Daily on Healthcare: Nearly 4.7 million signed up for Obamacare plans as enrollment period enters homestretch

Nearly 4.7 million signed up for Obamacare plans as enrollment period enters homestretch. Nearly 4.7 million people signed up for 2018 Obamacare plans through the federal healthcare.gov website as of Saturday, according to the Centers for Medicare and Medicaid Services. Of the customers who have signed up, 3,299,885 were renewing coverage and 1,378,476 were new customers for the period that ended Dec. 9. While the numbers currently outpace the totals at the same time last year, they still have a long way to go to match the 9.2 million people who enrolled on the federal exchange for 2017, when the open enrollment period was twice as long. A surge of signups is expected during the final days of open enrollment, which ends Dec. 15. On the surface, it would seem like a stretch for nearly as many people to sign up for open enrollment in the final six days as signed up in the first 39. But it’s also worth remembering that current enrollees who don’t take any action will be automatically placed into a similar plan. That could add millions to the eventual total.

Will people drop out of Obamacare plans at a higher rate in 2018? What we’ve learned in the first several years of Obamacare is that there is typically a sizable gap between the number of people who are announced as signing up for Obamacare during the open enrollment season and those who actually remain enrolled in plans. Many stop paying their premiums, find coverage through their employers or drop out of the insurance market for another reason. For instance, at the end of the previous open enrollment period, the Department of Health and Human Services announced 12.2 million signups — but the number of individuals enrolled had dropped to 10.1 million by the end of June. It’s worth asking, even if this year’s open enrollment total matches last year’s, whether more individuals will drop out of the individual market in 2018 than had in previous years. As noted above, those who are currently enrolled and take no action during open enrollment are automatically enrolled in similar plans. However, in January, those who don’t receive subsidies will be facing significant premium increases. People who blew past the open enrollment period and see their premiums rise may be more likely to cancel their plans. Throw in the fact that there’s a strong chance that the individual mandate penalties will disappear as a result of the Republican tax bill, and there’s a good case that next year’s dropout rate will be noticeably higher.

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.

Democrats, Obamacare allies press for tax reform delay after Jones victory. Top Senate Democrats and Obamacare advocacy groups demanded that tax reform legislation be delayed until after Doug Jones is seated in the Senate, giving Republicans an even slimmer margin of error. Democrats hoped to press their advantage after Jones scored a major upset Tuesday over controversial GOP nominee Roy Moore, leaving Republicans with a 51-49 majority in the Senate. “I am hoping that Republican leaders accept the will of the people of Alabama and halt their attempt to jam through massive tax cuts for the rich until Senator-elect Jones is seated,” said Sen. Patty Murray of Washington, the top Democrat on the Senate Health, Education, Labor and Pensions Committee. The Obamacare advocacy group Protect Our Care also called for a delay in taking up the legislation. “They must allow Doug Jones to be sworn in and force every Republican senator to decide if they want to be the deciding vote on a bill that devastates American healthcare to give tax breaks to billionaires and big corporations,” the group said. Senate Majority Leader Mitch McConnell said Tuesday that current Republican Sen. Luther Strange would serve until Dec. 31. Republicans hope to vote on tax reform, which is likely to include repeal of Obamacare’s individual mandate, by Christmas.

Republicans say ‘no dice.’ Republicans will stick to their plan to clear the tax bill before adjourning at the end of next week, according to a Capitol Hill source with knowledge of the plan. House and Senate lawmakers from both parties who are participating in a conference on the tax bill will meet at 12:30 today with President Trump to discuss the legislation, which would cut corporate and individual tax breaks, end popular deductions and repeal the Obamacare mandate penalties.

Jones gives a shout-out to the Children’s Health Insurance Program during victory speech. “Take this opportunity in light of this election and go ahead and fund that CHIP program before I get up there,” he said. “Put it aside and let’s do it for those million kids and 150,000 here in Birmingham, Alabama.”

Alabama to notify parents about end of children’s health fund around Christmas. Alabama health officials plan to send letters to families the day after Christmas to warn them that a federally funded medical insurance program that covers 80,000 children in the state will run out. Cathy Caldwell, who runs the program that is funded by the federal Children’s Health Insurance Program, told the Anniston Star that if Congress doesn’t renew spending, her office would send notices to families on Dec. 26. If Congress doesn’t approve the funding, it would run out by Feb. 1. New enrollees would be prevented from joining the program as early as Jan. 1.

