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Health spending passes $10,000 per person for first time. The average amount spent on healthcare per person reached $10,348 in 2016, surpassing $10,000 for the first time, according to an annual report by the Centers for Medicare and Medicaid Services. The amount is a $354 increase from the year before. The latest findings, published in the journal Health Affairs, show that overall spending grew by an average of 4.3 percent, resulting in a spending total of $3.3 trillion. The share of the gross domestic product devoted to healthcare climbed to 17.9 percent from 17.7 percent in 2015. Hospital care accounted for the largest share of healthcare spending, at 32 percent, while spending on doctors accounted for 20 percent. The total represents a slowing in growth from the year before, when spending increased by 5.8 percent, and from 2014, when spending increased by 5.1 percent. That occurred largely because of Obamacare, when more people were covered by health insurance and more were using more healthcare services. Also contributing to the overall slowing was a deceleration in spending on prescription drugs and a slowdown in people's use of other healthcare services.

Paul Ryan refuses to embrace Obamacare bills. House Speaker Paul Ryan refused to offer support to two Obamacare stabilization bills that President Trump and Senate GOP leadership has agreed to support. Ryan only said during his press conference Thursday that “we are gonna fix healthcare.” He added that Sen. Susan Collins, R-Maine, who secured the support for two bills in exchange for her vote on tax reform, put some “productive solutions on the table.” But a major question has been whether the House will bring up the two bills, which include funding for Obamacare insurer payments that Ryan has previously opposed. Collins has pressed for the bills as a way to blunt any impact on premiums from repealing the individual mandate in tax reform. However, Ryan only said that he believes the mandate should be repealed and that action will “invite a new conversation.”

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.

Republicans race the clock to finish tax overhaul before Christmas. Wednesday's Senate vote to negotiate a tax bill with the House started the clock on an ambitious plan by Republicans to finalize a sweeping tax overhaul in just a matter of weeks, in the hopes of putting the bill on President Trump's desk by Christmas. Even before the Senate vote, Republican leaders were talking behind the scenes to mull some of the major revisions needed to bring the bills into alignment. Some of the biggest changes to the Senate bill were added just before it passed to expedite the process. Although the version of the bill passed by the Senate created new problems to fix, Republicans projected optimism that the obstacles were not a threat to final passage. The broadest issues to be addressed are whether the conference committee can maintain all the promises made to members to gain their votes without giving up on the 20 percent corporate tax rate and how to fix the Senate’s last-minute decisions to keep the individual and corporate alternative minimum taxes.

Prescription drug spending slows after two-year surge. Spending on prescription drugs slowed in 2016 after rapid growth during the two previous years, according to an analysis by the Centers for Medicare and Medicaid Services. Prescription drug spending accelerated by 8.9 percent in 2015 and by 12.4 percent in 2014, but slowed to 1.3 percent in 2016, according to the analysis. Total expenditures on prescription drugs reached $328.6 billion. The rapid slowdown in growth occurred because fewer new drugs hit the market, because of slower growth in prices of both brand-name and generic drugs, and because fewer prescriptions were written for expensive drugs that cure hepatitis C.

PhRMA’s take: The Pharmaceutical Research and Manufacturers of America said in an email that the data was "reaffirming how our nation’s competitive marketplace for medicines controls costs while supporting the development of new treatments and cures." "This is possible due to a competitive marketplace for medicines where insurers and pharmacy benefit managers negotiate aggressively and generic utilization rates are nearly 90 percent," said Holly Campbell, spokeswoman for the group.

Rep. Mark Walker says 'no energy' for Obamacare bills. A top House Republican said there is “no energy” to take up two Obamacare stabilization bills and that leadership has not discussed the legislation with him. Rep. Mark Walker of North Carolina, chairman of the 170-member Republican Study Committee, would not speculate on whether he would support the two bills if Trump throws his weight behind them. Walker said there is “no discussion on that over here, none, not with leadership or the Republican Study Committee.”  Maine Sen. Susan Collins and other Republicans supporting the bills point to Trump as the linchpin for House approval. “I think we need the president’s support for that to happen,” said Sen. Mike Rounds, R-S.D., a co-sponsor of legislation crafted by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., to stabilize the Obamacare markets for two years. “I think once the president goes to the House and lets them know his support for those bills, then I think we will be able to move forward with it. Without the president’s support, you can understand the House not willing to step into the fray.”

