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Political Cartoon: 'Regime Change'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Regime Change'" by Monte Wolverton.

Here's today's health policy haiku:

A CRYSTAL BALL WOULD HELP RIGHT NOW

Tradeoffs essential
Twenty million with health care
Will they replace bill?

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Summaries Of The News:

Capitol Hill Watch

The Battle Lines Are Drawn In The Messaging War Over The Obamacare Repeal

Both parties are trying to claim the high ground as the protectors of Americans' health while casting their opponents' positions as dangerous.

The New York Times: Senate Republicans Open Fight Over Obama Health Law
Congress opened for battle over the Affordable Care Act on Wednesday as Republicans pushed immediately forward to repeal the health care law and President Obama made a rare trip to Capitol Hill to defend it. The bitterness that has long marked the fight intensified as Republicans seized the opportunity to make good on a central campaign promise to get rid of the law, a pledge reinforced on Wednesday by Vice President-elect Mike Pence, who met with House Republicans not far from where the president gathered with Democrats. (Kaplan and Thrush, 1/4)

The Wall Street Journal: GOP’s Health-Law Attack Spurs Messaging Battle
The new Congress is moving swiftly to decide the fate of the ACA, and both sides appeared to be as mindful of the political stakes as of how any changes would affect consumers. While opponents of the law point to sharp premium increases on the ACA insurance exchanges, the latest government estimates indicate about 20 million previously uninsured people have obtained coverage under the law. (Nicholas, Peterson and Armour, 1/4)

Bloomberg: Republicans Want To Kill Obamacare Without The Blame 
Republicans have a problem. They’ve vowed to repeal Obamacare, but they don’t want to take the blame when some of the 20 million people who get health insurance under the Affordable Care Act lose it. The GOP strategy is to argue that they aren’t actually killing Obamacare; all they’re doing is giving it a proper burial. “People must remember that Obamacare just doesn’t work; and it is not affordable,” President-elect Donald Trump tweeted on Jan. 3. “It will fall of its own weight - be careful!” he added the next day. (Coy and Kapur, 1/4)

Politico: Congress Prepares For Obamacare Message War
As Republicans near their long-sought repeal of Obamacare, their battle with congressional Democrats entered a new phase Wednesday, with both parties vowing to convince Americans the other side will be to blame if millions of people see their health care disrupted. (Cheney, Bade and Sherman, 1/4)

The Associated Press: Analysis: Health Care Battle Could Decide Balance Of Power
The messaging battle is over on repealing and replacing President Barack Obama's health care law, and the balance of power in Washington may be at stake. Democrats believe they already lost the public opinion fight over the law once, when they pushed through the Affordable Care Act in the first place, and Republicans grabbed hold of the issue to drive Democrats into the minority. Democrats are determined that this time, they'll come out on top. (Werner, 1/4)

The Hill: Battle Lines Drawn On ObamaCare Repeal
Democrats and Republicans are honing their lines of attack for a battle over ObamaCare repeal that is likely to consume Washington for much of the year. The messaging war started in earnest Wednesday on Capitol Hill, where Democrats and Republicans huddled in separate meetings to discuss strategy. Vice President-elect Mike Pence met with both House and Senate Republicans, and emphasized that repeal of ObamaCare will be the first order of business for Republicans under President-elect Donald Trump. (Sullivan and Carney, 1/4)

The Associated Press: Obama, Pence Harden 'Obamacare' Battle Lines At Capitol
Outnumbered in the new Congress, Democrats didn't sound confident in stopping the Republicans cold but signaled they wouldn't make the GOP's job any easier. New Senate Minority Leader Chuck Schumer, D-N.Y., said that if the Republicans do scuttle the health care law, they will have to come up with a replacement plan before Democrats consider whether to help them revamp the system. That adds pressure on Republicans, who for years have battled among themselves over what a new law would look like, including how to finance its programs and whether to keep Obama's expansion of Medicaid for more lower-income people. (Fram, 1/4)

The Washington Post: Democrats: Trump Will Make America Sick Again
Democrats can’t stop the Republicans from gutting the Affordable Care Act so they want to make sure Donald Trump and the GOP take the full blame for any blow-back of and when the health-care system comes apart. Their message: Trump wants to Make America Sick Again. (Snell, 1/4)

CQ HealthBeat: Democrats Predict Health Care Repeal Will Backfire On GOP
Congressional Democrats on Wednesday emerged from a meeting with President Barack Obama pledging to highlight the consequences of Republican plans to repeal the 2010 health care law without having a replacement ready, but stopped short of offering any policies or changes that they would like to see in a bipartisan replacement themselves. Obama urged Democrats to continue fighting the Republican effort, citing the uncertainty that could ensue in the healthcare system and the setbacks that could occur if gains on health care are lost, according to Democratic lawmakers who attended the meeting. Obama believes that the American public would like to see the health law improved upon, but do not actually want it repealed. (Siddons, 1/4)

Dynamics Of Repeal: GOP Grapples With Challenges Of Day-One Promises

Part of the reality President-elect Donald Trump and Republican lawmakers face is finding ways to undo the 2010 health law without harming the 20 million people who gained insurance as a result of it. It's leading some policy experts to predict the evolution of an "Obamacare lite."

Bloomberg: Repealing Obamacare Could Be Trump's First Lesson In The Glacial Pace Of Congress 
Donald Trump promised voters an immediate repeal of Obamacare, but Republicans in Congress likely won’t have a bill ready for him on Day One. Or Day Two. Or perhaps even his first two weeks. Republican leaders will start deploying fast-track procedures Wednesday to get the bill through the Senate, but that will require weeks of wrangling, if not longer. It’ll be an early lesson for Trump in the sometimes-glacial pace of Congress. (Dennis, 1/4)

Modern Healthcare: Obamacare Lite Deal May Look Increasingly Attractive To GOP 
Could President-elect Donald Trump and Republicans decide it's politically smarter to reach a deal with Democrats this year to modify the Affordable Care Act, rather than repealing it and trying to create a new system from scratch? It's possible, say both conservative and liberal health policy experts. There are plenty of areas where pragmatic Republicans and Democrats could reach agreement, such as tightening enrollment rules to reduce costs, giving insurers more leeway in setting premiums, and replacing the ACA's individual mandate with strong incentives for people to maintain continuous insurance coverage. (Meyer, 1/4)

In all of this action on Capitol Hill, though, investors found some positive signs -

Bloomberg: Promise Of Orderly Obamacare Repeal Sends Hospital Stocks Rising 
At the end of a day when incoming and outgoing presidents tussled over the fate of U.S. health care, it was the words of Vice President-elect Mike Pence that seemed to matter most to anxious investors. Pence, in a visit to Congress, sought to ease concerns that a repeal of Obamacare would be done so abruptly that it leaves millions of Americans without insurance and throws health-care companies into chaos across the country. He told reporters that he was talking with Republican leaders to coordinate “both a legislative and executive action agenda to ensure that an orderly and smooth transition to market-based health care system is achieved.” (House and Kapur, 1/4)

And what about job-based coverage?

