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Trump administration rolls out guidelines for Medicaid work requirements. The guidelines out this morning would allow states to require that some Medicaid enrollees hold a job, participate in volunteer work, or enroll in classes or work training for a certain number of hours each week. States could choose to include caregiving for a disabled child or elderly adult as meeting the requirement. "This is in response to proposals we are receiving from states. It is entirely optional for states," Seema Verma, administrator for the Centers for Medicare and Medicaid Services, said in a phone call with reporters Wednesday. "This is in no way a requirement." The guidance contains numerous exemptions, and states cannot enact programs until they are approved through a waiver by CMS. Medicaid recipients would not need to abide by the stipulations if they are elderly, disabled, children, or pregnant. It also allows states to determine that specific populations are medically frail, such as providing exemptions for people who are undergoing treatment for an opioid addiction. Ten states — Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah, and Wisconsin — have asked to be allowed to implement the requirement. Verma declined to say which waivers were set to be approved, but did allow that "now that we have taken this big important step, we expect that you will hear from us on waivers in short order."

Will the requirements in some states affect Medicaid enrollment? CMS didn’t have an estimate because officials said they didn’t know what states would choose to do. Verma said she was aware that most Medicaid recipients had jobs and said she didn't expect the policy would affect them. Medicaid covers 43 million Americans, with 15 percent of Medicaid dollars going toward people who can be described as "able-bodied" and "working-age" adults. Most funding goes toward children, older Americans, and people who are disabled. According to the Kaiser Family Foundation, 40 percent of Medicaid recipients do not work, 42 percent work full time and 18 percent work part time. Among those who do not work, which the group estimates at 9.8 million people in 2016, 36 percent report that they are ill or disabled, 30 percent report they are taking care of an ill family member or friend, 15 percent say they are in school and 9 percent say they are retired. "If you look at this population you can say a vast majority of the working-age, able-bodied population are already engaged in some kind of work, education or caregiving," Salo said. "So apart from documenting that, there may not be a huge impact. It's quite possible it doesn't have much of an impact other than confirming this is a population that is otherwise engaged." Verma said that CMS would continue to evaluate how the program was doing, but said lower enrollment as a result of a shift to private coverage would be considered a positive sign.

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Medicaid guidelines invite backlash, lawsuit threats. The guidelines may be challenged in court, and pro-Obamacare group Families USA vowed to pursue legal means of blocking waivers from going into effect. “Today’s decision will likely be challenged in the federal courts. Families USA is working closely with the National Health Law Program and others to support those legal challenges. Many lives are at stake if today’s CMS decision stands — we will be working to ensure that it does not,” said Eliot Fishman, senior director of health policy for the group. The pro-Obamacare group Protect Our Care called the guidelines the latest attempt at “sabotage” from the administration. “Today’s attack on Medicaid is just the latest salvo of the Trump administration’s 2018 war on healthcare,” said Brad Woodhouse, campaign director for the group. “Having faced overwhelming public rejection of their failed attempts to repeal healthcare, Trump and his congressional Republicans are now going for death by a thousand cuts.” Opponents to work requirements say they would impose a barrier on people who need coverage and hurt a demographic Medicaid is supposed to help. The true intent, they have argued, is to assuage middle-income voters who stigmatize low-income people. “The administration’s actions today are wrong and in direct contradiction to longstanding federal law. Congressional Democrats will do everything we can to prevent these mean-spirited proposals from ever taking effect,” said House Energy and Commerce Ranking Member Rep. Frank Pallone Jr., D-N.J. Critics have been concerned that caregivers would be targeted, or that people who need to undergo care full time, such as someone with cancer, would be unable to provide proper documentation.

Lawmakers confident CHIP will be in spending bill. Republicans are increasingly confident that a five-year reauthorization for the Children’s Health Insurance Program will be included in a must-pass spending bill next week. Rep. Fred Upton, R-Mich., told the Washington Examiner that he has been talking with House GOP leadership about including a five-year reauthorization. The measure has received support from various Republican groups, including the centrist Tuesday Group. Upton said that he has not received approval from leadership on CHIP but he feels “pretty good that it will be part of the package next week.” Congress is expected to take up another short-term continuing resolution to replace the existing spending bill that is funding the government until Jan. 19. Upton has been meeting with various Republican groups in recent days about the reauthorization. Meanwhile, the second-ranking Republican senator said it is probable that CHIP will be reauthorized next week. Sen. John Cornyn, R-Texas, told reporters Wednesday that it is “highly likely” a five-year reauthorization will happen on or about Jan. 19, when the spending bill expires, according to the Dallas Morning News.

Individual mandate repeal playing a big part in advancing talks. Upton said the nonpartisan Congressional Budget Office gave a lift to efforts to reauthorize CHIP. CBO said recently that repealing Obamacare’s individual mandate in the tax legislation helps to lower the cost of CHIP. The agency projected that without the mandate for everyone to have health insurance, fewer parents will sign up their children for the program. As a result, CBO found that it would cost $800 million to fund CHIP over the next decade, $7.3 billion less than the agency’s estimates before tax reform was passed. “CBO rejiggered the whole thing,” Upton said. “Now it can be fairly easily covered I think.” He also believes that funding for community health centers, which also expired Sept. 30, will be part of the greater reauthorization package.

