• Nearly 12 Million People Enrolled in 2018 Health Coverage Under the ACA  Washington Post by Amy Goldstein — A total of 11.8 million Americans signed up for Affordable Care Act health insurance for 2018, a drop of just 400,000 from the previous year despite widespread predictions that enrollment would plummet amid political and insurance industry turbulence surrounding the law. The final figures, released Tuesday by the Centers for Medicare and Medicaid Services, show that the proportion of first-time customers for this year dipped slightly, from 31 percent to 27 percent, while the high proportion qualifying for government subsidies that help consumers afford their insurance premiums stayed level at 83 percent. The enrollment total in the new federal report is identical to that from a compilation issued in February by an outside group, the National Academy for State Health Policy.
  
  
• Premiums Shoot Up, but Many Are Paying Less for 'Obamacare'  Associated Press by Ricardo Alonso-Zaldivar — Consumers getting financial assistance under former President Barack Obama's health care law will pay lower premiums this year, even though the "list price" for their health insurance shot up. That odd result is reflected in a report issued Tuesday by the Trump administration. After federal aid, the average monthly premium paid by subsidized customers on HealthCare.gov is dropping to $89 from last year's $106. That's a 16 percent savings even though the "list price" premium went up about 30 percent, now averaging $639 for those subsidized customers. The bottom line is counterintuitive, but it shows how "Obamacare" subsidies cushion consumers from rising premiums.
  
  
• Ohio Seeks First-ever Individual Mandate Waiver  Modern Healthcare by Virgil Dickson — Ohio officials asked the Trump Administration on Friday to formally waive the Affordable Care Act individual mandate that requires residents to have health insurance, making it the first state to make such a waiver request. Ohio's legislature called for the 1332 waiver last summer, and Congress zeroed out the financial penalty for not having coverage in its tax bill in December. "The [tax] legislation zeroed out the penalty that is associated with the individual mandate … but … did not eliminate the mandate itself," Ohio Department of Insurance Director Jillian Froment said in a March 30 letter to HHS Secretary Alex Azar. "That is why Ohio is submitting an application to waive [the mandate]."
  
  
• Iowa Tries Another End Run Around the Affordable Care Act  Washington Post by Amy Goldstein — As a growing number of Republican-led states look for end runs around the Affordable Care Act, Iowa is embracing a strategy that contends that not all health plans are actually health insurance. Gov. Kim Reynolds (R) on Monday signed into law a bill allowing the century-old Iowa Farm Bureau to collaborate with the state's dominant insurer to sell "health benefit plans," which are expected to cost health customers less than ACA coverage because they will not have to comply with federal requirements. The law says such plans "sponsored by a nonprofit agricultural organization . . . shall be deemed not to be insurance." That means they will be allowed to avoid both federal and state insurance regulations.
  
  

• To Curb Rising Health Insurance Costs, Some States Try 'Reinsurance Pools' Stateline by Michael Ollove — The Gopher State (Minn.) is one of four states trying to calm roiling health insurance markets by creating state reinsurance pools — even as actions by Congress and the Trump administration continue to create uncertainty in the health insurance industry. Maryland became the latest to do so when Republican Gov. Larry Hogan last week signed a bill creating a reinsurance pool financed in part in the next year by a $380 million tax on health insurers. Another six states are taking steps to launch their own reinsurance programs. Reinsurance has long had a place in the private insurance market.

• The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care New York Times by Reed Abelson and Julie Creswell — People are flocking to retail clinics and urgent care centers in strip malls or shopping centers, where simple health needs can usually be tended to by health professionals like nurse practitioners or physician assistants much more cheaply than in a doctor's office. Some 12,000 are already scattered across the country, according to Merchant Medicine, a consulting firm. On the other side, office visits to primary care doctors declined 18 percent from 2012 to 2016, even as visits to specialists increased, insurance data analyzed by the Health Care Cost Institute shows.  There's little doubt that the front line of medicine — the traditional family or primary care doctor — has been under siege for years. Long hours and low pay have transformed pediatric or family practices into unattractive options for many aspiring physicians.
  