Most want Obamacare changes separate from tax bill: poll. A new poll found that a large majority of Americans believe that changes to Obamacare should be separated from tax reform tax legislation. The poll released Thursday from CBS found that 68 percent believe changes to the 2010 healthcare law should be separate, and 21 percent believe that it should be included in tax reform. The Senate version of tax reform includes a repeal of Obamacare’s individual mandate that everyone buy insurance and it is likely to be included in the final version being hammered out in a conference by the House and Senate now. A majority of Republicans (62 percent) joined majorities of Democrats (72 percent) and independents (67 percent). There were 1,120 respondents to the poll, which had a margin of error of 4 percentage points.

Conservatives fret about costly gifts being added to short-term funding bill. Conservative House lawmakers say they are worried that Republican leaders will add more spending to a short-term government funding measure as a way to drum up support for final tax reform legislation. The House Freedom Caucus is pushing for a continuing resolution to fund the government until Dec. 30, eight days longer than the Dec. 22 resolution pushed by House leadership, to try to avoid leaders adding money to the resolution as they work on the tax legislation.

Surgeon general opens up about his brother’s struggles with addiction.  Surgeon General Jerome Adams opened up about his brother Phillip’s struggle with drug addiction in an interview with Stat News. The story details the difficulty that Phillip had finding treatment, and how he was repeatedly incarcerated instead. “This story is painful to read and is all true,” Adams tweeted this morning. “Hopefully, sharing my family's story about addiction can help others know they aren't alone. And that no one -- not even a surgeon general -- can tackle this without help and support.” Adams’ family believe that Phillip’s difficulties are tied to an untreated mental health disorder.

Jimmy Kimmel's wife says angry letters were sent to their home after healthcare monologues. Molly McNearney, comedian Jimmy Kimmel's wife, revealed on Wednesday people told her and her husband they "deserved" to have a sick child for politicizing their newborn baby's health while Congress was debating how to repeal and replace Obamacare. “People were sending letters to our home, attacking both of us on Twitter, saying things like we deserve this and we're terrible people," McNearney told the Hollywood Reporter. "That's been the ugliest part of all of this, and it's been harder for me to deal with than the weekly cardiologist appointments and making sure my baby is breathing properly," she continued. "We took a personal experience and we shared it with the world, and then it just so happened that this was going on while people were trying to take healthcare away from children like ours … It's scary to make yourself vulnerable the way we have, but the encouragement that we're helping other people far outweighs my fears about our lack of privacy."

Sen. Lamar Alexander: ‘The Alexander-Murray bill: Lower premiums, less debt, and new permanent flexibility for states.’ “Congress can pass a Christmas present that would mean lower health insurance premiums for 9 million Americans who get no government subsidies.

Specifically, this Christmas present would lower premiums by 18 percent in 2019, according to a new study published today by Avalere, a health consulting company. And according to the Congressional Budget Office, this present would also mean fewer federal dollars for Obamacare subsidies, less federal debt —and no taxpayer money bailing out insurance companies. It has the support of President Trump and Senate Majority Leader Mitch McConnell. Senate Minority Leader Chuck Schumer has said every Senate Democrat would vote for it. And almost all House Republicans have already voted for its provisions earlier this year,” writes Alexander in the Washington Examiner.

‘Morning Joe’ questions Trump’s mental capacity. The panel on MSNBC's "Morning Joe" suggested Thursday that Trump is suffering from diminished mental capacity after he delivered a speech and slurred some of his words toward the end. Republican strategist and MSNBC contributor Steve Schmidt, a regular on the show, said Trump appeared to have an "impairment" and called it "chilling" to watch. "This is not the person that we knew even three years ago. ... There’s a remarkable change," said host Joe Scarborough. "He seemed like he was almost hanging on to the prompter and hanging on to the words," co-host Mika Brzezinski said. "Something, I don’t know. ... There was a struggle happening." The Daily Beast columnist Mike Barnicle said on "Morning Joe" that stress and poor physical condition might have been the cause. The speculation comes a week after reporters pressed the White House on whether Trump will get a physical and make the findings public, as some other presidents have done.  White House press secretary Sarah Sanders said she didn't know what Trump's plans were for reporting his health outcomes, but said she would check on it.

