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Cities sue Trump, calling ‘sabotage’ of Obamacare unconstitutional. A group of five cities are suing President Trump over his administration of Obamacare, claiming that his actions undermine the healthcare law and violate the Constitution. The cities’ claim in the lawsuit filed Thursday is that Trump is violating his duty under the Constitution to “take care” that laws are faithfully implemented by sabotaging Obamacare. The cities: Baltimore; Chicago; Cincinnati; Columbus, Ohio; and Charlottesville, Va. The left-leaning advocacy group Democracy Forward is also part of the lawsuit. As evidence that Trump is intentionally undermining the law, the lawsuit points to the administration slashing funds for outreach and ads to promote Obamacare. Also, it cites the administration’s efforts to promote insurance plans that don’t comply with Obamacare’s requirements. Cheap non-compliant plans that the administration says are meant to help people priced out of Obamacare’s marketplaces could also cause younger and healthier people to opt out of the exchanges, causing destabilization.

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The lawsuit is the latest healthcare legal fight to embroil Trump administration. The lawsuit opens a new legal front on efforts by states and cities to fight moves by the Trump administration. Previously, a group of 11 states and the District of Columbia sued the Trump administration to stop the expansion of association health plans. And a collection of 18 states sued the Trump administration last year to stop the president from cutting payments to Obamacare insurers called cost-sharing reductions. A group of Democratic states also sued the administration over the tax reform law, which included repeal of the individual mandate’s financial penalty.

Azar denies HHS is ‘sabotaging’ Obamacare, which he wants to repeal. Health and Human Services Secretary Alex Azar pushed back on the criticism that met him Wednesday after he unveiled new rules to expand access to cheaper plans: That the rules are part of a campaign to “sabotage” Obamacare. Azar said that Obamacare is “fundamentally flawed,” and that Congress needs to repeal and replace it. New efforts to expand the duration of short-term plans and access to association health plans, he said, will not cause people to flee Obamacare’s exchanges, as numerous experts have predicted. “The ACA is sabotaging itself by its own structure,” Azar told reporters. Azar spoke shortly after finalizing a new regulation that expands the duration of short-term plans from 90 days to 12 months. Azar said both of the rules are about providing choice for consumers, especially Obamacare customers who don’t get income-based subsidies that lower premiums. Azar also expressed doubt that the plans will affect enrollment on Obamacare’s marketplaces, where 87 percent of customers get a subsidy.

But Azar reiterates he isn’t a fan of Obamacare. Democrats and Obamacare allies portray the new short-term plans rule as part of an administration effort to destabilize Obamacare and make it easier for Congress to repeal it. “With this latest act of health care sabotage, President Trump is once again putting millions of people nationwide who have pre-existing conditions at risk of being priced out of coverage they can afford or denied coverage altogether,” said Sen. Patty Murray, D-Wash., a member of Senate Democratic leadership. While Azar said that the move was not intended to sabotage Obamacare, he did say that the long-term vision for the Trump administration is to repeal and replace the healthcare law. Until Congress repeals the law, he said, he will try to transform the system “to make insurance as private-sector as possible, as affordable as possible, as state-choice based as possible and present as many options to individuals as possible.”

Marco Rubio unveils plan providing paid parental leave in exchange for delaying retirement. Parents could draw from their Social Security early to spend time with a new child in exchange for delaying retirement, under a proposal unveiled by Sen. Marco Rubio, R-Fla. The move to address paid family leave is unusual for a Republican, as the idea has typically had Democratic support, and it’s unclear whether Rubio’s idea will be able to gain traction. Although a House version of the legislation, the Economic Security for New Parents Act, will be filed by Rep. Ann Wagner, R-Mo., it does not yet have any co-sponsors in the Senate. The provision would be voluntary and would not add taxes to people’s paychecks. In exchange for the leave, parents would delay retirement benefits from three to six months. “There is widespread agreement among the folks we have been talking with that this is the direction to go,” an aide from Rubio’s office said. “Sen. Rubio is getting the bill out to start the conversation. This has been a topic among Democrats and the folks on the Left, but there hasn’t been a concerted effort by Republicans.” Rubio had introduced the bill, the aide continued, “fully realizing that people will be forced to engage and changes will be made along the way.”

