Why GOP leaders are considering axing the ACA mandate ... again Presented by

WHY GOP LEADERS ARE CONSIDERING AXING THE ACA MANDATE — AGAIN. There are lots of reasons for the GOP to leave the issue alone. Congressional Republicans have tried and failed to repeal Obamacare's individual mandate at least five times this year. Many voters on Tuesday said they backed Democrats because of health care concerns spurred by the GOP.

But there was Senate leadership, once again, whipping members on Wednesday afternoon to see if there would be support for repealing Obamacare’s individual mandate, POLITICO's Seung Min Kim and colleagues first reported. This time, they'd use the tax bill as the vehicle to do it.

— The effects of repealing the mandate. It would save the government $338 billion over a decade and result in 13 million more uninsured Americans in 2027, according to a new CBO score posted on Wednesday. More for Pros on CBO's score and methodology.

— Why to include it in the tax plan: It helps Republicans pay for the bill's tax cuts and lets them show progress to donors and voters on rolling back the ACA after months of failures.

— Why not: GOP leaders are worried that the provision would be rejected in the Senate because it would also mean millions in coverage losses and revive the partisan debate on the rest of the Affordable Care Act.

— How one senator is making the case: In a letter addressed to Senate Finance Chair Orrin Hatch on the eve of the scheduled release of the Senate’s version of tax reform, Sen. Steve Daines (R-Mont.) asked not only for a full repeal of the mandate but a government rebate to Americans who paid a tax penalty for lack of health insurance.

“Obamacare’s individual mandate is an affront to freedom and is deeply unpopular,” Daines wrote. “[The Congressional Budget Office] projected that repealing the individual mandate will prevent Americans from paying $43 billion in tax penalties over the next ten years.”

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.

TRUMP MAY ACT ON HIS OWN TO NIX MANDATE — The president has been readying an executive order, the Washington Examiner and other outlets reported this week, although the administration denies that any action is imminent.

Most legal observers believe the administration has the necessary authority to interpret the law and substantially weaken enforcement of the tax penalty levied on most Americans who fail to obtain coverage, POLITICO's Paul Demko writes. The downside is that unraveling the mandate might ultimately make it harder for Republicans to follow through on their long-standing promise to repeal and replace Obamacare. More for Pros.

Republicans are again weighing a potential repeal of the ACA's individual mandate, this time as part of tax reform. | Getty

THIS IS THURSDAY PULSE — Where Americans' emotional health has fallen this year — except for men, whose self-reported levels of well-being remain the same.

How are you feeling, one year after the most shocking presidential election in PULSE's liftetime? Tips to [email protected] or @ddiamond on Twitter.

With help from Rachana Pradhan (@RachanaDixit), Renuka Rayasam (@RenuRayasam), Colin Wilhelm (@colinwilhelm) and Jennifer Haberkorn (@JenHab).

PULSE CHECK: SEN. BENNET ON MEDICARE-X AND MORE — The Colorado Democrat joined POLITICO's "Pulse Check" podcast to discuss his new legislation, his role on the Senate HELP and Finance committees and why he can't stand CMS administrator Seema Verma's new direction for Medicaid.

Plus: Josh Peck of Get America Covered sits down to debrief on the first few days of ACA open enrollment.

Listen to the podcast.

MORE ON TAX REFORM

Senate Republican considering expansion of child tax credit to help parents. “We have a child tax credit for after they’re born. Anyone who has had a child can tell you that year leading up to it is a pretty costly year,” Oklahoma Sen. James Lankford told POLITICO's Jennifer Haberkorn. “There are an awful lot of costs before the child is ever born.”

Lankford declined to reveal details but said “it’s a little more complicated” than extending the tax credit to a fetus, a contentious proposal that would get into abortion politics. More for Pros.

[GUIDE TO TAX REFORM] Easily understand and explain tax reform. Tax reform is complicated, to say the least. Download POLITICO Pro’s Guide to Tax Reform and become an expert. Includes six tax-related infographics. GET YOUR GUIDE TO TAX REFORM.

GOP seeking new conscience-clause protections for anti-abortion health care workers. They're pushing to add new permanent protections to the Labor-HHS appropriations bill. The legislation, which would allow health care workers who are fired over the issue to take their employer to court, was included in the consolidated appropriations package the House passed in September.

GOP Sen. Lankford said Republicans will push the issue in the Senate, although it would likely face resistance from abortion rights supporters who say the rules could prevent women from accessing care, particularly medication abortion or in rural areas.

NDAA moves forward as lawmakers discuss separate fix for drug approval provision. Must-pass defense policy legislation will move forward unchanged despite protests from health committees over a provision that would shift some approvals for drugs and medical products from the FDA to the Pentagon, POLITICO's Connor O'Brien reports.

Instead of delaying a vote on the National Defense Authorization Act H.R. 2810 (115) to make changes, the House Armed Services and Energy and Commerce Committees will continue talks on a potential fix, an Armed Services aide told POLITICO. The fix could then be attached to another must-pass bill, the aide said.

