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President Donald Trump’s administration said Wednesday he would maintain critical funding for health plans, a pledge that reduced the chances of a government shutdown but left uncertainty in the already fragile insurance markets. White House Chief of Staff Reince Priebus told House Minority Leader Nancy Pelosi (D., Calif.) Wednesday afternoon that the administration would keep making “cost-sharing reduction” payments to insurers despite the lack of a formal appropriation for them in the April spending bill, a Pelosi aide said. (Radnofsky, Peterson and Wilde Mathews, 4/26)

The “cost-sharing subsidies,” which congressional Republicans have long contended the Department of Health and Human Services is not authorized to make, subsidize insurers who offer lower premiums on state exchanges. A federal judge sided with Republicans in 2016, saying the executive branch could not continue the payments without an appropriation from Congress. The payments were allowed to continue while the Obama administration appealed the ruling. (Facher, 4/26)

The dispute with Democrats, especially House Minority Leader Nancy Pelosi, threatened to hold up the $1 trillion-plus spending bill. A temporary funding bill expires Friday at midnight, and GOP leaders late Wednesday unveiled another short-term spending bill to prevent a government shutdown this weekend — Trump's 100th day in office. The weeks-long sniping over the health care issue had snagged the talks, which have progressed steadily for weeks and gained momentum earlier this week after Trump dropped demands for immediate money for building his long-promised border wall. (Taylor, 4/26)

House Minority Leader Nancy Pelosi, D-Calif., had been advocating to ensure an upcoming spending bill includes funding for the so-called cost-sharing subsidies, in part because congressional action would provide more clarity on the payments than a decision by the administration to continue them. She nevertheless called the White House commitment "progress." “Our major concerns in these negotiations have been about funding for the wall and uncertainty about the CSR payments crucial to the stability of the marketplaces under the Affordable Care Act. We’ve now made progress on both of these fronts,” she said in a statement. (Williams and Mershon, 4/26)

The funding, totaling about $7 billion this year, soon became a bargaining chip in the current talks over a must-pass spending bill to prevent a government shutdown before a midnight Friday deadline. Democrats seized on Trump's threat to end the payments as a way to negotiate with Republicans who wanted extra funding for military programs or the border wall with Mexico. (Mascaro and Levey, 4/26)

[It] would allow Republicans to avoid blame for causing chaos and confusion in the insurance markets. “If we pull the subsidies … I think there would be nobody with a health insurance plan next year.” said Rep. Phil Roe (R-Tenn.). But some Republicans slammed the White House decision, saying it undermines the party’s position in an ongoing lawsuit that the payments are unconstitutional. (Everett, Caygle and Dawsey, 4/26)

The U.S. Congress inched toward a deal to fund the government through September but was preparing to possibly extend a midnight Friday deadline in order to wrap up negotiations and avoid an imminent government shutdown. The one-week extension would give leading Republicans and Democrats "a little breathing room" to finish negotiations and present their plan for spending around $1 trillion through the rest of the fiscal year to rank-and-file lawmakers, according to a House of Representatives source familiar with the talks. (Cowan, 4/26)

The trade group America's Health Insurance Plans (AHIP) said it still believes Congress should actively appropriate the funds for the cost-sharing reduction (CSR) payments and not leave it up to the administration. "Our position has not changed – The American people need Congress to fund CSRs now," said Kristine Grow, spokeswoman for AHIP. (Sullivan, 4/26)

The electronic cigarette industry and its free-market allies are seeing fresh opportunities to ease federal rules on e-cigarettes as Congress races to pass a government spending bill this week and President Trump fills key public-health posts in his administration. More than a dozen conservative groups wrote to congressional leaders this week, calling on them to add a pro-vaping provision to a spending measure that must pass by midnight Friday to avert a government shutdown. If successful, the measure would be the latest sign of the $4.4 billion vaping industry’s growing clout in Washington. (Schouten and O'Donnell, 4/26)