�鶹Ů��

By a vote of 318 to 109, the House on Thursday approved the tax-cut package, which will add more than a half-trillion dollars to the deficit, and supporters and critics alike said that the bill represented Mr. Ryan’s deeply held belief that tax cuts ultimately pay for themselves by fostering economic growth. The measure would postpone some key components of the Affordable Care Act, by delaying, for example, the so-called Cadillac tax on high-cost, employer-sponsored health plans. (Herszenhorn, 12/17)

Going forward, Republicans will need to do less annual maintenance work in the tax code because fewer provisions will expire, thus freeing up time for their bigger goal of lowering tax rates and broadening the tax base. By locking the breaks in now, Republicans also lower the government’s total revenue forecast for the next decade. (Rubin, 12/17)

The tax and spending package is the last major legislation that Congress will pass before it adjourns for the year. It was the first big budget compromise negotiated under new House Speaker Paul Ryan, R-Wis. (Kelly, 12/17)

The House and Senate are rushing to send President Barack Obama the massive budget package that would fund the entire government through September 2016. Obama has promised to sign the measure, but it must first overcome some resistance. House Democrats are upset over a victory for big oil, while tea party lawmakers say it spends too much money. (12/18)

The dynamics on the spending bill are far different than those of the tax measure, and at this time, passage is far from assured. The Capitol isn't in full panic yet, but there does appear to be a rising level of concern on the Democratic side of the aisle that they will be short the votes needed to pass the omnibus spending bill. (Sherman, Bresnahan and French, 12/17)

A rider in the federal spending bill creates a significant obstacle to the District’s ability to assess and spend excess surplus dollars collected by the Washington region’s largest health insurer. District insurance regulators last year ordered CareFirst BlueCross BlueShield to spend $56 million out of its billion-dollar cash reserves on local community health needs, effectively upholding a D.C. law passed in 2009 that required assessments of the company’s surplus dollars every three years. (Hauslohner, 12/17)

Congress is scheduled to vote on a $1.1 trillion spending bill Friday that would avert a government shutdown until next October and fund almost all federal activities. But like just about any bill in Congress, this one's full of little goodies and pet projects that can have a big effect on medical research and health and science policies. (Fox, 12/17)

The administration also reiterated its view that reforms to Puerto Rico's Medicaid system should be put in place to help relieve budgetary pressures and again called on lawmakers to make the island's residents eligible for the Earned-Income Tax Credit for low- and moderate-income individuals. (12/17)

Companies want to kill it. Unions hate it. Republicans want to eliminate it. Some Democrats agree. We're talking about the much-reviled Obamacare Cadillac tax, which is set to levy a hefty 40% excise tax on employer health plans that are considered generous. (Luhby, 12/19)

Congress is nearing a vote on a $1.1 trillion spending bill that will fund the government into next fall. It includes the biggest changes so far to one of Congressional Republicans' top legislative targets over the last half-dozen years: Obamacare. (Gorenstein, 12/17)

A set of delays on Obamacare-related taxes in the new federal spending bill will give corporate earnings a modest boost but are unlikely to undo the law or produce significant changes in the health-care industry. Medical-device companies such as Medtronic Plc, health insurers like UnitedHealth Group Inc., and big employers across the U.S. have been preparing for years for a slate of new taxes under the Affordable Care Act. They’ll find it easier just to collect extra profit from a tax cut rather than undo those changes, such as job reductions and revamped health benefit plans. (Cortez and Tracer, 12/16)

Businesses have been adjusting their benefits plans for several years now, to ease in changes that will help them avoid the tax. They’ve been raising deductibles and other out-of-pocket expenses for workers. Many also are adding surcharges on the coverage of spouses who can get benefits elsewhere. (Murphy, 12/17)

The number of Texans with health insurance has increased 20 percent since 2013 under federal health care reform, but Texas’ health insurance gains continue to lag behind the rest of the nation, according to a pair of reports released this week. While the Obama administration has declined to say how many enrollees in federally subsidized health insurance were previously uninsured, a study to be released Friday by consulting firm Milliman sheds new light on that number, finding that the Texas health insurance market has grown by about 760,000 people under the Affordable Care Act. (Walters, 12/18)

