The potential silver lining for Democrats

Just enough Senate Democrats agreed to vote with Republicans to pass a key procedural motion to reopen the government. They did so without achieving their main objective, extending the extra tax credits that have led to a doubling of ACA plan enrollment in the past five years. (The Senate passed the stopgap government funding bill Monday evening, and the House will take it up later in the week.)

One of the interesting aspects of the fight over ACA tax credits is that, despite reports of Democratic voters being deflated a week after elections that energized the party, Democrats will probably benefit politically from Republicans not renewing them.

Costs of many everyday goods are rising, and while Republicans technically cut taxes, they actually extended cuts that were already in place, so it won't feel like more money in folks' pockets. Much of the growth in ACA plan enrollment has been in states that President Trump won in the last election and among key groups of voters. Sharp increases in premium payments would likely help Democrats make their case that life has gotten more expensive under Trump.

Most Republican concessions involve policies and actions that wouldn't have been an issue were it not for the shutdown, such as rehiring federal employees fired during the shutdown and funding the Supplemental Nutrition Assistance Program for a year.

The silver lining of the deal is that Senate Majority Leader John Thune (R-S.D.) will allow a vote next month on legislation to extend the credits — Thune had been offering that concession for weeks. The outcome of that Senate vote is far from certain, and Democrats did not secure a similar promise of a vote from House Republicans. But Democrats hope the shutdown and everything that follows will convince voters that Republicans are to blame for rising insurance costs.

The shutdown and debate over ACA credits also got Republicans talking again about Obamacare repeal, which Democrats view as a vulnerability for Republicans. The GOP says Obamacare is to blame for high insurance costs, but that argument has not worked well for them in the past.

In all, the shutdown is probably too far away from the midterms to have much impact. But if Congress doesn't extend ACA subsidies, at least partially, the issue will likely be a factor in next year's midterm election campaigns.

vaccines

The long game

Children's Health Defense, the vaccine-skeptical organization once led by now-health secretary Robert F. Kennedy Jr., has a plan for permanent change in America that outlives the current administration.

Daniel Payne interviewed CHD CEO Mary Holland about her vision for cementing the group's agenda of rolling back government vaccine requirements, restricting access to Covid-19 vaccines, making information about adverse events related to the shots public, and protecting anti-vaccine speech online.

Read more about Holland's playbook, including the role that cultural change plays in court and policy battles, and why it scares vaccine and public health experts.

drug prices

Is Trump's GLP-1 deal a game changer?

President Trump's deal with drugmakers to cut prices of weight loss drugs was heralded as good news. Elaine Chen looks into how big of a difference the agreement will make for patients.

GLP-1 drugs, while extremely beneficial for a host of conditions, are driving up health care spending. KFF said the drugs' rising popularity is among the contributing factors to higher premiums in the ACA marketplace.

The deal is expected to significantly expand access to Wegovy and Zepbound for people in Medicare. But the impact to Medicaid is probably not that big. It might not expand access much for cash-paying patients, it's not clear how it'll affect prices in the commercial insurance market, and maybe the prices would've come down without the deal.

It still seems like a significant development, but a lot of details are still unknown. Read more.

women's health

Allaying concerns about hormone therapy

Since 2003, hormonal therapy products have included a warning for menopausal women. The FDA is asking drugmakers to remove that black box warning, specifically mentions of cardiovascular, dementia, and breast cancer risk, according to Theresa Gaffney and Chelsea Cirruzzo.

The impetus for the black box warning was a 2002 landmark study called the Women's Health Initiative that suggested that hormone therapy came with an increased risk of heart disease and breast cancer. Since then, studies have shown the products benefit menopausal women in many ways, including improving heart health.

This line from the JAMA article about the change caught my eye. You'll see why.

"With the exception of antibiotics and vaccines, there may be no medication in the modern world that can improve the health outcomes of older women on a population level more than hormone therapy," FDA officials wrote.

What we're reading

Canada loses measles elimination status — as does the entire Americas region, STAT
Legal immigrants face loss of Obamacare help, threatening insurance markets, Politico
Cassidy drops into liver meeting to talk of shutdown, insurance overhaul and vaccines, STAT
Ten seconds in the Oval Office that overshadowed Trump's drug-price win, The Washington Post