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D-Day for Obamacare enrollment. The six-week period for individuals to sign up for Obamacare in most states ends today. As we detailed on Wednesday, the 4.7 million signups the administration reported through Dec. 9 means that there would have to be a huge surge in signups this week to equal the 9.2 million who signed up on the federal exchange last year, when the enrollment period was twice as long. But it’s also worth remembering that current enrollees who don't take any action will be automatically placed into a similar plan, which could add millions to the eventual total.

Advocates, lawmakers push for grace period as Obamacare heads to deadline rush. Pro-Obamacare lawmakers and activists are urging the Trump administration to allow a grace period for open enrollment so that people who have trouble using healthcare.gov are able to finish their applications. The Trump administration has not said if it will allow a grace period, but an announcement about a final decision may not come until later Friday. During the 2015 and 2016 open enrollments, the Obama administration announced extensions on the same day as the deadline. The final days of open enrollment tend to bring a surge of visitors and applicants to healthcare.gov and onto call lines, causing delays and sometimes telling users that they will need to return later, or allowing them to leave their information to receive a followup. Obamacare customers, who do not get health insurance through a government program or through work, have until 3 a.m. EST Friday to sign up for plans. So far, signups on healthcare.gov have outpaced previous years, but advocates are concerned that fewer people will know about the deadline and that people will be unable to afford premiums, which have increased for people who do not receive subsidies. Healthcare.gov is the exchange that 39 states use. Some states, such as California and New York, have their own exchanges with later deadlines.

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Lori Lodes, who ran healthcare.gov outreach under the Obama administration, says deadline could be extended. “Every year, the Dec. 15 deadline has needed to be extended to manage the surge in enrollments around the Dec. 15 deadline and to make sure consumers have a smooth experience so are able to sign up if they want coverage,” she wrote. “Also worth noting, we never announced it until Dec. 16 so it wouldn’t impact consumer behavior ahead of the deadline.”

Covered California extends deadline, citing surge in consumer interest. Covered California, the name of the state’s exchange, said Thursday that more than 38,000 people had signed up for coverage over the last three days, totalling more than than 182,000 new customers since the start of open enrollment. That outpaces the total at the same time last year of 156,000 people. Covered California’s final deadline is Jan. 31, but people who sign up before the Dec. 15 deadline will be covered beginning Jan. 1. That deadline has been extended by a week, to Dec. 22.

Health, defense spending battle sparks new government shutdown threat. Disputes over defense and healthcare spending are threatening to hold up a spending bill that has to be passed next week to avoid a partial government shutdown, the same week Republicans are hoping to finish their tax legislation. Senate Minority Leader Chuck Schumer, D-N.Y., has pledged to block a House proposal to fund the government through Jan. 19. The spending battle will unfold over the next week, as current spending authorization expires Dec. 22. It's a jammed calendar, as Republicans will be using the week to pass its tax bill. But House Republicans are likely to take up tax reform legislation only after the Senate passes the measure, which Senate Majority Whip John Cornyn, R-Texas, predicted will happen Tuesday. The spending battle is complicated by various factors. House Minority Leader Nancy Pelosi, D-Calif., said Thursday she will not support a clean CR because the measure lacks Democrats’ wish-list items, which she said were provided to President Trump at a recent White House meeting. The House CR includes federal funding for the Children’s Health Insurance Program, or CHIP, but Democrats don’t like the way it is written and say it will draw money from other critical health programs for children. “Children's health paying for children's health,” Pelosi said Thursday. Democrats also insist the spending deal include extra money for states to battle opioid addiction. “So let's see what they send over,” Pelosi said, referring to the Senate. “Maybe they'll add some things to it.”

Susan Collins: Senate eyes adding Obamacare bills to short-term funding deal. Sen. Susan Collins said Thursday she isn't concerned that House Republicans didn't include Obamacare stabilization bills in its short-term funding bill, saying GOP leadership will add them to the Senate version. The House GOP released a short-term continuing resolution Wednesday that funds the government until Jan. 19. It does not include two bills that the centrist Maine Republican has been pushing to stabilize Obamacare’s exchanges in return for her vote for tax legislation that includes a repeal of Obamacare’s individual mandate penalties. Collins shrugged off the House snub, saying it didn’t matter if the House passes a spending bill that doesn’t include the legislation. “That has never been the plan,” she told reporters. “The plan is for the majority leader to add [the bills] in the Senate.”

Paul Ryan laughs off suggestions he'll quit Congress after tax reform. House Speaker Paul Ryan laughed away speculation that he plans to quit his post after Congress passes tax reform and said next year's agenda will include legislation to transform the nation's welfare program into one that can move more people from dependency on government into the workforce. "Next year is going to be the year where we work on people," Ryan told reporters who asked about his welfare reform plan at his weekly news conference. "Next year is the year we work on getting people where they need to get in life, in better jobs, an actual career, closing the skills gap." Ryan has pledged to his largest faction of conservatives that the House would tackle entitlement reform in 2018 with a welfare-to-work proposal. Ryan is a longtime advocate of reforming the nation's welfare system to make it one that helps transition people away from dependency and into good paying jobs.

