Daily on Healthcare: McConnell won’t move on Alexander-Murray without Trump

McConnell won’t move on Alexander-Murray without Trump. When asked on CNN Sunday whether he might call a vote on the Alexander-Murray bill to stabilize Obamacare, Senate Majority Leader Mitch McConnell replied, “Well, what I’m waiting [for] is to hear from President Trump what kind of health care bill he might sign.” The White House has released details of how Trump would like to move the bill further to the right, including through providing “relief” against the individual mandate obligating people buy insurance or pay a fine. “I think he hasn’t made a final decision,” McConnell said of Trump. “When he does, and I know that we’re not just debating it, but actually passing something to be signed, I would be happy to bring it up.” It appears the bill would pass in the Senate, but currently does not have enough support in the House. Senate Minority Leader Chuck Schumer, D-N.Y., said that all 48 Democrats support it, and a least 12 Senate Republicans support it, so it would likely receive the 60 votes it needs for passage. “The president holds the key to preventing premiums from going up,” Schumer said in a statement. “Now that Leader McConnell has made it clear he will put the Murray-Alexander bill on the floor as soon as the president supports it, the president should say that he does. But even if the president doesn’t offer his support, I would respectfully urge Leader McConnell to put it on the floor where it would pass with a large number of votes and increase pressure on Speaker Ryan to put it on the floor in the House – and I doubt the president would veto it.”

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Some insurers see dollars in Trump’s Obamacare executive order. Trump last week came out against a bill to stabilize Obamacare because he says he doesn’t want to “bail out” insurers that have “made a fortune” from the healthcare law. But in a twist, some insurers are expecting a major windfall from another part of Trump’s actions: His executive order calling for federal agencies to expand short-term and association health plans. The order directs agencies to start making regulations to extend short-term plans from 90 days to 364 days. It also would loosen rules for association plans, which let businesses and groups band together to create larger purchasing power. The biggest insurer in the country, UnitedHealth, was excited about the prospect of expanding the regulations. Dan Schumacher, the head of its insurance division, said the company already sells many association plans. “All told, we have got about 300,000 members in association plans today,” he said on an earnings call Oct. 17. “So, we have got a lot of experience, the performance is strong and I would say generally in keeping with our broader portfolio.” Schumacher also was bullish about the prospects for expanding short-term plans, which the Obama administration had shrunk last year to 90 days. “We are excited to see that extended to the full year, because the reality is it provides a bridge for people in between coverage,” Schumacher said. “It’s a lot more affordable option.” Other insurers and medical underwriters also are eyeing a boon under new regulations to expand short-term plans. Independence Holding Co., a medical underwriting group, said it expects to “significantly increase sales of not only short-term medical insurance but also hospital indemnity,” which are bare-bones plans. The underwriting group is even making investments to prepare for the increase in sales. “In our experience, [short-term plans are] primarily purchased by people between jobs, people in counties with only a single insurer offering exchange plans, people with limited coverage networks and people who missed the open enrollment period but still want insurance,” said President and COO David Kettig.

Trump to fulfill months-long promise of opioid emergency declaration. Trump is expected this week to formally declare the opioid epidemic a national emergency, more than two months after verbally proclaiming it, which will help free up resources to respond to the crisis. “The opioid crisis is an emergency,” Trump said in August. “And I am saying officially right now: It is an emergency; it’s a national emergency.” But filing the legal paperwork took time, requiring input from legal and and medical experts even as White House officials said that the process was under “expedited review.” The paperwork details the kinds of responses the federal government and states will take and how long the emergency declaration will last. Declaring the epidemic a national emergency is unusual for a public health issue. Typically, a public health concern receives a “public health emergency” title from the secretary of Health and Human Services, such as the 2016 declaration for the Zika virus in Puerto Rico or the 2012 declaration in New York following Hurricane Sandy. While such a declaration has been done before for a medical issue, such as former President Barack Obama’s declaration on the swine flu epidemic, it is still considered unprecedented because it addresses issues of addiction, privacy, and potential distribution of treatment medications for widespread use.

Urban areas have fewer insurers this year. A new study found that competition among health insurers has declined by 8 percent this year in metropolitan areas. The American Medical Association study comes as Obamacare has struggled with major insurer defections and less competition on the law’s exchanges. AMA found that “in 169 of 389 metropolitan areas (43 percent) a single insurer had at least 50 percent of the market share.” That was an 8 percent increase over two years. The study focused on the competition in the employer-sponsored health insurance market. The individual market, which has Obamacare’s exchanges and is used by people without employer-sponsored or government insurance, also has been dealing with less competition for 2018. The Trump administration predicts that 48 percent of U.S. counties will have only one insurer next year.

