• Trump Moves to Relax Rules on Cheaper Health Insurance  New York Times by Robert Pear — The Trump administration took another swipe at the Affordable Care Act on Tuesday, proposing new rules that would make it much easier for consumers to buy less expensive health insurance policies that do not comply with coverage requirements of the law. Under current rules, such "short-term, limited-duration insurance" cannot last for more than three months. Under the proposal, the limit would be 364 days. The move carries out an executive order by President Trump, who said the change would benefit consumers because "short-term, limited-duration insurance is exempt from the onerous and expensive insurance mandates and regulations" in the Affordable Care Act.
  
  
• Trump’s Obamacare Changes to Push up Premiums, Report Projects Bloomberg News by John Tozzi — The Trump administration’s efforts to loosen health insurance rules will increase premiums for Obamacare plans by double-digit percentages in most states next year, according to a new analysis by the Urban Institute. Monthly payments for a traditional health insurance plan sold through Obamacare will go up by 18 percent, on average, in 43 states where there aren’t limits on less-comprehensive but less-expensive coverage the administration is calling for, according to the Washington-based policy group.
  
  
• Trump Administration Dismantles LGBT-Friendly Policies  Politico by Dan Diamond —Despite Trump's promise to defend LGBT rights, his health agency has blocked efforts to combat discrimination.  The nation's health department is taking steps to dismantle LGBT health initiatives, as political appointees have halted or rolled back regulations intended to protect LGBT workers and patients, removed LGBT-friendly language from documents and reassigned the senior adviser dedicated to LGBT health. The sharp reversal from Obama-era policies carries implications for a population that's been historically vulnerable to discrimination in health care settings, say LGBT health advocates. A Health Affairs study last year found that many LGBT individuals have less access to care than heterosexuals; in a Harvard-Robert Wood Johnson-NPR survey one in six LGBT individuals reported experiencing discrimination from doctors or at a clinic.

• Spending Growth on Prescription Drugs Will Double This Year  Stat by Ed Silverman — Hold on to your wallets — the growth in spending on prescription drugs is forecast to more than double this year. Spending will increase by 6.6 percent in 2018, compared with a 2.9 percent increase last year, according to new estimates released by the Centers for Medicare and Medicaid Services. In actual dollars, spending on medicines is projected to reach $360.2 billion, up from $338.1 billion.
  
  
• ER Reduces Opioid Use by More Than Half With Dry Needles, Laughing Gas  National Public Radio by Hansi Lo Wang — One of the places many people are first prescribed opioids is a hospital emergency room. But in one of the busiest ERs in the U.S., doctors are relying less than they used to on oxycodone, Percocet, Vicodin and other opioids to ease patients' pain. In an unusual program designed to help stem the opioid epidemic, the emergency department at St. Joseph's University Medical Center in Paterson, N.J., has been exploring alternative painkillers and methods. That strategy has led to a 58 percent drop in the ER's opioid prescriptions in the program's first year, according to numbers provided by St. Joseph's Healthcare System's chair of emergency medicine, Dr. Mark Rosenberg. "There is a complete change in philosophy, a complete change in culture in the department," says Rosenberg, who launched the Alternatives to Opiates program in 2016 with Dr. Alexis LaPietra, the medical director of pain management in the emergency department. One challenge his program has had to work through is the cost of using alternatives to opioids.

• Work for It. What Trump's Tough New Medicaid Rules Mean  NBC News by Benjy Sarlin — Under the new system, called Kentucky HEALTH, nonelderly adult Medicaid recipients will have to hold a job or perform 80 hours a month of "community engagement" activity like classes and volunteering, pay a monthly premium of $1 to $15, earn their vision and dental treatment through a rewards program, and go through the enrollment process again every year. Those who fail to meet the requirements could lose their coverage or face additional copays. Interviews with health professionals, administrators, patients and advocates preparing for the change reveal deep concerns. The new rules, they warn, will jeopardize health care for numerous vulnerable residents. The state has added over 450,000 residents to Medicaid through Obamacare, which provided funding for adults making up to 138 percent of the poverty line, and the new work requirements primarily affect this group. The Medicaid changes are becoming a national flashpoint as the political parties diverge on health care, with Democrats increasingly treating government-backed health care as a fundamental right for all Americans and Republicans arguing it should be earned through work or limited to the most vulnerable citizens.

• Spending Deals Signal End of Unpopular Obamacare Cost Checks  Politico by Jennifer Haberkorn — Republicans and Democrats finally found something they can agree on about Obamacare: killing unpopular policies that were supposed to pay for the law or reduce health costs. The recent congressional spending deals repealed or delayed several Obamacare taxes, as well as a Medicare cost-cutting board. Removing those powerful levers, which terrified health providers and unions, is not a good omen for efforts to control health spending, which is expected to surge in the next few years. "This was a skillful effort by the groups that would have faced the sharp end of these measures," said John McDonough, a former Senate HELP Committee aide who helped draft the law, who is now a Harvard professor of public health practice. "The reason people got so exercised ... is not because they wouldn't have been effective. They would have been effective."
  
  
• The U.S. Health Care System Needs More Skills for Paying Bills, Study Shows  Los Angeles Times by Karen Kaplan — Health care in the United States is really expensive, and one of the reasons is that managing health care bills is really, really expensive. Just how expensive? At one large academic medical center, the cost of collecting payments for a single primary-care doctor is upward of $99,000 a year. And billing for primary-care visits is a bargain compared with billing for trips to the emergency room, a hospital stay or a surgical procedure, according to a report published Tuesday in the Journal of the American Medical Association. Researchers from Duke University and Harvard Business School figured this out by reconstructing the entire life cycle of a medical bill — from the time a patient makes an appointment until the time the health system pockets the money for the services rendered.

• Dem Asks Trump Health Chief for Timeline on Gun Research  The Hill Peter Sullivan — Sen. Ed Markey (D-Mass.) is asking Secretary of Health and Human Services Alex Azar what his next steps are on gun violence research after he expressed support for the idea last week.In an unexpected move, Azar told a congressional hearing last week that he backs research on gun violence at the Centers for Disease Control and Prevention (CDC), which he oversees. Starting that research is a top goal for Democrats on gun issues, and Markey said he was "heartened" by Azar's comments. "With the CDC now poised to return to this critical public health and safety research, Congress needs to know how it can be supportive," Markey wrote in a letter to Azar on Thursday.
  
  
• More Governors Willing to Consider Gun Law Changes After Florida Shooting Washington Post by Michael Scherer and Dan Balz — A growing bipartisan number of state governors have joined calls for a reconsideration of gun laws and school safety measures after the mass shooting in Parkland, Fla., a sign that resulting legislative changes could extend far beyond Florida in the coming months. The impact of the shooting rippled through the winter meeting of the National Governors Association in Washington this weekend, as state leaders expressed willingness to consider new limits on gun ownership and stepped up efforts to address mental-health factors. But most said they were opposed to President Trump’s proposal to allow more teachers to be armed. Individual governors said they would be open to raising the age limit for the purchase of long guns to 21, a measure opposed by the National Rifle Association, or said they believed there should be better ways for family members or others to take concerns about unstable individuals to a judge and have weapons confiscated.

Editor: Peter Van Vranken