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The week in health care, explained

This is the web version of VoxCare, a daily newsletter from Vox on the latest twists and turns in America’s health care debate. Like what you’re reading? Sign up to get VoxCare in your inbox here.

Doug Jones probably saved most of Obamacare

It's really hard to imagine a scenario in which Republicans can repeal Obamacare with a 51-seat Senate majority when they couldn't do it with a 52-seat majority. Doug Jones might have ended Obamacare repeal for good when he won the Alabama Senate seat on Tuesday.

The two Republican senators who have opposed every version of Obamacare thus far — Susan Collins of Maine and Lisa Murkowski of Alaska — reiterated this week that they don't really want to revisit health care next year.

I'll have more on this on Monday, but this is a big deal. Yes, the individual mandate will likely be repealed in the Republican tax bill next week, and that is going to hurt the insurance markets. But it probably won't destroy them.

On top of that, Medicaid expansion will be left untouched. The protections for people with preexisting conditions will stay on the books. The financial aid for private insurance will still be available. Those are big parts of the health care law that look here to stay.

"The heart of the ACA has always been the Medicaid expansion, the premium subsidies to make insurance more affordable to lower-income people, and the protections for preexisting conditions," Larry Levitt at the Kaiser Family Foundation told me. "Those things will all still be in place."

Obamacare enrollment is almost over

The deadline to sign up in most states through HealthCare.gov is today, if you didn't already know.

Important notice: If you or somebody you know is automatically enrolled in a plan with a different insurer on Friday, you can shop around and sign up for a new plan, according to Kimberly Leonard at the Washington Examiner.

We've talk a lot about the Trump administration's deliberate sabotage of open enrollment. The way things have been trending, enrollment is going to fall short this year.

CHIP still hasn’t been funded

We're nearing three months since CHIP funding technically expired. House Republicans have proposed funding the program for five years in the government spending bill they introduced this week, basically reupping the bill they've already passed.

Republicans are holding out hope that the CHIP issue will finally be laid to rest in the spending bill, which must pass by December 22, according to Politico's Jennifer Haberkorn. But if this drags out, we face the real possibility that children are going to start losing their insurance.

The New York Times had a great rundown (and some handy graphics) of the timeline for CHIP the longer it remains unfunded:

  • At the end of January, 16 states that cover 4.9 million children through CHIP run out of funding.
  • At the end of February, 24 states that cover 5.4 million children through CHIP run out of funding.
  • At the end of March, 36 states (plus DC) that cover 7.7 million children through CHIP run out of funding.

Reminder: CHIP covers about 9 million children altogether.

Chart of the Day

Pew Research Center

Obamacare's improving reputation. It's been one of the great paradoxes of the 2017: In the year when the law's future was most in doubt, the American public has really warmed up to it. Pew found that for the first time, more people think the health care law has improved things in the US.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

  • “Bipartisan Health Bill Is Losing Support”: “The seemingly imminent repeal of the Affordable Care Act’s insurance requirement, which could happen next week as part of the final passage of Republicans’ broad tax overhaul, has focused attention on Congress’ potential next moves on health care, including a bipartisan plan to shore up the insurance markets.” —Stephanie Armour, Wall Street Journal
  • “White House tamps down expectations of additional opioid funding this year”: “White House press secretary Sarah Sanders on Thursday told reporters she was unsure when Congress would fund new initiatives specific to addressing the opioid crisis. Sanders declined to guarantee that additional spending would be included in either a stopgap spending bill Congress is expected to approve in the coming week or a longer-term budget agreement many expect lawmakers to reach in January.” —Lev Facher, STAT
  • “Centene, Lacking Doctors, Is Forced to Halt Sales in Washington State”: “Centene Corp. halted sales of health insurance plans in Washington State after regulators found the company failed to cover enough doctors and other care providers, threatening to leave some counties with no Obamacare insurance options.” —Zachary Tracer, Bloomberg

Analysis and longer reads

  • “How will the tax bill impact health care? 5 experts weigh in”: “The tax bill could repeal the individual mandate — a centerpiece of the Affordable Care Act — and could also trigger cuts in Medicaid and Medicare funding down the line. We reached out to economists, health care analysts and other experts for answers to key questions on the bill’s impact on health policy.” —Daniel Bush, PBS
  • “Doug Jones Called on Congress to Fund CHIP. Why Hasn’t It?”: “CHIP does not cover the poorest children in America; those young people are generally covered by Medicaid. CHIP covers the children of parents who earn too much to qualify for Medicaid but can’t afford other options. And, at this moment, those children are distinctly vulnerable” —Amy Davidson Sorkin, New Yorker
  • “FCC repeals net neutrality rules, potentially affecting telemedicine”: “Whereas all internet traffic previously shared the same 'lane,' it can now be split among different lanes with different speeds. Those differing speeds could hurt telemedicine since it requires a 'pretty robust connection,' said Mei Kwong, interim executive director and policy adviser for the Center for Connected Health Policy.” —Rachel Z. Arndt, Modern Healthcare

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