Colleagues expect John McCain to return to Capitol Hill soon despite poor health report. Sen. John McCain was hospitalized again this week as he contends with an aggressive form of brain cancer and is reportedly not looking so healthy, but colleagues are optimistic that he will return to Capitol Hill soon. The Arizona Republican missed votes Monday and Tuesday, and on Wednesday it was revealed he was "receiving treatment at Walter Reed Medical Center for normal side effects of his ongoing cancer therapy," according to a statement from his office. Sources told CNN that McCain, who is 81 and was diagnosed in July with a primary glioblastoma, has been less chatty and not looking as healthy as he once did. Sen. Lindsey Graham, a close friend of McCain's, said he spoke to McCain's wife, Cindy, on Wednesday for an update, which he indicated bore positive news. "He is receiving treatment for the side effects of therapy," Graham, R-S.C., said, according to CNN. "I feel pretty good about the way the treatment is affecting his underlying cancer. But the treatment has a downside. So he is trying to rest up. I am very confident that he will come back and continue to participate for a long time to come."

White House will publish funding proposal on opioid crisis. The Trump administration is working on releasing a dollar figure for how much federal funding it believes will be needed to help stave off tens of thousands of drug overdose deaths and addictions caused by opioids, the White House indicated Thursday. "The amount of money that it will take to combat this crisis is huge," White House press secretary Sarah Sanders said during the daily media briefing. "We are going to continue to look at the best ways to do that. We are working an inter-agency process to see what that the number looks like. That hasn't been finalized. But we are going to continue looking at every way possible." She declined to specify a dollar amount or to promise that an appropriation would be made by the end of the year. New Jersey Gov. Chris Christie, who is leading the president's commission on opioids, had previously defended the White House for not putting out a funding request or allocating funding directly to the effort, saying that it was Congress's job to appropriate the money.

Anti-abortion group sends warning shot over Obamacare bills. A top anti-abortion group warned Congress Thursday to not pass insurer payments to stabilize Obamacare unless they include anti-abortion protections. The Susan B. Anthony List said it would oppose any spending bill that includes Obamacare insurer payments not protected by the Hyde Amendment. The amendment is a spending rider that prevents any federal funding from going toward abortions. “The pro-life Republican Congress promised voters it would repeal and replace pro-abortion Obamacare, not prop it up,” SBA List President Marjorie Dannenfelser said. “Preventing taxpayer funding of abortion should be a bare minimum requirement for any new Obamacare spending advanced by a Republican Congress.” Congress is considering a bill from Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., to make Obamacare insurer payments called cost-sharing reduction payments for two years. The payments reimburse Obamacare insurers for lowering co-pays and deductibles for low-income Obamacare enrollees.

Babies with Zika-caused microcephaly face challenges as they age, research finds. Nineteen babies in Northern Brazil born with abnormally small heads as a result of being infected by Zika while in the womb had severe health and development issues as they aged, a long-term government study found. The condition, known as microcephaly, led to babies having difficulties sitting up by themselves as well as difficulties with sleeping and feeding. They faced hearing and vision problems and had seizures. It is the first study that assesses how babies with microcephaly caused by the Zika virus are faring as they reach age 2, and the long-term prognosis for these children continues to be unknown as they age. Dr. Brenda Fitzgerald, director of the Centers for Disease Control and Prevention, said the children would need to continue to be monitored. “Children severely affected by Zika virus are falling far behind age-appropriate developmental milestones, and their challenges are becoming more evident as they age,” she said.

Medical device manufacturers warn of ‘devastating impact’ of Obamacare tax. “Since its enactment, the medical device tax has had a significant negative impact on medical innovation and has resulted in the loss or deferred creation of jobs, reduced R&D and slowed capital expansion,” AdvaMed wrote Thursday in a letter to congressional leaders. The group noted that the tax had been suspended for the past two years but was set to take effect in 2018, and urged Congress not to suspend it retroactively. “Our companies begin making payments in January and going forward on a bi-weekly basis,” the group wrote, noting that it would spend millions in compliance costs.

Opinion from Rep. Jim Banks: Ditch the medical device tax by New Year's. “Last November, the American people sent a message to Washington: Get things done. With Republican control of both chambers of Congress and the Oval Office, the time to enact pro-growth, pro-innovation policies that benefit American workers and businesses is now. This month, Congress and the Trump administration have the opportunity to significantly boost one of America’s most vibrant and growing industries by suspending the federal excise tax on medical devices. This misguided tax is set to go back into effect on Jan. 1, which is why Reps. Jackie Walorski, R-Ind., and Erik Paulsen, R-Minn., recently introduced legislation that would suspend the medical device tax for five years,” writes Banks.

RUNDOWN

The Hill Welfare reform moving to center of Republican agenda

Kaiser Health News Medicare fails to recover hundreds of millions of dollars in lab overcharges

Axios ACA enrollment won’t make things better, but it could get worse

Associated Press At crunch time for health signups, hold times are growing

STAT News White House tamps down expectations for additional opioid funding this year

Wall Street Journal Bipartisan health bill is losing support

Politico Health program for 9 million kids falls victim to partisan squabbling

Modern Healthcare FCC repeals net neutrality, potentially affecting telemedicine



Calendar

THURSDAY | Dec. 14

MACPAC December meeting. Details.

SATURDAY | Dec. 16

3 a.m. EST. Deadline for open enrollment on healthcare.gov.

TUESDAY | Dec. 19

Noon. Health officials to discuss hepatitis A outbreak in webinar. Details.