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What if the people not signing up for Obamacare don’t want it? Enrollment in Obamacare plans for 2019 is lagging last year’s pace, which supporters of the law have attributed to a drop off in advertising and other efforts by the Trump administration to “sabotage” the law. But what if there’s a much simpler explanation? What if those who aren’t enrolling this year are people who simply don’t want Obamacare? Supporters of Obamacare have looked at a Kaiser poll showing a lack of awareness of the upcoming Obamacare deadline and attributed it to the slashing of the Obamacare ad budget. But the lack of awareness of key Obamacare dates and benefits has not been any sort of new problem, as it was also an issue during the Obama administration, when the president was using all tools at his disposal to expand enrollment. It’s possible that what’s really happening is that there were a certain number of people who weren’t interested in purchasing Obamacare, but they were compelled to do so as a result of the tax penalty. Now, they are taking advantage of their increased freedom to go without purchasing coverage. This shouldn’t be a controversial view. Liberals actually predicted a drop off in enrollment as a result of the revocation of the mandate. So the question really is more of an ideological one. Republicans, who despite the last gasps of repeal rhetoric have de facto settled on government subsidized insurance as an acceptable status quo, have argued that the government should make insurance available for people, but that they shouldn’t be forced to purchase it. Liberals, meanwhile, won’t feel satisfied unless everybody purchases health insurance, regardless of whether they want it.

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Trump administration approves New Hampshire work requirements. New Hampshire has become the latest state to receive a green light for its Medicaid work requirement waiver from the Trump administration. The application, approved Friday, had been approved earlier this year as an amendment but had to be re-approved by the end of this year. Under the plan, certain beneficiaries will need to work, volunteer, or take classes for 100 hours a month as a condition of staying enrolled in the program. “The community engagement and work requirement will help bring more people into the workforce, empowering individuals with the dignity of work, self-reliability and access to high quality healthcare,” Republican Gov. Chris Sununu said in a statement. The requirements may start as early as April next year for people already in the program. They will be required to log their hours with the state every month in order to stay enrolled in Medicaid. The state will be using $3 million from its Temporary Assistance for Needy Families funds to help with tuition assistance and job training.

Trump administration plugs Medicare Advantage in emails to beneficiaries. The Trump administration is touting the benefits of Medicare advantage in emails to potential enrollees, the New York Times reported over the weekend. The emails say they are paid for by the department of Health and Human Services, and prompt beneficiaries to look at the Medicare Advantage online tool. It lets them know that they could receive more benefits and spend less money. The Trump administration denies that it’s trying to encourage one type of plan over another. One of the disadvantages of Medicare Advantage plans, advocates say, is that they come with a specific network whereas most providers will accept traditional Medicare. The open enrollment for Medicare closes Friday, and the Trump administration has projected that 37 percent of enrollees will move to these plans, up from 28 percent five years ago.

CMS ups staffing requirements for nursing homes. The Centers for Medicare and Medicaid Services on Friday announced it will add reporting requirements to nursing homes to help ensure they’re staffed adequately. “We’re deeply concerned about potential inadequacies in staffing, such as low weekend staffing levels or times when registered nurses are not onsite, and the impact that this can have on patient care,” CMS Administrator Seema Verma said in a statement. Data released by CMS show that some facilities have significantly lower weekend staffing, and that there are days with no registered nurse on site, even though it’s required to have one for a full work day every day of the week. CMS is sending a list of nursing homes to states that have had large drops in staffing on weekends or who went several days without a registered nurse on site. The states will then fill out surveys on the facilities and will cite them if they don’t make a fix. Other requirements include having facilities share data with states when issues arise on staffing, and clarify rules on how to report staff hours and count their meal breaks.

China agrees to stiffen fentanyl penalties in trade agreement. President Trump and Chinese leader Xi Jinping reached an agreement on trade Saturday night, the White House press secretary said, that amounts to a temporary stand-down in the two countries’ trade war. As part of the agreement, which happened at a summit in Buenos Aires, China agreed to stiffen penalties on sales of the powerful opioid fentanyl into the U.S., a step the White House press secretary described as “a wonderful humanitarian gesture.” The temporary truce, reached over a two-plus-hour dinner of steak and caramel pancakes, represents a rare moment of harmony between the two sides, whose ongoing trade battle has escalated in recent weeks leading into the meeting at the G-20 summit in Argentina.

