| Welcome to the Thursday's edition of Overnight Health Care. The Senate passed the Defense, Health and Human Services (HHS), Labor and Education appropriations bill. There was some wrangling over amendments throughout the day on issues like drug pricing and protecting pre-existing conditions. It was a big win for the Senate... We'll tell you why. Senate approves massive spending bill. The Senate on Thursday approved a massive spending bill funding the Department of Health and Human Services, other critical domestic agencies and the Pentagon in a significant victory for appropriators and Senate GOP Leader Mitch McConnell (R-Ky.) that could lower the chances of a government shutdown. This one was particularly important because it included funding for HHS, Labor and Education, as well as Defense. The health and labor portion is often a difficult package because of fights over abortion and other issues. Senators were able to avoid those fights in this case. The numbers: The Senate approved its third "minibus" package of spending bills in an 85-7 vote. Sens. Mike Crapo (R-Idaho), Jeff Flake (R-Ariz.), Mike Lee (R-Utah), Rand Paul (R-Ky.), Jim Risch (R-Idaho), Bernie Sanders (I-Vt.) and Pat Toomey (R-Pa.) opposed the bill. Why it was a big deal: The vote marked a big win for Senate leadership, which has not been able to pass funding for the Departments of Labor, Education or HHS, outside of an omnibus, since 2007. Senators are scrambling to avoid needing to pass another omnibus bill, which would roll the 12 traditional spending bills into one piece of legislation, after Trump warned in March that he would not sign a similar bill again. The breakthrough: Senate leaders from both parties made a deal earlier this year to avoid attacking so-called "poison pill" proposals, which would threaten bipartisan support, to the funding bills. More on the vote and the significance here. Speaking of potential 'poison pills'... GOP Planned Parenthood funding amendment fails. Earlier, the Senate rejected an effort by GOP Sen. Rand Paul (Ky.) to attach a provision blocking federal funding for Planned Parenthood into the government spending bill. Senators voted 45-48 on Paul's amendment, with 60 votes needed to add the provision into the spending bill. All present Democrats voted no, plus GOP Sens. Susan Collins (Maine) and Lisa Murkowski (Alaska). The vote came after Republicans initially blocked Paul from bringing up his amendment. The amendment was a messaging vote; it didn't have to pass, so long as senators were on record making tough votes. And it got the intended results. GOP campaign arm immediately jumps: The failed vote did provide fodder to the National Republican Senatorial Committee, which immediately sent out press releases hitting vulnerable red state Democrats for voting no. A sampling of subject lines: "Manchin votes to fund abortion providers" "Sleepin' Joe sides with big abortion" "Heitkamp doubles down on pro-abortion record" Read more on the vote here. Senate includes drug pricing amendment in spending bill. Congress is making a rare move to take some action aimed at high drug prices, a contentious issue that has been a recent target of Democrats and the Trump administration. Sens. Chuck Grassley (R-Iowa) and Dick Durbin (D-Ill.) worked up until Thursday to get their amendment included, warning that powerful pharmaceutical companies were working against them. "What we're up against here is a very powerful interest in this town," Grassley said earlier on Thursday. The pharmaceutical industry opposes requiring prices to be disclosed in TV ads. The Pharmaceutical Research and Manufacturers of America, the main drug industry lobbying group, warned the move would "confuse patients" and could violate the First Amendment. The Trump administration supports the idea, and has proposed it as part of President Trump's plan to lower drug prices. Advocacy group's reaction, a first step: David Mitchell, president of the advocacy group Patients for Affordable Drugs, said the move was not a major step but was going in the right direction. "We don't see this as a big step that will lower drug prices," he tweeted. "But giving consumers/patients more info is a good thing in and of itself." Sen. Joe Manchin's amendment, which would direct the Senate legal counsel to intervene in an ongoing ObamaCare lawsuit, didn't get a vote, though it came pretty close. Democrats are tying Republicans to the Trump administration's decision not to defend ObamaCare's pre-existing conditions protections in an ongoing lawsuit. Manchin's amendment would have allowed the Senate legal counsel to intervene and defend the health care law, he said on the floor Thursday. The amendment likely wouldn't have passed even if it did get a vote, but the goal was to get Democrats on the record on preexisting conditions ahead of the midterms. It would have been a tough vote for Republicans, who argue they still support protecting pre-existing conditions even as they continuously call for the repeal of ObamaCare. "We have an opportunity to stand up for millions of Americans with pre-existing conditions that are trusting us to protect their health care access," Manchin said from the floor. Context: A group of Republican attorneys general, led by Texas, filed suit against the Trump administration, arguing that Congress' repeal of ObamaCare's individual mandate makes the entire law unconstitutional. The administration said most parts of the law should stand, but argued that its protections for people with preexisting conditions should not. The first arguments in the case are Sept. 5. Mississippi tests Trump administration's