The provision, first included in the Senate-passed NDAA, drew opposition from Energy and Commerce Chairman Greg Walden (R-Ore.) and Senate HELP Chairman Lamar Alexander (R-Tenn.), who argued the broadly written provision could endanger troops and undercut the FDA. But Armed Services leaders contend the provision is needed to ensure access on the battlefield to freeze-dried plasma, which hasn't been approved by the FDA.

FIRST IN PULSE: Religious groups urge Congress to protect D.C.'s Death with Dignity Act. Fifty-nine religious leaders from various faiths want to preserve the District's ability to let terminally ill patients end their lives with the help of a physician, POLITICO's Rachana Pradhan reports.

"As children of God who comfort the terminally ill and their families, often at the dying person’s bedside, we have seen the suffering that can occur during our final days," reads the letter, which was organized by advocacy group Compassion & Choices and includes individuals from 23 states and the District. "We believe God is a God of love and compassion, one who would not abandon a dying person who is suffering and refuse that person the means to die peacefully in whatever way is consistent with their own individual faith and beliefs."

… In mid-September the House passed an appropriations bill that would block the District's Death with Dignity Act. The legislation was signed by Mayor Muriel Bowser in December and mirrors statutes in a handful of other states. Former Rep. Jason Chaffetz was among the House Republicans pushing to strike down the law.

American Hospital Association defends mergers after POLITICO story. The hospital association criticized an article, written by your PULSE correspondent, that looked at the future of hospital chains and the struggles of some mega-mergers. The article linked to evidence that hospital mergers led to higher costs with no quality improvements.

"An article in today’s Politico suggests hospital mergers are having an adverse impact on health local markets and is leading to substandard care and higher prices," AHA's Tom Nickels wrote. "But the most recent research on the subject tells a far different and less sensationalist story," he added, linking to an AHA-funded study that found positive effects of hospital mergers. See AHA's rebuttal.

… Experts stood by the finding that hospital mergers don't do much for health care.

"The rebuttal relies on a study paid for by the AHA which has not been subject to scientific peer review and which runs counter to an entire body of peer reviewed literature published in scientific journals," tweeted economist Martin Gaynor, a former FTC official who was quoted in POLITICO's story.

FIRST IN PULSE: Health care price growth remains near historic lows. That's according to the Altarum Institute's monthly indicators, which found that health care prices rose just 1.1 percent year-over-year through September. That's the lowest rate of price growth in nearly two years, partly because prescription price growth slowed down. See the pricing data.

… Hospital spending growth also remained sluggish, rising 1.9 percent year-over-year. "These trends toward slower growth may reflect the continuing shift in the delivery of care from inpatient to outpatient settings and in hospitals’ ongoing efforts to control increasing costs," Altarum said in a statement. See the spending data.







Texas: Federal trial over 'D&E' abortion ban concludes. The five-day trial is likely the first stop in a lengthy court battle over the legality of “dilation and evacuation” abortions, POLITICO's Renuka Rayasam reports from Austin.

— Background on the court battle: Abortion providers sued the state, arguing that this year's ban on D&E abortions — a common second trimester procedure — would subject women to alternate procedures that are riskier and come with more complications.

But the state countered that the procedure, in which the fetus is dismembered before being removed, shouldn’t be allowed because it causes the fetus pain. The law “is unquestionably constitutional,” said Darren McCarty, who argued for the state. He said alternatives, which cause the demise of the fetus before it is extracted, are within the standard of care for women seeking second trimester abortions.

— What's next: U.S. District Court Judge Lee Yeakel acknowledged that regardless of his decision, the ruling will be appealed to the Fifth Circuit Court of Appeals — which tends to rule for conservatives, Renuka notes. More for Pros.

One year later: 'Optimism' about HHS vaccine policy, although 'uncertainty' persists. Despite "grave concerns" by scientists that Trump's election would weaken U.S. vaccination policies — given the new president's public flirtation with fringe theories about vaccines and autism — HHS's support for vaccines remains strong and scientifically rigorous, Yale professor Jason Schwartz writes in the American Journal of Public Health.

While Trump met with some vaccine skeptics, he ultimately appointed champions of the science, Schwartz writes, pointing to statements by FDA commissioner Scott Gottlieb, CDC director Brenda Fitzgerald and Surgeon General Jerome Adams — all Trump appointees who have reaffirmed their commitment to vaccines.

… Schwartz acknowledges that Trump, if he chooses, could quickly throw national vaccine policies into disarray with a single tweet.

"This work is increasingly difficult already, but it would become immeasurably more so if the president were to express doubts again about vaccine safety via social media or other means," like establishing a commission to review vaccine safety, an idea that Trump floated after his election, Schwartz concludes. More.

By Paul Demko

There are no good options for overhauling the health care system, argues Pascal-Emmanuel Gobry in National Review. Instead, tinkering around the edges is the best bet for now. More.

Anti-vaxxers have found a way around California’s strict new immunization law. They need to be stopped, argues The Los Angeles Times’ editorial board. More.

House Republicans’ tax package would eliminate the deduction for long-term care expenses. That could hit some individuals with chronic illnesses hard, report Katie Zernike and Abby Goodnough in The New York Times. More.

The Atlantic’s Emma Green explores why Notre Dame reversed course on covering contraception. More.

Writing in the Washington Post, Katy Kozhimannil and Austin Frakt explore why maternity care options are dwindling in rural America. More

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