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This week: House wants to vote on spending and taxes, then go home. House lawmakers are hoping to wrap up legislative business this week by passing three tax reform bills and a massive spending bill that would prevent a government shutdown. The fiscal year ends Sept. 30, and lawmakers are poised to cleanly avoid the usual partisan showdown over federal spending that has ensnared the House and Senate for years. They are expected to approve a massive measure funding the Defense Department for fiscal year 2019 at $607 billion. The measure would provide the Health and Human Services, Labor, and Education Departments with a total of $178 billion for the year. Trump has been tweeting angrily about the lack of wall funding, suggesting he might refuse to sign the government spending bills without significant border wall funding, but he has also said he’s worried that a government shutdown would hurting GOP candidates ahead of the Nov. 6 midterm election.

Following GOP criticism, CBO commits to revamping insurance coverage model. The nonpartisan Congressional Budget Office said Friday that it plans to roll out a new model for gauging insurance coverage in spring 2019, following Republican complaints the methods it currently uses are inaccurate. The new model could have a major impact on future debates over the repeal of Obamacare. Republicans complained that the CBO’s estimates for coverage losses under their repeal bills last year were not accurate and hurt their legislative efforts. For instance, CBO said 23 million people would lose coverage over the next decade under the House’s first Obamacare repeal bill released in March of last year. The White House criticized CBO’s estimates, particularly the idea that millions of individuals would decline to sign up for Medicaid without the individual mandate penalties in effect.  

Welcome to Philip Klein’s Daily on Healthcare, compiled by Washington Examiner Managing Editor Philip Klein (@philipaklein), Senior Healthcare Writer Kimberly Leonard (@LeonardKL) and Healthcare Reporter Robert King (@rking_19).  Email [email protected] for tips, suggestions, calendar items and anything else. If a friend sent this to you and you’d like to sign up, click here. If signing up doesn’t work, shoot us an email and we’ll add you to our list.

Trump administration formally proposes plan to limit legal immigration to those not dependent on public benefits. The Trump administration formally announced late Saturday a long-anticipated proposal to change a public rule to potentially favor legal immigrants in the United States who are applying for green cards and those applying to enter the country on visas who have not used or do not have plans to use public benefits, including Medicaid, food stamps, and public housing. The Department of Homeland Security rolled out the proposal, saying a “public charge,” a person who receives financial support from the U.S. government for greater than a select period of time, will become a “heavily weighed negative factor” in immigrant admissions.

Gottlieb defends crackdown on e-cigarettes, even if adults are affected. Food and Drug Administration Commissioner Scott Gottlieb defended the agency’s wide crackdown on e-cigarettes as addressing public health crisis, but admitted that the products could be helpful for adults. “#FDA recognizes that there is some evidence that e-cigs may represent an important opportunity for adult smokers to transition off combustible tobacco products and onto nicotine delivery products that may not have the same level of risks associated with them,” Gottlieb tweeted Sunday. But Gottlieb later added the agency wouldn’t tolerate a “whole generation of young people becoming addicted to nicotine as a tradeoff for enabling adults to have unfettered access to these same products.

California bans short-term plans, work requirements in Medicaid. Democratic Gov. Jerry Brown signed a bill into law this weekend that will ban the sale of short-term plans in California. The Trump administration is allowing people to be enrolled in these plans for just short of a year, and they can be renewed to last three years, though states are allowed to implement their own limits. Brown also signed a bill that specifically denotes that the state’s Medicaid program, known as Medi-Cal., is not to add work requirements as a condition of staying enrolled in the program.

FDA: Pharmaceutical testing and brewing beer don’t mix. A pharmaceutical testing laboratory brewed up some trouble with the Food and Drug Administration by sharing its space with a microbrewery. The FDA issued a warning on Aug. 29 to Pharmaceutical Laboratories and Consultants for several manufacturing quality violations, the most notable of which was that the company’s testing laboratory was too close to a microbrewery. The Illinois-based company is a contract testing facility, with which drugmakers sometimes contract to test the quality of their products and to submit such data to the FDA for approval. FDA came to the facility in Sept. 2017 for an inspection, and found several routine deficiencies, such as not having proper records or improper training procedures for staff. But in an odd turn of events, the agency also found that the company’s pharmaceutical testing area was overlapping with beer brewing. “A brewery employee was also preparing beer kegs in this area,” the FDA noted in the letter to the company, which was recently posted online by the FDA.

Ron Johnson presses administration to end Medicaid ‘shell games.’ Sen. Ron Johnson, R-Wis., is demanding the Trump administration answer how it is going to end “shell games” through which states artificially inflate their contributions to Medicaid in order to get a greater share of federal funding. Johnson sent letters on Friday to Centers for Medicare & Medicaid Services Administrator Seema Verma and U.S. Comptroller General Gene Dodaro regarding a lack of audits of states’ use of Medicaid funding. “Without timely, complete and accurate data subject to independent audits, CMS and Congress cannot determine the extent of Medicaid maximization schemes and how much they are costing federal taxpayers,” Johnson wrote to Verma. Johnson charges that the federal government’s commitment for Medicaid funding is “open-ended” and incentivizes states to explore ways to get more money from the federal government for Medicaid. He gave an example of a tax that some states levy on hospitals. States return the revenue from the tax back to hospitals as Medicaid payments, triggering a higher reimbursement from the federal government.

