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POLITICO New York Health Care: Obamacare deal struck -- The legal argument for how the Essential Plan survives -- Cuomo takes on Pence at hospital event

By Dan Goldberg | 10/18/2017 09:59 AM EDT

HOUSEKEEPING — I'll be in Albany next Tuesday through Thursday and, as always, would love to meet with readers to discuss how we can do a better job, what stories we are missing, and what we should be paying attention to during the coming legislative session. Email me at dgoldberg@politico.com.

CSR DEAL STRUCK — Sens. Lamar Alexander and Patty Murray say they have reached an agreement on a bipartisan Obamacare deal to fund a key insurance subsidy program and provide states flexibility to skirt some requirements of the health care law. There is no assurance that the agreement will get to the Senate floor, however. Republicans on Tuesday were lukewarm about the prospect of resuming debate over whether to try to prop up Obamacare after multiple failed GOP attempts to repeal the law. The deal would include funding through 2019 for Obamacare's cost-sharing program, which President Donald Trump cut last week. It would allow states to use existing Obamacare waivers to approve insurance plans with "comparable affordability" to Obamacare plans, Alexander said. But it would notably not allow states to duck the law's minimum requirements for what a health insurance plan must cover. Read more here.

... TRUMP NEEDED FOR THIS — The framework, which got more immediate support from Democrats than Republicans, will need the lobbying muscle of the White House to win over skeptical Republicans in Congress. More here.

... ABOUT THE STATE'S ESSENTIAL PLAN — The conventional wisdom has been that Trump's decision to stop paying the cost-sharing reduction payments would hamper the state's Essential Plan, which receives about $900 million in CSR funding to help provide low-cost or no cost insurance to those who earn less than twice the federal poverty level. But that may not be the case. Attorneys representing Republicans in the House v. Price lawsuit said there is no reason to think that funding would stop. "Significantly, the amount of cost-sharing reductions that would have been provided to eligible individuals is unaffected by whether insurers receive cost-sharing offset payments because the statutory obligation to provide cost-sharing reductions is not contingent on insurers' receipt of those offset payments," the House attorneys wrote. "Thus, a cessation of the cost-sharing payments to insurers would have no impact on the amount of a state's [Essential Plan] subsidy." That gives the Cuomo administration, and insurance companies in New York, some legal ground to stand on should the Trump administration decide to withhold payments that cover the Essential Plan. Read more here.

SHARE ME: Like this newsletter? We've got a brand new link to make it even easier to sign people up. Share this link with your friends, check out our new health care page and please let us know if you have any problems.

AND MAKE SURE YOU FOLLOW Dan on Twitter @DanCGoldberg and Nick @NickNiedz. And for all New Jersey health news, check out @katiedjennings.

WE'D LOVE TO HEAR FROM YOU: This roundup is for you, so please tell us how we can make it even better. Send tips, news, ideas, calendar items, releases, promotions, job postings, birthdays, congratulations, criticisms and corrections to dgoldberg@politico.com.

MONEY IN YOUR EARS: POLITICO's new Money podcast brings you to the intersection of Washington and Wall Street with the most influential minds on the economy. Every Wednesday, Ben White will help you understand the economic and financial policies that move markets. While money never sleeps, you have to — so let Ben keep you up to speed and turn dollars into sense. The first POLITICO Money podcast, premiering with our launch sponsor, Morgan Stanley, features Treasury Secretary Steven Mnuchin. Click HERE to subscribe.

CUOMO TAKES ON D.C. AT HOSPITAL EVENT — With Vice President Mike Pence touching down to tout the Trump administration's tax plan, Gov. Andrew Cuomo took the podium in Buffalo on Tuesday to again denounce what he says are Washington's attacks on the Empire State. Ostensibly celebrating next month's opening of the Oishei Children's Hospital on the Buffalo Niagara Medical Campus, the event put the Democratic governor in direct proximity to Pence — in town later in the day for a fundraiser benefiting embattled Rep. Chris Collins and a factory visit. "We have federal proposals that are on the table now that threaten New York State more than any other state in the nation," said Cuomo. More from Nick here.

NOW WE KNOW — This one is for all the moms out there: Don't eat the placenta after giving birth. Sure, lots of celebrities say it's rich in vitamins but science says no, according to Newsweek.

HEASTIE DOWNPLAYS SPECIAL SESSION — Assembly Speaker Carl Heastie says there are things that could be done in a special session, but there still isn't anything in particular that would require the Legislature to return to the Capitol before its scheduled start in January. Gov. Andrew Cuomo, a Democrat, has been pushing for a special session this year. Read more here.

