The Trump administration is looking to wring as much political capital as possible from the Affordable Care Act's unpopular mandate to buy health coverage. Even though Congress repealed the requirement last month as part of its tax overhaul, administration officials are still seeking more ways to excuse people from the mandate before it's ultimately laid to rest a year from now.

Yesterday I teamed up with my colleague Juliet Eilperin to scoop that the Centers for Medicare and Medicaid Services is working on guidance expanding the “hardship” exemptions from the mandate. Agency officials haven’t finalized the guidance, but they aim to increase the number of reasons people could cite as justifications for being uninsured when they file their tax returns, according to two people familiar with the effort.

Now, this move probably won't have a ton of practical effects. The IRS announced last year it would pull back on the Obama administration's planned ramp-up of enforcement of the mandate. The agency will continue its practice of basically turning a blind eye when people fail to indicate on their tax returns whether they purchased health coverage for the previous year. IRS agents will still process such returns, essentially giving people an easy out if they were uninsured but want to skip paying the penalty.

But the move does further Republicans' narrative that they're lightening the load for those people who don't want Obamacare, even though Congress failed to repeal most of the 2010 law. The additional exemptions under review at CMS would apply to the current year (repeal of the mandate doesn't go into effect until 2019) , meaning they could be cited by filers preparing their 2018 taxes next year.

Larry Levitt, senior vice president of the Kaiser Family Foundation:

Kaiser Health News's Julie Rovner: 

When we asked the Health and Human Services Department yesterday to confirm the guidance is in the works, a spokesman declined to comment. It's unclear when the agency might release the new exemptions, especially since the department is awaiting an incoming secretary, Alex Azar, who was confirmed by the Senate yesterday.

There are also legal questions around how far CMS can go in exempting Americans from the individual mandate. During the Obama administration, federal agencies defined multiple circumstances in which people could be excused from that requirement. For example, people can qualify for a hardship exemption if they experienced a serious financial difficulty such as eviction from their homes or were forced to file for bankruptcy — or they experienced a personal difficulty such as domestic violence or the death of a family member.

The penalty for not having health coverage is $695 per adult and $347.50 per child — up to $2,085 per family — or 2.5 percent of family income, whichever is greater. About 6.5 million taxpayers paid a fine for being uninsured in 2015, according to the IRS, although the fine that year was $470 per adult.

 Republicans have run up against all sorts of difficulties in building support for various plans to repeal and replace the ACA, but their opposition to the law's mandate has been a political winner for them, especially among the GOP base. A November Kaiser Family Foundation poll found that 55 percent of the public supported getting rid of the mandate, while 73 percent of Republicans held that position.

“I have always said we should be focused on providing the families trapped in Obamacare with as much relief as possible — as soon as possible,” Rep. Peter Roskam said in a response to the planned executive action.  “The administration’s decision to broaden the hardship exemption will deliver much-needed relief” from the mandate."

Democrats were quick to criticize the apparent CMS decision. “This appears to be yet another step by the Trump administration to undermine health care markets, which means higher premiums for families and those who need health care the most,” said top Senate Finance Democrat Ron Wyden.

Josh Peck, co-founder of Get America Covered, questioned what additional circumstances would justify letting taxpayers off the hook for not buying insurance. He said that while he was working at CMS under former President Obama, the agency had thoroughly explored the broad sweep of possible exemptions.

“The previous administration looked very closely at the hardship exemption to make sure it was serving the people who needed the exemption,” Peck told me.


AHH: Cecile Richards, who has served at the helm of Planned Parenthood for about a dozen years, is expected to step down from her role as president of the abortion rights and women’s health-care organization. Her departure comes on the heels of a tumultuous run for the group, as it's under FBI investigation and faces ongoing efforts by Republicans to ban it from the Medicaid program. Rumors of Richards' departure had been circulating in the liberal political world for months, and there'd even been talk before the 2016 election that she was ready to move on if Hillary Clinton won, The Post's Dave Weigel reports. 

