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Summaries Of The News:

Capitol Hill Watch

Repeal And Replace Top The GOP To-Do List... But Completing That Task Brings Some Risks, Challenges

This ambitious and complicated undertaking, which would have significant impact on both the insurance marketplace and political landscape, is leading to differences in opinion among Republican lawmakers about how best to proceed.

Los Angeles Times: Republicans Finally Have The Power To Repeal Obamacare, But They're Still Not Sure How
Congressional Republicans, despite pledging to quickly repeal the Affordable Care Act, are struggling with what parts of the law to roll back and how to lock up the votes they will need, particularly in the Senate, to push their ambitious plans. Settling these questions may delay any major repeal vote for months. Just as importantly, a protracted debate could force President-elect Donald Trump and GOP lawmakers to preserve parts of the healthcare law they once swore to eliminate. And this all must be resolved before they even turn to the question of how to replace the law. (Levey, 1/3)

CNN: What Obamacare Could Be Replaced With Under Trump
The so-called "repeal and delay" tactic, however, is not sitting well with some in Congress, particularly a few top GOP senators. Senator Lamar Alexander, who chairs the health committee, said if the process is rushed, harm may be done or mistakes made. These senators would like to wait until a more solid replacement plan is in hand so it's possible they will try to slow down the reconciliation process. (Luhby, 1/3)

Morning Consult: GOP Senators Stress Need for ACA Replacement Sooner Rather Than Later
Sens. Susan Collins (R-Maine), Bill Cassidy (R-La.) and Rand Paul (R-Ky.) expressed hesitation about repealing the health care law without having a replacement plan ready to go, citing concerns about how the market would react to the swift repeal without an alternative to take its place. While none have said they would vote against a repeal measure without an alternative in place, several sit on key committees that will work directly on the law’s repeal and replacement. (McIntire, 1/3)

Kaiser Health News: Vowing To Jettison Obamacare, Republicans Face Immediate Resistance And Risks
The 115th Congress started work Tuesday with Republican majorities in both the House and Senate in agreement on their top priority — to repeal and replace the 2010 health law, the Affordable Care Act. “The Obamacare experience has proven it’s a failure,” House Majority Leader Kevin McCarthy, R-Calif., told reporters at an opening day news conference. But that may be where the agreement among Republicans ends. Nearly seven years after its passage, Republicans still have no consensus on how to repeal and replace the measure. (Rovner, 1/3)

Morning Consult: Trump Focuses Rhetoric On ACA As Congress Readies Repeal
President-elect Donald Trump on Tuesday focused his rhetoric on the Affordable Care Act, calling the insurance plans offered under the law “lousy healthcare.” “People must remember that ObamaCare just doesn’t work, and it is not affordable,” Trump said in a tweet Tuesday morning. (McIntire, 1/3)

Modern Healthcare: Could Delayed Replacement Save Key Parts Of Obamacare? 
The phrase “repeal and replace” the Affordable Care Act long has been popular among Republicans. But the “replace” part has always been thorny. With Republicans taking control of the White House and having majorities in the Senate and House, the prospect of leaving up to 30 million people without healthcare appears to have chilled the rhetoric. Still, members of the newest Congress took swift action Tuesday to make good on their longtime promise of repealing the ACA. But more Republicans are suggesting a slow death of the landmark legislation and a gradual replacement. That opens the door to keeping key provisions of the ACA, such as subsidies to help people buy insurance and the provision allowing people to stay on their parents' plans until they're 26. (Muchmore, 1/3)

Senate Takes First Steps Toward Health Law Repeal In Budget Resolution

The resolution, which was introduced yesterday by Budget Committee Chair Mike Enzi, R-Wyo., includes directions that will serve as a vehicle for taking apart much of the statute.

The Wall Street Journal: Senate Moves To Dismantle Health Law
The Republican-controlled Senate on Tuesday took its first step toward dismantling the 2010 Affordable Care Act, using its initial day in office to introduce a measure that sets an aggressive timeline for developing plans to repeal much of President Barack Obama’s signature health law. (Hughes and Peterson, 1/3)

The New York Times: The Parliamentary Trick That Could Obliterate Obamacare
Republicans hope to repeal major parts of the Affordable Care Act using an expedited procedure known as budget reconciliation. The process is sometimes called arcane, but it has been used often in the past 35 years to write some of the nation’s most important laws. “Reconciliation is probably the most potent budget enforcement tool available to Congress for a large portion of the budget,” the Congressional Research Service, a nonpartisan arm of Congress, has said. Here is a primer. (Pear, 1/4)

NPR: Obamacare Repeal Launched By Senate Republicans
Lawmakers returned to Washington and wasted no time getting to work on the repeal of Obamacare. Senator Mike Enzi, R-Wyo., introduced a resolution just hours after the new Congress convened Tuesday that will serve as the vehicle for repealing much of the president's signature health care law. (Kodjak, 1/3)

Reuters: U.S. Republican Senator Introduces Obamacare Repeal Resolution
Republican U.S. Senator Mike Enzi introduced on Tuesday a resolution allowing for the repeal of President Barack Obama's signature health insurance program, which provides coverage to millions of Americans, Enzi's office said in a statement. The move by the Senate's budget committee chairman on the first day of the new Congress set in motion the Republican majority's promise to repeal the 2010 Affordable Care Act, known as Obamacare, as its first major legislative item. (Cornwell, 1/3)

