“There’s a real worry that consumers will believe they’re buying comprehensive insurance that protects them financially from the unexpected, but then are left high and dry with medical bills.” — Sabrina Corlette, Georgetown University

The U.S. spends more per capita on health care than any other developed nation. It will soon spend close to 20 percent of its GDP on health — significantly more than the percentage spent by major Organization for Economic Cooperation and Development nations. What is driving costs so high? As this series of charts shows, Americans aren’t buying more health care overall than other countries. But what they are buying is increasingly expensive. Among the reasons is the troubling fact that few people in health care, from consumers to doctors to hospitals to insurers, know the true cost of what they are buying and selling. Providers, manufacturers, and middlemen operate in an opaque market that can mask their role and their cut of the revenue. Mergers give some players more heft to enlarge their piece of the pie. (Joseph Walker, Wall Street Journal)

Consumers will have more options to buy cheaper, short-term health insurance under a new Trump administration rule, but there’s no guarantee the plans will cover preexisting conditions or provide benefits like coverage of prescription drugs. Administration officials said Wednesday the short-term plans will last up to 12 months and can be renewed for up to 36 months. With premiums about one-third the cost of comprehensive coverage, the option is geared to people who want an individual health insurance policy but make too much money to qualify for subsidies under the Affordable Care Act (ACA). “We see that it’s just unaffordable for so many people who are not getting subsidies and we’re trying to make additional options available,” said Health and Human Services Secretary Alex Azar. “These may be a good choice for individuals, but they may also not be the right choice for everybody.” The nonpartisan Congressional Budget Office estimates that roughly 6 million more people will eventually enroll in either an association plan or a short-term plan. The administration says it expects about 1.6 million people to pick a short-term plan when the plans are fully phased in. (Ricardo Alonso-Zaldivar, Associated Press)

President Donald Trump can’t kill Obamacare, no matter how hard he tries. His administration’s latest threat to the law, unveiled Wednesday, expands the availability of short-term health plans that critics deride as “junk” insurance. However, despite the administration’s unrelenting efforts to sideline Obamacare, more insurers are signing up to sell 2019 coverage, and premium increases will be the lowest in years. There are promising signs across the country that Obamacare rate hikes for the 2019 enrollment season won’t approach the eye-popping increases of the past two years, though rates won’t be finalized until the fall. (Paul Demko and Adam Cancryn, Politico)

Four cities on Thursday sued President Trump, arguing that he is violating his constitutional duty to enforce the law by “sabotaging” Obamacare. The cities of Baltimore, Chicago, Columbus, and Cincinnati filed the lawsuit in federal court in Maryland, arguing that Trump’s actions against the ACA violate the Constitution’s provision that the president “shall take care that the laws be faithfully executed.” The lawsuit states that Trump’s actions are “an affront to the rule of law: to our constitutional system, under which Congress enacts laws and the President faithfully implements them.” (Peter Sullivan, The Hill)

Hoping to head off a full expansion of Medicaid under the Affordable Care Act, some senior officials in the Trump administration and Republican governors have been pushing hard for a smaller expansion to satisfy a growing political demand in their states. But President Trump decided on Friday to shut down the debate until after the midterm elections, administration officials said. The debate has divided the Trump administration between top officials at the Department of Health and Human Services and hard-liners, mainly at the White House, more determined to snuff out the ACA. And it gained steam as states pressed forward with Medicaid expansions that could leave more people with health coverage under the ACA next year than when Mr. Trump took office. (Robert Pear, New York Times)

After years of being told “no” by GOP-controlled state legislatures, health care advocacy groups have spent much of 2018 leading campaigns to put the question on the ballot before voters in November. Behind the scenes, those groups have been aided by The Fairness Project, a Washington-based organization that has become the primary funder of these ballot-initiative campaigns, spending close to $5 million in five states over the past year.…The group got its start in 2015 with a $5 million grant from United Healthcare Workers West in California, part of the Service Employees International Union, which continues to be the group’s primary funder. (Jessie Hellmann, The Hill)

A July tweet from President Donald Trump sent panic through the C-suites of some of the world’s biggest drug companies, prompting Pfizer and nine other companies to roll back or freeze prices. But there’s less to those announcements than meets the eye. The gestures turned out to be largely symbolic — efforts to beat Trump at his own game by giving him headlines he wants without making substantive changes in how they do business. The token concessions are “a calculated risk,” said one drug lobbyist. “Take these nothing-burger steps and give the administration things they can take credit for.” Of the few companies that actually cut prices, for instance, most targeted old products that no longer produce much revenue — such as Merck’s 60 percent discount to a hepatitis C medicine that had no U.S. revenues in the first quarter. (Sarah Karlin-Smith, Sarah Owermohle and Andrew Restuccia, Politico)

By allowing the federal government to negotiate with drug makers, Medicare and its beneficiaries could save an estimated $2.8 billion in a single year for the top 20 most commonly prescribed medicines, according to a new analysis by Democrats on the Senate Homeland Security and Governmental Affairs Committee. In crunching the numbers, the committee staff found that other government agencies that are permitted to negotiate with drug companies — such as the Department of Veterans Affairs and the Department of Defense — were able to secure pricing that rose at “significantly lower rates” than wholesale prices for the most widely prescribed brand-name drugs in Medicare Part D. (Ed Silverman, Stat)