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Senator claims Trump preparing to cripple individual mandate, but WH says it wants legislative solution. The Trump administration has prepared an executive order that would unravel Obamacare's individual mandate, but has put it on hold to see whether it might be included in the Republican tax bill instead, a GOP senator told the Washington Examiner. But a White House official pushed back by saying that the administration wants Congress to resolve the issue. Sen. Tom Cotton, R-Ark., pushed for the inclusion of the individual mandate repeal in the tax bill, and has been supportive of its inclusion in statements he has made on Twitter. When asked about the order's status, a White House official replied, “Pursuant to the President’s January EO on Obamacare, we are always looking for ways to provide relief from Obamacare. The long-standing issues with the mandate would be best resolved legislatively." The senator who spoke to the Washington Examiner, who asked to remain anonymous, thinks colleagues could embrace repeal in the tax bill, because the revenue generated "pays for so many tax cuts." According to a Congressional Budget Office report published in December, repeal of the individual mandate would save $416 billion over a decade, since it would mean fewer people would be enrolled in Medicaid and fewer subsidy payments would go to people who sign up for private coverage. A new CBO report is expected Monday. Trump cannot repeal the individual mandate through executive order, but he can broaden "hardship exemptions," which under Obamacare are left to the discretion of the administration. The exemptions allow customers to have ways to get out of paying the fine for not having coverage, which is $695 per adult or 2.5 percent of income, whichever is higher. The executive order alternatively may include language that essentially makes it against the administration's policy to collect fines from people who don't have health insurance coverage, the Republican senator said.

Legal issues likely to surface if executive order is issued. Trying to decapitate the mandate by executive order would likely trigger legal questions, depending on how it is crafted, if it ever happens. "What counts as a hardship is a matter of the secretary’s judgment," said Nicholas Bagley, an administrative law expert and professor at the University of Michigan Law School. "That doesn’t mean it’s unbridled. You still have to explain why someone is facing a hardship." If the administration chooses to broaden the hardship exemptions, a rulemaking process would need to take place, which could take as long as a year. If the administration instead were to decline to collect penalties against people who don’t have coverage, the administration could argue that the market is in chaos so it is suspending the mandate, Bagley said. That approach would not require rulemaking, but could be challenged as unconstitutional because the president is supposed to enforce laws that are on the books. Josh Blackman, constitutional law expert and associate professor of law at the South Texas College of Law, said legal challenges would be likely to come from state attorneys general. Blackman is the author of “Unraveled: Obamacare, Religious Liberty, and Executive Power,” in which he puts forth an argument for how exemptions under former President Barack Obama weakened the law. “The irony is they are going to have to say Obama’s exemptions were fine but these aren’t,” he said.  

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Paul Ryan: Repeal of individual mandate in tax reform 'being discussed.' House Speaker Paul Ryan said he was confident the House would pass the GOP's tax reform legislation before its self-imposed Thanksgiving deadline, adding that a repeal of Obamacare's individual mandate could be included in the final version of the proposal. "Yes, we are on track for moving this through the House before Thanksgiving, that's our plan," Ryan told "Fox News Sunday" in an interview taped Friday. "We expect our friends in the Senate to be about a week behind us." Ryan said doing away with the individual mandate was still on the negotiating table among House Republicans. "We have an active conversation with our members on a whole host of ideas on things to add to this bill and that's one of the things being discussed," he said.

Conservatives plot how much to push Obamacare mandate repeal in tax bill. House conservatives want the repeal of Obamacare’s individual mandate included in tax legislation, but some are shying away from saying that inclusion is critical to their support. “That’s icing on the cake,” said Rep. David Brat, R-Va. “I would push everything that is pro-growth,” he added. But Brat, a member of the House Freedom Caucus, said it wouldn’t be a deal-breaker if the final bill doesn’t include the repeal. Rep. Ted Yoho, R-Fla., also supports adding the repeal to tax reform. “I’m gonna push any time I can to get rid of the individual and employer mandates,” he said. While Yoho said he wants repeal included, it's not a dealbreaker for him if it's not in the final bill. “More than likely no, but I would have to see the language before I would answer that,” he said. The House Freedom Caucus, a group of two dozen conservative Republicans, hasn’t taken an official position on the issue. Freedom Caucus Chairman Mark Meadows, R-N.C., told reporters Friday that he is pushing for inclusion, but “I don’t know if the Freedom Caucus is pushing it. We have not had a discussion as a caucus and we won’t until Monday night when we get back.”