Bloomberg: Trump's Efforts To Undo Obamacare Will Be An Early Lesson In The 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. And it’s likely to get more difficult from here, as the incoming president moves on to other areas where Republicans aren’t in such lockstep, such as infrastructure spending, where he might need bipartisan support. (Dennis, 1/4)

Vox: Senate Republicans Just Introduced An Obamacare Repeal Plan Democrats Can’t Stop
Senate Budget Committee Chair Michael Enzi (R-WY) introduced a budget resolution Tuesday that includes "reconciliation instructions" that enable Congress to repeal Obamacare with a simple Senate majority. Passing a budget resolution that includes those instructions will mean that the legislation can pass through the budget reconciliation process, in which bills cannot be filibustered. That means Republicans will only need 50 of their 52 members in the Senate, and a bare majority in the House, to pass legislation repealing the Affordable Care Act. According to the Wall Street Journal, the budget resolution could be passed by both houses as early as next week. (Matthews, 1/3)

Roll Call: Senate Republicans Start Obamacare Repeal Process
On Tuesday, Senate Budget Chairman Michael B. Enzi started the process known as reconciliation. ... One of the committees with jurisdiction is Senate Health, Education, Labor and Pensions and the panel’s chairman, GOP Sen. Lamar Alexander of Tennessee said Tuesday that any repeal bill will be crafted “carefully.” Lawmakers have until Jan. 27 to draft the measures. But before then, Democrats plan to put Republicans on the record regarding certain provisions of the 2010 health care law. Senate Minority Whip Richard J. Durbin said Democrats plan to offer health-related provisions when the Senate votes on amendments to the budget resolution. A marathon vote series known as a vote-a-rama is expected next week. (Bowman, 1/3)

The Hill: Senate Turns Toward ObamaCare Repeal
The Senate is turning toward a fight over repealing large parts of the Affordable Care Act, as Republicans move to fulfill a years-long campaign pledge. ... Lawmakers want to use "reconciliation" to repeal large swaths of the law this year. The procedural maneuver will allow the repeal effort to clear the upper chamber with 50 votes, bypassing a string of 60-vote procedural hurdles. (Carney, 1/3)

Meanwhile, in the House of Representatives -

Bloomberg: Ryan Re-Elected Speaker As He Tries To Forge Peace With Trump 
[Paul] Ryan won resounding re-election with 239 votes -- clearing the 218 needed -- with only one Republican voting for someone else. But his relationship with the incoming president will face a test as he carves out his own agenda for Republicans in Congress. But the speaker faces competing pressures from different parts of his own caucus. Some members warn they’ll be monitoring his loyalty to Trump. ... The two men see eye to eye on repealing Obamacare as the first order of business, but don’t agree yet on the details of how to replace it. (House, 1/3)

Obama Takes To The Hill To Brainstorm With Democrats On Strategy To Save Health Law

At the same time, Vice President-elect Mike Pence will meet with GOP lawmakers to discuss the best way to dismantle Obamacare. These separate strategy sessions will take place on the second day of the new Congress -- just a little more than two weeks before President-elect Donald Trump moves into the White House.

The Washington Post: Obama To Huddle With Democrats On Protecting His Signature Health Care Law
President Obama will meet behind closed doors Wednesday morning with congressional Democrats to map out a strategy to defend the Affordable Care Act and other health care policies — the very day Republicans will begin debate on getting rid of the sweeping 2010 health-care law. Obama’s rare visit to Capitol Hill, 2 ½ weeks before Donald Trump assumes the presidency, marks the start of his administration’s final push to defend its achievements before handing over the reins of power in Washington. Next week, Obama will deliver his farewell address in his adopted hometown of Chicago. (Eilperin and Goldstein, 1/4)

The Wall Street Journal: Obama To Discuss How To Salvage ACA With Democrats At The Capitol
The White House said that Mr. Obama will rally Democrats on Capitol Hill behind some of the broadly popular parts of the law, which include a ban on excluding people from coverage due to with pre-existing medical conditions and a provision allowing young adults to remain on their parents insurance plans until age 26. Republicans have vowed to keep those measures in place but will likely need to find alternative ways to pay for them. (Tau, 1/4)

NPR: President Obama Tries To Salvage Obamacare From Trump
President Obama meets with Democrats on Capitol Hill today, looking for ways to preserve his signature health care law in the face of stiff Republican opposition. Senate Republicans have already taken the first step toward repealing Obamacare. On Tuesday, they introduced a budget resolution that would ultimately allow Republicans to unravel large parts of the Affordable Care Act with a simple majority vote. (Horsley, 1/4)

CQ Roll Call: Obama, Pence To Hit The Hill To Rally Members On Obamacare
Obama — whose name adorns the colloquial term "Obamacare" used to refer to his landmark domestic achievement — aims to help Democrats strategize about how to publicize the law's benefits and defend it from Republican attacks. Already, Democrats have laid out plans for events aimed at heralding the law, including its impact on reducing the nation's uninsured rate to a record low. Senate Minority Leader Charles E. Schumer, D-N.Y., and Sen. Bernie Sanders, I-Vt., as well as House Minority Leader Nancy Pelosi, D-Calif., urged lawmakers in a letter last week to hold rallies and other events in support of the law on Jan. 15. (Mershon, 1/3)

The Associated Press: Obama, Pence To Capitol As Health Care Overhaul Fight Begins
While they can hardly prevent the GOP repeal effort from proceeding, the president and House and Senate Democrats were meeting Wednesday to discuss how to best defend a law that's extended health insurance coverage to 20 million Americans and which Obama considers one of the proudest pillars of his legacy. "The more the people understand what's included in the Affordable Care Act and how they benefit from it, the more popular the program is, and the harder it is for Republicans to have political support for tearing it down," White House spokesman Josh Earnest told reporters Tuesday, using the law's formal name. (Fram, 1/4)

