"The proposed changes to this bill would leave too many of my constituents with pre-existing conditions paying more for health insurance coverage, and too many of them will even be left without any coverage at all." 

—Representative Ileana Ros-Lehtinen (R-FL)

• GOP Faces Make-or-Break Moment on Obamacare Repeal Politico by Rachael Bade, John Bresnahan, and Kyle Cheney—This week may be the last, best chance to get it done in the House. House Republican leaders and White House officials are increasingly confident about passing their long-stalled Obamacare replacement bill: More lawmakers than ever are committed to voting "yes," they say, and GOP insiders insist they're within striking distance of a majority. But the window of opportunity for Speaker Paul Ryan and his leadership team is closing fast. The House is scheduled to leave town for a one-week recess on Thursday, and some senior Republicans worry that failing to get it done by then would fritter away critical momentum.

• Pushing For Vote on Health Care Bill, Trump Seems Unclear on Its Details New York Times by Robert Pear—After two false starts on President Trump's promise to repeal the Affordable Care Act, Trump administration officials are pressing the House to vote on a revised version of the Republican repeal bill this week, perhaps as soon as Wednesday, administration officials said. And on Sunday, Mr. Trump insisted that the Republican health legislation would not allow discrimination against people with preexisting medical conditions, an assertion contradicted by numerous health policy experts as well as the American Medical Association. "Preexisting conditions are in the bill," the president said on CBS's "Face the Nation." "And I mandate it. I said has to be." Mr. Trump appeared to be unfamiliar with details of the amendment that would allow states to obtain a waiver permitting insurers to charge higher premiums based on a person's "health status." Nor did he explain how the Republicans' new health plan would produce "much lower premiums."

• Fears of Losing Preexisting Conditions Protection under GOP AP by Ricardo Alonso-Zaldivar and Alan Fram—From cancer to addiction, doctors and patient groups are warning that the latest Republican health care bill would gut hard-won protections for people with preexisting medical conditions. Some GOP moderates who may seal the legislation's fate are echoing those concerns. In a strongly worded statement this week, the American Medical Association said the Republican protections "may be illusory." The American Cancer Society Cancer Action Network said the plan could take the nation back to a "patchwork system" that pushes costs on people with life-threatening conditions. Such stark messages may be connecting with lawmakers anxious about making the right decision on issues that touch every family.

• CBO Won't Have Score On Revised ObamaCare Bill Next Week The Hill by Jessie Hellmann—The budget scorekeeper for Congress is apparently a few weeks away from releasing an analysis of the GOP's revised ObamaCare repeal-and-replace bill. The nonpartisan Congressional Budget Office (CBO) told House Minority Leader Nancy Pelosi's (D-Calif.) office Thursday that a score of the bill would not be ready this week or next.  The score would detail the impacts the American Health Care Act could have on Obamacare enrollees. It's unclear when GOP leadership plans to call the bill for a vote, but they have said repeatedly it won't be on the floor until it has the support to pass.  Many moderate Republicans would likely have issues with voting on the legislation without an updated CBO score.

• GOP Shuts Out Doctors, Experts, Democrats—Pretty Much Everybody—As They Work On Obamacare Repeal Los Angeles Times by Noam Levey—President Trump and House Republicans, in their rush to resuscitate a bill rolling back the Affordable Care Act, are increasingly isolating themselves from outside input and rejecting entreaties to work collaboratively, according to multiple healthcare officials who have tried to engage GOP leaders. And senior House Republicans and White House officials have almost completely shut out doctors, hospitals, patient advocates, and others who work in the health care system, industry officials say, despite pleas from many health care leaders to seek an alternative path that doesn't threaten protections for tens of millions of Americans.

• Congressional Negotiators Reach $1 Trillion Deal to Fund Government But Provide Little for Trump's Priorities Los Angeles Times by Lisa Mascaro—Congressional negotiators reached a bipartisan deal late Sunday to fund the federal government through September, easing the threat of a shutdown but denying President Trump several key priorities—including money for his promised border wall with Mexico. It actually would increase federal spending on medical research, green energy programs, and other areas that the White House had pegged for sharp reductions. Under it, the National Institutes of Health would see an increase of 6 percent or $2 billion.
  
  
• Congress Settles for Stopgap to Avoid Government Shutdown AP by Erica Werner and Alan Fram—Congress took the easy way out to keep the government open on the eve of Donald Trump's 100th day in office, passing a weeklong stopgap spending bill Friday that amounted to more of a defeat for the president than a victory. House leaders are still short of votes for the revised health bill, though they could bring it to the floor next week if they find the support they need. House Majority Leader Kevin McCarthy said the plan was to pass the bill "as soon as possible." Also next week lawmakers plan to pass a $1 trillion package financing the government through Sept. 30, the end of the 2017 fiscal year. The temporary spending bill keeps the government functioning through next Friday, to allow lawmakers time to wrap up negotiations on the larger measure. The Senate sent the stopgap bill to Trump by voice vote Friday after the House approved it by a lopsided 382–30 margin.

