If you’re already bored with State of the Union coverage, tune in this morning to the House Budget Committee for a hearing that we’re dubbing Republicans vs. the Congressional Budget Office.

Still smarting from the CBO’s rather unfavorable analyses of their Obamacare repeal-and-replace bills last year, House Republicans are turning their glare to Congress’s official scorekeeper this morning in the first of five planned hearings focused on the agency and how it estimates the cost of legislation. 

Staff for Budget Committee Chairman Steve Womack (R-Ark.) said the purpose of the 10 a.m. hearing, where CBO Director Keith Hall will testify, is for lawmakers to understand "how CBO carries out its nonpartisan mission in service and support to Congress." But Democrats told me they’re gearing up for some pointed attacks on the agency.

"There has been a dramatic shift recently in the treatment of CBO," ranking member John Yarmuth (D-Ky.) plans to say in prepared remarks shared in advance with The Health 202. "Questioning and fair criticism of CBO have morphed into more caustic attacks, many that have crossed the line. And much of this friction seems to center on analysis of my Republican colleagues' efforts to repeal the Affordable Care Act."

Today’s hearing and the ones to follow stem primarily from the outrage expressed last summer by some Republicans — particularly hardline conservatives —  when the CBO estimated both the House and Senate health-care bills would result in 22 to 23 million fewer Americans with health coverage a decade from now.

Those coverage projections plagued the GOP as lawmakers unsuccessfully endeavored to repeal parts of the ACA and replace it with alternative legislation that would cost the government a lot less but also significantly pare the benefits  accessible to low-income Americans. They also caused some Republican lawmakers and administration officials to step up their criticism of the nonpartisan score-keeper, including most prominently Office of Management and Budget Director Mick Mulvaney.

Last week, the Senate Budget Committee also hosted Hall for a hearing in which Sens. Tom Cotton (R-Ark.), David Perdue (R-Ga.) and Ron Johnson (R-Wis.) drilled him on questions around the way the agency evaluates health-care legislation – including why it overestimated coverage under the ACA and why it didn’t use the most recent baseline to evaluate the GOP health-care bills (an action Republicans have charged could have resulted in a better coverage score).

Cotton told Hall that CBO reports are “usually pretty good when it comes to government revenues and outlays” but said they “leave something to be desired when it comes to things like political judgments or market forces and incentives.”

Let’s pause here and remember that the influential CBO — whose job is to provide the official estimate of the cost of legislation and other potential impacts — is a nonpartisan agency led by Hall, who was actually picked by Republicans in 2015.

From time to time, the agency serves as a punching bag for both parties after reaching conclusions that are not to Democrats' or Republicans' liking. But Republicans took that criticism to a whole new level last year, when some tea party Republicans started alleging it was politically motivated and even top Trump administration officials attacked its staff.

Mulvaney, for instance, went after the CBO’s top health analyst, Holly Harvey, last May, telling the Washington Examiner that she was an alum of the “Hillarycare program in the 1990s who was brought in by Democrats to score the ACA.”

In July, GOP Reps. Scott Perry (Pa.) and H. Morgan Griffith (Va.) offered amendments to a spending bill to halve the CBO’s funding and eliminate 89 agency employees who work on scoring estimates. Both amendments failed by wide margins, but they showcased how far Republicans are willing to go in targeting an agency for issuing evaluations they don't like.

Last summer, Perdue expressed skepticism of the CBO on the Senate floor: 

Johnson dismissed the need for a CBO score on a subsequent health-care bill from GOP Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.). Per CNN's David Wright: 

To be fair, the CBO gets estimates wrong sometimes. Most analysts whose job it is to make future forecasts do. But at this point, most experts agree it’s the best independent evaluator of legislation in a Capitol Hill environment that is more politically charged than ever.

Doug Holtz-Eakin, former CBO director under President George W. Bush, said he’s not surprised that Congress is holding CBO oversight hearings -- he believes lawmakers should have done so earlier. It’s their job, after all, to oversee the agency that scores their bills.

Holtz-Eakin told me he was troubled by GOP criticisms of the agency, but by bringing Hall before Congress lawmakers are giving the CBO a chance to better explain its methods and approach. It's a good opportunity for Hall to respond to GOP charges that his employees are politically motivated and give his take on why the agency gets it wrong sometimes, Holtz-Eakin said.

“There are many people with the impression that when you do your work, you drop the numbers into a magic calculator and the estimate comes out,” Holtz-Eakin explained. “There is no magic calculator.”


