Trumpcare is coming to an association health plan near you


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Trumpcare is coming to an association health plan near you. President Trump is expected to sign an executive order this week that will allow people to buy lower-cost health insurance that can circumvent some of the mandates created under Obamacare. Trump will direct the Departments of Health and Human Services, Labor, and Treasury to take steps to make it easier for people to band together and buy coverage through what is known as “association health plans.” The executive order also would allow people to buy low-cost, short-term health insurance plans, which the Obama administration limited to three months, and would expand the use of health savings accounts. The plans offered by associations or short-term providers would be less expensive because they wouldn’t have the same requirements as Obamacare coverage. For instance, they wouldn’t be required to cover customers with pre-existing illnesses and could deny coverage or charge these customers more. They also would not be required to provide coverage for a range of medical care, from addiction to maternity services. Insurers would be likely to sell coverage from a state with the fewest restrictions, which is why its supporters bill it as a move that would allow a long-stated conservative goal to sell health insurance across state lines. Lifting these protections would offer less comprehensive coverage, but would make health plans less expensive. Critics worry that they set people up for “junk insurance” and would further destabilize the Obamacare exchanges. Still, the proposal is popular with conservatives. Middle-class customers who don’t receive subsidies under Obamacare are facing the prospect of buying more expensive coverage in 2018 through Obamacare’s exchanges and could avail themselves of some of these options.

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States plead for federal flexibility on health spending. State officials say they are unable to make changes to healthcare programs, such as Medicaid or Obamacare, in ways that best address the needs of their residents. They have said they want more flexibility not just on which healthcare programs they craft but also on how quickly federal officials approve them. States have complained that filing waivers is cumbersome, involving piles of paperwork and months of work with no guarantee of approval. It can involve top officials from the Department of Health and Human Services and the Office of Management and Budget, as well as state officials and governors. What is allowed can also vary depending on the party and priorities of an administration. For instance, the Obama administration was not willing to allow work requirements in Medicaid, while the Trump administration told governors it supports that approach. “States try to get it in when there is an administration friendly to them. It’s a political question as much as anything else,” said Amy Lischko, who helped implement Massachusetts’ healthcare system under Gov. Mitt Romney, after which Obamacare was modeled. States can request changes to address a healthcare emergency, such as after a hurricane. Some states have a waiver that funds supportive housing or employment services for people with addiction or mental health disorders, and others target people who have HIV. States are trying to do more. Out of cost concerns, Massachusetts is considering a waiver that would limit the number of medications covered by Medicaid and Hawaii wants to use the program to pay for helping homeless people find housing. In the past, states have pushed for housing to be covered, while others have urged coverage for air conditioners, vacuums, and other cleaning supplies that would help create healthier homes and reduce hospitalizations for patients with asthma or chronic lung diseases.

Anti-abortion groups don’t want to ditch legislative filibuster. While Trump and the sponsor of the House version of the legislation that would ban abortions after 20 weeks have called for the end to the legislative filibuster, groups such as March for Life Action and National Right to Life are not. The issue for anti-abortion groups is what happens when power changes hands.

Trump called Schumer to talk about Obamacare. Senate Minority Leader Chuck Schumer confirmed Saturday that Trump called him to discuss healthcare, but indicated they had not reached an agreement on what needed to be done. “The president wanted to make another run at repeal and replace and I told the president that’s off the table,” the New York Democrat said. “If he wants to work together to improve the healthcare system, we Democrats are open to his suggestions. A good place to start might be the Alexander-Murray negotiations that would stabilize the system and lower costs.” The negotiations Schumer raised are between Sen. Lamar Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee, and Patty Murray, the committee’s top-ranking Democrat. The duo has been unable to reach a deal as Democrats press for funding and Republicans push for states to have more flexibility in how they implement Obamacare. It’s unclear whether an agreement would lower costs in time for Obamacare customers who will receive coverage under the program in 2018. Trump tweeted Saturday morning about the phone call with Schumer, but did not say what had been proposed other than seeing whether a bipartisan agreement might be possible. “ObamaCare is badly broken, big premiums,” he wrote. “Who knows!”

