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Potential trouble sign for Obamacare enrollment. Obamacare’s open enrollment is more than halfway done, but a new poll found that one in four potential Obamacare customers don’t know that it ends on Dec. 15 if they want to buy a plan on healthcare.gov. The poll from the research firm Kaiser Family Foundation released Wednesday also found that one in five potential customers would buy a short-term plan, which are cheaper than Obamacare plans but offer fewer benefits. The poll found that 24 percent of potential customers that it interviewed know the correct date that open enrollment ends and 61 percent have no idea. Kaiser also looked into the effect of the loss of the individual mandate’s financial penalty, which is zeroed out in 2019. It found that 31 percent are aware of that the penalty doesn’t exist anymore. About 49 percent of potential Obamacare customers said they plan to buy coverage and 42 percent said they would go without it. Kaiser interviewed 1,201 people and has a margin of error of three percentage points. Of the 1,201, there were 168 potential Obamacare customers who either purchase their own insurance or are currently uninsured.

Just 5 percent say coverage for all should be top healthcare priority for new Congress. Although the liberal push to expand Medicare to everybody has received a lot of attention in the past year, the same Kaiser poll suggests the issue is off the radar for most Americans. In the survey, Kaiser asked respondents to react to an open-ended question: "Thinking about next year, which healthcare issue would you most like the next Congress to act on in 2019?" Among the answers, 19 percent named "affordability and cost"; 10 percent named the Affordable Care Act (aka Obamacare); 6 percent named Medicare; and just 5 percent said, "Healthcare/insurance for everyone." Even among Democrats, just 7 percent pegged healthcare for all as the top priority. Instituting some sort of "Medicare for all" plan would cost $32 trillion, necessitate historic tax increases on the middle class, cause massive disruption to medical providers, and kick more than half of Americans off their private insurance, passing anything close to it is going to be an uphill battle. To survive the onslaught of opposition to such a radical policy, liberal activists will have to generate a groundswell of demand on a near revolutionary scale. This survey suggests they are far from reaching that critical mass.

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Alexander, Murray say they want to get back to bipartisan Obamacare plan. During a Senate Health, Education, Labor, and Pensions Committee hearing this morning devoted to analyzing healthcare costs, Chairman Lamar Alexander of Tennessee and top Democrat Sen. Patty Murray of Washington both expressed they would like to find a bipartisan way forward on Obamacare. Each side blamed the other for the failure earlier this year to pass a bill aimed at shoring up Obamacare that became known as Alexander-Murray. Republicans brought it to the floor but attached anti-abortion language to it, a provision common for spending bills but the root behind why Democrat said they rejected the deal. "I’m hopeful we can revive those discussions in the new Congress, and find a way past the ideological standoffs of the past,” Murray said. Alexander said he thought senators could more broadly address healthcare costs, and perhaps even Obamacare. "I regretted that that didn't work, and maybe we can find a way to make it work in the new session," he said. Watch the hearing here.

Chances of partial government shutdown edge closer. Republicans and Democrats aren't budging in their fight over how much money to spend on President Trump's border wall, which is increasing the chances of a stalemate that leads to a partial government shutdown next month. President Trump has drawn a red line on the wall, telling GOP appropriators and leaders he wants $5 billion included in final fiscal year 2019 spending bill. The Homeland Security spending bill is where Republicans would like to include that money, and that bill needs to be passed by Dec. 7 to avert a partial government closure. But Senate Democrats say they want to stick to the $1.6 billion Senate lawmakers agreed to earlier this year. Neither side is backing down and Trump is threatening to use his veto pen if the spending legislation doesn’t provide his requested wall funding. With no deal in sight, Republicans are already considering whether to split off the Homeland Security spending bill and passing the six other bills that don't relate to border wall funding. The idea is to pass those bills, and then leave the contentious Homeland Security bill for last.

House Democrats prepare for marathon days of leadership votes. Private voting is expected to start this morning for about a dozen leadership positions – including House speaker, majority leader, and majority whip – and may go on until Thursday. The members will shape the House’s agenda on healthcare and preview what a 2020 challenger to Trump can deliver to the public. Current minority leader Nancy Pelosi, D-Calif., is running unopposed for House speaker, and if she wins she will face a full House vote Jan. 3, where she will need 218 supporters to claim the top spot. Also running unopposed is Rep. Steny Hoyer of Maryland, who is running for majority leader, and Rep. James Clyburn of South Carolina, who is running for majority whip. Pelosi and Hoyer have said if elected they plan to focus on fixing Obamacare, but the majority of rank-and-file House Democrats support the Medicare for All Act, a bill that would overhaul the healthcare system by rolling every person in the U.S. into Medicare. Clyburn is the only one in the top leadership slot who has co-sponsored the bill.

In the Senate, Republicans hold 53-47 advantage, boosting confirmation of justices. Sen. Cindy Hyde-Smith, R-Miss., on Tuesday easily defeated former Democratic Rep. Mike Espy in the runoff election in Mississippi, the final contest of the 2018 campaign cycle that will give Republicans 53 Senate seats in the next Congress. The latest tally in effect gives Senate Majority Leader Mitch McConnell, R-Ky., three votes to spare when it comes to confirming Trump's judges. The added cushion also means that Trump and his team can have more leeway to nominate more conservative judges given that there is now less pressure to placate centrists. McConnell has said that he plans to confirm 35 justices by Dec. 14, a plan blasted by Planned Parenthood given the abortion cases making their way through the courts. Planned Parenthood on Wednesday calling out certain nominees for their “hostile views on reproductive rights,” including Wendy Vitter, Jonathan Kobes, Matthew Kacsmaryk, and Michael Truncale.

