"The clock is ticking on CHIP, and states like Oregon are running out of time."

— Senator Jeff Merkley (D-Ore.)

• Obamacare Sign-ups Are Surging, but There's a Twist New York Times by Haeyoun Park — Despite the Trump administration's efforts to scale back the health law, about 300,000 more people have signed up for health insurance in the Affordable Care Act marketplaces in the first weeks of this enrollment period than last year. But it's still early in the 2018 enrollment period, and people who sign up early are often those who need health care the most. Because the Trump administration cut the enrollment period in half this year, to 45 days from three months, weekly sign-ups would need to double to match the number of sign-ups in previous years.  The deadline to sign up this year is Dec. 15 in most states. Last enrollment period, it was Jan. 31. ... But with the Trump administration's decision to cut the law's advertising budget by 90 percent this year, it is possible that the last-minute spike that helped boost enrollment in past years will disappear.

• Uninsured Rates Lower in States That Run Their Own ACA Exchanges Modern Healthcare by Shelby Livingston — The average uninsured rate in states that use the federal HealthCare.gov exchange is nearly double that of states that set up their own public health insurance exchanges, data released by the Centers for Disease Control and Prevention show. In the first six months of 2017, HealthCare.gov states had an average uninsured rate of 16.1 percent, while states with their own exchanges — like California and Colorado — had an average uninsured rate of 8.3 percent. The disparity in coverage in states that use HealthCare.gov and those with state-based exchanges can be explained, at least in part, by Medicaid expansion. 

• Higher Premiums Would Cancel Out Some Tax Cuts Axios by Caitlin Owens — Some people's tax cuts under the GOP Senate bill would be canceled out by the increased premiums they would face due to the repeal of the Affordable Care Act's individual mandate, according to an analysis by The Commonwealth Fund. And, for those roughly 7 million people who buy insurance on their own but don't get premium subsidies, high health care costs would endure even after the bill's tax cuts expire.
  
  
• Actuaries Warn Congress Mandate Repeal Would Increase Premiums The Hill by Peter Sullivan — The American Academy of Actuaries is warning Congress against repealing Obamacare's individual mandate in tax reform, saying the move could lead to higher premiums and insurers leaving the market. The group warned in a letter to Congress on Tuesday against repealing the mandate in tax reform, as Senate Republicans propose.
  
  
• Murkowski Says She Backs Obamacare Mandate Repeal Politico by Dan Diamond — Senator Lisa Murkowski says she supports GOP efforts to repeal the Affordable Care Act's individual mandate, the Alaska Republican wrote in an op-ed for a local newspaper Tuesday. "I have always supported the freedom to choose," Murkowski wrote in her op-ed for the Daily News-Miner, an Alaska newspaper. "I believe that the federal government should not force anyone to buy something they do not wish to buy, in order to avoid being taxed."
  
  
• A Vote for the GOP Tax Bill Is a Vote to Cut Medicare Huffington Post by Nancy Altman and Linda Benesch — According to the Congressional Budget Office, the GOP tax bill will instantly trigger $400 billion in automatic cuts to Medicare in the next ten years, including $25 billion in the first year after enactment alone. These cuts are the result of a law known as Statutory PAYGO. That law requires an automatic cut in spending when Congress increases the deficit. The tax bill is, in Donald Trump's words, "a big, beautiful Christmas present" for Trump's family and other billionaires. If the Republicans are successful in passing a tax bill that increases the deficit by $1.5 trillion, as they intend, the provisions of PAYGO will be activated. To be clear: If the tax bill passes the Senate and is signed into law by Donald Trump, nothing more needs to be done to cut Medicare. If the House and Senate do nothing, the cuts take effect immediately after the end of the Congressional session and get bigger with every passing year. A vote for this tax bill is a vote to cut Medicare.

• He Rails Against the Drug Industry, but Trump Is Turning to Its Ranks to Fill His Administration  Stat by Erin Mershon — President Trump has vilified the pharmaceutical industry and made bold promises to lower prescription drug prices. But when it comes to staffing the health care agencies empowered to oversee those efforts, he has turned regularly to the pharmaceutical industry. His Food and Drug Administration chief, Scott Gottlieb, was a longtime industry investor and adviser to major players like GlaxoSmithKline and Bristol-Myers Squibb. A senior adviser at the Health and Human Services Department, Keagan Lenihan, joined the administration after running the lobby shop for the drug and distribution giant McKesson. And Trump has a former Gilead lobbyist, Joe Grogan, reviewing health care regulations at the Office of Management and Budget. The chief of staff at HHS, Lance Leggitt, lobbied for a whole host of drug clients, even last year.

• 13 Hospitals Join CMS' s Rural Pay Experiment Modern Healthcare by Virgil Dickson — The Centers for Medicare and Medicaid Services (CMS) on Monday added more hospitals to a program that industry executives say has been key to ensuring access to care in underserved communities. All in all, 13 additional hospitals will participate in the Rural Community Hospital Demonstration Program, which reimburses hospitals for the actual cost of care for inpatient services provided to Medicare beneficiaries rather than standard Medicare rates. Medicare typically pays as little as 80 percent of inpatient services costs. The program started in 2014 and was extended last year under the 21st Century Cures Act for an additional five years.

Editor: Peter Van Vranken