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What you need to know about Trump’s healthcare executive order.

President Trump on Thursday signed an executive order aimed at lowering premiums and expanding choices for health insurance. It includes three basic categories of changes.

  • It directs the secretary of labor to look into ways to explore the use of association health plans, allowing employers in a similar industry to band together, even if located in different states, to buy insurance. The insurance could flow through an existing association, such as the Chamber of Commerce, or could be a new organization formed for the purposes of insurance. The plans are not subject to the same regulations as Obamacare, and the administration is looking at whether there are ways to let individuals enroll in these type of plans.
  • It directs the departments of Labor, Treasury, and Health and Human Services to look into ways to expand the coverage options of short-term insurance, which are plans that operate legally outside of Obamacare’s rules to offer coverage to individuals for a few months.
  • It directs the departments of Labor, Treasury and HHS to change the rules governing Health Reimbursement Arrangements, which allow employers to contribute to workers’ health benefits.

The executive order will not result in any immediate changes to the law and thus will not help any consumers shopping for insurance when open enrollment starts Nov. 1. Instead, it will only start the process of trying to find ways to work within existing rules to expand options. The different agencies would be given 180 days report to the president about any other changes that could be made, at the state or the federal level, to increase choices for consumers. Once new rules are issued by the agencies, they could be subject to legal challenges, depending on how they are crafted.

Politically, the Trump administration is touting the law as providing relief to consumers, and Democrats are pointing to it as another act of “sabotage” against Obamacare, seeing the potential for healthier individuals to bolt the market and thus make Obamacare plans more expensive for those who remain. In reality, however, until the agencies report back with actual rules, it will be difficult to evaluate the true scope of the order.

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Trump touts ‘very powerful’ and ‘very good’ executive order, praises Rand Paul.  "We are all gathered together to do something that is very powerful for our nation and very good for our people," Trump said at the White House, surrounded by officials and small business owners. Trump was joined by Sen. Rand Paul, R-Ky., who has been discussing the proposal with him for months. "When you get Rand Paul on your side it has to be positive," he said. As he ended his remarks and prepared to exit the office, an official told him, "You need to sign it." "Oh!" Trump said to laughs from attendees. "I'm only signing it cause it costs nothing," he added.

Democrats claim ‘sabotage.’ Democrats criticized Trump’s executive order as the latest evidence of the Republican effort to kneecap Obamacare. “I do know it is a sabotage of the Affordable Care Act and quite frankly a disservice to the American people,” House Minority Leader Nancy Pelosi said. Rep. Lloyd Doggett of Texas said the order will mean “bare-bones, junk insurance” that undermines protections for people with pre-existing conditions. “Having failed legislatively to replace Obamacare, President Trump continues his effort to sabotage it,” he said. Sen. Tim Kaine, D-Va., also called it sabotage in a series of tweets. “It would allow cheap, low-quality plans onto the market that could discriminate against people with pre-existing conditions, seniors, women,” he tweeted.

Bipartisan talks on CHIP funding off to rough start. Bipartisan talks on funding the Children's Health Insurance Program got off to a rocky start Wednesday as a top Democrat doubted lawmakers would reach a deal by the end of the week. Democrats are highly skeptical of Republican efforts to pay for the insurance program by charging wealthy seniors more for Medicare, which some say is part of a larger effort by Republicans to cut the entitlement program. That skepticism and opposition to Obamacare changes to fund the program come as Democrats and Republicans go back to the table to determine how to fund a five-year reauthorization of the traditionally bipartisan CHIP. "I can't accept these [Affordable Care Act] cuts and so far there isn't any willingness to not include them," said Rep. Frank Pallone of New Jersey, the top Democrat on the House Energy and Commerce Committee. Chairman Rep. Greg Walden, R-Ore., said Tuesday he would delay sending a reauthorization bill to the House floor to restart bipartisan talks on how to fund the program. Pallone said lawmakers still have time to negotiate, even though Walden set an end-of-week deadline. Walden said he would send the bill to the House floor if a deal wasn't reached. "Obviously it is not coming up this week and we have another week," Pallone said.

