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Congress returns as CHIP funding deadline looms. Congress will return from its Martin Luther King Jr. holiday to a looming deadline to reach a spending deal before the government runs out of money at midnight Friday. Congress is looking at approving another short-term deal to fund the government possibly into February, and lawmakers are pressing for a long-term reauthorization of the Children’s Health Insurance Program. Rep. Fred Upton, R-Mich., told the Washington Examiner last week that he is pursuing a five-year deal but hasn’t received an OK from leadership. A long-term deal for CHIP became closer to reality after the Congressional Budget Office estimated that CHIP would save the federal government $6 billion if it were extended over 10 years. The reason is that the matching rate for state funds falls starting in 2021. The loss of Obamacare’s requirement for everyone to buy health insurance also will lead to fewer families to sign up their children for coverage, the CBO reported in a separate estimate. CHIP serves about 9 million low-income children. CHIP is traditionally a bipartisan program that has been mired in a partisan quagmire since it expired on Sept. 30 because of disputes over how to pay for it. States have been using leftover funding from prior years to keep afloat, and a short-term spending bill passed on Dec. 22 included nearly $3 billion in temporary funding to keep the program going until the end of March. However, a report from Georgetown University found that 11 states would run out of funding by the end of next month, putting a greater impetus on Congress to fund the program in the Jan. 19 spending deal.

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.

UnitedHealth boosts 2018 outlook due to tax bill. UnitedHealth Group expects to make $1.7 billion more than previously forecast in 2018, thanks to the passage of the tax bill late last year. The company now expects 2018 adjusted earnings of $12.30 to $12.60 per share, up from its initial forecast of $10.55 to $10.85. In its first-quarter earnings call Tuesday, UnitedHealth said it would shift the windfall it received from the law to investments in technology, data analytics and health-related initiatives in local communities. "Corporate tax reform is expected to improve earnings and cash flows by $1.7 billion in 2018," company CEO David Wichmann said in the earnings call. “That’s after an estimated $400 to $500 million reduction in premium revenues due to minimum loss ratio and lower net health insurers fee recapture effects and a $200 to $300 million additional investment in operating costs." UnitedHealth already was performing well before the tax bill's passage. Revenue for the year grew 9 percent, to $201 billion, led mostly by its Optum offerings, which provides health services like a pharmacy benefits manager. UnitedHealth posted a 115 percent increase in net income over the year-ago period to $3.6 billion on $52 billion in revenue. Company executives said they were supportive of Trump's executive order on Obamacare, which will allow for more people to band together to buy insurance, and would contain other proposals not yet detailed that allow people to purchase short-term plans. Executives said the order would allow for lower-cost plans and give customers more choice. The company stopped participating in the Obamacare exchanges in 2017.

White House doctor to release details of Trump’s medical exam. The White House physician, Dr. Ronny Jackson, is set to deliver the results from President Trump’s routine medical exam this afternoon. Previous results have indicated a president’s weight, height and cholesterol levels, as well as a list of medications and whether doctors have recommended any changes in lifestyle. They also may include specialists who were involved in carrying out the exam, and details about whether any procedures were conducted, such as the removal of a mole. The physicians who presented the results for former Presidents George W. Bush and Barack Obama declared them “fit for duty.” On Friday, Jackson said President Trump was “in excellent health.”

A first since Obamacare went into effect: Number of uninsured rises in 2017. The number of people in the U.S. who became uninsured in 2017 increased by 3.2 million, according to the latest Gallup-Sharecare Well-Being Index. The increase, which is equal to a 1.3 percentage point change since the fourth quarter in 2016, means that 12.2 percent of the U.S. population was uninsured last year. The 2016 figure, of 10.9 percent uninsured, represented a record low since Gallup and Sharecare began to track rates in 2008, before Obamacare was signed into law and before its provisions to expand coverage took effect. The figure is still lower than the peak uninsured rate of 18 percent in 2013, in the wake of the economic downturn and before people became able to buy government-subsidized healthcare plans through exchanges or enroll in expanded Medicaid, both provisions of Obamacare.

