Internal document reveals Trump’s strategy on ObamaCare changes

An internal Trump administration document shared with Republican lawmakers last year shows officials’ plans to change ObamaCare through administrative actions, in what Democrats say is evidence of “sabotage” of the health-care law.

The one-page document lists 10 actions the administration planned to take to make conservative-leaning changes to how the law is implemented. It was shared at a meeting with House GOP lawmakers on March 23, in the heat of the effort to win votes for the House’s ObamaCare repeal measure, which was pulled the next day.

Many of the actions have been implemented since March, and none are viewed as fatal to ObamaCare. Instead, the actions move the law in a more conservative direction. 

Democrats say the document is evidence of a plan to “sabotage” the law.

The actions listed in the document include shortening the Affordable Care Act’s enrollment period, giving states more flexibility to determine what ObamaCare plans must cover and speeding up the approval of waivers in the health-care law that allow states to change certain rules.

The document was obtained by Sen. Bob CaseyRobert (Bob) Patrick CaseyThe Hill’s 12:30 Report Avalanche of Democratic senators say Franken should resign Dems look to use Moore against GOP MORE Jr. (D-Pa.) after months of requests to the administration, and after he eventually put holds on Health and Human Services (HHS) Department nominees.

The document was first reported by Politico.

Casey’s office said in a report that the document “details how the Administration plotted secretly behind closed doors with Congressional Republicans on regulatory changes to undermine the [Affordable Care Act].”

The release comes as Trump’s nominee to be Secretary of Health and Human Services, Alex Azar, is considered by the Senate.

Democrats have warned that Azar could continue the “sabotage.”

“While Sen. Casey has not announced how he will vote on Mr. Azar, he has serious concerns that the next HHS Secretary could continue this pattern of sabotage,” said Casey spokesman John Rizzo.

“Under the Trump Administration, HHS has been and remains committed to any and all actions, within the confines of the law, to provide relief and access to affordable healthcare for all Americans,” HHS press secretary Caitlin Oakley told The Hill in a statement.

Updated at 1:56 p.m.

Trump officials move to allow Medicaid work requirements

The Trump administration on Thursday unveiled guidance allowing states for the first time to impose work requirements in Medicaid, a major shift in the health insurance program for the poor.

The move opens the door for states to apply for waivers to allow them to require Medicaid enrollees to work in order to receive coverage, something that has never before happened in the 50-year history of the program.

Seema Verma, the administrator of the Centers for Medicare and Medicaid Services (CMS), says the move will help people get out of poverty.

“Our policy guidance was in response to states that asked us for the flexibility they need to improve their programs and to help people in achieving greater well-being and self-sufficiency,” Verma said in a statement.

Democrats are sharply opposed to the changes, saying people will lose coverage if they can’t meet the requirements or simply because new bureaucratic hurdles will discourage them from applying.

Democratic groups are expected to sue over the changes, arguing that the administration does not have the power to make them without action from Congress. Approving waivers from states must be done to further the “objectives” of the Medicaid program, which Democrats argue is not accomplished by a policy that could cause people to lose insurance.

“Today’s attack on Medicaid is just the latest salvo of the Trump Administration’s 2018 war on health care,” Brad Woodhouse, director of the pro-ObamaCare group Protect Our Care, said in a statement. “Having faced overwhelming public rejection of their failed attempts to repeal health care, Trump and his Congressional Republicans are now going for death by a thousand cuts.”

Asked about the possibility of dropping Medicaid enrollment as a result of the new policy, Verma said on a press call that it is a good thing if people leave Medicaid and find coverage through employers.

“People moving off of Medicaid is a good outcome because we hope that that means they don’t need the program anymore,” Verma said.

The counterargument is that people could also simply become uninsured if they are forced off of Medicaid due to the new requirements.

Verma also defended the legality of the move when asked about court challenges, saying that the waiver language in existing law gives the administration “broad authority.”

Experts said the move is a dramatic shift in Medicaid.

“Conditioning Medicaid eligibility and coverage on work is a fundamental change to the 50 plus year history of the Medicaid program,” MaryBeth Musumeci, Associate Director of the Kaiser Family Foundation’s Program on Medicaid and the Uninsured, wrote in an email.

“There is a real risk of eligible people losing coverage due to their inability to navigate this process or miscommunication or other breakdowns in the administrative process,” she added.   

