• From Clinics to Child Insurance, Budget Deal Affects Health Care  New York Times by Robert Pear — The budget deal in Congress is billed as a measure to grant stability to a government funding process that has lurched from crisis to crisis — but it is also stuffed with provisions that will broadly affect the nation's health care system, like repealing an advisory board to curb Medicare spending and funding community health centers. Many of the provisions have been in gestation for months, even years in some cases. Some will save money. Many will cost money — potentially a lot of money. Among the more significant provisions is one that would eliminate a powerful 15-member panel, known as the Independent Payment Advisory Board, created by the Affordable Care Act to control the rising costs of Medicare.
  
  
• Popular Bill to Fight Drug Prices Left Out of Budget Deal  The Hill by Peter Sullivan — Drug pricing advocates are decrying the budget deal announced Wednesday for leaving out a bipartisan drug pricing measure that they had pushed for. The measure would prevent branded drug companies from using delay tactics to prevent cheaper generic competitors from coming onto the market.  It is one of the few drug pricing measures that has bipartisan support in Congress, but it did not end up being included in the bipartisan budget deal announced Wednesday. Drug pricing advocates are blaming the pharmaceutical industry, which has been lobbying hard against the measure. They point out that much of the rest of the health-care world supports it.
  
  
• New Spending Agreement Repeals Obamacare's Mythical Death Panel  Huffington Post by Jonathan Cohn —The bill would also repeal the Independent Payment Advisory Board, or IPAB, which is a commission of experts that the Affordable Care Act created back in 2010.  The Affordable Care Act sets a spending target for Medicare, as part of a broader effort by the law's architects to reduce the cost of medical care. IPAB's job is to make those targets stick, by recommending cuts if Medicare costs exceed the threshold. But at the end of the day, holding the line on medical spending almost inevitably means taking money away from the health care industry. And that's never easy to do. As Larry Levitt, senior vice president of the Henry J. Kaiser Family Foundation put it, there is "a bipartisan consensus that health care cost containment generally seems better in theory than in practice." Occasionally the political will to impose cuts exists, and that's arguably what happened when the architects of the Affordable Care Act created the IPAB. But the board's enemies didn't give up, and it looks like they have finally won.

• Nearly 11.8 M Enroll for Obama Health Law in 2018 Associated Press by Ricardo Alonso-Zaldivar and Kevin S. Vineys — Call it the political equivalent of a death-defying escape: former President Barack Obama's health care law pulled in nearly 11.8 million customers for 2018, despite the Republican campaign to erase it from the books. An Associated Press count found that nationwide enrollment was about 3 percent lower than last year. California, with more than 1.5 million sign-ups, was the last state to report, announcing its numbers on Wednesday. Sixteen states increased their enrollment from last year, according to AP's analysis. Six of those were carried by President Donald Trump in 2016, while 10 went for Democrat Hillary Clinton. However, of the total number of people signed up this year about 6 in 10 live in states that went for Trump, according to AP's analysis.
  
  
• Obamacare Enrollment Tells Tale of Two Systems The Hill by Jessie Hellmann — Most states that operate their own Obamacare exchanges saw more people sign up in 2018 than last year, while 29 of the 34 states that rely on the federal government to promote enrollment saw their sign-ups fall. Of the 17 state-based marketplaces, 11 saw enrollment increases: Colorado, Connecticut, Washington, D.C., Massachusetts, Minnesota, New York, Rhode Island, Nevada, Washington, Kentucky and Oregon while California, Idaho, Maryland, Vermont, Arkansas and New Mexico saw decreases. The 34 states using the federal marketplace, in contrast, saw a 5.3 percent drop in enrollment, according to data released Wednesday by the National Academy of State Health Policy (NASHP). Louisiana, one of those states, saw a 23 percent drop in enrollment — a difference of about 33,700 people.   Overall, total enrollment in Obamacare dropped about 4 percent, or by 500,000 people, as the increases in the state-based exchanges did not increase enough to offset the losses on the federal exchange.

• Kentucky Rushes to Remake Medicaid as Other States Prepare to Follow The New York Times by Abby Goodnough — With approval from the Trump administration fresh in hand, Kentucky is rushing to roll out its first-in-the-nation plan to require many Medicaid recipients to work, volunteer or train for a job — even as critics mount a legal challenge to stop it on the grounds that it violates the basic tenets of the program. At least eight other Republican-led states are hoping to follow — a ninth, Indiana, has already won permission to do so — and some want to go even further by imposing time limits on coverage.

• Trump Thought the British Were Protesting Their Health Service. They Weren’t. Washington Post  by Karla Adam — President Trump took a swing at Britain’s beloved National Health Service (NHS) on Monday, tweeting that Britons were marching in the streets because their universal health care system was financially strapped and dysfunctional, and got a swift rebuke from the British prime minister. “The Democrats are pushing for Universal HealthCare while thousands of people are marching in the UK because their U system is going broke and not working. Dems want to greatly raise taxes for really bad and non-personal medical care. No thanks!” he wrote. A spokesman for Prime Minister Theresa May said that “the prime minister is proud of our NHS, that is free at the point of delivery.” The spokesman said that funding “is at a record high and was prioritized in the budget with an extra 2.8 billion pounds. In the recent Commonwealth Fund international survey, the NHS was rated the best in the world for a second time.”
  
