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Say goodbye to Obamacare’s ‘death panel.’ Senate Republicans and Democrats have reached the outlines of a deal that includes funding for anti-opioid epidemic programs, medical research, community health centers, and the Children’s Health Insurance Program. The deal also includes repeal of Obamacare’s ill-fated Independent Payment Advisory Board, long the scourge of the law’s opponents. IPAB consisted of a group of experts who would come up with cuts to restrain Medicare spending growth. The board was never impaneled as the spending ceiling was never triggered, but it became controversial because it was seen as a means by which the federal government would begin to ration care as is the case in many single-payer systems such as Britain’s National Health Service. During the debate over Obamacare, Sarah Palin infamously attached the hyperbolic “death panel” nickname to IPAB. Another key criticism from conservatives, and even some Democrats, was that the board takes away Congress’ role in managing Medicare by installing the mandatory cuts to the program if spending gets to a certain level. Congress could overrule the cuts but only through a super majority.

Also say goodbye to cost containment. The failure of IPAB is another reminder of how unpopular any type of healthcare cost containment strategies are, regardless of party. During the 2010 Obamacare debate, the “Cadillac Tax,” which was supposed to tax expensive employer plans as a way to encourage less generous coverage, was deferred until 2018. But it didn’t go into effect this year, as it has been delayed several times by Congress, and currently isn’t slated to go into effect until 2022. During the drive to repeal Obamacare, Republicans failed to get consensus around ideas that were once a core part of GOP healthcare proposals — efforts to cap the employer tax exclusion, and to encourage the use of higher deductible plans combined with health savings accounts. So, in an era of fierce partisanship, both parties have rejected both approaches to cost containment — either government-centered approaches or market-based approaches.

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More details on the budget deal. It would provide $54 billion in funding for the military above mandatory federal spending caps and $37 billion for domestic programs. The deal includes $6 billion in funding to fight the opioid epidemic, according to a source familiar with the deal, a boost from the extra $1.4 billion that Congress devoted to it in the 2017 and 2018 fiscal years. The deal includes other major healthcare funding boosts, including an additional $2 billion for research at the National Institutes of Health, the source said. The money is above a funding boost that was included in the 21st Century Cures Act signed into law in December 2016. That bill gave the NIH an additional $4.8 billion in funding over 10 years. It also would lengthen the reauthorization of CHIP from six to 10 years. A short-term spending deal passed last month reauthorized CHIP for six years. The deal devotes $7 billion in funding for two years for community health centers, which are nonprofit clinics that offer care to underserved areas. Funding for the centers expired Sept. 30. It also includes a host of extensions for certain healthcare programs. Those include five years of funding for a home visiting program that gives pregnant women and families help on how to raise children. However, the deal also takes $1.35 billion from an Obamacare disease prevention fund to help pay for the new health programs. This figure is below what the House was planning to remove. Conservatives have long hated the prevention fund, claiming it is a “slush fund” for Obamacare. House Republicans sought to use the fund to pay for CHIP last year, but a bill that passed the House that included the cuts didn’t go anywhere in the Senate.

Trump signals support for bipartisan budget deal. President Trump signaled Wednesday he supports the bipartisan budget deal. “The Budget Agreement today is so important for our great Military. It ends the dangerous sequester and gives Secretary Mattis what he needs to keep America Great. Republicans and Democrats must support our troops and support this Bill!” Trump tweeted. Though Trump has indicated his support for the plan, conservatives in both chambers have decried the proposal as being fiscally irresponsible.

Ryan confident House has votes to pass budget deal, Dems cheer opioid funding. House Speaker Paul Ryan believes he has the votes in the lower chamber to pass the two-year budget deal, the Wisconsin Republican said Thursday. “I think we will. I feel good,” Ryan told radio host Hugh Hewitt when asked if the votes are there in the House.  Democratic senators were pleased that the two-year deal includes funding to fight the opioid epidemic, even though it was far lower than what some lawmakers had pushed for.

Deal doesn’t attempt to stabilize Obamacare. The deal does not include two bills aimed at stabilizing Obamacare’s insurance marketplaces, but senators behind the legislation said they are pushing to include them in a long-term spending deal called an “omnibus” in March that locks in the spending deal.