Politico: Desperate Democrats Scramble For An Obamacare Strategy
Democrats don’t have the votes to stop Republicans from gutting Obamacare. So as they watch their signature domestic policy accomplishment about to be dismantled, they’re looking to the ground game that helped pass it seven years ago. They're holding rallies in Ohio, Pennsylvania and West Virginia, featuring the stories of some of the red-state Americans who have benefited from the law. They’re urging followers to bombard lawmakers’ district offices and phone lines with calls against repeal. And they’re targeting moderate Republicans in Alaska, Arizona, Maine, Nevada and Tennessee who are up for reelection in 2018 — or who could be influential in the repeal vote — with a seven-figure television and print ad campaign. (Haberkorn and Pradhan, 1/4)

As Lawmakers Mull Plans For Obamacare's Demise, Issues And Wrinkles Emerge

One Republican governor hopes the GOP-controlled Congress and White House will spare his state's "unique" Medicaid expansion program while some self-employed people are getting nervous about what will become of their individual coverage and some experts question whether concerns about medical malpractice are skewing Republican officials' views.

Detroit News: Snyder Fights For Medicaid Plan In Obamacare Repeal
Gov. Rick Snyder wants Republican President-elect Donald Trump and the GOP-led Congress to spare Michigan’s unique form of Medicaid expansion as they consider dismantling the Affordable Care Act, calling it a “successful” program that could serve as a national model. ... Snyder and Michigan’s GOP-led Legislature signed off on Medicaid expansion in 2013 but added unique requirements for recipients who earn between 100 and 133 percent of the poverty level, including Health Savings Account contributions and co-pays that can be reduced through healthy behaviors. (Oosting, 1/4)

Modern Healthcare: Self-Employed Fear Repealing Affordable Care Act Will Bring Back 'Job Lock'
[Joshua] Lapp is deeply worried about the push by President-elect Donald Trump and congressional Republican leaders to rapidly repeal the ACA and then craft a replacement system over the next several years. He's particularly nervous about whether the individual market he depends on will collapse in the interim, and whether Republicans will adequately replace the ACA's ban on insurance discrimination against people with pre-existing conditions like his. He and other young entrepreneurs don't like that the GOP repeal-and-delay strategy will leave them hanging in insurance limbo for several years. “If it's repealed, I might have to go back to working for a bigger employer,” he said. “The prospect of losing my business because I'm losing my insurance is sort of ridiculous to me.” (Meyer, 12/31)

California Healthline: Leading Republicans See A Costly Malpractice Crisis — Experts Don’t
As top Republicans see it, a medical malpractice crisis is threatening U.S. health care: Frivolous lawsuits are driving up malpractice insurance premiums and forcing physicians out of business. Doctors and hospitals live in fear of litigation, ordering excessive tests and treatments that make health care unaffordable for Americans. That’s why Republican House Speaker Paul Ryan and Rep. Tom Price, tapped to be the nation’s top health official by President-elect Donald Trump, are vowing to make tort reform a key part of their replacement plan for the Affordable Care Act. (Terhune, 1/4)

Meanwhile, some consumers are focused on challenges related to their current coverage through the health law's exchanges -

Nashville Tennessean: Demand Rises For Alternatives To Obamacare Plans
[April] Bean is part of the roughly 15 percent of Tennesseans who shop for a marketplace plan but don't qualify for tax credits. She'll be paying the full cost of the premium — and the deductible before insurance covers anything — so she's trying to take a different route: She's applied for an underwritten plan from Farm Bureau Health Plan in the individual "off-exchange" market. The premium is lower and the deductible is about $2,000. There are some unknowns: her application could be rejected for pre-existing conditions, and she might be facing a penalty from the Internal Revenue Service come tax season in 2018. [Fletcher, 1/3)

Doctors' Group Urges GOP Lawmakers To Proceed With Caution On Repeal Strategy

The American Medical Association, the nation's largest professional organization for physicians, wrote a letter to congressional leaders asking them to provide clear details about how their replacement plan would ensure that people do not lose their health insurance once Obamacare is repealed.

Stat: AMA To Congress: Don't Repeal Obamacare Without A New Plan
The head of the nation’s largest professional association of doctors is urging Republicans to think twice about dismantling Obamacare without a replacement plan. In an open letter to Congress, Dr. James L. Madara, the CEO of the American Medical Association, urged lawmakers to “lay out for the American people, in reasonable detail, what will replace current policies” on health coverage. (Blau, 1/3)

The Hill: Doctors Group Warns Against Loss Of Coverage From ObamaCare Repeal 
The country’s leading doctors group is urging Republicans to take steps to ensure that people do not lose their health insurance once ObamaCare is repealed. The American Medical Association (AMA), wrote a letter to congressional leaders on Tuesday calling for the gains in coverage from ObamaCare, which has expanded insurance to 20 million people, to be preserved.  (Sullivan, 1/3)

Medicare

Bundled Payments Model For Joint Replacement Could Save Government Billions: Study

In other regulatory news, revised federal rules guarantee people in nursing homes more flexibility on food and roommate choices, as well as improved procedures for grievances and discharges.

