"Health center advocates and other supporters are continuing to emphasize with congressional leaders the critical need for health center funding to be renewed ASAP to avoid severe consequences to health center operations and their ability to serve patients, especially during a major flu epidemic and opioid crisis."

— Amy Simmons, National Association of Community Health Centers

• Short-Term Spending Agreement Provides Longer-Term Relief for CHIP Washington Post by Amy Goldstein — The spending bill that the Senate and House adopted Monday, and that President Trump signed, provides six years of federal money for the Children's Health Insurance Program, a bipartisan creation that furnishes coverage to nearly 9 million children and 375,000 pregnant women. The measure approved Monday will ward off that escalating drama, providing about $124 billion through 2023. For the first two years, federal money will pay for at least 88 percent of the program's expenses in every state — keeping a heightened federal match that was part of the Affordable Care Act. After that, the federal share will decrease over two years to its level before the 2010 ACA. For nearly five months, lawmakers of both parties rued that CHIP's budget had lapsed, with each side trying to claim the high ground in urging their colleagues to restore the funding. The spending plan does not provide financial relief for other important health programs — the nation's community health centers or the National Health Service Corps, which provides scholarships and loans for students planning careers in primary care medicine.
  
  
• Community Health Centers Await Funding That Expired Months Ago The Hill by Jessie Hellmann — While Congress on Monday extended CHIP for six years, more than 1,000 community health centers around the country are still waiting for the government to take action on their own funding.  Both programs expired at the end of September, but only CHIP was funded in the short-term spending bill signed by President Trump. Health centers — and those who advocate for them — are becoming anxious and frustrated. Community health centers cover about 27 million low-income people in 9,800 rural and urban communities across the U.S.

• Trump's Move May Nudge Holdout GOP States to Expand Medicaid  Associated Press by Ricardo Alonso-Zaldivar — In an ironic twist, the Trump administration's embrace of work requirements for low-income people on Medicaid is prompting lawmakers in some conservative states to resurrect plans to expand health care for the poor. Trump's move has been widely criticized as threatening the Affordable Care Act's Medicaid expansion. But if states follow through, more Americans could get coverage. "I think it gives us a chance," said Kansas state Rep. Susan Concannon, a moderate Republican who pushed unsuccessfully for Medicaid expansion last year in her state.
  
  
• Kentucky's Medicaid Work Requirement Isn't Only Target in Court  Bloomberg by Erik Larson — Kentucky's proposed work requirement for Medicaid recipients is just one aspect of the state's overhaul of the health care plan that some experts say puts it at risk of being overturned in court. The proposed class-action suit filed Wednesday in federal court in Washington contends the rules contradict the stated purpose of Medicaid, which is to encourage coverage. They cite more documentation of work and income and lockout periods for people who fail to pay revised premiums on time or miss re-certification deadlines. The income documentation requirement is a particular problem for lower-wage workers "whose income can fluctuate considerably from month to month or season to season," said Deborah Bachrach, who ran New York state's Medicaid program and advises clients on health-care law Manatt Phelps in Manhattan. Kentucky's proposal just "adds hoops that an individual has to jump through in order to maintain health care."
  
  
• Oregon Approves New Taxes to Address Medicaid Costs  Associated Press by Gillian Flaccus —  Oregon approved taxes on hospitals, health insurers, and managed care companies in an unusual special election Tuesday that asked voters — and not lawmakers — how to pay for Medicaid costs that now include coverage of hundreds of thousands of low-income residents added to the program's rolls under the Affordable Care Act. Measure 101 was passing handily in early returns Tuesday night. The single-issue election drew national attention to this progressive state, which aggressively expanded its Medicaid rolls under President Barack Obama's health care reforms. Oregon now has one of the lowest rates of uninsured residents in the nation at 5 percent. About 1 million Oregonians — 25 percent — now receive health care coverage from Medicaid. The measure creates a 0.7 percent tax on some hospitals and a 1.5 percent tax on the gross health insurance premiums and on managed care organizations. The nonpartisan voter pamphlet said if the measure failed, the state might lose an additional $630 million to $960 million in federal Medicaid matching funds that flow to the poorest in the state.