Turns out California Obamacare enrollment actually fell. The 3 percent increase that was widely shared by Covered California was only referring to enrollment of new customers. When factoring in the percentage of people who did not re-enroll in the program, overall enrollment in Covered California actually decreased by 2.3 percent, according to figures from the Kaiser Family Foundation. Officials attributed some of the change to people choosing to go off the exchange to enroll in coverage. The state spent $110 million in advertising and outreach to encourage enrollment.

Azar meets with Trump, flu leaders. Health and Human Services Secretary Alex Azar on Wednesday met with the president, and tweeted afterwards that they had discussed healthcare reform, lowering drug prices and combating the opioid epidemic. He also received a briefing on preparedness and response efforts for seasonal and pandemic influenza from Anne Schuchat, acting director of the Centers for Disease Control and Prevention; Anthony Fauci, director at the National Institute for Allergy and Infectious Diseases;  Robert Kadlec, assistant secretary for Preparedness and Response.

Doctors prescribe too many powerful opioids, report says. Doctors should lower the dosage and duration of opioid prescriptions to help fight the opioid epidemic, according to a new insurance industry study. Insurance lobby America’s Health Insurance Plans released data on Wednesday that details prescribing patterns of opioids from 2009 to 2013 in employer-sponsored health plans. The data showed doctors were prescribing too many opioids, a key driver that fueled the opioid epidemic that federal data shows kills 91 people each day. AHIP looked at insurance claims to determine how doctors met six of 12 recommendations from the Centers for Disease Control and Prevention on how to prescribe opioids. The data was based on claims from 2009 to 2013, before the recommendations were released in 2016. Overall, 97 percent of opioid prescriptions during that time were for immediate-release opioids. That hews closely to the CDC’s recommendation that doctors need to prescribe immediate-release opioids as the first prescription for a patient with chronic pain, instead of an extended-release painkiller. However, the claims data also showed that 25 percent of initial opioid prescriptions exceeded the CDC’s recommended dosage.

CVS to boost wages and benefits following GOP tax law. Retail chain CVS Health plans to boost benefits and increase starting wages for employees to $11 an hour, a change it credited to the tax law. Overall, the company is seeing a $1.2 billion gain in tax savings from the law.  “As part of our ongoing commitment to the patients, customers and communities we serve, we said that we would invest our tax savings back into our business, and that’s exactly what we’re doing,” Larry Merlo, CVS Health president and CEO said in a statement. The minimum wage increase, from its current $9 an hour, will take effect in April, and the company also said it planned to increase pay for its pharmacists, front store associates and other hourly employees later in the year. It will create a new paid parental leave program beginning in April that will give new parents four weeks, fully paid leave. The changes to employee benefits and wages will cost CVS $425 million a year. The money comes just ahead of its planned purchase of health insurer Aetna, a massive $69 billion deal. The agreement, announced in December, must be approved by federal regulators.

Cancer drug overpriced, new study says. A new immunotherapy cancer drug aimed at treating certain types of leukemia is wildly overpriced, according to an analysis published in the journal Health Affairs. The analysis focuses on a drug called Kymriah, which was approved by the Food and Drug Administration in August to treat bone marrow and blood cancer in children and young adults. Drug maker Novartis charged $475,000 for one infusion of the drug, but said it would charge patients only if they respond to the treatment after the first month of use. However, the analysis said Novartis is overcharging the patients. It points to more than $200 million in research funded by the National Institutes of Health that developed the innovative approach to cancer care that the drug uses. Novartis says it spent $1 billion to develop the drug, but there is no way to verify what that figure was spent on. After taking into account manufacturing costs and the potential patient population, the analysis found that Novartis could earn an average profit of 84 percent on Kymriah over 10 years at the current price. So the authors believe that Novartis is overcharging cancer patients for the new treatment.

RUNDOWN

USA Today Ivanka Trump teams up with conservatives to push Democratic themes

Reuters Puerto Rico in line for nearly $5 billion in aid for Medicaid

Washington Post ACA’s state-run exchanges fare better than the law’s federal marketplace

Axios Democrats want to increase ACA subsidies in stabilization bill

Associated Press New Mexico studies expanding Medicaid with buy-in coverage

STAT News He calls animal testing ‘taxpayer funded torture’ and got the FDA to listen

Los Angeles Times Snooping around in hospital pipes, doctors find DNA that fuels the spread of superbugs

The Hill Obamacare enrollment tells a tale of two systems