"This legislation will have immediate consequences for Americans' health. It not only fails to deliver on the promise of increasing prosperity for the lower and middle classes, but will ruin their health in the process. It will leave Americans sicker, poorer, and with a government unprepared and unequipped to respond to urgent threats to public health as soon as next year."

—Georges Benjamin, M.D., American Public Health Association

• U.S. Senate Tax Bill Accomplishes Major Obamacare Repeal Goal Reuters by Yasmeen Abutaleb — The sweeping tax overhaul that passed the U.S. Senate on Saturday contains the Republicans’ biggest blow yet to former President Barack Obama’s healthcare law, repealing the requirement that all Americans obtain health insurance. The individual mandate is meant to ensure a viable health insurance market by forcing younger and healthier Americans to buy coverage to help offset the cost of sicker patients. It helps uphold the most popular provision of the law, which requires insurers charge sick and healthy people the same rates. Removing it while keeping the rest of Obama’s Affordable Care Act intact is expected to cause insurance premiums to rise and lead to millions of people losing coverage, policy experts say. “It’s going to take a bunch of healthy people out of the insurance market,” said Craig Garthwaite, director of the healthcare program at Northwestern University’s Kellogg School of Management. Obamacare “is going to collapse even more now,” he said.
  
  

• Senate’s Huge Tax Bill Would Have Potent Ripple Effects for Health-Care System Washington Post by Amy Goldstein — The Republican tax overhaul that squeaked through the Senate early Saturday morning would reach deep into the nation’s health-care system, with a clear dagger to a core aspect of the Affordable Care Act and broader ripple effects that could threaten other programs over time. The measure would abolish the government’s enforcement of the ACA requirement that most Americans carry insurance coverage. It would not end the individual mandate itself but would eliminate tax penalties for flouting that requirement. The result could cause an extra 13 million people to become uninsured and drive up insurance premiums in marketplaces created under the law, according to an estimate by Congress’s nonpartisan budget analysts. Yet downstream effects of the bill that have drawn less attention could potentially damage the health care and well-being of far more people. The Senate plan would increase the federal deficit starting in the current fiscal year and — unless lawmakers intervene — would unleash a budgetary sequence of events cutting billions of dollars from Medicare and public health services. The reductions would flow from a “pay as you go” law that basically requires offsets to increases in federal spending.
  
  

• The Senate's Tax Bill Is a Sweeping Change to Every Part of Federal Health Care Vox by Sarah Kliff — The Senate tax bill is really a health care bill with major implications for more than 100 million Americans who rely on the federal government for their health insurance. The bill reaches into every major American health care program: Medicaid, Medicare, and the Obamacare marketplaces. These are expected outcomes based on two significant policy changes in the bill. First, the bill repeals the individual mandate, a key piece of Obamacare that requires most Americans get covered. Economists expect its elimination to reduce enrollment in both the Affordable Care Act's private marketplaces and Medicaid by millions. The money saved will be pumped into tax cuts for the very wealthy. The bill also includes tax cuts so large that they would trigger across-the-board spending cuts — including billions for Medicare. The last time Medicare was hit with cuts like this, patients lost access to critical services like chemotherapy treatment. This tax bill deserves a broader name. Its policies will cause millions of vulnerable Americans to lose coverage, disrupt care for the elderly, and potentially change the health care system in other ways we can't fully predict.

• The Damage to Children's Health Insurance Is Already Being Done The Atlantic by Annie Lowrey — Right now, a draft of a letter informing thousands of Virginia parents that their kids might lose their health coverage just after the holidays is sitting on Linda Nablo's desk. "People are going to panic," Nablo, who is the chief deputy director of the Virginia Department of Medical Assistance Services, told me. "It's going to cause mass confusion. It's going to be an increase in the lack of trust in government, that government will do what it says it will do. People will lose their managed-care plans. They'll lose their provider. It's going to cause chaos." Hill staffers insist and the states anticipate that Congress will pass new funding for the Children's Health Insurance Program (CHIP) in the coming weeks. But the situation has left doctors fuming, administrators bewildered, parents frightened, and politicians shocked. Even if no states end up running out of money and no kids end up losing coverage, the dithering has already diverted state resources, degraded state programs, and sapped state coffers, and Congress's dysfunction has pushed the stability of an effective, respected program with bipartisan support into doubt.
  