You may be strong with the Force, but you still need health insurance. That’s the message the District of Columbia’s health insurance exchange hopes to send to moviegoers this weekend. DC Health Link will have representatives stationed at the Regal Gallery Place Stadium 14 theater in downtown Washington starting Friday afternoon. (12/18)

Gov. Terry McAuliffe proposed Thursday to use projected savings from expanding Virginia’s Medicaid program to pay for corporate and individual tax relief, as well as a handful of other spending initiatives. McAuliffe presented a two-year, $109 billion budget to the General Assembly’s Republican-controlled money committees that includes almost $157 million in projected savings from using federal funds under the Affordable Care Act to provide health coverage for hundreds of thousands of uninsured Virginians, which he called “necessary and inevitable.” (Martz, 12/17)

Gov. Terry McAuliffe announced a two-year budget proposal Thursday that calls for expanding Medicaid, defying a Republican-dominated General Assembly that has vowed to strip that out for a third consecutive year. The spending plan totals $109 billion, and includes $3 billion for the federal health insurance program. It also calls for a new tax on hospitals to help bankroll Medicaid expansion, but would slightly cut personal and corporate taxes. (Portnoy and Vozzella, 12/17)

Martin Shkreli was arrested Thursday on securities and wire fraud charges stemming from an alleged Ponzi scheme he ran as a hedge-fund manager. Mr. Shkreli has pleaded not guilty to the charges. (Rockoff, 12/17)

He's a millionaire music aficionado who riled rap fans by buying the only known copy of an album by the Wu-Tang Clan. He's an unabashed self-promoter who livestreams his daily life and boasts he's "the world's most eligible bachelor" and "the most successful Albanian to ever walk the face of this Earth." And he's an equally unabashed provocateur who jousts online with his critics. Now, prosecutors say Martin Shkreli is a fraudster. (12/18)

During his three months as a household name, Martin Shkreli has been a walking, talking (incessantly) personification of one of the pharmaceutical industry’s worst nightmares — the greedy drug company executive. So his arrest Thursday on securities fraud charges might bring some private cheer to pharmaceutical company executives, who blame him for setting off a public uproar over drug prices. (Pollack, 12/17)

Fraud charges against Turing Pharmaceuticals boss Martin Shkreli are a symptom of the sector’s ills. Healthcare has been prone to financial finagling, but the recent boom created more opportunities for misconduct. With good times fading, the excesses suddenly stand out like a sore thumb. Controversy has long been Shkreli’s calling card. He made his name publicly criticizing biotechnology stocks whose value his hedge fund bet would drop. Then he switched tactics, founding two biotech companies himself. (Cyran, 12/17)

The arrest of Martin Shkreli gave pharmaceutical industry executives a golden opportunity to separate themselves from the “$750 pill guy” who has done so much damage to their image. They might not want to celebrate too much. (Robbins and Nather, 12/17)

KQED's Lisa Aliferis, working in partnership with Kaiser Health News, reports: "Kaiser Permanente, the managed health care giant that now offers patients an integrated system combining insurance, hospitals and outpatient physicians, is adding a Southern California medical school to its portfolio, the company announced Thursday." (Aliferis, 12/18)

HMO giant Kaiser Permanente plans to launch a medical school in Southern California, bucking the healthcare establishment and promoting a new generation of physicians that looks more like the community it serves. (Terhune, 12/17)

Kaiser officials said the new school would include hands-on experience for students in clinics and hospitals, with a focus on primary care, the use of new technologies, and physicians’ role as part of a caregiving team. (Wilde Matthews, 12/17)

GlaxoSmithKline PLC has agreed to pay Bristol-Myers Squibb up to $1.5 billion to acquire the U.S. company’s pipeline of HIV drugs, a move which will bolster one of the U.K. drug makers’ strongest-performing areas. (Roland, 12/18)

Pharmaceutical group GlaxoSmithKline said its majority-owned HIV business would buy drugs at different stages of development from U.S. rival Bristol-Myers Squibb for an initial $350 million. GSK said the acquisitions would provide ViiV Healthcare, its HIV unit in which Pfizer and Shionogi are junior partners, with new opportunities for growth. The British company is reviving its position in HIV treatment as part of its strategy to return to earnings growth in 2016. (12/18)

