SIGN UP! If you’d like to continue receiving Washington Examiner’s Daily on Healthcare newsletter, SUBSCRIBE HERE: http://newsletters.washingtonexaminer.com/newsletter/daily-on-healthcare/

Trump steers conversation from guns to mental health in Florida shooting aftermath. In the wake of a school shooting this week that claimed the lives of 17 children and adults, President Trump has sought to steer the national conversation to mental illness as critics question why he has failed to mention guns in his comments about the attack. Trump said Thursday that his administration would work with state and local officials to “tackle the difficult issue of mental health” and prioritize security in schools. However, his failure to mention guns on Thursday rankled Democrats, who have long accused the White House of avoiding the debate over gun legislation any time a national tragedy strikes.

Here’s why CMS actuaries see much less coverage impact from repealing the mandate than CBO. Perhaps no estimate in Washington had a greater effect on legislation last year than Congressional Budget Office estimates that suggested the elimination of the mandate would cause up to 15 million individuals to go uninsured (an estimate that was later adjusted to 13 million). During the healthcare debate, CBO assumptions about the importance of the mandate were a crucial part of estimates showing the number of uninsured would grow by 20 million or more individuals under various Republican proposals to repeal, replace or overhaul Obamacare. These estimates provided ammo to Democrats and pro-Obamacare activists, and made it a lot harder for Republicans to convince their centrist members to back repeal. Republicans bristled at the CBO’s assumption that millions of people would go without basically free Medicaid coverage if there were no mandate on the books. However, after the healthcare effort went down in flames, Republicans then turned around and relied on the CBO’s assumptions about the mandate to repeal it later and thus improve the budgetary math of their tax legislation. Yet this week, actuaries at the Centers for Medicare and Medicaid Services broke with the CBO, projecting that the Republican decision to repeal Obamacare’s penalties for going uninsured will result in just 4 million fewer individuals choosing to purchase coverage over the next decade.

So what explains the difference? While CMS and CBO did agree that shortly after the repeal of the fine, roughly 2 million of those who will become uninsured will choose to forgo coverage their employer offers them, they significantly differed in assumptions about the impact the individual mandate will have in two other areas: Medicaid and the Obamacare exchanges. CBO projected that Medicaid rolls would fall by 5 million, while CMS actuaries indicated they believed Medicaid enrollment wouldn’t have a noticeable impact. On the exchanges, CMS assumes the impact would be limited mainly among healthier individuals, particularly those with incomes too high to qualify for subsidies. Another way of looking at it is that CMS actuaries focused on tangible financial motivations, assuming that people who can qualify for free or near free care would be relatively unaffected by the existence of the mandate. On the other hand, CBO analysts have given more weight to non-financial factors, such as assuming the existence of a mandate creates a new set of social norms for getting covered that act as a more intangible motivator that disappears once penalties are eliminated. CBO has indicated the group’s assumptions about the mandate are under review, so it should be interesting to see if their highly anticipated revision brings their estimates more in line with CMS.

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 [email protected] 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.

Azar says HHS will be ‘laser focused’ on mental health. Health and Human Services Secretary Alex Azar vowed that his agency would be “laser focused” on addressing untreated serious mental illness in response to the mass shooting. “The Department of Health and Human Services will be laser focused on this issue in the days, weeks and months to come,” Azar said. “And it has already been a priority under this administration.” Law enforcement officials have confirmed that Nikoloas Cruz was expelled from the school because of behavioral problems and had been living with a family friend following the death of his mother in November. Earlier in the day, while appearing before a House committee to discuss the president’s budget, Azar said he believed the Centers for Disease Control and Prevention had the authority to study gun violence, saying that federal law prevented the agency from advocating against gun control, but not from carrying out scientific studies. Over at the Incidental Economist, Bill Gardner argues a change in mental health policy, whatever the broader benefits, is unlikely to do much to reduce mass shooting incidents.

Flu shot 36 percent effective in adults this year. The flu shot is 36 percent effective in adults this winter, while getting young children vaccinated for the flu can make them 59 percent less likely to become infected and have to go to the doctor, federal health officials said Thursday.

The number of children who died from the flu climbed to 63 this past week, and additional deaths are expected to be announced soon. Three out of four children who died had not been vaccinated. “We continue to recommend parents get their children vaccinated even though it’s fairly late in the season,” said Anne Schuchat, acting director at the Centers for Disease Control and Prevention.

Uninsured expected to reach nearly 40 million in a decade. The total number of people who are uninsured is expected to grow because of factors outside the individual mandate repeal, according to CMS. Its analysis projects that by 2026 the number of uninsured will rise to 37.7 million people, a 9.1 million increase from 2016, when the number of uninsured in the U.S. reached a historic low. John Poisal, deputy director for the National Health Statistics Group, noted the expected trend showing a rise in the number of people who are uninsured is “influenced by economic factors, such as the impact of growth in GDP, and employment on private health insurance enrollment, as well as growth in population.” The projections, which come out annually by CMS, do not make any assumptions about what new legislation might influence enrollment and spending, meaning that they presume no other healthcare law will pass and acknowledge that this is a key uncertainty in laying out forecasts.

House votes to ease enforcement of Americans with Disabilities Act. The House on Thursday passed legislation that would ease the enforcement of regulations against businesses that fail to be accessible to people with disabilities. The bill, the ADA Education and Reform Act, would change the 1990 Americans with Disabilities Act to give businesses accused of being inaccessible a months-long grace period to fix structural problems with their facilities before they can be sued. The bill passed 225-192. Republicans said during debate that the bill was necessary because some lawyers were taking advantage of the system through “drive-by lawsuits.” Rep. Jeff Denham, R-Calif., said 70 percent of the businesses facing these lawsuits were owned by immigrants or minorities, and said some of the Spanish-language guidelines for accessibility had not been updated. Critics said the bill was unnecessary because existing laws can address frivolous lawsuits by disbarring attorneys, and that people with disabilities only receive injunctive relief and legal fees. In opposing the bill, Rep. James Langevin, D-R.I., the first quadriplegic to be elected to Congress, spoke about how he was injured at the age of 16, before the passage of the ADA. He had to decline his admittance to his first-choice college because the campus wasn’t accessible. “I certainly remember what life was like before,” he said. “I remember that I couldn’t go into a public building that didn’t have a ramp … I struggled to wash my hands at a sink, access a restroom, and enter a classroom.”

RUNDOWN

NJ.com Lawmakers restore $7.5M for Planned Parenthood after years of Christie vetoes

Axios DC doesn’t know what to do about the opioid crisis

Washington Post Nine organizations sue Trump administration for ending grants to teen pregnancy programs

The Hill GOP negotiators meet on Obamacare market fix

Kaiser Health News Pain hits after surgery when a doctor’s daughter is stunned by $17,850 urine test

Reuters Rights group sues to block Ohio Down syndrome abortion ban

Forbes Insurers predict stable 2018 Obamacare marketplace

California Healthline Couple makes millions off Medicaid managed care as oversight lags