  

• Why Does the U.S. Spend So Much More on Healthcare? It's the Prices Modern Healthcare by Harris Meyer — The sharp difference between two doctors' experiences partly explains why the U.S. healthcare system has much higher administrative costs than Canada and other countries. Those costs, plus much higher prices for medical services and pharmaceuticals and much higher pay for physicians and nurses, were the major reasons the U.S. spent a larger share of GDP on healthcare in 2016 than 10 other wealthy nations, according to a recent study in JAMA. The authors said the huge spending gap — 17.8 percent of GDP in the U.S. versus an average of 10.8 percent in the other 10 countries — was not primarily driven by the factors that often get the blame. 

• CMS Gives Medicare Advantage Plans a Raise  Modern Healthcare by Virgil Dickson — The Centers for Medicare and Medicaid Services (CMS) finalized a rule Monday giving Medicare Advantage plans a 3.4 percent pay hike in 2019. That's well above the 1.84 percent bump the agency initially proposed and higher that the 2.95% increase for 2018. CMS is also moving forward with plans to increase the use of encounter data to determine risk scores for plans. As a result of the finalized rule, 75 percent of Medicare Advantage risk scores will be based on traditional fee-for-service data, and 25 percent based on encounter data.
  

• Virginia Is Close to Expanding Medicaid After Years of Republican Opposition  New York Times by Trip Gabriel — As Gov. Ralph Northam orders the House and Senate back to the capital on Wednesday for a special session, what remains of Republican opposition to Medicaid expansion appears to be cracking. Two Republican state senators said this week they would accept some form of broader Medicaid benefits, as provided under the Affordable Care Act — enough votes to carry the day on an issue that is widely popular in state polls. Although the two Republican senators' embrace of expansion seem to promise a speedy resolution, there are enough differences in the proposals that a deal could founder.

• Senate Health Committee Releases Draft of Bipartisan Opioid Bill  The Hill by Rachel Roubein — Senate Health Committee leaders released Wednesday a bipartisan discussion draft of a bill aimed at combating the opioid epidemic — legislation that's the result of six hearings over the past six months. The panel will hold a hearing next week on the draft aimed at stemming the crisis killing thousands of people each year. It includes measures attempting to make it easier to prescribe smaller packs of opioids for limited durations, spur the development of non-addictive painkillers and bolster the detection of illegal drugs at the border.

• China Tariffs Could Raise Prices for Prescription Drugs in U.S., Groups Warn  The Hill by Jessie Hellmann — President Trump's proposed tariffs on goods from China could lead to higher prescription drug costs in the U.S., pharmaceutical groups warn. The Trump administration's list of Chinese-manufactured products that could be slapped with a 25 percent tariff includes many ingredients used to manufacture drugs such as insulin, antidepressants, and the anti-allergic-reaction drug epinephrine. China, according to the Food and Drug Administration, is one of the largest suppliers of ingredients used to make U.S.-consumed prescription drugs. Advocates and drugmakers worry that the tariffs would make generic products more expensive as the nation continues to struggle with already high drug prices. 


• A Rare Loss for U.S. Pharma Lobby Will Cost the Industry Billions Bloomberg News by Anna Edney — Deep in a budget deal Congress passed earlier this year —just 118 words in Section 53116, a little before passages on prison reporting data and payment yields for seed cotton — was a hit to pharmaceutical companies that will cost them billions, and could signal more losses to come. Despite an intense lobbying push, lawmakers changed a Medicare rule, putting manufacturers on the hook for more of seniors' prescription costs. The companies will have to offer a much more generous discount to beneficiaries who fall into the so-called donut hole coverage gap, marking down retail costs by 70 percent instead of the current 50 percent. It was a rare defeat for some of the biggest spenders in the political influence game and raised new questions about how they'll fare in upcoming battles. Lawmakers have introduced bills that would squeeze the industry, and President Donald Trump has said he will roll out proposals this month to curb drug prices.

Editor: Peter Van Vranken