Daily on Healthcare: House to vote on stopgap spending bill that extends CHIP…unlikely to woo Dems

House to vote on stopgap spending bill that extends CHIP. The House will vote as early as Thursday on a measure to temporarily extend government funding until Feb. 16 and to reauthorize the Children’s Health Insurance Program for six years. The legislation, at this point, does not include immigration reform language or a provision to protect “Dreamers” from being deported. The legislation includes a few “sweeteners” aimed at drawing GOP and Democratic votes, although it’s unlikely to win much Democratic support. It also would delay by two years a tax on medical devices and a tax on high-cost health plans. Another tax on Obamacare insurers would be delayed for one year. All of the taxes were created to help fund Obamacare. The medical device tax was delayed in 2015 for two years but went back into effect on Jan. 1, as did a tax on Obamacare health insurers. The tax on high-cost health plans, often called the “Cadillac” tax, has never gone into effect and is delayed until 2020. Republicans leaving the meeting said they are generally in favor of voting for the stopgap measure, even though it will mark the fourth time in fiscal 2018 a short-term bill has been passed to keep the government open.

CHIP may not be enough to win support from Democrats. Democrats are fuming that the short-term CR won’t include a deal with protections for “Dreamers,” immigrants who were brought into the country illegally as children. President Trump rescinded the Obama-era Deferred Action for Childhood Arrivals program and set it to expire in March. A bipartisan immigration deal fell apart last week because of White House opposition. It appears that a DACA deal is more integral than the funding for CHIP. “I think Democrats are very upset over the fact that Trump rejected a bipartisan DACA agreement,” said Rep. Frank Pallone, D-N.J., who had been pushing a permanent reauthorization for CHIP now that the Congressional Budget Office predicted it will save the government money. “I am not going to vote for a CR if it just has the six years for CHIP and doesn’t address these other issues including DACA,” he said. But Republicans are hoping that adding CHIP will get at least some Democrats, or at least make it a hard vote. “It puts some pressure on Democrats to vote against it,” said Rep. Chris Collins, R-N.Y. Senate Democrats are still pushing for a permanent reauthorization. Sen. Ron Wyden, D-Ore., said during a Senate Finance Committee nomination vote Wednesday that he is working with committee Chairman Orrin Hatch, R-Utah, to get “as many years as we can and cover as many children as we can.”

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What about community health centers? Pallone said any deal for CHIP needs to include funding for community health centers, which also expired Sept. 30. And Collins said he expects the CHIP deal to include that funding. But Republicans leaving the closed-door meeting Wednesday did not say if community health centers were included. A community health center is a nonprofit organization that provides healthcare services to a certain area.

Ron Johnson says Obamacare Medicaid expansion made opioid epidemic worse. The expansion of Medicaid under Obamacare allowed the opioid epidemic to swell, according to a report commissioned by Sen. Ron Johnson, chairman of the Senate Homeland Security and Governmental Affairs Committee. The report suggests that because millions of people who were uninsured now have government-funded Medicaid coverage under Obamacare, they have more access to prescription painkillers such as OxyContin and are selling them illegally on the streets. “I’m not saying this is a primary cause,” Johnson, R-Wis., said in a hearing on the topic Wednesday. “I think what we are certainly saying is this is an unintended consequence. It’s certainly a contributing factor. It maybe enables something that shouldn’t be enabled. It’s a very serious problem that has to be taken a look at.” Johnson has been raising questions about the way that Medicaid contributed to the opioid epidemic since last year.

Health insurance tax opponents miffed it’s back in 2018. The Health Insurance Tax went back into effect this year after a two-year delay. The spending deal appears to keep the tax on the books for 2018 but suspend it for 2019. Critics of the tax are miffed that the House isn’t suspending it for this year for this year, too. “Millions of small businesses — as well as seniors, middle-class families, and consumers — would benefit from a tax rebate this year as a result of [health insurance tax] suspension,” said Elena Tompkins, executive director of the group Stop the HIT.

