• Bare-Bones Health Policies Are Cheaper Than ACA Plans — and Riskier Too Wall Street Journal by Anna Wilde Mathews — Sales are growing for a type of bare-bones health policy that offers a cheaper alternative to traditional insurance but leaves buyers risking big bills if they have major medical needs. Known as fixed indemnity plans, the products offer limited help, typically paying set amounts toward the cost of doctor visits, hospital days, or other services. They generally carry restrictions on people with preexisting conditions, and they aren't considered true health insurance under the Affordable Care Act. But insurance agents say individuals are increasingly purchasing the plans as a substitute for ACA coverage, which has become far more costly for many people who don't get federal subsidies.
  
  
• GOP in Retreat on Obamacare  The Hill by Peter Sullivan — Republicans are retreating from calls to repeal Obamacare ahead of this year's midterm elections. Less than a year after the GOP gave up on its legislative effort to repeal the law, Democrats are going on the offense on this issue, attacking Republicans for their votes as they hope to retake the House majority. GOP strategist Ford O'Connell said the political winds have shifted on the issue, turning Obamacare into a subject Democrats want to tout and many Republicans want to duck. "I don't think it's seen as a winning issue," he said. "It's also an issue that tends to fire up the Democratic base more so than the Republican base." Republican supporters of repeal argue the House is paying for the Senate GOP's sins.

• Virginia House Passes Medicaid Expansion, Sends to Senate  Associated Press — The Virginia House of Delegates has approved a state budget that would expand Medicaid eligibility to about 400,000 low-income adults. The Republican-led House approved the state spending plan Tuesday with bipartisan support, but the measure still has to pass the state GOP-controlled Senate. Lawmakers are taking another stab at passing a budget after attempts during the regular session ended in a stalemate over disagreement about Medicaid expansion, a key part of former President Barack Obama's health care law. After years of near-unified opposition to Medicaid expansion, Virginia Republicans are now split on the issue. The proposed budget now moves to the Senate, which has previously rejected Medicaid expansion. But pro-expansion lawmakers are now in the majority after a GOP lawmaker recently announced his support.
  
  
• The High Cost of Taking Away Prisoners' Medicaid Coverage  CNN by Lydia DePillis — Local jails and prisons are required to provide prisoners with adequate health care. But the interruption of federal and state programs inmates had been depending on can cause major problems, making it more likely that people will cycle in and out of jail. Federal rules prohibit states from billing Medicaid for any inmate care unless the covered individual requires a hospital stay of at least 24 hours. They also cut off Social Security and Disability payments and some veterans' benefits. Medicaid benefits are taken away as soon as a suspect has been booked into jail, whether they've been proven guilty or not. If they are convicted and incarcerated, Social Security and VA benefits disappear 30 and 60 days later, respectively. Some states simply suspend benefits, allowing inmates to pick them back up as soon as they're released. But 34 states still terminate enrollment either immediately or after the prisoner spends a certain period of time behind bars.
  
  
• Michigan Senate Wants Many Medicaid Recipients to Find Jobs  Detroit Free Press by Kathleen Gray —The debate ranged from experiencing the "joys of work" to a more spiritual take about helping the "least of these," but in the end, work prevailed and the full Senate passed legislation Thursday that would require many recipients of Medicaid to be gainfully employed for at least 29 hours a week. Sen. Mike Shirkey, R-Clarklake, said the work requirements were an essential element of keeping viable the Healthy Michigan program, which has 680,000 low-income Michiganders enrolled in an expansion of Medicaid. But Democrats said the legislation was both unneeded and immoral.

• U.S. Spending on Prescription Drugs Rose Less Than 1 Percent Last Year  Stat by Ed Silverman — Amid national turmoil over rising drug costs, a new report finds that spending on prescription medicines in the U.S. last year grew a modest 0.6 percent, to $324 billion, after accounting for rebates and discounts that are paid by drug makers. And real net per-capita spending fell by 2.2 percent, when adjusted for those allowances, as well as for population and economic growth. The rebates and discounts mean that drugmakers are realizing less revenue than the stated list prices for their medicines. The difference last year was $130 billion, up from $74 billion, according to data from the IQVIA Institute for Human Data Science, which is part of the IQVIA market research firm. List prices, meanwhile, rose a modest 1.4 percent.
  
