But the increase in choice also comes at a cost. Proposed premiums for mid-level plans, or “silver” plans, will increase by 15 percent on average, in 2019 compared to 2018. If the filings are approved, these plans will increase from an average of $642 per month to $740 per month. That is consistent with expert predictions of rate increases in response to the elimination of mandate penalties, which could reduce the number of younger and healthier insurers from purchasing insurance, thus leaving insurers with a pool of customers with relatively higher medical costs.

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 [email protected] 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.

Controversial bill to strip limit on addiction treatment passes the House. A measure to undo a limit on how many people with addiction can receive treatment in a hospital has been partially stripped out in a House bill that passed Wednesday. Under the legislation, the provision known as the “IMD exclusion” would be changed to allow Medicaid to reimburse hospitals that provide treatment for cocaine and opioid addiction, even if they serve more than 16 patients. The bill, by Rep. Mimi Walters, R-Calif., passed 261-155. Democrats began to oppose it a few months ago because they said resources should instead go to care in the community, and that it should include coverage for addictions to other substances. Both the Trump administration and the Obama administration had invited states to apply for waivers that would undo the restriction, which dates to 1965, when lawmakers were working to de-institutionalize mental health and addiction services.

Iowa’s Obamacare plans stabilize for 2019. At least one health insurance company that plans to sell Obamacare coverage in Iowa is proposing small premium increases, state officials reported Wednesday. Health Insurers Medica and Wellmark have filed paperwork to sell Obamacare plans in all 99 of Iowa’s counties. The health insurance division would not provide specifics on the rate filings, but did say that Medica’s proposed rate filing was less than 5.6 percent. Last year, it raised rates by more than 50 percent. Wellmark will not face a rate hearing because it did not participate in the Obamacare exchange in Iowa last year. It had participated in 2016 but then exited, saying that a single patient was costing the company $1 million a month in claims associated with care for hemophilia, a blood clotting disorder. In 2019, Iowa will allow the sale of “health benefit plans,” which cover fewer benefits than Obamacare offerings and which Wellmark also plans to sell.

Iowa blames the Obamacare, not Trump or GOP, for high prices. Commissioner Doug Ommen, a Republican, said Congress needs to act on Obamacare and did not blame the Trump administration or GOP for the high prices. He did not cite which policies to pursue in a statement issued alongside the rate filings, but in the past the state has proposed selling plans that do not abide by Obamacare’s mandates. “I encourage Iowans to contact us regarding these rate increases, but I would also encourage folks to call members of Congress to fix this,” Ommen said. “Middle-class Iowans cannot be left with a choice of coverage they can’t afford or going uninsured. Entrepreneurs, farmers and early retirees relying on this market deserve and need to have a functioning individual health insurance market.”

Health chief: Trump’s lawsuit against Obamacare makes the same argument Obama did. The argument the Trump administration is making to gut Obamacare’s protections for people with pre-existing illnesses is the same stance the Obama administration once took, President Trump’s health chief said Wednesday. Alex Azar, secretary for the Department of Health and Human Services, was speaking about the Department of Justice’s request for a court to undo the Obamacare-created requirements that health insurers must sell coverage to people with pre-existing illnesses and cannot charge them more than other customers. By taking this stance, the Department of Justice is agreeing with a lawsuit filed by 20 states saying that repeal of the individual mandate, the Obamacare penalty for going uninsured, makes Obamacare unconstitutional. Azar said that he “of course” supported the conclusions the Trump administration had drawn, and said it was similar to the position the Obama administration took when it argued the legality of the individual mandate before the Supreme Court in 2012. “If you were to strike down the individual mandate, guaranteed issue and community rating are inextricably linked and must fall as a requirement of statutory interpretation,” Azar said at a Washington Post Live event, describing the position and using the formal name for the Obamacare provisions.

