried to nurture months back before “repeal and replace” fever broke in the beltway for the gazillionth and likely last time. On Tuesday, they reached an agreement to fund key federal health care subsidies that Trump ended last week.

And in yet another twist, the president expressed support for the plan, which would provide states with greater flexibility under the ACA in exchange for authorizing the cost-sharing reduction payments for two years.

Trump, of course, takes credit (until he doesn’t). “Yes, we have been involved, and this is a short-term deal because we think ultimately block grants going to the states [are] going to be the answer,” the president told reporters Tuesday.

If you’re thinking this is a very implausible story line, you’re right.

But we’re choosing to think of this suspense movie as the death spiral of the GOP’s long-desired Obamacare death spiral. And we’re choosing to think of Marino and Price as collateral storm damage — hastened to their downfalls with the self-inflicted wounds of their own arrogance and greed.

It remains completely unclear whether Senate GOP leaders will embrace the Alexander-Murray proposal, but their options seem to be narrowing.

What is completely clear, however, is that health care guarantees we once thought we had — like the emergency war on opioids we were told we would have — are still quite murky.

Alexander told Washington Post reporters Tuesday that the deal he struck with Murray would extend ACA subsidy payments for two years and provide states “meaningful flexibility” under the ACA’s existing waiver program. He said the proposal would offer states greater freedom by allowing them to make changes to insurance offerings as long as the plans had “comparable affordability,” which is a looser definition than the existing one.

The proposal would allow insurers to offer catastrophic insurance plans to consumers aged 30 and older on ACA exchanges, while maintaining a single risk pool.

But Alexander stressed that the legislation would not allow states to change the essential benefits now required, or let insurers discriminate against consumers with pre-existing conditions. He also said it would shorten the time period for federal review of state waiver applications, expedite review for states in emergency circumstances and states with waivers already approved.

Importantly for Tennessee, it would allow governors to approve state waiver applications rather than requiring state legislative approval. Tennessee’s Republican majority General Assembly forbade Gov. Bill Haslam from approving a Tennessee-specific ACA waiver without state lawmakers’ OK, leaving thousands of Tennesseans without insurance and robbing Tennessee coffers of available federal money.

The Alexander-Murray bill also would assess the budget impact of any state proposal over the life of the waiver, rather than on an annual basis.

This isn’t a movie. It’s a long-playing series. Stay tuned.