Kaiser Health News: Bundled Payments Work, Study Finds, But HHS Nominee No Fan
A recent change in the way Medicare pays for joint replacements is saving millions of dollars annually — and could save billions — without impacting patient care, a new study has found. But the man Donald Trump has picked to be the secretary of Health and Human Services has vocally opposed the new mandatory payment program and is likely to revoke it. Under the new program, Medicare effectively agrees to pay hospitals a set fee — a bundled payment — for all care related to hip or knee replacement surgery, from the time of the surgery until 90 days after. Traditionally, hospitals collect payments for many components of care and rehabilitation individually. (Bluth, 1/3)

Kaiser Health News: New Nursing Home Rules Offer Residents More Control Of Their Care
About 1.4 million residents of nursing homes across the country now can be more involved in their care under the most wide-ranging revision of federal rules for such facilities in 25 years. The changes reflect a shift toward more “person-centered care,” including requirements for speedy care plans, more flexibility and variety in meals and snacks, greater review of a person’s drug regimen, better security, improved grievance procedures and scrutiny of involuntary discharges. (Jaffe, 1/4)

Marketplace

One Small Texas Hospital Defies National Trends And Finds A Way To Survive

Although rural hospitals are struggling in many areas of the country, the facility serving Childress, Texas, is thriving. In other health industry news, navigators help patients understand how to improve their care, Washington state officials weigh a takeover of the Group Health Cooperative, a New Hampshire hospital joins the Massachusetts General health system, Kaiser Permanente opens new facilities in California and a survey of millennials shows what they want from health care providers.

Stat: In A Small Town In Texas, A Rural Hospital Thrives Against All Odds
Rural hospitals around the country have struggled to stay afloat; at least 80 have shut down since 2010. Thirteen of those closures occurred in Texas, the most of any state, according to the data from the North Carolina Rural Health Research Program. But Childress Regional, which has just 39 beds, is a case study in success. It’s solvent. It’s expanding its services. And in an era when medical care seems increasingly fragmented — with high-tech diagnostics and high-priced specialists called in for every ailment — it’s a reminder that the old-fashioned way can work, too. (Huff, 1/4)

Stat: In A Byzantine Health System, Navigators Help At-Risk Patients Find Their Way
Even patients who read and speak English fluently face challenges navigating the increasingly Byzantine health care system. But patients who are less well-equipped, whether because of poverty, education level, or cultural barriers, are at a particular disadvantage when it comes to getting the health care they need. For these patients, seemingly small concerns, such as how and when to make a doctor’s appointment or how to get to the clinic, play an outsize role in their care. For instance, women without the skills to understand and process essential health information — a capacity known as health literacy — are twice as likely to have never received a Pap test and are 50 percent less likely to have had a mammogram in the past two years compared to those with better health literacy. (Bond, 1/4)

Seattle Times: State Regulators Endorse Kaiser Acquisition Of Group Health
The acquisition of Washington’s historic Group Health Cooperative by California-based Kaiser Permanente moved a key step closer to completion Tuesday. State regulators endorsed the deal at a hearing before Insurance Commissioner Mike Kreidler, who has final say on the proposal. Kreidler is expected to issue his decision by the end of the month. Accountants, lawyers and other experts with the Office of Insurance Commissioner began reviewing the deal early last year. (Young, 1/3)

New Hampshire Union Leader: Wentworth-Douglass Hospital Now Officially Part Of Massachusetts General 
Wentworth-Douglass Hospital was officially acquired by Massachusetts General Hospital on Jan. 1. Officials at the hospital announced their plans to merge in April of last year. In November, the director of the Attorney General’s Office of Charitable Trusts concluded the proposed deal included sufficient protections for the charitable purposes and assets of Dover’s hospital — but made full approval of the merger conditional on the addition of eight full-time behavioral health staff to provide mental health and substance abuse services, and the creation of a new system for the collection and reporting of data over time so the AG’s office can track access to WDH. The hospitals also had to promise to keep up their levels of community benefit spending. (Haas, 1/3)

Modern Healthcare: Millennials Give Providers One Shot To Gain Their Business 
Providers keen to attract millennial patients should make sure to impress them the first time around or risk losing them to another provider, according to a recent study. Millennials are paying close attention to office appearance, cost, customer service and the quality of products used during a visit, according to a recent survey conducted by the Health Industry Distributors Association. The insights on millennials follow a wider survey HIDA released last year on the impact medical products have on patient satisfaction. (Rubenfire, 1/3)

Public Health And Education

Judge Rejects Motion To Overturn Verdict Upholding Amgen's Cholesterol Drug Patents

Sanofi and Regeneron, which manufacture rival drugs, filed the suit against Amgen. In other industry news, the FDA investigates complaints of exploding batteries in e-cigarette devices.

Reuters: Sanofi, Regeneron Lose Bid To Overturn Amgen Win In Patent Case
A federal judge on Tuesday refused to throw out a court verdict upholding two Amgen Inc patents related to the company's cholesterol drug, a defeat for Sanofi SA and Regeneron Pharmaceuticals Inc, which make a rival drug. In an October 2014 lawsuit, Amgen had sought to stop Paris-based Sanofi and Tarrytown, New York-based Regeneron from selling Praluent, a drug intended to lower bad LDL cholesterol by blocking a protein known as PCSK9. (Pierson, 1/3)

State Watch

Conn. State Legislature Primed To Tackle An Array Of Health Policy Issues

Also, in Minnesota, Gov. Mark Dayton is pushing for quick action on a plan to provide relief to state residents who are facing big hikes in their health insurance premiums.

The Connecticut Mirror: 5 Health Care Stories To Watch In The 2017 Legislative Session
The new year is likely to bring lots of potential changes in health care policy at the federal level, as President-elect Donald J. Trump and Republicans in Congress are expected to take on Obamacare, Medicaid and, potentially, Medicare. But there will also be plenty of health care issues debated in Connecticut’s Capitol during the upcoming legislative session, which begins Wednesday, Jan. 4. (Levin Becker, 1/3)

The Connecticut Mirror: As The 2017 Legislative Session Opens: What To Know
Gov. Dannel P. Malloy will propose his two-year budget Feb. 8. Once again, the process of crafting a budget is expected to be less than pleasant: Nonpartisan analysts have projected a $1.45 billion deficit in the upcoming fiscal year, and that’s after several years of unpopular cuts and multiple unpopular tax hikes. (Levin Becker, 1/4)

In Texas, Arguments Begin In Legal Challenge To State's Fetal Remains Burial Rule

A U.S. district court judge halted a hearing on Tuesday on the rule's constitutionality and ordered state lawyers to appear in his Austin courtroom with answers to key questions first thing Wednesday morning.

The Austin American Statesman: Judge’s Question Could Spell Trouble For Fetal Burial Law
A Texas regulation requiring fetal remains to be buried or cremated ran into potentially serious trouble Tuesday when a federal judge raised questions about the scope and impact of the rule. U.S. District Judge Sam Sparks abruptly halted a hearing on the constitutionality of the rule and ordered state lawyers to appear in his Austin courtroom, with answers, at 8:30 a.m. Wednesday — a half-hour before the hearing was set to continue for a second and final day. (Lindell, 1/3)

The Associated Press: Federal Judge Mulling Fate Of Texas Fetal Remains Rules
Abortion providers told a federal judge Tuesday that Texas' attempt to require burial or cremation of fetal remains was "government interference" without public health benefits, while state lawyers countered that clinics want to be allowed to continue disposing of such remains in landfills. The question of what becomes of tissue left over from abortions and miscarriages is the latest legal battle over abortion in Texas, which saw the U.S. Supreme Court last summer strike down much of its larger abortion restrictions that had been among the nation's toughest. (Weissert, 1/3)

Reuters: Texas Abortion Provider Says Fetal Tissue Burial Rule Is 'Offensive'
The president of an abortion provider told a federal court on Tuesday a proposed Texas regulation requiring facilities to dispose of aborted fetal tissue through burial or cremation is unnecessary and "offensive. "Women's health providers, which provide abortions, among other services, argue the rules are part of a nationwide agenda to place restrictions on abortions and make it harder for women to get the procedure. But officials in Texas have argued it would afford dignity to the tissue. (Herskovitz, 1/3)

In other abortion-related news -

The Associated Press: Virginia Governor Vows To Veto 20-Week Abortion Ban Bill
Virginia Gov. Terry McAuliffe is promising to veto legislation banning abortion after 20 weeks of pregnancy, saying such a "socially divisive" proposal hurts the state's image. The legislation, proposed by a Republican delegate, mirrors similar measures supported by Congressional Republicans and one signed into law in Ohio last month. Abortion-rights opponents have been emboldened by the election success of Donald Trump and the Republican Party and plan a broad push both at the state and federal level this year. (Suderman, 1/3)

State Highlights: Ore. Court Medicaid Decision Leads Some Families To Try To Recoup Estate Payments; Ga. Struggles To Address Backlog Of Nursing Home Complaints

Outlets report on health news from Oregon, Georgia, Kansas, West Virginia, Texas, Illinois and Florida.

Oregon Public Broadcasting: Oregon Supreme Court Ruling Prompts Families To Try To Recoup Medicaid Payments
When a couple grows old, one spouse often gets sick and needs long-term care — like a nursing home. That can cost $6,000 a month. To qualify for Medicaid, couples often transfer the title for an asset, like a home, to the other spouse. In 2008, the state tightened the rule governing asset ownership in an effort to recover more money. Now the Oregon Supreme Court has found that exceeded the state’s authority. (Foden-Vencil, 1/3)

Georgia Health News: State Admits To Slow Pace In Addressing Nursing Home Complaints
Georgia is dealing with a large backlog of complaints about nursing homes, and also has a substantial vacancy rate in surveyors who check conditions in these facilities, a state health agency said Tuesday. The complaint situation has helped lead to “a mess’’ with federal health officials, Frank Berry, commissioner of the Department of Community Health, told Georgia House lawmakers at a hearing. (Miller, 1/3)

KCUR: Kansans Struggle Through Maze Of Autism Therapy Coverage
ABA [applied behavior analysis] consists of one-on-one sessions with trained experts who try to keep kids with autism in step developmentally with their age-group peers. It’s the most common autism therapy in the United States. [Jill] Wagner and other parents of kids with autism are told ABA is essential for their children’s development. But finding a qualified provider and getting insurance to cover it can feel impossible, she said. (Marso, 1/3)

Stateline: Telemedicine In Schools Helps Keep Kids In The Classroom
Telemedicine, increasingly used in prisons, nursing homes and remote areas, is becoming more common in schools. According to the American Telemedicine Association, at least 18 states authorize Medicaid reimbursement for telemedicine services provided in schools and 28 states plus Washington, D.C., require private insurers to cover telemedicine appointments as they would face-to-face doctor visits. Telemedicine can’t always replace an in-person examination — a doctor often has to touch a patient, for example, to diagnose the cause of abdominal pain — but it does make it less likely that a child will have to miss class for a visit to the doctor’s office. (Ollove, 1/4)

Chicago Tribune: Chicago, Public Housing Agencies To Implement Federal Smoking Ban 
The federal rule, announced Nov. 30 by the U.S. Department of Housing and Urban Development, will require all public housing agencies to go smoke-free by June 2018. The rule prohibits tobacco products — cigarettes, cigars, pipes and hookahs — in living units, indoor common areas, administrative offices and outdoors within 25 feet of housing and administrative office buildings. Although electronic-cigarettes are not explicitly banned, HUD encourages individual public housing agencies to "exercise their discretion" in their smoke-free policies. (Moreno, 1/4)

Prescription Drug Watch

Drug Prices Expected To Spike Even Higher In 2017, Experts Predict

News outlets report on stories related to pharmaceutical drug pricing.