Senate Finance Committee sets vote for HHS pick. The Senate Finance Committee will vote Wednesday whether to confirm Alex Azar, President Trump’s choice to lead the Department of Health and Human Services. If Azar clears the committee, as expected, he will head to the Senate floor where he needs to get only 51 Republicans to be confirmed. Republicans, who have a one-vote majority in the committee, have praised Azar, a former HHS veteran during the George W. Bush administration and a former pharmaceutical executive. Democrats are skeptical of Azar due to his tenure at Eli Lilly from 2012 to 2017, questioning if Azar will be an advocate for reining in drug prices. If Azar clears the committee, confirmation on the Senate floor is widely expected. Democratic Sens. Joe Manchin of West Virginia and Heidi Heitkamp of North Dakota have both said they will support Azar. Both are up for re-election this year in states that Trump won handily in 2016. If confirmed, Azar would replace former HHS secretary Tom Price, who resigned after a scandal surrounding his rampant use of private jets.

FDA aims to divulge more information on how it approves drugs. The Food and Drug Administration will release more information on how it reaches decisions on which drugs to approve. The agency said Tuesday it is creating a pilot program that will release certain information from clinical study reports, which are detailed results on clinical trials for a new drug that address effectiveness and safety. The FDA currently does not include that information when it approves a drug. The agency releases a summary written by the reviewer of the drug, which includes information such as the data on whether the drug is safe and proposed labeling for the product. But the agency is looking to divulge more information about the process. “We expect that making a CSR publicly available after a drug’s approval will provide stakeholders with more information on the clinical evidence supporting a drug application and more transparency into the FDA’s decision-making process,” FDA Commissioner Scott Gottlieb said. The pilot will include up to nine new drug applications across various disease areas. After the pilot is complete, the FDA will seek public comments on expanding the effort.

FDA pilot follows controversy over drug approvals. The FDA has been criticized in recent years about how it makes decisions about new drugs. Some advocates have criticized the agency for approving certain products after public pressure. That was the case of the drug Sarepta to treat the rare pediatric disease Duchenne Muscular Dystrophy. Sarepta was approved in 2016 despite an FDA advisory panel recommending against approval. The FDA does not have to follow the recommendations of its advisory committees, but it usually does. The panel found there wasn’t enough evidence that the drug was effective. However, the agency approved the drug after intense lobbying from grassroots groups seeking any cure for Duchenne, which had no treatment at the time.

Francis Collins shrugs off Trump’s decision to cut NIH in budget proposal. The director of the National Institutes of Health isn’t concerned his new boss tried to cut his agency’s funding. Francis Collins told the Washington Post’s Health 202 that he isn’t concerned with the administration’s push to cut 20 percent of his budget in its first budget proposal last year. “I think that was very early in the administration, coming in and needing to have a budget shortly after arrival,” Collins said. “I think a lot of talk and conversation in a very productive way has gone on over the past year since that original budget.” The budget request went nowhere and NIH, which has a lot of bipartisan support, received a funding boost in recent budget deals. Collins added that Trump has pushed for a greater response to combating the opioid epidemic, recounting an Oval Office meeting in March. He said the president wanted him to both channel NIH’s resources and work with the industry to address addiction treatment. Collins’ remarks comes a few days after numerous Senate Democrats pushed the president to renew the emergency declaration on the opioid epidemic. Lawmakers complained that the emergency declaration hasn’t done much and that more funding is needed to combat the epidemic that is killing 91 Americans a day.

Emergency rooms not a major source of opioids, new study finds. A new study found that emergency rooms are not a major source of opioid prescribing, especially compared to doctor or dentist offices. Opioid prescribing increased by 471 percent from 1996 to 2012, according to the study in the journal Annals of Emergency Medicine. The analysis is based on an annual survey of 15,000 patients. The study showed that a typical patient received 44 percent of his or her opioids from an office-based prescription and 26 percent from a dentist or other outpatient source. Another 16 percent got the drugs from an emergency room and 14 percent from an inpatient setting. The study also found a staggering increase in the number of opioid refills originating from a doctor’s office prescription, jumping by 446 percent from 1996 to 2012. However, one-time prescriptions increased by 277 percent during the same period. Federal data shows that 91 Americans die each day from an opioid overdose. A major factor in the spread of the epidemic has been overprescribing from healthcare providers. Healthcare groups and federal agencies have targeted more training for doctors to try to curb opioid prescribing. The number of opioids prescribed in the U.S. peaked in 2010 and fell each year through 2015, according to the Centers for Disease Control and Prevention.