WOMEN WERE BRANDED — The New York Times reports on Nxivm, a secret society that has women submit to being "slaves," lose an unhealthy amount of weight and, at least on one occasion, be branded with cauterizing device that seared a two-inch-square symbol below each woman's hip. Turns out, the state authorities weren't interested in following up. Read more here.

SICK LEAVE FOR DOMESTIC VIOLENCE — New York Daily News reports: "Domestic violence and sexual assault victims will be able to take paid time off from work under a bill passed by the City Council Tuesday. The legislation allows up to five days off a year for things like court appearances, meetings with law enforcement, serving an order of protection, counseling, or moving to get away from an abuser.

ON THE AIR — State Sen. Pat Gallivan said he was optimistic the bill to prevent the relocation of the Western New York Children's Psychiatric Center would be sent to the governor's desk "two or three weeks" after he has a chance to meet with the governor's staff on the issue. Gallivan appeared on "The Capitol Pressroom" with Assemblyman Mickey Kearns, his fellow bill sponsor. Listen to the interview here.

CHIP CLOCK — It's been 18 days since Congress let the Children's Health Insurance Program lapse. New York has enough cash to keep its program running through December.

... The Centers for Medicare and Medicaid Services has sent millions of dollars to Washington state and Arizona to help maintain Children's Health Insurance Program coverage after Congress failed to extend funding by a Sept. 30 deadline. Washington state received $10.4 million in redistributed unspent CHIP funds and Arizona was sent $21.8 million earlier this month, according to spokespersons for each state's CHIP agency. Congress is still working on legislation to renew funding for the roughly 9 million kids who are covered.

MEDICAID SPENDING — New York's Medicaid program spent $20 million more than projected through the first four months of the state fiscal year, according to the state's monthly Medicaid report. Long term managed care was $29 million over budget, mostly due to higher than expected enrollment, according to the Department of Health's monthly Medicaid report. Read the report here.

NEW HELGERSON VIDEO — State Medicaid director Jason Helgerson is out with a new video, entitled, "Best Practices in DSRIP Year 3." Video is here.

GRANT LAND —The New York State Health Foundation awarded the Home Care Association of New York State a nearly $150,000 grant for training and implementation of HCA's first-in-the-nation sepsis-intervention protocols in home care provider settings across New York State. Read more here.

MAKING ROUNDS — Nathan Levitt, a family nurse practitioner and a recognized national leader in transgender care, recently joined NYU Langone Health to enhance services for the hospital system's growing patient population seeking gender-affirming care.

FUNDRAISER — Maimonides Medical Center raised $2.8 million at its annual gala at the Barclays Center. Jimmy Kimmel is taping his show at the Brooklyn Academy of Music this week. Each night, Kimmel will ask his celebrity guests to sign several guitars, which will be auctioned off between October 20 and October 30. The proceeds will go to the Maimonides Children's Hospital.

PHARMA REPORT:

WHAT'S LIFE WORTH — Kaiser Health News writes about new CAR-T therapies that could cost more than $1 million. Read more here.

WHAT WE'RE READING:

WOULD-BE DRUG CZAR DEPOSED — President Donald Trump on Tuesday announced that Rep. Tom Marino has withdrawn as the administration's drug czar nominee, shortly after media reports revealed how the Pennsylvania Republican championed a law that hobbled federal efforts to combat opioid abuse. Read more here.

PHARMA EXEC LEADS HHS RACE — President Donald Trump is leaning toward nominating Alex Azar, a former pharmaceutical industry executive and George W. Bush administration official, to serve as HHS secretary, according to two White House officials. Read more from my D.C. colleagues here.

HEALTH PLANS FACE LOSSES FROM CSR CUT OFF — Plans may have largely baked in the lost cost-sharing reduction payments into their 2018 premiums, but that doesn't protect them from losses for the rest of this year. Avalere estimates losses could range from $1.2 million in North Dakota to $200 million in Florida through the end of 2017. Here's the Avalere study.

UNDOCUMENTED MINOR ABORTION CASE HEARING ON WEDNESDAY — A federal court in Washington will hear the case of an undocumented, pregnant teenager detained in a federally funded shelter that the Trump administration is preventing from getting an abortion.

TODAY'S TIP — Comes from the state Department of Health, which reminds us all to get a flu shot.

STUDY THIS:

BIOMARKER FOUND — Scientists at the Icahn School of Medicine at Mount Sinai, Sema4, and collaborating institutions including Colorado State University and Fred Hutchinson Cancer Center say they found a biomarker for glioblastoma that is indicative of a patient's prognosis and likely response to specific therapies, according to an article in Cancer Research. Read more here.

MISSED A ROUNDUP? Get caught up here.

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