"We are the wealthiest nation on earth, but far from the healthiest, and things are getting worse, not better. The CDC report is yet another call to action for fundamental health system change that should include, among other things, reforming our pharmaceutical markets and making good
health insurance available to all Americans."  

• Trump's Move to Make Skimpier Health Plans More Available Threatens to Undermine Obamacare Los Angeles Times by Noam Levey — The Trump administration moved Thursday to further loosen regulations on health insurance plans, taking a modest step toward the president's oft-stated goal of rolling back requirements imposed by the Affordable Care Act that many Republicans blame for high premiums. The proposed rules posted Thursday by the Department of Labor would make it easier for self-employed Americans, small businesses and others to band together to get health insurance through what are called association health plans. … "The rule proposed today will almost certainly result in more people facing financial distress when an unexpected health crisis happens and they discover their association health plan coverage is inadequate," said Chris Hansen, president of the advocacy arm of the American Cancer Society, The proposed rules on association health plans are open for public comment for the next 60 days, after which they may be adjusted before becoming final.
  
  
• Credit Rater Predicts Stable Year for Obamacare Markets The Hill by Jessie Hellmann — The ObamaCare insurance markets will be relatively stable through 2018, analysts predicted Wednesday. Insurers have adapted to the uncertainty surrounding the Trump administration's handling of the law, A.M. Best, a global credit rating organization, wrote in a briefing released Wednesday. It said insurers should have a stable 2018.  The analysts had previously predicted a negative outlook for insurers in 2018. Insurers benefited from high rate increases, limited competition and narrow provider networks in 2016 and 2017, the analysts note, as well as a stabilizing exchange population between sick and healthy customers. The analysts said while issues could arise if Republicans try to repeal and replace Obamacare again, they believe Congress will focus on other issues this year. 

• House GOP Whip: Entitlement Reform, ObamaCare Repeal on 2018 AgendaThe Hill by Jessie Hellmann — Obamacare repeal and entitlement reform are at the top of the agenda for House Republicans in 2018, Majority Whip Steve Scalise (R-La.) said Tuesday. "The next big thing you're going to see is a need for workers, and I think the next thing we can do is to go and reform those welfare programs that are trapping people in a failed welfare state," Scalise said on Tuesday morning.  "Let's actually put some work requirements in place so that we can get people back to work, rebuild the middle class." House Speaker Paul Ryan (R-Wis.) has said recently that Republicans will focus on giving states "more flexibility in Medicaid," which could involve allowing them to impose work requirements on recipients. 



• On Health Care, Democrats Are Shifting to Offense Associated Press by Ricardo Alonso-Zaldivar — Democrats are shifting to offense on health care, emboldened by successes in defending the Affordable Care Act. They say their ultimate goal is a government guarantee of affordable coverage for all. With Republicans unable to agree on a vision for health care, Democrats are debating ideas that range from single-payer, government-run care for all, to new insurance options anchored in popular programs like Medicare or Medicaid. There's also widespread support for authorizing Medicare to negotiate prescription drug prices, an idea once advocated by candidate Donald Trump, which has languished since he was elected president. .. “We’re tired of just playing defense,” said Sen. Tim Kaine, D-Va., the party’s 2016 vice presidential candidate. “It is now time to talk about the next big idea. It is a good time for everybody to put their big ideas on the table.” His offering: “Medicare-X,” a public insurance plan to be initially deployed in communities that lack private insurer competition

• CHIP Funding Could Run Out On Jan. 19 For Some States NPR Shots by Phil Galawitz — Some states are facing a mid-January loss of funding for their Children's Health Insurance Program despite spending approved by Congress in late December that was expected to keep the program running for three months, federal health officials said Friday. The $2.85 billion was supposed to fund states' CHIP programs through March 31. But some states will start running out of money after Jan. 19, according to the Centers for Medicare and Medicaid Services (CMS). CMS did not say which states are likely to be affected first.

• Seven Key Changes the New Tax Law Will Force Hospitals to Consider  Modern Healthcare by Harris Meyer — The end of the year is always a busy time for health care finance and tax professionals. But with the Dec. 20 passage of the Tax Cuts and Jobs Act — details of which were unveiled only several days earlier—it's crazy busy. Tax professionals are scrambling to understand the complex, often-confusing provisions of the hastily written law while trying to do tax planning for hospitals, medical groups, and other health care clients. The law's generous new break for pass-through entities is a particular head-scratcher. Not-for-profit hospital systems will have to grapple with a number of changes that make their tax-exempt status less advantageous, including new provisions on unrelated business taxable income and executive compensation.

• Trump Poised to Take Action on Medicaid Work Requirements The Hill by Peter Sullivan — The Trump administration is preparing to release guidelines soon for requiring Medicaid beneficiaries to work, according to sources familiar with the plans, a major shift in the 50-year-old program. The guidelines will set the conditions for allowing states to add work requirements to their Medicaid programs for the first time, putting a conservative twist on the health insurance program for the poor. Democrats are gearing up for a fight, likely including lawsuits, arguing the administration is trying to undermine Obamacare's Medicaid expansion on its own after Congress failed to repeal the health care law.  

• Trump's Firing Sets Back AIDS Prevention Efforts Politico by Brianna Ehley — President Donald Trump's decision to fire his HIV/AIDS advisory panel and refusal to fill other key policy positions puts the U.S. at risk of slipping backward on prevention just as the opioid epidemic threatens to spread the virus among intravenous drug users. The advisory panel, which has existed in some form since the Reagan years, sits empty after Trump removed all 16 of its remaining members last week. That, combined with proposed massive cuts to prevention programs in Trump's fiscal 2018 budget and his not naming a director for the White House Office of National AIDS Policy, sends troubling signals about the administration's commitment and represents a marked departure from his predecessors, say advocates and lawmakers. 

• Drug Prices Rise as Pharma Profit Soars Modern Healthcare by Alex Kacik — The amount of money people spend on prescription drugs has nearly doubled over the past three decades as pharmaceutical sales and profit margins have ballooned, according to a government report. Retail prescription drug expenses accounted for about 12 percent of total U.S. healthcare spending in 2015, up from about 7 percent through the 1990s. Pharmaceutical and biotechnology sales revenue increased from $534 billion to $775 billion between 2006 and 2015, according to a recent report from the U.S. Government Accountability Office. About two-thirds of drug companies saw their profit margins increase over that period, averaging 17.1 percent.  "Drug companies raise prices far exceeding inflation because they can," said Scott Knoer, chief pharmacy officer at Cleveland Clinic. "In the absence of regulation and without consumer awareness—since consumers don't generally see the price due to insurance—the sky is the limit." Ultimately, all of these costs are passed on to the government, insurance companies, patients and taxpayers, he added.

Editor: Peter Van Vranken