Ten states are currently applying to impose work requirements in Medicaid. Many experts expect Kentucky will be the first state approved.

CMS officials emphasized that the work requirements would only apply to “able-bodied” adults, and has exemptions for children, the elderly, and people with disabilities.

States can also designate other activities, such as job training, education, or caregiving, as satisfying the work requirements, though it will be up to each state to make that decision.  

Verma argued that research shows having a job improves people’s health.

Joan Alker, executive director of the Georgetown Center for Children and Families, countered that the administration has the “causality backwards” and “you’re more likely to be able to work” if you have health insurance such as Medicaid in the first place.

Of the 9.8 million non-elderly Medicaid enrollees not working in 2016, 36 percent said illness or disability was their main reason for not working, according to the Kaiser Family Foundation. Thirty percent said they were caring for a family member, while 15 percent said they were going to school.

Verma said that in travelling the country, she finds that people want to get off Medicaid and get insurance elsewhere.

“They want to get off of public assistance,” she said. “They want to have a better life.”

Sen. Ron WydenRonald (Ron) Lee WydenDemocratic senator predicts Franken will resign Thursday Avalanche of Democratic senators say Franken should resign Lobbying world MORE (D-Ore.), the top Democrat on the Senate Finance Committee, said in a statement that the vast majority of Medicaid enrollees either already have a job or “are unable to work due to age or impairment.”

“This action by the Trump administration goes after people who are just trying to get by while taking care of their kids or elderly parents, struggling with a chronic condition, or going to school,” Wyden said.

 

Trump admin moves to block abortion for fourth undocumented minor

The Trump administration has moved to block a fourth undocumented minor from receiving an abortion, according to the American Civil Liberties Union (ACLU)

The woman, known to the court as Jane Moe, has requested an abortion but has been prevented from getting one by the Office of Refugee Resettlement (ORR), an office within the Department of Health and Human Services. 

A spokesperson said HHS does not believe it is required to facilitate the abortion. 

“The Jane in this case, Jane Moe — who entered the country illegally — has the option to voluntarily depart to her home country or find a suitable sponsor. If she chooses not to exercise these options, HHS does not believe we are required to facilitate Jane Moe’s abortion, out of concern and responsibility for the mother’s best interests.”

The ACLU asked the U.S. District Court for the District of Columbia on Thursday for a temporary restraining order for Moe so she could obtain an abortion. 

According to court documents, Moe is a 17-year-old unaccompanied immigrant minor living in a government-funded shelter. Moe is in her second trimester of pregnancy. 

She first requested an abortion two weeks ago, but her request has been denied. 

This is the fourth time the ORR has tried to block immigrant minors in the care of the U.S. from getting abortions. 

In the previous cases, the minors have been eventually allowed to obtain abortions. 

In March, the administration established a policy of prohibiting all federally funded shelters from taking “any action that facilitates” abortion access for unaccompanied minors without the approval of ORR Director Scott Lloyd. 

The ACLU argues the policy is unconstitutional.

GOP chairman eyes floor action for CHIP next week

House Energy and Commerce Committee Chairman Greg WaldenGregory (Greg) Paul WaldenOvernight Regulation: Feds push to clarify regs on bump stocks | Interior wants Trump to shrink two more monuments | Navajo Nation sues over monument rollback | FCC won’t delay net neutrality vote | Senate panel approves bill easing Dodd-Frank rules Dems push for more money for opioid fight Overnight Health Care: Ryan’s office warns he wasn’t part of ObamaCare deal | House conservatives push for mandate repeal in final tax bill | Dem wants probe into CVS-Aetna merger MORE (R-Ore.) said on Thursday that he is aiming to bring a six-year reauthorization of the Children’s Health Insurance Program (CHIP) to the floor next week.

Speaking to reporters, Walden pointed to new Congressional Budget Office estimates as the catalyst that broke the logjam over funding for the program, which covers 9 million children.

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“If we go to six years, it may have no cost,” Walden told reporters. “The good news is you can do six years and it costs you nothing.”

Funding for CHIP has been stalled for months amid partisan fighting over how to pay for the program.

Its reauthorization could be attached to a short-term government funding bill that must pass before Jan. 19. Broader leadership negotiations, however, will determine whether the reauthorization is ultimately tied to the bill.