New York warns HHS about CHIP funding. New York state’s health commissioner warned the Department of Health and Human Services that it will end its Children Health Insurance Program, which gives insurance to 350,000 children in the state, if there is no new funding. “If Congress fails to renew funding for the program in the next few weeks, the governor will have no choice but to call a special session of the legislature,” Health Commissioner Howard Zucker wrote in the letter Wednesday. “However, it is unlikely the legislature can fill a $1 billion hole left by the federal government to continue to provide coverage to all the children currently enrolled in CHIP.” Most states are expected to run out of CHIP funds in early 2018 and some as soon as late November.

Senate Democrats ask Trump administration to renew gun research. Senate Democrats are asking the National Institutes of Health to resume conducting research on gun violence after funding lapsed early this year. "In spite of the toll of gun violence on Americans' health and safety, a dearth of scientific research has hindered efforts to reduce gun-related fatalities and injuries," they wrote in a letter sent Wednesday to NIH Director Francis Collins. Senators said last week's mass shooting in Las Vegas, which resulted in 59 deaths and more than 500 injuries, was the impetus for their request, though they also noted that 30,000 gun-related deaths occur each year, two-thirds of which are suicides. "With 93 Americans dying per day from gun-related fatalities, it is critical that NIH dedicate a portion of its resources to the public health consequences of gun violence," the senators wrote. Senators who signed the letter include Elizabeth Warren, D-Mass., Chris Murphy, D-Conn., Patty Murray, D-Wash., and Bernie Sanders, I-Vt.

California adds surcharge to compensate for losing insurer subsidies. California's Obamacare exchange plans to add a 12 percent surcharge to certain Obamacare plans to make up for the federal government's lack of a long-term commitment to paying insurer subsidies.

Covered California, the state-run exchange, said Wednesday it hopes to soften the blow of the surcharge by pegging it only to silver plans. The goal is to ensure that people who get federal subsidies will be the only customers to pay the surcharge, as federal subsidies to lower the cost of insurance rise with any premium hikes. Covered California said the surcharge on silver-tier plans, the most popular of Obamacare's three tiers, is necessary because the Trump administration has not committed to paying cost-sharing reduction payments in 2018. The state's exchange has 1.4 million enrollees, with about 689,602 who buy plans on the Obamacare exchange.

FDA to e-cigarette fans: No samples for you! The Food and Drug Administration outlined what is affected by a ban on businesses handing out free samples of e-cigarettes. The agency banned free samples in August 2016 as part of sweeping regulations on the sale of e-cigarettes, which included a ban on sales to minors. The FDA released a guidance document Wednesday outlining what is affected by the ban. The agency said e-cigarettes are part of a ban on all free samples of tobacco products. The restriction comes as the FDA is taking a more lenient approach to e-cigarette regulation The FDA in May delayed regulatory deadlines facing e-cigarette makers as part of a new approach by the Trump administration.


Axios America is spending more on doctors and less on hospitals

Washington Post Trump’s executive order has a history and the government says it’s not all great

Reuters Trump healthcare order could face strong legal objections

STAT News The pharmacist to Congress has something to say about that Alzheimer’s remark

Wall Street Journal Ebola vaccines show promise in early study

NPR Could making cancer screening simpler increase women’s risk?


THURSDAY | Oct. 12

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.

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


1:30 p.m. 1615 H St. NW. U.S. Chamber of Commerce on “A Path Forward on Health Reform: Advancing Priorities and Innovative Solutions Amid Uncertainty.” Details.

6:30 p.m. 950 New Hampshire Ave. NW. Milken Institute School of Public Health. Panel discussion on “Female Genital Mutilation/Cutting: Half a Million Girls & Women in the United States at Risk.” Details.