Planned Parenthood releases 2018 predictions for reproductive health. Planned Parenthood published a report Tuesday about moves it expects the Trump administration and Congress to attempt to restrict abortion rights and alter healthcare services in 2018. The group said it appeared shielded from certain restrictions, such as “defunding” Planned Parenthood, particularly given that Republicans lost a Senate seat in Alabama but the Senate still may vote on a bill that would ban abortion after 20 weeks. Planned Parenthood noted, as well, that some Republicans were looking at returning to an overhaul of how government-funded healthcare is delivered, but it’s not clear to what extend lawmakers would target any programs that alter Medicaid or Medicare, given public backlash and promises Trump made about the programs while campaigning. Medicaid work requirements were recently approved in Kentucky, and more states are considering them. The program helps pay for a range of reproductive healthcare services, including cancer screenings and testing of sexually transmitted infections, as well as maternity services.

Maryland advocates push more initiatives to tackle drug prices. Maryland made history last year when it signed into law a bill that clamped down on big price hikes for generic or off-patent drugs. Now activists are hoping to pursue new drug initiatives in 2018. The Maryland Health Care for All Coalition was scheduled to announce the the proposals during a press conference Tuesday. The coalition of activists is airing radio ads to push new legislation aimed at controlling the prices of brand-name drugs.


Axios Kentucky’s healthcare microcosm

Washington Post Scientists find cause for mysterious epidemic that wiped out Mexico 500 years ago

STAT News A Minnesota advocate’s crusade brings harmful skin lightening out of the dark

Kaiser Health News Inside the global race to deliver a vital radioactive isotope used to detect cancer

CNN IV bags in short supply in U.S. after Hurricane Maria

Reuters Greater screen time linked to worsening sleep quality in early childhood


TUESDAY | Jan. 16

Johns Hopkins Bloomberg School of Public Health. Forum on Transparency at the Food and Drug Administration. Includes keynote from FDA Commissioner Scott Gottlieb. Began 9:45 a.m. View Live.

1 p.m. Atlanta. Centers for Disease Control and Prevention Grand Rounds about severe influenza. Details.

3:30 p.m. White House Physician Dr. Ronny Jackson will deliver results of President Trump’s medical exam.

5 p.m. H-313 Capitol. House Rules Committee hearing on the Born-Alive Abortion Survivors Protection Act. Details.


9:30 a.m. 1225 I St. NW. Bipartisan Policy Center event on “Reinventing Rural Health Care: A Case Study of Seven Upper Midwest States.” Details.

10 a.m. 215 Dirksen. Senate Finance Committee to vote on Alex Azar nomination for secretary of the Department of Health and Human Services.

10 a.m. 430 Dirksen. Senate Health, Education, Labor and Pensions Committee hearing on “Facing 21st Century Public Health Threats: Our Nation’s Preparedness and Response Capabilities.”  Details.

10 a.m. SD-342 Dirksen. Senate Homeland Security and Governmental Affairs Committee hearing on “Unintended Consequences: Medicaid and the Opioid Epidemic.” Details.

10 a.m. 1100 Longworth. House Ways and Means Committee hearing on preventing opioid misuse. Details.

THURSDAY | Jan. 18

1p.m. 1330 G St. NW. Kaiser Health News event on healthcare in 2018. Details.

FRIDAY | Jan. 19

Deadline for government spending bill.

45th annual March for Life rally in protest of Roe v. Wade. Will include speech from House Speaker Paul Ryan.

9 a.m. 2123 Rayburn. House Energy and Commerce Committee hearing on “Safety of the U.S. Food Supply: Continuing Concerns Over the Food and Drug Administration’s Food-Recall Process.” Details.