Walden also said the legislation would likely not include funding for community health centers or any other Medicare “extenders.”

“At this point it would just be CHIP. I’d like to do it all if we can, but we believe that CHIP could move forward,” Walden said.

 

 

 

Sanders to host ‘Medicare for all’ town hall

Sen. Bernie SandersBernard (Bernie) SandersSchumer: Franken should resign Franken resignation could upend Minnesota races Avalanche of Democratic senators say Franken should resign MORE (I-Vt.) will host a town hall on his “Medicare for all” proposal, a 90-minute event that will be streamed online Jan. 23.

The event comes as some high-profile Democrats — including potential 2020 candidates and thus potential rivals if Sanders decides to run again — have gotten on board with Sanders’s plan: expanding Medicare into a national health insurance program so every American would have health coverage.

Sanders will aim to answer a pressing question — how exactly a “Medicare for all” system would work — and will be joined by “leading health care experts,” according to a news release. The Washington Post reports that the town hall will break out into three segments: the current state of health care in the country, the possible economic impacts of single-payer and the way universal health care works in other countries.

“For the first time in American history we will be holding a nationally televised town meeting on Medicare for all. The United States is the only major country on earth not to guarantee health care to all people, but amazingly there has not been one network town hall to discuss why our system lags so far behind every other industrialized country,” Sanders said.

“We are going outside the traditional media to change that, to talk about the real issues affecting the American people.”

The event will be livestreamed by various online outlets, including NowThis, ATTN: and The Young Turks, as well as on Sanders’s own social media accounts, from 7 p.m. to 8:30 p.m.

In September Sanders introduced a “Medicare for all” bill in the Senate to much fanfare. His announcement brought a crowd of about 300 to pack into a Senate hearing room, and millions more to watch online and on cable television. Sixteen of his colleagues have signed onto the bill, in a stark contrast to when he last introduced a “Medicare for all” bill in 2013 that didn’t garner a single co-sponsor.

CMS pressed to give more time for comment on Medicaid-work changes

The National Health Law Program (NHeLP) is pressing the Centers for Medicare and Medicaid Services (CMS) to give the public more time to comment on state proposals to impose work requirements in the Medicaid program.

NHeLP sent a letter to the agency just hours after CMS unveiled guidance letting states apply for waivers requiring certain Medicaid enrollees work or participate in community engagement in order to get health coverage. The guidance marked a major policy shift in the joint federal-state health program for low-income and disabled Americans.

The state and federal comment periods have closed for at least seven states that have already asked CMS to allow them to institute work requirements, according to NHeLP. Though the public has already commented on those specific waivers, NHeLP argues that “as advocates, we had no opportunity to respond to the various, specific issues raised in CMS’s letter.”

“As a result, these state-specific comments fall far short of the type of public notice and comment that typically attaches to such a significant about face,” Jane Perkins, NHeLP’s legal director, writes. The letter asks CMS to reopen or extend those comment periods.

CMS Administrator Seema Verma touted the guidance, tweeting that “We owe beneficiaries more than a #Medicaid card; we owe them the opportunity and resources to connect with job skills, training and employment so they can rise out of poverty.”

She praised the move as one of freeing up flexibility for states, which Republicans say is sorely needed in the health-care system.

But Democrats and many advocates are pushing back on the guidance, arguing people will lose coverage if they don’t meet the requirements or the requirements will lead some not to apply because the process may become too cumbersome. They say the move doesn’t meet the objectives of the Medicaid waiver program, and Democratic groups are expected to file lawsuits over Medicaid work requirements.

“The Trump administration is on wobbly legal ground in trying to limit Medicaid enrollment by imposing onerous work requirements,” Perkins said in a statement. “As our letter explains, the administration is making an about face in its efforts to overturn established [Department of Health and Human Services] policy against work requirements without public comment.”

On a press call, Verma defended the legality of imposing work requirements, saying the waiver language in the law gives the administration “broad authority.”

Officials defend ending ‘flawed’ mental health, drug abuse program registry

The Trump administration ended a national database for evidence-based mental health and substance abuse programs because it was “flawed” and potentially dangerous, officials said Thursday. 

The administration announced earlier this month it would discontinue the database, which was created in 1997 to help people, agencies and organizations identify and implement evidence-based programs and practices in their communities. 

