• Obamacare Fight Could Threaten Shutdown Deal The Hill by Nathaniel Weixel — A fight over ObamaCare is spilling into Congress’s December agenda, threatening lawmakers’ ability to keep the government open. President Trump signed stopgap legislation Friday aimed at averting a shutdown and keeping the government funded through Dec. 22. The bill allows lawmakers to focus on the next — and seemingly more difficult — negotiating period. Lawmakers on both sides of the aisle have a host of priorities they want to include in the bill, but the question of funding ObamaCare’s cost-sharing reduction (CSR) payments appears to have divided Republicans.  Senate Republicans want to include the cost-sharing payments in the spending package, but House conservatives have little interest in funding subsidies they see as bailing out a law they despise. Senate Republican leaders view the payments as a necessary bargaining chip. In order to pass their tax-reform bill and get a much-needed legislative victory, Senate Majority Leader Mitch McConnell (R-Ky.) made a deal with Sen. Susan Collins (R-Maine), a key swing vote.
  
  
• Tax Bill Is Likely to Undo Health Insurance Mandate, Republicans Say New York Times by Robert Pear and Thomas Kaplan — House and Senate negotiators thrashing out differences over a major tax bill are likely to eliminate the insurance coverage mandate at the heart of the Affordable Care Act, lawmakers say. But a deal struck by Senate Republican leaders and Senator Susan Collins of Maine to mitigate the effect of the repeal has been all but rejected by House Republicans, potentially jeopardizing Ms. Collins's final yes vote. "I don't think the American people voted for bailing out big insurance," said Representative Dave Brat, Republican of Virginia, who opposes a separate measure to lower insurance premiums that Ms. Collins thought she had secured.
  
  
• Health Care Lobbyists Not Optimistic on Changing GOP Tax Bill Modern Healthcare by Harris Meyer — Health care lobbyists are scrambling to win changes in congressional Republican tax legislation, as Senate and House GOP leaders race to merge their separate bills into something both chambers can pass on a party-line vote this month. But provider, insurer, and patient advocacy groups doubt they can convince Republicans to remove or soften the provisions they find most objectionable. They say GOP leaders are moving too fast and providing too little opportunity for health care stakeholders to provide input. "It's a madhouse," said Julius Hobson, a veteran healthcare lobbyist with the Polsinelli law firm. "What you worry about is this will get done behind closed doors, even before they start the conference committee process." 

• Democrats Rip 'Highly Partisan' Bill to Fund Children's Insurance The Hill by Nathaniel Weixel — Nearly 100 House Democrats are urging congressional leaders to pass a bipartisan extension of the Children’s Health Insurance Program (CHIP). In a letter sent Friday, 99 House Democrats urged leaders of the House and Senate to reject the House-passed CHIP extension and instead work on a bipartisan solution. The letter dismissed the House effort as a "highly partisan bill" that "seeks to provide healthcare for some at the expense of others, undermining CHIP's mission." Federal funding for CHIP expired in September. The Democrats said they want Congress to pass a five-year extension without any partisan funding offsets.
  
  

• The CHIP Program Is Beloved. Why Is Its Funding in Danger? New York Times by Abby Goodnough and Robert Pear — But CHIP, a program that has had unusually strong bipartisan support since it was created in 1997, is now in limbo — an unexpected victim of the partisan rancor that has stymied legislative action in Washington this year. Its federal funds ran out on Sept. 30, and Congress has not agreed on a plan to renew the roughly $14 billion a year it spends on the program. Congressional leaders may provide some temporary relief to a handful of states that expect to exhaust their CHIP funds before the end of this year. It would be tucked into a short-term spending bill intended to avert a government shutdown after Friday. Lawmakers from both parties hope to provide more money for CHIP in a separate, longer-term deal on federal spending. But Republicans will almost surely need Democratic votes to pass such legislation, and the antagonism between President Trump and Democrats in Congress is so great that no one can be sure of the outcome.

• CVS Likely Wants FTC Antitrust Review, Not Justice Department, of Aetna Deal Reuters by Diane Bartz — It is uncertain who in the U.S. government will carry out an antitrust review of CVS Health Corp.'s deal to buy health insurer Aetna Inc, but the drugstore company is likely hoping the potentially more lenient Federal Trade Commission gets the nod, antitrust experts say. The Justice Department's Antitrust Division and Federal Trade Commission share the job of reviewing mergers to make sure they don't hurt consumers, but sometimes it comes down to a coin toss as to who reviews a deal that involves both agencies' areas of expertise.  The Justice Department might be best-placed since it recently reviewed, and stopped, two insurance industry tie-ups, including Aetna's plan to buy rival Humana Inc.
  
