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Surge of signups expected during final week of healthcare.gov open enrollment. The last week of open enrollment for Obamacare plans has typically resulted in a surge of signups as people who procrastinated move to buy coverage. The open enrollment period is half the time it has been in previous years, so it’s difficult to assess exactly how large the surge will be. Latest enrollment numbers from HHS are expected Wednesday, but through Dec. 2, 3.6 million people have signed up for plans. Though this is higher than the same date last year, healthcare.gov eventually signed up 9.2 million a year ago, leaving HHS with quite a hole to fill by Dec. 15. But one factor to keep an eye on: Customers who don’t affirmatively change or cancel their plans by Friday will be automatically re-enrolled in the plan they had this year or placed in a similar plan. That could provide a big late boost. Early numbers suggest that there could be more than 6 million current enrollees who, as of Dec. 2, had not taken any action. Last year, 2.8 million people were automatically enrolled in plans. However, customers who don’t receive subsidies from the federal government and end up auto-enrolling could wind up paying significantly higher premiums.
Collins ‘absolutely confident’ congressional leaders will stick to the deal they made for her tax bill vote. Sen. Susan Collins said she has a written agreement from House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell to honor the promises made to her for her vote supporting tax reform legislation. Collins has seemingly been left in the lurch after House conservatives refused to say they would back some of the promises made to her during Senate tax negotiations. Among Collins’ proposals are including in a spending bill a provision that would replenish Obamacare subsidy payments to reduce premiums. Another bill promised for consideration is a bill she sponsored that woul give states $10 billion in reinsurance funding over two years. Collins said on CBS’ “Face The Nation” she has no reason to think the leaders will back out of their promise. “I’m absolutely confident, I have it in writing, a statement by both Mitch McConnell and Speaker Ryan,” she said. While the tax reform bill is negotiated in conference committee, Collins said she has been given no reason to worry that her deal has been tossed aside. “I’ve had a lot of conversations, not only with my colleagues in the Senate but with my colleagues from the House side and with the White House, I’ve talked to the president three times about this issue, and once again I have no reason to believe that that commitment will not be kept,” she said. Collins is reserving a statement about how she will vote on the tax bill until she sees the final product from the conference committee.
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House, Senate conferees scheduled to meet Wednesday. The conference committee will meet publicly Wednesday to work on the final version of the legislation, Chairman Kevin Brady of Texas announced Friday, and GOP members are expected to work through the weekend to reach an agreement. “The House and the Senate are working together now on a unified, pro-growth tax reform bill that will deliver more jobs, fairer taxes, and bigger paychecks,” said Brady, the chairman of the House Ways and Means Committee in addition to the conference committee. The meeting is scheduled for 2 p.m. Republicans have been working on resolving the differences between the two bills while maintaining support among their rank-and-file members. One of the biggest differences in the two versions of the legislation is the repeal of Obamacare’s individual mandate, which forces everyone to buy health insurance or pay a penalty. The Senate bill included repeal while the House did not. However, House Republicans have sounded optimistic about adding it into the final version.
Hospitals fight to keep tax break for hospital financing. The American Hospital Association is pulling out all the stops to preserve a tax exemption for private activity bonds used to finance new hospitals. The AHA wrote to House and Senate lawmakers meeting to iron out the tax bill. The House version eliminated a tax exemption for private activity bonds, a key financing tool for new hospitals and other nonprofits. The Senate version keeps the exemption in. Republicans hope to pass a final version of tax reform by the end of the year. The AHA lists other concerns with the legislation, including the Obamacare mandate repeal in the Senate version and the House version’s elimination of the medical expense deduction, which is preserved in the Senate bill.
House could be first up to tackle entitlement reform. Republicans who want to overhaul Medicare and Medicaid will have to look to the House to take the first crack at it next year. House Speaker Paul Ryan told radio show host Ross Kaminsky on Wednesday that he wants to revisit entitlement reform after tax reform is finished. But the last effort to tackle entitlements in Obamacare repeal failed in the Senate last summer, and a member of Senate leadership said that the House will have to take the first step at any reform bill. “I don’t know that that is something that we talked about that over here, but my understanding is the House is considering it,” said Sen. John Thune, R-S.D., the third-ranking GOP senator. Thune was asked if the Senate would take up an entitlement reform bill if the House passed one. “If the House sends us something, yeah,” he responded.