The Connecticut Mirror: What ‘Repeal-Replace’ Could Mean For Your Employer Health Plan
If you’re like most Connecticut residents and get your health insurance through an employer, chances are the future of Obamacare doesn’t have nearly as much bearing on your coverage as it does for the nearly 300,000 people in the state whose coverage can be directly tied to the Affordable Care Act. But that doesn’t mean there’s nothing at stake for you. (Levin Becker, 1/5)

Tweets, Tough Talk And A Trump Fact Check By Bernie Sanders

There's no lack of drama as President-elect Donald Trump takes to Twitter and Democratic leaders issue verbal barbs.

Roll Call: Trump Calls Schumer 'Head Clown' Over Obamacare Stance
President-elect Donald Trump on Thursday harshly accused Democrats of refusing to talk with Republicans about an Obamacare replacement plan, using a series of tweets to brand Senate Minority Leader Charles E. Schumer as his party’s “head clown.” The latest Trump broadside on one of his foes came via the same platform many others have: Twitter. In a series of posts on the social media site around 7 a.m. ET, the president-elect again exhibited behavior that breaks with just about every one of his predecessors in recent memory. (Bennett, 1/5)

Morning Consult: Democrats Dare GOP To Repeal Obamacare Sans Replacement
Senate Minority Leader Chuck Schumer (D-N.Y.) said it is Republicans’ obligation to have a replacement at the ready when they move to repeal the law. He called the Republican plan a “full-scale assault on the three pillars that support the American health care system.” “We’re gonna say, let’s see the Republican plan,” Schumer said. “We want to cover these 20 million — we did already.” “To repeal and delay is an act of cowardice — it means they don’t know what they’re doing,” House Minority Leader Nancy Pelosi (D-Calif.) added. (Reid, 1/4)

The Hill: Sanders Calls Out Trump: He's A Liar If He Cuts Medicare, Social Security 
Sen. Bernie Sanders (I-Vt.) Wednesday called on President-elect Donald Trump to announce he would veto any legislation to cut Medicaid, Medicare and Social Security, or admit that he "lied" to the American people. "Let me quote somebody who I suspect I will not often be quoting," Sanders said while speaking on planned GOP changes to ObamaCare alongside other lawmakers. "On May 7, 2015, Donald Trump tweeted, ‘I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid.’ Now the point is Trump didn’t just say this in passing; this was a cornerstone of his campaign. He said it over and over and over again.” (Seipel, 1/4)

Pence Rallies GOP Lawmakers Toward Repeal; But Disagreements Over Strategy Still Emerge

Republicans are moving toward their long-desired repeal of President Barack Obama's signature health law. Vice President-elect Mike Pence holds meetings on Capitol Hill as the rank and file begin to focus on some of the realities of taking apart the law that has touched the nation's $3 trillion health sector and covers millions of Americans.

Politico: GOP Airs Obamacare Divisions In Pence Meeting
Republicans are fast-tracking the process of repealing Obamacare, aiming to get it done in several weeks. But they’re not even close to agreement about what comes next — or even when the repeal should take effect. Those disagreements spilled over Wednesday at a closed-door meeting with Vice President-elect Mike Pence that had been intended to unify the Senate GOP. Instead, multiple senators stood up to express concern that the party’s plans to repeal and replace the law could blow massive holes in the budget, according to a source familiar with the exchange. (Haberkorn and Everett, 1/4)

The Washington Post: GOP Launches Long-Promised Repeal Of Obamacare With No Full Plan To Replace It
Congressional Republicans on Wednesday launched their long-promised effort to dismantle the Affordable Care Act, even as they acknowledged that they may need several months to develop a replacement along conservative lines. Signifying how enormous a priority the issue is for the incoming administration, Vice President-elect Mike Pence met privately to discuss it with House and Senate Republicans. He offered no details afterward about what a new health-care law might look like but vowed to unwind the existing one through a mixture of executive actions and legislation. (Eilperin, Goldstein and Snell, 1/4)

Roll Call: House GOP Hails Pence As Obamacare Slayer
House Republicans on Wednesday cast Vice President-elect Mike Pence as a conservative white knight uniquely qualified to dismantle the 2010 health care law, while shrugging off his decision to embrace the law’s Medicaid expansion while governor of Indiana. (Bennett, 1/4)

The vice president-elect's schedule also included a meeting with one Senate Democrat --

The Hill: Manchin Touts 'Productive' Meeting With Pence 
Sen. Joe Manchin met privately with Vice President-elect Mike Pence on Wednesday .... Manchin's meeting with Pence comes after he skipped a closed-door session with Obama earlier on Wednesday, arguing he wouldn't attend a meeting about ObamaCare with only Democrats. "If anyone listened and paid attention to what the American people said when they voted, they want this place to work," he told MSNBC's "Morning Joe" on Wednesday morning. "We have the incoming vice president coming up to talk only to Republicans. ...That's not what makes this place work and that's really what's wrong with the place. I just think it's absolutely wrong." (Carney, 1/4)

What Will The Replacement Look Like?

News outlets analyze the various approaches congressional Republicans could take as they sharpen their focus on developing an Obamacare alternative.

Los Angeles Times: Republicans Offer No Plan To Repeal Obamacare As More Party Members Express Concern
After demanding for six years that the Affordable Care Act be gutted, Republican leaders refused Wednesday to outline concrete steps to repeal and replace it, even as members of their party voiced growing reservations about rolling the law back without a viable alternative. Neither President-elect Donald Trump nor Vice President-elect Mike Pence, who met with House and Senate Republicans at the Capitol, offered lawmakers details about their repeal plan — a centerpiece of their winning campaign — short of vague promises that Trump would take executive action after he assumes office in just over two weeks. (Levey and Mascaro, 1/4)

The New York Times: Republicans’ 4-Step Plan To Repeal The Affordable Care Act
How they can uproot a law deeply embedded in the nation’s health care system without hurting some of the 20 million people who have gained coverage through it is not clear. Nor is it yet evident that millions of Americans with pre-existing medical conditions will be fully protected against disruptions in their health coverage. But a determined Republican president and Congress can gut the Affordable Care Act, and do it quickly: a step-by-step health care revolution in reverse that would undo many of the changes made since the law was signed by President Obama in March 2010. (Pear, 1/4)

The Wall Street Journal: How Republicans Might Replace Obamacare
Republicans are preparing to follow through on their vow to repeal the Affordable Care Act, or Obamacare. But it is far from clear what will replace it. Various Republicans have put forward a grab bag of policy ideas about what could take the place of President Barack Obama’s health law, but have yet to reach a consensus. It remains uncertain what happens to current health plans that people bought through the law’s insurance exchanges. (Armour, 1/4)