• Obamacare 101—What's the Big Debate Over Health Insurance Cost-Sharing Subsidies? Los Angeles Times by Noam Levey—As President Trump and congressional leaders scramble to put together a spending bill to keep the government from shutting down at the end of this week, negotiations could turn on the fate of an arcane, but critical part of the Affordable Care Act: cost-sharing reduction payments, or CSRs. If you've never heard of this piece of the Obamacare puzzle, here's a rundown of what they are and why they're getting pulled into Trump's first budget fight.

• Health Insurers Try to Plan Ahead as Congress Deliberates on Health Law NPR by Alison Kodjak—As Republicans in Congress debate changes to the Affordable Care Act, insurance executives across the country are trying to make plans for next year. Companies that sell policies on the exchanges created by the Affordable Care Act, also known as Obamacare, face fast-approaching deadlines to inform states about what plans they want to sell, and what they intend to charge. "Insurance companies need to file rates in 2 1/2 months," says Tom Policelli, CEO of Minuteman Health, which sells Obamacare policies in Massachusetts and New Hampshire.

• Insurers Say Trump Commitment on Obamacare Payments Falls Short The Hill by Peter Sullivan—Health insurers say a new commitment from the White House to continue paying Obamacare insurer subsidies is not enough.  While top congressional Democrats spoke positively of the White House's commitment on Wednesday to maintain the payments, insurers say the move does not give them the enough long-term certainty. The trade group America's Health Insurance Plans (AHIP) said it still believes Congress should actively appropriate the funds for the cost-sharing reduction (CSR) payments and not leave it up to the administration.  "Our position has not changed—the American people need Congress to fund CSRs now," said Kristine Grow, spokeswoman for AHIP. 

• The Cost of Not Expanding Medicaid Urban Institute/Robert Wood Johnson Foundation by Stan Dorn and Matthew Buettgens—The 19 states that have not yet expanded Medicaid could reduce the number of uninsured by more than four million people collectively by expanding Medicaid. Expanding Medicaid in these states would also increase their federal funding by $595.8 billion to $664.8 billion from 2018-2027, while raising state Medicaid costs by just $82.5 billion to $90.8 billion over 10 years. Expanding Medicaid would also reduce uncompensated care—saving these states between $22.5 billion to $27.9 billion over ten years. The report also includes a state-by-state look at the impact of Medicaid expansion on the number of uninsured, state and federal funding, and consumer health care spending.

• Florida Deal Would Reverse Key Part of Obama's Medicaid Expansion New York Times by Robert Pear—The Trump administration appears to have scrapped one of the key tools the Obama administration used to encourage states to expand Medicaid under the Affordable Care Act. The shift involves funding that the federal government provides to help hospitals defray the cost of caring for low-income people who are uninsured. Under a deal with Florida, the federal government has tentatively agreed to provide additional money for the state's "low-income pool," in a reversal of the previous administration's policy. The Obama administration balked at providing more money to help hospitals cope with the costs of "uncompensated care" for people who could be covered by Medicaid. If Florida expanded Medicaid eligibility, the Obama administration said, fewer people would be uninsured, and hospitals would have less uncompensated care.

• Physicians Ask CMS to Cut Medicare Red Tape Modern Healthcare by Virgil Dickson—In response to a request by the Centers for Medicare and Medicaid Services (CMS) to find ways to attract and retain Medicare providers, physicians say they want less red tape. Doctors are asking CMS to better synchronize policies for Medicare Advantage, Medicare fee-for-service, and accountable care organizations as a way to reduce their regulatory burden. The CMS requested the feedback in a 2018 Medicare Advantage rate notice. The agency asked for ideas on reforming rules related to benefit design, operations, and protecting the doctor-patient relationships in Medicare.

• Corporate Feud Exposes Big Profits on Drug Sales Wall Street Journal by Charley Grant—The rising pressure on drug pricing has shifted to the companies that were supposed to guard against rampant increases. A dispute between two of the most important companies in the health care industry, Express Scripts Holding Co., the largest pharmacy benefit manager, and health insurance giant Anthem Inc., has shown in stark terms how profitable some relationships have become. That will give more ammunition to critics of the system. Express Scripts announced Monday that Anthem, its largest customer, is unlikely to renew its contract once it expires at the end of 2019. Anthem, which accounts for roughly one-sixth of total Express Scripts revenue, has sued the company for allegedly overcharging on prescription drugs over several years.

Editor: Peter Van Vranken