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Another reason experts expect an enrollment decline is the Trump administration’s management of the program, which has included neglect and outright sabotage. Over the past year, the administration has reduced spending on “navigators,” the official counselors who help people enroll, by 40 percent. And it has cut spending on advertising by 90 percent, despite evidence that such efforts boosted enrollment and encouraged people to shop around for better deals. (Jonathan Cohn, 12/13)

Even before his grand giveaway to corporations and the wealthiest Americans has passed, Republicans are sharpening their knives to carve up programs that assist the middle class and the poor to pay for it. ...Senate Republicans already inserted a sneaky way in their bill to lower Social Security payments by changing the way they’re calculated. (Joni Ashbrook, 12/14)

Soon, Congress will once again consider a short-term spending bill designed to keep the government running while procrastinating lawmakers figure out how to run the country. Once again, Congress is expected to put off a decision on fully funding the Children’s Health Insurance Program, known as CHIP. The delay is unnecessary. (12/14)

While health policy attention in recent months has focused on Washington, D.C., several proposals from individual states have garnered less publicity despite their potentially far-reaching implications. One such proposal comes from Massachusetts, which has applied for a waiver from federal rules in order to shift 140,000 near-poor adults — those with incomes between 100% and 138% of the federal poverty level — from Medicaid into private plans on the state’s health insurance marketplace and, perhaps more important, to create a closed drug formulary for Medicaid, which would be a first for the program. (Benjamin D. Sommers and Aaron S. Kesselheim, 12/13)

Uncontrolled asthma keeps many kids from low-income communities out of school and their parents out of work, and in the worst cases puts them in the hospital — or the morgue. But it is among the most manageable diseases if patients are diagnosed, given medication (and education on how to use it), and empowered to live in environmentally-friendly homes. Yet two academic medical pillars in Baltimore — Johns Hopkins and the University of Maryland Medical Center — have chosen profit over public health in the city’s poorer neighborhoods. (John Fairhall, 12/13)

As the U.S. Congress debates the future of the Affordable Care Act (ACA), the public has increasingly called for bipartisan solutions on health care reform. An immediate challenge is stabilizing the ACA marketplace, where 10.3 million people enroll in coverage. Given that certain areas of the country have few insurers participating in the marketplace — because of high enrollee costs, uncertainty over cost-sharing–reduction payments from the federal government, and the expiration of protections for insurers such as reinsurance and risk corridors (which limit how much they can gain or lose through risk sharing) — policies that encourage insurers to enter and stay in the marketplace are needed. (Zirui Song, 12/14)

Congress gave veterans the freedom to receive medical care from providers in their local communities through the Veterans Choice Program. The program was intended to make certain that veterans would never again be forced to wait in long lines or drive hundreds of miles to access care they deserve. ... From the program’s inception, however, we emphasized that Choice was only the first step toward broader reform of veterans’ health care. That’s why we have introduced legislation that incorporates lessons learned from Choice to transform the VA into a modern, high-performing and integrated health care system that will improve veterans’ access to timely and quality care — within the VA and in the community. (Sens. John McCain (R-Ariz.) and Jerry Moran, (R-Kan.) 12/15)

The opioid epidemic has claimed more than 300,000 lives in the United States since 2000 and could claim another half million over the next decade. Although heroin and illicitly manufactured fentanyl account for an increasing proportion of opioid-involved overdoses, the majority of persons with opioid addiction started with prescribed painkillers. The search for solutions has spread in many directions, and one tentacle is probing the legal accountability of companies that supply opioids to the prescription market. Even as the federal government, among others, pursues civil and criminal actions against physicians and pharmacies to address inappropriate prescribing and dispensing of opioids, a variety of lawsuits have been filed and continue to be filed against opioid manufacturers and distributors. (Rebecca L. Haffajee and Michelle M. Mello, 12/14)

An in-depth study commissioned by the California Endowment’s Building Healthy Communities found that in some rural counties, death rates for whites ages 25 to 34 have more than doubled because of premature deaths. Drug overdoses account for only about a third of these excess deaths, while suicide and alcoholic liver disease each cause almost as many. (Anthony Iton, 12/14)

The gravity of the opioid epidemic in the United States barely needs introduction. The numbers speak for themselves: in 2015, more than 33,000 Americans died from an opioid overdose, according to the Centers for Disease Control and Prevention — similar to the 35,000 and 36,000 deaths attributable to motor vehicle accidents and firearms, respectively, in the same year. The dramatic rise in opioid prescribing in the United States since the 1990s is frequently blamed as a driver of this epidemic, and policymakers have focused substantial energy on curbing prescribing rates. (Michael L. Barnett, Josh Gray, Anna Zink and Anupam B. Jena, 12/14)

My best Route 88 AC transit friend has cancer. He’s waiting until the end of the holidays to “turn himself in” to the hospital, where they’ll “poke him all over,” but he knows in any case he has to do this soon because there’s a big lump on his stomach. I didn’t know how much I’d begun to care for him, my fellow in-a-wheelchair bus rider, until I felt my sadness become a different kind of lump in my throat. (Katie Savin, 12/15)

Question: With the US Congress apparently unable to advance federal policies, except for a tax reform bill, how do we move forward the policies needed for improving health and health care, while reducing costs? Answer: One state at a time and with a committed constituency. (Diana Mason, 12/13)

On December 13th the Campaign for Tobacco-Free Kids released its annual report “Broken Promises to Our Kids,” which evaluates how states address the “enormous health problems caused by tobacco use in the United States.”  One of the key metrics is funding, and I’m proud to report that – after many years of stagnant or declining funding – Tennessee has risen in the rankings, spending $6.2 million on tobacco prevention and cessation for 2018.  (Bill Frist, 12/13)