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Ted Cruz wants another go at Obamacare repeal, pushes for a new reconciliation bill. Sen. Ted Cruz, R-Texas, on Wednesday said Republicans needed to “finish the job” on repealing and replacing Obamacare in 2018, and he is pushing his colleagues to use one last reconciliation bill before the midterms to deliver on their long-running promise. In a meeting with the Washington Examiner in his Senate offices, Cruz said he has had long conversations with the Republican senators who blocked legislation last time around, and still thinks they can get something across the finish line. He also said there has been talk of asking the Congressional Budget Office to rescore repeal legislation now that the individual mandate is off the books, which is expected to drive down the CBO’s estimate of the number of individuals who would be uninsured under Republican legislation. “The biggest unfinished task is Obamacare,” Cruz said, reflecting on what Congress did in 2017 and his priorities for 2018. “We need to finish the job. I still believe it is possible to bring Republicans together. I think we got very close last time and that’s something I’m continuing to devote a lot of time trying to unite our fractious conference and build consensus to get at least 50 Republicans on the same page.”

One of the stumbling blocks during last year’s healthcare push was that the CBO estimates of the increase in uninsured under Republican bills, which was substantially attributed to the repeal of the mandate. For instance, in one score of a draft of the Senate bill in June, the CBO found that 22 million fewer would be uninsured, and that 15 million of that would be due to the repeal of the individual mandate. Now that the mandate is off the books, any CBO score would have to compare repeal and replace legislation against a new reality in which no mandate exists, which in turn could make any estimate more favorable. In pushing individual mandate repeal in tax reform, Cruz said, “I and several other people made the case that it made going back to Obamacare repeal in 2018 easier to accomplish. Because of CBO’s screwy scoring, they projected that not having the IRS fine people because they can’t afford insurance would lead to 15 million people not to purchase it. And that in turn dominates all the headlines...That made it harder to get 50 Republicans on the same page, because more than a few senators get really nervous when they see nasty headlines.”

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Senate confirmation expected for Alex Azar. President Trump’s pick for Health and Human Services secretary is up for his confirmation vote at 2:15 p.m. today. He’s expected to be cleared, as six Democrats joined with nearly all Republicans Tuesday on a procedural vote to advance his nomination. Azar is a former executive at pharmaceutical giant Eli Lilly and was a health official during the George W. Bush administration.

Changes may be coming to Obamacare bills. Sen. Susan Collins, R-Maine, hinted that there could be a change to her Obamacare reinsurance bill that senators are hoping to add to a long-term “omnibus” spending deal. “We are going to continue working with the House,” she said in response to a question on whether changes will be made to two Obamacare stabilization bills. “They made some suggestions on the Collins-Nelson bill I actually like. This is a negotiation.” The bill led by Collins and Sen. Bill Nelson, D-Fla., gives states $10 billion to states to set up a reinsurance program to cover the sickest claims from Obamacare insurers who in turn lower premiums overall. Another bill from Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., funds Obamacare insurer payments called cost-sharing reductions for two years in return for giving states more latitude to waive Obamacare insurer regulations. Collins has been working with the House on the bills as some Republicans don’t like the Alexander-Murray bill, which they deem a “bailout” of a law they despise.

Congressman lashed out at aide, blames stress on Obamacare repeal. Rep. Pat Meehan, R-Pa., who paid a secret settlement to a younger aide, said he reacted poorly when he found out she had begun a serious relationship with another man. Meehan, who is decades older and married, denied harassing the woman but said any hostility he may have given off was the result of stress about votes on repealing Obamacare.

Spending on Medicaid enrollees under Obamacare expansion rose steadily. That’s the latest finding from an analysis by consulting firm Avalere Health. The findings show that average monthly costs for people who enrolled under Obamacare's Medicaid expansion rose by an average of 20 percent, from $324 in 2014 to $389 after 2.5 years of being enrolled. The analysis found that healthier enrollees tended to leave the program over time, perhaps because they dropped out or took on a new job where they earned more and no longer qualified for the program. Those who stayed were more likely to have chronic medical needs. “Contrary to some expectations that Medicaid expansion enrollees would be relatively healthy, beneficiaries who have remained on the program have increasing healthcare needs, likely due to previously unidentified or untreated conditions,” said Caroline Pearson, senior vice president at Avalere.

Senators predict more money to fight opioid abuse, just don’t ask how much. Senate Democrats on Tuesday touted a commitment from Senate GOP leadership to provide more funding to fight the opioid epidemic, but Republicans say it's not clear how much more money they can deliver. Top GOP senators said any details on funding would have to wait until a long-term spending bill called an “omnibus” is hammered out. “I think everybody here is concerned about effectively treating the opioid epidemic in this country, but I don’t think there are any numbers agreed to,” said Sen. John Thune of South Dakota, a member of GOP leadership.

FDA, FTC warn opioid abuse scammers. The federal government warned marketers and distributors of 11 opioid cessation products about illegally marketing unproven claims about the products’ ability to help curb addiction and withdrawal. The Food and Drug Administration and Federal Trade Commission sent the warning letters Wednesday about the products, none of which were FDA-approved. “These products have not been demonstrated to be safe or effective and may keep some patients from seeking appropriate, FDA-approved therapies,” the agencies said. The 11 companies warned were Opiate Freedom Center, U4Life, CalmSupport, TaperAid, Medicus Holistic Alternatives, NutraCore Health Products, Healthy Healing, Soothedrawal, Choice Detox Center, GUNA and King Bio. The FTC also warned other marketers of opioid cessation products that peddled false claims. If the companies don’t stop making false claims, the agencies could take legal action. Federal data shows that 91 Americans die each day from an opioid overdose. Local communities have been overwhelmed by the crisis, which has spurred a desire to find products to curb addiction.

Second-in-command at CMS to leave the agency next month. Brian Neal helped oversee guidance for states to implement work, school and volunteer requirements in Medicaid, and helped approve Kentucky’s plan. CMS Administrator Seema Verma announced the decision to employees Tuesday and touted Neal’s efforts in establishing the guidelines for Medicaid waivers. “Next month, Brian will be leaving CMS to pursue other opportunities, and I wanted to write today and recognize the extraordinary dedication Brian brought to the job and our team, and thank him for his tireless service to the agency,” Verma wrote.

VA, HHS partner against waste, fraud and abuse. The Department of Veterans Affairs and the Centers for Medicare and Medicaid Services announced Tuesday that they would partner to share data, data analytics tools and protocols for identifying and preventing fraud, waste and abuse. “The VA-HHS alliance represents the latest example of VA’s commitment to find partners to assist with identifying new and innovative ways to seek out fraud, waste and abuse and ensure every tax dollar given to VA supports veterans,” VA Secretary David Shulkin said. “This effort marks another step toward achieving President Trump’s 10-point plan to reform the VA by collaborating with our federal partners to improve VA’s ability to investigate fraud and wrongdoing in VA programs.”

New York allows Dreamers to keep using Medicaid. New York’s Dreamers would be eligible for Medicaid even if the immigration program is changed or terminated, the state’s Democratic governor said Tuesday. Gov. Andrew Cuomo's announcement comes as Congress struggles to reach an agreement on how to address Dreamers, who are children who came to the U.S. with their parents illegally. Deportation protections for Dreamers will expire March 5. New York has about 42,000 recipients of the Deferred Action for Childhood Arrivals program, Cuomo’s office said.

Oregon voters add taxes on healthcare entities to pay for Medicaid expansion. A special election Tuesday resulted in a decision to impose higher taxes on hospitals, health insurance companies and managed care companies. The taxes will help pay for Medicaid costs added by Obamacare’s expansion of Medicaid and are expected to generate between $210 million and $320 million in revenue over two years. The expansion resulted in 25 percent of Oregonians now receiving medical coverage under the program. The measure adds a 0.7 percent tax on some hospitals and a 1.5 percent tax on gross health insurance premiums and on managed care organizations.