CBS News: Prognosis For Rx In 2017: More Painful Drug-Price Hikes
If there’s a remedy for rising drug costs, it’s not likely to be available to many Americans in 2017. Prescription drug costs for Americans under 65 years old are projected to jump 11.6 percent in 2017, or at a quicker pace than the 11.3 percent price increase in 2016, according to consulting firm Segal Consulting. Older Americans won’t get much of a break: Their drug costs are projected to rise 9.9 percent next year, compared with 10.9 percent in 2016. By comparison, wages are expected to rise just 2.5 percent in 2017. (Picchi, 12/30)

The Motley Fool: The Most Expensive Drugs Of 2016
Prescription drug prices have gotten out of control for many Americans and many insurers. Some drugs cost as much as premium sports cars. Here are the five most expensive prescription drugs in 2016 as compiled by prescription drug comparison website GoodRx -- and which companies are profiting from them. (Speights, 12/30)

The Wall Street Journal: Drug Pricing Report Shows Limits Of Transparency Push
A new Vermont law—the first of its kind in the U.S.—aims to shine a light on the murky world of prescription-drug pricing by requiring manufacturers to justify big increases. But the transparency push has its limits, as seen in the first report that Vermont officials prepared based on the drugmakers’ explanations. (Loftus, 12/31)

The New York Times: Costly Drug For Fatal Muscular Disease Wins F.D.A. Approval
The Food and Drug Administration has approved the first drug to treat patients with spinal muscular atrophy, a savage disease that, in its most severe form, kills infants before they turn 2. “This is a miracle — seriously,” Dr. Mary K. Schroth, a lung specialist in Madison, Wis., who treats children who have the disease, said of the approval, which was made last week. “This is a life-changing event, and this will change the course of this disease.” Dr. Schroth has previously worked as a paid consultant to Biogen, which is selling the drug. The drug, called Spinraza, will not come cheap — and, by some estimates, will be among the most expensive drugs in the world. (Thomas, 12/30)

Daily Press: Specialty Drug Prices Continue To Pressure Medicaid
The rising cost of drugs for rare and complex conditions that come from pharmaceutical companies' newest research continues to squeeze Virginia's Medicaid program, two new state reports suggest. The average spent on specialty drugs for people covered by Medicaid's traditional "fee-for-service" coverage rose by more than 14 percent last year, to $12,938 per recipient, the state Department of Medical Assistance Services' annual review for the General Assembly reported. Medicaid, a joint federal-state program, provides health coverage for low-income children, seniors and people with disabilities. (Ress, 12/29)

NewYorkUpstate.com: NY Step Therapy Law To Boost Prescription Drug Costs By As Much As $530M, Insurers Say
A new state law that took effect Jan. 1 that curbs the ability of insurers to use "step therapy" will boost prescription drug costs in New York by as much as $530 million, according to an estimate by an insurance industry group. The New York Health Plan Association criticized Gov. Andrew Cuomo for signing on New Year's Eve a bill that reforms a practice used by insurers to force patients to use the least expensive drug first, even if a patient's doctor believes a different drug is more appropriate. (Mulder, 1/3)

Stat: Q&A: Vermont Legislator Says Drug Pricing Law Is The Start Of A ‘Long Battle'
Last June, Vermont became the first state in the country to pass a law requiring drug makers to justify their price hikes. The move, which was opposed by the pharmaceutical industry, was borne out of frustration that the federal government had not acted on the rising cost of prescription medicines. ... We spoke with Chris Pearson, a Vermont legislator who was vice chair of the House Committee on Health Care and championed the bill, about the results and where this is headed. (Silverman, 1/3)

Perspectives On Drug Costs: Tackling The Price Spikes

Read recent commentaries about drug-cost issues.

The New York Times: To Stop Price Spikes On Prescription Drugs, A Widening Radar
Congressional reports can be a snooze. But that is not how I’d characterize Wednesday’s in-depth account of price gouging among prescription drug makers. The 130-page narrative prepared by the United States Senate Special Committee on Aging was juicy, detailing how four pharmaceutical companies have taken advantage of our health care system to enrich themselves and their executives, harming patients and taxpayers. (Gretchen Morgenson, 12/23)

The Hill: There’s A Right Way To Tackle High Health Costs
We spend 18 percent of GDP on healthcare. We get a lot for that money, but no other developed country spends more than 12 percent. Something is wrong, and with the election over, now is the time for an overhaul. But to make the right repairs, we have to understand which parts are truly broken. Let’s start by recognizing just how complicated and opaque it is — and how many myths pervade the public discourse. A good place to begin is prescription drugs. (James K. Glassman, 1/2)