• As Trump Attacks the Federal Health Law, Some States Try to Shore it Up  Stateline by Christine Vestal — This year, a handful of Democratic-led states are gearing up to curb further rate hikes by enacting laws and adopting insurance regulations designed to shore up the traditional insurance industry and restore parts of the Affordable Care Act, known as Obamacare. At the same time, at least one Republican-leaning state has moved to further unravel the federal health law by encouraging insurance companies to offer cheap policies with fewer benefits. Others are expected to follow. Both red and blue states are reacting to a series of federal actions. It's too early to know how many other states will move this year to fill the policy gaps in the tattered ACA. But consumer advocates are urging lawmakers and governors to act sooner rather than later.
  
  
• Trump Administration Seeks New Ways to Allow People to Dodge Obamacare's Individual Mandate  Washington Post by Paige Winfield Cunningham and Juliet Eilperin — The Trump administration is exploring ways to excuse more Americans from the requirement that they prove they're insured in the remaining months before the ACA's individual mandate is laid to rest. The Centers for Medicare and Medicaid Services is working on guidance expanding the "hardship" exemptions from the 2010 health care law's mandate that people purchase health plans, according to two people familiar with the effort. Agency officials haven't yet finalized the guidance, but aim to increase the number of reasons people could cite as justifications for not showing they're insured when they file their tax returns. 

• Few Doctors See Medicare Pay Bumps for Care Quality  Modern Healthcare by Virgil Dickson — Few doctors will benefit this year from a Medicare pay-for-performance program that promised more money if they hit key quality metrics in patient care. Only 20,000 clinicians will receive a pay bump of 6.6 percent to 19.9 percent this year based on how they performed in the final year of the value-based modifier program, which ended in 2016. However, "the overwhelming majority of clinicians received neutral payment adjustments," the Centers for Medicare and Medicaid Services (CMS) said in a notice. There are roughly 1.1 million clinicians that bill Medicare annually. CMS is withholding raises from some providers this year because they did not submit the data necessary to be evaluated. The agency estimates that nearly 300,000 clinicians failed to submit the data. In earlier years, these participating providers would have seen their pay reduced, but the 2018 physician-fee schedule gave these providers a pass and dictated that they would receive a neutral payment update instead.

• Price Spikes Drove Employer-Based Health Care Spending in 2016Modern Healthcare by Shelby Livingston — Employer-sponsored health care spending rose to its highest point in 2016 even though patients sought less health care.  The culprit? Rising health care prices, according to the latest annual report by the Health Care Cost Institute (HCCI). "Working Americans are using the same or less healthcare and are paying more and more for it every year," HCCI President Niall Brennan said. Spending per person in 2016 grew 4.6 percent to $5,407 over 2015. In 2015, spending grew 4.1 percent over the prior year. Healthcare spending per person has grown cumulatively by 15 percent over the entire study period of 2012 to 2016, according to the report released Tuesday.


• The Drug Industry's Two Big Trade Groups Set a New Record for Lobbying in 2017 STAT by Rebecca Robbins — The two big groups that lobby on behalf of drug companies set a new record for their collective spending in the first year of the Trump administration. Shelling out a combined sum of nearly $35 million to lobby the federal government in 2017, the Pharmaceutical Research and Manufacturers of America and the Biotechnology Innovation Organization upped their expenditures at a time when the sweeping tax overhaul was on the line and fears of a crackdown on drug pricing were top of mind. Remarkably, however, the record-setting spending push came in spite of the fact that neither group took a position on the biggest health policy story of the year, the long and steady Republican quest to repeal and replace the Affordable Care Act.

• Apple, in Sign of Health Ambitions, Adds Medical Records Feature for iPhone  New York Times by Natasha Singer — In the latest indication of Apple's growing ambitions in the digital health market, the tech giant on Wednesday unveiled a new feature that would allow users to automatically download and see parts of their medical records on their iPhones. The feature is to become part of Apple's popular Health app. It will enable users to transfer clinical data — like cholesterol levels and lists of medications prescribed by their doctors — directly from their medical providers to their iPhones, potentially streamlining how Americans gain access to some health information. A dozen medical institutions across the United States — including Johns Hopkins Medicine in Baltimore and Cedars-Sinai in Los Angeles — have agreed to participate in the beta version of the new feature. Apple plans to open the beta test to consumers on Thursday.

Editor: Peter Van Vranken