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Obamacare sign-ups fall slightly behind last year’s mark, even after late surge. Final enrollment in the Obamacare exchanges fell roughly 300,000 people short of last year’s tally, the Trump administration revealed Wednesday. Democrats have warned that sign-ups would fall behind this year, accusing the Trump administration of trying to sabotage Obamacare by cutting the budget for navigators and advertisements for open enrollment, in addition to reducing the sign-up period from three months to six weeks. A federal judge also ruled Obamacare to be unconstitutional just a day before the sign-up period ended. But the latest figures from the Centers for Medicare and Medicaid Services showed a significant jump from where they were a couple weeks ago, when enrollment was behind by about 11 percent. The final numbers are similar to last year’s, despite Republicans also, as part of the tax overhaul they passed, zeroing out the fine for going uninsured. Final enrollment landed at roughly 8.5 million people, compared to the 8.8 million who enrolled last year. Shortly after, some people had dropped plans, bringing the final total to about 8.7 million. The agency is also still returning calls to 200,000 people who left their information to receive a call back and enroll.

CMS celebrated the tally. The Trump administration praised the enrollment figures, calling them “stable,” and hypothesized that one factor possibly contributing to lower enrollment was the strong economy. Most states use healthcare.gov, and employment in those states increased by 2 million, according to CMS. The exchanges are for people who don’t get coverage through work or a government program. “With the lowest unemployment rate in 50 years, it’s possible that more Americans have employer based coverage, and don’t need exchange plans,” CMS Administrator Seema Verma said in a statement. Still, she noted, certain enrollees don’t get help from the federal government to pay their premiums, and these customers may be priced out.

Agency officials also noted that Virginia’s Medicaid expansion that started this year would pull some people out of the marketplace and into Medicaid coverage, which is fully funded by the federal government and the state for individuals making less than roughly $17,000 a year. CMS estimated that about 100,000 people would qualify for Medicaid in Virginia who were formerly enrolled in the exchange. CMS did not provide information about the extent to which people had signed up for short-term plans, which are plans that can be bought outside of Obamacare’s rules obligating coverage for pre-existing conditions such as cancer or diabetes.

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Is a God-fearing scientist the next casualty of the Trump White House? Anti-abortion advocates want President Trump to fire Dr. Francis Collins, the wildly popular, Obama-appointed head of the government’s medical research agency. The calls to oust the National Institutes of Health director are coming to a head amid White House and congressional scrutiny over government-funded experiments that use parts of aborted fetuses. The prospect that the research might end, or that Trump might appoint someone else to Collins’ position, terrifies many scientists. Anti-abortion organizations, though, say that Collins’ leadership clashes with the deeply held values of the administration and that he should go. Abortion controversies, involving questions about ethics, scientific advancement, and the beginning of life, are familiar to the NIH, the world’s premier research institution. But the latest comes with a particularly sardonic twist for Collins, a physician-geneticist and passionate evangelical Christian who describes himself as “troubled by abortion.” “I do think that part of the argument has been missing a little bit in the fetal tissue debate: the sort of immediate assumption that if you’re in support of fetal tissue research that you must also think abortion is just fine,” Collins told the Washington Examiner. “Even for people who are pro-life, who are troubled by abortion, the use of fetal tissue for research, since they are being derived anyway, if that is going to save a life someday, seems like a credible stance.” Read our deep dive on the controversy.

Anti-abortion groups want change in policy. Ten anti-abortion organizations sent a letter to Trump this morning asking for him to end government funding on fetal tissue research. The groups did not in unison call for Collins to be fired, but they condemned comments he made to Science Magazine that suggested fetal tissue research would continue. “There is absolutely no moral or ethical justification for treating children and their organs like commodities,” wrote the groups, which included Susan B. Anthony List, National Right to Life, and Live Action.

Interview: Lawyer challenging constitutionality of Obamacare explains to Philip Klein what he thinks critics missed. After a federal judge in Texas declared Obamacare unconstitutional on what I saw as shaky legal grounds, I declared the decision an ” assault on the rule of law.” On Wednesday, I met with Rob Henneke, a lawyer for individual plaintiffs in the suit, who said that myself and other critics “missed the mark” in our analysis, and he explained why.

Senate quickly and quietly passes bill to avoid Saturday shutdown. The Senate late Wednesday quickly approved a two-month spending bill and sent it to the House, just two days before funding is set to expire for several federal agencies. Senators passed the bill with little debate and by voice vote. The bill funds the Department of Homeland Security and other agencies through Feb. 8. After the voice vote, Senate Majority Leader Mitch McConnell, R-Ky., said the Senate would be in session on Thursday because it needs to see what the House does with the bill. But the House is expected to quickly approve it. The final hurdle is President Trump, who has not said specifically whether he will sign the measure, or veto it. Trump has been pushing for $5 billion in new funding for a border wall, which is not in the bill the Senate passed Wednesday night.

