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Trump heads to Senate lunch with Obamacare stabilization package in limbo. As President Trump heads to Capitol Hill to lunch with Republican senators, much of Washington will be eager to find out whether the feud with retiring Sen. Bob Corker, R-Tenn., which Trump reignited Tuesday morning on Twitter, explodes in person. But for the healthcare policy world, the bigger question will be whether Trump and Republicans will get on the same page about what to do about Obamacare. Though Sen. Lamar Alexander has negotiated a bipartisan agreement that would pay out cost sharing reduction subsidies to Obamacare insurers, Trump has said he cannot support it unless Democrats are willing to make more changes to provide Americans with relief from Obamacare. And without his support, Senate Majority Leader Mitch McConnell, R-Ky., has indicated he will not bring up the bill for a vote, regardless of whether it has the support to pass.

Ron Johnson working with White House on Obamacare fix. The Wisconsin Republican senator said Tuesday he is working with the White House as well as House and Senate lawmakers to make changes to a bipartisan Obamacare stabilization bill. Both Trump and House Republicans are opposed to a Senate bill that would fund Obamacare insurer payments for two years in exchange for flexibility to states to waive the law's insurance regulations. Johnson said Tuesday that bill wouldn't mean much if it all it could do is pass the Senate. "I am trying to show we can actually pass this in the House," he said Tuesday during a meeting with the Washington Examiner. "It doesn't do a whole lot of good to pass this in the Senate." But Johnson added that he is getting resistance from Democrats to any of his changes. Democratic leaders in the Senate have called for McConnell to bring the bill to the floor for a vote because it has 60 votes. "The problem is they have that bipartisan agreement now," Johnson said. "They will cling to that until we can show them an alternative."

House, Senate committee leaders reach own deal. The leaders of the Senate Finance and House Ways and Means committees put out a framework for their own agreement to fund CSRs for two years. The deal would delay enforcement of the individual and employer mandate and expand health savings accounts.

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Iowa pulls Obamacare waiver, calling law 'inflexible' and 'unworkable.' Iowa Gov. Kim Reynolds said Monday that state officials were officially withdrawing a waiver to overhaul Obamacare in the state, blaming the outcome on the healthcare law's lack of flexibility. Reynolds, a Republican, said she was "extremely disappointed" about the result, calling Obamacare "unworkable" for what Iowa health officials proposed. "We need Congress to repeal and replace," she said, noting that the waiver process, known as the 1332 or innovation waiver, was too inflexible to meet their request. The pathway to approval for the waiver was always uncertain because Iowa did not follow specific requirements through Obamacare. Doug Ommen, Iowa's health insurance commissioner, acknowledged that Iowa's approach was different from other states. President Trump reportedly told the Department of Health and Human Services to halt the Iowa waiver, after the state worked for months with top officials. Ommen and Reynolds did not blame the Trump administration for the result, but thanked officials, saying that Obamacare was the problem. The waiver would restructure Obamacare's tax credits available to people in the exchange, making a single, standard plan available to every eligible customer, instead of tiered levels, and would have a flat credit to help anyone who enrolls pay for his or her premiums, based on age and income. Under the plan, Iowa also would create a reinsurance program, which would take funding from federal tax credits for premiums and cost-sharing reduction subsidies that go to out-of-pocket costs, and put the money toward the claims of more costly enrollees. Minnesota-based Medica is the only insurer that has committed to selling plans on the exchange in Iowa, but Wellmark Blue Cross Blue Shield had said it would return if the short-term solution were approved.

Lamar Alexander: Iowa is example of restrictions of Obamacare. “Iowa’s decision is further evidence that the Affordable Care Act is too restrictive to allow states to help people who need to buy insurance,” Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander said after the Iowa announcement. “The so-called guardrails have become road blocks. The Alexander-Murray bipartisan legislation – co-sponsored by Senator Grassley and Senator Ernst – would allow the Secretary of Health and Human Services to approve Iowa’s waiver as originally submitted.”