Wall Street Journal: The FDA’s Rigged Drug Committees
Among the Republican priorities in 2017 should be dismantling a culture of bureaucratic control at the Food and Drug Administration that poisons innovation and costs lives. Here’s an idea: Update part of the approval process that was patient zero for distorting data on a drug for Duchenne muscular dystrophy. (12/30)

The Washington Post: An Opioid Epidemic Is What Happens When Pain Is Treated Only With Pills
The United States is in the midst of a massive opioid epidemic, as The Washington Post and other news organizations have documented extensively. In 2015, more than 33,000 people died from overdoses of opioids, meaning prescription painkillers, heroin, fentanyl or any combination. That easily keeps pace here with fatal motor vehicle accidents and gun-related deaths. ... But there’s another side to the story. Opioids can be an effective treatment for chronic pain, and too many people around the world have limited access to them. (Joel Achenbach, 12/23)

Health Affairs: Germany’s Model For Drug Price Regulation Could Work In The US
Donald Trump and Hillary Clinton agreed on almost nothing during the 2016 presidential campaign — but they did agree that the U.S. needs to address unaffordable prescription drug prices. And the public also supports this idea. A survey released in October 2016 showed that 64 percent of voters, including 52 percent of Republicans, believe that the federal government should place a “limit on how much pharmaceutical companies can increase prescription drug prices.” Further, 73 percent of all voters (68 percent of Republicans) concur that the federal government should be able to negotiate with drug companies to lower Medicare drug prices for seniors. While the November 8 federal election results have dampened prospects for policy change along these lines, does anyone believe that this issue now will disappear? We think not. (Karl Lauterbach, John McDonough and Elizabeth Seeley, 12/29)

Editorials And Opinions

Thoughts On Repeal: Risks Comes With Delay Strategy; Businesses Need To Weigh In

Opinion writers offer their views on the politics of repealing and replacing the federal health law.

Health Affairs: The Problems With ‘Repeal And Delay’
Republican leaders in Congress and the incoming Trump administration have said that they plan to move quickly to repeal the Affordable Care Act (ACA) in the early weeks of 2017, with a delay in the date of when key aspects of the repeal would become effective until perhaps 2019 or 2020. ... We do not support this approach to repealing and replacing the ACA because it carries too much risk of unnecessary disruption to the existing insurance arrangements upon which many people are now relying to finance their health services, and because it is unlikely to produce a coherent reform of health care in the United States. (Joseph Antos and James Capretta, 1/3)

The Wall Street Journal: Stand Up For ObamaCare, CEOs
America’s CEOs might not admit it in public, but the Affordable Care Act — aka ObamaCare — has been good for business. Company benefits managers have watched as the double-digit premium increases under President George W. Bush slowed to a crawl. Venture funding has flooded into health care, boosting startups and stimulating innovation. This is the progress President Obama is trying to preserve as he meets Wednesday with Democrats on Capitol Hill in a strategy session about how to protect the health law. (Annie Lamont and Ezekiel J. Emanuel, 1/3)

The New York Times: A Bipartisan Reason To Save Obamacare
The A.C.A. is more than insurance. As the Times reported yesterday, the law is leading a transformation of America’s health care system. It’s a change that nearly everyone, Republicans and Democrats, agrees is desperately needed — and for it to happen, the relevant parts of the A.C.A. must be preserved. The transformation moves health care away from a fee-for-service model, which pays doctors and hospitals according to the number of procedures they do, toward value-based care, which pays based on what helps patients get better. (Tina Rosenberg, 1/4)

JAMA Internal Medicine: Alternative Alternative Payment Models
Some of the most promising strategies for controlling spending and improving the quality of care delivered in the United States are payment reforms that aim to give health care providers an incentive to improve value. Health care providers are often in the best position to identify ways to reduce waste and help their patients chose the most efficient sites and types of care. Giving health care providers a financial stake in driving value can be much more effective and palatable than runaway health care spending, pushing the risk onto patients, or subjecting them to one-size-fits-all insurer rules. (Katherine Baicker and Michael E. Chernew, 1/3)

Stat: Behavioral Science Suggests That Obamacare May Survive
Perhaps Obama is seeking to capitalize on the well-studied phenomenon known as loss aversion. In a nutshell, loss aversion means that it feels worse to lose something than never to have had it in the first place. Consumers, including those signing up for health insurance, tend to make relative judgments about their own welfare, rather than absolute judgments, and losses loom larger than gains. By urging more Americans to enroll for health insurance now, Obama is simultaneously satisfying an ethical responsibility for expanded insurance coverage and making it more difficult for Republicans to dismantle the ACA. The more people who are insured, the more who will object when this benefit stands to be lost. (Christopher T. Robertson, Holly Fernandez Lynch and I. Glenn Cohen, 1/3)

JAMA: Health Care In The United States: A Right Or A Privilege
The United States is about to embark on a great challenge: how to modify the current system of providing health care coverage for its citizens. However, the fundamental underlying question remains unanswered and was rarely mentioned during the past 8 years — Is health care coverage a basic right or a privilege (regardless of how that coverage is provided or who provides it)? Until that question is debated and answered, it may not be possible to reach consensus on the ultimate goal of further health care reform. (Howard Bauchner, 1/3)

Huffington Post: Kellyanne Conway Makes Some Surprisingly Tempered Comments On Obamacare
Kellyanne Conway was on television Tuesday morning, talking about Obamacare in a way that could signal differences between President-elect Donald Trump and congressional Republicans ― or that could mean nothing at all. During an appearance on MSNBC’s “Morning Joe,” Conway, a key Trump adviser, said that simultaneously repealing and replacing the Affordable Care Act ― rather than repealing it first ― is “the ideal situation. Let’s see what happens practically. Some experts say it could take years to complete the process.” (Jonathan Cohn, 1/3)