A generic drug maker owned by Endo International Plc has reached a $39 million settlement with the U.S. government and 47 states stemming from the unlawful labeling of multivitamins that contained fluoride. New York Attorney General Eric Schneiderman announced the settlement on Wednesday. The case stemmed from a 2013 whistleblower lawsuit filed under the False Claims Act in which the U.S. Department of Justice and state attorneys general later intervened. (Baryln and Raymond, 12/16)

The prices of many Medicaid-covered generic drugs have increased faster than inflation in recent years, according to a new report from the U.S. Department of Health and Human Services. The report, issued Thursday by HHS's Office of Inspector General, said that if generic drugs had been treated the same way as brand-name drugs under Medicaid, states and the federal government could have gotten at least $1.4 billion in additional rebates from 2005 through 2014. (Pierson, 12/17)

Academic scientists who ignore legal requirements to publicly report clinical trial results often have received large payments from drug companies involved in the studies, a STAT review of federal data found. (Piller, 12/17)

Montana health officials have signed a two-year contract worth more than $16 million making Blue Cross and Blue Shield of Montana the first commercial insurance provider to administer a state’s Medicaid expansion program under President Barack Obama’s Affordable Care Act. Department of Public Health and Human Services Director Richard Opper and Blue Cross President Mike Frank signed the contract Wednesday, and it was released to The Associated Press on Thursday. The contract can be renewed for up to seven years. (Volz, 12/17)

No matter who wins next year's presidential election, it's a sure bet that the new leader will want to tinker with the Affordable Care Act, says Independence Blue Cross CEO Daniel J. Hilferty. And when it happens, Hilferty wants to be at the table. "From a Blue insurers' perspective, we want it to work," said Hilferty, who, effective immediately, will become board chairman of the Blue Cross and Blue Shield Association of America. The job, while unpaid, comes with clout. (Bergen, 12/18)

The VA has agreed to pay for the powered exoskeleton for eligible paralyzed veterans with spinal cord injuries — marking the first federal coverage policy for robotic legs in the United States. (12/17)

ReWalk Robotics Ltd. shares surged after the U.S. Department of Veterans Affairs agreed to pay for the company’s robotic exoskeleton to help paralyzed soldiers walk again. The shares rose 83 percent to $11 at the close in New York, the biggest single-day jump since their September 2014 debut. The stock had fallen from a peak of $37.15 just days after the initial public offering as the Israeli company struggled to build a market for the device that is strapped onto paraplegics to power their knees and hips and provide support as they walk again. (Cortez and Clark, 12/17)

A new wave of wearable computing devices that detect and monitor serious diseases is moving from the laboratory to the market, potentially transforming the treatment of conditions ranging from epilepsy to diabetes and creating business opportunities estimated to be worth tens of billions of dollars. (12/18)

Part of raising a teenager is figuring when and how to let go of the reins so adolescents learn to make smart choices on their own. But when it comes to healthcare, today’s generation of so-called helicopter parents may be hovering so much that they prevent their teens from getting the most out of visits to the doctor, a new U.S. poll suggests. (Rapaport, 12/17)

The mother of a Maple Valley 9-year-old with a rare muscle disorder is lobbying the federal Food and Drug Administration (FDA) for what she says would be a “Christmas miracle” — approval of the first drug to treat the progressive and fatal disease. Tonya Carlone, 44, has testified before an FDA advisory panel, written letters and emails to media outlets and launched an online petition now signed by more than 5,000 people — all in hopes of helping her son, Gavin, who has Duchenne muscular dystrophy. (Aleccia, 12/16)

Perched on an exam table at the doctor’s office watching the clinician type details about their medical problems into their file, what patient hasn’t wondered exactly what the doctor is writing? As many as 50 million patients may have a chance to find out in the next few years, following the announcement this week of $10 million in new grants to expand the OpenNotes project, which works with medical providers to expand patient access to clinician notes. (Andrews, 12/18)