California Obamacare exchange sees boost in new enrollment. California’s state-run Obamacare exchange said it has signed up more than 102,000 new customers from Nov. 1 to Nov. 30, a 28 percent increase from the same time last year. Overall 1.2 million people have signed up, which the exchange said was similar to last year’s totals. “We know that Californians sign up when they realize how low their costs are,” said Peter Lee, executive director of the exchange called Covered California. “We’re seeing many Californians shop and enroll because the financial help is bringing coverage within reach for many.” The average price for plans selected by customers this year is $120, down from $134 per month at the same point last year, Covered California said. For people who selected a bronze plan, the cheapest of Obamacare’s four metal tier plans, the price is only $45 a month, compared to $87 last year. The data comes a day after the Trump administration reported that 3.6 million people signed up for plans on, which is used by residents in 39 states and the District of Columbia to buy plans. However, open enrollment for ends on Dec. 15, while in California it ends on Jan. 31. Covered California said if people want their plans to start on Jan. 1, they need to sign up by Dec. 15.

Nevada Insurance Division warns customers about short-term health insurance. Because of increases in premiums, unsubsidized Obamacare customers often turn to short-term health insurance plans as a lower-cost alternative, which have less robust coverage. The Nevada Division of Insurance, which runs its own exchange called Nevada Health Link, warned consumers to make sure they understood their policies well, noting that people who buy short-term plans would still have to pay the penalty. “There are many websites out there trying to lure consumers into purchasing a short-term plan while disguising them as ACA compliant policies,” Insurance Commissioner Barbara Richardson said in a statement. “While it is up to the consumer to decide if they would like to purchase such policies, they just need to understand what they are purchasing.” People who buy the plans are exempt if the cheapest bronze plan available to them is more than 8.05 percent of income.   

Retail drug prices increase more than 50 times faster than inflation rate: study. An AARP study of 768 medications widely used by older Americans shows an increase by an average of 6.4 percent in 2015, outpacing the general inflation rate of 0.1 percent. The report looked at prices of 268 brand name, 399 generic and 101 specialty drugs. In 2015, the average annual cost of therapy for one prescription drug was nearly $13,000.  “Year after year, drug price increases far outpace price increases for the other kinds of goods and services that consumers use every day,” said Debra Whitman, AAPR chief public policy officer. “These increases are simply unsustainable for everyone, including patients, employers, insurers, and taxpayer-funded programs like Medicare and Medicaid.”


The Hill Democrats sound alarm over CVS-Aetna deal

Wall Street Journal Kevin Brady: Lawmakers re-examining medical expense deduction

Axios Congress’ favorite hashtag of 2017: #Trumpcare

Kaiser Health News Brokers tout mix-and-match coverage to avoid high-cost Affordable Care Act plans

Reuters Obamacare insurance options dwindle for neediest U.S. patients

New York Times Trump’s pick to lead consumer safety board is seen as too close to industry

Associated Press Poor health and high expectations for Medicaid

NPR Even low-dose contraceptives slightly increase breast cancer risk


THURSDAY | Dec. 7 

Noon. Capitol Visitor Center. Congressional Meeting Room, South. Capitol Visitor Center. American Psychiatric Association briefing on “Improving the Physical Health of Patients with Serious Mental Illness:Identifying Breakthroughs in Approaches to Treatment.” RSVP to

FRIDAY | Dec. 8

Deadline for Congress to pass a spending bill before the government runs out of money.

Noon. G-50 Dirksen. Alliance for Health Policy event on “The Role of the Health Care Workforce in Delivery System Reform.” Details.

TUESDAY | Dec. 12

8:30 a.m. AARP Family Caregiving Summit. Details.

10 a.m. 430 Dirksen. Health, Education, Labor and Pensions Committee hearing on prescription drug costs. Details.

10 a.m. Dirksen 226. Senate Judiciary hearing on “Oversight of the Ensuring Patient Access and Effective Drug Enforcement Act.” Details.


10 a.m. 430 Dirksen. Health, Education, Labor and Pensions Committee hearing on the 21st Century Cures Act focusing on mental health needs. Details.