The Associated Press: Health Overhaul Revisited: The Impact Of Some GOP Ideas
Dozens of GOP-inspired ideas are being bandied about on Capitol Hill, and it could take months or years to fully understand the costs and benefits of complex changes lawmakers are considering. A GOP replacement may cover fewer people than the 2010 Affordable Care Act, or ACA. But Republicans are betting that their goal of "universal access" with fewer requirements will be more politically acceptable than the Democratic ideal of "universal coverage," with Washington in charge. A look at the potential impact of some of the ideas put forth by Republicans. (Alonso-Zaldivar, 1/4)

Obamacare Repeal Has Hefty Price Tag -- $350 Billion Over Ten Years, Study Finds

The analysis by the Committee for a Responsible Federal Budget estimated the repeal would lead to savings of $1.55 trillion resulting from reduced spending on providing coverage, but that would be negated by cancelling $800 billion in tax increases and $1.1 trillion in Medicare and other cuts.

The Hill: Study: ObamaCare Repeal Would Cost $350 Billion
Repealing ObamaCare would increase the budget deficit by $350 billion over 10 years, according to a new study. The analysis from the Committee for a Responsible Federal Budget (CRFB) finds that repealing the law’s spending on providing coverage would save $1.55 trillion, but that would be canceled out by repealing $800 billion in tax increases and $1.1 trillion in Medicare and other cuts. The CRFB warned that Republicans should be trying to reduce the debt, not increase it, and that they also will need savings in order to pay for a replacement for the Affordable Care Act (ACA). (Sullivan, 1/4)

The Fiscal Times: Obamacare Repeal Is A Fiscal Minefield For The GOP
Congressional Republicans have begun the process of repealing the Affordable Care Act, which will not only force them to come up with a plan to replace the program, but as an analysis released by the Committee for a Responsible Federal Budget demonstrates, to fill a hole in the federal budget of as much as $350 billion through 2027. (Garver, 1/4)

Meanwhile, the budget resolution advanced by Senate Republicans to advance the repeal effort claims its first victory while the new interim chair of the House Budget Committee outlines a way to offset some of the associated costs -

CQ Rollcall: Republicans Win First Budget Vote On Path To Obamacare Repeal
Senators took the first crack at ripping apart President Barack Obama's signature health care law Wednesday, mustering the votes to proceed to a budget resolution that sets the gears in motion for repeal. It was a significant victory for Republicans, who have voted more than 60 times in the House to dismantle all or part of the law but until now have lacked the power to accomplish their goal. Though the Senate merely took a procedural vote to advance a stripped-down fiscal 2017 budget resolution (S Con Res 3), the 51-48 vote to advance the measure was an major step forward on a spending blueprint needed to unlock a Democrat-proof path for killing the law (PL 111-148, PL 111-152). If passed by both chambers, it would greenlight separate repeal legislation for President-elect Donald Trump to sign when he assumes office. (Mejdrich and Shutt, 1/4)

CQ Rollcall: Black: Budget Reserve Funds Would Finance New Health Care Law
Diane Black, the new interim chairwoman of the House Budget Committee, said Wednesday that she likes the concept of two reserve funds in the pared-down fiscal 2017 budget resolution that would allow savings from repeal of the health care law to be used to offset the cost of replacement legislation. “That will give us an opportunity when we come up with a reform to use those dollars for the reform,” the Tennessee Republican told CQ. Black added that “potentially there may be also some money that’s there for deficit reduction as well.” (Krawzak, 1/4)

Rand Paul Defects On Senate Budget Resolution To Repeal -- And It's All About The Debt

The Kentucky senator made clear his opposition to this budget measure. He's known for making such "protest votes." In this case, his reason is that the resolution would add too much to the federal budget deficit for fiscal year 2017.

The Wall Street Journal: Rand Paul Defects On Proposed Health Law Repeal
Sen. Rand Paul (R., Ky.) said Wednesday that he would oppose the budget measure Republicans are counting on to begin the process of repealing the Affordable Care Act, leaving the effort in danger of derailing if any other GOP senators defect. ... Mr. Paul said Wednesday he would vote against the budget measure because it adds too much to the federal budget deficit for fiscal year 2017. (Peterson and Hughes, 1/4)

USA Today: Sen. Rand Paul Using Obamacare Repeal To Protest Debt
Sen. Rand Paul voted Wednesday against the first step in repealing the Affordable Care Act because the underlying budget proposal increases the federal debt over 10 years. Paul, a Kentucky Republican with a history of casting protest votes, was the only GOP senator opposed. After the 51-48 vote in the Senate, the budget resolution, which includes the mechanisms to start repealing the 2010 health care law in addition to general spending levels for the federal government over the next decade, will be debated for the next week. (Troyan, 1/4)

Roll Call: Paul, Freedom Caucus To Meet On Fiscal 2017 Budget Resolution
The House Freedom Caucus will meet with Sen. Rand Paul Thursday morning at the Kentucky Republican’s request to discuss his concerns about the fiscal 2017 budget resolution Republicans are using to set up an expedited process for repealing the 2010 health care law. “We are meeting with Senator Rand Paul tomorrow to discuss his ideas on replacing the Affordable care Act and the timing of repeal and replacement,” Freedom Caucus Chairman Mark Meadows, R-N.C., told Roll Call. “As a health care provider and as a senator he brings a unique perspective.” Paul was the lone Republican senator to vote against the motion to proceed to the budget resolution, arguing that the measure increases the national debt. (McPherson and Bowman, 1/4)

GOP House Panel Urges A Stop In Federal Funds For Planned Parenthood

The GOP majority of the Select Investigative Panel, which was formed in 2015 after the release by antiabortion activists of undercover videos that they said documented abuses by abortion providers that provide fetal tissue to researchers, suggested in its 471-page report that these business arrangements could create incentives to perform more abortions.

The Washington Post: House Panel Recommends Cutting Funding For Planned Parenthood, Reigniting Old Debate
A House panel formed by Republicans to investigate the procurement of human fetal tissue for medical research has recommended stripping federal funds from Planned Parenthood, heralding a new congressional assault on the nation’s largest provider of abortions and women’s health care. The GOP majority on the Select Investigative Panel included the recommendation in the 471-page final report, which was issued Tuesday on the dissolution of the panel. It was formed in 2015 after antiabortion activists recorded a series of undercover videos that they said documented abuses by abortion providers and intermediaries that provide fetal tissue to researchers. (DeBonis, 1/4)

The Associated Press: GOP House Panel: Halt Federal Money For Planned Parenthood 
A Republican-run House panel created to investigate Planned Parenthood and the world of fetal tissue research urged Congress on Wednesday to halt federal payments to the women’s health organization. Democrats said the GOP probe had unearthed no wrongdoing and wasted taxpayers’ money in an abusive investigation reminiscent of the late Sen. Joseph McCarthy. (1/4)

Health Law

Sign-Ups For Marketplace Plans Outpace Last Year With 8.8 Million People Enrolled So Far

As Republicans begin their effort to repeal the federal health law, Obama administration officials announce that the number of people getting individual coverage in 2017 is higher than at this time in 2016. Also, news outlets look at enrollment issues in Tennessee, South Carolina and Arizona.