--It's officially the Alex Azar era at the Department of Health and Human Services. The former drug executive was sworn-in yesterday morning as 24th secretary of the massive agency – the Trump administration’s second HHS leader in less than a year – and immediately pledged to carry out his boss's charge to tackle the “scourge of the opiate crisis” and high drug prices, reports The Washington Post's Susan Levine, who watched the ceremony.

Unlike his predecessor, Tom Price, who resigned last fall amid intense criticism of his travel expenses, Azar was introduced by President Trump himself. “He’s going to get those prescription drug prices way down … it’s going to come rocketing down,” Trump said as Azar smiled, nodded and then laughed.

Trump also said Azar will help “lead our efforts to confront the national emergency of addiction and death due to opioids." "I think we’re going to be very tough on the drug companies in that regard and very tough on doctors in that regard," said the president, whose administration has been faulted for talking tough about the epidemic but doing little to bolster efforts, much less funding, to address it. 

This is Azar's second run at HHS. During the George W. Bush administration, he served both as general counsel and deputy secretary. He moved to Eli Lilly after that and rose to become president of its largest affiliate, Lilly USA. Azar's work there was something of a flash point during his confirmation hearing, with Democrats charging the former executive did nothing to help moderate drug prices while at Lilly.

Trump alluded to that industry experience, telling Azar, “You know the system, and you can do it, because it’s wrong.”

See Trump talk about Azar:

A welcome from National Institutes of Health Director Francis Collins:

And Vice President Pence, who administered the oath of office to Azar: 

From Gannett Washington correspondent Maureen Groppe: 

Bloomberg News's Alex Ruoff: 

Bloomberg's Jennifer Jacobs: 

--Roger Severino, head of HHS's Office of Civil Rights, heads to Capitol Hill this morning to speak to a group of House conservatives about the office's new Conscience and Religious Freedom division. Severino is scheduled to address the Republican Study Committee at 12:30 p.m., according to a memo sent to members and staff.

The new division, rolled out by HHS on Jan. 18, is intended to enforce protections for health-care workers who refuse to provide services that run counter to their moral or religious convictions. It will consider complaints from doctors, nurses and others who feel they have been pressured by employers to perform, accommodate or assist with procedures that violate their beliefs. 


AHH: Attorney General Jeff Sessions announced yesterday dozens of federal agents and analysts will form a team aimed at disrupting illicit opioid sales online, The Post's Sari Horwitz reports. The new team, dubbed Joint Criminal Opioid Darknet Enforcement (J-CODE), will double the FBI's effort in fighting online opioid trafficking. "Criminals think that they are safe online because they're anonymous, but they are in for a rude awakening," Sessions said to law enforcement officials gathered in Pittsburgh's federal courthouse. 

"Open-air drug markets still flourish in many U.S. cities," Sari writes. "But in others, instead of turning to drug dealers controlling city corners and defending their turf with violence, drug buyers are using encrypted communications and messaging apps on their phones."

Sessions noted that a record 64,000 people died of drug overdoses in 2016. "It's unbelievable," he said. "That's more than the population of Lancaster, Pa., dead in one year. And in 2017, it appears that the death toll was even higher."

OOF: Senate Democrats blocked a bill yesterday to ban late-term abortions past 20 weeks of pregnancy. Three Democrats -- Sens. Bob Casey of Pennsylvania, Joe Manchin of West Virginia and Joe Donnelly of Indiana -- voted with 48 Republicans to advance the measure, but it failed to gain the 60 votes necessary to clear a procedural hurdle, The Post's Ed O'Keefe reports. Two Republicans -- Sens. Susan Collins of Maine and Lisa Murkowski of Alaska -- joined 44 Democrats to oppose it.

Senate Republicans have tried before to advance the so-called "pain-capable" bill, based on the idea that a fetus can feel pain midway through pregnancy (the House passed the measure last fall). Senate Majority Leader Mitch McConnell (R-Ky.) said the legislation "reflects a growing mainstream consensus" that abortions should be banned after 20 weeks. "There is no reason why this should be a partisan issue," McConnell said. "I hope that my Democratic colleagues will not obstruct the Senate from taking up this bill."

Polls have found the public is divided over banning abortions midway through pregnancy. A January 2017 Quinnipiac University poll asked whether people would support such a ban if it were enacted in their state: ­Forty-six percent supported it while 46 percent opposed it. Nearly six in 10 Republicans supported the ban, while nearly six in 10 Democrats opposed it, Ed writes.

Abortion opponents correctly note the United States is one of just seven countries that allow elective abortions after 20 weeks of pregnancy. The Post's fact-checker Michelle Ye Hee Lee writes that North Korea, Vietnam, China, Canada, the Netherlands and Singapore are the only other countries which permit elective abortions that late into pregnancy.