Tina Smith, former Planned Parenthood executive, will replace Al Franken in Senate. Gov. Mark Dayton, D-Minn., announced Wednesday that Lt. Gov. Tina Smith will replace outgoing Sen. Al Franken in January. “Tina Smith is a person of the highest integrity and ability. There is no one I trust more to assume the responsibilities of this important office. I know that she will be a superb senator, representing the best interests of our state and our citizens,” Dayton said during a press conference in St. Paul Wednesday morning. “I accept this appointment, and it will be my great honor to serve Minnesota as United States senator,” Smith said. “Though I never anticipated this moment, I am resolved to do everything I can to move Minnesota forward. I will be a fierce advocate in the United States Senate for economic opportunity and fairness for all Minnesotans.” Smith has served as Minnesota lieutenant governor since 2015 and worked as Dayton’s chief of staff for the five years leading up to that promotion. She was vice president of a regional Planned Parenthood and graduated from Stanford University. Smith will hold the temporary office until a special election is scheduled next year, though her term will formally conclude in January 2019 if she loses. Franken’s term was set to expire in 2020.

House Republicans seek delays of Obamacare taxes. House Republicans introduced legislation Tuesday to delay Obamacare’s taxes on medical devices and insurers as well as the law’s employer mandate to provide coverage to workers. Legislation from Reps. Erik Paulsen of Minnesota and Jackie Walorski of Indiana would delay a sales tax on device makers for five years and would delay for one year a tax on Obamacare insurers. Republicans also filed bills to provide relief for two years from a tax on over-the-counter drugs and a one-year delay of the “Cadillac tax” on high-cost medical plans. A bill from Rep. Carlos Curbelo of Florida would provide two years of relief from the health insurer tax for healthcare plans regulated by Puerto Rico. The goal of the five bills is to head off some of the taxes from going into effect at the start of 2018. For instance, the medical device and insurer taxes are scheduled to go back into effect in January after a temporary moratorium expires.

Actuaries say Alexander-Murray won’t offset repeal of Obamacare individual mandate penalties. A bipartisan bill that would help fund out-of-pocket costs for Obamacare customers would not be enough to offset the cost effects of repealing the law’s provision that requires people buy insurance or pay a fine, the American Academy of Actuaries warned Tuesday.

The warning came in a letter to congressional negotiators drafting a final version of the Tax Cuts and Jobs Act. The group recommended reinsurance funding as an alternative but did not say how much funding was needed. “When considering this legislation, policymakers should consider the potential adverse consequences of eliminating the mandate, including increases in premiums and the number of uninsured, unless adequate alternative mechanisms or market stabilization provisions are implemented,” the group wrote, citing reinsurance later in the letter. The actuaries acknowledged in their letter that the Obamacare penalty had not worked well, writing that, “in practice, its financial penalty is usually low as a share of premiums, many individuals are exempt, and enforcement is weak.” Still, the group concluded that the mandate “increases enrollment above what it would otherwise be.”

Maine prepares to consider Medicaid expansion. Maine voters in November passed a ballot initiative to accept Obamacare’s Medicaid expansion, and the legislature’s budget committee is gathering today to determine how to pay for it. Maine Gov. Paul LePage, who opposed the expansion, sent a letter to lawmakers this week saying the program must be paid for without raising taxes or tapping the state’s budget stabilization fund. LePage is leaving office next year. A 2014 study by the Maine Department of Health and Human Services found that expansion could cost more than $800 million over a decade.

Aetna to cover opioid overdose antidote at no cost to customers. Health insurer Aetna announced Tuesday that it will provide the lifesaving opioid overdose reversal drug Narcan to some of its customers at no cost. The medicine will be available to customers who are insured under Aetna’s commercial plans, such as those through work, beginning on Jan. 1. Narcan is a nasal spray that works to awaken someone who has overdosed on an opioid such as a prescription painkiller or heroin and also works to combat more potent drugs like fentanyl. A package of Narcan, which includes two nasal sprays, typically costs as much as $150. Some states allow naloxone, the active drug in Narcan, to be given to patients without a prescription. Prior to the announcement Aetna already paid for most of the cost of the drug, and patients paid between $30 and $40 in co-pays.

FDA moves to end snortable chocolate, calling it ‘street drug alternative.’ The Food and Drug Administration warned a pair of Florida companies Tuesday to stop distributing a snortable chocolate powder, claiming it’s being sold as an unapproved new drug and as a “street drug alternative.” The regulatory action against Coco Loko comes six months after the product’s debut, and after Senate Minority Leader Chuck Schumer, D-N.Y., called it “cocaine on training wheels.” The FDA warned Legal Lean LLC and distributor Arco Globus Trading LLC they have 15 business days to respond with steps to come into compliance. Neither company immediately responded to requests for comment. Legal Lean’s website was offline Wednesday morning. Unless the companies challenge the FDA, they likely will have to discontinue sales or dramatically change promotional materials discussing nasal use and experiential effects.