Trump administration rejects Massachusetts Obamacare waiver. The Trump administration on Monday said it could not accept an Obamacare waiver from Massachusetts because officials from the commonwealth hadn't filed it sufficiently ahead of time.  Federal health officials need at least 180 days to review waiver applications and the proposals must undergo a public comment period. Massachusetts filed its waiver Sept. 8 and wanted it to be approved before Nov. 1, when open enrollment begins. Republicans have complained that the waiver process is burdensome, lengthy and prevents states from meeting the needs of their residents. Though the Trump administration had encouraged the use of such waivers, they said their hands were tied by Obamacare's requirements.  "Given that the waiver was submitted less than two months prior to the beginning of the 2018 open enrollment period and, if the application were deemed complete, the federal public comment period would not end until after the beginning of open enrollment, the departments have determined that there is not sufficient time to implement the proposed waiver," wrote Randy Pate, deputy administrator at the Centers for Medicare and Medicaid Services. Alexander said that if his Obamacare stabilization bill had been passed, the Massachusetts waiver would have been accepted on time. His legislation would make changes to Obamacare's 1332 waivers that include allowing states to file for an expedited review that would last 45 days. "Under the Alexander-Murray bill, states can get waivers approved in 45 days if the situation requires urgent action — so Massachusetts could have had its waiver approved by now to help reduce chaos when open enrollment begins next week," he said. The waiver would have allowed the state to create a fund given to insurers rather than rely on cost-sharing reduction subsidies.

Centene posts third-quarter profits despite Obamacare changes. The president and CEO of health insurer Centene said Tuesday its Obamacare plans "continue to perform well" and the company had prepared for some of the changes the Trump administration made to the implementation and promotion of the law. Centene chief Michael Neidorff said the company’s third-quarter profits rose 22 percent to $239 million, or $1.35 per share, from $196 million, or $1.12 cents per share, a year ago. Heading into open enrollment, Centene is planning to conduct its own marketing for Obamacare customers to help make up for cuts to the federal outreach by the Trump administration. It also filed rates that assumed insurer payments, known as cost-sharing reduction subsidies, wouldn't be paid. "After repeal and replace failed, we fully recognize CRSs may not be funded and as such planned accordingly," Neidorff said in the company's third-quarter earnings call. The rates filed have been approved in all markets they applied for, he said, including in Kansas, Missouri and Nevada, states Centene hadn't sold Obamacare plans before.  Companies cannot change their rates headed into the rest of the year, and Centene estimates it will lose 7 cents to 12 cents per diluted share if it does not receive cost-sharing subsidies for the fourth quarter. Neidorff pushed back on suggestions by politicians that the funds were intended to help insurer profits. "They are not a profitable contributor," he said. "They are intended to cover the out-of-pocket healthcare costs for the country's most vulnerable populations." Centene did not specify how much it had made from the Obamacare market, but said it has 1 million customers and it was "business as usual." Revenue overall increased 10 percent from the third quarter of last year, to $11.9 billion.

Top Democrat: Vote on children’s insurance bill could come this week. A top House Democrat is trying to convince Republicans to delay this week's scheduled vote on a bill to reauthorize the Children's Health Insurance Program, to leave time for more bipartisan talks. Rep. Frank Pallone, D-N.J., said at an event in New Jersey Monday that the House is expected to vote on the bill this week. Pallone is urging Republicans to rethink controversial funding offsets for the five-year reauthorization of CHIP and two-year reauthorization of funding to community health centers. "If it passes the House this week and the Senate hasn't acted and we have to go to conference, we are just gonna delay this thing for months and the end result could be we don't deal with this until the end of the year," he said.

Manchin to attend Trump's opioid speech. When Trump delivers his address on the opioids crisis Thursday, he will be joined by a special guest: Sen. Joe Manchin. The West Virginia Democrat's state has been one of the hardest hit by opioids — prescription painkillers and heroin — in the nation. Manchin, who is up for re-election in 2018, has been willing to engage Trump on a variety of issues, making it no surprise that he was invited by the White House to join Trump for the speech. The president is expected to declare the opioid epidemic a national emergency, which he promised to do more than two months ago. "I intend to be there," Manchin told the Washington Examiner, adding that an emergency declaration is "extremely important to getting assistance on the ground level." West Virginia had the highest rate of deaths due to a drug overdose in 2015 — 41.5 per 100,000 — according to the latest available data from the Centers for Disease Control and Prevention. Manchin is one of 10 Democratic senators up for re-election next year in states Trump carried. The president won West Virginia by 42 points.

