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'The Producers' effect: How Trump could be boosting Obamacare enrollment. In the Mel Brooks comedy "The Producers," the characters set out to make a Broadway flop, only to see it become a smashing success. What if something similar is happening with Obamacare's first open enrollment period under President Trump?

To be clear, the idea of Republican "sabotage" of Obamacare has been exaggerated. Even when former President Barack Obama was in office and willing to do everything in his power (or even take actions that were illegal) to prop up his signature healthcare law, the program's health exchanges were running into problems. That having been said, it is true that Trump has, on several occasions, talked about letting Obamacare "implode." And whereas Obama did everything in his power to promote and advance his law, Trump in many cases has done the opposite. This caused experts to predict a decrease in enrollment.

But then something funny happened. On Thursday, the Centers for Medicare and Medicaid Services released data on the first four days of open enrollment, and they smashed expectations. More than 600,000 signed up in that short time for coverage through the federal healthcare.gov website, a seemingly much faster pace than last year. Now, many caveats should be applied. It's merely four days, which isn't much of a sample size. With the open enrollment period being half as long, the daily average would have to be double just to sign up the same number of people as a year ago. But it’s at least worth asking: If experts are wrong, what could an increased open enrollment scenario under Trump look like?

One direct way in which Trump actions branded "sabotage" by Democrats could end up playing out differently is when it comes to CSR payments. On the surface, Trump's decision not to fund them would mean higher premiums and lower enrollment. But insurers and regulators have worked together to counteract some of this, in some way making it possible for subsidized consumers to qualify for free or near-free plans. Furthermore, the months-long debate over repealing Obamacare, which was handled poorly by Republicans, ended up increasing the popularity of the law (and possibly, raising awareness of its features). It's also possible that signing up for Obamacare becomes the latest symbol of “resistance” against an administration that's particularly unpopular under younger Americans.

To be clear, I'm not necessarily saying this is the most likely scenario. I could easily see enrollment fall, especially with premiums as high as they are. But, healthcare, just like politics, often has a way of confounding the experts. So it's worth entertaining alternate possibilities.    

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 dailyonhealthcare@washingtonexaminer.com 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.

Senate tax bill keeps adoption tax credit, individual mandate and medical expenses deductions. The Senate tax bill will not include a repeal of the adoption tax credit and preserves Obamacare’s individual mandate as well as a deduction for medical expenses. "I believe we should repeal the individual mandate which is an IRS penalty," said Sen. Ted Cruz, R-Texas. Sen. John Hoeven, R-N.D., said of the individual mandate repeal, “There is a lot of discussion on that. We are still working through how it would be done and the impact.” The medical deduction under current law allows taxpayers to deduct expenses of they exceed 10 percent of a person’s adjusted annual gross income.

Rare drug tax break back in, but limited. In a departure from the House bill, the Senate tax reform version doesn’t fully eliminate a tax credit aimed to spur drug makers to develop treatments for rare diseases. The bill limits the drug credit to 50 percent of “so much of qualified testing expenses for the taxable year as exceeds 50 percent” of the average testing expenses over a three-year period. If there aren’t qualified expenses over a three-year period, then the credit is equal to just 25 percent, according to the chairman’s mark of the legislation. Congress had pressure from the drug industry and biotech groups such as the Biotechnology Industry Organization to restore the credit.

But there are some other problems for Big Pharma. While pharmaceutical companies must love the cut in the corporate tax rate to 20 percent from 35 percent, they are most likely not loving the delay of implementing that rate until 2019. The House version, by comparison, puts in the corporate rate cut immediately, but the Senate delays it by a year to save about $100 billion used to fund other cuts.

