• Hopes Fade That Congress Will Stabilize Obamacare New York Magazine by Ed Kilgore — Remember "Obamacare stabilization," one of the great bipartisan causes of 2017? Mostly in response to the president's suspension of so-called cost-sharing-reduction reimbursements to insurers required to limit the out-of-pocket costs to low-income participants in the Obamacare markets, legislation developed by Senators Lamar Alexander and Patty Murray developed a real head of steam in the Senate, until opposition from House Republicans and the White House stalled its momentum. Then in December, Senator Susan Collins got assurances from both Mitch McConnell and the president that both the Alexander-Murray legislation and a bill she co-sponsored with Florida Democrat Bill Nelson giving states money to set up reinsurance pools for high-cost Obamacare patients would be included in an omnibus spending bill that was being negotiated. Collins gave Republicans a critical vote for their tax bill in no small part due to these assurances. Well, nearly three months later, the promises to Collins have yet to be kept; the only real excuse is that Congress has passed a series of short-term spending measures, with the real omnibus appropriations bill still being negotiated in advance of a pretty serious March 23 deadline. But the odds of Obamacare stabilization legislation making it into this package are definitely fading. For one thing, House Republicans are now demanding strict language prohibiting use of any Obamacare subsidy dollars for purchase of private insurance policies covering abortion services.
  
  

• Lamar Alexander Seeks Support for Obamacare Stabilization Plan Washington Times by Tom Howell Jr. — With time running out, Sen. Lamar Alexander is pleading with Congress to rally behind his Obamacare-stabilization plan for two simple reasons — it will slash premiums, and it pays for itself. The Congressional Budget Office estimates that a bipartisan plan to restore insurer payments that President Trump canceled last year, and free up billions of dollars to subsidize super-costly enrollees, would cut consumers' premiums by 10 percent nationwide next year. States that win waivers to allow alternative health plans could cut their consumers' premiums by 20 percent in 2020 and 2021, the CBO said in its preliminary evaluation of Mr. Alexander's bill. The Tennessee Republican said it's critical to do something as part of this week's must-pass spending bill before insurance companies set their 2019 prices, which could shock consumers this fall. "They'll be announced on October 1. About a month before the next election. There are a lot of people who are going to be looking at that," Mr. Alexander said. The senator has been pushing for months for some version of the plan he crafted with Sen. Patty Murray, Washington Democrat, that would pay insurers billions of dollars a year in "cost-sharing reductions" (CSRs) to cover poor customers' out-of-pocket costs.
  
  

• Shutdown Looming, Congress and White House Seek Budget Deal Associated Press by Andrew Taylor — Congressional leaders and the White House are pressing to strike an accord on a $1.3 trillion catchall spending bill, though disputes remain over immigration, abortion, and a massive rail project that pits President Donald Trump against his most powerful Democratic adversary. ...While most of the funding issues in the enormous measure have been sorted out, fights involving a number of policy "riders" — so named because they catch a ride on a difficult-to-stop spending bill — continued into the weekend. Among them are GOP-led efforts to add a plan to revive federal subsidies to help the poor cover out-of-pocket costs under President Barack Obama's health law and to fix a glitch in the recent tax bill that subsidizes grain sales to cooperatives at the expense of for-profit grain companies.
  
  

• Obamacare Insurers Just Had Their Best Year Ever — Despite Trump Politico by Paul Demko — Obamacare is no longer busting the bank for insurers. After three years of financial bloodletting under the law — and despite constant repeal threats and efforts by the Trump administration to dismantle it — many of the remaining insurers made money on individual health plans for the first time last year, according to a POLITICO analysis of financial filings for 29 regional Blue Cross Blue Shield plans, often the dominant player in their markets. The biggest reason for the improvement is simple: big premium spikes. The Blue plans increased premiums by more than 25 percent on average in 2017, meaning many insurers charged enough to cover their customers' medical costs for the first time since the Affordable Care Act marketplaces launched in 2014 with robust coverage requirements.…The healthier balance sheets are a welcome development for insurers after three years of major Obamacare losses, estimated at more than $15 billion by McKinsey.