White House doctor: Trump ‘fit for duty,’ could lose 10-15 pounds. President Trump is “fit for duty,” but could lose 10-15 pounds and is taking Propecia to promote hair growth, White House physician Dr. Ronny Jackson told reporters Tuesday. “In summary, the president’s overall health is excellent … he continues to enjoy the significant long-term cardiac and overall health benefits that come from a lifetime of abstinence from tobacco and alcohol,” Jackson said. But the physician did give the president advice about diet and exercise, and said he recommended a diet that’s lower in fat and carbohydrates, and that he exercise more. Jackson said Trump is 6-foot-3 and is 239 pounds, three pounds more than his last physical, and just one pound short of being classified as “obese.” That’s what prompted Jackson to recommend exercise and try losing 10-15 pounds. “He is more enthusiastic about the diet part than the exercise part, but we are going to do both,” Jackson said, noting that he would work with the president over the next year.

Trump scored 30 out of 30 on a cognitive exam he requested. Trump insisted on taking a cognitive assessment exam as part of his annual physical last week, and scored a perfect 30 on the test, confirming his doctor’s belief that he does not show any signs of mental deterioration. “I had no concerns about the president’s cognitive ability,” Jackson said. Still, Jackson said Trump nevertheless requested that he undergo a neurological exam, presumably to combat heightened speculation by his critics about his fitness for office and overall mental health. He said it’s the first time any president took this kind of test, as far as he knows. “He mentally is very sharp, very tact,” Jackson told reporters, noting that Trump scored 30 out of of 30 on the Montreal Cognitive Assessment, a test that can help detect mild cognitive impairment or Alzheimer’s disease.

Trump slurred speech because of dry mouth, doctor said. Trump slurred his words during a speech last month because a dose of cold medicine dried out his mouth, the president’s physician told reporters. Jackson addressed questions about why the president had appeared to slur his speech last month, likely referring to remarks Trump gave in early December announcing the administration’s decision to recognize Jerusalem as the capital of Israel. Jackson said he had recently given Trump a dose of Sudafed, which he said likely dried Trump’s mouth ahead of the speech. The doctor said Trump does not wear dentures, which was one theory circulated at the time for why Trump seemed to struggle with his speech that day.

Democrat behind ‘Stable Genius Act’ pleased by Trump’s exam. The author of the “Stable Genius Act” that would require presidential candidates to undergo a medical screening believes Trump’s exam boosted his position. “It actually bolstered my case for the legislation because it seemed pretty simple for him to give a physical as well as a cognitive examination, so there is absolutely no reason why in the future presidential nominees of both parties couldn’t go through the same examination with the same admiral doctor who was in charge of providing the healthcare for our president,” said Rep. Brendan Boyle, D-Pa. Asked about whether he believed Jackson had accurately disclosed information about Trump’s health, Boyle replied: “I have absolutely no reason to doubt the integrity of first a medical doctor, and second, an admiral in our Navy. That’s exactly the kind of assurance the public needs and deserves.”

CNN’s Sanjay Gupta disputes Trump’s personal doctor: ‘He does have heart disease.’ CNN medical correspondent Dr. Sanjay Gupta declared Trump likely has heart disease, disputing Jackson’s findings. Speaking Wednesday on CNN, Gupta said the test results demonstrated a heart malady. “A few years ago, dating back to 2009 President Trump started having these tests that are actually looking for the presence of calcium in the blood vessels that lead to the heart … and steadily, up until just this past week, when he had them performed again, those numbers have gone up,” Gupta said. “Well, when they get to a certain range, and his number is in the 130s, that means he has heart disease.” He added there was “no question” that “by all standards, by all metrics, any way a doctor or cardiologist would look at it, the president does have heart disease.” He said, however, that it could be controlled by medication and diet.

Kentucky governor threatens to end Medicaid expansion if work requirements challenged. Kentucky Gov. Matt Bevin issued an ultimatum that he would end the state’s Medicaid expansion if his plan to install work requirements is struck down in court. No lawsuits have been filed over the state’s plan to implement work requirements, according to the Louisville Courier Journal. The Trump administration approved a waiver to require “able-bodied” Medicaid enrollees to work or volunteer for 20 hours a week to receive coverage. However, advocates have criticized the Trump administration’s guidance issued last week to allow work requirements and said that lawsuits are in the offing because they argue it is against federal law to add requirements to the healthcare program. Kentucky is one of the first red states to expand Medicaid under the Affordable Care Act and nearly half a million state residents get coverage under the expansion. Bevin campaigned on ending the Medicaid expansion but he declined to do so after he became governor.

