10/12/2017 10:00 AM EDT
By DAN DIAMOND (email@example.com; @ddiamond)
FED UP WITH CONGRESS, TRUMP WHACKS OBAMACARE WITH HIS PEN - President Donald Trump is expected to sign an executive order this morning intended to encourage the rise of cheap, loosely regulated health insurance plans that don't have to comply with certain Obamacare consumer protections and benefit rules. They'd attract younger and healthier people - leaving older and sicker ones in the Obamacare markets facing higher and higher costs, POLITICO's Adam Cancryn writes.
- What Trump's pledged. The president has pitched the order, which focuses on association health plans that allow small-business owners, trade groups and others to band together to purchase health insurance, as delivering on a campaign promise: More options and lower costs.
"Private insurers are going to give you incredible health care," Trump told truckers at an event in Pennsylvania on Wednesday, suggesting that the truckers could band together to get covered.
- How it would work. The association health plans would be exempt from certain Obamacare rules, including requirements that it cover standard benefits, such as prescription drug coverage. To make those changes, the administration is already working to reinterpret ERISA, a massive federal law that governs many workplace benefits, people familiar with the order said - opening the door to more expansive changes that could affect Obamacare plans more directly.
The administration is also preparing to roll back Obama-era restrictions on short-term health insurance plans, allowing insurers to once again sell stopgap policies which don't cover pre-existing conditions, mental health services and many other costly benefits. Coverage could extend for as long as a year, up from a current three-month limit.
- Some key caveats.
It's not yet clear how far the administration will go, or how quickly it can implement the president's order, Adam writes. Insurers and others have discussed the possibility of suing to block the order's changes from taking effect.
But if successful, the new rules could upend the way businesses and individuals buy coverage - lowering premiums for the healthiest Americans at the expense of key consumer protections and potentially tipping the Obamacare markets into a tailspin.
- Advocates sound the alarm.
Analysts say that young and healthy enrollees would likely flock to the skimpy but cheap plans sold by associations and short-term insurance specialists, leaving behind the nation's sickest patients in the increasingly expensive and untenable Obamacare markets.
"Within a year, this would kill the market," said Karen Pollitz, a senior fellow at the Kaiser Family Foundation who previously worked at former President Barack Obama's HHS Department.
Keep reading: More for Pros.
Donald Trump is poised to sign an executive order shaking up the individual insurance market. | AP Photo
SOME MENTAL HEALTH ADVOCATES SAY GOOD RIDDANCE TO TIM MURPHY -
While Wednesday's issue of PULSE quoted advocates at national associations who said that Murphy's resignation could be a setback for mental health issues in Congress, other advocates say that the Pennsylvania Republican pushed policies that harmed their goals.
"I have always been surprised by the support that Rep. Murphy received from parts of the mental health community," said Bethany Lilly of the Bazelon Center for Mental Health Law, citing Murphy's efforts to repeal the Affordable Care Act's Medicaid expansion and his advocacy for institutional approaches to care. "We have far better mental health champions in Congress - in particular any member who voted against the AHCA." Staff at organizations like the National Mental Health Consumers' Self-Help Clearinghouse and the Mental Health Association in Pennsylvania echoed Lilly's concerns.
... Even advocates at national organizations who said that Murphy's departure would be a loss also admitted that they didn't agree with all of his policies on mental health. But they appreciated that he made their issues a priority in Congress, the advocates told POLITICO earlier this week.
THIS IS THURSDAY PULSE - Tips to firstname.lastname@example.org or @ddiamond on Twitter.
With help from Luis Sanchez (@_luissanchez1), Victoria Colliver (@vcolliver), and Dan Goldberg (@DanCGoldberg).
PhRMA gets new board leadership. PhRMA elected Amgen chairman and CEO Robert A. Bradway as chairman-elect effective immediately. Bradway replaces Joseph Jimenez, the CEO of Novartis, as chairman-elect and will replace Johnson & Johnson Vice President Joaquin Duato as chairman of the board in Feb. 2018. In the same month, Sanofi CEO Olivier Brandicourt will become chairman-elect and James Robinson, president of Astellas Americas, will assume the role of board treasurer.