The governor says the shift would save money and provide more flexible benefits. But federal officials have heard from hundreds of Iowa critics who say Branstad is courting chaos by rushing to make the switch before the managed-care companies are ready. One of the main complaints has been that Iowa Medicaid participants were supposed to choose a managed-care plan by Thursday, even though they had little information about which plans their doctors, hospitals and other health care providers would participate in. (Leys, 12/18)

Gov. Terry Branstad announced plans to transition Iowa’s $5 billion Medicaid system to four out-of-state, private care companies earlier this year. In August, the state awarded contracts to Amerigroup Iowa, AmeriHealth Caritas Iowa, UnitedHealthcare Plan of the River Valley and WellCare of Iowa. Since then, many providers and Medicaid recipients have called the move rushed, with the Iowa Hospital Association even asking a Polk County District Court judge to delay the implementation of the managed-care plan until a legal conflict is addressed. (Baker, 12/18)

It’s been a complicated handoff. The change was originally planned to take effect Jan. 1. With two weeks to go, the federal Centers for Medicare & Medicaid Services, which oversees state programs, deemed Iowa “not yet ready” in a letter to the state on Dec. 17. By mid-December, many of the state’s hospitals and other medical providers—such as clinics, nursing homes, and home health-care services—still hadn’t signed contracts with the Medicaid insurers. That made it impossible for patients to know whether they could keep their existing doctors. (Tozzi, 12/17)

Federal officials told the state on Thursday it doesn’t believe Iowa is ready to transition its $5 billion Medicaid program to managed care on Jan. 1 — delaying the move until March 1. The Centers for Medicare and Medicaid Services “expects that we will ultimately be able to approve Iowa’s managed-care waivers. However, we do not believe that Iowa is ready to make that transition on Jan. 1,” according to a letter addressed to Iowa Medicaid Director Mikki Stier. (Keenan, 12/17)

Federal officials have told Iowa the state is not ready to transition management of its Medicaid system to private companies. The Centers for Medicare and Medicaid Services has told Iowa in a letter today it may transition to private management on March 1st instead of January 1st, 2016, as long as the state makes sufficient progress toward readiness by that time. (Boden and Leland, 12/17)

The future of Doctors' Hospital of Michigan in Pontiac will remain uncertain for at least another week after creditors failed Thursday to reach a conclusive vote on competing bankruptcy reorganization plans for the long-struggling hospital. None of the three rival plans for buying the hospital out of bankruptcy attracted enough votes from the hospital's nearly 700 creditors to win confirmation by the U.S. Bankruptcy Court in Detroit. (Reindl, 12/17)

The state Agency for Health Care Administration asked the Florida Supreme Court this week to take up a dispute about whether a Baker County hospital can challenge plans for a new Jacksonville medical center. The agency and West Jacksonville Medical Center want justices to overturn a 1st District Court of Appeal decision in October that allowed Baker County's Ed Fraser Memorial Hospital to challenge what is known as a "certificate of need" for the project. Certificates of need are a controversial regulatory process in which the state must approve plans for new and expanded hospitals and other types of health-care facilities. (12/17)

The Centers for Medicare and Medicaid Services has given Michigan a waiver for its Healthy Michigan plan, allowing nearly 600,000 low-income residents to continue with health care coverage. The waiver was needed because Michigan lawmakers instituted cost-sharing initiatives and healthy behavior incentives for Healthy Michigan recipients, who are getting coverage under an expanded Medicaid program brought about by the federal Affordable Care Act. (Gray and Spangler, 12/17)

Dueling versions of legislation would each create a prescription drug monitoring program in Missouri, the only state that doesn't have one. Rep. Holly Rehder, R-Sikeston, pre-filed the House version of the bill Thursday, which would give doctors and pharmacists easy access to recent drug purchases by patients as a way to combat doctor shopping. (Griffin, 12/17)

A state official who wants to rescue insured patients from surprise health-care bills has crafted a road map for the Florida Legislature’s upcoming session. Sha’Ron James, Florida’s Insurance Consumer Advocate, released a proposal Thursday that would shield emergency patients from so-called “balance billing” by doctors, hospitals and other health-care providers that are not part of the patient’s insurance network. This practice refers to a demand that the patient pay the difference between the amount being charged and what the insurer agrees to pay. (Gentry, 12/17)