Response to IV fluid shortage leads to shortage of IV bags. Hospitals have taken the initiative to make their own IV fluid after crippling shortages. But that has caused its own shortage of IV bags, Food and Drug Administration Commissioner Scott Gottlieb said Wednesday. Hurricane Maria slammed Puerto Rico, which house facilities that produce IV fluid. Gottlieb said the FDA is working to address a new shortage of IV bags that occurred after hospitals started making their own fluid. “The demand for IV containers continues to increase,” Gottlieb said. He added that the new shortage brings up a glaring deficiency within the FDA. The agency can’t make manufacturers notify FDA officials over device shortages, so it has to seek out reports or hope for volunteers. “There are going to be lessons learned for this episode,” he said.

Colorado reports slight increase in Obamacare signups. Colorado’s state-run Obamacare exchange signed up more than 165,000 people for 2018 coverage at the end of open enrollment, a nearly 3 percent increase from last year. Connect for Health Colorado reported that it overcame “some confusion in the market” over the future of the healthcare law. Colorado is one of 11 state-run exchanges that sign up their own residents, while 39 states use the federally run healthcare.gov.

Obamacare navigators relied on donations, other aid to make up for funding cuts. Nonprofit groups tasked with Obamacare outreach relied on partnerships and donations to make up for the Trump administration’s nearly 40 percent cut to funding for the 2018 open enrollment season. The Trump administration cut the navigator funding by nearly 40 percent last year because of concerns that the groups didn’t enroll enough people, and pointed to some navigators who only signed up a handful of people for 2017 coverage. Georgetown University’s Center on Health Insurance Reforms talked to 14 navigators to determine how they fared during the 2018 open enrollment session that ended Dec. 15, six weeks earlier than the 2017 open enrollment period. So far, 8.8 million people signed up for Obamacare through healthcare.gov, which is used by residents in 39 states. That figure, which does not include totals from 11 state-run exchanges, is only slightly below the 9.2 million that signed up for 2017 coverage.

RUNDOWN

Axios Paul Ryan’s latest bargaining CHIP

Politico Media poke and prod at Trump’s health

NPR Home care agencies often wrongly deny Medicare help to the chronically ill

Roll Call Anti-abortion groups look for wins in 2018

Kaiser Health News When food stamps pass as tickets for better health

STAT News As opioid crisis grows, states are opening Medicaid to alternative medicines

The Hill Lawmakers weigh measure to fight high drug prices

Calendar

WEDNESDAY | Jan. 17

9:30 a.m. 1225 I St. NW. Bipartisan Policy Center event on “Reinventing Rural Health Care: A Case Study of Seven Upper Midwest States.” Details.

10 a.m. 430 Dirksen. Senate Health, Education, Labor and Pensions Committee hearing on “Facing 21st Century Public Health Threats: Our Nation’s Preparedness and Response Capabilities.”  Details.

10 a.m. SD-342 Dirksen. Senate Homeland Security and Governmental Affairs Committee hearing on “Unintended Consequences: Medicaid and the Opioid Epidemic.” Details.

10 a.m. 1100 Longworth. House Ways and Means Committee hearing on preventing opioid misuse. Details.

THURSDAY | Jan. 18

1p.m. 1330 G St. NW. Kaiser Health News event on healthcare in 2018. Details.

FRIDAY | Jan. 19

Deadline for government spending bill.

45th annual March for Life rally in protest of Roe v. Wade. Will include speech from House Speaker Paul Ryan.

9 a.m. 2123 Rayburn. House Energy and Commerce Committee hearing on “Safety of the U.S. Food Supply: Continuing Concerns Over the Food and Drug Administration’s Food-Recall Process.” Details.