• The Real Reason the U.S. Spends Twice as Much on Health Care as Other Wealthy Countries Washington Post by Carolyn Y. Johnson — A sweeping new study of health-care expenditures found that the United States spends almost twice as much on health care as 10 other wealthy countries, a difference driven by high prices — including doctors' and nurses' salaries, hospital charges, pharmaceuticals and administrative overhead. For years, it has been clear that Americans are not getting a good bang for their buck on health care. The United States spends more than any other country and gets much less, at least as measured by life expectancy or infant mortality. Policy fixes have tended to focus on the idea that medicine is being overused. The thinking goes that the American health care system is uniquely set up to incentivize wasteful imaging scans, oodles of unnecessary prescriptions, and procedures that could have been prevented. The new study, published in the Journal of the American Medical Association, suggests instead that Americans are using health care at similar rates to other rich countries, and the real difference is the prices of procedures and treatments.

• Trump Administration to Seek Stiffer Penalties Against Drug Dealers, Reduce Opioid Prescribing  Washington Post by Katie Zezima — The Trump administration said it will seek stiffer penalties against drug dealers — including the death penalty where appropriate under current law — and it wants the number of prescriptions for powerful painkillers to be cut by one-third nationwide as part of a broad effort to combat the opioid crisis. Administration officials said Sunday that the measures are part of a three-pronged approach to fighting the opioid epidemic, which killed tens of thousands of people in 2016. The White House said it aims to reduce the demand for opioids by slowing overprescribing, cutting off the supply of illicit drugs, and helping those who are addicted. The White House said it wants people who deal fentanyl, a powerful synthetic opioid that has caused deaths to skyrocket nationwide, to be prosecuted more aggressively. The administration had considered making trafficking large quantities of fentanyl a capital crime, because tiny amounts can kill many people, but it said Sunday that the Justice Department will seek capital punishment for drug traffickers under current federal law.

• Trump Wants to Liberalize Health Data. Easier Said than Done Vox by Sara Kliff — The Trump administration appears to be taking on one of the thorniest issues in American medicine: giving patients control of their own health care data. About a week ago, Medicare administrator Seema Verma announced a new initiative called MyHealthEData. The program, according to trade publication Becker's Hospital Review, aims to "enable patients to both electronically receive a copy of their health record and share their data with whomever."
  
  "We don't expect Amazon and Walmart to share background on their customers, but we do expect competing hospital systems to do so," David Blumenthal, who coordinated health policy for the Obama administration from 2011 to 2013, told me late last year. "Those institutions consider that data proprietary and an important business asset. We should never have expected it to occur naturally, that these organizations would readily adopt information exchange."

• Senate Lays Groundwork for 340B Reporting Legislation Modern Healthcare by Susannah Luthi — Senators on Thursday signaled their chamber will join the U.S. House of Representatives to push hospitals to report where they direct their 340B drug discounts, wading into the fierce lobbying battle between Big Pharma and hospitals that has been waging for months. In an often-contentious Senate Health, Education, Labor & Pensions Committee hearing Thursday, Chair Lamar Alexander (R-Tenn.) made it clear he wants to know where hospitals and clinics are applying the discounts they get from drugmakers, how much of the discounts go directly to patients and which kinds of programs the providers are funding for patients with the money that isn't directly passed on. "That could lead to question of whether we could restrict [where the money goes]," Alexander said. "But one way to avoid restrictions is to help us know better what the money is going for."

• Gun Violence Research Gets Little Support, So States Step In  Washington Post by Michael Ollove — As deaths from mass shootings have mounted across the United States, some states are moving to collect hard data to guide their decisions about guns — even as the federal government has retreated from such research in the face of pressure from pro-gun groups. The New Jersey legislature, for example, is weighing a measure that would create a gun-violence research center at Rutgers University. The center would be modeled on the new Firearm Violence Prevention Research Center at the University of California at Davis, which launched last summer with $5 million in state money over five years. The impetus for both initiatives is a vacuum created by the federal government's virtual abandonment of research into gun violence — its causes, its patterns, its perpetrators, its victims and the best ways, based on scientific evidence, to curtail it.
  
  
• Congress Quashed Research Into Gun Violence. Since Then, 600,000 People Have Been Shot  New York Times by Sheila Kaplan — The NRA pushed Congress in 1995 to stop the Centers for Disease Control and Prevention (CDC) from spending taxpayer money on research that advocated gun control. Congress then passed the Dickey Amendment in 1996, and cut funding that effectively ended the CDC's study of gun violence as a public health issue. The result is that 22 years and more than 600,000 gunshot victims later, much of the federal government has largely abandoned efforts to learn why people shoot one another, or themselves, and what can be done to prevent gun violence. The Dickey Amendment technically did not ban gun research, only advocacy. Its real goal — one it easily achieved, according to public health officials in place at the time — was to scare federal agencies into thinking twice about even collecting data that might reflect badly on gun ownership.

Editor: Peter Van Vranken