Supporters of new Obamacare replacement search for Senate momentum. Several Republican senators applauded a new plan to overhaul Obamacare as the leaders of the new plan search for enough support in the divided GOP conference. The plan officially released Wednesday would convert Obamacare’s funding into block grants for states. Leaders of the plan are in talks with Republicans, who face a smaller margin to approve an Obamacare overhaul this year than in 2017, when a narrow plan fell short of one vote. Sens. Lindsey Graham, R-S.C., and Lamar Alexander, R-Tenn., both praised the nascent effort. “Using this innovative proposal, we can continue to push for legislation that will lower costs and increase choices,” Graham said Wednesday. “Ultimately, I believe we will have a breakthrough and deliver for the American people.” Last year, Graham touted a similar plan with Sen. Bill Cassidy, R-La., which would have converted Obamacare funding into block grants. It fell apart in September because of insufficient GOP support.

But the overhaul has a rough road. Former Sen. Rick Santorum, who is pushing the proposal, said the plan is to use reconciliation, a budget pathway that allows budget legislation to go through the Senate with only 51 votes as opposed to 60 required to break a filibuster. Republicans have a 51-vote majority, but Sen. John McCain, R-Ariz., has been absent as he recuperates from treatment for brain cancer. That means that Republicans can lose only one senator as Vice President Mike Pence can break a 50-50 tie. McCain joined centrist Sens. Lisa Murkowski, R-Alaska, and Susan Collins of Maine in opposing a narrow Obamacare repeal bill that failed in the Senate last summer. Neither Murkowski nor Collins have said they are open to changing their mind on opposing any Obamacare replacement.

Oscar Health will sell Obamacare plans in six more markets. Oscar Health has filed to sell Obamacare plans in six more markets to cover customers in 2019, the health insurer announced Thursday. Mario Schlosser, the company’s co-founder and CEO, said in a blog post that the move positioned Oscar to be one of the “fastest-growing insurers in the country.” He announced that the company would sell plans across Arizona, Florida, and Michigan, and would expand into more large metro areas in Ohio, Tennessee, and Texas. In all, the company will be selling plans in 14 markets across nine states.

Applications for disability benefits plummet, extending life expectancy of the program. The number of Americans applying for Social Security disability benefits has dropped dramatically, reversing a decades-long trend that would have forced the program to end earlier than planned. According to a New York Times report, the trend prompted the agency to change its estimate for when it would deplete its funds. Two years ago, the funding was projected to be gone by 2023, but this month the agency suggested they wouldn’t run out until 2032, which is four years later than last year’s estimate. The report pointed to strong economic growth as one of the reasons for the change. It also noted the recent tightening of eligibility standards and how much of the baby boomer generation is now eligible for Social Security retirement benefits and Medicare. About 1.5 million Americans applied for disability benefits last year, the lowest number since 2002.

Delta cracks down on ’emotional support pets’ after passengers bring spiders, possums. Delta Air Lines will begin limiting the number of emotional support animals that passengers can bring on its planes, a shift that comes as lawmakers tighten rules governing the practice. Starting July 10, the Atlanta-based carrier will allow only one such pet per customer and stop considering pit bulls in the category. Congress began considering legislation narrowing the definition of such animals for air travel this year after a series of incidents, including one in which a dog died in an overhead bin during a United Airlines flight. Since 2016, Delta has noted an 84 percent increase in incidents involving service and support animals. Aside from dogs, customers have attempted to bring turkeys, gliding possums, and spiders aboard for emotional comfort.

CMS seeks to cut red tape for doctors. The Trump administration wants recommendations on how to overhaul a physician self-referral law that healthcare providers say creates too much red tape for doctors. The measure known as “Stark Law” prohibits a doctor from referring a patient to a healthcare entity that the doctor has a financial relationship with. But the Centers for Medicare and Medicaid Services said that the law could hinder the agency’s effort to improve coordination of healthcare. “To achieve a truly value-based, patient-centered healthcare system, doctors and other providers need to work together with patients,” CMS said Wednesday. “The Stark Law and regulations, in its current form, may hinder these types of arrangements.”

RUNDOWN

Axios Everyone is trying to end the opioid epidemic

The Hill Cigna announces goal to reduce opioid overdoses by 25 percent in key areas

STAT News Number of drug makers lobbying Congress on price issues skyrockets

Politico Trump federal reorganization plan due to arrive this week

Associated Press New flu vaccine only a little better than traditional shot

Washington Post New shingles vaccine is highly effective, long-lasting and in short supply

CNN Hospital drugs policy killed 456 patients. Now families want justice

Wall Street Journal Insurers to expand presence in Obamacare marketplaces despite uncertainty