Welcome to the third issue of Headlines in Health Policy, a roundup of recent news about health coverage, health delivery system reform, and more.

• Republicans Aim to Start Obamacare Repeal in January Politico by Jennifer Haberkorn—Republicans on Capitol Hill are growing confident that they can begin to repeal Obamacare once President-elect Donald Trump is sworn in, along with a pledge to replace it later.  “I don’t have a lot of people in my district who are crying about the possibility of losing Obamacare. In fact, they’re cheering for it to go away,” said Rep. John Shimkus (R-Ill.), who is running to be chairman of the House Energy and Commerce Committee, which has jurisdiction over health care. “No one is banging on my door saying, ‘Save this program.’" .. “I don’t think we should take a lot of time,” said Sen. Orrin Hatch (R-Utah), chairman of the Senate Finance Committee. “We understand what the problems are and we know that Obamacare is a destructive force in America and almost everybody admits it.”
  
  
• Many in Florida Count on Obama’s Health Law, Even Amid Talk of Its Demise New York Times by Abby Goodnough—Florida helped hand Mr. Trump the presidency when he narrowly won the state, but it has also provided more customers for the federal health insurance marketplace than any other state. This makes Florida a window to the complex and delicate task Mr. Trump and congressional Republicans face in deciding whether to scrap the entire law, which has brought coverage to more than 20 million people, and what to replace it with.
  
  
• Trump Health Overhaul Could Follow Paul Ryan's Playbook NPR by Alison Kodjak—The absence of specifics on health care from the president-elect makes the 37-page plan that Speaker of the House Paul Ryan has released the fullest outline of what Republicans would like to replace Obamacare. Some health policy analysts say it looks a bit like Obamacare light. .. "Don't force people to buy insurance," Ryan told the crowd. "Make insurance companies compete for our business." "And, yes," he added, "we're going to help you buy insurance."
  
  
• Trump's Path on Health Care Law Intersects with a Lawsuit AP by By Ricardo Alonso-Zaldivar—President-elect Donald Trump says he wants to preserve health insurance coverage even as he pursues repeal of the Obama-era overhaul that provided it to millions of uninsured people. How his administration handles a pending lawsuit over billions of dollars in insurance subsidies will reveal whether Trump wants an orderly transition to a Republican-designed system or if he’d push “Obamacare” over a cliff. Stripping away the subsidies at issue in the case would put the program into a free-fall.

• Trump's Win Puts Medicaid Expansion on Hold in Red States Forbes by Bruce Japson—Several states led by Republican governors appear to be putting Medicaid expansion under the Affordable Care Act on hold given talk by the incoming administration of Donald Trump to scrap the law or move to federal block grants to cover poor Americans.  State elected officials in Idaho, Nebraska and South Dakota and political pundits in Georgia are saying talk of expanding Medicaid before the election has now subsided at least for the 2017 legislative sessions. That means more than 500,000 Americans will have to wait for health benefits.
  
  
• Major Changes For Medicaid Coming Under Trump And The GOP CNN by Tami Luhby—Donald Trump likely won't let Medicaid collapse, but he will vastly change the health insurance program for low-income Americans. Think less federal funding, more state control, fewer participants and higher costs for those in the program. "You cannot let people die on the street, ok?," he said at a CNN town hall in February. "The problem is that everybody thinks that you people, as Republicans, hate the concept of taking care of people that are really, really sick and are gonna die. We gotta take care of people that can't take care of themselves."  But he also championed turning much of the program over to the states. Instead of funding the program through a federal match based on enrollment, Trump would give states a fixed amount of money, known as a block grant, and let them administer it. His presidential transition platform calls for maximizing state flexibility, enabling them "to experiment with innovative methods to deliver healthcare to our low-income citizens."
  
  
• Many Insured Children Lack Essential Health Care, Study Finds New York Times by Marc Santora—A new study to be released on Monday by the Children’s Health Fund, a nonprofit based in New York City that expands access to health care for disadvantaged children, found that one in four children in the United States did not have access to essential health care, though a record number of young people now have health insurance. The report found that 20.3 million people in the nation under the age of 18 lack “access to care that meets modern pediatric standards.” … While Medicaid and many private insurance plans recommend or require that all of those services be provided, under the umbrella of what is known as the medical home, the study found that millions of insured children are not receiving many of the benefits.

• Battle to Change Medicare Is Brewing, Whether Trump Wants It or Not New York Times by Robert Pear—Donald J. Trump once declared that campaigning for “substantial” changes to Medicare would be a political death wish. But with Election Day behind them, emboldened House Republicans say they will move forward on a years-old effort to shift Medicare away from its open-ended commitment to pay for medical services and toward a fixed government contribution for each beneficiary… Democrats will “stand firmly and unified” against Mr. Ryan if he tries to “shatter the sacred guarantee that has protected generations of seniors,” said Representative Nancy Pelosi of California, the Democratic leader.
  