  
• Wall Street Is Wary of an Untested Strategy in CVS-Aetna Megamerger Bloomberg by Zachary Tracer — The success of CVS Health Corp.'s $67.5 billion acquisition of health insurer Aetna Inc. rides on a bet on a complex and untested strategy, and some in Wall Street are questioning whether the companies can pull it off. CVS plans to build mini health centers in some of its 9,700 stores, turning them into key locations where Aetna members — and customers of rival insurers — get low-level care for ailments and chronic diseases. Already, CVS has 1,100 MinuteClinics in its pharmacies, and is testing out hearing and vision offerings in a handful of locations. "The strategy seems logical, but we believe there will be considerable execution risk for the combined companies," Steve Halper of Cantor Fitzgerald said in a Dec. 4 research note. "Given the prolonged regulatory process, we do not expect any changes (if any) in the competitive landscape until the 2020 coverage plan year."

• Study: States Get Big Medicaid Savings from Social Services, Outreach to Sickest Patients USA Today by Jayne O'Donnell  — Some states have achieved dramatic savings in health care costs for their sickest Medicaid patients by providing intensive one-on-one assistance and social services that help the patients better address their multiple, overlapping ailments. A report out Tuesday by the National Governors Association found states may be able to save more than $2 for every dollar they spend dealing with these so-called health care super-utilizers' more basic social needs.  Ten states and Puerto Rico are part of a national pilot project to target and coordinate the health care and social services needs of these patients to save money and improve health. Among the early findings, emergency room usage dropped by 25% in Alaska among those who received face-to-face outreach in their communities, the report shows.
  
  
• Poor Health and High Expectations for Medicaid Associated Press by Ricardo Alonso-Zaldivar — It's one of Medicaid's challenges. While low-income people are more likely to struggle with health problems such as smoking and depression, new research shows many are motivated to improve. Thursday's study from the Gallup-Sharecare Well-Being Index found that 40 percent of people on Medicaid say they're in fair or poor health, compared with 11 percent of those with workplace coverage. The analysis for The Associated Press also showed that Medicaid recipients are invested in their health, with 4 out of 5 saying they have a personal doctor, 3 out of 5 saying they eat healthy, and nearly half saying they exercise frequently.  Still, survey director Dan Witters said that's only half the story. "Just because they smoke more, doesn't mean that they don't have an interest in their health," Witters said of those with Medicaid. "Their interest in their health is generally just as high as it is for other groups ... although I think they are swimming upstream."

• Enrollment in ACA Marketplaces Brisk Yet Lags Last Year's Total as Deadline Nears Washington Post by Amy Goldstein — The number of Americans getting Affordable Care Act (ACA) health plans for the coming year accelerated last week in states relying on the federal insurance exchange, bringing the total to 3.6 million sign-ups with less than two weeks left in an abbreviated enrollment season. The latest federal snapshot, coming amid fresh political turbulence over the future of insurance marketplaces created under the law, is slightly ahead of the first five weeks' pace last fall. But compared with data from two-thirds of the way through the longer enrollment seasons of past years, the number of consumers who have chosen health plans is lagging far behind. The 3.6 million figure is half of the total at the comparable point in the sign-up period for 2017 coverage, according to an analysis by the Washington-based consulting firm Avalere Health. To reach the 9.2 million enrollees that states relying on the federal marketplace had by the final deadline, a huge surge of people would need to take action by the time the season concludes on Dec. 15 or be automatically re-enrolled just afterward.
  
  
• Deadline Week Crunch for Health Law Sign-Ups Under Trump Associated Press by Ricardo Alonso-Zaldivar — The Trump administration came into office looking to dismantle Barack Obama’s health care law, but the ACA survived. Now the administration is on the hook to deliver a smooth ending to sign-up season, with a crush of customers expected this week. For millions of eligible consumers time runs out on Friday. Dec. 15 is the last day for procrastinators to enroll in subsidized private coverage in 39 states served by the federal HealthCare.gov website. Consumer interest has remained brisk, even as the Trump administration cut the sign-up season in half, reducing it from roughly from 90 days to 45 days. “It’s more likely than ever that they’re going to run into real volume problems in the last week because that’s when everybody is going to show up,” said Tim Jost, a legal analyst who closely follows the workings of the ACA.

• Pace of U.S. Health Spending Slows in 2016 Kaiser Health News by Phil Galewitz — U.S. health spending rose to $3.3 trillion in 2016, but the pace slowed compared to the previous two years as demand for drugs, hospital care and physician services weakened, according to a federal study released Wednesday. The analysis from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) showed a shift from the dramatic escalation in health spending that accompanied the coverage gains in 2014 and 2015 as millions of Americans found insurance under the Affordable Care Act. The rate at which spending grew last year was lower across many measures — including figures for Medicare, Medicaid, private insurance, prescription drugs and hospitals — than in the previous two years.
  
  
• Out-of-Pocket Health Spending in 2016 Increased at the Fastest Rate in a Decade Washington Post by Carolyn Y. Johnson — U.S. health care spending increased to $3.3 trillion in 2016, with out-of-pocket health care costs borne directly by consumers rising 3.9 percent — the fastest rate of growth since 2007. The findings, published Wednesday by Health Affairs, are considered the authoritative breakdown of American health care spending and are prepared each year by the Centers for Medicare and Medicaid Services.

Editor: Peter Van Vranken