"We've been working with the administration on a daily basis to map out and plan a very bold and aggressive agenda to make good on our campaign promises and to fix these problems—to repeal and replace and repair our broken health care system."  

House Speaker Paul Ryan (R-WI)

• Drop in Late Obamacare Enrollment Appears to Be a Trump Effect New York Times by Margo Sanger-Katz—In the waning days of this year's Affordable Care Act sign-up period, the Trump administration declared war on the health law, releasing an executive order that could weaken its requirements and yanking advertisements and outreach off the air. Those actions appear to have made a difference. Sign-ups for health plans in the states managed by the federal government are down slightly compared with last year. About 9.2 million Americans picked an Obamacare marketplace plan for this year, according to a government report released Friday. Last year, that number was 9.6 million.
  
  

• Talk of Repeal Sends People Running to, and From, Affordable Care Act New York Times by Abby Goodnough & Robert Pear—A flurry of actions by President Trump and Congress against the Affordable Care Act injected confusion and uncertainty into the final weeks of the annual period to sign up for coverage, and many, but not all, enrollment groups were reporting a drop in people seeking insurance as the deadline loomed on Tuesday. Confusion, though, has prevailed, with Mr. Trump often repeating his pledge to repeal the law and a handful of Republicans proposing complicated replacement plans, none of which would most likely cover as many people.

• G.O.P. Campaign to Repeal Obamacare Stalls on the Details New York Times by Robert Pear & Reed Abelson—Congress's rush to dismantle the Affordable Care Act, once seemingly unstoppable, is flagging badly as Republicans struggle to come up with a replacement and a key senator has declared that the effort is more a repair job than a demolition. The struggles and false starts have injected more uncertainty into insurance markets that thrive on stability.
  
  
• Republicans Rebrand Obamacare Strategy From 'Repeal' to 'Repair' Bloomberg by Anna Edney, Billy House and Zachary Tracer—Some Republicans in Congress are starting to talk more about trying to "repair" Obamacare, rather than simply calling for "repeal and replace." There's good reason for that. Using the word repair "captures exactly what the large majority of the American people want," said Frank Luntz, a prominent Republican consultant and pollster who addressed GOP lawmakers at their retreat. 
  
  
• For Rhode Island, Interstate Health Insurance Sales Didn't Pan Out NPR—Tuesday is the last day of open enrollment for health coverage for 2017 under the Affordable Care Act. And while Republicans in Congress are working to repeal the law, it's not at all clear what might replace it. During the campaign, President Trump suggested a nationwide insurance market that would allow insurance plans to be sold across state lines. The idea has been kicking around for years, and some states have tried it, including Rhode Island, where it didn't work too well. 

• U.S. Senate Panel Suspends Rules, Backs Price, Mnuchin for Cabinet Reuters by Susan Cornwell—Republicans on the Senate Finance Committee suspended committee rules and confirmed U.S. Representative Tom Price to head the U.S. Department of Health and Human Services and banker Steven Mnuchin to be Treasury secretary Wednesday on a straight party line vote, sending the nominations to the Senate floor. Under pressure from their political base to block President Donald Trump's nominees, Democrats stayed away from the meeting for a second day running. This normally would have stopped action, but Republicans plowed ahead by voting to suspend the rule that required at least one Democrat to be present for business to be conducted.
  
  
• HHS Nominee Tom Price Bought Stock, Then Authored Bill Benefiting Company USA Today by O'Donnell—President Trump's nominee to be the nation's top health official introduced legislation last May that benefited a health company he had recently invested in. The $15,000 purchase of shares in McKesson is but the latest financial action raising questions about possible conflicts of interest during the confirmation battle over Rep. Tom Price, R-Ga.  

• Hospitals Feeling the Early Effects of Trump Immigration Ban Modern Healthcare by Elizabeth Whitman and Steven Ross Johnson—Hospitals and health care systems are feeling the effects of President Donald Trump's executive order banning immigrants from seven Muslim-majority countries. Health care providers are trying to figure out what a stricter immigration policy means for the thousands of non-U.S. citizens who come and live in the country every year to train and work. Some employees, including physicians, have been directly affected, while others fear that they will be. 

• Health Care Costs Remain High Despite Obamacare Coverage Gains Bloomberg News by Katherine Greifeld—Uninsured rates in low-income families have fallen under the Affordable Care Act, yet more than a third of Americans continued to face difficulties paying their medical bills in 2016, a survey found. Adults in poor families were among the greatest beneficiaries of the ACA, with uninsured rates falling as much as 17 percentage points since it became law in 2010, according to a study from the Commonwealth Fund, a private, New York-based research organization. Still, 34 percent of Americans said it's difficult or impossible to find affordable health coverage. How the Affordable Care Act Has Improved Americans' Ability to Buy Health Insurance on Their Own
  
  
• Risk to Women's Health Benefits Seen in Health Law Repeal AP by Ricardo Alonso-Zaldivar & Kelli Kennedy—From a return to higher premiums for women to gaps in coverage for birth control and breast pumps, the Republican push to repeal the Obama-era health care law already is raising concerns that women could be hit hard. The 2010 law ended a common industry practice of charging women more than men for policies purchased directly from an insurer. It made maternity and newborn care a required benefit for individual market health plans. And it set a list of preventive services to be provided at no extra cost to women, including birth control and breast pumps used by nursing mothers.
  
  
• Prevention Benefits at Risk with an Obamacare Repeal Modern Healthcare by Harris Meyer—The Affordable Care Act extended 100 percent coverage for a range of preventive healthcare services, including some types of cancer screening, to seniors on Medicare. That first-dollar coverage likely saved lives by increasing diagnoses of early-stage colorectal cancer by 8 percent among Medicare beneficiaries during the first three years it was in effect, a new study in Health Affairs reported. 
  
  
• Health Insurers Warn of Wider Defections from ACA Marketplaces for 2018 Washington Post by Amy Goldstein—Leaders for the health insurance industry, state insurance commissioners and brokers warned Wednesday that more health plans almost certainly will defect from Affordable Care Act marketplaces unless Congress and the Trump administration provide some concrete assurances within the next two months. Unless the government promises to continue subsidies and other features of the law for at least another year, some states probably will not have any insurers selling health plans to individuals buying coverage on their own for 2018, the witnesses warned at a Senate hearing. 

• Trump Tells Drugmakers He'll Tackle Prices Politico by Sarah Karlin-Smith and Nolan McCaskill—Trump appeared to reiterate his support for drug negotiations. He contended that drugmakers need to face increased competition and bidding. Yet he appeared to suggest that Medicare, which is banned from negotiating with drugmakers, is hurting competition. 

• U.S. Proposes 0.25 Percent Hike in Medicare Advantage Payments Reuters by Caroline Humer—The U.S. government on Wednesday proposed an increase of 0.25 percent on average in payments to health insurers who offer Medicare Advantage insurance, which provides health benefits to more than 18 million elderly or disabled people. Enrollment in these plans grew by about 7 percent last year to account for about one-third of Medicare members, making it an important growth business for private insurers who are facing changes in their business as Republicans seek to repeal and replace Obamacare.