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Trump CMS announces new flexibility from Obamacare for individuals and states. Having failed to repeal Obamacare, the Trump administration has moved forward with plans to give more flexibility to individuals and states. The Centers for Medicare and Medicaid Services on Monday expanded the list of hardship exemptions for the law’s requirement that individuals purchase health insurance. CMS said people who live in a county that has only one Obamacare insurer can receive an exemption from the penalty. It also lets people avoid the fine if the only affordable plans available on the law’s exchanges cover abortion. The law’s exchanges are on the individual market that is used by people who don’t get insurance through a job or the government. The mandate was repealed in Republicans’ tax legislation starting in 2019, meaning taxpayers must have insurance or pay a penalty this year. “We have been looking for ways to bring relief for Americans from Obamacare’s individual mandate penalty,” CMS Administrator Seema Verma said on a call with reporters. CMS officials said the new exemptions would apply in the 2017 and 2018 coverage years. The penalty is $695 or 2.5 percent of household income, whichever is highest. CMS did not provide an estimate of how many people would use the new exemptions. The law already has hardship exemptions including job loss or low income.

On Monday, The administration released new regulations aimed at giving states more flexibility to offer cheaper plans on Obamacare’s exchanges next year. The new rules, which outline how insurers can apply to offer plans on Obamacare’s exchanges in 2019, would ease the requirements on the health benefits that plans must cover in an effort to offer more affordable options on the exchanges, according to CMS. The changes include new flexibility in how states cover essential health benefits and how much money insurers must devote to improving services. Critics say the new rule will allow insurers to charge higher prices and skirt patient protections. The agency also is changing the requirements for how much money an insurer must provide toward medical services and quality improvement. Obamacare requires insurers to spend 80 percent of the money it takes in from premiums on health costs and quality improvements and 20 percent on administrative overhead or marketing. CMS would allow a state to change that ratio based on certain factors.

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Democrats attack new rule as undermining consumer protections. Critics weren’t too happy with the new rule, saying it makes it easier for states to roll back patient protections. Sen. Patty Murray, D-Wash., the top Democrat on the Senate Health, Education, Labor, and Pensions Committee, said the rule is an end-run around Obamacare’s patient protections. She charged that the essential health benefit rule would “open the door” to less comprehensive coverage, and she criticized the flexibility for the medical loss ratio. The pro-Obamacare group Protect Our Care also called out the administration for changes to requirements for navigators, which are nonprofits that help people sign up for Obamacare. “Today’s Trump administration action will make it even harder for Americans to sign up for coverage next year, with further cuts to local assisters who help families navigate their options and enroll,” said Protect Our Care Campaign Director Brad Woodhouse.

Long-simmering battle over e-cigarettes erupts as FDA clamps down on nicotine. The Food and Drug Administration is pressing ahead on regulating tobacco products, but a long-simmering battle has erupted over the future of e-cigarettes. Anti-tobacco groups say it’s time for vaping companies to submit information about their products to the FDA, while e-cigarette manufacturers say such a demand is burdensome, unnecessary, and would create a black market of dangerous products. Meanwhile, tobacco companies are hoping to cash in by creating their own inhalant alternatives that would heat, rather than burn, nicotine. Adding to the tension is the desire to settle lingering questions over the extent to which vaping is safer than traditional cigarettes and whether it can be effective at helping people quit.

CBO: Healthcare programs will cost U.S. nearly $17 trillion over next decade. Spending for major healthcare programs such as Medicare and Medicaid are expected to explode by nearly $17 trillion over the next decade, according to a new outlook from the nonpartisan Congressional Budget Office. The agency found that federal spending on major healthcare programs including Medicaid, Medicare, subsidies offered on Obamacare’s exchanges and the Children’s Health Insurance Program will grow from 5.3 percent of gross domestic product in 2018 to 6.6 percent in 2028. The boost is mainly because of Medicare spending, caused by an aging population and a speedup in the increase of healthcare costs.

‘Silver loading’ costs government $10 billion this year. CBO found that the spending on Obamacare exchange subsidies is expected to jump by $10 billion, or 21 percent, in 2018 from 2017. The reason stems from an average increase of 34 percent in premiums for the second-cheapest silver plan, which is the most popular of Obamacare’s four metal tiers. That was caused by “silver loading.” After President Trump cut off cost-sharing reductions for insurers, most states let insurers put the entire cost of the stopped payments onto the second-cheapest silver plan. Obamacare’s insurer subsidies are linked to the cost of the second-cheapest plan. That means that when the cost of that plan rises, so do the income-based tax credits. Some Obamacare enrollees got a hefty amount of tax credits that they used to buy plans in other tiers. For instance, some enrollees could purchase a bronze plan, which is a tier below silver, for practically nothing. CBO projects that spending for Obamacare subsidies will rise from $58 billion in 2018 to $91 billion by 2028.

RUNDOWN

The Hill Trump appointee at center of fight over religious freedom

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Reuters Mississippi’s last abortion clinic expands lawsuit on restrictions

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Kaiser Health News How a drugmaker turned the abortion pill into a rare-disease profit machine

Wall Street Journal FDA adds restrictions on sale of Bayer’s Essure