Republicans’ already narrow doorway to repealing Obamacare shrank even further last night as Alabamians -- for the first time since 1992 -- chose a Democrat as U.S. senator.

In what my colleagues describe as a “stunning setback for the Republican Party,” Doug Jones narrowly defeated Republican Roy Moore, a former state judge who was twice removed from the bench and faced allegations he’d made sexual advances toward teenagers while in his 30s.

Moore’s defeat is surely a relief to many Republicans – he already faced a likely ethics investigation in the Senate had he won – but it also means the GOP is now down to a one-vote margin in the Senate when it comes to repealing and replacing the Affordable Care Act, a task at which the party failed miserably over the summer but is contemplating returning to in 2018.

Up until now, the Senate GOP's 52-seat majority allowed the party to lose two votes on a health-care bill, with tie-breaking help from Vice President Pence. That’s an important number, because the two most moderate Republicans – Sens. Lisa Murkowski of Alaska and Susan Collins of Maine – have been regarded as nearly impossible to bring on board.

When Jones joins the Senate likely in early January, Republicans will now have a 51-vote majority, meaning they can lose either Murkowski or Collins, but not both, and still achieve their long-touted political hopes of rolling back the ACA. Jones is likely to cross the aisle on some issues – he will represent Alabama, after all – the Democrat has already said the ACA should be improved, not repealed.

“Repeal and replace is a political slogan,” Jones said at a press conference in November. “It’s not something that’s workable.”

Politico's Dan Diamond:

Time's Nash Jenkins:

The whole situation is an increasingly big disappointment for President Trump, who has repeatedly promised to return to healthcare once Congress finishes its tax overhaul effort:

“The administration is confident Congress will come back to town in the new year and work to repeal and replace the Obamacare disaster,” White House Press Secretary Hogan Gidley said in a statement provided to The Health 202. “Healthcare costs continue to skyrocket and many doctors won’t take patients who have it – Obamacare has failed.”

It’s hard to imagine how Republicans could resume debating what were unpopular health-care bills in a midterm election year, when they couldn’t manage it in an off-election year, especially with what seems like Democratic political momentum. But behind the scenes, some GOP lawmakers are also convinced they should return to the effort once taxes are out of the way -- after all, repealing Obamacare is something they relentlessly promised when a Democrat was in the White House.

The GOP idea is to pass a new budget resolution for next year, giving them another way to avoid attracting Democratic support for a controversial health-care measure by seeking just 50 votes for it.

“I don’t think we’re ever going to be able to get away from [health-care],” No. 2 Senate Republican John Cornyn (R-Texas) told me last week.

Republicans are particularly buoyed by the prospect of a health-care measure that might come in more favorably on coverage estimates as scored by the Congressional Budget Office. If the ACA’s individual mandate is repealed in the tax overhaul, which appears likely, future GOP health-care bills might compare more favorably to the status quo (we’ve explained this previously in The Health 202).

“I’ve been in meetings with members who say this is so awesome, we get to say we repealed the mandate and we take all our hits on the coverage losses,” one health-care lobbyist told me.

If Republicans return to health care – and that’s still a big, big if – GOP aides, members and lobbyists say the top contender remains the measure put forward by Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.), which the Senate made a last-gasp effort to pass back in September after various versions of their other health-care bills failed.

“I think the general feeling is it will come up again -- but not sure on the timing,” said Graham spokesman Kevin Bishop.

Sen. James Lankford (R-Okla.) said Cassidy-Graham is “still the leading candidate for whatever we’re doing.”

In the meantime, Jones is focusing his health-care energy on calling for Congress to reauthorize the Children's Health Insurance Program, which technically expired in October. The House has passed a reauthorization bill, which Democrats tried to block because they disliked how it was paid for, but the Senate has yet to pass a measure. Some states have started notifying recipients that the program is in serious jeopardy as federal funds run low.

From BuzzFeed's Brandon Wall: 

PBS NewHour's Courtney Norris:

Sen. Chris Van Hollen (D-Md.):


AHH: Republican strategists believed that for Alabama’s antiabortion hard-liners, a vote for Jones would be a bridge too far. They were wrong, The Post's Marc Fisher reports. Jones’s unlikely victory was driven in part by revulsion over the allegations of sexual misconduct against Moore, but also by resistance against a torrent of TV ads that urged voters to make abortion a defining litmus test, Marc writes.

