Daily on Healthcare: 2.3 million sign-ups: People enrolling in Obamacare more rapidly under Trump…mandate repeal gains momentum

2.3 million sign-ups: People enrolling in Obamacare more rapidly under Trump. In the past few weeks, we’ve been speculating about the “Producer’s effect” — that is, the possibility that Obamacare enrollment grows under President Trump, despite his moves against it and dire predictions. So far, the rate of sign-ups has outpaced the enrollment during the last year of the Obama administration. During the first 18 days, 2,277,079 signed up for coverage, the Centers for Medicare and Medicaid Services said on Wednesday. Last year, the final open enrollment of the Obama administration, it took 26 days to sign up 2,137,717 people. There are a few very important caveats. One is that the open enrollment period this year is half as long, or six weeks instead of three months. That means that, on average, twice as many people will have to sign-up each day to match last year’s sign-up number of 12.2 million. The second is that the pace of sign-ups has appeared to slow down. The third week resulted in 798,829 people signing up for plans, which was down from the 876,788 who signed up in the second week. In the first four days, 601,462 signed up. People tend to procrastinate enrolling in plans, making the last week or two of open enrollment the busiest. So, signups will have to increase at a rapid pace after Thanksgiving to equal last year’s enrollment total.

Mandate repeal gains momentum ahead of Thanksgiving. Sen. Lisa Murkowski, R-Alaska, provided a big boost to efforts to repeal the individual mandate penalty when she said she supports the latest GOP effort.. “Repealing the individual mandate simply restores to people the freedom to choose,” Murkowski wrote in the Fairbanks Daily News-Miner in an opinion piece published Tuesday. But Murkowski added that she also backed “enacting the bipartisan compromise Alexander/Murray legislation into law as fast as possible to stabilize our markets, provide more control to states and more choices to individuals.” The deal put forth by Sen. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., would restore payments to ACA insurers for two years in exchange for giving states more flexibility to waive Obamacare insurer regulations. Murkowski’s endorsement comes after she was the deciding vote to kill her party’s Obamacare repeal effort over the summer. It is significant, because it comes ahead of the Senate Republican’s tax plan being considered on the upper chamber’s floor, as the bill contains a mandate repeal measure. A spokesperson for Murkowski cautioned against assuming the senator was in favor of the tax proposal.

Happy Thanksgiving and 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. Note: We will not be publishing a newsletter on Thursday or Friday in observance of the Thanksgiving holiday. But, we will be back in action next Monday, Nov. 27.

Trump administration: Most Obamacare enrollment groups failed to meet their goal. Only 16 out of 98 groups aimed at boosting Obamacare enrollment met or exceeded their enrollment goals for 2017, according to new data from the Trump administration. The administration on Wednesday released its final list of grant recipients for Obamacare nonprofit “navigator” groups for 2018. The administration cut funding to the groups by roughly 40 percent for 2018 because of low enrollment signups. The Centers for Medicare & Medicaid Services also posted a list of enrollment goals set by each navigator for 2017’s open enrollment, along with the actual enrollment figures. Of the 98 navigators, only 16 made or exceeded those goals. Some came up woefully short, such as Great Plains Tribal Chairmen’s Health Board in South Dakota that had a goal of 2,000 people but only signed up one person.

Democrats warn Obamacare deal won’t solve problems if mandate repealed. The impact of the deal brokered by Sen. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., is being hotly debated as momentum to repeal the mandate gains steam. Sen. Lisa Murkowski, R-Alaska, who voted against a “skinny” repeal bill that would have gutted the mandate this summer, said on Tuesday that she is in favor of repealing the mandate. Senate Democratic staff on the Health, Education, Labor and Pensions Committee sent their Republican counterparts a memo Monday outlining why the Alexander-Murray legislation isn’t enough. The deal would restore funding for cost-sharing reduction payments to insurers that reimburse them for lowering co-pays and deductibles on low-income Obamacare enrollees. In exchange, states would have more flexibility under Obamacare. The memo leans heavily on an estimate from the nonpartisan Congressional Budget Office that predicts 13 million people would forego insurance over a decade. Repeal would save about $330 billion over a decade, money that Republicans plan to use to expand the child care tax credit and other cuts. “CBO estimates that Alexander-Murray wouldn’t have any impact on the number of people who purchase coverage,” the memo said

Obamacare individual mandate repeal could drive insurers out of exchanges, actuaries say. Health insurers would drop out of Obamacare if Congress repeals the provision that requires every American to purchase health insurance or pay a fine, the American Academy of Actuaries warned Tuesday. “Insurers would likely reconsider their future participation in the market,” the group said in a letter to Senate leaders. “This could lead to severe market disruption and loss of coverage.”

Association of State and Territorial Health Officials says latest reports on opioids point to urgency for government funding. A report released by Trust for America’s Health estimates that deaths from drugs, suicide and alcohol combined are projected to increase 41 percent nationwide in the next 10 years without additional investment in prevention. Additionally, the White House’s Council of Economic Advisors reported that the economic cost of the opioid epidemic has been underestimated, with the true cost now projected at $504 billion—six times more than originally thought. “The cost of this crisis is staggering — not only in terms of dollars, but also in terms of the suffering, loss, and grief sustained by our nation’s families,” ASTHO Executive Director Michael Fraser said in a statement. “Investments in treatment and prevention are what is needed to turn the tide on this epidemic. We urge Congress to act swiftly to fund the many important priorities identified in the President’s Commission report as soon as possible, with a special emphasis on preventing substance misuse and addiction.” Trump directed his HHS acting secretary to declare the opioid epidemic a public health emergency, but funding has not been appropriated by Congress yet.

