By Jason Millman

With help from Jennifer Haberkorn and Brett Norman

WHY THE 85 HOUSE REPUBLICANS VOTED YES -- They were outvoted about 2:1 by members of their own party when they approved tax hikes on the top earners in this week’s fiscal cliff deal. So, why’d they break decades of GOP anti-tax orthodoxy? POLITICO’s Alex Isenstadt has an idea: “Their districts are conservative — but not so conservative that jumping off the fiscal cliff wouldn’t potentially backfire in the next election. A general-election challenge from the left is a bigger threat than a primary from the right. And being able to tell most of their constituents they shielded them from a big tax hike was more important than being accused by a vocal few of selling out Republican principles.” There were other factors, too. The 85 included a bunch of moderates and veteran lawmakers who don’t see compromise as taboo, as well as outgoing members and others who wanted to support Speaker John Boehner. The POLITICO story: http://politi.co/UcUKcz

NO BOEHNER-CANTOR RIFT -- Don’t read too much into Majority Leader Eric Cantor’s vote against the fiscal cliff deal and the mess created by Boehner’s decision to pull the Hurricane Sandy aid bill, reports POLITICO’s Jake Sherman. “Both men were reflecting a private political calculus, not attempting to cross one another,” Sherman writes. Boehner and Cantor just happened to read the politics of the situation differently. The POLITICO story: http://politi.co/Ud1Fm3

Happy Thursday, and welcome to PULSE. We really thought we had read everything possible about the fiscal cliff — that was until we saw New York Magazine’s Jonathan Chait positing that the cliff showdown could be explained by “The Big Lebowksi.” (http://nym.ag/THsVVY) Republicans won’t be happy with Chait’s assessment, but we believe there’s bipartisan support for using Lebowski as a frame of reference for many more things. The PULSE abides.

“I tripped on a cloud and fell eight miles high, I tore my PULSE on a jagged sky”

OUT WITH THE OLD, IN WITH THE NEW CONGRESS -- Lawmakers have their first-day-of-Congress outfits all picked out for the start of the 113th Congress, which will be sworn in at noon. Then they’ll focus immediately on health care — well, maybe they’ll take some time to celebrate today, but entitlement cuts are at the top of the docket with sequestration and the debt limit now two months away.

--The minor intrigue of the day is whether some of the most conservative House members will vote against Boehner in leadership elections. Boehner will win the gavel again, but the leadership vote comes less than 48 hours after two-thirds of House Republicans rejected the fiscal cliff bill.

--NEW DOCS JOIN THE HOUSE TODAY -- And they’re both California Democrats. When Ami Bera and Raul Ruiz are sworn in today, they’ll join Rep. Jim McDermott of Washington and Del. Donna Christensen of the Virgin Islands as the only Democratic doctors in Congress. Ruiz, a 40-year-old ER doctor, defeated Rep. Mary Bono Mack in November. Bera, 47, knocked off Rep. Dan Lungren in one of 2012’s closest House races.

CLINTON RELEASED FROM HOSPITAL — Secretary of State Hillary Clinton was released last night from New York Presbyterian Hospital, where she had been treated since Sunday for a blood clot in her head. “Her medical team advised her that she is making good progress on all fronts, and they are confident she will make a full recovery,” spokesman Philippe Reines said in a statement. No word yet on when she gets back to work. The POLITICO story: http://politi.co/134RekM

--PROGNOSIS GOOD, BUT CAUSE IS OBSCURE — Clinton is expected to make a full recovery, but we may never know what caused the clot to begin with. The State Department has released scant details about Clinton's fainting episode that caused a concussion — and not enough to make even a good guess as to whether the clot may have contributed to the fall, or the fall to the clot. Outside medical experts said Clinton's prognosis is good, however. “You pump her full of fluids, read her the riot act about staying hydrated, treat her with anti-coagulants and send her home,” said Anders Cohen, chief of neurosurgery at The Brooklyn Hospital. Tests will determine whether she has a predisposition to clotting, which would determine how long she has to keep taking blood thinners. The Pro story: http://politico.pro/12ZqIdH

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CLASS ADVOCATES LAMENT PROGRAM’S ELIMINATION -- Though the Obama administration suspended the CLASS Act more than a year ago, its most ardent supporters had still been carrying a torch for the voluntary long-term care insurance program that was killed off in the fiscal cliff deal. A supporting coalition, known as Advance CLASS, said yesterday that it’s “extremely disappointed” by the decision to repeal the program, but the group has hope for a new national long-term care commission also created by the cliff deal. In a statement, Advance CLASS Executive Director Connie Garner said she hopes the commission “will work quickly and aggressively to propose a plan that holds true to the core principles of the CLASS Act: broad participation, supporting personal responsibility, and flexibility in choice of long-term services and supports.”