commitment to Medicaid work requirements. The Trump administration is facing a key test with Mississippi's Medicaid program as the state seeks permission to be the first ever to impose work requirements without expanding Medicaid under ObamaCare. Already one of the poorest states in the nation, advocates say work requirements for "able-bodied" beneficiaries could decimate the health coverage that tens of thousands of residents depend on. While the administration touts state flexibility and has already approved work requirements in Medicaid expansion states, there could be far reaching practical and political consequences for approving them in Mississippi. Searching for a reason: Advocates are sounding the alarm. Mississippi recently amended their waiver and asked for more public comments, a sign advocates say means the Trump administration is trying hard to find a justification for approval. "They're trying to strengthen their hand by getting more public comments," said Joan Alker, executive director of the Georgetown University Center for Children and Families (CCF). "So that worries me they are trying to get to yes." Seema Verma, administrator of the Centers for Medicare and Medicaid Services, has also never explicitly said the administration will refuse to grant waivers to non-expansion states. Read about Mississippi's efforts here. In other Medicaid news: Maine high court tells GOP governor to start implementing Medicaid expansion. In a blow to GOP Gov. Paul LePage, the state's highest court on Thursday denied his request to delay implementation of Medicaid expansion. However, the court did not rule on the merits of the case; it dismissed LePage's appeal of a lower court decision, sending the case back to Superior Court. The decision means LePage must move ahead with submitting an expansion plan to the federal government. A Superior Court judge on June 4 ruled against the LePage administration and set a June 11 deadline for the governor to submit the plan to the federal government. The state appealed that order to the Maine Supreme Judicial Court, and a temporary stay was issued so arguments could be heard. Thursday's ruling lifted the temporary stay and ordered the lower court to resolve outstanding questions in the original lawsuit. Read more on the decision and LePage's efforts to block expansion here. Government watchdog blasts administration's handling of ObamaCare The Trump administration needs to take more steps to better manage ObamaCare after enrollment dropped by 5 percent in 2018, the nonpartisan Government Accountability Office (GAO) said in a critical report released Thursday. The GAO recommended that the Department of Health and Human Services (HHS) set enrollment targets for 2019, a practice taken by the Obama administration but abandoned by the Trump administration, and better manage local groups responsible for signing people up for ObamaCare. Why it matters: Democrats say the conclusions are proof the administration is purposely sabotaging the health care law. Read more here. Drug pricing advocates push FDA to finalize key guidance The Campaign for Sustainable Rx Pricing is pushing the FDA to finalize guidance on the approval of lower-cost drugs known as "biosimilars." Biosimilars are the equivalent of generic drugs for complex, and often expensive, medications known as biologics. The Campaign says that approving more biosimilars would help in the administration's efforts to fight high drug prices by promoting cheaper alternatives. "We are very hopeful that this guidance will increase access to affordable biological products and strongly urge the FDA to finalize it as soon as possible," the campaign wrote in the letter to FDA Commissioner Scott Gottlieb. Thursday roundup: - ObamaCare is more popular than the GOP tax law, according to a new Fox News poll. The 2010 health-care law registered a 51 percent approval rating, compared with 40 percent for the 2017 Republican tax cuts, according to the survey released on Thursday.
- In another poll, a vast majority -- 70 percent -- of Americans said they support "Medicare for all," also known as a single-payer health-care system. The Reuters–Ipsos survey found 85 percent of Democrats said they support the policy along with 52 percent of Republicans.
- Equity Forward, a reproductive rights watchdog group, is running a full-page ad in the Washington edition of the New York Times Friday calling on HHS Secretary Alex Azar to fire Scott Lloyd. The ad targets Lloyd's recently revealed comments in which he compared abortion to the Holocaust.
Join The Hill Wednesday, Sept. 12 for "A Healthy Start: Infant and Early Childhood Nutrition," featuring Reps. Nanette Barragán (D-Calif.) and Bobby Scott (D-Va.), and Administrator of the Food and Nutrition Service Brandon Lipps. Editor in Chief Bob Cusack will sit down with the headliners to discuss maternal, infant, and early childhood nutrition, and what steps can be taken to establish healthier eating patterns across all communities. RSVP here. What we're reading NIH is investigating researchers who might have failed to disclose contributions from foreign governments (Stat) Trump tells Sessions he favors death penalty for fentanyl dealers (Bloomberg) Russian trolls and Twitter bots exploit vaccine controversy (Washington Post) State by state A first: ObamaCare premiums to decline in Georgia (Atlanta Journal Constitution) Blue Cross lowers rates for Affordable Care Act plans across NC (WFAE) From The Hill's opinion page US health-care system still struggling to address impacts of mental health on overall health | 
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