1. Health care talks continue
2. House’s big test
3. White House on sidelines
4. Rising cost worries
5. Kennedy’s controversy overload

Why Obamacare subsidy negotiations aren’t going away

Congressional negotiators across the aisle — and across both chambers — are going into overtime on expiring enhanced Affordable Care Act tax credits. The House will vote on Democrats’ three-year clean subsidies extension in January, but Senate Republicans say it won’t become law after failing last week. “We already had that vote,” Sen. Shelley Moore Capito, R-W.Va., said. “So I don’t think it’s going to happen.” Hearing from constituents back home whose premiums are rising might drive members towards a solution, though, she said: “I think we’re all feeling that pressure.” Democrats are already blaming Republicans for going over the cliff, and Senate Minority Leader Chuck Schumer said “the toothpaste is out of the tube.” Sen. Peter Welch, D-Vt., said Schumer is right that “damage is being done as we speak. But I will keep trying.”

— Burgess Everett

Health care tests House leaders

Navigating health care has proved especially challenging for leaders in the House, where Republicans’ majority is razor-thin. Speaker Mike Johnson has “the toughest job in DC,” said Rep. Scott Fitzgerald, R-Wis., looking ahead to a January vote on extending enhanced Affordable Care Act subsidies. Fitzgerald warned that “there will only be a one-vote majority” when that vote occurs. Johnson excluded an ACA subsidies extension from a health care package he pushed through despite objections from Republicans who want to work on bringing down premiums. “People want us to do something to help them with costs, and I don’t think they really care about who voted for what 20 years ago,” Sen. Josh Hawley, R-Mo., said. It’s been a smoother ride for Minority Leader Hakeem Jeffries, who faced only fleeting pressure this week as members waited to see if he’d support a bipartisan extension.

— Eleanor Mueller

White House stays on the sidelines of subsidy debate

The White House is standing on the sidelines as Congress battles it out on health care — much to the chagrin of some Republicans who hope President Donald Trump will take on a more active role. The administration still hasn’t released its own plan for expiring health care credits, but also hasn’t ruled it out — a position deputy chief of staff James Blair laid out when he told Semafor the White House is open to a deal with Democrats on the issue. In the same breath, though, Blair said Democrats aren’t serious about striking a bipartisan agreement and simply want to campaign on the issue. The debate remains a sensitive subject for the Trump administration: Senior officials are aware of the downfalls of allowing subsidies to expire as well as the intraparty issues that could arise should they push any one plan too hard. For now, it seems they’re betting the safest option is to stay (mostly) out of it.

— Shelby Talcott

Americans are more concerned about health costs

Americans are as worried as ever right now about the rising cost of health care — and their views of the US system are bound to worsen as expiring ACA subsidies force costs up even higher. Twenty-nine percent of US adults said in November that cost is the most urgent health care challenge facing the country this year, exceeding access and obesity, according to recent polling from Gallup and West Health. That represents a two-decade high, and isn’t far from the record high. A record low of 16% also reported satisfaction with national health care costs. The silver lining: Americans tend to be much more satisfied with the cost or quality of their own health coverage, compared with how they view national coverage and its cost. Still, nearly a quarter said the US health system is in “crisis.”

Kennedy seeks to avoid personal controversy

Health and Human Services Secretary Robert F. Kennedy Jr. wants to move past the long-running Washington drama over his alleged affair with a journalist, but there’s plenty of policy-based controversy keeping his department busy. Kennedy is facing pressure from anti-abortion conservatives, including a call for his firing by former Vice President Mike Pence, over a delayed review of the abortion pill mifepristone. A CDC vaccine committee whose members he replaced with allies recently moved to end the recommendation for hepatitis B vaccination of infants at birth, drawing harsh criticism even from conservatives like the New York Post editorial board. And his recent baseless theorizing that Lyme disease may have originated from military bioengineering is now close to getting a formal government investigation as part of this year’s defense policy legislation, which passed Congress on Wednesday.

White House

• President Trump is expected to announce an order to ease restrictions on marijuana today. — Reuters
• HHS Secretary Robert F. Kennedy Jr. announced plans to restrict hospitals from performing gender-affirming care for minors during a news conference Thursday, characterizing it as an outgrowth of an executive order Trump signed earlier this year.

Congress

• Health care workers protested House-passed bans on gender care for transgender minors.
• This week, Congress passed a bill to put whole milk back into school lunches.

Outside the Beltway

• The share of US adults who rate their mental health as excellent reached a new low of 29% in a poll from Gallup and West Health.
• Following President Trump’s intense criticism of Minnesota Gov. Tim Walz, the USDA has ordered Minnesota to verify certain households’ eligibility for SNAP benefits or else lose funding.
• A drop in childhood vaccination rates has caused whooping cough cases to explode nationwide. — NBC
• Fearing abortion restrictions, more US women are choosing sterilization surgery. — NYT
• Nebraska is the first state to implement Medicaid work requirements.

Inside the Beltway

• HHS cut off funding to the American Academy of Pediatrics. — WaPo
• The VA unveiled plans for an overhaul of its health care system.

Business

• The FDA is fast-tracking reviews of a Merck cholesterol drug and a cancer therapy, via a voucher program launched in June. — Reuters
• Novartis, Roche, and other drugmakers plan to announce more price-cut deals with the Trump administration as soon as Friday. — Bloomberg

Courts

• Attorney General Pam Bondi has ordered charges dropped against a surgeon accused of faking COVID-19 vaccination cards, something health experts worry could embolden like-minded vaccine skeptics. — ProPublica
• New state lawsuits against UnitedHealth accuse it of delaying patients’ lifesaving hospital care. — The Guardian

Immigration

• US health researchers are looking abroad to fund their work. — STAT

Semafor DC Team

Edited by Morgan Chalfant, deputy Washington editor

With help from Elana Schor, senior Washington editor

Emily Ford, editor

Graph Massara and Marta Biino, copy editors

Contact our reporters:

Burgess Everett, Eleanor Mueller, Shelby Talcott, David Weigel