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Can Obamacare survive without Obama there to prop it up? The first open enrollment for Obamacare starts Nov. 1 without its architect and chief advocate in the White House, raising questions about how it will fare under a new administration that views repeal of the law as one of its main priorities. When former President Barack Obama was in office, he openly worked to sell plans on the law's exchanges and to fund the law, sometimes issuing decisions beyond what his critics considered were allowable under presidential authority. During his first open enrollment in 2014, Obama targeted young people by appearing on the comedy interview show "Between Two Ferns" with Zach Galifianakis, soon after the federal exchange website,, failed to launch properly. By his last open enrollment, he doubled ad funding from $50 million to $100 million. Obama oversaw three open enrollment seasons. During that time he made numerous administrative moves to ensure Obamacare's success, such as delaying the end of open enrollment several times, creating special enrollment periods for people to sign up outside of the designated timeframe, and propping up smaller insurers called co-ops. He allowed people to sign up for plans that did not comply with Obamacare's mandates and authorized insurer funds known as cost-sharing reduction subsidies, a move that a federal judge ruled illegal because they weren't appropriated by Congress. Obama's departure, and subsequent arrival of an administration not as interested in the law's success, leaves open the question of whether Obamacare can succeed without a massive lift from the White House. Read more from our magazine feature.

Welcome to Philip Klein’s Daily on Healthcare, compiled by Washington Examiner Managing Editor Philip Klein (@philipaklein), Senior Healthcare Writer Kimberly Leonard (@LeonardKL) and Healthcare Reporter Robert King (@rking_19).  Email for tips, suggestions, calendar items and anything else. If a friend sent this to you and you’d like to sign up, click here. If signing up doesn’t work, shoot us an email and we’ll add you to our list. premiums rise, choices dwindle under Obamacare. Health insurance prices for the first Obamacare open enrollment under President Trump will be 37 percent higher than last year for mid-level plans sold on, according to a new report by the Department of Health and Human Services. The report, prepared by the Office of the Assistant Secretary for Planning and Evaluation, finds that a 27-year-old who buys a mid-level plan, known as a silver plan, and does not receive a subsidy from the federal government will pay an average of $4,932 in premiums for the year. During Obamacare's first year, someone with that profile would have paid $2,616. In total, 55 percent of Obamacare customers will have one or two health insurance options, up from 43 percent last year. Twenty-nine percent of enrollees will have one health insurance company to buy coverage from, an increase from 2 percent of customers in 2016. Eight states will have one insurer offering coverage across the entire state. In total, 132 health insurers are selling Obamacare plans across the country, down from 237 insurers two years ago. “This data demonstrates just how rapidly Obamacare’s exchanges are deteriorating with skyrocketing premiums year after year, more than half of Americans with no more than two insurers to choose from, and the taxpayer burden exploding," Caitlin Oakley, press secretary for the Department of Health and Human Services, said in an email. "There is an urgent and serious need to repeal this failed law and replace it with patient-centered solutions.” Premium subsidies are increasing by 45 percent to make up for the difference in costs to subsidized customers. The federal government is kicking in an average of $555 per subsidized customer every month. Last year it paid an average of $382 per month.

Trump tries to pin the blame for Obamacare increases on Democrats. Trump Sunday tried to put the blame for increasing healthcare costs on the Obamacare exchanges on Democrats, despite his decision this month to end cost-sharing subsidies. "As usual, the ObamaCare premiums will be up (the Dems own it), but we will Repeal & Replace and have great Healthcare soon after Tax Cuts!" Trump tweeted.

Money to fight opioid crisis may be going to wrong places, report says. More federal funding for treatment is needed to truly fight the opioid epidemic, according to advocates and some lawmakers. But a new report Saturday says federal assistance for addiction medications, such as methadone, may be going to the wrong places and that the federal government needs to figure out how to give funding to the places that need it the most. The report from the Clinton Foundation and the Johns Hopkins Bloomberg School of Public Health was released Saturday, two days after President Trump declared the opioid epidemic a public health emergency. But Trump did not add any new money for combating the epidemic that kills 91 Americans a day. That left him open to criticism from Democrats and advocates that more money needs to be devoted to treatment. However, the report found that more thought needs to be put into where exactly that money should go, especially to fund access to the addiction treatments buprenorphine and methadone. “Treatment services are disproportionately distributed across communities and do not always reflect need,” the report signed by 38 experts says. “Using federal resources to identify communities most in need of treatment services and to expand treatment capacity will help to address this disparity.” For instance, the ability to expand the use of methadone is “limited by a short supply of licensed programs in non-urban communities and requirements such as daily attendance,” the report says.