Bloomberg: Obamacare Sign-Ups Reach 8.8 Million As Repeal Efforts Start 
Obamacare sign-ups for 2017 coverage rose about 2.3 percent from the same time last year, as efforts to repeal President Barack Obama’s health care reform begin in Congress. About 8.8 million people enrolled in individual insurance plans through the HealthCare.gov website as of Dec. 31, compared with 8.6 million last year, the Centers for Medicare and Medicaid Services said in an e-mailed statement. The figures are the first to include automatic re-enrollments, providing the most complete picture to date of participation. Sign-ups for Obamacare plans are a key measure of the program’s success, as Republicans in Congress have begun efforts to repeal at least parts of the 2010 health law. (Tracer, 1/4)

Nashville Tennessean: Tennessee's Obamacare Activity Remains Constant Amid Repeal Rhetoric
More than 230,000 Tennesseans are enrolled in a health insurance plan on the federally run exchange just as the new Republican-led Congress clamors to repeal the Affordable Care Act. Across the state, 234,222 people selected a plan or were re-enrolled as of Dec. 31, according to data from the U.S. Department of Health and Human Services. That's in line with the number of enrollees at the same time last year. There also are people shopping for individual plans that don't qualify for tax credits or alternative plans and risk paying a tax penalty. (Fletcher, 1/4)

Kaiser Health News: In Towns That Lost Most Obamacare Insurers, Rate Increases Still Competitive
People in [Columbia, S.C.] had their pick of four health insurers last year when they shopped for policies during the Affordable Care Act’s open enrollment. This time they have just one: Blue Cross Blue Shield of South Carolina, which had the most Obamacare consumers in Richland County in 2016 due to its low prices. It’s a change that’s been repeated around the country after big health insurers such as Aetna, Humana and United Healthcare pulled out of dozens of Obamacare marketplaces that they judged unprofitable. (Galewitz, 1/5)

The Arizona Republic: Arizona 'Obamacare' Supporters Defend Health Law
As Republicans in Congress move to repeal the Affordable Care Act, supporters of the law mounted a campaign to salvage the federal law that has extended health-insurance coverage to more than 20 million Americans. Arizona Democrats and "Obamacare" allies held a rally at the state Capitol on Wednesday, defending the health-care law passed in 2010. (Alltucker, 1/4)

And in news about Colorado's marketplace --

Denver Post: Colorado’s Obamacare Exchange Misspent $9.7 Million In Federal Grants, Audit Alleges 
Federal auditors are recommending that Colorado be forced to repay nearly $9.7 million from grants used to set up Connect for Health Colorado, the state’s Obamacare exchange, after concluding that the money was misspent or not properly accounted for. The audit, released last week by the U.S. Department of Health and Human Services’s Office of Inspector General, found that Connect for Health Colorado didn’t sufficiently document how it spent roughly $4.4 million on contractors and consultants. The audit also accused the exchange of allocating $4.5 million from the grants to prepay for contracts that would run past the end of 2014, the time by which all grant money was supposed to be spent. (Ingold, 1/4)

New N.C. Governor Seeks To Expand Medicaid Without Legislative Approval

The state legislature passed a law in 2013 prohibiting this sort of executive action, but Gov. Roy Cooper says it "infringes" on a governor's right to negotiate Medicaid issues with the federal government. Also in Medicaid news from other states, a study identifies expansion benefits in Michigan, New York's governor releases data about the effects there and Arkansas's governor asks the incoming Trump administration to soften the expansion rules.

Raleigh News & Observer: Gov. Roy Cooper Wants To Expand Medicaid; Republicans Vow To Fight
Gov. Roy Cooper plans to take immediate executive action aimed at expanding Medicaid, defying a state law and setting up a confrontation with the Republican-dominated state legislature. Addressing a group of business leaders at an economic forum Wednesday morning, the governor – who was sworn into office on New Year’s Day – said he would file an amendment to the state Medicaid plan by Friday. The new plan would allow hundreds of thousands more people to sign up for government health insurance. (Ranii and Bonner, 1/4)

WRAL (Raleigh, N.C.): Cooper Seeks Business Help To Repeal HB2, Expand Medicaid
Gov. Roy Cooper urged North Carolina business leaders Wednesday to support his efforts to repeal a state law limiting LGBT rights, expand Medicaid and boost school funding. Speaking at the annual economic forecast event sponsored by the North Carolina Chamber and the North Carolina Bankers Association, Cooper told attendees that he would be "an aggressive recruiter" as governor to bring jobs to the state and would work on programs to help small business. But he asked them to get behind him in three proposals that he said would help North Carolina's economy. (Burns, Leslie and Binker, 1/4)

Winston-Salem (N.C.) Journal: Cooper To Pursue Medicaid Expansion By Nearly 500,000 People Despite Stiff GOP Opposition
Medicaid expansion was a hot-button issue throughout Pat McCrory’s term as governor. Currently, Medicaid covers about 1.9 million North Carolinians, and is a $14 billion a year program. ... Cooper said he believes the law prohibiting the expansion of Medicaid in the state, approved in 2013, infringes on “core executive functions” of the governor’s role for negotiating the waiver request with the Centers for Medicaid and Medicare Services. McCrory said he was pursuing federal waiver exceptions for what he called “a North Carolina plan, and not a Washington plan” that could have featured expansion. (Craver, 1/4)

The Associated Press: NC Governor Pledges To Expand Medicaid, Despite State Law
As many as 650,000 working people who can't get private insurance or otherwise make too much to get Medicaid could benefit, generating jobs, helping rural hospitals and boosting the economy, Cooper said. Under the proposal, the state would have to match 5 percent of the cost, which the governor said could come from an assessment on hospitals that stand to benefit. (Robertson, 1/4)

Detroit News: Study: Medicaid Expansion Gives $2.3B Boost To Michigan
Michigan’s expanded Medicaid program has boosted state tax revenues and personal income in the state, and can be expected to pay for itself for the next five years and beyond, according to University of Michigan study released late Wednesday. The Healthy Michigan Plan, which provides Medicaid coverage to more than 600,000 Michiganians, added nearly $554 million to the state budget in 2016, due to increased tax revenues and decreased state health care spending, according to the analysis published late Wednesday in the New England Journal of Medicine. (Bouffard, 1/4)