Illegal immigrant teen could be forced between having abortion or staying in U.S. The Justice Department's argument that an illegal immigrant is not entitled to an abortion could force the teenager to choose between staying in the U.S. or having the abortion. The Justice Department filed a brief Monday urging the D.C. Court of Appeals not to provide a full "en banc" review of Garza v. Hagan because the decision last week from the federal appeals court's three-judge panel failed to contradict Supreme Court precedent. A federal judge first ruled in favor of the pregnant teenager, who is represented by the American Civil Liberties Union and is listed in court documents as "Jane Doe," but a three-judge panel at the D.C. Circuit Court of Appeals ruled the government did not need to immediately allow the girl to have an abortion. The D.C. Circuit's panel opinion directed the government to find a sponsor to take custody of the girl, who is living in a government shelter in Texas, before the end of October. The girl is 16 weeks pregnant, and Texas prevents most abortions after 20 weeks. The teen followed state law by obtaining permission from a state judge in Texas to have an abortion and said she would pay for the procedure or would do so with help from her court-appointed guardian.

Democrats turn to Trump to support high drug prices bill … again. Lawmakers are seeking Trump's support for a bill to give Medicare the power to negotiate lower drug prices. Sen. Bernie Sanders, I-Vt., and Reps. Elijah Cummings, D-Md., Lloyd Doggett, D-Texas, and Peter Welch, D-Vt., intend to introduce the bill Wednesday. It is not clear if the bill has any chance in the Republican-controlled Congress since prior efforts to give Medicare negotiating power have gone nowhere. But Democrats are hoping to get an assist from Trump, who backed Medicare negotiating power on the campaign trail. Trump, however, has shown little interest in adopting Democratic policies to tackle high drug prices since assuming the presidency. Sanders and House Democrats also sought Trump's support for a bill in February that would let Americans buy cheaper drugs from Canada. That bill has gone nowhere in Congress, and Trump never signaled his support for it.

RUNDOWN

The Hill Senate Republicans push Trump to join Obamacare talks

Orange County Register Are new implants for opioid addicts a new hope or a new scam?

The Conversation Newfound Type3c diabetes widely misdiagnosed as Type 2

STAT News The ‘Uber of birth control’ expands in conservative states, opening a new front in war over contraception

Washington Post World leaders rehearse for a pandemic that will come ‘sooner than we expect’

Wall Street Journal Republicans face tough choices decision on bipartisan health bill

Axios Childrens’ insurance extension may not happen until December



Calendar

MONDAY | Oct. 23

Oct. 23-24. Milken Institute Future of Health Summit. Details.

TUESDAY | Oct. 24

Noon. President Trump to attend GOP Senate lunch.

12:15 p.m. Dirksen 106. American Action Forum event on The Future of Medicare Part D:

Innovation & Lessons Learned.” Includes keynote by Sen. Lindsey Graham, R-S.C. Details.

1:30 p.m. Alliance for Health Policy webinar previewing open enrollment. Details.

WEDNESDAY | Oct. 25

8:30 a.m. 1777 F St. NW. The Hill event with Dr. Ben Carson, secretary of Housing and Urban Development, on “The Future of Housing.” Details.

10 a.m. 2358-C Rayburn. House Appropriations Committee hearing on “Down Syndrome: Update on the State of the Science and Potential for Discoveries Across Other Major Diseases.” Details.

10 a.m. 2123 Rayburn. House Energy and Commerce Committee hearing on “Federal Efforts to Combat the Opioid Crisis: A Status Update on CARA and Other Initiatives.” Details.

2:30 p.m. Dirksen 562. Senate Aging Committee hearing on “Working and Aging with Disabilities: From School to Retirement.” Details.

THURSDAY | Oct. 26

Oct. 26-30. San Francisco. World Conference of Science Journalists. Details.

Oct. 26-28. American University. Event on “Next Steps in Health Reform 2017.” Details.

11 a.m. Library of Congress. House Energy and Commerce Committee to hold forum on “Public Health Solutions to Gun Violence.” Details.

FRIDAY | Oct. 27

11:45 p.m. G50 Dirksen. The National Institute for Health Care Management briefing on “Transforming Health Care to Drive Value.” Details.