Forbes: Learning From CBO's History Of Incorrect ObamaCare Projections
As Congress readies legislation to repeal and replace the Affordable Care Act (ACA), Congressional Budget Office (CBO) estimates will play an important and respected role as they did in the passage of the law in 2010. We now know that many of CBO’s projections of important aspects of the ACA have significantly differed from actual outcomes. (Brian Blase, 1/2)

The Wall Street Journal: Obama Can’t Redefine Sex
Among President Obama’s ironic legacies will be how frequently this former teacher of constitutional law has been called out by the federal courts for his aggressive abuse of executive power. The latest rebuke came on the last day of 2016 in federal court in Texas. Judge Reed O’Connor sided with eight states and three private health-care providers that sued to block a new Health and Human Services rule. This rule defines the Affordable Care Act’s prohibitions against sex discrimination in a way that plaintiffs say will force doctors, hospitals and insurers that take federal funds to cover or perform abortions and gender-transition procedures even when this runs against their best medical judgment or religious beliefs. (1/3)

Miami Herald: Medicare May Be Under Assault In The Newly Convened Republican-Controlled Congress
It’s not just Obamacare that will be under assault in 2017. Medicare may also get a makeover when the new Republican-controlled Congress convenes Tuesday. While on the campaign trail President-elect Donald Trump promised to leave retirement programs alone, but senior advocates and political pundits alike say House Republicans have long wanted to change the national insurance program that provides healthcare to more than 55 million Americans who are 65 or older and younger people with disabilities. (Ana Veciana-Suarez, 1/3)

Viewpoints: Fake Medical News; The Cost Of Growing Old; Gun Violence's Toll

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

Los Angeles Times: It's Not Just Politics: 2016 Was An Epidemic Year For Fake News In Science, Too
One of the watchwords of politics in 2016 was the epidemic of “fake news” — a catch-all term encompassing propaganda, misinformation, disinformation and hoaxing — impinging on the presidential campaign. But let’s not overlook its spread in the spheres of science and medicine. That point is made in a recent article by Ivan Oransky and Adam Marcus. ... The No. 1 episode of scientific fake news must be what Oransky and Marcus termed the “cage match of credulity” staged by that noted purveyor of pseudoscience, Dr. Mehmet Oz, and then-presidential candidate Donald Trump in September. The encounter was billed as an inquiry into Trump’s health. But it was a grotesquely misleading program. (Michael Hiltzik, 1/3)

Los Angeles Times: Not Rich, Not Poor, And Not Ready For The Cost Of Growing Old
Caroline from Sierra Madre wrote to me about the “five-year-long funeral” that followed her father’s stroke, saying “he retired a member of the middle class and died impoverished after all the family funds were spent on care.” Art from Studio City wrote about his 96-year-old father, who has dementia and whose bank account “is evaporating at a fast pace because of the cost of caregivers, food, medicine and daily expenses.” (Steve Lopez, 1/3)

JAMA Internal Medicine: Responding To Firearm Homicide In Urban Areas
Although mass shootings are horrid events that grip the public attention, they account for relatively few homicides in the United States. Many more people die in everyday shootings in urban areas that may go unnoticed. The victims of firearm homicide are primarily young, male, or black. Of the 10 945 firearm homicides in 2014, 65.8% of the victims were age 15 to 34 years, 84.3% were men, and 57.5% were black. (Robert Steinbrook, 1/3)

The Washington Post: The Pain Pill Epidemic Isn’t Going Anywhere Until We End Coal’s Dominance
Coal mining is one of the most dangerous jobs in the United States. According to the U.S. Bureau of Labor Statistics, underground bituminous coal miners are three times more likely to suffer serious injuries and illnesses than workers in any other private industry. Many of those I worked with who were abusing were not “pill heads.” They had weighed a difficult choice: take pain medication to be able to continue to work, or risk fighting for disability compensation that’s seldom enough to pay the bills. Those taking medication on the job were often ashamed of their dependency. In many cases, they avoided working in positions that could get someone hurt. (Nick Mullins, 1/3)

Des Moines Register: A New Year’s Resolution: Reduce Childhood Obesity In Iowa
Unfortunately, there is not enough public awareness about the long-term consequences of childhood obesity, which is destructive to future generations. The medical effects are dangerous, and can lead to fatal complications. However, there are other repercussions to obesity other than the medical issues. Obesity among children causes emotional, social and mental barriers. ... To alleviate childhood obesity, there needs to be a total lifestyle change that includes greater education for younger children, making nutritious food affordable, and more organization dedicated solely to tackling childhood obesity. (Yogesh Shah and Sreelekha Kundu, 1/3)

The Washington Post: The Man Who Beat Lou Gehrig’s Disease
When Ted was diagnosed in 2010 by Jonathan Glass, a doctor at the Emory ALS Center, he was deteriorating quickly. He could walk only short distances with the help of a cane. Simple tasks, such as getting the mail or walking up the stairs to put his kids to bed, had become impossible for him. ... But two years later, on Oct. 20, 2012, Ted completed Atlanta’s two-and-a-half-mile Walk to Defeat ALS with no difficulty. In fact, Ted completed the ALS walk four years in a row. He ditched his cane and was able once again to play with his kids in the pool and walk up the stairs to tuck them in for bed. (Marc A. Thiessen, 1/3)