Detroit Free Press: U-M Study Shows Benefits Of Michigan Expanding Medicaid
Even though the state’s bills for the expansion of Medicaid to more than 640,000 low-income Michiganders is growing from $152 million this year to $399 million in 2021, the economic benefit of providing the health care will more than make up for the cost to the state, according to a study released Wednesday by the University of Michigan. The study, commissioned by the New York-based Commonwealth Fund and published in the New England Journal of Medicine on Wednesday, reports that cost savings to the state include $235 million the state isn’t spending for health care services, such as for prisoners in the state’s correctional facilities and mental health care for poor residents. The federal government, through the Affordable Care Act, is picking up those costs. (Gray, 1/4)

Reuters: Obamacare Repeal Would Cost New York State At Least $3.7 Billion: Governor
The repeal of the Affordable Care Act, the goal of Republicans in Washington, would cost New York state $3.7 billion and strip 2.7 million residents of health coverage, Governor Andrew Cuomo said on Wednesday. Cuomo, a Democrat, also said counties in the state could lose nearly $600 million of federal Medicaid funding combined if the law, otherwise known as Obamacare, is repealed. New York City would lose the most, more than $433 million. (Russ, 1/4)

Administration News

Trump's Plans For Possible VA Privatization Expected To Be Reflected In Pick For Top Job

In other transition news, Joe Biden reveals his post-vice presidential plans, which include continued cancer and prescription drug costs work.

Medicare

Costly Specialty Medications Help Triple Medicare Spending For Patients With High Drug Costs

Federal spending for Medicare Part D catastrophic coverage — which pays 80 percent of all drug costs once a Medicare beneficiary hits a spending threshold each month — spiked to $33 billion in 2015, a government report shows.

The Wall Street Journal: U.S. Spending More On Specialty Drugs Under Medicare
Federal spending on a Medicare program for people with high drug costs has ballooned over the past five years, largely due to the soaring costs of expensive specialty medications, a new government report has found. Federal payments for Medicare Part D catastrophic coverage, which pays 80% of drug costs after a beneficiary has spent a certain amount annually, surpassed $33 billion in 2015, more than triple the amount paid in 2010. (Hackman, 1/5)

In other Medicare news —

Boston Globe: Seniors Face Big Hikes For Blue Cross Medicare
Thousands of seniors enrolled in Medicare plans through the state’s largest health insurer will see their monthly premiums jump by as much as one-third this year. The increases for Medicare Advantage customers of Blue Cross Blue Shield of Massachusetts range from $10 a month to about $60 a month, depending on the plan. Blue Cross said it had to raise premiums to make up for a decline in federal reimbursements and to contend with the higher costs of medical care and prescription drugs. (Dayal McCluskey, 1/4)

Bay Area News Group: Diagnosing Alzheimer’s: Medicare Now Pays Doctors To Stop And Assess Memory Loss
After years of pressure from patient advocate groups, starting this month, Medicare will reimburse doctors for the time it takes to test patients with cognitive impairment such as Alzheimer’s disease or dementia, at any stage, and offer information about care planning. While that may seem odd to many who might assume that doctors — mostly primary care physicians — would already be doing this, that’s not always the case. (Seipel, 1/4)

Marketplace

Drugmakers Face Fines For Overcharging Hospitals For Medicine Purchased Under Federal Discount Program

In other marketplace news, closing arguments in the Anthem-Cigna merger antitrust trial are delivered, new filing alleges that Alexion managers encouraged improper sales practices by employees and Abbott Labs acquires medical device company St. Jude Medical.

Modern Healthcare: Drug Companies Will Be Fined For Overcharging 340B Hospitals
The Obama administration has finalized a rule that imposes fines on drug companies that overcharge hospitals and clinics for medication purchased under the government's 340B drug discount program. Drug companies must reimburse providers that overpaid for products and they are subject to fines of up to $5,000 per instance if they overcharged "knowingly and intentionally." The penalties were outlined in a final rule released Wednesday by HHS' Health Resources and Services Administration. The rule also establishes a system for calculating “ceiling prices” for covered outpatient drugs—which some industry stakeholders say the agency lacks the authority to do. (Dickson, 1/4)

Politico Pro: Trial Contesting Anthem's $54 Billion Acquisition Of Cigna Wraps
The fate of Anthem’s $54 billion acquisition of Cigna, which would create the largest health insurance company in the country, is now in the hands of a federal judge. Lawyers for the Justice Department and Anthem made their closing arguments in the antitrust trial on Wednesday morning, during which they were peppered with persistent questioning from U.S. District Court Judge Amy Berman Jackson. (Demko, 1/4)

The Wall Street Journal: Alexion Says Senior Management Improperly Pressured Staff To Boost Sales
The finding, reported in a securities filing, followed an investigation by members of Alexion’s board of directors into allegations of improper sales practices made by a former employee that had delayed the submission of its most-recent financial report. Alexion, based in New Haven, Conn., is a leading seller of drugs for rare diseases and had $2.6 billion in 2015 total product revenues. Soliris, the drug at the center of the investigation, treats a rare blood disorder known as paroxysmal nocturnal hemoglobinuria. (Rockoff, 1/4)

In other pharmaceutical news —

The New York Times: A Fitness Downside To Statin Drugs?
Taking cholesterol-lowering statin drugs seemed to make exercise more difficult and less beneficial, a new study in mice suggests. Mice are not humans, obviously, but the study does raise interesting questions about whether and how statins might affect physical fitness in all of us. In the experiment, statins were very effective in lowering cholesterol levels. But animals moved less if they were taking statins than if they were not taking the drugs. And when they did move, mice on statins developed fewer advantageous physical changes within their muscles than animals that were not given the drugs. (Reynolds, 1/4)

Public Health And Education

Flu Season Ramps Up As More Cases Reported In Several States

Meanwhile, a USA Today investigation finds a series of safety-related incidents at the Centers for Disease Control and Prevention that the agency has tried to keep secret. And the search for a malaria vaccine turns to human volunteers.