  
• Cigna-Express Scripts Deal to Face Justice Department Review  Bloomberg News by Zachary Tracer and David McLaughlin — Cigna Corp. confirmed that its proposed $54 billion acquisition of Express Scripts Holding Co. will be reviewed by the U.S. Department of Justice, which has raised the bar for approving deals that don't combine direct competitors. The health insurer has been telling investors since at least early April about the review, but hadn't made a public statement until late Wednesday. Analysts at Credit Suisse sent an alert to clients on April 5, saying Cigna Chief Executive Officer David Cordani told investors during an event in Europe that the deal would be looked at by the Justice Department. Cigna agreed in March to acquire Express Scripts, a pharmacy-benefits manager, wagering that the combination can reduce costs and improve benefits for Americans by simplifying the health-care supply chain. CVS Health Corp. separately struck a $68 billion deal for Aetna Inc., a transaction that's also facing Justice Department review.
  
  
• Drug Industry Facing Onslaught from Frustrated States  The Hill by Rachel Roubein — Congress hasn't done much to rein in the costs of prescription drugs, so states are taking matters into their own hands. While lawmakers have railed against pharmaceutical executives and accused them of jacking up prices, they haven't passed major legislation on the issue. That lack of action has, in part, spurred state legislatures to consider a slew of bills aimed at decreasing the cost of drugs, increasing price transparency and cracking down on controversial industry practices.

• New Data: Americans Filling Far Fewer Opioid Prescriptions  Associated Press by Linda A. Johnson — The number of prescriptions for opioid painkillers filled in the U.S. fell dramatically last year, showing their biggest drop in 25 years and continuing a decline amid increasing legal restrictions and public awareness of the dangers of addiction. Health data firm IQVIA's Institute for Human Data Science released a report Thursday showing an 8.9 percent average drop nationwide in the number of prescriptions for opioids filled by retail and mail-order pharmacies. All 50 states and the District of Columbia had declines of more than 5 percent. Declines topped 10 percent in 18 states, including all of New England and other states hit hard by the opioid overdose epidemic, such as West Virginia and Pennsylvania.
  
  
• Will New Payment Model for Treating Opioid Abuse Help Meet Demand for Treatment?  Modern Healthcare by Steven Ross Johnson —The American Medical Association and the American Society of Addiction Medicine on Monday advocated for a new way to reimburse physicians who treat patients for opioid use disorder, hoping it will help meet the increasing demand for medication-assisted therapies. The new alternative payment model, called Patient-Centered Opioid Addiction Treatment, would give providers an initial, one-time payment to cover the costs associated with evaluating, diagnosing, and planning treatment for a patient, as well as a month of outpatient medication-assisted treatment. "Medication-assisted treatment is an evidence-based treatment for opioid use disorder, certainly there is no one-size-fit-all approach, but this is an important therapy," said Dr. Patricia Harris, chair of the AMA's Opioid Task Force. " Harris said current provider reimbursement and payment is a major barrier to patients accessing medication-assisted treatment.
  
  
• Citing Opioid Crisis, Feds Seek Rule Change for Drugmakers  Associated Press by John Raby — Drugmakers would be required to identify a legitimate need for controlled substances to justify their production under a proposed rule change intended to rein in the diversion of drugs for illicit purposes, the Drug Enforcement Administration (DEA) announced Tuesday. According to the DEA, current regulations were issued in 1971 but need to be updated to reflect the nation's opioid abuse crisis and changes in the manufacture of controlled substances. "It's a common sense idea: the more a drug is diverted, the more its production should be limited," U.S. Attorney General Jeff Sessions said in a statement.

Editor: Peter Van Vranken