Senate rejects Cruz’s bid to stop D.C.’s effort to start own individual mandate. The Senate voted down an amendment Wednesday from Sen. Ted Cruz, R-Texas, to block the District of Columbia from creating its own individual mandate. The Senate voted 54 to 44 to table Cruz’s amendment to an appropriations bill that would prohibit any funding from going towards the District of Columbia’s individual mandate law. The House already passed a bill that strips the D.C. law. The new Republican tax law passed in December zeroed out the financial penalty under Obamacare for not having insurance starting in 2019, but several state and local governments are pursuing their own individual mandates due to concerns about premium hikes. Congress can block any laws passed by the District of Columbia’s local government but it normally doesn’t. “Under the Constitution it is Congress that has the responsibility for the District of Columbia,” Cruz told reporters.

Senate defeats move to protect vegan milk. The Senate has defeated a measure that would have protected plant-based companies who want to keep calling some of their dairy-free foods “milk,” “yogurt,” or “cheese.” The amendment, offered by Sen. Mike Lee, R-Utah, would have blocked the Food and Drug Administration from using government funds to enforce its definitions on all food and drink. It was defeated 84-14. Banning these products from using the dairy terms may happen at the administrative level. The Trump administration is starting to consider whether to enforce the definition of “milk,” “yogurt,” and “cheese,” something that the dairy industry has long asked for as sales have fallen. Currently the FDA’s language defines “milk” as a “lacteal secretion” from a cow, so products such as soy, rice, almond, or coconut milk do not meet the definition. The FDA has these definitions, known as “standards of identity,” to protect consumers from being tricked into buying something different from what they expect. The dairy industry argues that the plant-based alternatives don’t contain the same levels of vitamins and minerals, and so they shouldn’t be marketed as being similar to dairy milk.

Cigna posts revenue growth as concerns rise over merger with Express Scripts. Cigna’s healthcare business helped spur a 10 percent growth in revenue for the three months through June, the company said on Thursday after reports surfaced that a top activist investor is set to disapprove of the health insurer’s merger with Express Scripts. At the end of June, Cigna insured 16.2 million individuals, a 329,000 increase over last year. Cigna is awaiting federal approval for its attempted acquisition of Express Scripts, one of a handful of mergers that seeks to combine a health insurer with a pharmacy benefit manager. The combined entity would be expected to have more control over, among other things, negotiations on drug prices with pharmaceutical companies. The insurer expects to comply with a second request for information from the Department of Justice in August, after which the government will have 90 days to complete its review of the transaction. But opposition from Carl Icahn could complicate the merger. The activist investor, who has a less than 5 percent stake in the insurer, reportedly believes Cigna is paying too much to acquire Express Scripts, the Wall Street Journal reported on Wednesday. The two companies are set to vote on the merger on Aug. 24, and Icahn is reportedly considering trying to convince other shareholders to vote against it.

California insurance commissioner opposes CVS-Aetna merger. The move would have anti-competitive results, concludes California Insurance Commissioner Dave Jones. He urged the Department of Justice in a 15-page letter to reject the deal. “The proposed merger of CVS and Aetna will significantly reduce competition in the PBM and Medicare Part D markets, affecting millions of health care consumers throughout the country,” Jones said in a statement. “A merger of this size and type, according to experts on health insurer and health care mergers, will likely lead to increased prices and decreased quality.”

Missouri Obamacare insurers raise and lower rates for 2019. Two of the Missouri’s four Obamacare insurers proposed raising prices for 2019, while another is decreasing its rates by nearly 10 percent. Cigna is proposing an average rate hike of 7.3 percent and Healthy Alliance Life Insurance Company is proposing a 3.67 average hike, the state’s insurance regulator said Wednesday. But Celtic Insurance Company calls for lowering rates by an average 8.6 percent. Also, new Obamacare insurer Medica is entering the market in 2019.

RUNDOWN

The Hill Meet the group funding the fight to expand Medicaid in red states

Politico Trump’s losing fight against Obamacare

Kaiser Health News How rival opioid makers sought to cash in on alarm over Oxycontin’s dangers

New York Times What to know before you buy a short-term plan

Wall Street Journal Insurers seek smaller rate increases for Obamacare plans

Health News Florida Florida’s Medicaid request could be affected by Kentucky ruling

STAT News Did a blockbuster drug make hundreds gamble compulsively? A legal fight may decide what science can’t confirm

Bloomberg Teva plunges as U.S. sales drop amid generic price erosion