St. Louis Post Dispatch: Flu Has Come To Town, Not Too Late To Get Vaccine
The latest statewide and national data shows minimal flu activity across Missouri up until Dec. 24 – before the peak of holiday togetherness and travel – but a jump in the number of patients showing up with symptoms at St. Louis-area emergency departments over the past week. “We have really just started in the last couple of weeks seeing flu cases,” said Dr. Kimberly Quayle, medical director of the emergency department at St. Louis Children’s Hospital. “We would expect the number of cases to keep going up significantly.” (Munz, 1/4)

The Philadelphia Inquirer: Lots Of Us Are Sick, And It's Probably Going To Get Worse. Here's Why.
Public health officials say we are definitely in the early weeks of this year's flu season. Tina Tan, state epidemiologist for the New Jersey Department of Health, said flu activity in the state was "moderate" by Dec. 24, the most recent  period  included in the state's flu report.  She described the season so far as "pretty typical," but said many other viruses were also circulating.  The report shows more flu cases in the middle of the state.  Pennsylvania's Department of Health reported "widespread" flu in the last week. The number of confirmed flu cases rose sharply in the last three weeks of 2016.  But many people with the flu do not go to a doctor, and many who do go are not tested for the virus. (Burling, 1/5)

USA Today: CDC Keeps Secret Its Mishaps With Deadly Germs
The Centers for Disease Control and Prevention, which has faced congressional hearings and secret government sanctions over its sloppy lab safety practices, is keeping secret large swaths of information about dozens of recent incidents involving some of the world’s most dangerous bacteria and viruses. CDC scientists apparently lost a box of deadly and highly-regulated influenza specimens and experienced multiple potential exposures involving viruses and bacteria, according to heavily-redacted laboratory incident reports obtained by USA TODAY. (Young, 1/4)

The Associated Press: Volunteers Get Bit To Test New Strategy For Malaria Vaccine
Researchers infected lab mosquitoes with genetically weakened malaria parasites, and then recruited volunteers willing to be bitten — a lot — to test a possible new strategy for a vaccine. The idea: Vaccinate using living malaria parasites that are too weak to make people sick. It’s a huge challenge, and while Wednesday’s study is a small step, it illustrates the urgent quest for a powerful malaria vaccine. (Neergaard, 1/4)

State Watch

Only Four States Report Drop In Opioid-Related Hospitalizations

Nationally, the rate rose 24 percent between 2009 and 2014. Other stories on how state and local officials are coping with the opioid crisis are reported from Minnesota, Tennessee, Missouri, Maryland and Ohio.

New Orleans Times-Picayune: Opioid-Related Hospitalizations Have Dropped In Louisiana
Louisiana was one of only four states to show a decline in the rate of opioid-related hospital stays between 2009-2014, new federal data shows. During that same time period, opioid-related hospitalizations nationwide increased by a rate of nearly 24 percent. The report, published by the Agency for Healthcare Research and Quality, a division of the U.S. Department of Health and Human Services, said Louisiana showed a 6.4 percent decline in hospitalizations due to the misuse of prescription pain relievers and the use of illicit opioids like heroin and fentanyl. (Lipinski, 1/4)

St. Louis Public Radio: St. Louis County To Begin Testing Database To Prevent Opioid Abuse
After years of opposition in the Missouri legislature to a statewide program to monitor prescription drugs, St. Louis County is preparing to test its own. By using a new database, pharmacists in the county will help flag consumers who may be “doctor shopping” for highly addictive opioid-based painkillers. Missouri is the only state in the country without such a system. (Bouscaren, 1/4)

The Baltimore Sun: Harford Ends 2016 With 54 Fatal Heroin Overdoses, First Of 2017 Was 45 Minutes Into New Year
Just 45 minutes into 2017, Harford County recorded its first fatal heroin overdose – a 36-year-old white woman who died in Edgewood, police said Tuesday. Her death follows a deadly year in Harford County, when at least 54 people died of heroin overdoses, up from 28 in 2015, according to the Harford County Sheriff's Office. That's a nearly 97 percent increase in the number of fatalities in one year. The number of fatalities could increase pending results of toxicology reports in some cases still with the medical examiner's office. (Butler, 1/4)

Kaiser Health News: A Peer Recovery Coach Walks The Frontlines Of The Opioid Epidemic
Charlie Oen’s battle with addiction started when he was 16 and his family moved to Lima, Ohio. It was the last stop in a string of moves his military family made — from Panama to North Carolina, Kentucky, Texas and Germany. “I went toward a bad group because those were the people that accepted me,” he says. Drugs became a substitute for real friendships. ... One year later, he started working as a peer recovery coach, using his own experiences to help other people stay in recovery. (Herald and Sable-Smtih, 1/5)

Texas Fetal Remains Rule On Hold Again As Judge Casts Doubt On Aspect Of Law

Needing more time to rule on a lawsuit challenging Texas' requirement that medical providers bury or cremate fetal remains, U.S. District Court Judge Sam Sparks delays its start for another three weeks. The law was scheduled to take effect Dec. 19.

State Highlights: Colorado's Use Of Jails For Mental Health Holds Challenged; Audit Finds Shortcomings In N.J. Medicaid Billing Practices

Outlets report on health news from Colorado, Pennsylvania, New Jersey, Illinois, Maryland and Massachusetts.

Denver Post: Colorado Must Stop Using Jails For People In Mental Health Crisis, Panel Says 
Colorado should stop using jails to house people placed on involuntary mental health holds who haven’t been charged with a crime, says a task force created by Gov. John Hickenlooper. The state is one of only six that still put people having a mental health episode behind bars. The 30-member panel, ordered by Hickenlooper after he vetoed a bill in June that would have strengthened Colorado’s 72-hour mental health hold law, acknowledged rural communities without hospitals or mental health centers would have the toughest time adapting to new rules. Still, the practice should end now or, at the latest, by next January, the group said. (Brown, 1/4)

NJ Spotlight: Federal Audit Finds Problems With NJ’s Medicaid Billing System, Wants $95M Refund 
A federal audit claims New Jersey officials have not done enough to monitor the billing practices of community-based organizations that treat outpatients with serious mental illness. It’s calling for the the state to refund nearly $95 million for federally funded Medicaid services it says were not properly documented. The U.S. Department of Health and Human Services’ Office of Inspector General said the review was prompted in part by earlier findings, published in 2012, that suggested the state needed to beef up oversight of its Medicaid claims process and clarify the guidance it gives providers. The latest report, announced in late December, included an analysis of 100 claims randomly selected from the nearly 3.9 million bills submitted from 2009 through 2011. (Stainton, 1/4)

The Wall Street Journal: Pennsylvania Is Ordered To Provide Hepatitis C Drug To Inmate
A federal judge ordered Pennsylvania’s corrections department to provide costly new antiviral drugs to an inmate infected with hepatitis C, and rebuked the state for restricting inmates’ access to the drugs. Hepatitis C is an epidemic in prisons, but state corrections departments have treated relatively few prisoners because the drugs are expensive, costing about $54,000 to $94,500 per patient. (Loftus, 1/4)

Chicago Sun Times: Rahm Says He 'Wasn't Bragging' About Cutting Retiree Health Care 
Mayor Rahm Emanuel said Wednesday he “wasn’t bragging” as much as he was “acknowledging how we stabilized” skyrocketing health care costs in a 2015 email exchange that has infuriated retired city employees stripped of their 55 percent health care subsidy.“ You can call what I did heartless. We worked it through over a three-year period. We avoided raising taxes. And we avoided cutting basic neighborhood services. And we still met the objective of providing and giving people health care,” the mayor said. (Spielman, 1/4)

