Welcome to the fifth issue of Headlines in Health Policy, a roundup of recent news about health coverage, health delivery system reform, and more.

"Our research shows that when people with complex needs require medical help, they encounter a health care system that’s expensive, inefficient, and poorly coordinated. We want to better understand what works for effectively treating these patients, so we can identify gaps, reduce duplication, and accelerate what works." 

—David Blumenthal, M.D., president of The Commonwealth Fund

—Representative Kevin McCarthy of California, the majority leader

—Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University

• How Do We Improve Care for America's Most Complex Patients?: Politico Pulse by Dan Diamond—According to a new "playbook" from five foundations, it starts with boosting social services—and investing in staff like care coordinators and shuttle drivers. An accompanying survey from The Commonwealth Fund also underscores the importance of addressing social determinants of health, which can contribute to ongoing health challenges. Nearly two-thirds of high-needs patients experienced stress about their ability to afford housing, utilities or nutrition. That's almost twice the response from patients without high needs. Read: How High-Need Patients Experience Health Care in the United States. 
  
  
• Online 'Playbook' for High-Need Patients Released: Medscape Medical News by Ken Terry—A new online "playbook," designed to improve the care provided to patients with complex needs, including medical, behavioral, and social issues, was launched today at the inaugural meeting of the National Center for Complex Health and Social Needs. This new organization is led by Jeffrey Brenner, M.D., who is nationally recognized for his work with high-need patients in Camden, New Jersey. Five foundations—the John A. Hartford Foundation, the Peterson Center on Healthcare, the Robert Wood Johnson Foundation, the SCAN Foundation, and The Commonwealth Fund—sponsored the playbook and will also participate in its further development and dissemination.

• Sweeping Health Measure, Backed By Obama, Passes Senate New York Times by Jennifer Steinhauer & Robert Pear—The Senate approved complex health care legislation on Wednesday that would increase funding for disease research, address weaknesses in the nation’s mental health systems and vastly alter the regulatory system for drugs and medical devices. The vote sealed a final legislative victory for President Obama, who strongly supported the bill against objections from many liberal Democrats and consumer groups. In many ways the bill, known as the 21st Century Cures Act, is a return to a more classic approach to legislation, with policy victories and some disappointments for both parties, and potential benefits for nearly every American whose life has been touched by illness, drug addiction and mental health issues. Years in the making, the measure passed 94 to 5 after being overwhelmingly approved by the House last week.

• G.O.P. Plans Immediate Repeal of Health Law, Then a Delay New York Times by Robert Pear, Jennifer Steinhauer & Thomas Kaplan—Republicans in Congress plan to move almost immediately next month to repeal the Affordable Care Act, as President-elect Donald J. Trump promised. But they also are likely to delay the effective date so that they have several years to phase out President Obama’s signature achievement. This emerging “repeal and delay” strategy, which Speaker Paul D. Ryan discussed this week with Vice President-elect Mike Pence, underscores a growing recognition that replacing the health care law will be technically complicated and could be politically explosive.

• Repealing Obamacare to Be First on Senate Agenda in 2017 Reuters by Susan Cornwell—Repealing Obamacare will be the first order of business in the U.S. Senate in January, Senate Majority Leader Mitch McConnell, a Republican, said on Tuesday. Republicans will replace President Barack Obama's signature health insurance program that provides coverage to millions of Americans "step by step," said Senator John Thune, another member of the Republican leadership. McConnell did not say when the repeal of the Affordable Care Act, as it is officially known, would go into effect. Senator John Barrasso said it might be effective in two or three years, and that the timeframe was still being debated. Democrats scoffed at the Republican plans, saying they do not even know what they want to replace Obamacare with. "Bring it on," said Senator Chuck Schumer, who will be the Democrats' leader in the Senate next year.

• Trump's Pick for HHS Signals He Is Dead Serious About Repealing Obamacare The Huffington Post by Jonathan Cohn—President-elect Donald Trump will name an ultra-conservative surgeon, Rep. Tom Price (R-Ga.), to run the Department of Health and Human Services. The choice, which Trump’s transition team announced on Tuesday morning, would appear to signal Trump’s determination to proceed with a major overhaul of federal health care programs―including not just Obamacare, which Republicans have sworn to repeal, but also Medicare and Medicaid. And Price has said he wouldn’t stop with Obamacare. In mid-November, not long after the presidential election, Price said that Republicans could also use reconciliation to change Medicare, as well.

• Study: 'Obamacare' Repeal-Only Would Make 30M Uninsured AP by Ricardo Alonso-Zaldivar—Repealing President Barack Obama's health care law without a replacement risks making nearly 30 million people uninsured, according to a study released Wednesday.  Separately, a professional group representing benefit advisers warned congressional leaders of the risk of "significant market disruption" that could cause millions of Americans to lose their health insurance. Republicans dismiss such dire scenarios, saying that they are working on replacement legislation for a President Donald Trump to sign. Nonetheless, the complex two-stage strategy the GOP Congress is contemplating has raised concerns not only among supporters of the law, but also industries like hospitals and insurers.

• Repealing Obamacare with No Viable Replacement Ready to Go Could Wreak Havoc, Health Insurance Experts Warn CNBC by Dan Mangan—The slogan "repeal and replace Obamacare" could end up being a recipe for disaster if the "replace" part gets delayed. A top group of experts who analyze the financial risks of insuring people warned Congress on Wednesday that repealing major parts of Obamacare without also enacting a replacement plan at the same time could significantly disrupt the individual plan health insurance market. The American Academy of Actuaries said that could include more insurers dropping out of that market and ever-increasing premiums, "leading to millions of Americans losing their health insurance."

• Hospitals Warn of Job Losses, Billions in Cuts If Trump Repeals ACA Modern Healthcare by Virgil Dickson—The nation's hospital lobbying groups are warning that President-elect Donald Trump's promise to repeal the Affordable Care Act could lead to massive service cuts, layoffs, and hospital closures if an adequate replacement is not developed.

• Obama Urges the Public to Tell Republicans Not to ‘Abandon’ the ACA Washington Post by Amy Goldstein—President Obama on Friday urged the American public to press the Republican-led Congress not to abandon gains in insurance coverage and access to health care that the Affordable Care Act has brought during the past six years. The president’s brief remarks, on Facebook Live in front of a White House fireplace with Christmas decorations, were his most pointed since last month’s election about the fate of the health-care law that stands as the largest domestic achievement of his presidency—and a main target of President-elect Donald Trump and the Republican majority in Congress.

• Trump Promised to Repeal Obamacare, But It Turns Out Americans Like Most of It, a Poll Finds Los Angeles Times by Noam Levey—Despite sharp partisan differences over the Affordable Care Act, Democrats and Republicans, including voters who backed President-elect Donald Trump, strongly support most of the law’s key provisions, a new national poll indicates. And although most Trump voters still favor repealing the law, often called Obamacare, an increasing share of Americans overall oppose that approach, according to the poll, which was conducted in mid-November, following Trump’s election. Just a quarter of Americans say they wanted to scrap the law, down from nearly a third in October. By contrast, nearly half say they want the law expanded or implemented as it is. Another 17% say they want the law scaled back. This apparent paradox—in which Americans view the law unfavorably but overwhelmingly support most of its key provisions—has characterized opinion about Obamacare for years, said Robert Blendon, an authority on public attitudes about health care at Harvard University.

• Democrats Relish Battle With GOP Over Medicare Boston Globe by Victoria McGrane—Now, a new fight over the popular entitlement program is shaping up to be an early battle between Democrats on one side and Trump and the Republicans on the other. Battered Democrats and their allies, in need of political reinvigoration after Trump and Republicans stunned them in last month’s elections, are readying their powerful, emotional lobbying efforts to stave off changes in Medicare. Advocacy groups including AARP, the powerful seniors lobby with close to 38 million members, are pulling out battle-tested weapons and drawing up plans of attack. A key part of the strategy will be using Trump’s own promises from the campaign trail to not cut Medicare, Social Security, or Medicaid, the federal health insurance program for the poor.

• GOP's Medicare Plans Run into Wall in the Senate Politico by Jennifer Haberkorn & Adam Cancryn—The GOP’s dream of privatizing parts of Medicare is running up against resistance from Senate Republicans. Interviews with more than a dozen GOP lawmakers reveal they’re not planning to pursue big changes to the popular health care program for seniors—at least not in the first year of the Trump administration. That hesitation starts with the chairman who would lead any overhaul in the Senate. “We’ll have to see,” said Sen. Orrin Hatch (R-Utah), head of the Senate Finance Committee, which oversees Medicare. “We’re going to have a whole new look at a lot of things. … It depends on what it is. It depends on how it is written. It depends on what it would do.”

• U.S. Life Expectancy Declines NPR by Rob Stein—One of the fundamental ways scientists measure the well-being of a nation is tracking the rate at which its citizens die and how long they can be expected to live. So the news out of the federal government Thursday is disturbing: The overall U.S. death rate has increased for the first time in a decade, according to an analysis of the latest data. And that led to a drop in overall life expectancy for the first time since 1993, particularly among people younger than 65. "This is a big deal," says Philip Morgan, a demographer at the University of North Carolina, Chapel Hill who was not involved in the new analysis… On average, the overall life expectancy, for someone born in 2015, fell from 78.9 years to 78.8 years. The life expectancy for the average American man fell two-tenths of a year—from 76.5 to 76.3. For women, it dropped one-tenth—from 81.3 to 81.2 years.

• U.S. Health Care Tab Hits $3.2T; Fastest Growth in 8 Years AP by Ricardo Alonso-Zaldivar—The nation's health care tab grew at the fastest rate in eight years in 2015, driven by the coverage expansion in President Barack Obama's law and by costly prescription drugs, the government said Friday. The growth of 5.8 percent in 2015 boosted total health care spending to $3.2 trillion. That's an average of $9,990 per person, although the vast share of that money is spent caring for the sickest patients. Health spending grew about 2 percentage points faster than the overall economy in 2015, said the report from nonpartisan economic experts at the Department of Health and Human Services. That's a problem because it makes it harder for government programs, employers, and individuals to afford the level of health care that Americans are used to having.

• Stat: Drug Makers Are Getting Ready to Shape Trumpcare Stat by Dylan Scott—The upcoming fight over repealing and replacing the Affordable Care Act promises to shake up hospitals and insurers, but drug makers also stand to gain—or lose—a lot.  On the upside, congressional Republicans have already signaled that they plan to roll back billions of dollars in fees the law imposed on the industry. But drug makers also risk losing millions of new customers who became insured under the health care law. And if President-elect Donald Trump and Congress decide they need to cover the full cost of whatever they propose to replace the law, they might turn to drug companies to pay up

• Global Prescription Drug Spend Seen at $1.5 Trillion in 2021: Reuters by Berkrot—Global spending on prescription medicines will reach nearly $1.5 trillion by 2021, although the annual rate of growth will decrease from recent years, according to a forecast by Quintiles IMS Holding released on Tuesday. That figure, based on wholesale pricing, is up nearly $370 billion from estimated 2016 spending. The United States will account for up to $675 billion of the $1.5 trillion. When accounting for anticipated discounts and rebates to health insurers and other payers, 2021 net spending will be closer to $1 trillion, the QuintilesIMS Outlook for Global Medicines through 2021 report found.