"Allowing insurers to sell narrow, low-cost health plans likely will cause significant economic harm to women and older, sicker Americans who stand to face higher-cost and fewer insurance options." 

— American Academy of Family Physicians

• Trump to Scrap Critical Health Care Subsidies, Hitting Obamacare Again New York Times by Robert Pear, Maggie Haberman and Reed Abelson — President Trump will scrap subsidies to health insurance companies that help pay out-of-pocket costs of low-income people, the White House said late Thursday. His plans were disclosed hours after the president ordered potentially sweeping changes in the nation's insurance system, including sales of cheaper policies with fewer benefits and fewer protections for consumers. The twin hits to the Affordable Care Act could unravel President Barack Obama's signature domestic achievement, sending insurance premiums soaring and insurance companies fleeing from the health law's online marketplaces. After Republicans failed to repeal the health law in Congress, Mr. Trump appears determined to dismantle it on his own.
  
  
• Trump Health Care Order Could Face Strong Legal Objections Reuters by Brendan Pierson and Nate Raymond — U.S. President Donald Trump's expected plan to let Americans buy insurance across state lines could violate federal law governing employee benefit plans and will almost certainly be challenged in court, several legal experts said.  Several experts in health care and employment law said Trump's plan could violate the U.S. Employee Retirement Income Security Act (ERISA), a federal law that governs large group plans that must be provided or maintained by employers or employee organizations..."The E in ERISA is employee," Joseph Antos, a health care expert at the American Enterprise Institute, a think tank that has been critical of Obamacare. "They are going to have to stretch the definition of whether you're an employee or not," he said of Trump's expected plan.
  
  
• How Trump Set Up Obamacare to Fail Vox by Dylan Scott — The most critical time of the year for the health care law is almost here: open enrollment, when millions of people log on to online marketplaces, check whether they qualify for federal subsidies to help them pay their premiums, and shop for plans. For the past three years, at least 10 million people have gotten insurance that way each year. But this year, open enrollment is in the hands of a White House that's openly hostile to the Affordable Care Act — and the Trump administration is taking advantage of the best opportunity it has to undercut the law.
  
  
• In New Test for Obamacare, Iowa Seeks to Abandon Marketplace  New York Times by Abby Goodnough — With efforts to repeal the Affordable Care Act dead in Congress for now, a critical test for the law's future is playing out in one small, conservative-leaning state. Iowa is anxiously waiting for the Trump administration to rule on a request that is loaded with implications for the law's survival. If approved by the federal Centers for Medicare and Medicaid Services, it would allow the state to jettison some of Obamacare's main features next year — its federally run insurance marketplace, its system for providing subsidies, its focus on helping poorer people afford insurance and medical care — and could open the door for other states to do the same. Iowa's Republican leaders think their plan would save the state's individual insurance market by making premiums cheaper for everyone. But critics say the lower prices come at the expense of much higher deductibles for many with modest incomes, and that approval of the plan would amount to another way of undermining the law. 

• Critics Say Trump Birth Control Rule Ignores Science Associated Press by Ricardo Alonso-Zaldivar — The Trump administration's new birth control rule is raising questions among some women's health experts, who say it overlooks known benefits of contraception while selectively citing data that raise doubts about effectiveness and safety. "This rule is listing things that are not scientifically validated, and in some cases things that are wrong, to try to justify a decision that is not in the best interests of women and society," said Dr. Hal Lawrence, CEO of the American Congress of Obstetricians and Gynecologists, which represents women's health specialists.  Doctors and researchers say the administration ignored studies that didn't support its conclusions and stretched others. 

• Californians Will Get More Information on What's Driving Prescription Drug Prices Under Law Signed by Governor Los Angeles Times by Melanie Mason — Gov. Jerry Brown approved a measure Monday to increase disclosure on prescription drug prices, the focal point of growing efforts to clamp down on climbing pharmaceutical costs. Supporters call the law the nation's most sweeping effort to make prescription drug pricing more transparent. The measure would require drugmakers to provide notice to health plans and other purchasers 60 days in advance of a planned price hike if the increase exceeds certain thresholds. The measure, SB 17 by state Sen. Ed Hernandez (D-Azusa), will also require health plans to submit an annual report to the state that details the most frequently prescribed drugs, those that are most expensive and those that have been subject to the greatest year-to-year price increase.
  
  
• Trump's Fastest Moving Agency Is Approving Drugs and Pleasing Wall Street Bloomberg News by Caroline Chen and James Paton — Gridlock under the Trump administration, particularly the repeated failures to repeal and replace Obamacare, is riveting the nation's attention. Yet at least one government agency is running smoothly -- and even accelerating its operations. The U.S Food and Drug Administration, under Commissioner Scott Gottlieb, is taking advantage of policy groundwork laid in past years to speed drug approvals. Thirty-four new drugs -- treating everything from cancer to rare genetic diseases -- have been approved so far this year. That's on pace to nearly double last year's approvals. So far, at least nine decisions came more than 20 days ahead of the FDA's scheduled action date. Wall Street is paying attention, with some portfolio managers shifting their strategies, anticipating faster approvals and less restrictive labels. 

• House GOP Delays Vote on Children's Health Care Funding to Negotiate with Dems The Hill by Jessie Hellmann — Republicans on the House Energy and Commerce subcommittee on health have agreed to return to negotiations with Democrats on a bill to continue funding for the popular Children's Health Insurance Program (CHIP).  House Energy and Commerce Chairman Greg Walden (R-Ore.) said Monday he would delay floor consideration of the bill passed by the committee last week "in hopes of reaching a bipartisan agreement on offsets."  The bill last week passed with no support from Democrats, who complained that the bill took money from Medicare and the Affordable Care Act to offset the costs of the program. "I am pleased to know that Democrats are willing to seriously consider reasonable, bipartisan ways to offset the cost of CHIP and important public health priorities like community health centers, the National Health Service Corps and the special diabetes program," Walden said in a statement.

• Delivery System Reform Hampers ACO Progress on Risk-Based Contracts Modern Healthcare by Maria Castellucci — Accountable care organizations (ACOs) are participating more and more in risk-based contracts, but that progress has been stalled by sluggish care-delivery changes, a new survey suggests.  Roughly 50 percent of ACOs are involved in at least one downside risk contract, such as shared savings and capitation contracts, according to a Leavitt Partners and National Association of ACOs report recently published in Health Affairs. About 47 percent of ACOs plan to participate in shared-savings risk-based contracts in the next year or so. However, ACOs are focusing mostly on "low-hanging fruit" strategies to save money and improve quality of care, which mitigates how well the organizations are able to perform in riskier contracts, the report said.

Editor: Peter Van Vranken