  

• Lawmakers Making Progress in Talks on Children's Health Care The Hill by Peter Sullivan and Rachel Roubein — Congressional negotiators are making progress toward a bipartisan deal to reauthorize children's health insurance and several other important health-care programs, sources say. Staff from the relevant committees in both parties and chambers met over the Thanksgiving break and are getting closer to an agreement, according to lobbyists and aides. The package would include funding for CHIP and community health centers, and an extension of a range of other expiring Medicare programs. It could also include a bipartisan bill from the Senate Finance Committee known as the Chronic Care Act that seeks to make Medicare spending more efficient and save money.
  
  

• 'Scary' Prediction for U.S. Kids: 57 Percent Could be Obese by Age 35 USA Today by Kim Painter — A whopping 57 percent of the nation's children and teens will be obese by age 35 if current trends continue, according to a sobering new study out Wednesday. The research, published in the New England Journal of Medicine, goes beyond previous studies suggesting unhealthy childhood weights often lead to adult obesity. It suggests that while heavy children face the highest risk, even those who make it to age 20 in good shape face substantial peril in a world where obesity could soon be the new normal. "This study is the first to make precise predictions for today's generation of children," and the news is not good, said lead author Zachary Ward, a researcher at the Harvard T.H. Chan School of Public Health. The findings, he said, show the need for stepped-up prevention efforts from infancy through young adulthood.  

• Sign-Up Pace Much Slower in Week Four of 2018 Obamacare Enrollment Reuters — The pace of people signing up for individual insurance under Obamacare slowed significantly during the fourth week of 2018 enrollment, as nearly 37 percent fewer people signed up for the healthcare plans than in the previous week, a U.S. government agency reported on Wednesday. The U.S. Department of Health and Human Services said that 504,181 people signed up for 2018 Obamacare individual insurance in the 39 states that use the federal government website HealthCare.gov for the week ended Nov. 25, down from 798,829 people in the previous week. New consumer sign-ups fell to 152,243 from 220,323 in the previous week. Total sign-ups reached 2.78 million during the first four weeks of enrollment, which lasts through Dec. 15. Despite the slowdown, enrollment is up from last year, according to Evercore ISI analyst Michael Newshel.
  
  
• Putting Money Where Its Mouthpiece Is: Calif. Outspends U.S. to Market Obamacare California Healthline by Ana Ibarra and Carmen Heredia Rodriguez —The marketing blitz is on. Californians are getting barraged with online pop-up ads, radio spots and television commercials, all aimed at persuading them to sign up for Affordable Care Act health plans during this year's open-enrollment season. Covered California, the state's Obamacare exchange, is wielding a monster marketing budget that devotes $45 million to ads, including $18 million for TV and $8 million for radio. The agency is so flush with marketing dollars that it also spent $100,000 for a dozen freshly painted murals across the state, most of which have nothing directly to do with health insurance enrollment. Covered California's marketing riches contrast starkly with the advertising budget for the federal health insurance exchange, healthcare.gov. The feds have slashed ad dollars to $10 million, down from $100 million last year. 

• CVS to Buy Aetna for $67.5 Billion, Remaking Health Care Sector Bloomberg by by Zachary Tracer and Robert Langreth — CVS Health Corp. will buy Aetna Inc. for about $67.5 billion, creating a health-care giant that will have a hand in everything from insurance to the corner drugstore. CVS will pay $207 a share for Aetna, with $145 a share in cash and the rest in stock, the companies said in a statement Sunday. That’s a 29 percent premium to Aetna’s share price on Oct. 25, the day before the companies were reported to be in talks. The deal is among the biggest health-care mergers of the past decade, combining the largest U.S. drugstore chain with the third-biggest health insurer. CVS also manages drug-benefits plans for employers and insurers, a business that could help steer some of Aetna’s 22 million customers into CVS drugstores when they fill a prescription. The deal will give Aetna’s insurance plans a closer on-the-ground tie to where customers get care.