  
• Trump Administration Ponders Lifetime Benefit Limits for Medicaid  McClatchy by Tony Pugh — After allowing states to impose work requirements for Medicaid enrollees, the Trump administration is now pondering lifetime limits on adults' access to coverage. Capping health care benefits — like federal welfare benefits — would be a first for Medicaid, the joint state-and-federal health plan for low-income and disabled Americans. If approved, the dramatic policy change would recast government-subsidized health coverage as temporary assistance by placing a limit on the number of months adults have access to Medicaid benefits.  The move would continue the Trump administration's push to inject conservative policies into the Medicaid program through the use of federal waivers, which allow states more flexibility to create policies designed to promote personal and financial responsibility among enrollees. .. "I think you have to be very thoughtful here in a way that's quite different from cash assistance," said Gail Wilensky, a senior fellow at Project HOPE who ran the Medicaid program from 1990 to 1992 under President George H.W. Bush. "It depends on what the safeguards and defaults are in a program like this. Otherwise it does not make a lot of sense and seems to be cruel and inappropriate."
  
  
• Kellyanne Conway's 'Opioid Cabinet' Sidelines Drug Czar's Experts  Politico by Brianna Ehley and Sarah Karlin-Smith — President Donald Trump's war on opioids is beginning to look more like a war on his drug policy office. White House counselor Kellyanne Conway has taken control of the opioids agenda, quietly freezing out drug policy professionals and relying instead on political staff to address a lethal crisis claiming about 175 lives a day. The main response so far has been to call for a border wall and to promise a "just say no" campaign. Trump is expected to propose massive cuts this month to the "drug czar" office, just as he attempted in last year's budget before backing off. He hasn't named a permanent director for the office, and the chief of staff was sacked in December. For months, the office's top political appointee was a 24-year-old Trump campaign staffer with no relevant qualifications. Its senior leadership consists of a skeleton crew of three political appointees, down from nine a year ago.

• Trump's Big Promises on Drug Costs Followed by Modest Steps Associated Press by Ricardo Alonso-Zaldivar and Matthew Perrone — President Donald Trump makes big promises to reduce prescription drug costs, but his administration is gravitating to relatively modest steps such as letting Medicare patients share in manufacturer rebates. Those ideas would represent tangible change and they have a realistic chance of being enacted. But it’s not like calling for Medicare to negotiate drug prices. Skeptics say the overall approach is underwhelming, and Trump risks being seen as an ally of the powerful pharmaceutical industry, not its disrupter.  The White House Council of Economic Advisers has released a 30-page strategy for reducing drug costs, and it calls current policies “neither wise nor just.” The plan, outlined before Trump releases his new budget proposal Monday, focuses mainly on Medicare and Medicaid changes, along with ideas for speeding drug approvals and fostering competition.
  
  
• Coalition of 44 Groups Calls for Passage of Drug Pricing Bill  The Hill by Peter Sullivan — A coalition of 44 groups is calling on Congress to pass a measure aimed at fighting high drug prices that has gained support from across the political spectrum. The letter is signed by groups that are often directly opposed to each other, such as the conservative group FreedomWorks and the liberal group Families USA. The bill, called the Creates Act, has bipartisan co-sponsors and is designed to increase competition and bring prices down by preventing branded drug companies from using delay tactics to prevent generic competitors from getting onto the market. It is a rare anti-drug pricing measure that has some momentum in Congress, and it could be included as a way to help pay for a coming budget deal.
  
  
• Express Scripts Plans See Lower Gains in Prescription Drug Spending CNBC  by Bertha Coombs — Prescription drug prices may still be high, but Express Scripts says the commercial insurance plans it works with saw the lowest increase in drug spending last year in nearly a quarter of a century. For private employer and individual health plans, total drug spending rose 1.5 percent last year, according to the latest Express Scripts annual Drug Trend Report. That was the smallest increase since the pharmacy benefits company first began tracking spending in 1993. Nearly half of all private insurance plans spent less per person year over year, including plans on the Obamacare exchange market, which saw drug spending fall more 3 percent. Overall drug spending for Medicare rose 2.3 percent, while the Medicaid safety net program saw a 3.7 percent spending increase last year. Among the biggest drivers of the lower trend, a near 31 percent drop in the unit cost of cholesterol drugs, and a 13 percent decrease in pain and inflammation drug costs due to more patients being steered to new lower-cost generics.
  
  
• Trump Proposes Reduction of Drug Costs Under Medicare  Associated Press by Ricardo Alonso-Zaldivar & Matthew Perrone — President Donald Trump will propose lowering prescription drug costs for Medicare beneficiaries by allowing them to share in rebates that drug companies pay to insurers and middlemen, an administration official said. A senior administration official outlined the plan Thursday on condition of anonymity ahead of the release of Trump's 2019 budget plan next week. Pharmaceutical companies now pay rebates to insurers and pharmacy benefit managers to help their medications gain a bigger slice of the market. Insurers apply savings from rebates to keep premiums more manageable. Under Trump's proposal, seniors covered by Medicare's popular "Part D". 

Editor: Peter Van Vranken