Anti-abortion groups urge White House to defund Planned Parenthood, fetal tissue research in 2019. Students for Life of America has outlined a list of priorities for the administration in 2019 that includes only signing budgets that defund Planned Parenthood and cutting off funds from the organization that go toward sex education. In a letter sent Trump this morning ahead of a planned meeting with members of the administration at the White House, Students for Life urged the Trump administration to cut off federal family planning grants from Planned Parenthood and for research arms of the government to discontinue medical research using fetal tissue. Planned Parenthood receives reimbursements for services such as birth control, STD testing, and cancer screenings, and anti-abortion groups say this frees up funds for abortion services.

FDA finds 'disturbingly high' levels of metals in kratom. The Food and Drug Administration warned Tuesday that it had found "disturbingly high levels of heavy metals" in products using the herbal supplement kratom. FDA scientists said they discovered lead and nickel in 26 products when they were testing kratom for salmonella following an outbreak that had spread across multiple states. The metals were at levels "not considered safe for human consumption," but were not likely to poison someone who had used kratom only once, the FDA said in a statement issued by its commissioner, Scott Gottlieb. "Some of these products included levels that, with chronic use, could cause some people to suffer from heavy metal poisoning," the FDA said. "We are concerned that there may be other kratom products on the market that also contain heavy metals."

Maine GOP governor requests delay on Obamacare's Medicaid expansion. The Maine governor's office has asked for a stay on a court order for officials to implement Obamacare's Medicaid expansion as it seeks to appeal the decision to the Maine Supreme Judicial Court.

The lawyer who filed the stay on behalf of Republican Gov. Paul LePage on Tuesday said the order to start the expansion on Dec. 5 would cause a "fiscal crisis" to the state's Department of Health and Human Services. He wrote that the move would require the state to spend millions of dollars appropriated for other services and noted that the Trump administration had not yet signed off on the expansion. Under Obamacare, the federal government is supposed to pick up at least 90 percent of the tab. Last week, Kennebec County Superior Court Justice Michaela Murphy ordered Maine officials to begin taking steps to carry out the Medicaid expansion, which would cover an additional 80,000 people in the state. Murphy wrote in her order that the expansion could be paid for through the current Medicaid fund until May 2019 and that the legislature needed to address the issue.

Improper use of active shooter alarm shakes Walter Reed. A tenant command inadvertently set off a mass notification system on Tuesday at Walter Reed National Military Medical Center, causing widespread confusion and early conflicting reports about a possible active shooter on campus. The incident led to a lockdown on the sprawling Bethesda, Md.,-based campus, where people were urged to hide in safe areas as authorities investigated the scene. Initial reports said the alarm was part of a drill, but by nightfall officials said the alarm had been a mistake. "While preparing for an upcoming drill, the notification system was inadvertently enacted without containing the words 'exercise' or 'drill,'" the U.S. Navy said in a statement. The people who saw the notification alerted security on campus, which then sent out a widespread alarm. The U.S. Navy originally tweeted that the incident was part of a scheduled drill. "After investigating the call and the origin, NSA Bethesda has determined that this was a false alarm and not part of a scheduled drill as has been reported," the Naval Support Activity Bethesda said in a statement.

Former opioid maker executive expected to plead guilty in kickback scheme. A former executive at the opioid maker Insys Therapeutics is expected to plead guilty for participating in a scheme to pay doctors to prescribe Insys’ opioid product, according to a report in Reuters. Former executive Alec Burlakoff is expected to plead guilty for taking part in a racketeering scheme. Insys had paid the Justice Department $150 million in response to the scheme. Insys is the latest company embroiled in lawsuits surrounding the opioid epidemic. Purdue Pharma, maker of the popular painkiller Oxycontin, has been sued by several states for deceptively marketing Oxycontin and downplaying addiction risks.

HHS issues strategy aimed at reducing doctor burden on health IT. Health and Human Services put out a strategy on Wednesday aimed at reducing the burden that clinicians have faced by adopting health IT such as electronic health records. The strategy has recommendations to help physicians incorporate EHRs and other health IT products into their practices. “With the significant growth in EHRs comes frustration caused, in many cases, by regulatory and administrative requirements stacked on top of one another,” HHS Secretary Alex Azar said in a statement. HHS has made easing burdens for adopting health IT a major plank of its effort called Patients over Paperwork. The administration argues that documentation guidelines for adopting EHRs has led to “note bloat,” as clinicians have reported spending more time entering data into an EHR than with their patients.

FDA releases 63 product-specific regulatory guidances on generic drugs to increase competition. The Food and Drug Administration put out regulatory guidances on 63 drugs to help generic drug makers develop generic versions of the products. The product-specific guidances show data on how a company can complete studies to get approval for a generic version of the product. The agency said that four of the 63 guidances are new and 31 are revised and updated guidances. The agency has made improving generic drug competition a major part of the Trump administration’s effort to combat high drug prices. The guidances are being updated to make it easier for companies to develop competitors. The agency approved or tentatively approved a record 971 generics in fiscal 2018.

RUNDOWN

The Hill Google parent company seeking to eliminate mosquito-spread diseases globally: report

Axios What the criminal justice reform bill would mean for the opioid crisis

Wall Street Journal Big tech expands footprint in health

New York Times JUUL’s new product: Less nicotine, more intense vapor

Reuters Humana cuts 2019 membership forecast for prescription drug plans

Associated Press At FDA, a new goal, then a push for speedy device reviews

Kaiser Health News Chronically ill, traumatically billed: The $123,000 medicine for MS