– Letter to congressional leaders from a bipartisan group of 12 governors

• Health Law Sign-up Deadline Extended for Some People  AP — After a rush of last-minute sign-ups, the Trump administration says it's extending the deadline for some people to finish health insurance applications for next year under the Affordable Care Act. Callers to the HealthCare.gov service center on Saturday morning got a recorded message saying "don't worry" — if they'd called and left their phone number before the deadline, they'll get a call back and still can enroll for 2018. HealthCare.gov issued similar extensions previously under the Obama administration.  Although the deadline has passed for most consumers in the 39 states served by HealthCare.gov, several states running their own enrollment websites have longer deadlines. Also, longer sign-up periods are available on HealthCare.gov for people in special circumstances, including those affected by this year's hurricanes.
  
  
• Obamacare Expected to Suffer Enrollment Decline as Trump Cuts Timeframe The Hill by Rachel Roubein and Jessie Hellmann — Fewer people are expected to sign up for Obamacare coverage ahead of Friday's deadline to enroll in the exchanges. The Trump administration's abbreviated enrollment period has left advocates acknowledging the numbers are almost surely going to be lower than the 9.2 million who signed up on HealthCare.gov at the end of the last open enrollment season. It's not clear how much the numbers will drop.…"The open enrollment period is shorter than prior years, so the pace of enrollment has to be more rapid for us to even have stable enrollment in the program," said Dan Mendelson, president of Avalere, a health-care consulting company in Washington, D.C. "If you normalize for the fact that it's a shorter period, sign-ups are running behind for what they were last year.

• Health Program for 9 Million Kids Falls Victim to Partisan Squabbling  Politico by Jennifer Haberkorn — It's a mess that can happen only in Washington — Everyone in Congress claims to be a champion of children's health. But funding for the Children's Health Insurance Program ran out Sept. 30. And some lawmakers worry it might not be replenished until early next year. It's a mess that can happen only in Washington: Even a bipartisan program that covers 9 million poor and middle-class children is caught up in partisan squabbling, with Republicans and Democrats split over how to pay for renewed funding and placing blame on the other party. But with unified GOP control of the government, voters and the program's enrollees — who are beginning to get notices that money could be running out — could hold Republicans responsible if the program remains in limbo. The nearly three-month funding lapse has raised the profile of a program that's spent most of the year in the shadows of Republican efforts to overhaul the tax code and fund the government. Late-night host Jimmy Kimmel this week called for CHIP funding while holding his young son, who just went through heart surgery. So did Alabama's Sen.-elect Doug Jones, who used his victory speech Tuesday night to urge lawmakers to address CHIP before he is seated in Washington.
  
  
• Parents Worry Congress Won't Fund the Children's Health Insurance Program NPR by Alison Kodjak — Pennsylvania's CHIP program is forecast to run out of money in February. Though 9 million kids across the U.S. get their health insurance through CHIP, Congress let the program expire Sept. 30. Since then, states have been burning through the cash that remains in their CHIP accounts, and parents, doctors and state officials are wondering whether Congress will save what has traditionally been a popular program with strong bipartisan support. "CHIP is probably one of the most successful government programs we've enacted in the last couple of decades," says Timothy McBride, a professor of health economics at Washington University in St. Louis and chairman of that state's Medicaid oversight committee, which also oversees CHIP.

• Actuaries Warn of Premium Increases from Repealing Obamacare Mandate The Hill by Peter Sullivan — A group of insurance experts is warning Congress against repealing Obamacare's individual mandate, saying the move would raise premiums and could cause insurers to drop out of the market. The American Academy of Actuaries wrote to congressional leaders on Tuesday saying that "eliminating the individual mandate would lead to premium increases." The Republican tax-reform bill which is nearing completion in Congress would repeal the Obamacare mandate that people have health insurance or pay a fine. Republicans argue the measure included in the Senate-passed bill is tax relief by removing a penalty for low-income people who choose not to buy insurance. .. The insurance experts also say that a measure pushed by Sen. Susan Collins (R-Maine), intended to help offset the premium increases from repealing the mandate, would not be enough to make up the difference.
  