Doctor groups caution against Medicaid waivers involving work requirements. Doctor groups recommended a list of “principles” on Medicaid in a letter sent to Health and Human Services Acting Secretary Eric Hargan and CMS Administrator Seema Verma, writing that “our members believe that Section 1115 demonstration waivers, and other legislative or regulatory policies, must be evaluated based on the standard of ‘first, do no harm’ to patients enrolled in Medicaid.” The waivers allow for states to apply for changes to the program, and Verma said recently that the Trump administration would sign off on changes that require enrollees to work, volunteer or be enrolled in an education program. The doctor groups made it clear that they object. “CMS should ensure that waivers and other proposed changes to Medicaid do not impose punitive requirements that individuals be employed, be actively seeking a job, or be enrolled in a job training or job recruitment program and/or impose mandatory drug testing as a condition of eligibility,” they wrote. The letter was signed by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Osteopathic Association and the American Psychiatric Association.
Maine, Pennsylvania, Arizona top mental illness ranking. The ranking, published by MentalIllnessPolicy.org, studies states based on the percentage of state-controlled funds each state spends on mental illness. States that spent a lower percentage of their budget were Arkansas, West Virginia, Idaho, Kentucky, Oklahoma, Louisiana and Delaware. The most generous states were Maine and Pennsylvania at 5. Percent, which allocated eight times more as a percentage of total state spending than the lowest-spending state, Arkansas, at 0.7 percent.
Generic drug makers concerned about consolidation. The generic drug industry is getting worried after consolidation among pharmacies and wholesalers. The Association for Accessible Medicines, the industry’s leading trade group, wrote to the Federal Trade Commission to clamp down on supply side consolidation that is affecting generic competition. The group charged that three purchasers account for more than 90 percent of wholesale revenue. “As these purchasing consortia move more and more toward single-source contracts for generic contracts for generic drugs, it creates a dynamic where it is possible that no more than three generic manufacturers may be able to successfully market any given product,” the letter to the FTC said. The generic drug industry charges that smaller companies may be locked out of the market and the mergers could lead to drug shortages. The prices of generics have been a major focal point among lawmakers worried about high drug prices. However, most of the attention on Capitol Hill has focused on speeding up approval of generic drugs by the Food and Drug Administration.
RUNDOWN
Associated Press Deadline crunch for health law sign-ups under Trump
STAT News The way over-the-counter drugs is regulated is a mess. And Congress is ready to step in
The Hill Cadillac tax is sticking point for Congress
Los Angeles Times Drug manufacturers ask federal court to block California’s new prescription medicine transparency law
Politico Behind Trump’s plan to target the federal safety net
Kaiser Health News Sen. Collins’ strategy to stabilize insurance market raises doubts among analysts
Wall Street Journal Obamacare’s individual mandate: On its way out, or already gone?
New York Times Under new tax plan, cost of aging could rise
Reuters ‘Ground-breaking’ new drug gives hope in Huntington’s disease
Calendar
MONDAY | Dec. 11
1 p.m. America’s Health Insurance Plans to host Facebook Live event on open enrollment. View stream.
1 p.m. 529 14th St. NW. National Press Club media event on “Financial Capability of Adults with Disabilities.” Details.
TUESDAY | Dec. 12
Dec. 9-12. Atlanta. American Society of Hematology Annual Meeting. Details.
8:30 a.m. AARP Family Caregiving Summit. Details.
10 a.m. 430 Dirksen. Health, Education, Labor and Pensions Committee hearing on prescription drug costs. Details.
10 a.m. Dirksen 226. Senate Judiciary hearing on “Oversight of the Ensuring Patient Access and Effective Drug Enforcement Act.” Details.
10 a.m. Brookings Institute Webinar on “Impact Bonds for Health.” Details.
10:15 a.m. Rayburn 2322. House Energy and Commerce Committee hearing on “Examining Concerns of Patient Brokering and Addiction Treatment Fraud.” Details.
WEDNESDAY | Dec. 13
10 a.m. 430 Dirksen. Health, Education, Labor and Pensions Committee hearing on the 21st Century Cures Act focusing on mental health needs. Details.
10 a.m. Rayburn 2123. House Energy and Commerce Committee hearing on “Examining the Drug Supply Chain.” Details.
THURSDAY | Dec. 14
9 a.m. Ronald Reagan Building. 1300 Pennsylvania Ave. Medicaid and CHIP Payment and Access Commission to host public meeting. Details.