DEA, Justice Department support change, not repeal, of opioid-shipment law. The Drug Enforcement Administration and the Department of Justice support changing a law that critics say hamstrings their ability to freeze suspicious shipments of prescription opioids. “We are in agreement with a change,” Demetra Ashley, acting assistant administrator for the DEA’s Diversion Control Division, said while testifying during a Senate Judiciary Committee hearing. “What that change will look like ultimately is going to require further discussion.” She said the agencies prefer an amendment over repealing the law, called the Ensuring Patient Access and Effective Drug Enforcement Act. Sen. Claire McCaskill, D-Mo., has said she plans to introduce legislation to repeal the measure.  “We believe now we are leaning more toward more amending it,” Ashley said, adding that current legislation had made it more difficult to halt suspicious shipments. Ashley declined to say how the law should be changed, saying a lawyer would need to draft the language. Sen. Ted Cruz, R-Texas, asked the DEA to submit a recommendation in writing once the agency had a chance to review it. “We can’t understand what you are requesting if the agency does not request it clearly and with language attached,” Cruz said.

The Pentagon says it has to train 23,000 personnel by Jan. 1 to prepare for transgender recruits. The Pentagon needs to prepare more than 23,000 personnel to begin accepting the Defense Department’s first transgender recruits on Jan. 1 following a court order, according to a top human resources official. That includes “preparation, training and communication” with recruiters and personnel at military entrance processing stations, who must have a working knowledge or in-depth medical understanding of the requirements for accepting transgender enlistees. That’s according to Lernes Hebert, the acting deputy assistant secretary of defense for military personnel policy, in a Washington district court filing. The Trump administration has argued the military is not prepared and is seeking an emergency delay in the Jan. 1 recruiting deadline, which was imposed by a D.C. district court judge as part of a lawsuit over the president’s ban on transgender military service.

Pennsylvania legislature passes 20-week abortion ban. Pennsylvania’s legislature passed a bill Tuesday to ban late-term abortions after five months of pregnancy. The bill does not include exemptions for rape, incest or fetal abnormality. It now heads to Democratic Gov. Tom Wolf, who has pledged to veto the legislation. The legislature’s move comes as anti-abortion advocates are pressing for the Senate to take up a 20-week abortion ban. The legislation passed the House, but McConnell has not brought it up. The legislation would likely fail since it would need 60 votes in the Senate. Planned Parenthood said the legislature was “passing a measure that strips women of their basic reproductive rights and actually puts them at risk.”

California, North Carolina, New York hospitals would see biggest cuts to drug program, study shows. Hospitals in three states would see cuts of $62 million to $126 million because of new cuts to a program that gives hospitals drug discounts. The research from consulting firm Avalere Health looked at how a 30 percent reduction in payments under the 340B program would affect states. Six states will see drug cuts of more than $50 million in 2018, Avalere said. The Trump administration has said that the interim final rule to institute the cuts would help lower drug prices, but critics say that there is no oversight to ensure the discounts given to hospitals are passed along to patients. Avalere found that because Medicare beneficiaries are responsible for a large portion of total drug reimbursement, lower Medicare payments to providers would result in savings to patients. California, New York and North Carolina would also see the highest consumer savings, ranging from $32 million to $15 million. “This payment change represents a significant reduction in drug-related revenue and profitability for some hospitals, and will require immediate action to plan for 2018 budgets,” said Dan Mendelson, president at Avalere. “At the same time, the payment change also delivers meaningful savings to Medicare beneficiaries who are responsible for paying a portion of their drug costs.”

Mo Brooks reveals he has prostate cancer. Rep. Mo Brooks, R-Ala., said Wednesday he has been diagnosed with high-risk prostate cancer and credited his loss in the Republican primary for the Alabama Senate with saving his life. The Alabama congressman revealed the diagnosis in an emotional speech on the House floor, during which he said he had to explain why he would be missing votes in the lower chamber. Brooks said he will be having a prostatectomy Friday and will spend next week recovering in Alabama unless he is medically cleared to travel. “God works in mysterious ways,” Brooks said. “When you are an elected official, missed votes require an explanation. That’s why I disclose this very personal, very private and very humbling matter.” The Alabama Republican said he learned of his prostate cancer on Halloween night when he received a phone call from his doctor while standing on the steps of the Capitol.

RUNDOWN

Politico Obamacare signups are expected to lag at the end of open enrollment

Axios The healthcare merger arms race

Washington Post Doug Jones’ win victory nearly closes the GOP doorway to Obamacare repeal

NPR Down syndrome families divided over abortion ban

Kaiser Health News Why do people hate Obamacare anyways?

STAT News What pharma is watching as Congress tries to hammer out a tax bill

Washington Post Fact checking Jimmy Kimmel on CHIP funding

Associated Press Lawyers clash over impact of Trump’s rules on birth control

Calendar

CALENDAR  

WEDNESDAY | Dec. 13

Health and Human Services Innovation Day. Livestream.

THURSDAY | Dec. 14

9 a.m. Ronald Reagan Building. 1300 Pennsylvania Ave. Medicaid and CHIP Payment and Access Commission to host public meeting. Details.