The Baltimore Sun: New Program Trains Health Care Interpreters At Howard Community College 
As the number of people whose primary language is not English continues to rise — 23 percent of county residents speak a language other than English at home — the need grows for people who can help doctors and patients understand one another. The task often falls to the children of immigrants, says Nikki Highsmith Vernick, president and chief executive of the Horizon Foundation. Sometimes, however, those children are too young to translate medical discussions, and patients often are asked for sensitive personal information that they might not be inclined to share with their children, no matter how old those children are. Horizon, a Howard County philanthropic organization that offers seed money for health-related initiatives, awarded a grant of $166,691 to the college to launch the health care interpreter program. (Miller, 1/4)

The Philadelphia Inquirer/Philly.com: North Philadelphia Health System Enters Bankruptcy
North Philadelphia Health System, which stopped paying numerous vendors in 2015 and then closed St. Joseph's Hospital last March after state officials halted a long-running subsidy, filed for bankruptcy protection late last week in Philadelphia...The tax-exempt organization said it owed $24.8 million to its 30 largest unsecured creditors. Independence Blue Cross topped the list, with $10.87 million owed for employee benefits. (Brubaker, 1/4)

Weekend Reading

Longer Looks: Obamacare's Legacy, Concussion-Proof Football And Changing How We Die

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

FiveThirtyEight: As Obamacare Faces Repeal, Its Legacy Is Still Up In The Air 
When President Obama took office in 2009, the U.S. was in trouble — 50.7 million people were uninsured, the largest number in history. Mortality rates were on the rise, even as health care spending grew faster than the nation’s economy. Obama was always going to address the situation through some type of health care reform, Jason Furman, chairman of the president’s Council of Economic Advisers, said recently. As the number of days left in Obama’s presidency approaches single digits, it’s clear that part of his legacy will be that his administration implemented the biggest health care overhaul since the creation of Medicaid and Medicare. What’s less clear is how those changes will be viewed years from now — and part of that depends on what happens next. (Anna Maria Barry-Jester, 1/3)

The New Yorker: Can Technology Make Football Safer? 
St. Thomas wanted to make the assessment of student concussions more objective, and this summer it agreed to participate in a research project with the University of Miami. Michael Hoffer, a professor of otolaryngology and neurological surgery, had developed goggles, equipped with two high-resolution cameras, that could detect the desynchronization of the wearer’s rapid eye movements—a mark of a concussion. Hoffer was funded, in part, by the N.F.L., but the goggles would be useful to all types of athletes. According to a 2016 study published in Pediatrics, the number of school-aged soccer players seeking E.R. treatment for concussions has risen sixteen hundred per cent in the past twenty-five years. (Nicholas Schmidle, 1/1)

The New York Times: Kitty Dukakis, A Beneficiary Of Electroshock Therapy, Emerges As Its Evangelist
[Kitty] Dukakis was desperate. Rehabilitation, talk therapy and antidepressants had failed to ease her crippling depression, so in 2001, at age 64, she turned to shock therapy. To her amazement, it helped. After the first treatment, Mrs. Dukakis wrote, “I felt alive,” as if a cloud had lifted .... Now, 15 years later, [she and her husband, former presidential candidate Michael Dukakis,] have emerged as the nation’s most prominent evangelists for electroconvulsive therapy. Truth be told, there is not much competition. Few boldface names who have had the treatment will acknowledge as much; the stigma is still too great. (Katharine Q. Seelye, 12/31)

The Atlantic: How Trump Could Slow Medical Progress
The president-elect is not known for being particularly religious, but he’s surrounding himself with traditional conservatives, including staunch pro-life policymakers like Representative Tom Price of Georgia and Vice-President-elect Mike Pence. At this point, watchers of the field can only speculate as to the Trump administration’s stance on embryonic stem cells. (His team did not return a request for comment). But some fear the new regime may halt stem-cell and fetal-tissue research, which many abortion opponents consider to be life and many scientists regard as the ingredients of breakthroughs. (Olga Khazan, 12/28)

The Washington Post: Suburbs Increasingly View Their Auto-Centric Sprawl As A Health Hazard
A more health-oriented approach to urban planning is taking on new urgency across the United States as rates of child and adult obesity have soared, along with Type 2 diabetes, heart disease and other weight-related illnesses — despite public education campaigns and doctors’ warnings. Last year, U.S. life expectancy declined for the first time since 1993, in part to rising fatalities from heart disease, stroke and diabetes, according to a federal report released earlier this month. It’s not just physical health. Preserving trees and other green space is cited as key to a community’s mental health, as recent Stanford University studies have found that spending time in nature can boost mood and working memory while reducing brain activity related to depression. (Katherine Shaver, 12/28)

NPR: Where Does Alzheimer's Treatment Go From Here?
In a disappointment to Alzheimer's patients and researchers, drugmaker Eli Lilly said in late November that a clinical trial of solanezumab, an experimental medication to treat the degenerative neurological condition, had failed. ... Solanezumab is just the latest casualty in a decades-long parade of disappointing dementia drug trials. But the frustration brought by this particular failure could signal a shift in Alzheimer's research — a shift away from targeting accumulations of so-called amyloid protein in the brain, long considered by many in the field to be the crux of Alzheimer's pathology. (Bret Stetka, 12/29)

Vox: The Senate’s Complicated Plan To Repeal Obamacare, Explained By An Expert On Congress
Senate Republicans took initial steps to repeal the Affordable Care Act Tuesday, using a process called budget reconciliation to start the process of gutting some of the health care law’s major provisions. The budget reconciliation process is complex, and not the normal way that Congress passes laws. It is a three-step process that starts with a budget resolution — essentially a list of spending targets for the coming years — and a set of instructions for how committees can hit those targets (in this case, by repealing Obamacare). (Sarah Kliff, 1/4)

Editorials And Opinions

Viewpoints: GOP Will Soon 'Own' Obamacare; Need To Act Fast; Health Law Is No 'Failure'

A selection of opinions on health care from around the country.

