“Substance abuse is much more complicated than a simple choice of yes or no.”

— Lori Criss, chief executive officer of the Ohio Council of Behavioral Health and Family Services Providers,
on the administration's plans to use advertising to curb the opioid epidemic

• Trump's Obamacare Move May Bolster Law The Hill by Peter Sullivan — President Trump's decision to cancel key Obamacare payments could be backfiring.  Trump has claimed the health law is "imploding," and earlier this month he took an action seemingly aimed at that goal: cutting off key payments to insurers known as cost-sharing reductions. But there are inadvertent benefits of Trump's action: Many Obamacare enrollees are actually getting a better deal and the potential to get more generous insurance because Trump cut off the payments....If the plans are more expensive, people get a bigger subsidy.
  
  
• Federal Judge Refuses to Order the Trump Administration to Resume ACA Payments Washington Post by Amy Goldstein and Juliet Eilperin — A federal judge in California on Wednesday denied a request from 19 attorneys general across the country to force the Trump administration to resume funding of cost-sharing payments under the Affordable Care Act. The ruling leaves intact President Trump's decision earlier this month to immediately end the payments that reimburse insurers for discounts the law requires them to give lower-income customers with health plans through ACA marketplaces. The attorneys general, from 18 states and the District of Columbia, were seeking a temporary order that would have maintained the funding while the rest of the case is decided. In his decision, Judge Vince Chhabria of the U.S. District Court for the Northern District of California wrote that resuming the payments to insurers "would be counterproductive."

• Trump Tells Senate to Fix Taxes — Not Obamacare Politico by Jennifer Haberkorn and Adam Cancryn — President Donald Trump on Tuesday steered Senate Republicans toward tax reform and away from health care, pushing off any deal to fund controversial Obamacare subsidies to the end of the year at best. Trump joined Senate Republicans at their weekly policy lunch but gave no direction on what he wants to see in a health care bill. He praised Sen. Lamar Alexander's (R-Tenn.) work on a bipartisan deal meant to stabilize the Obamacare markets, but his emphasis on taxes led senators in the room to believe Trump doesn't want a stand-alone Obamacare vote anytime soon...Without a clear directive from the president, Republicans are still debating whether to work with Democrats to fund Obamacare's "cost-sharing" program, which helps low-income people pay their out-of-pocket medical bills.
  
  
• CBO: Bipartisan Bill to Stabilize Insurance Would Reduce Budget Deficit Modern Healthcare by Harris Meyer — The bipartisan Senate bill to stabilize the individual insurance market and fund cost-sharing reduction payments to insurers would reduce the federal budget deficit by $3.8 billion from 2018 to 2027, the Congressional Budget Office reported Wednesday. The bill, authored by Sen. Lamar Alexander (R-Tenn.), chairman of the Senate health committee, and Sen. Patty Murray (D-Wash.), senior Democrat on the committee, would fund the payments for 2018 and 2019.
  
  
• U.S. Lawmakers Will Not Tackle Health Care This Year, Ryan Says Reuters by Richard Cowan and Doina Chiacu — Republican lawmakers will not take up a bipartisan plan to stabilize Obamacare insurance markets or try again to repeal and replace the law this year, House of Representatives Speaker Paul Ryan said on Wednesday, signaling his party was shelving the matter until the 2018 U.S. congressional election year. "I think that is something we should do next year," Ryan said in an interview with Reuters when asked about prospects of the House passing a bipartisan bill that would reinstate federal subsidies to private insurers to help lower-income people buy medical coverage through the Affordable Care Act. 

• 1.1 Million Fewer People Could Sign up for Obamacare This Year Due to Trump Funding Cuts The Hill by Jessie Hellmann — The Trump administration's funding cuts to ObamaCare's advertising budget could result in at least 1.1 million fewer people signing up for coverage this year, according to an analysis released Monday. "The threat to Open Enrollment this year is very real," wrote Josh Peck, the author of the analysis, who served as healthcare.gov's chief marketing officer during the Obama administration. "People will be hurt by the administration's actions." 

• Trump Declares Opioid Crisis a 'Health Emergency' but Requests No Funds New York Times by Julie Hirschfeld Davis — President Trump on Thursday directed the Department of Health and Human Services to declare the opioid crisis a public health emergency, taking long-anticipated action to address a rapidly escalating epidemic of drug use. But even as he vowed to alleviate the scourge of drug addiction and abuse that has swept the country — a priority that resonated strongly with the working-class voters who supported his presidential campaign — Mr. Trump fell short of fulfilling his promise in August to declare "a national emergency" on opioids, which would have prompted the rapid allocation of federal funding to address the issue.
  
  
• AP Fact Check: Past Anti-Drug Campaigns Show Little Success Associated Press by Matthew Perrone — President Donald Trump is promising a "massive advertising campaign" as part of his administration's response to the worst drug crisis in U.S. history, but past marketing efforts have shown few results and experts say other measures could be far more effective in curbing the current epidemic. Yet government and academic assessments of "Just Say No"-style messages have repeatedly shown poor results. Between 1998 and 2004 the U.S. government spent nearly $1 billion on a national campaign designed to discourage use of illegal drugs among young people, particularly marijuana. A 2008 follow-up study funded by the National Institutes of Health found the campaign "had no favorable effects on youths' behavior" and may have actually prompted some to experiment with drugs, an unintended "boomerang" effect.

• House GOP Leaders Announce Children's Health Insurance Vote Roll Call by Sandhya Raman — Arguments erupted on the House floor Thursday between Republican and Democratic leaders over the prospect of a vote next week on a GOP-only bill to renew funding for the Children's Health Insurance Program, or CHIP. House Majority Whip Kevin McCarthy, R-Calif., announced the bill would be debated next week — a plan opposed by Minority Whip Steny H. Hoyer, D-Md. Democrats have pushed to delay the House bill until an agreement is reached on a bipartisan solution to pay for it. "CHIP and community health centers, as the majority leader pointed out, have always been a bipartisan priority. Unfortunately, this bill did not come out of the committee as a bipartisan bill," said Hoyer. "Negotiations were not fruitful."
  
  
• States Risk Exhaustion of Children's Coverage Funds CQ by Sandhya Raman — Inaction on passing legislation to extend funding for CHIP is causing further uncertainty for states and families, according to a new report. The findings from the Georgetown Center for Children and Families underscore previous concerns from advocates that the delay in renewing CHIP funding will negatively impact states. The report said five states — Arizona, California, Minnesota, Ohio and Oregon — as well as the District of Columbia are projected to exhaust funds before or shortly after December.

• Administration Denies More States' Plans to Customize Insurance Markets NPR by Alison Kodjak — Two states looking for approval to customize their health insurance systems under the Affordable Care Act reversed course after the Trump administration said their applications couldn't be approved in time for next year. Iowa withdrew its proposal to the federal Centers for Medicare and Medicaid Services for a waiver to alter its Affordable Care Act markets. Massachusetts' proposal was effectively denied by the administration. Both states sought to use some of the money that would have gone toward subsidies for consumers to instead create reinsurance programs that would protect insurers from major losses....The failures of the two states' waiver applications follow a trend. Several states have seen their proposals delayed, denied, or only partly approved, after administration officials actively encouraged states to apply.

• Low-Value Care Persists Five Years into Choosing Wisely Campaign Modern Healthcare by Maria Castellucci — The Choosing Wisely campaign, which launched five years ago, hasn't curbed the widespread use of low-value services even as physicians and health systems make big investments in the effort, a new report found. The analysis, released Tuesday in Health Affairs, said a decrease in unnecessary health care services "appear to be slow in moving" since the campaign was formed in 2012. The report found that recent research shows only small decreases in care for certain low-value services and even increases for some low-value services. The Choosing Wisely campaign was created by ABIM Foundation and Consumer Reports to raise awareness in the healthcare community about unnecessary care and encourage providers to change practices.
  
  
• CMS Experiment Saves Millions, Decreases Hospital Visits Modern Healthcare by Virgil Dickson — CMS has seen a drop in avoidable hospitalizations of seniors and generated nearly $50 million in savings from an experiment that aimed to keep nursing home residents out of inpatient care. The agency recently touted the results of its three-year Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, which saw a 17 percent relative reduction in potentially avoidable hospitalizations in participating facilities. "These findings provide persuasive evidence of the initiative's effectiveness in reducing hospital inpatient admissions, ED visits, and hospitalization-related Medicare expenditures," the report said.

• Seema Verma's Plan to Upend the Medicaid Expansion, Without Congress Stat by Casey Ross — With a broad overhaul of Obamacare stalled in Washington, one of President Trump's top health care leaders is drawing the outlines of sweeping changes to Medicaid that could pare enrollments and cut costs without congressional approval. Seema Verma, director of the federal Centers for Medicare and Medicaid Services, is promising to give states an "unprecedented level of flexibility" to design their Medicaid programs as they see fit. In an appearance in Cleveland this week, she pledged to reduce scrutiny of state requests for waivers from federal rules meant to preserve access and quality standards. "We want to get to the point where we are making the whole waiver process easier," Verma said during a discussion at the Cleveland Clinic's annual medical innovation summit. "We're not going to tell the states what their priorities are. They are going to come and tell us what their priorities are."

Editor: Peter Van Vranken