"Late last year, Republicans rammed a tax package through Congress with no debate whatsoever as to its potential effects on the U.S. health care system. Unfortunately, the legislation will most likely result in fewer Americans with insurance, stripped-down public programs, and less access to substance abuse treatment." — David Blumenthal, Commonwealth Fund President

• Out-of-Pocket Health Spending Dropped by Nearly 12 Percent — but Premiums Rose After Obamacare Rolled Out CNBC by Dan Mangan — The launch of Obamacare was followed by a nearly 12 percent average decrease in out-of-pocket health spending among all Americans in a two-year span — but premiums rose by the same percentage and by a bigger dollar amount, according to a study released Monday. The poorest Americans as a group saw an even bigger plunge in out-of-pocket health spending — 21.4 percent, the study published in the journal JAMA Internal Medicine found. Overall, the JAMA study identified a shift in health care spending, with poorer people spending less after the Affordable Care Act was fully implemented, and higher-income households spending more.
  
  
• Trump Makes No Calls for Obamacare Repeal in State of the Union  The Hill by Rachel Roubein —  President Trump made no mention of repealing or replacing Obamacare during his first State of the Union address on Tuesday, cementing how far the issue has fallen off of the GOP's agenda.'' Instead, the Trump administration has looked to alter the health law administratively. Trump's choice to lead the Department of Health and Human Services, Alex Azar, knows the regulatory process well, according to Azar's former colleagues. During Azar's swearing-in ceremony at the White House Monday, Trump noted, "As our new secretary, Alex will continue to implement the administrative and regulatory changes needed to ensure that our citizens get the affordable high-quality care that they deserve."
  
  
• Republicans Give Up on Obamacare Repeal  Politico by Burgess Everett — Most GOP lawmakers aren't interested in another failed effort to gut the health law in an election year. Though the GOP still controls both chambers of Congress and maintains the ability to jam through a repeal-and-replace bill via a simple majority, there are no discussions of doing so here at House and Senate Republicans' joint retreat at The Greenbrier resort. Republicans doubt they can even pass a budget providing for the powerful party-line "reconciliation" procedure used to pass tax reform last year, much less take on the politically perilous task of rewriting health care laws in an election year.
  
  
• House GOP Warming to Obamacare Fix  The Hill by Peter Sullivan — Key House Republicans are warming to a proposal aimed at bringing down Obamacare premiums, raising the chances of legislative action this year to stabilize the health-care law. House GOP aides and lobbyists say that top House Republicans are interested in funding what is known as reinsurance. The money could be included in a coming bipartisan government funding deal or in another legislative vehicle. Any action from Republicans to stabilize Obamacare would be a major departure from the party's long crusade against the law, but after having failed to repeal the Affordable Care Act last year, the discussion is shifting. 
  
  
• Nine States Considering Individual Mandate Rules: Report The Hill by Greenwood — Nine states are considering laws that would require their residents to purchase health insurance, The Wall Street Journal reported Saturday. The proposals come less than two months after Republicans, as part of a sweeping tax code overhaul, voted to repeal the Affordable Care Act's (ACA) mandate requiring individuals to have health insurance.  Lawmakers in Maryland are considering a law requiring residents to buy health insurance. California, Connecticut, Hawaii, Minnesota, New Jersey, Rhode Island, Vermont and Washington, as well as the District of Columbia, are also considering similar proposals, according to the Journal report.… "The federal government has just stalled. They don’t accomplish the basics, and that leaves states with a great opportunity to step up and craft policy," Connecticut state Rep. Sean Scanlon (D), who sits on a health-care working group, told the Journal.

• Trump: New Health Secretary Will 'Get Those Prescription Prices Way Down'  Stat by Ike Swetlitz —  President Trump used the swearing-in of the new secretary of health and human services as an opportunity to decry high prescription drug prices and pledge to bring them down — an intention he has long trumpeted but on which he has yet to follow through. "He's going to get those prescription drug prices way down," Trump said as he introduced Alex Azar at the White House Monday. Trump also pointed to the disparity in the cost of prescription drugs in America compared to other countries, saying that "the exact same pill in an identical box from the same factory costs us much more than, many times more than it does in other countries."
  
  
• Among Those Who Want to Lower Drug Prices, Cacophony, Not Consensus  Stat by Erin Mershon— Of all his campaign promises, President Trump's vow to bring down drug prices was perhaps the most popular. An assortment of interest groups spoke out loudly and passionately on the need for action, from hospitals to doctors to insurers to generic drug makers to patients themselves.'….[But] in interviews with STAT, lobbyists, lawmakers, and congressional staffers, Republicans and Democrats alike, said the most powerful health industry players conspicuously disagree about exactly how to move forward. The disarray was on full display at a recent congressional hearing, when representatives from nearly every major trade group with any stake in the country's drug prices — the American Medical Association, Association of Health Insurance Plans, and the American Hospital Association included — spent almost an hour and a half testifying without more than a cursory discussion of how Congress could fix the problem."
  