The Wall Street Journal: The Politics Of TrumpCare
Going by his business background Donald Trump won’t mind putting his name on a health-care plan, or anything else, but Republicans need to appreciate the reality that they will soon own ObamaCare. Until they pass a coherent and market-oriented substitute, as a political matter ObamaCare is TrumpCare, like it or not. This isn’t a great political position, given the law’s large and ongoing failures on almost every measure: premium trends, enrollment, limited doctor and hospital networks, insurer participation. Affordability, choice and competition are due for another tumble next year under the status quo. (1/4)

USA Today: GOP Needs To Act Fast On Obamacare
Republicans have campaigned against Obamacare since its passage. Democrats, struggling to defend it, have lost seats, statehouses, and now the White House. It has been a toxic issue for the left, as twice as many people say they have been hurt by the law as helped. Far too many Americans have lost their plans and their doctors, only to be faced with fewer, more expensive choices. Now Republicans control the levers of power in Washington — and they need to deliver immediate relief to the law’s victims. Unfortunately, all indications are that Congress intends to follow the template of the partial repeal bill vetoed by President Obama in 2015. (Heather R. Higgins and Phil Kerpen, 1/4)

The New York Times: Republicans Are Courting Disaster On Health Care
Republican opponents of the health care law insist that it has failed, though it has reduced the number of uninsured Americans to the lowest level in history. They say that it has driven up costs, though health care costs have risen at a much slower pace since 2010 than they did in years past. And opponents promise they will somehow make health care cheaper and more readily available, though after all these years of reviling Obamacare they have yet to offer any serious alternative. The reality is that the repeal-at-all-costs crowd is ideologically opposed to any government role in the health care system, though every other advanced economy in the world has embraced some form of government intervention as the only way to manage costs and ensure universal access. (1/5)

Los Angeles Times: Republicans Call Obamacare A 'Failure.' These 7 Charts Show They Couldn't Be More Wrong
Congressional Republicans, evidently hoping that by repeating an untruth they’ll convince American voters, and perhaps themselves, that it’s a truth, on Wednesday said the Affordable Care Act has “failed.” The undistilled version of this view came from House Speaker Paul Ryan (R-Wis.), who emerged Wednesday from a meeting with Vice President-elect Mike Pence to assert: “This law has failed. Americans are struggling. The law is failing while we speak. … Things are only getting worse under Obamacare. … The healthcare system has been ruined — dismantled — under Obamacare.” Every one of those statements is demonstrably untrue. (Michael Hiltzik, 1/4)

The New York Times: The Health Care Plan Trump Voters Really Want
This week Republicans in Congress began their effort to repeal and potentially replace the Affordable Care Act. But after listening to working-class supporters of Donald J. Trump — people who are enrolled in the very health care marketplaces created by the law — one comes away feeling that the Washington debate is sadly disconnected from the concerns of working people. Those voters have been disappointed by Obamacare, but they could be even more disappointed by Republican alternatives to replace it. They have no strong ideological views about repealing and replacing the Affordable Care Act, or future directions for health policy. What they want are pragmatic solutions to their insurance problems. The very last thing they want is higher out-of-pocket costs. (Drew Altman, 1/5)

Fox News: Trump And The GOP Target Obamacare, But Must Avoid The Land Mines
After six long years, the Republicans finally have a chance to kick off the Trump era by abolishing Obamacare. Even as the outgoing president huddled with Democrats on the Hill yesterday, the incoming president voiced criticism of the program and the incoming vice president said they had a mandate to junk it. But it’s a little more complicated than that. (Howard Kurtz, 1/5)

The Washington Post: The Cost And Calamity Of An Obamacare ‘Repeal And Delay’ Strategy
Put simply, a complete repeal with no fixed alternative is grossly irresponsible. It’s a rush to show the base, which was once again promised an easy solution (repeal Obamacare!) that Republicans can “deliver.” But what they are “delivering” is more debt, massive loss of coverage, chaos and true hardship for those who can least afford it. This is dumber politically than abolishing an independent ethics office. Republicans are perpetuating a fable — that there is a solution that is “better” than Obamacare that can pass both houses. If they think there is such a plan, let’s see it and pass it simultaneously with repeal. (Jennifer Rubin, 1/4)

Bloomberg: Rand Paul Sticks To Old Health-Care Gimmick 
Senator Rand Paul is skeptical. He thinks something's fishy about this whole "repeal and replace" thing that Republican congressional leaders have planned for Obamacare .... After Republicans were handed control of Washington in November, their longtime insistence on "repeal and replace" began morphing into "repeal and delay." Politically, Republicans find this easy to justify. ... they have never actually had a replacement policy, do not now have a replacement policy, and, given ideological and cost constraints, are highly unlikely ever to have a replacement policy. (Francis Wilkinson, 1/4)

Huffington Post: Doctor’s Orders: Don’t Repeal Obamacare Until You Have A Plan To Replace It
The largest and most influential organization of American physicians has sent two stark messages to the Republican Party: Don’t mess with Obamacare until you know what you’re putting in its place. And don’t do anything that would backtrack on the law’s most important accomplishment ― bringing the number of uninsured Americans to a historic low. The American Medical Association delivered these messages on Tuesday, in an open letter addressed to congressional leaders of both parties. (Jonathan Cohn, 1/4)

The Washington Post: How Democrats Can Defeat The Repeal Of Obamacare
It was no small feat for Republicans to suffer an embarrassing public defeat on the very first day of the new Congress, but they managed to do it by first voting to gut the Office of Congressional Ethics, then reversing themselves within hours after a public outcry and a spate of bad press. This is likely to be a Democratic talking point for a long time to come (“The first thing Republicans did was try to destroy the ethics office!”). But more than a mere embarrassment, it points the way for Democrats to win the most important battle of the opening year of the Trump administration: the one over repeal of the Affordable Care Act. (Paul Waldman, 1/4)

The Washington Post: What Does Donald Trump Really Think About Health Care?
[Kellyanne] Conway seemed to commit Trump to supporting only a replacement plan that covers just as many people as the Affordable Care Act currently does. This puts Trump at odds with many Republicans, who are opposed to the taxes, spending, and regulations that are necessary to make Obamacare’s large coverage expansion possible. Which prompts a good question from Ezra Klein: When you get past all of Trump’s bluster and noise about what a disaster Obamacare is, what does he actually think about health care reform? (Greg Sargent, 1/4)

The Washington Post: Fox News Host Propagates Obamacare Congressional Exemption Myth
Seeking to start a panel discussion on the matter, [Jon] Scott turned to commentator Simon Rosenberg, “As I was listening to Nancy Pelosi talk about how great Obamacare is, I was wondering, why, then, did Congress exempt themselves and members of their staffs from having to live under it?” Untrue. As numerous fact-checkers have pointed out, congressional lawmakers and staffers were once eligible for enrollment in the fabulous FederalEmployees Health Benefits (FEHB) Program. (Erik Wemple, 1/4)

Georgia Health News: The Rush To Throw Out Obamacare Could Backfire Disastrously
We are the most religious democracy in the world, and our Judeo-Christian ethic demands that we take care of the downtrodden. But we are also the only advanced democracy without universal health coverage. Are we confused . . . or just hypocrites? My bet is that we are very confused. The public’s reaction to Obamacare (also known as the Affordable Care Act, or ACA) is a prime example of our confusion. (Jack Bernard, 1/4)