CDC warns public not to drink raw milk … again. The Centers for Disease Control and Prevention seems tired of warning people not to drink contaminated raw milk. The agency sent the second warning in three months over raw milk peddled by a company called Udder Milk that may contain a germ called Brucella abortus RB51. The germ can cause anyone to become sick and cause pregnant women to suffer miscarriages and other pregnancy complications, CDC said. Back in September, a New Jersey woman became ill after drinking raw milk from the company, the agency added. It noted that the company delivers milk in four states: Connecticut, New Jersey, New York and Rhode Island. Udder Milk refuses to say which farms it sells to, so CDC is at a loss on how to trace any infections from tainted milk. It is against federal law to sell raw milk across state lines.

Poll finds Americans trust Democrats more on healthcare issues. More Americans report that they trust Democrats to handle healthcare issues than they do Republicans, according to the latest poll from Morning Consult and Politico. Of the 2586 registered voters who answered questions about healthcare in the poll, which covers a wide-range of topics, 44 percent reported that they trusted Democrats, compared to 34 percent or respondents who reported that they trusted Republicans to handle healthcare issues. When casting their vote for members of the House and Senate, 20 percent of respondents said that healthcare was the top issue that was on their mind. This ranked second, behind economic issues, which came in at 26 percent.

Senators ask for details on opioid shipments through the mail. Sens. Claire McCaskill, D-Mo., and Ron Johnson, R-Wis., have asked several agencies including the Postal Service to detail how they work to stop illegal drugs like fentanyl from coming into the U.S. from other countries. Various reports have show that overdose deaths from the opioid fentanyl, which is more potent than heroin, have nearly doubled from 2015, to 20,000 in 2016. Drug investigations have shown that fentanyl largely comes through the mail from China, and people who use or sell them often them online. “Fentanyl is now killing more Americans than heroin or any other opioid, and we should use every tool at our disposal to keep it from entering the United States,” McCaskill, who is the top-ranking Democrat on the Homeland Security and Governmental Affairs Committee, said in a statement.  

Thanksgiving Trivia

Nearly 51 million people will be traveling this Thanksgiving season. This is the highest volume in over a dozen years and is a 3.3 percent increase from last year, according to AAA. Travel times are projected by AAA and INRIX, a global transportation analytics company, to reach as much as three times longer than the optimal trip when traveling in the most congested U.S. cities. Of these travelers, 45.5 million will be driving.

Why is it higher than usual? “A strong economy and labor market are generating rising incomes and higher consumer confidence, fueling a strong year for the travel industry, which will continue into the holiday season,” Bill Sutherland, AAA senior vice president of travel and publishing, said in a statement.  

The Thanksgiving season is the deadliest holiday for alcohol-related driving. The Wednesday night before Thanksgiving, or “Thanksgiving Eve,” is associated with drinking alcohol and is a big night for bars. From 2012 to 2016, more than 800 people died in alcohol-impaired-driving crashes during the Thanksgiving holiday, making it the deadliest holiday on the road, according to the National Highway Traffic Safety Administration.

Number of calories in a Thanksgiving meal. An average of 3,000, according to the Calorie Control Council, an industry group. Eating appetizers and drinking alcohol can bring that total to more than 4,500 calories. On typical days, women are advised to eat 2,000 calories and men are advised to eat 2,500 calories to maintain their weight.  

‘Turkey Bowl’ injuries expected in ERs. Roughly 1,400 emergency room visits were associated with football last Thanksgiving, an uptick from the 2016 average of roughly 1,000 a day, according to the United States Consumer Product Safety Commission.

Advice from ER doctors. “Distractions, multitasking and poor decisions make Thanksgiving one of the busier days in many emergency departments,” Dr. Paul Kivela, president of the American College of Emergency Physicians, said in a statement. “If an emergency does occur, don’t delay a trip to the ER, putting off care might seem convenient at the time but poses serious health risks.” More Thanksgiving safety advice.

RUNDOWN

Axios How activists are blocking states from getting execution drugs

Roll Call Lawmakers push alcohol tax cut despite rising drinking rates

Bloomberg Millions face pain and withdrawal as opioid prescriptions plummet

New York Times Sugar industry long downplayed potential harms of sugar

STAT News These bacteria keep swapping resistance genes, even with no antibiotics around

Kaiser Health News This Thanksgiving, carve out time for lively discourse on end-of-life wishes

Washington Post SCOTUS will consider free speech for anti-abortion pregnancy centers

Calendar

WEDNESDAY | Nov. 22

Congress is out all week.

THURSDAY | Nov. 23

Nov. 23-24. Thanksgiving holiday. No Daily on Healthcare newsletter.

MONDAY | Nov. 27

Nov. 27-Dec. 1. Politico’s Women Rule Week. Details.

Senate in session. House not in session.

WEDNESDAY | Nov. 29

9:30 a.m. Senate Health, Education, Labor and Pensions Committee hearing on the nomination of Alex Azar for Health and Human Services Secretary. Details.

12:30 p.m. House Committee on Oversight and Government Reform hearing on “Combating the Opioid Crisis.” Details.