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Once a political punching bag, small Obamacare insurers chug along. When Obamacare’s marketplaces went online in 2014, the Obama administration created 23 small insurers to boost competition on the law’s insurance exchanges. Of those 23, only four now remain. Their demise became a political talking point for Republicans, who claimed that the collapse was evidence of Obamacare’s failure. But the remaining insurers, called consumer oriented and operated plans, or co-ops, say that they are stable and will offer plans in 2019 and that they are fulfilling the original goal of boosting competition, if only for a few states. A vast majority of co-ops closed in rapid succession back in 2015 and 2016. They failed for a variety of reasons, ranging from insufficient federal funding to misjudgment about who would sign up for Obamacare when the exchanges went online in 2014. When the majority of co-ops collapsed, Republicans in Congress argued that their failures presaged a “death spiral” that would collapse the entire individual market, in which people who don’t get insurance through their jobs or the government buy policies, and which is served by Obamacare’s insurance exchanges.

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Seven things to know about Obamacare as open enrollment begins. Obamacare’s sixth open enrollment begins Thursday, with a slew of new regulations and changes for customers to navigate as they shop for health plans. The healthcare law, formally known as the Affordable Care Act, over the years has faced website problems, regulation alterations, price hikes, and legal changes. It remains politically loaded, but is still the law of the land. Customers will still be able to buy coverage regardless of whether they are sick. Here are the seven things customers should know about open enrollment, the period when people can shop for health insurance plans on healthcare.gov or on state websites, both of which are known as “exchanges.” The rules apply to people in the U.S. who do not receive health insurance through a government program or work.

Midterms could result in nearly 3 million more people enrolling in Medicaid. Roughly 2.7 million people would sign up for Medicaid if their states elect a Democratic governor or if their state ballots pass, according to a study from Avalere Health. Fourteen of the 36 states with governors races have not expanded. Of those, six could go to expansion because the Democrat up for office supports it, and the other expansions would come from ballot measures in Idaho, Nebraska, and Utah. Florida could enroll more than 1 million in Medicaid, and next would be Georgia, where nearly 700,000 people qualify for the expansion. “The popularity of Medicaid expansion has risen, particularly in states with high rates of uninsured,” Chris Sloan, director at Avalere, said in a statement. “Although state legislatures can restrict the governor’s authority to expand Medicaid unilaterally in certain states, changing voter preferences around expansion may put pressure on legislators, many of whom also face reelection in November.”

Trump administration pushes back on criticism of drug pricing policy. The Trump administration addressed several criticisms that have surfaced against its proposal to tie prices for certain Medicare drugs to prices paid by other wealthy countries. Dan Best, Health and Human Services point man on drug pricing, released a blog on Tuesday that sought to address concerns of the proposal rolled out last week. He took on whether the proposal is “freeloading off of socialist price-setting systems,” a reference to government-run single payer programs that negotiate with drugmakers to lower rates. Conservatives have criticized the proposal that sets a price control for physician-administered drugs like a vaccine or chemotherapy covered under Medicare. Best responded that the proposal only replaces an artificially high price point with a “more rational price point, between that average of private payers and the average of what foreign governments pay for these drugs.” Currently Medicare pays the average sales price for a physician-administered drug, plus an extra six percent of that price to the doctor. But by tying the prices to the prices that wealthy countries like Germany or France pays, “the pharmaceutical industry would finally be pressured to fairly allocate the burden of funding innovation across wealthy countries.”

Limited Internet access in Arkansas imperiling Medicaid coverage, analysis says. A new analysis found that 18 percent of Arkansas residents lack Internet access in their homes, even through a cell phone. The analysis from the left-leaning think tank Urban Institute released Tuesday references a prevalent issue for the state where more than 4,000 people have lost coverage because of failing to comply with the state’s work requirements. The state has used an online portal as the primary means for Medicaid enrollees to report their completed work hours or an exemption. Urban Institute also interviewed 18 Medicaid enrollees in several different parts of the state and found that they had a “low awareness” of the work requirements and were concerned about being unable to successfully report any work hours or an exemption.