CMS issues proposed rule on Obamacare’s essential health benefits. The Centers for Medicare and Medicaid Services issued a 365-page proposed rule Friday that would give states flexibility on how to administer essential health benefits, which include coverage for prescription drugs, maternity care, mental health and addiction treatment and emergency services. While the broad categories are defined by statute, some of the finer details are left to state discretion, though it’s not clear that changes would significantly affect the costs of premiums, which CMS acknowledges in its report. The proposed rule also recommends regulators review premium rate increases when they surpass 15 percent, rather than the current 10 percent, "in recognition of significant rate increases in the past number of years," officials write. The public comment period lasts until Nov. 27.


New York Times The governor blocked Medicaid expansion. Now Maine voters could overrule him

Quartz What’s killing America’s new mothers?

Politico Backed by UnitedHealth, HHS Nominee would now help oversee it

STAT News A former drug czar weighs in: What Trump should have done about the opioid crisis

HuffPost An Iowa teenager didn’t wreck his state’s health care market. Here’s who did.

The Hill Obamacare heads into crucial first sign-ups under Trump

New Yorker A pill to make exercise obsolete

The Associated Press Health law sign-ups start, and some see a ‘hostile takeover’

Wall Street Journal CVS bid for Aetna followed a long hunt


MONDAY | Oct. 30

Oct. 26-30. San Francisco. World Conference of Science Journalists. Details.

TUESDAY | Oct. 31

Oct. 31-Nov. 2. Crystal Gateway Marriott. PCORI’s Annual Meeting. Details.

8:30 a.m. Aetna third quarter earnings call. Details.

10 a.m. SVC-203. National Coalition on Healthcare event on “Prevention Across the Lifespan.” Details.

2:30 p.m. 430 Dirksen. Senate Health, Education, Labor and Pensions Committee hearing on “Implementation of the 21st Century Cures Act: Achieving the Promise of Health Information Technology.” Details.



First day of Obamacare open enrollment.

Nov. 1-3. Renaissance Hotel Downtown. U.S. News & World Report Healthcare of Tomorrow event. Details.

9:30 a.m. National Press Club. 529 14th St. NW. Discussion on “Children and Screens: A Summit with National Experts in Pediatrics and Media.” Details.

Noon. National Press Club. 529 14th St. NW. Summit on “National Lung Cancer Awareness Month.” Details.


PhRMA scientists and researchers meeting with senior Hill staffers.

8 a.m. W Hotel. 515 15th St. NW. Politico event on “The Opioid Crisis: Crucial Next Steps.” Details.

8:30 a.m. Cigna to release third-quarter earnings results. Details.

10:15 a.m. Rayburn 2322. House Energy and Commerce Committee hearing on “Concerns Over Federal Select Agent Program Oversight of Dangerous Pathogens.” Details.

3 p.m. 325 Russell. Discussion among Sens. Rob Portman, R-Ohio, Sheldon Whitehouse, D-R.I., Jeanne Shaheen, D-N.H. on “Across the Aisle: A Conversation on our Nation's Opioid Epidemic.” Details.

3 p.m. Kaiser Health News to hold Facebook live events on consumer questions about Obamacare’s open enrollment. Watch stream.

FRIDAY | Nov. 3

9:30 a.m. 1775 Massachusetts Ave. NW. Brookings Institution discussion on “Policy Approaches to the Opioid Crisis.” Details.

Noon. National Press Club. 529 14th St. NW. Luncheon with FDA commissioner Scott Gottlieb. Details.


Nov. 4-8. American Public Health Association 2017 Annual Meeting and Expo. Theme: Creating the Healthiest Nation: Climate Changes Health. Details.

MONDAY | Nov. 6

Noon. National Press Club. 529 14th St. NW. Luncheon with VA Secretary David Shulkin. Details.