Used to be, Marianne Power could sit down one night, do all of her own billing and get paid 10 days later. That was before Florida hired private insurance companies to manage its Medicaid program in 2014. Power is a midwife in Lakeland. She’s been practicing for 17 years, and most of her patients use the Medicaid HMO program. She’s had problems since Medicaid transitioned to managed care. (Aboraya, 12/17)

The Office of State Ethics is not calling for Insurance Commissioner Katharine L. Wade to recuse herself from overseeing her agency’s review of Anthem's proposal to buy Cigna, where Wade previously worked and her husband serves as an attorney. But Executive Director Carol Carson said the office has raised concerns. (Levin Becker, 12/17)

Kansas is one of seven states that rank in the bottom tier in a newly released report measuring states’ readiness to deal with infectious disease outbreaks. The report, “Protecting Americans from Infectious Diseases,” was produced by the Trust for America’s Health and the Robert Wood Johnson Foundation. It finds that most states are ill-prepared to deal with the threat of antibiotic-resistant superbugs, resurgent illnesses like whooping cough, tuberculosis and gonorrhea, and other bacterial, viral and parasitic diseases. (Margolies, 12/17)

A federal judge Thursday told state officials and the U.S. Department of Justice to speed up efforts to reach agreement on improving Georgia’s system for people with mental illness and developmental disabilities. The hearing before U.S. District Court Judge Charles Pannell came in the wake of a September report describing Georgia’s lack of progress in moving people with developmental disabilities out of state hospitals. (Miller, 12/17)

After months of mulling over the details, an unlikely coalition of convenience stores, gas stations and low-cost cigarette companies has hit the streets to collect signatures for a proposed 23-cent-a-pack hike in Missouri’s tobacco tax – now the nation’s lowest. Under the initiative petition that the group began circulating this week, the estimated $100 million a year that the higher tax would raise would be designated for the state’s transportation needs. (Mannies, 12/17)

A transgender Arkansas inmate in a men's prison who castrated herself cannot sue prison officials for refusing to provide hormone therapy to assist her efforts to change genders, a federal appeals court ruled on Thursday. The court in a panel decision said Arkansas prison officials had heeded the advice of their medical professionals in declining to provide the inmate with hormone therapy and thus did not display "deliberate indifference" to her complaint, the court said. (Barnes, 12/17)

If you haven't heard much about the effects of the Excellence in Mental Health Act yet, you're not alone. However, that's about to change. New programs launched this fall will shine what many advocates say is a long-overdue spotlight on the delivery of community behavioral health services in California and 23 other states. (Stephens, 12/17)

Five mothers sued last month. They argued that the 2013 Department of Health and Mental Hygiene rule was invalid because it wasn’t voted on by the Legislature. They also argued they would be excluded from certain types of preschools if they chose not to get their children immunized. (12/17)

The Detroit City Council passed an ordinance Thursday that could drastically curtail the city's booming medical marijuana industry. Many of the city's more than 150 pot shops are in violation of the new zoning law, which takes effect March 1. By a 6-1 vote, the council passed an ordinance that will prohibit the shops from operating within 1,000 feet of a church, school, park, liquor store, other marijuana shops and other places considered a drug-free zone under city law, such as libraries and child-care centers. The council rejected an amendment that would've limited the stores even further, to only the city's industrially zoned areas. (Guillen, 12/17)

When patients are prescribed medicine for chronic conditions, studies show, they stick to the schedule for taking the medicine only half of the time. Proposed legislation aims to do something about that. The bill, A-333/S-3111, would allow pharmacists, with the consent of patients, to be paid extra to synchronize patients’ prescriptions when they don’t begin and end on the same days. Pharmacists already do this for Medicare recipients, but the legislation would allow them to follow the same practice for everyone else. Pharmacists argue that it’s badly needed, since studies have shown that patients who have prescriptions that are out of sync are 50 percent to 70 percent less likely to take their medications. (Kitchenman, 12/17)