• Maine's Obamacare Vote Revives Medicaid Expansion Debate in Some States Governing by Mattie Quinn — Last month's election has re-energized Obamacare advocates. Meanwhile in Maine, the matter is being complicated by Gov. Paul LePage, who has vowed not to implement an expansion until lawmakers can show how they'll fund it. Prior to last month’s elections, no polling had been done on Maine’s first-of-its-kind ballot initiative to expand Medicaid. Considering how controversial the health-care debate in Congress has been all year and the fact that the state elected a Republican governor, health policy experts were expecting a nailbiter. But to their pleasant surprise, the vote was quickly called in their favor. Sixty percent of Maine voters chose to expand Medicaid, which is one of the key provisions of the Affordable Care Act (ACA), otherwise known as Obamacare. That means more low-income people in Maine should soon be eligible for Medicaid, the government-run health insurance program. (The governor, however, has vowed to implement it only under certain conditions.) The victory in Maine has re-energized Obamacare advocates hoping to replicate that success in other states.
  
  
• North Carolina Seeks to Widen Medicaid Network by Paying Docs' Debt Modern Healthcare by Virgil Dickson — North Carolina wants to entice more providers to treat its Medicaid population by paying off their debts. The state is also looking at imposing premiums and work requirements on Medicaid enrollees. North Carolina officials want to increase access by expanding the Medicaid provider workforce in underserved areas. They hope to recruit more doctors through a loan repayment and incentive program that would be funded by up to $45 million from the federal government over five years. State officials especially hope the repayment program will attract general surgeons, OB-GYNS, psychiatrists, psychologists, and midlevel behavioral health providers.

• Teen Pregnancy and Abortion Rates See Big Drops, Which Colorado Officials Attribute to IUD Program Denver Post by Jennifer Brown — The steep drop in teen pregnancies and abortions in Colorado since 2009 is mainly due to one thing: free, low-cost access to IUDs. Intrauterine devices — tiny, T-shaped pieces of plastic placed in the uterus — are the main reason Colorado's teen birth rate fell 54 percent and the teen abortion rate declined 64 percent in the last eight years, state health officials said Thursday. The astounding numbers, capturing the eight-year period since IUDs became an affordable option for low-income health clinics, were released along with a study estimating the state avoided paying nearly $70 million for labor and delivery, well-baby check-ups, food stamps , and child-care assistance because of fewer births to teen moms. "This is one of the biggest public-health home runs that I've seen in my 35-year public-health career," said Dr. John Douglas, executive director of the Tri-County Health Department, which has six clinics in Douglas, Arapahoe and Adams counties. "The work that's happened is really striking." Thanks to a grant from billionaire Warren Buffett's family, Colorado spent $28 million during eight years supplying IUDs to 75 public health clinics throughout the state, several based inside high schools. From 2009 to 2016, the program provided 43,713 contraceptive implants to women, plus trained medical staff on how to insert the devices.

• How Opioids Started Killing Americans Bloomberg News by Natasha Rausch — It's been conventional wisdom for some time now that America's opioid epidemic began at the pharmacy. Now there are numbers that put any doubt to rest. More than half of all people who succumbed to an overdose between 2001 to 2007 were chronic pain sufferers who filled an opioid prescription and sometimes even saw a doctor in the month before they died. Only 4 percent were ever diagnosed as having an abuse problem, said Dr. Mark Olfson, one of five researchers who conducted a massive study of the crisis and its causes for Columbia University Medical Center. The findings of the new study, published Tuesday in the American Journal of Psychiatry, split the epidemic into two groups: those who were diagnosed with chronic pain and those who weren't. In the year before they died, about two-thirds of those studied were diagnosed with chronic pain and prescribed an opioid. (Many would also get a prescription for anti-anxiety drugs called benzodiazepines, which can make for a deadly combination.) The other third among those who died had no diagnosed chronic pain but became addicted to opioids in another way. "Those are different populations," Olfson said in a telephone interview. "Understanding those things puts us in a better position to combat the epidemic."

Editor: Peter Van Vranken