  
• As States Target High Drug Prices, Pharma Targets State Lawmakers  Kaiser Health News by Jay Hancock and Shefali Luthra —  With federal officials seemingly unwilling or unable to come up with legislation to control skyrocketing drug prices, that task is increasingly moving to the states. But so is pharma muscle and money opposing the measures, regulatory disclosures and corporate filings from the last two years show. State lawmakers are likely to consider drug-price transparency bills this year in Connecticut, Michigan, Oregon, Washington, and New Jersey, to name just a few. Many of the measures are similar to a new California law that requires drugmakers to justify big price increases. Meanwhile, activists who backed a 2017 law enabling Maryland officials to challenge "unconscionable" price increases for generic drugs now advocate price regulation for all expensive pharmaceuticals. Policymakers in New Mexico, Massachusetts, and Arizona are talking about limiting drug coverage or negotiating drug prices under Medicaid.

• Amazon, Berkshire Hathaway and JP Morgan Chase Join Forces to Tackle Employees' Health-care Costs Washington Post by Carolyn Y. Johnson —  Three major employers, Amazon, Berkshire Hathaway, and JP Morgan Chase, announced Tuesday they were  partnering to create an independent company aimed at reining in health care costs for their employees. The independent company would be jointly led by executives from all three companies and would be focused on technology that could increase transparency and simplify health care, according to the joint announcement. It will be free from the need to deliver a profit. "The ballooning costs of healthcare act as a hungry tapeworm on the American economy. Our group does not come to this problem with answers. But we also do not accept it as inevitable," Warren Buffett, Berkshire Hathaway chairman said in a statement.

• Fitzgerald's Resignation Comes as CDC Faces Huge Funding Cuts  Modern Healthcare by Steven Ross Johnson —  Dr. Brenda Fitzgerald's resignation as head of the Centers for Disease Control and Prevention (CDC) comes at a precarious time for the agency. It's trying to address a flu epidemic while bracing for possible deep cuts to its funding.…T'he Trump administration suggested cutting the agency's annual budget by more than $1.2 billion. The president's next draft budget is due Feb. 5.

• Fewer Doctors Are Opting Out of Medicare  Modern Healthcare by Virgil Dickson —  The Centers for Medicare and Medicaid Services (CMS) saw a sharp decrease in the number of providers opting out of Medicare in 2017, after several years where thousands indicated that they did not want to participate in the program. For years, the CMS had few providers opting out of Medicare, with the number first hitting triple digits in 2010, with 130. But those numbers jumped to over 1,600 opt-out requests going into effect in 2013, and spiking at 7,400 in 2016. Opt-outs dropped to just 3,732 in 2017, according to data released by the CMS Monday. One theory is that MACRA ended the need for providers to renew opt-out affidavits every two years; now opt-outs can be indefinite, and providers must ask to rejoin the program. The drop in opt-outs may also stem from the nation's aging population. 

• More States Jump on Medicaid Work Requirements Bandwagon  Roll Call —   A growing number of mostly Republican-led states are rushing to follow Kentucky's lead in requiring thousands of people on Medicaid to work or lose health coverage. The governors of South Dakota, Alabama, Louisiana, and South Carolina have said in recent weeks that they plan to pursue work requirements for their Medicaid programs, following the Trump administration's release of guidelines for the concept in January. "Whenever possible, we should always endeavor to help South Carolinians in need find their path to gainful employment and away from temporary assistance of government," South Carolina GOP Gov. Henry McMaster tweeted Jan. 11, the same day federal officials announced the new guidance. At least four non-expansion states, including Mississippi and Kansas, have already submitted formal work requirement proposals to the Department of Health and Human Services. They are among at least 10 states, including Indiana and Arkansas, to do so.
  
  

• Trump Administration Approves Second Medicaid Work Requirement, for Indiana  Politico by Adam Cancryn - Health and Human Services Secretary Alex Azar on Friday granted Indiana permission to add work requirements to its Medicaid program, making it the second state to tie health coverage to employment for certain low-income enrollees. Azar, days after being sworn in, touted the work requirement plan as an innovative approach to boosting employment and lifting poor adults out of poverty. ...The Indiana waiver builds on the conservative Medicaid expansion model pioneered in 2015 by then-Gov. Mike Pence, and developed by Seema Verma, the administrator of the Center for Medicare & Medicaid Services, who was then a consultant. In order to qualify for coverage under the new plan, able-bodied individuals under 60 years old would need to work at least 20 hours a week on average, be enrolled in school, or participate in the state’s job training and search program. "There is a robust body of academic evidence to show that work is a key component of well-being," Azar said. "This in particular is going to help open new opportunities for a lot of Hoosiers."

Editor: Peter Van Vranken