"Any action to stop disbursements under the risk adjustment program will significantly increase 2019 premiums for millions of individuals and small-business owners, and could result in far fewer health plan choices. It will undermine Americans’ access to affordable care, particularly for those who need medical care the most." — Justine G. Handelman, Blue Cross and Blue Shield Association

The Trump administration took another major swipe at the Affordable Care Act (ACA), halting billions of dollars in annual payments required under the law to even out the cost to insurers whose customers need expensive medical services. In a rare Saturday afternoon announcement, the Centers for Medicare and Medicaid Services said it will stop collecting and paying out money under the ACA’s "risk adjustment" program, drawing swift protest from the health insurance industry. (Amy Goldstein, Washington Post)

As health insurers across the country begin filing their proposed rates for 2019, one thing is clear: The market created by the Affordable Care Act shows no signs of imminent collapse in spite of the continuing threats by Republicans to destroy it. In fact, while President Trump may insist that the law has been "essentially gutted," the ACA market appears to be more robust than ever, according to insurance executives and analysts. A few states are likely to see a steep spike in prices next year, but many are reporting much more modest increases. Insurers don't appear to be abandoning markets altogether. In contrast to last year, regulators are not grappling with the prospect of so-called "bare" counties, where no carrier is willing to sell ACA policies in a given area. (Reed Abelson, New York Times)

As premiums spiked in 2017, the market where people buy their own health insurance saw a significant decline in enrollment among those who don't qualify for federal subsidies. That is the conclusion of a new federal report that finds the number of unsubsidized individual-market enrollees in the U.S. dropped last year by about 1.27 million people, or roughly 20 percent. Enrollment among those who received tax credits, meanwhile, dropped by just 3 percent, according to the report from the federal Centers for Medicare and Medicaid Services. (Christopher Snowbeck, Star Tribune)

The Trump administration's drive to wean poor people from government benefits by making them work has been slowed by a federal judge framing a fundamental question: Are poverty programs meant to show tough love or to help the needy? U.S. District Judge James E. Boasberg in Washington last week halted Kentucky's first-in-the-nation experiment with Medicaid work requirements, ruling that the Trump administration glossed over potential coverage losses. He sent the state's plan back to federal authorities for a harder look. The debate goes well beyond Medicaid, the federal-state health program for low-income and disabled people. (Ricardo Alonso-Zaldivar, Associated Press)

The fallout from Friday's federal court ruling that struck down the Medicaid work requirement in Kentucky was swift. The decision by Judge James Boasberg immediately blocked Kentucky from enacting the provision in Campbell County, which had been set to start Sunday and roll out statewide later this year. Within 36 hours, Kentucky Gov. Matt Bevin, a Republican, eliminated vision and dental benefits to nearly 500,000 Medicaid enrollees, saying the state could no longer afford it. Meanwhile, Arkansas, New Hampshire, and Indiana are moving ahead with the implementation of their versions of a Medicaid work requirement. It is not clear how or if Boasberg's ruling invalidating the Trump administration's approval of Kentucky's plan affects these states. (Phil Galewitz, Kaiser Health News)

Maine's Republican governor is publicly laying out a proposed tax hike on hospitals to pay for voter-approved Medicaid expansion. Gov. Paul LePage's office says Medicaid expansion will offset a tax hike by decreasing charity care and bad debt. Maine's hospital tax rate is 2.23 percent, and Rabinowitz said Maine could go up to 6 percent. Maine Hospital Association lobbyist Jeffrey Austin previously told the Associated Press that Maine hospitals pay $100 million in annual taxes and would oppose an increase. (Associated Press)

The Centers for Medicare and Medicaid Services (CMS) wants to launch an experiment that allows doctors in Medicare Advantage plans to qualify as participating in an alternative pay model. To comply with MACRA (Medicare Access and CHIP Reauthorization Act), clinicians have two tracks to choose from: Merit-based Incentive Payment System (MIPS), which requires clinicians to report and meet quality goals, and advanced alternative payment models (APM), which require clinicians to take on financial risk as part of efforts to improve care and lower costs. If goals are met under an APM they're eligible for bonuses. Clinicians in Medicare Advantage plans have urged CMS to consider those plans as APMs since some are offering risk-based contracts. The White House's Office of Management and Budget must approve any experiment.  (Virgil Dickson, Modern Healthcare)

In the budding battle royale over the Supreme Court vacancy, what's the Democratic sweet spot between satisfying liberal activists' demands for an all-out fight against President Donald Trump's pick and protecting senators facing tight re-election races in deeply red states? So far, the party's formula is to cast itself as defending the right to abortion and the 2010 health care law against a president itching to use the court to snatch both away. Democrats want to make it as excruciating as possible for a pair of moderate, pivotal Republican senators to back the selection because without a GOP defection, it's game over.…The fight will be intense, fueled by Kennedy's status as the court's frequent swing vote and the GOP's hair-thin 51-49 Senate majority — effectively 50-49 since January, with Sen. John McCain battling cancer in Arizona. (Alan Fram, Associated Press)

At Norwegian American Hospital and other emergency departments around the country, doctors and nurses have been struggling for months without crucial drugs like morphine, which is used to ease the pain of injuries like broken bones, or diltiazem, a heart drug. Norwegian has been out of morphine since March, and the shortages are part of a nagging problem that has intensified this year as a rash of decades-old staples became scarce. The vast majority of the products in question are sterile injectable drugs, hospital workhorses that are cheaply priced even though they can be difficult to make. These low margins have led some companies to stop making the drugs, while others have failed to invest in older facilities, leading to a host of quality problems, recalls, and plant shutdowns. (Katie Thomas, New York Times)