Schumer: Trump change to birth control mandate ‘drags the country backwards.’ On Friday, Schumer blasted the Trump administration for its decision to allow more employers to opt out of Obamacare’s birth control mandate. “This outrageous decision rips a fundamental right away from millions of hard-working women in the workplace, risking their access to the critical healthcare coverage they depend on and have earned,” he said. “We have long turned the page on the days when a boss could stand in between a woman and her own healthcare decisions – this decision drags the country backwards. This decision is just the latest in a series of moves the Trump administration has made to undermine and sabotage our healthcare system.” The Trump administration announced Friday morning that employers could be exempt from providing insurance coverage for contraception if it conflicts with their religious or moral beliefs, scaling back a rule created under the Obama administration that mandated coverage for women with no co-pay.

California files legal challenge against Trump’s rollback of birth control mandate. California’s attorney general filed a lawsuit Friday against the Trump administration’s new rules on the contraception mandate. “Donald Trump wants businesses and corporations to control family planning decisions rather than a woman in consultation with her doctor. These anti-women’s health regulations prove once again that the Trump administration is willing to trample on people’s rights,” Attorney General Xavier Becerra said Friday. “What group of Americans will they target next?” he added. “Will they allow businesses to deny you cancer treatment? Will they exclude you from insurance coverage because of a pre-existing health condition? The California Department of Justice will fight to protect every woman’s right to healthcare, including reproductive healthcare. We’ll see the Trump administration in court.” The American Civil Liberties Union and Massachusetts Attorney General Maura Healey said they also will sue the Trump administration. In announcing her decision to sue the administration, Healey called the rollback “a direct attack on women’s health and the right to access affordable and reliable contraception.” Healey elaborated in a call with reporters that the rule was unconstitutional. “This rule is unconstitutional because it allows employers, businesses, companies to impose their religious beliefs on their employees and that is a violation of the Establishment Clause,” she said, referring to the First Amendment right to freedom of religion. She added that the rollback also violates the Administrative Procedures Act that sets up how federal rules need to be approved. ” The Center for Reproductive Rights also said it is “prepared to fight these discriminatory and unconstitutional restrictions in court.”

White House defends contraception move, rejects ACLU ‘talking points.’ White House press secretary Sarah Sanders on Friday defended the Trump administration’s decision to roll back the contraception mandate. “The president believes that the freedom to practice one’s faith is a fundamental right in this country,” Sanders told reporters at the White House. “And I think all of us do. And that’s all that today was about. Our federal government should always protect that right. And as long as Donald Trump is president, he will.” Sanders dismissed the concerns raised by organizations threatening to sue. “I don’t think it’s been a secret that I would never probably never use the ACLU to get any of my talking points,” she said.

California prepares to pass bill aimed at drug price hikes. California Gov. Jerry Brown is expected to sign a bill into law Monday that would require drug companies to justify planned price increases to their medications. Under the bill, drug companies would need to notify private health insurers and the state government health plan, known as Medi-Cal, of their intentions 60 days before the planned increase if it were to exceed 16 percent over a two-year period. Failure to report this would result in a civil penalty, but the bill doesn’t directly prohibit drug companies from price increases. The bill, known as SB 17, was authored by Sen. Ed Hernandez, D-West Covina, who said he believed it could be a model for other states. “If signed into law, SB 17 will set national healthcare policy, having impact for consumers and providers in other states,” he said. Pharmaceutical companies oppose the legislation. “It is disappointing that Gov. Brown has decided to sign a bill that is based on misleading rhetoric instead of what’s in the best interest of patients,” Priscilla VanderVeer, deputy vice president at Pharmaceutical Research and Manufacturers of America, said in an email.  “There is no evidence that SB 17 will lower drug costs for patients because it does not shed light on the large rebates and discounts insurance companies and pharmacy benefit managers are receiving that are not being passed on to patients. Nothing in SB 17 will help patients get the benefits of the savings that insurance companies are getting.”