As the face of both Planned Parenthood and its political arm, the Planned Parenthood Action Fund, Richards massively grew the group's public profile. “During her time as president, Richards greatly expanded the organization’s fundraising and organizing capabilities — and helped raise its profile through celebrity-oriented campaigns and increased political participation,” write BuzzFeed’s Ruby Cramer and Ema O’Connor, who first reported the news.  

“Over the past decade in particular, Democrats have further embraced abortion rights as a central part of the party’s platform — a shift that can be credited in large part to Planned Parenthood’s increased prominence under Richards," Ruby and Ema write.

Planned Parenthood was long one of the conservative movement’s top targets even before Republicans took back the White House. "For much of Richards’s tenure, Planned Parenthood was engaged in battles to protect its taxpayer funding, both federally and in states," Dave reports. In 2011, she led a high-profile campaign to block funding cuts, pointing out that Planned Parenthood enjoyed far more public support than Congress.

From antiabortion group Susan B. Anthony List:

Students for Life president Kristan Hawkins called the move "evidence of the collapsing abortion industry:" 

The news also sparked speculation of a potential political run by Richards, whose mother Ann Richards served as Democratic governor of Texas from 1991 to 1995. “She’s someone we have partnered with very happily,” billionaire Democratic donor Tom Steyer told Dave. “If she stops, I hope it’s because she’s doing something new and important. If she ran for any office, I’d support her.”

From Rep. Bonnie Watson Coleman (D-N.J.):

HuffPost's Laura Bassett: 

The Nation editor Katrina vandenHeuvel: 

OOF: The 24-year-old former Trump campaign worker who is leading the White House Office of National Drug Control Policy will step down by the end of the month because of controversy surrounding his appointment, The Post's Robert O'Harrow, Jr. reports. Taylor Weyeneth rose quickly to head the ONDCP, which is responsible for coordinating anti-drug initiatives at 16 federal agencies and supporting President Trump's efforts to confront the opioid epidemic. "Mr. Weyeneth has decided to depart ONDCP at the end of the month," the White House said yesterday in a statement. 

"The announcement follows Washington Post stories that detailed Weyeneth's rapid rise at ONDCP — in large part because of staff turnover and vacancies — and inconsistencies and inaccuracies on three résumés he submitted to the government," Robert writes. "Early last year, Weyeneth revised dates relating to certain jobs he held, including one at a New York law firm. A partner at the firm told The Post that Weyeneth was "discharged" because he stopped showing up for work."

OUCH: Larry Nassar, the disgraced former Michigan State University and USA Gymnastics team physician, was sentenced to 40 to 175 years in prison yesterday after more than 150 women testified about sexual abuse they suffered at his hands for decades. For seven days in the courtroom, women and their families described Nassar’s sexual abuse. In a letter to the court, Nassar maintained that touching patients was part of his medical therapy, our colleague Will Hobson reported. As parts of the letter were read, there were gasps in the room.

“It was not treatment what you did; it was not medical,” Judge Rosemarie Aquilina said after reading his letter out loud. “I wouldn’t send my dogs to you, sir.” “I’ve just signed your death warrant,” she added, after issuing Nassar's sentence. 

After reading the letter, she tossed it aside: 

Later on Wednesday, Michigan State’s long-serving president resigned, our colleague Susan Svrluga reports. “To the survivors, I can never say enough that I am so sorry that a trusted, renowned physician was really such an evil, evil person who inflicted such harm under the guise of medical treatment," Lou Anna Simon said in a statement. U.S. Olympic Committee chief executive Scott Blackmun also issued an apology, calling the abuse by Nassar “worse than our worst fears.”

“I don’t think people understand just how bad this was,” Olympian Aly Raisman told Post columnist Sally Jenkins. “I don’t think they have all the pieces and understand how USA Gymnastics and the USOC created the perfect environment for this monster.”


—  Azar is officially the next secretary of HHS. The Senate voted yesterday to confirm the former drug industry executive with pristine conservative credentials, ushering in his return to the government's largest domestic agency. Azar formerly held senior roles in the George W. Bush administration, The Post's Amy Goldstein reports. Azar will become the Trump administration's second HHS leader in 11 months, after his predecessor Tom Price resigned over his use of private charter planes.