Manchin will run for re-election but wants his Senate colleagues to know 'this place sucks.’ Colleagues of Sen. Joe Manchin III, D-W.Va., have been informed that the senator plans to run for re-election in the fall, allaying concerns that the seat would be turned over a Republican. Manchin notified aides of Senate Minority Leader Chuck Schumer, D-N.Y, of his decision, after expressing dissatisfaction to Schumer and others that “this place sucks.” “I was very vocal,” Manchin said, according to the New York Times. He noted, “they read between the lines.” Manchin said witnessing the bipartisan efforts of moderates who helped reach a solution to end the partial government shutdown confirmed “more than anything” he made the correct decision to run again. “That just reaffirms that, goddamn it, the place is much better than we give it credit for,” Manchin said. Manchin said Trump had requested to discuss with him and Sen. Doug Jones, D-Ala., ways to move forward in a bipartisan fashion on immigration and infrastructure Monday. Jones is a Democrat in a red state as well and also voted for the stopgap spending measure on Friday. “They want to get moderates and make sure we can get something done,” Manchin said.

Yale psychiatrist says she received death threats after briefing lawmakers on Trump's mental fitness. Dr. Bandy Lee, the psychiatrist from Yale who warned members of Congress about President Trump’s mental fitness, claims she received many death threats thereafter. “I was concerned because I was getting a thousand threatening messages a day at one point,” Lee said in an interview with the New Haven Register in a piece published Sunday. Lee met with lawmakers early in December regarding Trump’s mental fitness and reportedly claimed Trump is “going to unravel,” lawmakers told Politico. Lee faced backlash as some viewed it an ethical offense to comment on Trump’s mental fitness without actually meeting him and formally evaluating him, but Lee refuted those remarks.

Philadelphia moves ahead with plan to create injection sites for heroin users. The city may become the first in the nation to officially sanction the sites, which allow people to use drugs under medical supervision. City officials announced Wednesday that they planned to move ahead to establish the sites, which would allow drug users to inject using safe needles and with medical staff nearby to assist in the case of an overdose. They also would provide information about where to get treatment for addiction. Other cities considering a similar move are Seattle, San Francisco and New York. Questions remain about where the injection sites will be, what the timeline is to set them up and how they will be funded, according to Philadelphia’s local NBC affiliate.

Texas governor seeks approval of federal Medicaid waiver that could lead to Planned Parenthood defunding. Texas’ governor wants Trump to approve a waiver that would restart the state’s women’s health program. Republican Gov. Greg Abbott wrote to Trump on Tuesday that the program, which provides family planning and preventive services to low-income women, was not renewed under the Obama administration and lost federal funding. The state tried again under Trump but the Centers for Medicare and Medicaid Services has not approved the waiver. The waiver was not renewed partly because Texas would not have sent the federal funding to Planned Parenthood. Last week, the Trump administration announced new policies aimed at giving states more flexibility to defund Planned Parenthood.

RUNDOWN

The Hill Neighborhood health clinics popular with veterans face crisis as federal funding evaporates

Axios Congress’ next healthcare waiting game: Market stabilization

NPR After months in limbo for children’s health insurance, deal a huge relief

Washington Post Vermont is first state to legalize marijuana through legislature

STAT News Paying more and getting less: As hospital chains grow, local services shrink

Associated Press Trump’s move may nudge holdout states to expand Medicaid

WBUR Under Obamacare, out-of-pocket costs dropped but premiums rose, study finds

Wall Street Journal New York City sues companies over opioid abuse



Calendar

WEDNESDAY | Jan. 24

Noon. 214 Massachusetts Ave NE. Heritage Foundation event on “Pro-Life Victories and Policy Goals: Next Steps for Congress and the Administration.” Details.

2:15 p.m. Senate will vote to confirm Alex Azar as Health and Human Services secretary.

THURSDAY | Jan. 25

Jan. 25-26. Ronald Reagan Building. 1300 Pennsylvania Ave. NW. Medicaid and CHIP Payment and Access Commission’s January meeting. Details.

Jan. 25-27. Hyatt Regency. Families USA Health Action Conference. Details.

10 a.m. SD-342 Dirksen. Senate Homeland Security and Governmental Affairs Committee hearing on “Combating the Opioid Crisis: Exploiting Vulnerabilities in International Mail.” Details.

2 p.m. Commonwealth Fund Teleconference on association health plans. Details.

WEDNESDAY | Jan. 31

8:30 a.m. Kaiser Permanente Center for Total Health. 700 Second St. NE. AARP policy forum on “Social Isolation:  An Important Health and Public Health Issue and a Significant Cost to Medicare.” Details.