Florida nursing home where 12 died after Hurricane Irma is closed. The Rehabilitation Center at Hollywood Hills laid off its 245 employees and closed down, according to a notice from the state. After Irma, staff did not evacuate patients from the facility even though the air conditioners weren’t working. Causes of death haven’t been announced, but are believed to be heat-related because other patients were treated for such illnesses. In a letter dated Sept. 27 and reported by the Sun Sentinel, the nursing home told state officials that it had closed its facility seven days earlier. It said that its workers, which included nurses and occupational, speech, and physical therapists, were let go. “A 60-day notice could not be provided due to unforeseen business circumstances that occurred after the impact of hurricane Irma,” the letter said. The state’s Agency for Health Care Administration, which oversees nursing homes, prohibited the facility from admitting new residents, halted its Medicaid payments, and revoked its license.

Bipartisan senators urge Trump administration to not cut drug program. A group of 57 bipartisan senators wrote the Trump administration urging it to not cut a program that offers discounted drugs to safety net hospitals. The letter is in response to a proposal from the Centers for Medicare and Medicaid Services to cut reimbursements under the 340B program, which requires drugmakers to provide deep discounts to eligible hospitals and healthcare providers. CMS revealed the cuts in a proposed rule that has yet to be finalized. The senators call for CMS to not make the cuts because it could “ultimately result in higher beneficiary cost-sharing for other services.” Sens. John Thune, R-S.C.; Bill Nelson, D-Fla.; and Rob Portman, R-Ohio; are among the senators to sign the letter.


The Hill GOP senator: Obamacare repeal ‘alive and well’

Axios AMA’s doctor panel still operates behind closed doors

Washington Post Obamacare navigators aren’t getting credit for Medicaid work

Politico Republicans privately admit defeat on Obamacare repeal

Kaiser Health News Overlooked by ACA: Many people paying full price of insurance ‘getting slammed’

New York Times As cancer tears through Africa, drug makers draw up battle plan

Associated Press Oklahoma judge again overturns medical abortion restriction


MONDAY | Oct. 9

Columbus Day federal holiday.

Oct. 8-10. State Innovation Exchange Legislator Conference. Omni Shoreham Hotel. 2500 Calvert St. NW. Details.

TUESDAY | Oct. 10

World Mental Health Day.

House in session. Senate not in session.

Oct. 10-12. 2101 Constitution Ave. NW.  Microbiology of the Built Environment Research and Applications Symposium jointly organized by the National Academies of Sciences, Engineering, and Medicine and the Alfred P. Sloan Foundation. Details.

11:30 a.m. 1740 Massachusetts Ave. NW. Women’s Learning Partnership to hold screening on “Equality: It’s All in the Family.” Details.

Noon. 2044 Rayburn. PhRMA Research and Hope Awards Luncheon. Keynote from U.S. Olympian Michael Phelps. Details.


Oct. 11-13. Second National MACRA MIPS/APM Summit. Details.

10 a.m. 1225 I St. NW. Bipartisan Policy Center event on “An Issue for All Ages: Retirement in America.” Details.

10:15 a.m. Rayburn 2123. House Energy and Commerce Committee, health subcommittee hearing on “Examining How Covered Entities Utilize the 340B Drug Pricing Program.” Details.

10:15 a.m. Rayburn 2322. House Energy and Commerce member day on the opioid crisis. Details.

Noon. 214 Massachusetts Ave. NE. Heritage Foundation event on “Gender Dysphoria in Children: Understanding the Science and Medicine.” Details.

THURSDAY | Oct. 12

2154 Rayburn. House Oversight Committee hearing on the 2020 U.S Census. Details.

Noon. G-50 Dirksen. Alliance for Health Policy event on “Measuring Quality for  Person-Centered Accountable Care. Details.

Noon. 1 Dupont Circle. Aspen Institute event on “The Caring Economy: How to Improve Service and Work in the Long-Term Care Industry.” Details.


FRIDAY | Oct. 13


10 a.m. 2226 Rayburn. Democrats from the House Energy and Commerce Committee to host forum on traumatic brain injuries.




Oct. 14-16. National Academy of Medicine Annual Meeting. Details.

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Trumpcare is coming to an association health plan near you

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