In the run-up to yesterday's election, Moore denied any improper sexual behavior but also went on the offensive against Jones for being a pro-abortion rights radical, a supporter of abortion at any time, for any reason, Marc writes. Moore’s campaign saw the issue as a time-tested way of painting Democrats as extremists -- and indeed, it's a tactic that has worked well in the past.

But most Alabama voters didn't put abortion atop their list of defining issues, according to a Washington Post-Schar School poll last month which found that 41 percent of voters thought a candidate’s views on health care were most important, followed by moral conduct at 26 percent. Abortion trailed well behind at 14 percent. Moore did garner 70 percent of voters who said abortion should be illegal in all cases, according to exit polls. 

"Abortion remains one of the few issues that most voters call an absolute litmus test; that is, along with health care, same-sex marriage and immigration, abortion is a rare issue on which a majority of voters say they could not bring themselves to vote for a candidate who disagrees with them," Marc writes. "But in Tuesday’s vote, many did exactly that — an indication, some scholars said, that as Americans, even in the Deep South, become more secular, abortion politics no longer wields the same sway it once did."

(See my write up in yesterday's Health 202 explaining why this was a difficult call for antiabortion activists.)

OOF: Recall that 2016 law curbing the DEA’s powers to use its most potent weapons against drug companies failing to report suspicious orders of prescription painkillers? The head of the DEA office that regulates pharmaceutical opioids said yesterday the law should be either repealed or amended, because it has made enforcement more difficult in urgent circumstances, The Post's Lenny Bernstein and Scott Higham report.

Demetra Ashley told the Senate Judiciary Committee the DEA agrees with the Justice Department that the law should be altered to help curb the ongoing opioid epidemic. Under the law -- which The Post and "60 Minutes" reported on in October -- it's been harder for DEA investigators to show a company’s conduct poses an immediate danger of death or harm in order to shut down shipments of painkillers from a distributor to a pharmacy. The law was originally pushed by a small group of lawmakers allied with drug companies.

"Since the law was passed, Ashley said, DEA investigators have faced a greater challenge showing that a company’s conduct poses an immediate danger of death or harm in order to shut down shipments of painkillers from a distributor to a pharmacy," Lenny and Scott write. "That burden has moved the agency away from its traditional posture of preventing harm, she said."

Senators in the hearing broke down largely — but not completely — along party lines about whether changes are needed. Sen. Dianne Feinstein (D-Calif.) said that in her view, the law has done harm. But Sen. Orrin Hatch (R-Utah), who led Senate negotiations over it, pushed back against Ashley's criticisms.

“This wasn’t some effort to help drug companies kill people. Give me a break,” Hatch said. “This was an effort to ensure that DEA’s efforts . . . didn’t end up hurting legitimate patients.”

OUCH: The Associated Press spent some time with Judge Marilyn Moores, who handles child welfare cases in Indianapolis, to illuminate how the nation's spike in opioid abuse is straining an already overburdened foster care system. "Across the U.S., soaring use of opioids has forced tens of thousands of children from their homes, creating a generation of kids abandoned by addicted parents, orphaned because of fatal overdoses or torn from fractured families by authorities fearful of leaving them in drug-addled chaos," Matt Sedensky and Meghan Hoyer write.

“This isn’t a trickle. This isn’t a wave. It’s a tsunami,” Moores told the AP. Ever since Moores started as a judge in 2006, the number of filings for children in need of services has more than tripled to 4,649 in Marion County -- and it's largely because of a massive surge in cases involving opioids.

"Behind each of those cases is a child subjected to the realities of life amid addiction — of barren fridges, unwelcome visitors and parents who couldn’t be roused awake. Moores is still haunted by the story of a 2-year-old found alone at home with his father’s corpse, a needle still poking from his arm. A neighbor was drawn in by the boy’s relentless wails," Matt and Meghan write. "By Friday, the largest pile of cases on Moores’ desk has reached a towering two feet, and she has plodded on in bureaucratic fights to get more judges, more court reporters and more mediators to deal with work in which the despair dwarfs the fleeting moments of hope."

“It seems like there’s a whole generation of people disappearing,” Moores told them.


--Open enrollment on is scheduled to end on Friday. But more than half of people shopping for health insurance don’t know that enrollment is closing, according to a survey from eHealth out today. That’s true even among proactive health-care shoppers, the online broker finds. Here are some other key highlights from the survey.