Alexandria Ocasio-Cortez suggests Medicare for All be funded from Pentagon money. Congresswoman-elect Alexandria Ocasio-Cortez suggested that “Medicare for all” costs be covered by money allocated to the Department of Defense. The New York Democrat over the weekend referenced a Nation magazine report about problems with a Pentagon audit due to bookkeeping deficiencies, irregularities, and errors. “In all, at least a mind-boggling $21 trillion of Pentagon financial transactions between 1998 and 2015 could not be traced, documented, or explained,” the progressive publication reported. “$21 TRILLION of Pentagon financial transactions ‘could not be traced, documented, or explained.’ $21T in Pentagon accounting errors. Medicare for All costs ~$32T. That means 66% of Medicare for All could have been funded already by the Pentagon. And that’s before our premiums,” Ocasio-Cortez tweeted, citing the Nation article.  

Rebel Democrats regroup, vow to hold firm as Pelosi plots to outflank them. A core group of agitators aiming to prevent Nancy Pelosi from retaking the speaker’s gavel regrouped Thursday evening and vowed to stick together after suffering repeated setbacks as some softened in opposition to the longtime House Democratic leader. The group is determined to move forward as a bloc, according to multiple members. To shield against Pelosi’s powers of persuasion, the rebel members agreed to not propose individual negotiations or meetings with the California Democrat unless they’ve huddled among themselves first. Pelosi critics say they are open to negotiating with the minority leader and could come around to supporting her if she presents a definitive timeline for her departure. Barring that, they will block her from becoming speaker, confident that their coalition of 23 will hold.

FDA approves test to detect herpes in newborns. The Food and Drug Administration has approved the first test to detect 21 days after birth whether infants have been infected with the herpes virus. The virus type is called cytomegalovirus, and while most people who have it don’t have serious illness, it can hurt infants with weaker immune systems, causing hearing problems later in life. More than half of adults have been infected by the age of 40, and babies who test positive generally were infected while in the womb. The test, called Alethia CMV Assay Test System, works by using a saliva swab.

Signups on Washington exchange rise 3 percent. The Washington Health Benefit Exchange has enrolled 195,000 customers for 2019 coverage, a nearly 3 percent increase over the same time last year. This trend is different from what the federal exchange has seen so far, in which enrollment has fallen behind. The state has held more than 70 enrollment events with navigators and brokers. The enrollment period ends Dec. 15, the same as healthcare.gov.

CDC mourns death of public health advocate Betty Bumpers. Betty Bumpers, a former Arkansas first lady, passed away Nov. 23. She had campaigned with the Carter administration to have children vaccinated before they entered school, after first becoming involved on the issue by creating a vaccination campaign in the Arkansas in 1974. The Centers for Disease Control and Prevention later sought to replicate the campaign across the U.S. CDC Director Robert Redfield called Bumpers “one of the greatest heroes of public health.”  Her immunization campaign “Every Child by ‘74” used partners in government, academia, and the private sector, and resulted in Arkansas becoming one of the most vaccinated states. “We at CDC mourn the passing of this great American,” Redfield said. “Her accomplishments will continue to be an inspiration to everyone working in public health.”

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RUNDOWN

Associated Press Could anyone have stopped gene-edited babies experiment?

Science Universal flu vaccine remains ‘an alchemist’s dream’

Wall Street Journal Employers change tactics to curb health-insurance costs

Stat News As Ebola outbreak spreads in Congo, concern grows over supplies of experimental vaccine

Modern Healthcare Flaws in reporting create knowledge vacuum regarding community benefits

Fierce Healthcare He became a trauma surgeon after surviving his own gunshot wound. Now he’s launching a movement

Washington Post After a record number of U.S. deaths in 2017, the opioid epidemic may be receding

Reuters GSK to buy cancer drugmaker Tesaro for $5.1 billion