Rep. Jim Jordan, R-Ohio, a co-chairman of the Freedom Caucus, said including repeal was a “good idea.”

Premium increases may help customers avoid the individual mandate penalty. Some customers who paid the penalty in past years won't have to anymore because health insurance prices are higher. Under Obamacare, unsubsidized customers are exempt from the penalty if the cost of the cheapest bronze plan makes up more than 8.05 percent of their income.

Obamacare customers look for alternatives from high-priced Obamacare plans. Obamacare customers who do not receive government help to pay for health insurance are expected to look for ways to reduce their costs during the open enrollment season by going uninsured, buying less extensive coverage or altering their incomes. Industry and nonprofit insiders say people who are looking for ways to reduce their spending on monthly premiums tend to seek alternatives to Obamacare plans, such as through a religious health-sharing ministry, short-term health insurance, or indemnity plan. Others may choose to go uninsured or reduce their incomes so they can receive federal assistance. "There is a great deal of concern among the unsubsidized that are finding it very hard to afford health insurance to begin with and are now facing double-digit increases again this year," said Kev Coleman, head of research and data at Healthpocket, which sells a variety of health insurance plans. "I have had many people say to me, 'I will pay the penalty, it’s cheaper than buying insurance as I never go to the doctor,'" said Craig Gussin, owner of Auerbach & Gussin Insurance and Financial Services, Inc. in California.

Trump: Texas church shooting was about ‘mental health,’ not guns. Trump said Monday said the Sunday shooting at the First Baptist Church in Sutherland Springs, Texas, was a "mental health" issue, not a "guns" issue. "So sad, Sutherland Springs, Texas, such a beautiful, wonderful area with incredible people. Who would ever think a thing like this could happen," Trump said during a Tokyo press conference with Japanese Prime Minister Shinzo Abe. "I think that mental health is your problem here. This was a very, based on preliminary reports, very deranged individual." "But this isn't a guns situation. I mean, we could go into it, but it's a little bit soon to go into it," Trump added. "This is a mental health problem at the highest level," he said. "It's a very, very sad event." At least 26 people were killed and another 20 injured when the suspected shooter, 26-year-old Devin Patrick Kelley, opened fire at the small town church 30 miles southeast of San Antonio.

Hoyer uses Obamacare example to urge GOP to slow down on tax bill. House Minority Whip Steny Hoyer, D-Md., said Friday that it "didn't work" to try to rush Obamacare through the Democrat-controlled House and Senate in 2009 and 2010, and said that shows why Republicans shouldn't try to rush a tax bill. "Yes, we're replicating the Affordable Care Act," Hoyer said on the House floor about Republican plans to rush through its tax bill. "Put on the table, quickly passed, jammed through, sent to the Senate, and it didn't work. And I don't think this will work either," he said.

Trump signs diabetes bill. Trump signed into law on Monday a bill that establishes a national panel to look into diabetes care and prevention. Sens. Jeanne Shaheen, D-N.H. and Susan Collins, R-Maine. The bill would bring together public and private sector experts on diabetes research and treatment to focus on improving education, care delivery and patient outcomes,.

FDA chief urges 'more dramatic action' on opioids than past administrations. Food and Drug Commissioner Scott Gottlieb on Friday left the door open to the possibility of asking more drug companies to take their prescription opioids off the market. Gottlieb, who has worked for the FDA in a leadership role under other administrations, said that he thought a stronger approach was needed to tackle the opioid epidemic than had been carried out during the last decade when he said federal agencies were aware the problem but failed to get ahead of it. "To try to get ahead of it now, I think we need to be willing to take much more dramatic action, be much more potentially intrusive than what we thought we might have to do and what would have been our comfort zone five years ago or 10 years ago," he said at the National Press Club in Washington. He noted that when his agency is evaluating a drug, it will not only be looking at whether the risks of that drug outweigh their benefits if they are used as prescribed but also if the risks outweigh their benefits when they are used illicitly.