GOP tax cuts set for final House vote next week. House Republicans voted Thursday to advance their tax reform bill out of the Ways and Means Committee, setting up a vote on the House floor next week on the first major rewrite of the tax code in more than 30 years. "Americans deserve a new tax code for a new era of property, and today we deliver," said Ways and Means Committee Chairman Kevin Brady on the conclusion of the four-day markup of the Tax Cuts and Jobs Act. The committee approved the bill in a party-line 24-16 vote. The committee approved the bill shortly after adopting a Republican amendment to impose significant changes to limit the net tax cut to $1.5 trillion over 10 years. That language put back in a provision to keep the adoption tax credit and a tax sweetener for small businesses, among other changes. Brady said following the vote that he had an official score, not yet released, showing that the amended bill was "well within" the $1.5 trillion constraint. White House press secretary Sarah Sanders called the committee passage an "important step" toward the president's stated goals of cutting taxes for the middle-class and lowering business tax rates. "There is still much to do, but the administration remains confident that, through continued cooperation with Congress, we will achieve these priorities this year," Sanders said.

Anti-abortion groups praise restoration of adoption tax credit in House bill. Anti-abortion groups praised the inclusion of the adoption tax credit in the version of the bill that was passed in committee.  “This important pro-life tax credit costs the government relatively little, but by reducing the steep expenses of adoption, it makes all the difference to tens of thousands of families each year who open their homes and hearts to children in need,” said SBA List President Marjorie Dannenfelser. “The amended bill gives these families the support they deserve in making the courageous, loving decision to adopt.” Students for Life of America President Kristan Hawkins said, Jeanne Mancini, president of March for Life, said she was “grateful” for the change. “The adoption tax credit has helped so many families and saved so many lives – and needs to be safeguarded,” she said.

Washington state sees surge in Obamacare enrollment. Mirroring the surge seen in the federal exchange, Washington Healthplanfinder saw a 24 percent rise in site visits and more than 50 percent increase in new enrollees, according to the Washington Health Benefit Exchange. More than 320,000 visitors have reviewed their coverage options and 4,550 submitted applications at Washington Healthplanfinder since the start of open enrollment on Nov. 1. “We are very pleased to see this level of interest so early in open enrollment,” said Pam MacEwan, CEO of the Washington Health Benefit Exchange.

Justice Department, DEA expand scheduling and charging for fentanyl-related substances. The Department of Justice announced Thursday the Drug Enforcement Administration is expanding how fentanyl-related substances are scheduled, bringing them to the same illegality and charging level as heroin and marijuana. A DEA official told reporters that the agency is temporarily making any type of illicit fentanyl analogue a Schedule I drug. This new scheduling will make it easier for federal prosecutors and agents to criminally prosecute "anyone who possesses, imports, distributes or manufactures any illicit fentanyl analogue" like they already do other controlled Schedule I substances. According to the DEA official, drug manufacturers are making “tweaks” to the chemical structure of legal fentanyl and other opioid drugs, which allows them to skirt U.S. scheduling laws when importing the drugs. When the drug manufacturer is caught, prosecutors have to convict under the Analogue Act, a cumbersome process in which the federal government has to prove the drug similar to one in Schedule I or II should be categorized as such, despite molecular alterations.

Senate passes veterans bill targeting long-term care. The Senate on Thursday passed the State Veterans Home Adult Day Health Care Improvement Act, which would allow more veterans to live at home with a caregiver rather than receive care in a nursing home. The bill also would cut costs for veterans who need specialized medical assistance. The legislation has support from the National Association of State Veterans Homes, whose president, Sharon Murphy, said the bill “helps our most disabled veterans, as well as their caregivers, in order for them to receive the essential services they deserve without the burden of institutionalization.”

RUNDOWN

The Hill Red state lawmakers find blue state piggy bank

Axios Cancer blood tests getting closer to tissue biopsies in results

Washington Post Expensive specialty drugs are forcing seniors to make hard choices

Bloomberg Customers defy Trump attacks to buy Obamacare, and vote for it

Associated Press Virginia’s electoral changes boost Medicaid expansion hopes

New York Times With Obamacare fight lost, conservatives turn to veterans’ care

Reuters Opioid abuse crisis takes heavy toll on U.S. veterans

Los Angeles Times Fidget spinners sold at Target contain dangerous levels of lead, advocacy group warns

Forbes Red states revive Medicaid expansion after Tuesday Maine vote



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