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House to vote today on short-term CHIP funding in spending bill. House Republicans plan to push ahead today with a bill that would fund the government until January 19. A House panel will mark up the legislation this morning, but a floor vote has not yet been scheduled. Republican leaders last night were optimistic they could round up the votes to pass the measure with little or no support from Democrats, but the bill abandons a plan to fully fund the military for fiscal 2018, which could lead to GOP opposition. The short-term House spending bill includes nearly $3 billion to tide over states running out of funds from the Children’s Health Insurance Program. The continuing resolution released early Thursday morning gives CHIP $2.85 billion in new funding through the end of March. It also includes $750 million in new money for community health centers and a special diabetes program that also are short on funds. The short-term fix that House Republicans hope to pass today is not a long-term, multi-year reauthorization that some lawmakers had hoped. However, it does inject new funds for states that are running short. CHIP and community health center program funding expired on Sept. 30. Several states have needed redistributed funding from the federal government to keep CHIP programs running, although a majority will start to run out early next year.

Obamacare stabilization bills punted into next year. Sens. Susan Collins, R-Maine, and Lamar Alexander, R-Tenn., said a short-term spending deal to fund the government into January would not include two bills aimed at stabilizing Obamacare’s markets. The absence means Collins will not get her stated promise of having both bills signed into law by the end of the year. Collins and Alexander said it has “become clear that Congress will only be able to pass another short-term extension to prevent a government shutdown and to continue a few essential programs.” So the two senators asked Senate Majority Leader Mitch McConnell not to offer the legislation this week. But they are still hoping for a vote early next year. “It looks like the Christmas present of lower health insurance premiums will now have to be a Valentine’s Day present,” Alexander said. McConnell and President Trump gave Collins a commitment to get the bills signed into law by the end of the year. Collins sought the bills to blunt the impact of premium increases from repealing Obamacare’s individual mandate in the tax legislation, which is being sent to Trump’s desk. Collins and Sen. Bill Nelson, D-Fla., sponsored legislation to give states $10 billion in funding over two years to set up reinsurance programs which cover the highest medical claims from Obamacare insurers. Alexander sponsored legislation with Sen. Patty Murray, D-Wash., to fund Obamacare insurer payments for two years in exchange for more flexibility for states to waive the law’s  insurer regulations.

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The bill also includes a waiver for mandatory Medicare cuts. The bill also includes a waiver to prevent more than $100 billion in mandatory soending cuts from going into effect next year. These cuts include $25 billion in decreased funding for Medicare. Tax reform triggered the 2010 Statutory Pay-As-You-Go law that makes mandatory spending cuts if the deficit reaches a certain threshold. The tax bill is expected to raise the deficit by more than $1 trillion. Congress has triggered the law before, but has always gotten a waiver. There have been 16 “paygo” waivers since its passage in 2010. The approval of a waiver would impact when President Trump would sign tax reform into law. If President Trump waits until 2018 to sign the bill, then Congress would not have to vote on a waiver for the paygo cuts until 2019. This would take away leverage from Democrats in the coming spending bill as they would be needed for any waiver. Republicans instead are going for a waiver for next year, and if Trump gets it then he could sign the tax bill before the New Year.

Pelosi spars over funding offsets for CHIP. House Minority Leader Nancy Pelosi and Rep. Michael Burgess, R-Texas, sparred over the funding offsets for CHIP during a House Rules Committee hearing on a spending bill that includes a short-term patch for the program. A full, multi-year reauthorization for CHIP has lacked bipartisan support because House Republicans pushed for taking money from an Obamacare disease prevention fund and charging wealthy seniors higher Medicare premiums. Burgess said that the same fund, which gets $2 billion every two years to give to public health programs, was used for other congressional legislation. “It is not a foreign concept,” he said, adding that the fund was used for boosting medical research spending in the 21st Century Cures Act signed last year. He also defended charging premiums for Medicare seniors. “Assessing a larger [Medicare] Part B premium on individuals who earn over $500,000 a year did not seem like a stretch to me,” he said. Pelosi responded that opposition to using the funds were that it was taken from the base funding. “We did not think that should be the place to take money from children,” she said.  She added that opposition to raising Medicare premiums was sparked from a concern that wealthy seniors would leave Medicare to get other coverage and hurt premiums for other seniors. “We wanted to keep them in Medicare,” she said.

An opening in the House? Collins said in her statement that she spoke with House Speaker Paul Ryan Wednesday over the bills. Opposition in the House has been a major stumbling block for the two pieces of legislation as many House Republicans say the bills are “bailouts” for insurance companies. “This afternoon Speaker Paul Ryan called me and said that the House remains committed to passing legislation to provide for high-risk pools and other reinsurance mechanisms similar to the bipartisan legislation I have introduced,” Collins said. Ryan told Collins that by waiting until next year, Congress could use a new baseline from the nonpartisan Congressional Budget Office for determining the impact of losing the individual mandate.

The CBO has said that repealing the mandate would mean 13 million people would forgo insurance over the next decade. However, it is now looking at its baseline and methodology for determining the coverage estimate, and a new estimate won’t be available until early next year.

White House takes up job as salesman to a skeptical House. Ryan could get a lift from the White House, as President Trump has pledged to support the legislation. An administration official said that the White House is “actively working with Congress to move those bills forward.” Rep. Mark Walker, R-N.C., the head of the conservative Republican Study Committee, told the Washington Examiner he has been in contact with the White House about funding the payments. Other lawmakers said they haven’t heard from the White House, including Rep. Jim Jordan, R-Ohio, a member of the conservative House Freedom Caucus.