Trump administration to fund research on teen pregnancy prevention. The Trump administration is funding teen pregnancy prevention research that will include studies on abstinence as well as some assessment about why the rate of pregnancies among teens has dropped while the spread of some sexually transmitted diseases has increased. The projects, from the Office of the Assistant Secretary for Health and the Administration for Children and Families, will provide $10 million for Mathematica Policy Research and RTI International, which are nonpartisan research firms. The firms will conduct research on questions such as how delaying sex can affect a teen economically, how social media can help influence teen decision-making, and how teens who have engaged in "risky behaviors" can make "healthier choices in the future."

Feds release 10-year-old with cerebral palsy who was in the country illegally and detained after surgery. A 10-year-old girl with cerebral palsy who is in the U.S. without legal permission was discharged Friday by federal immigration authorities, after she had been detained last week following an emergency surgery.
 

RUNDOWN

The Hill Trump’s anti-opioid advertising campaign needs millions

Washington Post Obamacare is helping the poor and hurting the less poor

Axios The irony of Trump’s anti-ACA moves

STAT News Trump takes on hospitals: The facts behind the fight over 340B discounts

Kaiser Health News Sickle cell patients suffer discrimination, poor care and shorter lives

Wall Street Journal China plays down role in U.S. opioid crisis ahead of Trump visit

Politico Politically connected cancer mogul faces questions over his genetic tests

Bloomberg U.S. diabetes patients are about to get some high-tech relief

New York Times Don’t nudge me: The limits of behavioral economics in medicine



Calendar

MONDAY | Nov. 6

Nov. 4-8. American Public Health Association 2017 Annual Meeting and Expo. Theme: Creating the Healthiest Nation: Climate Changes Health. Details.

Nov. 5-7. Ritz-Carlton Half Moon Bay. San Francisco. Technomy. Details.

Nov. 6-8. Mandarin Oriental. 18th Annual Pharmaceutical and Medical Device Compliance Congress. Details.

Nov. 6-8. National Association of Medicaid Directors fall conference. Details.

Noon. National Press Club. 529 14th St. NW. Luncheon with VA Secretary David Shulkin. Details.

Noon. 1100 Longworth. House Ways and Means Committee markup of the Tax Cuts and Jobs Act. Livestream.

TUESDAY | Nov. 7

7:45 a.m. Hamilton Live. 600 14th St. Northwest. Washington Examiner event on “Breaking Down the Tax Reform Bill” with House Speaker Paul Ryan. Details.

8 a.m. 1777 F St. NW. Event with The Hill on “America’s Opioid Epidemic: Strategies for Prevention.” Details.

WEDNESDAY | Nov. 8

8:30 a.m. 400 7th St. SW. Federal Trade Commission workshop on “Examining Competition Issues Related to Prescription Drug Markets.” Details.

10 a.m. Rayburn 2123 House Energy and Commerce hearing on “MACRA and Alternative Payment Models: Developing Options for Value-based Care.” Details.

10:30 a.m. 2175 Rayburn.  Education and the Workforce Joint Subcommittee on Early Childhood, Elementary, and Secondary Education and Higher Education and Workforce Development hearing on “Close to Home: How Opioids are Impacting Communities.” Details.

3 p.m. 1330 G St. NW. Kaiser Health News discussion on “Advance Care Planning: What You Need To Know Now.” Details.

3:30 p.m. National Constitution Center. Philadelphia. Axios event on “A New Era in Cancer Innovation” including former Vice President Joe Biden. Details.

THURSDAY | Nov. 9

8:30 a.m. 500 5th St. NW. National Academy of Medicine Culture of Health meeting. Details.

8:30 a.m. 1801 K St. NW. Alliance for Health Policy event on “Care Delivery in the Future: The Role of the Health Care Workforce.” Details.

MONDAY | Nov. 13

Nov. 13-15. Crystal Gateway Marriott. National Alliance of Healthcare Purchaser Coalition. Details.

9 a.m. National Press Club. 529 14th St. NW. Alliance for Health Policy event on “Navigating Next Steps on Payment Reform: A Breakfast for Reporters.” Details.