Bill Cassidy touts Netflix, but for funding pricey hepatitis drugs. Sen. Bill Cassidy, R-La., co-authored a paper on Tuesday that proposes setting up a Netflix-like subscription model for states to cover skyrocketing costs for hepatitis C treatments. The idea, put forth in a paper published in the Journal of the American Medical Association, highlights the bind that many states are in, struggling to pay for high hepatitis C treatments.

Catholic Health Association President to retire. Sr. Carol Keehan will retire as president and chief executive officer of the Catholic Health Association of the United States, effective June 30, 2019. Keehan helped gather support for the passage of the Affordable Care Act and is considered one of the most influential people in healthcare. “It is an inspiration to see the genuine commitment of the members of the Catholic health ministry in the United States to providing people with the health care they need, not just the health care they can afford,” said Keehan said in a statement. “The efforts to do this as a ministry of the Church, both in our daily actions as well as in raising a voice for them in the public square, characterizes the members of CHA even in the most challenging times. Having been able to represent them in many forums is a privilege I will always treasure.”

Higher premiums, Medicare growth underpin Anthem profit gains. Higher revenue from insurance premiums and a larger federal insurance business fueled double-digit profit growth at insurer Anthem in the third quarter of 2018.

SBA List hits Manchin with new ad on abortion. The anti-abortion group Susan B. Anthony List has released an ad urging West Virginia voters to vote against Sen. Joe Manchin, D-W.Va. The ad is part of a $500,000 campaign in the state, and is aimed at showing that Manchin voted to fund Planned Parenthood.

Energy drinks causing long-term adverse health effects on soldiers. Energy drinks that are used to ward off sleep deprivation in the military are having long-term adverse health effects on soldiers, according to a study in the Military Medicine journal.

Cases of polio-like illness rise. More cases of acute flaccid myelitis, or AFM, have been confirmed, raising the total to 72. This number could end up going even higher because it falls within the 191 people that the Centers for Disease Control and Prevention is monitoring across 24 states. The director of the agency, Robert Redfield, said on CBS “This Morning” this week that it’s still not clear what’s causing the illness. AFM is still rare, but its symptoms are severe, with patients – mostly children – facing paralysis.

Pedestrian deaths rise on Halloween. That’s according to a study out Tuesday in the Journal of the American Medical Association. It found that every year as children are circling their neighborhoods for Trick-or-Treating, rates of pedestrian deaths go up. Authors of the study theorized that this happens because people may be drinking more this time of year, and people cross the street without checking to see whether a car is coming, or are walking outside of intersections. It also can be harder to see people at night time, and they are wearing costumes that blend in with the dark.

AMA gives $15 million to improve doctor training. The American Medical Association rolled out on Tuesday a new $15 million grant program aimed at boosting doctor residency training. The goal of the program is to create a seamless transition from medical school to residency at a hospital. It will provide $15 million over five years to fund up to eight experiments at medical schools and health systems. “The goal of the effort is to address the growing gap between how physicians are being trained and the skills they’ll need to practice in modern health systems,” the doctor group said in a statement.

RUNDOWN

Politico Obamacare enrollment opens facing pressure from new Trump attacks

CNBC CVS tests a membership program as Amazon pushes into prescription drugs

Buzzfeed JUUL offered to pay schools as much as $20,000 to blame vaping on peer pressure

New York Times In echo of Flint, water crisis now hits Newark

STAT News FDA says it will consider approval of the first dengue vaccine, despite controversy

Kaiser Health News In swing districts, Republicans may pay for having tried to reverse the health law

Washington Post Why are red states adopting Obamacare?

San Diego Union-Tribune Two years after it started, San Diego declares end to deadly hepatitis A outbreak