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Trump's budget won’t attempt to reach balance. President Trump’s second budget outline proposes to cut $3 trillion in spending over the next decade, White House officials indicated Sunday night, but it won’t be balanced. Instead of balancing the budget, the Trump administration is touting lowering the debt relative to the economy. The president’s budget is not law or legislation. Congress sets government spending levels, and as long as he signs them, that will dictate the fiscal reality facing the U.S. in the coming decade. Trump’s budget, to be named “Efficient, Effective, Accountable: An American Budget,” is officially a request to Congress and a statement of the administration’s priorities. Conservatives for years have set a goal of balancing the budget on paper, and criticized former President Barack Obama for not reaching balance in his budget documents. But that target has become more difficult in the last year, after Republicans enacted a $1.5 trillion tax cut and then struck a spending deal with Democrats to add about $320 billion to the deficit in the next two years. Adding to the complications, balancing the budget in a 10-year timeframe is more difficult each year because more baby boomers begin taking retirement benefits in the later years in the budget.

Budget endorses Graham-Cassidy Obamacare overhaul bill. Trump did not mention an Obamacare replacement during the State of the Union in January, but his budget indicates the White House has some support for taking another shot. The budget document reiterates Trump’s support for repealing Obamacare, first through the passage of the Graham-Cassidy-Heller-Johnson bill that would transfer Obamacare’s revenue to states so they could craft their own healthcare plans. The document specifically highlights that it supports the repeal of Obamacare’s Medicaid expansion, which the Graham-Cassidy bill would help accomplish by turning federal funding for the program into a block grant. The White House also encourages the passage of “additional reforms to help set government healthcare spending on a sustainable fiscal path that leads to higher value spending.” Repealing and replacing Obamacare would result in $675 billion in net mandatory savings across the departments of Health and Human Services and Treasury, the document states.

Other healthcare-related proposals in the budget include:

*A 21 percent cut to HHS compared to 2017 spending levels, bringing the total funding amount to $68.4 billion.

*Spending $85.5 billion to improve medical care for veterans.

*Spending $5 billion in new funding during the next five years to fight the opioid addiction crisis.

*Blocking facilities that provide abortions from receiving federal funds, whether through family planning grants or Medicaid.

*Exclude big lottery winners from being allowed to participate in Medicaid.

*Highlights the Trump administration’s intention to approve state proposals that require certain Medicaid beneficiaries work, volunteer or take classes as a condition of receiving medical coverage or food assistance.

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.

Budget includes proposals for lower drug prices. The White House has proposed lowering drug prices through speeding up government approvals and changing trade policies, as was first unveiled in a document from the Council of Economic Advisers. The administration said it was aiming not only to lower the prices of drugs for consumers but also to spur innovation for pharmaceutical companies. Trump has said that one of the top priorities for his administration will be tackling the high costs of prescription drugs, and the document is a detailed proposal of how it would achieve that goal. It proposed changing the way Medicaid programs pay for drugs so that the prices aren't inflated for patients who have private health insurance, as well as moving certain drugs through the government approval process faster so that less expensive alternatives are available. It also proposed making generic drugs less expensive for people on Medicare and suggested putting an annual limit on how much beneficiaries could spend on specialty drugs. HHS Secretary Alex Azar will defend the budget before lawmakers three times this week, beginning Wednesday.

Senators call for passage of drug transparency bill. Two bipartisan senators wrote to President Trump to get his support for a bill that requires drug makers to explain why they are raising prices. Sens. Tammy Baldwin, D-Wis., and John McCain, R-Ariz., wrote to Trump Monday asking for his support for the FAIR Drug Pricing Act. The bill would require drug makers to notify the Trump administration and submit a transparency report before substantially increasing the price of certain drugs, the letter said. “This will provide taxpayers, consumers and policymakers with more information, including research and development, marketing and advertising costs,” the senators said. “Transparency is a critical first step in tackling the complex problem of high prescription drug prices, so our actions should start at the beginning of the story.”

States tired of waiting for feds to tackle high drug prices. State legislatures are battling against high drug prices, tired of inaction from the federal government. Last year, states passed more than double the number of laws attacking high drug prices than in 2016, and legislatures show no signs of stopping. States approved 14 laws in 2017 targeting high drug prices through price transparency, compared to four in 2016, according to data from consulting firm PriceWaterhouseCooper's Health Research Institute.

John Kelly deputy Jim Carroll picked to be Trump's drug czar. Trump announced Friday that he intends to nominate former White House lawyer Jim Carroll to serve as the director of the Office of National Drug Control Policy. "We have full confidence in Jim to lead ONDCP to make significant strides in combating the opioid  crisis, reducing drug use, and coordinating U.S. drug policy," White House press secretary Sarah Sanders said in a statement Friday. Carroll has been fulfilling the duties of the White House principal deputy chief of staff, under chief of staff John Kelly, in an unofficial capacity since Kirstjen Nielsen left the position to become the secretary of homeland security. Trump tapped Rep. Tom Marino, R-Pa., last year to fulfill the position of drug czar, but the lawmaker withdrew his name from consideration in October following reports that legislation he sponsored hindered the fight against opioids.