--OIG: NOTHING TO SEE HERE -- We missed this one over break, but OIG last week issued a report confirming that the administration didn’t do anything on CLASS in 2012. “Following program suspension, the CLASS Office focused its efforts on organizing and storing key office documents and helping staff transition to other jobs,” OIG wrote. “The CLASS Office was officially abolished on April 18, 2012, with the publication of the Federal Register notice that incorporated the Administration on Aging into the newly created Administration for Community Living.” The OIG report: http://1.usa.gov/UGOTJP

HEALTH STOCKS RISE AFTER CLIFF DEAL -- Companies providing medical services did pretty well on Wall Street yesterday after the House approved the cliff deal that included a one-year SGR patch, The Associated Press reports. Still, a research analyst told the AP that health care stocks will probably stay where they are for the next couple of months as the battle over entitlements heats up in Washington. The AP story: http://yhoo.it/VwbmtY

KIRK: STROKE GAVE ME NEW PERSPECTIVE ON MEDICAID -- A year after suffering a major stroke, Sen. Mark Kirk (R-Ill.) says he has a heightened interest in his state’s Medicaid program. In an interview with the Chicago Sun-Times, Kirk said the state’s Medicaid program never would have provided the intensive rehab that he’s received.  “Had I been limited to that I would have had no chance to recover like I did,” Kirk said, telling the paper that Illinois Medicaid typically covers 11 rehab visits. “So unlike before suffering the stroke, I’m much more focused on Medicaid and what my fellow citizens face.” The Sun-Times story: http://bit.ly/ZV292B

WYNNE MOVES TO THORN RUN — Former Senate Finance Committee staffer Billy Wynne jumps this week from Health Policy Source to Thorn Run Partners. He joins the lobbying firm as a partner. Wynne was health policy counsel for Finance Chairman Max Baucus from 2006 to 2008.

E&C SUMS UP THE 112TH -- House Energy and Commerce Committee Chairman Fred Upton was in a reflective mood yesterday, issuing a report that summed up the panel’s accomplishments over the past two years. Upton cited the committee’s work on the FDA bill and efforts to promote increased Medicaid flexibility and a better payment system for Medicare providers. Of course, there’s the whole Obamacare business, which he described this way: “[B]ecause Obamacare remains a costly, overreaching law that we cannot afford and that the American people have rejected, the [health] subcommittee worked to repeal the law through effective oversight and a series of individual bills that identify and eliminate unaffordable, unaccountable new programs one at a time.” The report: http://1.usa.gov/W3kqT3

WHAT WE’RE READING, by Kathryn Smith

-- NPR takes a look back at the career of California Rep. Pete Stark, who lost reelection this November after serving 20 terms. http://n.pr/VjZsBf

-- Arkansas Republican state Sen. Michael Lamoureux, the incoming president of the state Senate, tells The AP that he thinks a deal on Medicaid expansion is possible in Arkansas. http://bit.ly/XjRWeu

-- In The Wall Street Journal, Karl Rove makes some predictions for 2013, saying Obamacare’s implementation will be “ragged and ugly” and President Obama and Republicans won’t reach a grand bargain on the budget. http://on.wsj.com/UlAosq

-- The New York Times reports on civil society activists doing grassroots HIV testing in China, where the rate of HIV infections is on the rise, but patients are stigmatized and the government has historically offered little support for prevention and treatment. http://nyti.ms/VCDGYt

-- Reuters columnist Mark Miller expresses more hope for the creation of a commission on long-term care insurance, calling it a bright spot in the fiscal cliff deal. http://reut.rs/WlskrL

-- The Village Voice writes about the crippling debt for most med students entering primary care, but finds they’re still staying positive about the health care law. http://bit.ly/W3bnl4

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