But officials told reporters on a press call Thursday that the database, called the National Registry of Evidence-Based Programs and Practices (NREPP), virtually ignored serious mental illnesses and drug abuse disorders, and that its standards for including programs in the registry were poor. 

“I believe at SAMHSA we should not be encouraging providers to use NREPP to obtain evidence-based practices given the flawed nature of the system,” said Elinore McCance-Katz, the assistant secretary for mental health and substance use at the Department of Health and Human Services who heads up the department’s Substance Abuse and Mental Health Services Administration (SAMHSA).

To be added to the database, a program or intervention must be reviewed by an independent contractor to ensure it’s scientifically sound and effective. 

But McCance-Katz argued that isn’t always the case. 

She said some practices listed in the database are “entirely irrelevant” to some disorders and some have little evidence proving they are effective. It also failed to address the needs of those with serious mental health issues and drug abuse disorders, she said. 

The website has been frozen and is being reviewed by an in-house “policy lab.” 

There are no current plans to remove it but “we are moving in a new direction,” McCance-Katz said. “NREPP will not continue in its present form.” 

She said her agency is still focused on the development and implementation of evidence-based programs and the policy lab is working to identify a new approach, which will involve working with the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH) and other agencies that can “comment on what constitutes evidence-based practices.” 

“We are now moving to implementation efforts through targeted technical assistance and training that makes use of local and national experts and that assist programs with actually implementing services that will be essential to getting Americans living with these disorders the care and treatment and recovery services that they need,” she said. 

McCance-Katz said she first questioned the program when she was SAMHSA’s chief medical officer from 2013 to 2015. 

When she became assistant secretary for mental health and substance use, she knew NREPP would be one of the first things she would address. 

She said the database, for example, doesn’t include any information about medicated-assisted treatment (MAT), which is often used to treat opioid abuse disorder.

Only one-third of specialty substance abuse treatment programs in the country offer MAT, she said.

That “tells me we need to do something different, and fast,” she added. 

“We have an emergency going on, and we in the Trump administration are not going to sit back and allow Americans to die while we simply leave things up on our website that don’t help people.” 

Lawsuit filed against ObamaCare insurer over coverage

The insurance carrier Centene misled enrollees about the benefits of its ObamaCare exchange plans and offered far skimpier coverage than promised, according to a class-action lawsuit filed Thursday.

The lawsuit, filed in federal court in Washington state, claims customers who bought Centene’s ObamaCare plans had trouble finding in-network doctors or hospitals and often found that doctors who were advertised as in-network actually were not.

ObamaCare requires plans to meet certain minimum requirements.

Centene covers about 10 percent of the ObamaCare individual market and is one of the largest insurance carriers that participates on the exchanges.

As many other insurers have pared back their ObamaCare exchange plans, or completely left the market, Centene has expanded. In some areas of the country, Centene is the only insurer offering plans for ObamaCare customers.

Centene markets its signature product — its three-tiered Ambetter plans — in at least 15 states, and covers more than 1.4 million customers.

According to the lawsuit, Centene targets low-income customers who qualify for substantial government subsidies “while simultaneously providing coverage well below what is required by law and by its policies.”

A spokeswoman for the company told The Hill they have not been served papers and only learned of the lawsuit Thursday morning.

“We believe our networks are adequate. We work in partnership with our states to ensure our networks are adequate and our members have access to high quality health care,” Marcela Manjarrez Hawn said in an email.

Narrow networks — insurance plans that limit which doctors and hospitals customers can use — are not uncommon, as they are cheaper than more expansive plans. But the lawsuit says Centene went far beyond the norm.

“Centene misrepresents the number, location and existence of purported providers by listing physicians, medical groups and other providers — some of whom have specifically asked to be removed — as participants in their networks and by listing nurses and other non-physicians as primary care providers,” the lawsuit claims.

According to the lawsuit, customers found the provider network Centene said was available was “largely fictitious. Members have difficulty finding — and in many cases cannot find — medical providers who will accept Ambetter insurance.”

The suit was filed on behalf of two Centene customers, but seeks class-action status to represent all customers who purchased Centene plans on the ObamaCare exchange.

Overnight Health Care: Officials move to allow Medicaid work requirements | GOP chairman eyes action on children’s health funding next week | Sanders to host ‘Medicare for all’ town hall

Trump officials move to allow Medicaid work requirements

The Trump administration on Thursday unveiled guidance allowing states for the first time to impose work requirements in Medicaid, a major shift in the health insurance program for the poor.

The move opens the door for states to apply for waivers to allow them to require Medicaid enrollees to work in order to receive coverage, something that has never before happened in the 50-year history of the program.

Seema Verma, the administrator of the Centers for Medicare and Medicaid Services (CMS), says the move will help people get out of poverty.

“Our policy guidance was in response to states that asked us for the flexibility they need to improve their programs and to help people in achieving greater well-being and self-sufficiency,” Verma said in a statement.

Democrats are sharply opposed to the changes, saying people will lose coverage if they can’t meet the requirements or simply because new bureaucratic hurdles will discourage them from applying.

Democratic groups are expected to sue over the changes, arguing that the administration does not have the power to make them without action from Congress.

Read more here.

 

And groups responded quickly…

The National Health Law Program (NHeLP) is pressing the Centers for Medicare and Medicaid Services (CMS) to give the public more time to comment on state proposals to impose work requirements in the Medicaid program.

NHeLP sent a letter to the agency just hours after CMS unveiled guidance letting states apply for waivers requiring certain Medicaid enrollees work or participate in community engagement in order to get health coverage. The guidance marked a major policy shift in the joint federal-state health program for low-income and disabled Americans.

The state and federal comment periods have closed for at least seven states that have already asked CMS to allow them to institute work requirements, according to NHeLP. Though the public has already commented on those specific waivers, NHeLP argues that “as advocates, we had no opportunity to respond to the various, specific issues raised in CMS’s letter.”

Read more here.

 

GOP chairman eyes floor action for CHIP next week

House Energy and Commerce Committee Chairman Greg WaldenGregory (Greg) Paul WaldenOvernight Regulation: Feds push to clarify regs on bump stocks | Interior wants Trump to shrink two more monuments | Navajo Nation sues over monument rollback | FCC won’t delay net neutrality vote | Senate panel approves bill easing Dodd-Frank rules Dems push for more money for opioid fight Overnight Health Care: Ryan’s office warns he wasn’t part of ObamaCare deal | House conservatives push for mandate repeal in final tax bill | Dem wants probe into CVS-Aetna merger MORE (R-Ore.) said on Thursday that he is aiming to bring a six-year reauthorization of the Children’s Health Insurance Program (CHIP) to the floor next week.

Speaking to reporters, Walden pointed to new Congressional Budget Office estimates as the catalyst that broke the logjam over funding for the program, which covers 9 million children.

“If we go to six years, it may have no cost,” Walden told reporters. “The good news is you can do six years and it costs you nothing.”

Funding for CHIP has been stalled for months amid partisan fighting over how to pay for the program.

Its reauthorization could be attached to a short-term government funding bill that must pass before Jan. 19. Broader leadership negotiations, however, will determine whether the reauthorization is ultimately tied to the bill.

Read more here.

 

Sanders to host ‘Medicare for all’ town hall

Sen. Bernie SandersBernard (Bernie) SandersSchumer: Franken should resign Franken resignation could upend Minnesota races Avalanche of Democratic senators say Franken should resign MORE (I-Vt.) will host a town hall on his “Medicare for all” proposal, a 90-minute event that will be streamed online Jan. 23.

The event comes as some high-profile Democrats — including potential 2020 candidates and thus potential rivals if Sanders decides to run again — have gotten on board with Sanders’s plan: expanding Medicare into a national health insurance program so every American would have health coverage.

Sanders will aim to answer a pressing question — how exactly a “Medicare for all” system would work — and will be joined by “leading health care experts,” according to a news release. The Washington Post reports that the town hall will break out into three segments: the current state of health care in the country, the possible economic impacts of single-payer and the way universal health care works in other countries.

Read more here.

 

Lawsuit filed against ObamaCare insurer over coverage

The insurance carrier Centene misled enrollees about the benefits of its ObamaCare exchange plans and offered far skimpier coverage than promised, according to a class-action lawsuit filed Thursday.

The lawsuit, filed in federal court in Washington state, claims that customers who bought Centene’s ObamaCare plans had trouble finding in-network doctors or hospitals, and often found that doctors who were advertised as in-network actually were not.

According to the lawsuit, Centene targets low-income customers who qualify for substantial government subsidies “while simultaneously providing coverage well below what is required by law and by its policies.”

