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President Donald Trump’s health secretary, Alex Azar, and his Medicare chief, Seema Verma, are increasingly at odds, and their feuding has delayed the president’s long-promised replacement proposal for Obamacare and disrupted other health care initiatives central to Trump's reelection campaign, according to administration officials. Verma spent about six months developing a Trump administration alternative to the Affordable Care Act, only to have Azar nix the proposal before it could be presented to Trump this summer, sending the administration back to the drawing board, senior officials told POLITICO. Azar believed Verma’s plan would actually strengthen Obamacare, not kill it. (Pradhan, Cancryn and Diamond, 11/26)

While the full impact of dismantling prior rules is unknown, the Centers for Medicare and Medicaid predicted the number of people buying just one type of newly deregulated plans will rise from 86,000 last year to 1.6 million by 2022. Regulators and consumer advocates worry that unsuspecting buyers could be vulnerable to staggering medical bills because the coverage they were sold is insufficient. (Deam, 11/27)

Kaiser Health News: KHN’s ‘What The Health?’: How’s That Open Enrollment Going?

Open enrollment for 2020 health coverage under the Affordable Care Act is halfway over. So far, sign-ups appear to be lagging behind last year’s, but not dramatically. Meanwhile, President Donald Trump and Congress still say they want to do something about the teen vaping epidemic, the high cost of prescription drugs and “surprise” medical bills. But it’s Thanksgiving week, and official Washington has not much to show for any of those issues. (11/26)

The CMS on Monday announced that it's accepting applications for its Primary Care First alternative payment model. The pilot will allow providers that deliver primary-care services to take on financial risk for original, fee-for-service Medicare patients in exchange for less federal oversight and the opportunity to earn financial rewards. Under the new payment model, small primary-care practices can volunteer to accept full or partial risk for managing the care of beneficiaries of traditional Medicare who are seriously ill or have a chronic illness. The CMS will pay them a fixed monthly fee for each participating enrollee. (Brady, 11/25)