Medicaid spending to hit $1 trillion within a decade: Study. Medicaid spending is expected to reach $1 trillion by 2026, according to a report from government actuaries. The report, released Thursday by the Centers for Medicare and Medicaid, concludes that the growth in Medicaid expenditures, which are expected to average 5.7 percent a year, would “place a growing strain on federal and state budgets.” In contrast, gross domestic product is projected to grow at an average of 4.1 percent, which would make Medicaid expenditures increase from an estimated 3.1 percent of GDP in 2016 to 3.7 percent of GDP in 2026. The part of Medicaid spending with the fastest growth is expected to be premiums and the fees that the government pays to private health insurance companies for them to manage enrollees. They are expected to grow by an average of 7.8 percent a year from 2017 to 2026, reaching $578 billion at the end of that time period. By 2026, about 82.3 million people are projected to be covered under Medicaid.

Polls show Democrats favored on healthcare in three Florida House races. Voters in three close House races in Florida approve of a Democrat handling healthcare more than the GOP incumbent, results that a pro-Obamacare group hopes gives Democrats a boost in the upcoming midterm elections. Democratic polling firm Public Policy Polling released three polls on Friday conducted on behalf of the pro-Obamacare group Protect Our Care. Each of the polls shows voters in the surveyed House district favored Democrats over Republicans to handle healthcare, even though the GOP incumbents are either ahead or close to their challengers.

The polling was conducted for the House races of Florida GOP Reps. Jose Diaz-Balart, Carlos Curbelo, and Brian Mast. Each poll has the GOP incumbents ahead or slightly behind. The poll also found that voters in each district were more likely to support a candidate that does not want to repeal Obamacare.

Hawaii law targeting anti-abortion crisis pregnancy centers struck down. A federal court has struck down a Hawaii law obligating anti-abortion pregnancy centers to inform women that they can obtain state-funded abortions elsewhere. District Court Judge Derrick K. Watson ruled Thursday in Calvary Chapel Pearl Harbor v. Suzukithat Hawaii’s law could not be enforced because it is similar to another that was struck down in California by the Supreme Court, in a case known as National Institute of Family and Life Advocates v. Becerra. In that case, the court ruled in June that the California law violated the First Amendment right to free speech.

The Hawaii law, which was signed by Gov. David Ige in July, obligated anti-abortion crisis pregnancy centers to post a website and phone number that would tell women about clinics where they could go to receive pregnancy services, including abortions. Violators would face a $500 fine for the first breach and a $1,000 fine every time it occurred later. “The bottom line is that no American should ever be forced to promote a message with which they disagree under threat of government punishment,” the Alliance for Defending Freedom, which brought the case, said on its website following the ruling.

World Health Organization calls for restrictions on alcohol. The World Health Organization on Friday called on countries to restrict alcohol consumption through taxes, bans on advertising, and limiting where it is sold, following its latest finding that alcohol is linked with more than 3 million deaths a year. The organization’s latest to action on booze is coming at a time where experts are reassessing the extent to which alcohol is a risk factor for cancer, after years of moderate drinking being framed as beneficial for people’s heart health. Critics of implementing restrictions are concerned that a war on alcohol could actually make the problem worse, while creating disadvantages for casual drinkers and businesses. In its latest report, WHO counted alcohol-associated deaths not only as alcohol poisoning or those caused by injuries, such as drunken driving or violence, but also deaths associated with long-term, chronic drinking, such as liver cirrhosis, heart disease, and cancer. In response to the report, the Distilled Spirits Council said, it was “strongly opposed to excessive alcohol consumption and underage drinking in any form.” “We support the WHO’s goal to reduce the harmful use of alcohol, however, we are concerned that some policy recommendations such as increasing alcohol taxes are misguided and don’t effectively address harmful consumption,” the group said in a statement. It pointed instead to policies to strengthen law enforcement and education, as well as targeted approaches aimed at people who have a dependency on alcohol.

Congo identifies Ebola case at border of Uganda. The Ebola outbreak in Congo may be spreading, as local health officials found a case of the deadly virus at the border of Uganda, which until now had not been affected by the outbreak ravaging Congo. The Democratic Republic of Congo reported on Friday that the newest infection is nearly 125 miles away from the nearest known case in the Congo, according to a Reuters report. Congo has been struggling with an outbreak of Ebola that had killed 97 people as of Sept. 19, according to data from the Centers for Disease Control. Uganda is prepping vaccinations to be ready to deploy in case the virus spreads further into the country, Reuters said. Congo officials have been able to use experimental vaccines to help contain the outbreak in the country.

Trump administration designates new drug trafficking areas. The Trump administration has announced 10 new areas at high risk of drug trafficking. The areas apply to parts of Kentucky, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina and West Virginia. The designation made by the White House’s Office of National Drug Control Policy means the areas can get “federal resources to further the coordination and development of drug control efforts,” according to a release from the office. “This new funding will allow law enforcement to disrupt trafficking operations in key areas,” ONDCP Deputy Director Jim Carroll said in a statement.

RUNDOWN

Axios GOP’s midterm healthcare strategy: Rally the base

The Hill Healthcare advocates decry funding transfer over migrant children

Kaiser Health News Blood, sweat and workplace wellness: Where to draw the line on incentives.

New York Times One big problem with Medicaid work requirements: People are unaware it exists

STAT News ‘Stuff floating’ in compounded drugs prompts FDA to appeal for more funding

Washington Post Many people live unaware of a hole in the heart that doesn’t close

Associated Press UN: Excessive drinking killed over 3 million people in 2016