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Mandate repeal gains momentum as John McCain backs tax bill. Sen. John McCain, R-Ariz., who thwarted GOP efforts to repeal and replace Obamacare this summer by voting against the “skinny repeal” bill that would have repealed the individual mandate, said Thursday that he would vote with his GOP colleagues to pass the tax bill that includes a repeal of the mandate penalties. “After careful thought and consideration, I have decided to support the Senate tax reform bill. I believe this legislation, though far from perfect, would enhance American competitiveness, boost the economy, and provide long-overdue tax relief for middle-class families," McCain said in a statement. McCain’s support is a huge boost for the bill’s prospects. The Senate voted Wednesday night to open debate on the $1.4 trillion bill after Republican leaders worked out preliminary deals to the smooth over the concerns of several Republican lawmakers -- and all 52 Republicans voted to advance the bill. That includes centrist Sen. Susan Collins, who told reporters that while she is still concerned about the bill's provision to repeal Obamacare's individual mandate penalty, she has received assurances from leadership that the Senate will take up the Alexander-Murray package to inject money into Obamacare markets as well as a bill she introduced that would fund a reinsurance program to reduce premiums. The vote means the bill is now open to debate and unlimited amendments, with Senate Republicans hoping to pass it this week. House Republicans said Wednesday they plan to go to conference with the Senate to work out a compromise plan between the two chambers, rather than simply endorse the Senate plan. Though McCain’s endorsement makes passage more likely, some Republicans remain undecided on final passage, including Sens. Jeff Flake of Arizona, Bob Corker of Tennessee, Ron Johnson of Wisconsin and Steve Daines of Montana.

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Obamacare plans will become even more restrictive in 2018: study. Health insurance plans that limit the number of hospitals and doctors who patients see make up most Obamacare plans, and plans are expected to become even more restricted in 2018, according to an analysis published Thursday by the consulting firm Avalere Health. The firm found that 73 percent of plans that will become active in 2018 have more restrictive networks, up from 68 percent in 2017 and 54 percent in 2015. “We continue to see insurers focusing on narrow network exchange products that enable them to offer competitive premiums and manage medical costs,” said Caroline Pearson, senior vice president at Avalere. “These narrow network plans may come at a lower price tag for consumers, but they may also limit consumer choice and access to specialist care.” Avalere's analysis found that deductibles for silver plans will rise to an average of $3,937 in 2018, or an increase of $234 since 2015.

CMS cancels bundled payment reforms touted by Obama administration. The Trump administration has finalized a plan to cancel a mandatory program aimed at lowering healthcare spending. The Centers for Medicare and Medicaid Services canceled the mandatory hip fracture and cardiac bundled payment models created by the CMS Innovation Center and long criticized by Republicans. The Obama administration approved a rule last year that mandated participation from certain hospitals in an experiment that revamps how hospitals are reimbursed from Medicare. The goal was to take into account other factors into payments, which include whether the patient is readmitted within 90 days after a heart surgery. But hospital and doctor groups lashed out that the mandatory requirement was too burdensome. The bundled payment models included a mandatory payment system for heart attacks, bypass surgery and hip or femur fractures. In the final rule released Thursday, CMS reduced the number of mandatory geographic areas participating in a separate joint replacement payment model from 67 areas to 34. It also canceled the hip fracture and heart bundled payment models that were scheduled to begin Jan. 1.

Governors urge 'immediate action' on CHIP. The National Governors Association in a letter sent to congressional leaders Thursday urged Congress to pass a funding bill before the end of the year for the Children's Health Insurance Program, community health centers and for a maternal home visiting program. "These disruptions have not been without consequences, and we write to convey that further delay into 2018 will only compound the issues facing our states and vulnerable citizens," they wrote. Colorado is the only state that has sent letters to families whose children are on CHIP, warning them to seek coverage alternatives if Congress doesn't come through on funding, but other states are expected to follow.

CVS closer to buying Aetna: Report. CVS Health is in the advanced stages of a $66 billion deal to buy health insurance giant Aetna, according to a report. The Wall Street Journal reported Thursday that the deal could be announced as early as Monday, but that it could still fall apart. The deal likely would be valued at between $200 and $205 per Aetna share. Neither CVS Health nor Aetna would confirm the report to the Washington Examiner. "As a matter of policy we never comment on rumors or speculation," said David Palombi, spokesman for CVS Health. Aetna had a similar response. "We don’t comment on rumors or speculation," said T.J. Crawford, the insurer’s spokesman.

Alex Azar takes heat for raising insulin prices. President Trump's nominee to lead the Department of Health and Human Services told senators Wednesday he would fight drug makers that try to block competition from generic companies, but he took heat from Democrats for raising drug prices for insulin while he was head of Eli Lilly’s U.S. operations. Alex Azar testified before the Senate Health, Education, Labor and Pensions Committee, which members of the committee used to remind Azar of his tenure at Lilly, when the company raised the price of insulin. The price of the Eli Lilly-made insulin drug Humalog rose from $122 for a vial in 2013 to $274 in 2017, according to the Indianapolis newspaper The Republic. A lawsuit filed this year charges the Indianapolis company of collusion with two other drugmakers to raise the price of insulin. Some senators called out Azar for that history during his hearing. "As a pharmaceutical executive, you raised drug prices year after year," said Sen. Patty Murray of Washington, the top Democrat on the committee.

Azar pushes back against accusations of Obamacare 'sabotage.’ During his confirmation hearing, Azar pushed back against accusations from Democrats that the administration was working to "sabotage" Obamacare. “We share the same goals, but we disagree on the approaches and tactics to get there," Azar said about health insurance coverage. Azar also appeared to tell Sen. Al Franken, D-Minn., that he supported repealing the individual mandate penalties under Obamacare. “What I do not support is forcing ... Americans to buy a product they don't want to buy," Azar said. Several times during the hearing, when asked about decisions the Trump administration had made on Obamacare such as cutting navigator or ad funding, Azar said that his answers were hypotheses, and that he couldn’t be sure because he hadn't reviewed the documentation at HHS. The decisions may have been associated with budget limitations, he said. Azar stressed that he believed that people should have health insurance they can afford. "I want the programs to work for people ... Of course I do. I want to make sure as many people have affordable insurance as possible," he said.

CBO finds Alexander-Murray won’t negate effect of repealing the individual mandate. The bipartisan deal to spend billions of dollars to reimburse Obamacare insurers won’t change the impact of repealing the individual health insurance mandate, which will lead to premium spikes and coverage losses, according to the Congressional Budget Office.

Poll: Public opposition to individual mandate intensifies as more Republicans oppose it. A November poll by Morning Consult and Politico found that 65 percent of Republican voters oppose the individual mandate, up from 51 percent in September. Across political parties, 54 percent of voters said they either “strongly” or “somewhat” disapproved of the individual mandate, while 35 percent reported they either “strongly” or “somewhat” approved of the provision. Fifty-one percent of registered voters who responded to the survey said they thought the individual mandate should be repealed, while 30 percent said they thought it should remain in place. When the survey pointed out that Republicans included the individual mandate repeal as part of the tax bill, 45 percent said they had some level of support for repealing the mandate this way while 30 percent have some level of opposition to it.

Washington state exchange sees increase in signups for Obamacare plans. The Washington Health Benefit Exchange released data Thursday showing that about 18,000 new customers signed up for plans during the first four weeks of open enrollment. That represents a 43 percent increase over last year. Website visits also have increased, by about 18 percent over last year, to 423,000 users. The state has the same Dec. 15 open enrollment deadline as

Kellyanne Conway overseeing White House opioid efforts. Attorney General Jeff Sessions announced Wednesday that the former pollster will supervise the White House's efforts to combat opioid addiction. "She is exceedingly talented," Sessions said about Conway, who has no experience in healthcare. "She understands messaging." Trump appointed New Jersey Gov. Chris Christie to a White House panel on opioid abuse earlier in the year. Conway had been involved in that effort as well. Trump declared opioid abuse a national public health emergency in October. Federal data shows opioids such as heroin, fentanyl, and prescription painkillers kill 71 Americans a day.

AARP lashes out over possible Medicare cuts triggered by tax bill. The AARP is making a last-minute dash to try to kill the GOP’s tax bill. The senior lobby was concerned about automatic federal funding cuts of $25 billion to Medicare in fiscal 2018 if the bill becomes law. AARP is referring to the Statutory Pay-As-You-Go law that triggers mandatory cuts if too much spending is added to the deficit. Congress would need to pass a new law to avoid the pay-go cuts from going into effect. The Congressional Budget Office has confirmed that the tax bill would trigger $136 billion in automatic cuts in fiscal 2018, which include the $25 billion cut to Medicare. “Such sweeping cuts would be detrimental to an already vulnerable population,” AARP said in a letter to the Senate Thursday.


STAT News Researchers allegedly used thousands in NIH grant money for trips with a ballet dancer and bar tabs.

The Hill Insurance officials worry mandate repeal will damage markets

Bloomberg CEO of pharmacy benefit manager giant Express Scripts open to insurer deal, ties with Amazon

NPR Health insurers are skimping on mental health coverage

Kaiser Health News Patients with rare diseases square off with Congress over orphan drug tax credits

STAT News Obamacare? That’s so last month. On Capitol Hill, drug prices are now the hot topic

Reuters U.S. healthcare shares climb as investors see upside from Republican tax bill

Forbes Trump’s Medicare chief says patient empowerment key to U.S. health fix



Began 9:30 a.m. 430 Dirksen. Senate Health, Education, Labor and Pensions Committee hearing on the nomination of Alex Azar for secretary of Health and Human Services. View live Stream.

2 p.m. 2172 Rayburn. Foreign Affairs Subcommittee hearing on “A Global Update on Alzheimer’s Disease.” Details.

THURSDAY | Nov. 30

Nov. 29-30. New York. Forbes Healthcare Summit. Details.

Nov. 30-Dec. 1. Washington Hilton. 1919 Connecticut Ave. NW. ONC Annual Meeting on “Tackling Barriers to Interoperability and Usability.” Details.

Noon. B-318 Sam Johnson Room in Rayburn. Congressional briefing with America’s Health Insurance Plans on “The Value and Future of Employer Health Plans.” Details.

1 p.m. National Press Club. 529 14th St. NW. National Academies to release 2017 Affordable Drugs Report. Details.

FRIDAY | Dec. 1

8:30 a.m. Washington Hilton. 1919 Connecticut Ave NW. CMS Administrator Seema Verma to deliver remarks at the ONC Annual Meeting on “Tackling Barriers to Interoperability and Usability.” Details.

Noon. Dirksen G50. Alliance for Health Policy and Commonwealth Fund event on “What's Next for Medicare Provider Payment?”  Details.