California: Regulators trim Anthem's price hike. The state Department of Managed Health Care on Wednesday released its review
of Anthem Blue Cross' proposed 2018 rate increases of more than 40 percent for the state's individual marketplace, 30 percent of which the insurer attributed to rising drug costs. The regulator managed to trim Anthem's premium increase by 3.3 percent, but that means consumers could face a whopping 37.3 percent increase (the department also pushed down Anthem's pharmacy increase by 7 percent, from 30 to 23 percent). The increases, particularly the pharmacy trend, were significantly higher than what other insurers had proposed.
Next year Anthem will have a much smaller footprint in California's individual marketplace by virtue of having withdrawn from most of the state. Anthem officials did not respond to an immediate request for comment.
...Meanwhile, Covered California officials announced that the state exchange will impose an average 12.4 percent surcharge next year on mid-tier plans in an effort to stabilize rates amid ongoing federal uncertainty about Obamacare's cost-sharing reduction payments. The good news for consumers: They'll be shielded from the surcharge because of a work-around put in place Wednesday by Covered California. More for Pros on that here.
** A message from PhRMA: Ever wonder who decides what you pay for your medicines? It's not who you might think. Biopharmaceutical companies set the list prices for their medicines, but it's your insurer that decides how much you pay out of pocket. More than one-third of the list price is rebated back to middlemen, but these savings aren't always shared with patients. http://politi.co/2yNMAwG **
New York: Health officials worried about CHIP delays. The New York State health commissioner told the Trump administration on Wednesday that Congress' failure to renew the Children's Health Insurance Program could force Albany to end its participation, putting 350,000 New York children at risk of losing health insurance.
"New York cannot continue the current program without federal funding," Commissioner Howard Zucker
wrote in a letter to acting Health and Human Services Secretary Eric Hargan. "When the State determines there are insufficient funds to provide coverage for the next month, the State will notify [the Centers for Medicare and Medicaid Services] of its intent to no longer provide CHIP eligibility and services."
Iowa: Democrats request Trump administration records on stalled Obamacare waiver
. They're seeking communications between President Donald Trump and state GOP leaders about Iowa's stalled request to overhaul its Obamacare marketplace, which the president reportedly urged his health department to reject.
The state Democratic Party filed a Freedom of Information Act request days after The Washington Post reported
that Trump in August personally asked top health officials to turn down the plan after reading about it in The Wall Street Journal. Iowa officials have said their plan, which would rewrite major parts of Obamacare, is needed to prevent its individual insurance market from collapsing. More for Pros.
By Paul Demko
In a little-known perk for lawmakers, a Capitol Hill pharmacy delivers prescription drugs to the Capitol nearly every day, reports STAT's Erin Mershon. More
Minnesota GOP Rep. Erik Paulsen's voting record on health care issues shows he's not the moderate portrayed on the campaign trail, argues Cory Zurowski in City Pages. More
Democrats are holding children's health hostage to protect millionaires and insurance companies, argues Chris Jacobs in The Federalist. More
Mental health professionals are struggling to explain a huge spike in teenagers suffering from debilitating anxiety, explains Benoit Denizet-Lewis in The New York Times Magazine. More
Mobile clinics are playing an increasingly important role in delivering preventive care to Americans who might otherwise go without treatment, reports Stateline's Scott Rodd. More
** A message from PhRMA: Are middlemen really holding down the cost of medicines?
Ever wonder who decides what you pay for your medicines? It's not who you might think. Biopharmaceutical companies set the list prices for their medicines, but it's your insurer that ultimately determines how much you pay out of pocket. More than one-third of the list price of a medicine is rebated back to middlemen, like insurers and pharmacy benefit managers (PBMs). These rebates and discounts create savings of more than $100 billion, but these savings aren't always shared directly with patients. Patients share the costs. They should share the savings.