Read more here.

 

Officials defend canceling ‘flawed’ mental health, drug abuse database

The Trump administration ended a national database for evidence-based behavioral interventions and programs because it was “flawed” and potentially dangerous, officials said Thursday.

The administration announced earlier this month it would discontinue the database, which was created in 1997 to help people, agencies and organizations identify and implement evidence-based programs and practices in their communities.

But officials told reporters on a press call Thursday that the database, called the National Registry of Evidence-Based Programs and Practices (NREPP), virtually ignored serious mental illnesses and drug abuse disorders, and that its standards for being included in the registry were poor.

Read more here.

 

Trump admin moves to block abortion for fourth undocumented minor

The Trump administration has moved to block a fourth undocumented minor from receiving an abortion, according to the American Civil Liberties Union (ACLU).

The woman, known to the court as Jane Moe, has requested an abortion but has been prevented from getting one by the Office of Refugee Resettlement (ORR), an office within the Department of Health and Human Services.

A spokesperson said HHS does not believe it is required to facilitate the abortion.

Read more here.

 

Doctors group gets a new name as it pushes to change the health system

The doctors group formerly known as CAPG is renaming itself America’s Physician Groups and stepping up its efforts to reform the health care system to make spending more efficient.

The group is pushing to move Medicare payments away from paying for the quantity of services provided, and towards a more efficient system of paying to reward healthy outcomes in patients.

“We like to think of ourselves as the tip of the spear in terms of the movement from volume to value,” CEO Don Crane told The Hill.

He praised efforts by the Obama administration to change how Medicare pays for care, as well as comments by HHS nominee Alex Azar endorsing the same idea at his confirmation hearings.

He acknowledged that “change is hard” for some doctors, particularly older ones, but said once they come to understand the new system, they often like it better. For example, in the new system doctors can be paid for patients not showing up because they are healthy enough they don’t need to make an appointment in the first place.

 

What we’re reading

Estimated number of health plans on federal exchange plummets by two-thirds (Modern Healthcare)

What if CHIP funds run out? Here’s what 6 families would do (The New York Times)

He was 21 and fit. He tried to push through the flu — and it killed him. (The Washington Post)

 

State by state

Despite progress, ethnic health disparities persist in Minnesota (Star Tribune)

Video shows apparently incapacitated, half-naked woman put out in cold by Baltimore hospital (The Washington Post)

Sheriff criticizes mental health system as inmate found dead (Associated Press)

New watchdog group targets Trump HHS on reproductive health

A new watchdog group focused on reproductive health care is taking on the Department of Health and Human Services (HHS).

Mary Alice Carter, the executive director of Equity Forward, which officially launched Friday, said the nonpartisan group will hold accountable organizations and individuals they argue limit access to reproductive health care.

Its first project, HHS watch, will include a full audit of decisionmakers at the agency, digging into their positions and backgrounds and monitoring their actions.

“Americans deserve to know when their government is hiring people with backgrounds antithetical to the mission of the offices in which they serve,” Carter said.

“The reason we exist is because there hasn’t been an organization like this up until now, and there are ways that organizations, entities and individuals have been able to act without full transparency.”

Equity Forward takes issue with political appointees at HHS that have worked for anti-abortion groups or have made critical comments in the past about some types of contraception.

“Instead of hiring qualified public health professionals, the administration has put anti-contraception political activists in charge of four million women’s birth control access,” Carter said.

Carter, who previously worked for Planned Parenthood, said the group plans to file a large volume of Freedom of Information Act requests “in order to understand what’s going on behind the scenes.”

“And we are more than willing to follow that up with legal action,” she said.

Equity Forward is particularly concerned about the future of the Title X program, a federally funded family planning program long criticized by conservatives.

The Trump administration is expected to make changes to the program, which could involve adding restrictions for clinics that provide abortions.

The group also takes issue with an HHS policy that blocks immigrant minors in the care of the government from getting abortions.

The launch comes as Alex Azar is poised to become the next HHS secretary, following the resignation of Tom PriceThomas (Tom) Edmunds PriceOvernight Health Care: Funding bill could provide help for children’s health program | Questions for CVS-Aetna deal | Collins doubles funding ask for ObamaCare bill Warren questions Conway’s role in curbing opioid epidemic Trump promised ‘best people’ would run government — they upended it MORE last year.