Trump administration recommends prescribing antidote alongside opioids amid scourge of overdoses. The Trump administration is recommending that doctors prescribe the opioid-overdose reversal drug naloxone when they give opioid painkillers to certain patients, a move aimed at reversing the scourge of overdoses across the country. In guidance released Wednesday, health officials recommended that prescriptions such as Percocet, Vicodin, OxyContin, and Tramadol be accompanied with naloxone under certain conditions, such as when patients receive high doses of opioids, of about 10 pills of Vicodin, or when they take other medications, such as Valium. Officials also recommended co-prescribing for patients with addictions to alcohol, cocaine, or methamphetamine, or who have a mental health disorder. “This is not a mandate or anything of the sort,” Dr. Brett Giroir, the Department of Health and Human Services assistant secretary for health and senior adviser for opioid policy, said in a phone call with reporters. “It’s still in the scope of guidelines and strong recommendations. This is voluntary among prescribers. But we do believe the rates we are seeing of co-prescribing are exceedingly low.”

Republicans block Democratic effort to intercede on Obamacare lawsuit. Senate Republicans on Wednesday blocked a resolution from Democrats that would have had the Senate counsel involved in the lawsuit that threatens to invalidate Obamacare. Democrats were aiming to get Republicans on the record to show that they will follow through on campaign promises they made during the midterm elections to guard protections for patients with pre-existing conditions, such as cancer or diabetes. The plan was in reaction to Judge Reed O’Connor’s ruling Friday to strike down the entirety of Obamacare. The law remains in place as 17 Democratic attorneys general plan to appeal the case, Texas v. Azar, to the U.S. Court of Appeals for the 5th Circuit in New Orleans. From there, it may go before the Supreme Court.

Obama plays Santa with surprise visit to children’s hospital. The former president made a surprise appearance at Children’s National Hospital in Washington, D.C., on Wednesday, wearing a Santa hat and carrying a bag of gifts. Obama handed out jigsaw puzzles, Hot Wheels sets, remote control cars, and glittery nail polish to young children who were making snowflakes in one of the hospital’s playrooms, according to the Washington Post. He also visited patients in their rooms for one-on-one visits with the kids and their parents.

Trump administration unveils strategy to protect children from lead poisoning. The Trump administration on Wednesday introduced a multi-agency strategy to reduce the exposure of children to lead poisoning in drinking water or in dust that is generated from old lead paint in homes and schools. Acting Environmental Protection Agency Administrator Andrew Wheeler, along with Housing and Urban Development Secretary Ben Carson unveiled the “federal lead action plan,” which is a big-picture strategy document, and not a formal regulatory proposal. “Lead exposure is a calamity that disproportionately harms children and low income communities,” Wheeler said during a press conference at EPA headquarters. “The Trump administration is committed to combating the problem head on.” The Cabinet officials belong to the President’s Task Force on Environmental Health Risks and Safety Risks to Children, a coalition established in 1997 featuring the leaders of 17 agencies.

Aetna to keep insurance business separate from CVS as federal judge reviews $69 billion merger.  Aetna will keep its insurance business separate from a newly combined entity with CVS Health, after a federal judge signaled concerns over the $69 billion merger. The Department of Justice previously approved the deal after requiring Aetna to sell its Medicare Part D business. But federal District Court Judge Richard Leon’s skepticism presents a new challenge to the merger, one that could open up new questions over the court’s ability to block a transaction under the Tunney Act, the law that requires a judge to sign off on consent decrees between companies and the federal government. Along with delaying the merger of Aetna’s health insurance business with CVS Health’s pharmacy benefit operations, lawyers for the two companies also agreed to hold off on the exchange of any competitively sensitive information, the the New York Times reported. Leon also floated the idea of appointing an official monitor to oversee the merger, a proposal CVS and Aetna are due to respond to on Thursday. In a statement, a CVS spokesperson said the pharmacy chain and Aetna “are one company, and our focus is on transforming the consumer health experience.”

RUNDOWN

Reuters Big Pharma returning to U.S. price hikes in January after pause

The Guardian Can the NHS be saved?

NPR Judge who invalidated Obamacare has been a ‘go-to judge’ for Republicans, critics say

Kaiser Health News Hep C and drug abuse often go hand in hand, but screening for infection lags

CNBC Walgreens to tackle health-care costs with Alphabet’s Verily

USA Today If you think Americans are getting fatter, the feds say: ‘You’re right, all of us are’