Seven Democrats voted for Azar's confirmation, while one Republican, Kentucky Sen. Rand Paul, opposed him. Before the vote, leading GOP senators praised Azar. “I can think of very few others as qualified to take the helm of this very large ship,” said Senate Finance Committee Chairman Orrin G. Hatch (R-Utah). “With experience both on the company side and the government side of health care, he is now only more experienced and knowledgeable.”

“Azar, 50, will take over as policies in the sprawling department, with its budget of more than $1.1 trillion, are tilting to the right,” Amy writes. “A new civil rights division has just been created to protect health-care workers who refuse to provide contraception and other services inconsistent with their moral or religious beliefs. For the first time, new rules allow states to impose work requirements as part of their Medicaid programs.”

“Other priorities Azar will oversee include trying to control rampant opioid addiction that is ravaging many U.S. communities,” Amy continues. “He will be under pressure to find ways to constrain drug prices — a realm in which suspicions of him run high given his years as a top executive of Eli Lilly. In addition, he will be at the vortex of the ongoing political feud over the Affordable Care Act, the 2010 law that has spread insurance to millions of Americans and is a main target of the administration and congressional Republicans.”

Sen. Elizabeth Warren (D-Mass.): 

Sen. Kirsten Gillibrand (D-N.Y.): 

Sen. Ron Wyden (D-Ore.): 

Bloomberg's Sahil Kapur: 

Politico's Sarah Karlin-Smith: 


— Who wants to keep trying to repeal the ACA? Big shocker: It's Sen. Ted Cruz of Texas, who yesterday told the Washington Examiner that Republicans needed to “finish the job” on repealing and replacing the health-care law in 2018. He said he's pushing his colleagues to use another budget reconciliation bill this year to accomplish their longstanding campaign promise before the midterm elections in November.

While it would be harder than ever for Republicans to pass a health-care bill — now that Sen. Doug Jones of Alabama, a Democrat, has diminished their Senate majority to just one seat — Cruz said he has had long conversations with the GOP senators who blocked legislation last time around. Cruz added there has been discussion about asking the Congressional Budget Office to rescore repeal legislation now that the individual mandate is gone since that change is expected to result in a more favorable insurance coverage estimate.

“The biggest unfinished task is Obamacare,” Cruz told the Examiner. “We need to finish the job. I still believe it is possible to bring Republicans together. I think we got very close last time and that’s something I’m continuing to devote a lot of time trying to unite our fractious conference and build consensus to get at least 50 Republicans on the same page.”

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

“My god, the president is paralyzed!” said Wilson’s physician. But really, who needed to know?
Monica Hesse
To Your Health
GW Pharmaceuticals, the company that developed the drug, on Wednesday announced promising results from a study on 171 patients randomized into treatment and placebo groups.
Ariana Eunjung Cha
Health & Science
Doctors have much more time to save threatened brain tissue, according to a landmark study released Wednesday.
Lenny Bernstein
The Switch
App would allow patients in some hospital systems to tether their medical records to their phone
Carolyn Y. Johnson
To Your Health
The products haven't been proven to be safe and divert consumers from effective treatments, officials say.
Laurie McGinley
Health & Science
Complaint alleges federal officials approved a plan that runs afoul of Medicaid law and will harm the poor.
Amy Goldstein
Oregon voters said "yes" to continuing funding the expansion, but other states are tightening restrictions.


  • The Families USA Health Action Conference continues.
  • The Senate Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations is scheduled to hold a hearing on combatting the opioid crisis.
  • The National Institutes of Health is scheduled to hold a meeting of the National Advisory Mental Health Council.
  • The Medicaid and CHIP Payment and Access Commission holds its January meeting starting.
  • Tivity Health sponsors an event on “Aging in Rural America: The Growing Crisis, a Movement for Change” with remarks from Sen. Chuck Grassley (R-Iowa).

Watch the courtroom bursts into applause after Larry Nassar's sentencing:

Watch as Judge Rosemarie Aquilina reads a statement by Nassar, defending himself as a "good doctor:"

Meet the first primates cloned by tissue cells: 

Jimmy Kimmel on Trump's visit to Davos: