Good morning … Nope, still no deal on the Children's Health Insurance Program.
There were plenty of reasons to think the individual mandate was here to stay. It was a linchpin of Republicans' failed effort to defeat the Affordable Care Act in 2010. They couldn't persuade the Supreme Court to strike it down in 2012, or muster enough votes in that year's elections to do it themselves.
They failed to repeal it once again in July. This July. Not even five months ago. And yet, here we are.
The bottom line: As important as the passage of Republicans' tax overhaul is for tax policy, and for President Trump's legislative agenda and Paul Ryan's legacy and everything else, this is at least as big a moment in the life of the ACA. After years upon years of dire warnings about what would happen to the ACA without an individual mandate, we're about to find out in a live experiment.
Yes, but: I asked some of the other people who have ridden out the entire individual-mandate saga whether they're as surprised as I am to see the coverage requirement actually about to vanish. They are mostly surprised Republicans haven't achieved more.
There's been a lot of focus on how repealing the individual mandate affects the individual market (it raises premiums and decreases competition). But, as my colleague Caitlin Owens notes, repealing the mandate is also likely to decrease the number of people with employer-based coverage, too.
The big difference is that while decreasing coverage on the individual market is likely to destabilize the market itself, the effect on the employer market is probably negligible.
The details, per Kaiser Family Foundation's Larry Levitt:
Sound smart: While the employer market will be absolutely fine, some of those 3 million newly uninsured people are sure to get sick — raising the question of who's on the hook for their health care bills, if they can't afford to pay.
After their victory with the tax bill, Republican leaders in the House have said they will go after entitlement and "welfare" spending, with both Medicare and Medicaid potentially on the table.
Yes, but: As Kaiser Family Foundation president Drew Altman notes in his latest Axios column, that's not a very popular agenda.
The big picture: Republican advocates of what they call entitlement reform have long been concerned about the growing share of the federal budget consumed by Medicare and Medicaid, and may believe they can capitalize on the momentum from passing tax reform and take on entitlements and federal health programs next.
The Government Accountability Office, at the request of Rep. Elijah Cummings and Sen. Bernie Sanders, put out a 78-page report detailing the evolution of the drug industry.
My colleague Bob Herman synthesized it down into three critical points:
Get smart: Massive profits at drug companies is the status quo, as Bob reported in November. It also shouldn't surprise you to see drug giants like Pfizer announce a $10 billion stock buyback program just as Congress passes major corporate tax cuts. The industry is only getting politically and financially stronger even as public criticism intensifies.
Correction: Yesterday's Vitals misidentified the senator who has co-sponsored Sen. Susan Collins' reinsurance bill. It is Bill Nelson. Ben Nelson has not been in the Senate for quite some time. I apologize for the error.
What we're watching this week: CHIP.