CBO says extending CHIP by a decade saves money. Extending funding for the Children’s Health Insurance Program over the next decade will save the federal government $6 billion, according to the nonpartisan Congressional Budget Office. CBO found that extending CHIP funding for 10 years yields net savings to the federal government because the costs for CHIP alternatives — primarily Medicaid, subsidized Obamacare coverage and employer coverage — are pricier. The agency estimated that a 10-year extension would increase the deficit from 2018 to 2020 but reduce it each year after that through 2027.

CBO to lower estimate of uninsured caused by repeal of Obamacare mandate. The Congressional Budget Office has found that the repeal of Obamacare’s individual mandate, which requires people to have health insurance or pay a fine, will result in fewer people becoming uninsured than it had projected. In presentation slides made public Wednesday by CBO and the Joint Committee on Taxation, the nonpartisan agencies laid out the steps they had taken to arrive at earlier projections that 13 million more people would become uninsured in a decade if the individual mandate penalties were repealed. The groups also had estimated that gutting the fines would result in the government spending $338 billion less. Amid the backlash from Republicans, CBO and JTC said they would re-evaluate their findings. Though they did not say in the latest report how much their projections would change or when they would release final figures, they concluded that estimates would be lower than they reported. “The preliminary results of analysis using revised methods indicates that the estimated effects on health insurance coverage will be smaller than the numbers reported in this presentation,” they concluded.

CHIP funds are dwindling in states. The Center for Children and Families at Georgetown University’s Health Policy Institute has assembled a brief showing that if Congress does not approve long-term funding for CHIP in January, nearly 1.7 million children in 21 states could lose coverage by the end of February. Eleven states — Arizona, Connecticut, the District of Columbia, Florida, Hawaii, Louisiana, Minnesota, Nevada, New York, Ohio and Washington — would exhaust their funding before the end of February. “This uncertainty and the ongoing inaction by Congress increases the likelihood that states will take action to prepare families for the worst,” the researchers write.

Trump signs health-related bills into law. Trump on Thursday signed into law the Law Enforcement Mental Health and Wellness Act, which requires the Justice Department to submit a report to Congress on mental health services and practices that could be adopted by federal, state, and local law enforcement agencies; and allows the use of grant funds under the Community Oriented Policing Services program to establish peer mentoring mental health and wellness pilot programs within state, local and tribal law enforcement agencies. He also signed the Interdict Act, which would increase chemical screening devices for U.S. Customs and Border Protection at entry ports and mail facilities, and would increase the number of staff who can analyze findings. Republican and Democratic lawmakers were present at the bill’s signing.

Lawsuit charges Obamacare insurer misled customers. A new lawsuit claims Obamacare insurer Centene misled customers about how many doctors would accept their insurance, according to a published report. The lawsuit filed Thursday in federal court by two customers says that they and others received skimpier coverage than what they signed up for, according to a report in Bloomberg. Centene has had success in Obamacare’s insurance exchanges and has expanded its presence in the exchanges while other insurers flee because of losses. The lawsuit, filed in the U.S. District Court for the Eastern District of Washington, charges that customers who bought Centene plans had a hard time finding doctors who would accept their insurance. It also said doctors listed by the insurer as health providers who would accept Centene insurance often did not, according to Bloomberg. Centene is a major insurer in Obamacare’s exchanges on the individual market, which is used by people who don’t have insurance through a job or the government. The insurer announced last week that 1.4 million people signed up for its Obamacare plans.

Lawsuit highlights Obamacare criticism over narrow networks. The lawsuit touches on a common criticism of Obamacare’s exchanges: that insurers provide narrow healthcare provider networks. A slimmer network with fewer doctors can help an insurer to control costs, a major issue for Obamacare insurers that have experienced a sicker-than-expected risk pool signing up on the exchanges. A 2016 study published in Health Affairs found that in 2014, the year the exchanges went online, a plan with a narrow network had a monthly premium 6.7 percent less than a plan with a large network.

ACLU trying to stop Trump administration from preventing fourth illegal immigrant teen from getting an abortion. The American Civil Liberties Union has filed a restraining order against the Trump administration, claiming federal officials are preventing a fourth female minor who is in the country illegally from obtaining an abortion. According to the ACLU legal filing, the girl, who is 17 and going by the name Jane Moe in court documents, has asked for an abortion but has been prevented from getting one by the Office of Refugee Resettlement, which is within the Department of Health and Human Services. The restraining order was filed in the U.S. District Court for the District of Columbia.


The Hill GOP chairman eyes floor action for CHIP next week

Bloomberg There’s a fight brewing over what pregnant women should eat

Politico Trump’s secret plan to scrap Obamacare

Kaiser Health News Fallout of ‘nuclear button’ tweets: Sales of anti-radiation drug skyrocket

STAT News An ‘unsustainable’ model: Drug makers signal interest in exiting vaccine development during crises

Reuters Judge deals setback to Cherokee Nation lawsuit over opioids

Associated Press Ohio imposes strict rule on workers’ back surgery, opioids

NPR Alcohol-related ER visits soar, especially among women


THURSDAY | Jan. 11

Jan. 8-11. San Francisco. 36th annual JP Morgan conference. Details.

Jan. 11-12. 1300 Pennsylvania Ave NW. MedPac January public meeting. Details.

FRIDAY | Jan. 12

Walter Reed National Military Medical Center. President Trump to undergo routine medical exam. Details.


1100 Longworth. House Ways and Means Committee hearing on preventing opioid misuse.