On March 5, the Trump administration’s top health official told a conference of hospital executives to hurry up. Washington has spent more than a decade slowly nudging the medical industry away from treating health care as a volume commodity business, where more care is better, and toward incentives that reward improving patients’ health. In all that time, almost nothing has changed. “That transition needs to accelerate dramatically,” said Alex Azar, a former Eli Lilly and Co. executive who was confirmed as secretary of Health and Human Services in January.

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Democrats revolted against this week’s spending package because the deal includes the 1970s Hyde Amendment, which bans federal funds from subsidizing abortion. The left claims this is some new GOP initiative. But Hyde protections have long applied to: Medicaid, Medicare, the Children’s Health Insurance Program, the Indian Health Service, the Federal Employees Health Benefits Program, the military health-care program Tricare, among others, as Republicans have pointed out. Such guarantees are standard for appropriations bills.

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When Republicans failed to repeal ObamaCare last year, it recalled the old line about snatching defeat from the jaws of victory. That loss, however, should not be allowed to overshadow an important Republican success on health care. Millions of Medicare beneficiaries now get their coverage through private plans under Medicare Advantage—a quiet step forward that brings real benefits. To ensure continued progress, Republicans must resist the temptation to choose short-term savings over long-term reform.

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Of the $88 billion HHS appropriation announced Wednesday night, not a penny is going toward Obamacare. Congress is however extending oversight requirements on HHS regarding its administration of the health exchanges.

Congressional leaders released the long-awaited $1.3 trillion, two-year spending omnibus after days of wrangling behind closed doors over contentious policies that included an embattled stabilization package for the individual market that would fund cost-sharing reduction payments and a $30 billion reinsurance pool.

The bill was passed late Thursday night.

Big news on the health-care policy front: Democrats appear to be converging on an actual agenda if they win in 2020.

Senator Elizabeth Warren introduced new legislation on Wednesday that policy guru Charles Gaba calls “ACA 2.0.” The Huffington Post’s Daniel Marans has details here.

This is, as Gaba describes it, more than just patching up Obamacare to make up for the damage done by Congress, states and design flaws in the original bill. It’s an upgraded version of the Affordable Care Act. At the same time, it’s nowhere close to the various single-payer or “Medicare for all” proposals that liberals have been spending a lot of time talking about over the last two years.

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The Trump administration this month announced its own effort to update the Electronic Health Record systems, which disrupt the doctor-patient relationship. The government could do even more good by deregulating EHRs, establishing a free market for user-friendly products. Perhaps Amazon, through its partnership with JP Morgan Chase and Berkshire Hathaway , could eventually do for medicine what it’s done for retail.

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Lawmakers hustled Monday to resolve policy disputes holding up an agreement on a sweeping spending bill needed to keep the government funded beyond Friday, but negotiations stretched into early Tuesday morning.

Disagreements over health-care policy, immigration and funding for a New York rail tunnel project persisted as Democrats, Republicans and the White House negotiated the measure that would keep the government open until October and prevent a partial shutdown when its current funding expires at 12:01 a.m. Saturday.

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We said Republicans would pay dearly for failing to replace ObamaCare, and the bill is already coming due this week in a political extortion fight with health insurers. The GOP may pad the omnibus spending bill with enough cash to preserve the law through the 2020 election.

Congress is debating how to handle cost-sharing reductions, which are payments to insurers for defraying out-of-pocket costs or deductibles for low-income individuals. The Trump Administration stopped these payments last year. Congress had declined to appropriate the money, and a federal judge said the Obama Administration wrote the checks illegally.

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As the debate continues in Virginia over whether to expand Medicaid, it is crucial to look at what the outcome has been for other states that have already expanded their programs. Thirty-one states have taken this step under the provisions laid out in the Affordable Care Act. The ACA expanded Medicaid eligibility to able-bodied adults below 138 percent of the federal poverty level, and covered 100 percent of the cost of the expansion enrollees for the initial period. That percentage declines, and by the year 2020 the federal government will only cover 90 percent of the cost of expansion enrollees. With funding after that unclear, residents of Virginia will face an unknown future of Medicaid. Given the facts staring back at us, why would any Virginian support expanded coverage?

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Arkansas recently became the third state to receive approval from the U.S. Department of Health and Human Services (HHS) to implement a work requirement for Medicaid adults. The hand-delivered approval follows the department’s endorsement of work requirements submitted by Kentucky and Indiana and comes ahead of action on similar requests from a host of other states, including Arizona, Maine, New Hampshire, Utah, and Wisconsin. Arkansas’s request was among several proposed amendments to the state’s Section 1115 demonstration waiver for its Arkansas Works program, including a proposed income eligibility cap at 100 percent of the federal poverty level (FPL) for the expansion population, which HHS did not approve at this time.

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