  • There’s a sharp contrast between prices for consumers who received subsidies compared with consumers who did not receive subsidies. The survey found 36 percent of people eligible for subsidies say they are paying $100 or less per month for coverage. And 36 percent of unsubsidized consumers say they are paying at least $1,000 per month.
  • The survey found 71 percent of people overall would still buy insurance even if the individual mandate is repealed. And that’s especially true of people who pay full price for insurance. Unsubsidized consumers are more likely to continue buying insurance plans without the individual mandate than those who receive subsidies.
  • One in five subsidized consumers said they were eligible for a zero-premium plan, and 12 percent said they actually enrolled in a plan without a monthly premium. 

--Two top Senate Democrats are urging the Trump administration to extend open enrollment, which spans only half the length of last year's sign-up season. In a letter to acting Health and Human Services Secretary Eric Hagan, Sens. Ron Wyden (D-Ore.) and Patty Murray (D-Wash.) criticized the administration for cutting down the enrollment period (even though we should note the plan was originally conceived by the Obama administration; the Trump administration just hastened it by one year).

“The administration’s decision to depart from years of agency policy by ending open enrollment on December 15th is compounded by the many other efforts by this administration to destabilize the insurance market, making it likely that many consumers miss this deadline and forgo insurance next year—all despite clear indications that consumers are highly interested in seeking coverage for 2018,” they wrote.


--Twelve Democrat and Republican governors are urging Congress to reauthorize funding for the Children’s Health Insurance Program as soon as possible, after it technically expired in October, per the AP. 

In a letter sent yesterday, Ohio Gov. John Kasich (R) and Colorado Gov. John Hickenlooper (D) -- along with the governors of Alaska, Louisiana, Massachusetts, Minnesota, Montana, Nevada, New Hampshire, Pennsylvania, Vermont and Virginia -- urged members of Congress to quickly reauthorize CHIP so their states don't experience any gaps in funding. Funding the program "without disruption" is something they can all agree on, the governors wrote.

Yet it's looking less and less likely that Congress will find a solution to their gridlock over CHIP before the end of the year, according to multiple reports over the past several days. The House has actually passed a five-year CHIP reauthorization bill, but Democrats refused to support it because they didn't like how it would be paid for. The Senate has agreed on a bipartisan reauthorization measure, but hasn't dealt with the controversy over how to fund it.

--A few more good reads from The Post and beyond:

Both camps are confident that their direct approaches will help their sides meet turnout models.
David Weigel
Lori Lodes and Joshua Peck — who also helped oversee past enrollment efforts — launched a group called Get America Covered in early October. They recruited the help of a handful of other Obama administration officials in the hope of filling what they see as an advertising and outreach void left by the Trump administration.
The Hill
D.C. Politics
Financial problems emerged after the District spent more than $5 million on a turnaround firm.
Peter Jamison
To Your Health
Experts debate the health effects of diet soda and its possible role in stroke, dementia and weight gain.
Marwa Eltagouri
A new poll reveals it's more complicated than it might appear.
Keith Humphreys
In attacking our argument, two economists make errors in logic and engage in a highly selective use of evidence.
Lawrence H. Summers and Jonathan Gruber
Aetna wants to "remove possible financial barriers to the lifesaving drug."


  • The Kaiser Family Foundation holds an event on “Living in an Immigrant Family in America: How Fear and Toxic Stress Are Affecting Daily Life, Well-Being, and Health.”
  • The Senate Health, Education, Labor and Pensions Committee has a hearing on “Implementation of the 21st Century Cures Act: Responding to Mental Health Needs.”
  • The House Energy And Commerce Subcommittee on Health holds a hearing on “Examining the Drug Supply Chain.”

"It's not over": Republican Roy Moore raises possibility of recount:

Watch Jones supporters celebrate after the election is called:

CNN's Jake Tapper explains to Roy Moore's campaign spokesman that elected officials don't have to be sworn in on the Bible:

White House press secretary Sarah Huckabee Sanders said there was no sexual connotation to President Trump’s tweet criticizing Sen. Kirsten Gillibrand (D-N.Y.):

Members of the Democratic Working Women's Group are calling for the Government Oversight Committee to investigate President Trump's sexual misconduct accusations: