In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

1. Can We Tax Away The Opioid Crisis?

Lawmakers in California, like their counterparts in Congress, are considering a tax that would pay for addiction prevention and treatment efforts. (Pauline Bartolone, 4/14)

2. Political Cartoon: 'Trick Shot?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Trick Shot?'" by Gary Varvel, The Indianapolis Star.

Here's today's health policy haiku:


Trump decrees both calm
And spook insurance markets.
Cognitive chaos.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Summaries Of The News:

Health Law

3. HHS Issues Final Rule To Stabilize Marketplaces; Insurers Pleased But Want Even More Changes

The rule introduces several targeted changes aimed at curbing some of the losses insurers have faced in the law’s exchanges.

Reuters: Trump Administration Issues Final Rule On Stricter Obamacare Enrollment
The Trump administration on Thursday issued a final rule that will shorten the Obamacare enrollment period and give insurers more of what they say they need in the individual insurance market, likely making it harder for some consumers to purchase insurance, healthcare experts said. It could also raise out-of-pocket medical expenses, the experts said, because it gives insurers more flexibility in determining the value of their coverage. (Abutaleb, 4/13)

The Wall Street Journal: Trump Administration Takes Steps To Stabilize Health-Insurance Market
The Centers for Medicare and Medicaid Services, a division of the Department of Health and Human Services, published its final rule aimed at steadying the individual market, which has seen large premium increases and insurers retreating from unprofitable markets across the country. President Donald Trump’s administration is pitching the move as a temporary fix, while it continues to work with Congress to strike an elusive deal to dismantle large portions of the health law known as Obamacare. But after GOP leaders yanked their health plan off the House floor late last month, the administration’s moves to either bolster or undercut the existing health-care law have come under increased scrutiny. (Hackman, 4/13)

CQ Roll Call: Health Insurers Score Win On Enrollment Rule For Exchange Plans
The 2018 open enrollment period will be reduced to run from Nov. 1, 2017, to Dec. 15, 2017, a shift from an earlier cutoff date of Jan. 31, 2018, the Centers for Medicare and Medicaid Services said in its final published rule. The earlier deadline will limit the number of people who can purchase insurance after learning they have a health condition that requires medical care, blocking such signups in late December and January, CMS said. Thus, this move will help improve the so-called risk pool for insurers, or the balance of their healthier customers to those in need of costly medical services, the agency said. (Young, 4/13)

Bloomberg: Trump Sweetens Obamacare For Insurers After Repeal Failure 
“These actions are necessary to increase patient choices and to lower premiums,” said Seema Verma, administrator for the Centers for Medicare and Medicaid Services Administrator, which oversees the health insurance program. “While these steps will help stabilize the individual and small group markets, they are not a long-term cure for the problems that the Affordable Care Act has created in our health-care system.” (Tracer and Edney, 4/13)

Kaiser Health News: Repeal, Replace … Revise: Your Guide To How A Trump Proposal Might Change ACA Insurance
The controversial proposal by the Health and Human Services Department drew letters from nearly 4,000 organizations and individuals during an unusually short, 20-day public comment period that ended in early March. In their comments, consumer groups hated it, saying it would wreak havoc by making it harder to get coverage, while insurers were generally supportive. But such experts as Christopher Condeluci of CC Law & Policy in Washington, D.C., saw the initial proposal released in February by HHS as helpful for insurers, though he also thinks more adjustments are necessary. (Appleby, 4/13)

Modern Healthcare: White House Finalizes ACA Rule To Strengthen Individual Market
The rule, however, does not address the insurance industry's major concern regarding continued enforcement of the individual mandate. It does continue and even increase subsidies for people who buy coverage on the Affordable Care Act's individual coverage exchanges. Both requests were made in a letter sent Wednesday to President Donald Trump that was co-signed by the U.S. Chamber of Commerce, which previously supported a rollback of the ACA. Other signers included America's Health Insurance Plans, the American Academy of Family Physicians and the American Hospital Association. (Dickson, 4/13)

Morning Consult: Trump Administration Makes First Mark On Obamacare With Regulation
As it stands, Cara Kelly, a vice president at Avalere Health, warned the changes may not be enough to keep more insurers from dropping out of marketplaces next year. “These changes likely are not significant enough to sway health plan decisions for the upcoming plan year,” she said. “Losing health plans from the exchanges is still a risk for 2018.” (McIntire, 4/13)

The Associated Press: Insurers Say Trump Must Do More To Stabilize ‘Obamacare’
While calling the administration action a step in the right direction, the industry is looking for a guarantee that the government will also keep paying billions in “cost-sharing” subsidies that help consumers with high deductibles. President Donald Trump says he hasn’t made up his mind on that. (Alonso-Zaldivar and Murphy, 4/14)

The Hill: Trump Admin. Moves To Stabilize ObamaCare Markets 
Marilyn Tavenner, the president and CEO of America's Health Insurance Plans (AHIP) and the former Centers for Medicare and Medicaid Services administrator, praised the rule for adopting "important changes" to "improve the functioning of the individual market" but said insurers still need to hear about the cost-sharing reduction subsidies. (Hellmann, 4/13)

4. 'I Think I Will Get It Done': Trump's Renewed Health Care Push Catches Republicans Off Guard

President Donald Trump's focus on health care has the potential of leading to a second embarrassing defeat that would raise more questions about the new administration’s ability to shepherd complicated legislation through Congress.

The Wall Street Journal: Trump Shifts Back To Health Care
After losing a fight to revamp the health-care system, President Donald Trump said last month he was prepared to put the setback behind him and move on to the next challenge, rewriting the tax code. Three weeks later, he said he is determined to resurrect the health-care bill even if it means delaying the tax overhaul, telling The Wall Street Journal in an interview: “I want to get health care done…I think I will get it done.” (Radnofsky, Nicholas and Rubin, 4/13)

In his efforts, the president is eyeing subsidies as a bargaining chip —

The New York Times: Trump Threatens Health Subsidies To Force Democrats To Bargain
In the weeks since President Trump’s attempts to replace the Affordable Care Act collapsed, the administration has debated what to do: Try again? Shore up the insurance marketplaces? Or let the whole system collapse? Mr. Trump has failed to get enough support from his own party, but he hopes to get the Democrats’ help by forcing them to the negotiating table with hints about the chaos he could cause. (Pear, 4/13)

Marketplace: President Trump Might Withhold ACA Subsidy Payments
Under current law, the federal government repays some money to insurance companies for covering people with very low income. President Trump said he was still considering what to do about those payments. Bob Atlas, president of healthcare consultancy EBG Advisors, said legally speaking, Trump can do that. (Uhler, 4/13)

5. Democrats Won't 'Negotiate With Hostage Takers,' Vow To Tie Insurer Subsidies To Spending Bill

The fight could lead to a government shutdown if neither side blinks.

The Wall Street Journal: Democrats Say They Won’t Be Bullied Into A Repeal Of Obamacare
Congressional Democrats said Thursday they won’t be coerced into negotiating a repeal of the Affordable Care Act by President Donald Trump’s threats to withhold federal payments critical to maintaining the stability of the insurance market. But the president’s comments could have a more immediate effect on Capitol Hill, thrusting the payments to insurers into negotiations over a spending bill needed to keep the government running beyond April 28, when its current funding expires. (son and Hughes, 4/13)

The Hill: Dems Link ObamaCare Payments To Shutdown Fight 
“The President’s comments on stopping the Cost Sharing Reduction payments will increase costs, is a threat to the good health of the American people and a threat to keeping government open,” an aide to House Democratic Leader Nancy Pelosi (Calif.) said in a written statement. Democrats say Pelosi and Senate Democratic Leader Charles Schumer (N.Y.) are in agreement that the payments must be included in the spending bill being negotiated ahead of an April 28 deadline. Democrats want the funds to become mandatory spending, which would provide the certainty insurance companies have requested. (Sullivan, 4/13)

Politico: Democrats Say Spending Bill Must Fund Obamacare Payments
"Given the threat, we'll be pushing for a robust cost-sharing reduction appropriation," a Senate Democratic aide said. The aide declined to say how much funding Democrats would insist upon. Others have estimated that full funding for one year would require between $7 billion and $8 billion. Funding for the program "must be included" as "permanent mandatory spending," a Pelosi aide said. (Haberkorn and Ferris, 4/13)

The Washington Post: Trump Is Playing A Risky Game Of Chicken With Health Insurers
“This is a very potent threat, because the administration has the authority unilaterally to do this, and this is really a kill switch. This makes the program unprofitable for the majority of health plans operating in it today,” said Dan Mendelson, chief executive of Avalere Health, a consulting firm. “The timing of this threat is really curious, in the sense that now is the time that the plans have to be deciding whether to bid on 2018. If you’re on the bubble and the president is making a threat like this . . . this just puts more uncertainty on the program." (Johnson, 4/13)