Obamacare allies predict ad cuts will cost 1.1 million fewer signups. The Trump administration’s cuts to Obamacare’s advertising and outreach funding will lead to at least 1.1 million fewer people signing up this year, according to a pro-Obamacare group. Get America Covered released the analysis Monday, less than two weeks before open enrollment starts Nov. 1. Critics have said that the Trump administration’s ad cuts are part of an effort to sabotage the law, while the administration says it is trying to spend money more efficiently. “A minimum of 1.1 million fewer people will enroll in the federal exchange solely because of the administration’s drastic cuts to open enrollment outreach,” Josh Peck, an Obama administration veteran, wrote on the website Medium on Monday. “Keep in mind, this is the least harm the administration’s outreach cuts could have — this is a best case scenario. It assumes they spend the $10 million they have budgeted well and that nothing else the administration has done will impact enrollment.”

Appeals court rules teen illegally in U.S. can have an abortion. A federal appeals court ruled Friday that an illegal immigrant teenager in U.S. custody must be allowed to get an abortion. The D.C. Circuit Court of Appeals said the Trump administration must find a sponsor by Oct. 31 so the government does not have to facilitate the abortion, according to a court filing.The 17-year-old is from South America and was caught crossing the U.S.-Mexican border. She is in U.S. custody in Texas. The American Civil Liberties Union sued to force the Department of Health and Human Services to allow her to have an abortion, which the Trump administration was blocking. The ACLU argued that the girl has a constitutional right to an abortion, while HHS argued she does not because she is in the country illegally. On Friday, the appeals court dissolved an earlier stay from a federal court in San Francisco. That federal judge ruled HHS had to facilitate the abortion, but the Trump administration appealed the ruling. The court agreed with the government’s argument that it is HHS policy for a minor to be released from HHS custody to a sponsor to facilitate the abortion but said finding the sponsor must occur “expeditiously.”

Justice Department says Obama-era medical marijuana prosecution wasn’t allowed. Federal prosecutors said this week that a high-profile Obama-era prosecution of medical marijuana growers wasn’t allowed because Congress voted to protect medical pot programs from federal interference. It’s a dramatic development in a case that pitted four family members and a friend — collectively known as the Kettle Falls Five — against federal prosecutors who won prison sentences for growers at a rural garden in Washington state. The admission in court that the family was right in claiming a federal spending bill’s protection has been too surprising from some long-time observers to accept at face value. Some believe there’s a secret motive in prosecutors requesting the case be remanded to district court, rather than dismissed outright by the U.S. Court of Appeals for the 9th Circuit, and note renewal of the protection has been blocked by GOP House leaders from a floor vote, potentially allowing for it to expire. Attorney and marijuana activist Douglas Hiatt, who initially was involved in the case, and Kari Boiter, a longtime liaison to national media outlets, expressed concern that prosecutors asked for remand to district court to allow for a lapse of the so-called Rohrabacher-Farr amendment. Assistant U.S. Attorney Earl Hicks, who prosecuted the case and co-signed the recent court filing with the U.S. Court of Appeals for the 9th Circuit, denied a secret motive, however. “There is no ploy,” Hicks told the Washington Examiner in an email, addressing the suspicion. “The law changed, and the United States is following the law as we always did during all the proceedings,” he said. “The Court of Appeals will determine the appropriate remedy.”

RUNDOWN

Washington Post McConnell says Trump needs to provide clarity on healthcare

The Hill Senators push to win support for Obamacare deal

Bloomberg French drugmaker crashes after peanut allergy drug fails in major trial

Axios Trump enlists family, cabinet and Congress in opioid response

NPR The FDA will decide if these 26 ingredients count as fiber

New York Times Cheaper health plans trumpeted by Trump have a history of fraud

STAT News How a blunder over Robert Mugabe has cost WHO the goodwill it needs

Associated Press More police officers receive training to help veterans in mental health crisis

Calendar

MONDAY | Oct. 23

Oct. 23-24. Milken Institute Future of Health Summit. Details.

TUESDAY | Oct. 24

9 a.m. Capital Hilton. 16th and K St. NW. Health Affairs event on “Choosing Wisely: Opportunities and Challenges in Curbing Medical Overuse.” Details.

10 a.m. 2358-C Rayburn. House Appropriations Committee hearing on “The Role of Facilities and Administrative Costs in Supporting NIH-Funded Research.” Details.

10 a.m. 2123 Rayburn. House Energy and Commerce Committee hearing on “Examining HHS’s Public Health Preparedness for and Response to the 2017 Hurricane Season.” Details.

Noon. President Trump to attend GOP Senate lunch.

1:30 p.m. Alliance for Health Policy webinar previewing open enrollment. Details.

WEDNESDAY | Oct. 25

8:30 a.m. 1777 F St. NW. The Hill event with Dr. Ben Carson, secretary of Housing and Urban Development, on “The Future of Housing.” Details.

10 a.m. 2358-C Rayburn. House Appropriations Committee hearing on “Down Syndrome: Update on the State of the Science and Potential for Discoveries Across Other Major Diseases.” Details.

10 a.m. 2123 Rayburn. House Energy and Commerce Committee hearing on “Federal Efforts to Combat the Opioid Crisis: A Status Update on CARA and Other Initiatives.” Details.

THURSDAY | Oct. 26

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

FRIDAY | Oct. 27

11:45 p.m. G50 Dirksen. The National Institute for Health Care Management briefing on “Transforming Health Care to Drive Value.” Details.