OUCH: In its latest eyebrow-raising action, the board of the District's only public hospital violated the city's Open Meetings Act on Dec. 13 when it excluded the public from its discussion and vote to permanently close the hospital's nursery and delivery rooms, The Post's Peter Jamison reports. A top ethics official said Friday the board of United Medical Center in Southeast Washington committed multiple violations of the law, which is designed to ensure transparency of government actions.

The board didn't enter its closed session with any of the valid exemptions provided under the Open Meetings Act, it failed to give public notice beforehand of its intent to enter a closed session, and it didn't follow requirements for entering closed session, the official concluded after looking into the meeting after complaints from The Post, the D.C. Open Government Coalition and the Washington Business Journal.

"The board's action left the nation's capital east of the Anacostia River without a hospital where women could give birth or seek prenatal care," Peter writes. "After the board met privately to debate and decide to close the obstetrics unit, chairwoman LaRuby May said that the decision had not been unanimous but that she could not provide the vote tally. She also could not provide any legal justification for holding the vote in private but said she had been advised by the board's attorney that the session was proper."

Ethics officials have instructed the board to make public an audio recording of its closed-door deliberations and roll-call vote, as well as any documents board members reviewed in their closed session.


--Among the areas Trump is likely to cover during his first State of the Union speech tonight – tax cuts, the stock market, immigration and trade to name a few – health-care is not expected to be a big talker. Bloomberg’s Felice Maranz reported policy research firm Capital Alpha predicted health care won’t be a main focus. That’s despite a Politico/Morning Consult poll published over the weekend that found more than four in five voters want Trump to address his plans for health care. 

Yet lawmakers are expected to highlight the opioid epidemic -- and other health-care issues -- with the guests they're bringing along:

  • Danielle Highley, a nine-year-old who will benefit from CHIP funding, has been invited by Rep. Marsha Blackburn (R-Tenn.), CNN reports.
  • Peter Rosenberger, whose family has been affected by the health-care system, has been invited by Sen. Steve Daines (R-Mont.)
  • Senate Minority Leader Chuck Schumer (D-N.Y.) is planning to bring Stephanie Keegan, the mother of Daniel Keegan, a U.S. soldier who died of a heroin overdose, according to The Journal News.
  • Sen. Maggie Hassan (D-N.H.) has invited McKenzie Harrington-Bacote, who focuses on preventing substance use among students as a program administrator for the Laconia School District’s office of school wellness, per the Concord Monitor.
  • Sen. Jeane Shaheen (D-N.H.) invited Jeanne Moser, whose son died of a fentanyl overdose.
  • Ryan Holets, a police officer from Albuquerque, who adopted a baby from parents who suffered from opioid addiction, is scheduled to attend, per CNN.

American Federation of Teachers leader Randi Weingarten weighed in: 

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

Eminent breast-cancer doctors disagree on whether to prescribe less chemotherapy; some worry about the treatment’s ‘toxicities’ and others say it saves lives.
Wall Street Journal
Few doctors, and even fewer patients, have heard of CHIP. But it is emerging as a major cause of heart attacks and stroke, as deadly as high blood pressure or cholesterol.
New York Times
America’s Health Insurance Plans (AHIP) has been the voice of the health insurance industry for years, but questions have been swirling about whether the association carries the same political clout it once did.
The Hill
U.S. District Judge Dan Polster, overseeing about 200 lawsuits against opioid makers, wants to see the opioid epidemic curbed this year.
USA Today
California would be the first state to require public universities to offer medication abortion under legislation approved in the state Senate Monday, a bill that if signed into law would mark a vast expansion of a service that's rare on college campuses.


  • President Trump delivers his first State of the Union address.
  • The Senate Health, Education, Labor and Pensions subcommittee on primary health and retirement security holds a hearing on small business health plans.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on the Compounding Quality Act, including FDA commissioner Scott Gottlieb.
  • The FDA Opioid Policy Steering Committee is meeting.

Coming Up

  • The Bipartisan Policy Center holds an event on “A Policy Roadmap for Individuals with Complex Care Needs” on Wednesday.
  • Health Affairs holds an event on health spending on Thursday.
  • The Senate Health, Education, Labor and Pensions committee holds a hearing on the opioid crisis on Feb. 8.

President Trump promised sweeping change at this first address to a joint session of Congress. Here's what he accomplished:

Trump says this year's address will be an "important speech" on trade and immigration:

Here's a look at the first televised State of the Union address: 

Stephen Colbert talks about the typo on tickets to Trump's first State of the Union: