Where the Alexander-Murray bill to patch Obamacare now stands Presented by

WHERE THE ALEXANDER-MURRAY BILL STANDS — The legislation to stabilize Obamacare's fragile insurance markets, authored by GOP Sen. Lamar Alexander and Democratic Sen. Patty Murray, is heading into a crucial week ahead of the start of ACA open enrollment. And after days of rocky public negotiations, including President Donald Trump's repeated flip-flops, the bill appears to be gathering momentum in the Senate.

— White House issues new demands. Under the White House's requests, which POLITICO's Jennifer Haberkorn scooped on Saturday, individuals would not pay for failure to comply with the coverage mandate this year and employers would not pay for failing to comply with the mandate in 2015, 2016 or 2017.

The White House also wants additional flexibility for states to pursue waivers, expanded use of health savings accounts and greater use of short-term, limited duration insurance plans.

Keep reading: More for Pros. | See the White House's list of requests: More for Pros.

… Alexander said that he welcomed the input. "This is the normal legislative process with people of different views saying what they are for and against," he said, adding that the bill's prospects this year are good.

Meanwhile, the Senate's majority and minority leaders on Sunday sent strong signals that the bill has a path forward. But this has been a very up and down process, and there's a lot of uncertainty about the House.

— McConnell will bring bipartisan health care bill to floor ... if Trump says he will sign. That's what Senate Majority Leader Mitch McConnell said on CNN's "State of the Union," suggesting that he needs the president to be more specific.

"I'm not certain yet what the president is looking for here but I'll be happy to bring a bill to the floor if I know President Trump would sign it," McConnell said. "If there is a need for some kind of interim step here to stabilize the market, we need a bill the president will actually sign."

— Schumer: Bipartisan health care bill 'has a majority.' Senate Minority Leader Chuck Schumer said on "Meet the Press" that most senators back the legislation and urged McConnell to bring it to the floor "immediately."

"This is a good compromise. It took months to work out. It has a majority. It has 60 senators supporting it. We have all 48 Democrats, 12 Republicans," Schumer said. "I would urge Sen. McConnell to put it on the floor immediately, this week. It will pass and it will pass by a large number of votes."

Lamar Alexander and Patty Murray's bill has some momentum in the Senate. | Bill Clark/CQ Roll Call

MEANWHILE, IN CALIFORNIA: COURT TO HEAR ARGUMENTS OVER CSRs — A federal judge in San Francisco today is scheduled to hear arguments over an emergency order filed by 19 Democratic attorneys general over Trump’s decision to stop making the cost-sharing reduction payments.

The state AGs, who have filed a lawsuit in the U.S. District Court for the Northern District of California, want the judge to issue a temporary restraining order to force the Trump administration to continue paying the cost sharing reduction subsidies while the case is litigated.

… When asked about the earlier federal court decision ruling the CSR payments illegal because the funds weren’t appropriated by Congress, California Attorney General Xavier Becerra told Fox News Sunday morning that that decision remains on hold.

“The Obama administration first, now, the Trump administration are in court against that decision. And we have now states joined in that effort as well to try to keep not only that decision on hold but permanently on hold and to move forward with the Affordable Care Act,” Becerra said, adding that some 7 million Americans depend on the CSRs.

THIS IS MONDAY PULSE — Where your author dutifully reports that it's been only three weeks since the Las Vegas shooting, even if it seems like it's been a year. The news cycle moves awfully fast in 2017, which means that even the most awful news doesn't always stick. Send tips to [email protected] or @ddiamond on Twitter.

With help from Victoria Colliver (@vcolliver) and Renuka Rayasam (@RenuRayasam)

DAYS UNTIL OPEN ENROLLMENT: Eight

DAYS SINCE CHIP FUNDING EXPIRED: 23

From opioids to HIV — a public health threat in Trump country. The next HIV epidemic in America is likely brewing in rural areas suffering under the nationwide opioid crisis, with many of the highest risk communities in deep red states that voted for Trump, POLITICO's Brianna Ehley reports.

Federal and state health officials say they are unprepared for such an outbreak, and don’t have the programs or the funding to deal with a surge in HIV cases. And given how little screening for HIV there is in some rural counties, they worry it may have already begun, Brianna notes. Keep reading: More for Pros.





A message from PhRMA: Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. More.





The legal battle over undocumented teen’s abortion escalates. In a decision issued late Friday, a three-judge panel split 2-1, overturning a decision from a federal judge issued earlier this week that would have allowed an undocumented, pregnant teenager to have an abortion immediately. But on Sunday night, the girl's lawyers took the unusual step of asking the full bench of a federal appeals court in Washington to permit her to have an abortion immediately despite resistance from the Trump administration.

— What happened this weekend: Friday's D.C. Circuit Court of Appeals ruling — apparently devised by Judge Brett Kavanaugh, a George W. Bush appointee — opted to find a path that would dispose of the case without making any precedent-setting decisions. The ruling stated that once federal authorities could find a suitable sponsor for the girl, the administration would have to allow her to follow state law to receive the abortion.

If the administration can't find a sponsor, a federal district court judge would again have the chance to step in and re-issue the order requiring the administration to permit the unaccompanied minor to leave the shelter for an abortion.

But the American Civil Liberties Union, which is representing the girl, argued in the en banc petition Sunday that wait would place a severe strain on the girl. Plus, they argue, administration officials have tried and failed for six weeks to find a sponsor.

— One complication: As the case makes its way through the courts, time is running out for Jane Doe, as the prospects of her receiving an abortion are becoming more complicated and difficult by the day, POLITICO's Renuka Rayasam and Josh Gerstein report. Texas bans abortion in most cases after 20 weeks. More.

Trump stokes hopes of Obamacare repeal — setting up Senate for another failure. The president says the Senate has the votes to repeal Obamacare… but that's news to the Senate, Jen reports.

"If there were 50 votes, we'd be voting," said Sen. John Thune, a member of Republican leadership.

Not a single "no" vote has flipped to a "yes." When senators talk about repeal after months of failure, they are talking about hopes and dreams — not about 50 votes to pass it. More.

West Virginia: Abortion could be key attack line in GOP Senate primary battle. State GOP Rep. Evan Jenkins voted to mandate contraception coverage while serving as a Democratic state legislator, a sign of how Jenkins’ past as a Democrat could come back to haunt him in next year's Republican Senate primary, POLITICO's Kevin Robillard reports.

In 2005, Jenkins voted in the West Virginia state Legislature to require insurance plans to cover contraceptives. Twelve years later, he praised President Donald Trump’s decision to roll back some of Obamacare’s contraceptive mandates: “I support religious freedom & believe the government has no right to make you violate your religious convictions.”

… Jenkins’ campaign noted the 2005 law included a religious liberty exemption and was non-controversial. But the dust-up still highlights how Jenkins’ decades as a Democratic legislator in West Virginia — where many other voters and politicians have made the switch from Democrat to Republican in recent years — will provide ample opportunity for Attorney General Patrick Morrisey to paint him as insufficiently conservative. More.

California: State to hold universal health care hearings. Two days of hearings begin today at the State Capitol in Sacramento, POLITICO's Victoria Colliver reports.

Assembly Speaker Anthony Rendon called for the hearings after pulling the state’s single payer bill, Senate Bill 562, and he took some heat for that. Rendon subsequently convened a Select Committee on Health Care Delivery Systems and Universal Coverage made up of Assembly leaders on health care, and charged them with finding a pathway for California to achieve universal health care that they can bring to the state legislature.

— What's on tap: The first day will focus on California’s current systems, and include discussion on its gaps in coverage. The second day will concentrate on universal coverage systems in other countries and allow time for public input. A full listing of the agenda and speakers can be found here, and the meetings will be broadcast on The California Channel.

— Where they stand: Expect the state’s biggest proponents of single payer – the California Nurses Association – to be out in full force rallying in support of SB 562, which has been held over until next year after Rendon cited concerns about cost and funding, Victoria tells PULSE.

The nurses lambasted Rendon’s decision, and want nothing less than full single payer. “We do not need more study of deficient models, such as ACA expansion or hybrid systems that fall short on universality, equity, access, and affordability,” said Bonnie Castillo, the union’s associate executive director. “The residents of California understand that the Democrats ‘own the fix’ here in this state. It’s not enough to ‘resist’ or blame the president. You have the ability if you so choose, to fix the system in a meaningful way and guarantee health care for all by allowing SB 562 to move forward.”

Georgia: Tom Price's wife defends AIDS quarantine remark as 'provocative.' Betty Price, the wife of former HHS Secretary Tom Price, is defending her widely reported comment about quarantining people with HIV as an attempt to be provocative about a public health crisis. The physician and Georgia state legislator says she does not favor quarantining people with HIV or AIDS.

"I made a provocative and rhetorical comment as part of a free-flowing conversation which has been taken completely out of context." she said in a statement to the Atlanta Journal Constitution on Saturday. "I do not support a quarantine in this public health challenge and dilemma of undertreated HIV patients. I do, however, wish to light a fire under all of us with responsibility in the public health arena." More.

… Price's comments last week at a state House Study Committee meeting were videotaped and circulated. "I don’t want to say the quarantine word, but I guess I just said it,” Price said then, before elaborating on possibilities to curtail the spread of HIV and AIDS.

In the New Yorker, Patrick Radden Keefe traces the connection between the Sacklers — one of America's richest families — and the rise of the nation's opioid epidemic. More.

At Health Affairs, Tim Jost reviews the latest briefs filed in California v. Trump, the legal battle over the CSR payments. More.

The new leader of the World Health Organization rescinded Robert Mugabe's appointment to an "ambassador" post, Helen Branswell writes at STAT. More. Mugabe, an infamous Zimbabwean strongman, has been criticized by human rights groups for years.

One tiny hospice agency in Washington state is an "outlier," JoNel Aleccia writes at California Healthline — it's powered by volunteers and has often been at odds with the for-profit hospice industry. More.

ICYMI: Why Oscar Health is betting bigger on Obamacare, a write-up of last week's POLITICO "Pulse Check" podcast. More.

Association health plans, now backed by Trump, have a long history of fraud, NYT's Robert Pear reports. More.

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