  
• Obamacare Mandate Repeal Would Put Pressure on States The Hill by Nathaniel Weixel — The expected repeal of the Obamacare mandate to buy health insurance means that states will soon have to step in and decide whether to create their own mandates. The requirement that everyone must purchase insurance or pay a fine is a bedrock principle of Obamacare, but it's also one of the most unpopular parts of the law. GOP leaders have tried for years to find a way to repeal it, arguing that it's an unaffordable burden on working class Americans. Now, by including a provision that eliminates the penalty in the tax bill, Republicans are on the cusp of achieving a major legislative victory. Outside experts and supporters of Obamacare predict chaos in the insurance markets if the tax bill passes and the mandate is repealed.  Premiums are expected to rise significantly and insurers could leave the marketplace. The Congressional Budget Office estimated that about 13 million more people would be without insurance in 10 years.
  
  
• House GOP Lawmakers Look to Delay Cadillac Tax, Other ACA Taxes Modern Healthcare by Susannah Luthi — The Affordable Care Act taxes are all on the U.S. House of Representatives' chopping block. Republicans on the House Ways and Means Committee introduced a bundle of bills on Tuesday to delay the Cadillac tax, employer mandate, and other taxes that health care industry groups have opposed. The employer mandate gets a retroactive repeal from 2015 and a delay through 2018; this measure is paired with a one-year delay of the Cadillac tax. While the Cadillac tax isn't slated to take effect until 2019, critics say that employees of companies with high-cost plans will see the effects next year as impacted carriers begin to raise rates. The employer mandate takes more immediate effect: In November, the IRS updated its website with instructions for employers as the agency planned to start collecting the penalties at the end of this year.
  
  
• Obamacare Is Helping Patients Get to the Doctor and Pay Their Medical Bills, New Report Finds Los Angeles Times by Noam Levey — Fewer Americans are putting off doctor visits or struggling with medical bills, according to a new report examining the effect of the Affordable Care Act. The report  — based on a state-by-state survey of data collected by the federal government — provides powerful new evidence that insurance gains made through the 2010 healthcare law are helping millions of patients get needed medical care. And the report's findings, which parallel a growing body of research into the law's effect, undercut arguments by the Trump administration and congressional Republicans who have tried to discredit and roll back the law. "The Affordable Care Act has put access to healthcare in reach for millions of Americans, particularly for people in states that embraced the law," conclude the authors of the report, published by the nonprofit Commonwealth Fund.

• Senate Republicans Are Divided Over Whether to Pursue Medicare Cuts in 2018  Washington Post by Jeff Stein — Senate Republicans are divided over whether they should use the months before the 2018 elections trying to cut spending on social programs, including Medicare. Sen. John Thune (R-S.D.), the third-ranking Republican in the Senate, said that Congress should consider reducing long-term spending on these federal programs next year. "If we're going to do something about spending and debt, we have to get faster growth in the economy — which I hope tax reform will achieve. But we have also got to take on making our entitlement programs more sustainable," including Medicare, Thune said on Thursday. "I think there is support, generally, here for entitlement reform."

• Hospitals Are Merging to Face Off with Insurers Bloomberg News by Zachary Tracer — A spate of hospital deals stands to further remake the U.S. health-care landscape, pushing up prices for consumers and insurers and changing how individuals get care. Just this month, health systems with at least 166 hospitals and $39 billion in combined annual revenue have announced merger plans. There's likely more to come: The Wall Street Journal reported on Sunday that Ascension and Providence St. Joseph Health, a pair of nonprofits that together have 191 hospitals and nearly $45 billion in annual revenue, are in deal talks. A fast-moving shakeout in the health care sector has led to once-unorthodox deals across formerly distinct corners of the industry, as large insurers shift their business models amid pressure to bring down costs. That in turn has led hospitals to look for ways to preserve their revenues.
  
  
• A CDC Ban on 'Fetus' and 'Transgender'? Experts Alarmed  AP by Mike Strobbe — Health leaders say they are alarmed about a report that officials at the nation's top public health agency are being told not to use certain words or phrases in official budget documents, including "fetus," "transgender," and "science-based." The health community was reacting to a story in The Washington Post published late Friday citing an anonymous source who said the prohibition was made at a recent meeting of senior budget officials at the U.S. Centers for Disease Control and Prevention. The seven words and phrases — "diversity," ″entitlement," ″fetus," transgender," ″vulnerable," ″evidence-based" and "science-based" — were not to be used in documents that are to be circulated within the federal government and Congress in preparation of the next presidential budget proposal, the paper reported.
  
  
• 2017 Health Care Year in Review  Modern Healthcare — For much of 2017, attention was on efforts to repeal and replace the Affordable Care Act. By the end of the year, though, industry trends pointed toward the market reshaping itself through mergers and new offerings.

Editor: Peter Van Vranken