  
• Not Just Obamacare: Medicaid, Medicare Also on GOP’s Chopping Block Huffington Post by Jonathan Cohn and Jeffrey Young—Donald Trump and Republican leaders in Congress have made clear they are serious about repealing Obamacare, and doing so quickly. But don’t assume their dismantling of government health insurance programs will stop there. For about two decades now, Republicans have been talking about radically changing the government’s two largest health insurance programs, Medicaid and Medicare… House Speaker Paul Ryan (R-Wis.) has championed these ideas for years. Trump has not. In fact, in a 2015 interview his campaign website highlighted, he vowed that “I’m not going to cut Medicare or Medicaid.” But the health care agenda on Trump’s transition website, which went live Thursday, vows to “modernize Medicare” and allow more “flexibility” for Medicaid.

• Trump Just Dropped a Big Hint to the Pharmaceutical Industry The Washington Post by Carolyn Y. Johnson—A single sentence in President-elect Donald Trump's health care platform sends a strong hint to the drug and medical device industry that they may have an easier time getting their products on the market under his administration. “Reform the Food and Drug Administration, to put greater focus on the need of patients for new and innovative medical products,” his health plan states.  ...“The language … is industry code for deregulation and reducing of safety standards,” said Robert Weissman, president of Public Citizen, a consumer watchdog. “Of course, the general deregulatory rhetoric from candidate Trump is a worry for us, but as applied to FDA, it would be very troubling.”
  
  
• High-Dollar Prescribers Proliferate in Medicare’s Drug Program ProPublica by Charles Ornstein and Ryann Grochowski Jones—The number of doctors who each prescribe millions of dollars of medications annually in Medicare’s drug program has soared, driven by expensive hepatitis C treatments and rising drug prices overall, federal data obtained by ProPublica shows. The number of providers who topped the $5 million mark for prescriptions increased more than tenfold, from 41 in 2011 to 514 in 2015. The number of prescribers—mostly physicians but also nurse practitioners—exceeding $10 million in drug costs jumped from two to 70 over the same time period, according to the data.
  
  
• Drug Prices Don’t Budge Even After Pressure from Congress AP by Matthew Perrone—Congress's routine of publicly shaming drug company executives over high prices works no better than a placebo: It may make some people feel better, but it doesn't treat the problem.  In the last two years, House and Senate committees issued more than a dozen subpoenas to price-hiking drugmakers, collecting hundreds of thousands of documents and berating executives for more than 16 hours of public hearings. But a review by The Associated Press of the list prices of nearly 30 brand-name medications and generic versions targeted by congressional investigators shows most haven't budged since coming under federal scrutiny, according to figures from Truven Health Analytics. "These companies have made clear that they are not going to change course on their own—they will keep bilking the American people for all they can unless Congress acts," said Rep. Elijah Cummings, D-Maryland, the ranking member on the House Committee on Oversight and Government Reform.

• Commonwealth Fund Says Americans Are Sicker, Skip Care More Than Citizens of Other High-Income Nations Modern Healthcare by By Shelby Livingston—Despite major coverage expansions under the Affordable Care Act, Americans are sicker and have more trouble affording care than 10 other high-income countries, a new survey shows. Moreover, almost half of the poorest U.S. adults can't get the care they need, and many resort to the emergency room for treatment, according to the Commonwealth Fund study.  The non-partisan group surveyed almost 27,000 adults across 11 high-income countries about their health and experience with their country's healthcare system. The nations surveyed included Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Read: In New Survey of 11 Countries, U.S. Adults Still Struggle with Access to and Affordability of Health Care
  
  
• How AHRQ's Low Profile Threatens Work on Health Care Best Practices Modern Healthcare by  Elizabeth Whitman—AHRQ—pronounced “arc” by wonks—is quietly lauded by fans and vocally scorned by detractors. Its mission of figuring out how to improve the healthcare system is all the more daunting for its relatively puny annual budget that for several years has hovered around $430 million. But research supported by AHRQ, sometimes solely so, has transformed the underpinnings of a sector that not only directly manages life and death but also encompasses nearly one-fifth of the U.S. economy. The HHS agency's anonymity might be inherent in the nature of its work, but its obscurity has serious implications as federal healthcare policy is thrown into tumult with the election of Donald Trump to the presidency. “If an airbag goes off in your car, you know it saved your life,” said Michael Millenson, a national healthcare consultant who also teaches at Northwestern University's Feinberg School of Medicine. “If a physician does a checklist before your surgery and finds a problem that could've killed you, not only will you not see it because you're asleep, but nobody will attribute that to a government effort to get checklists used in operating rooms.”

"It would be critically important to have sufficient transition time, and I doubt that one year is enough…It's enormously important for the incoming administration and Congress to be very clear about their intentions" 

—Ceci Connolly, CEO of Alliance of Community Health Plans

“The question I think we all have is, how do they transition out of it? How do they do it without dumping millions of people off the edge of a cliff?”

—Jay Wolfson, a professor of public health and medicine at the University of South Florida