Nevada to set up its own Obamacare exchange website. The state is moving away from healthcare.gov and will invest in creating its own website where people can buy federally subsidized private health insurance. The Legislative Interim Finance Committee has authorized state officials to spend $1 million to prepare a request for proposals and find a private provider.

Heather Korbulic, executive director of the state system, told the Associated Press that the change is necessary because healthcare.gov is steadily raising the rates it charges states that link their front-end systems to the federal exchange.

Company behind OxyContin will stop promoting opioid drugs to doctors. Purdue Pharma, the maker of OxyContin, will cease promoting its opioid drugs to doctors and will dramatically reduce its sales force. Employees were told that the sales force would be reduced by more than 50 percent and that next week doctors would be notified that salespeople would not be visiting clinics to discuss the products any longer.

FDA opens investigation into ​dog food contaminated by euthanasia drug. The Food and Drug Administration is investigating​ dog food that tested positive for traces of an euthanasia drug. ​The findings may indicate that companies are using euthanized animals to make their dog food, a practice that is illegal. ​Federal law states that the drug, pentobarbital, cannot appear in any food. Pentobarbital is used to euthanize animals and has been used in doctor-assisted suicide as well as in carrying out the death penalty. ​The dog food, called Gravy Train, showed trace​s of pentobarbital across more than two dozen brands of 62 wet dog food samples, according to Ellipse Analytics, the laboratory that did the testing. The firm was hired for the investigation by the Washington news organization WJLA. Gravy Train is made by Big Heart Pet Foods.

New York lawmakers: Tide pods need to look ‘less delicious.’ New York state Democratic Sens. Brad Holman and Assemblywoman Aravella Simotas say the laundry detergent packets look too much like candy and has proposed that Tide change them. Among their suggestions are making the packets a uniform, dull color; making the casing harder and getting rid of the fruity smell. “They look like gummy bears,” Hoylman said. “It makes no sense to me that with nearly 30 incidents a day, manufacturers still haven’t made these products safe. It’s way past time to fix these products or remove them altogether from store shelves.” The proposal also asks New York to mandate child-resistant packaging with individual wrappers that include warning labels. Teens are taking on the “Tide Pod Challenge,” in which they post videos of themselves biting into the laundry detergent capsules and challenging their friends to do the same. At least 40 teens since the start of 2018 have gotten sick from taking part.

RUNDOWN

CNN California starts investigation following stunning admission by Aetna medical director

New York Times FDA chief goes against the administration stereotype

Bloomberg Historic flu season drives sales across the healthcare industry

Politico Houston district becomes unlikely battleground for vaccine policy fight

Associated Press Nevada takes steps to leave healthcare.gov

Kaiser Health News Could a rare, deadly ‘superbug’ fungus be gaining a foothold?

Washington Post Kratom is hailed as a natural pain remedy, assailed as an addictive painkiller. The U.S. wants to treat it like heroin

STAT News How will Amazon revolutionize healthcare? Follow its footprints in Seattle

Calendar

CALENDAR  

Monday | Feb. 12

President Trump’s budget proposal released.

Feb. 12-13. National Academies of Sciences, Engineering and Medicine workshop on physician-assisted death. Details.

7 p.m. National Press Club event on ““Presidential Mental Health & Nuclear Weapons – What Standards Should We Have?” Details.

TUESDAY | Feb. 13

10 a.m. 430 Dirksen. Health, Education, Labor and Pensions Committee hearing on “Improving Animal Health: Reauthorization of FDA Animal Drug User Fees.” Details.

12:30 p.m. 1330 G St. NW. Kaiser Health News event on “Living Well with Dementia.” Details.

WEDNESDAY | Feb. 14

8 a.m. Newseum. The Hill event on “America's Opioid Epidemic: Supporting Recovery.” Details.

10 a.m. 1100 Longworth. Health and Human Services Secretary Alex Azar to testify on agency budget before House Ways and Means. Details.

10:15 a.m. 2322 Rayburn. House Energy and Commerce Committee hearing on “Examining the Impact of Health Care Consolidation.” Details.

THURSDAY | Feb. 15

9 a.m. SD-219. Senate Finance Committee hearing on the Health and Human Services budget. Details.

9 a.m. National Press Club. Public workshop with the Duke Margolis Center for Health Policy on “Strategies for Promoting the Safe Use and Appropriate Prescribing of Prescription Opioids.” Details.

10 a.m. Rayburn 2175. Joint Hearing: Subcommittee on Health, Employment, Labor, and Pensions; and Subcommittee on Workforce Protections to discuss “The Opioids Epidemic: Implications for America's Workplaces.” Details.

12:30 p.m. Rayburn 2123. House Energy and Commerce Committee hearing on “Oversight of the Department of Health and Human Services.” Details.

FRIDAY | Feb. 16

9 a.m. 1775 Massachusetts Ave NW. Brookings event on “Patient Cost Sharing for Prescription Drugs: Policy Issues.” Details.

Noon. National Academies of Sciences, Engineering and Medicine webinar on “Improving Care for High-Need Patients.” Details.