White House: Individual mandate repeal won't affect Obamacare enrollment. The White House believes enrollment in Obamacare plans will not be markedly different as a result of repealing the penalties Americans face if they don't buy insurance, despite several projections showing millions more will become uninsured. "With the repeal of the individual mandate you will actually not see a huge sea change in signing up," a senior White House official told the Washington Examiner. The official noted that many people are already uninsured under Obamacare, and made that choice even though it led to a penalty.  While the White House official said Obamacare signups won't change much, President Trump celebrated the passage of the tax bill with lawmakers at the White House on Wednesday and said the bill is a grave blow to the law. "I hate to say this but we essentially repealed Obamacare ... the individual mandate which was terrible," Trump said at the White House event. Andrew Bremberg, director of the Domestic Policy Council for Trump, called the repeal of the mandate penalties an "important legislative accomplishment." "I think this makes clear that the Democrats are finally admitting to the American people that they want to tax Americans, even those who cannot afford health insurance that has been made more expensive by Obamacare," he said in a phone interview.

Mike Rounds pushes changing Obamacare stabilization bill to address anti-abortion lobby concerns. Sen. Mike Rounds said he wants to ensure that money in a bill intended to stabilize Obamacare doesn't go toward abortions, a major concern of anti-abortion groups. Anti-abortion groups say the bill sponsored by Alexander and Murray does not include federal protections to ensure that Obamacare insurer payments aren't used to fund abortion services. Some House Republicans, already skeptical of supporting legislation to help Obamacare, cited the issue as reason for opposing the legislation. “I am pro-life and I don’t want any of it being used for abortion services,” the South Dakota Republican, who has been selling his colleagues on the bill, said Wednesday. The bill would provide cost-sharing reduction payments to Obamacare insurers for two years, reimbursing them for a requirement to reduce co-pays and deductibles for low-income Obamacare customers. Anti-abortion groups oppose the legislation. The reason is that the bill does not include the Hyde amendment, a spending measure that prevents federal funds from going toward abortion services. “We are strongly opposed to Obamacare stabilization funding unless amended so such funds cannot be used for plans that include elective abortion,” according to a letter signed by 67 anti-abortion groups sent to Congress this week. Rounds said the authors of Alexander-Murray didn't believe the funding could be used for abortion services and clarifying the issue could help sell the bill to Republicans. “If we can clarify that and get it cleared up, that would make it a whole lot easier for a lot of conservatives and pro-life members to support it,” he said.

Drug overdoses contribute to drop in US life expectancy. Life expectancy in the U.S. fell for the second year in a row in 2016, a trend that hasn't happened in other parts of the developed world and was fueled by a 21 percent rise in drug-overdose related deaths. "With the leveling off of cardiovascular deaths you don't have that decline to offset the increases seen with drug overdoses," said Robert Anderson, a chief statistician at the Centers for Disease Control and Prevention. "As a result, the drug overdose deaths have risen to prominence and are driving what is happening with overall mortality.” Life expectancy in 2016 was an average of 78.6 years, a decrease of 0.1 years from 2015, according to federal mortality data released Thursday. The study's researchers say it was the first time life expectancy in the U.S. has dropped two years in a row since declines observed in 1962 and 1963. The latest change was driven by a reduced life expectancy in males, which fell from 76.3 years in 2015 to 76.1 years in 2016. Anderson and his team have begun monitoring data from 2017 as well. Though it won't be available publicly until about a year from now, he said he already is beginning to see that deaths from drug overdoses are still rising. "What we have is provisional and not complete, but we are seeing an increase nonetheless," he said. "We may be in for a third year of life expectancy decline, which we haven't seen for 100 years." The most recent three-year decline was attributed to the Spanish flu pandemic in 1918, one of the deadliest infections in modern history that killed 500 million across the globe.

Workers in low-income areas more likely to be long-term opioid users, study says. A new study found that people that work in low-income counties have a higher opioid use. The study published Wednesday found in 2015 nationally there were 2.4 percent of adults with private insurance that were long-term opioid users. In lowest median income counties — defined as median average income of $30,000 or less — 4.9 percent of employed adults were long-term opioid users. Some counties had rates as high as 15.8 percent, according to the study published by the Health Cost Institute. Only 1.3 percent of the same population in high-income counties that make $100,000 or more were long-term opioid users. The study looked at median household income from the U.S. Census Bureau and looked at data from the Centers for Disease Control and Prevention on opioid prescriptions. Long-term opioid use was defined as people that got at least six prescriptions a year for opioids.


CNN Can the Kratom plant fix the opioid crisis?

Axios The Affordable Care Act is smaller, weaker and more liberal than Obama intended

The Hill Broken healthcare pledge tests Collins-McConnell relationship

Politico No, Trump hasn’t ‘essentially repealed Obamacare’

STAT News Trump’s zeal for deregulation could gum up the Food and Drug Administration, experts say

NPR/Propublica A prescription to reduce waste in healthcare spending

Forbes Medical technology firms to Trump: GOP forgot to ax medical device tax

Reuters U.S. EPA says glyphosate not likely to be carcinogenic to people


FRIDAY | Dec. 22

Deadline to pass government spending bill before funding runs out.