Some conservatives can’t find anything to like these days, crying betrayal at every turn. Witness the bad acid trip over the planks in the omnibus spending bill that undermine ObamaCare. The latest charge is that Republican leaders were dumb to delay three major Affordable Care Act taxes, and they may even have doomed the cause of repeal in 2017. (12/17)

After dozens of futile votes to repeal Obamacare, Republicans in Congress may have finally found a winning strategy: Delay or suspend the taxes that pay for the program, and enfold the provisions in a larger spending bill that has to pass. Even congressional Democrats are on board with the plan -- at least this year. But these taxes are crucial to the success of health-care reform, and Democrats need to ensure the delays and hiatuses remain temporary. (12/17)

Basically, there are two ways to think about the tax package. One is to focus strictly on the merits, or lack of merits, for the most well-known provisions. ... The new tax agreement also suspends or postpones introduction of several levies that became law as part of the Affordable Care Act. That includes a tax on health insurers and a tax on device-makers. ... But the device industry has howled about its contribution from the get-go, claiming that it would stifle innovation and destroy jobs. The innovation argument is shaky at best and, for all of the whining about the tax, which took effect two years ago, the industry appears to be making comfortable profits. But Congress is about to suspend the tax for two years anyway. ... More significant, perhaps, the tax package will delay by two years introduction of the “Cadillac tax” -- a levy on the most expensive health plans that, most economists believe, would help to reduce health costs. Key architects of the law, including former Budget Director Peter Orszag, consider it a pillar of the law’s architecture. ... To be clear, Greenstein doesn't believe the tax agreement represents smart policymaking. Neither would most experts. But the question is whether, given how Congress typically behaves, this agreement represents a better alternative. It might. (Jonathan Cohn, 12/17)

You’ve probably read about huge disparities in regional Medicare spending, without equivalently huge disparities in health outcomes. You’ve probably read that quite a few times. It is one of the most favorite data points for people writing about health-care costs, because it suggests there’s a magic pot of money that can be neatly drained out of the system without making anyone worse off. Unfortunately, like the other magic pots of money that people thought they’d found in the health-care system, this one turns out to be underwhelming. A new study looks at hospital spending not just by Medicare, but by private insurers. And it turns out that areas where Medicare spending is low often have high private spending, and vice versa. (Megan McArdle, 12/17)

Whatever Obamacare's shortcomings, a new paper shows one place where the law has been a clear success: narrowing the race gap in health insurance. So why aren't more Democrats shouting that from the rooftops? In 2013, the year before most of the law's provisions for subsidized insurance took effect, non-elderly blacks were 47 percent more likely than whites to be uninsured. For American Indians, that figure was 93 percent; for Hispanics, 120 percent. (Chris Flavelle, 12/17)

Still, I can't shake my sense of amazement that Shkreli seems to have gambled on redemption and won. If you believe the allegations in today's indictment, he lost (or stole) all of his investors' money, then lied to them to string them along, Ponzied it up by raising new money to keep them happy, and then finally found an investment that allowed him to pay off his earlier investors, with profits all around. He wasn't caught because his scheme, like most such schemes, eventually crashed under its own weight. His scheme worked! He was caught, as far as I can tell, for being so abrasive about everything. How could shareholders not complain; how could prosecutors not go after him? Still, it is quite an accomplishment. If he is a securities fraudster, he should be an inspiration to securities fraudsters everywhere. (Matt Levine, 12/17)

There is good news in the fight against obesity: Rates are finally falling in young children. The bad news? They’re continuing to rise to new heights in adults. The decline in childhood obesity rates is one achievement within a larger failure. By focusing so much attention on the young, in the hopes that avoiding unhealthy weight gain in childhood would prevent adult obesity, we made the same mistake health advocates made in the battle against smoking 25 years ago. (Thomas A. Farley, 12/18)

The technology for altering defects in the human genome has progressed so rapidly in the last three years that it has outstripped the ability of scientists and ethicists to understand and cope with the consequences. An international panel of experts has wisely called for a pause in using the technique to produce genetic changes that could be inherited by future generations. That would allow time to assess risks and benefits, they said, and develop a “broad societal consensus” on the work. (Editorial Board, 12/18)