In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

3. Podcast: 'What The Health?' Let’s Blow It Up

In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Margot Sanger-Katz of The New York Times, Sarah Kliff of Vox and Julie Appleby of Kaiser Health News discuss the Trump administration’s latest efforts to undermine the individual insurance market. (10/13)

6. Tending To Patients As Her New Home Burns

ICU nurse Julayne Smithson had only a few minutes to grab some things from her recently purchased home a block from the Santa Rosa hospital. Then she rushed back to help evacuate patients and has scarcely stopped working since. (April Dembosky, KQED, 10/16)

7. Political Cartoon: 'Aired Grievances?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Aired Grievances?'" by Mike s.

Here's today's health policy haiku:


The island’s health care
Was vulnerable before
The hurricane hit.

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

8. Trump's Move To End Insurer Subsidies May Force Congress To Act After Months Of Stagnation

Uncertainty over the payments to insurers has loomed over Congress for months, and senators have been trying to work toward an agreement to fund them. They'd so far been unsuccessful, but President Donald Trump's decision to end the payments may force the issue. Meanwhile, lawmakers react to the White House move.

The New York Times: End To Health Care Subsidies Puts Congress In A Tight Spot
President Trump’s decision to cut off critical payments to health insurance companies ratcheted up the pressure on Congress on Friday to take action to protect consumers from soaring premiums, while also adding a combustible new issue to negotiations to avert a government shutdown this year. Mr. Trump’s move, announced Thursday night, could cause chaos in insurance markets, sending insurers fleeing from the Affordable Care Act’s marketplaces, raising the federal government’s costs and pricing out some consumers. (Kaplan and Pear, 10/13)

The Wall Street Journal: Health Care Back On Congress’s Front Burner
The Senate this week will grapple with President Donald Trump’s decision to stop making subsidy payments to health insurers, with lawmakers seeking a deal that would keep the money flowing while Republicans try to fold in conservative-oriented health-care priorities. It remains unclear whether a package could emerge that attracts support from a critical mass of senators and also from House Republicans. That could be put to the test quickly, as Sens. Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.) are expected to introduce a plan within days and Sen. Ron Johnson (R., Wis.) unveils his own, more-conservative-leaning version. (Armour and son, 10/15)

Politico: Congress' Uncertain Path On Obamacare Subsidy Fix
A bipartisan attempt by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) to stabilize Obamacare, which would fund the subsidies for up to two years, has already encountered skepticism from GOP conservatives and growing opposition from the White House. The two lawmakers plan to keep talking — but it's a tough road. “Under no circumstance should Congress attempt to expand Obamacare by cutting a check for President Obama's bailout of insurance companies," Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee, tweeted late Thursday. (Haberkorn and Cancryn, 10/13)

The Associated Press: Trump's 'Obamacare' Move Jolts Health Care, Political Worlds
Defiant Democrats, convinced they have important leverage, promised to press for a bipartisan deal to restore the money by year's end. That drive could split the GOP. On one side: pragmatists seeking to avoid political damage from hurting consumers. On the other: conservatives demanding a major weakening of the Affordable Care Act as the price for returning the money. "The American people will know exactly where to place the blame," declared Senate Minority Leader Chuck Schumer, D-N.Y., all but daring Trump to aggravate what could be a major issue in the 2018 congressional elections. (Fram and Alonso-Zaldivar, 10/14)

The Wall Street Journal: Republicans Split Over Trump’s Move To End Health Subsidies
President Donald Trump’s decision to end payments to insurers under the Affordable Care Act triggered an immediate dispute Friday among Republicans over whether to reverse the decision and shore up the nation’s insurance markets or embrace Mr. Trump’s move. That fight is likely to intensify upon the announcement of a bipartisan deal to guarantee the insurer payments, which is expected to be released within days, according to people familiar with the talks. The deal, led by Sens. Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.), would authorize the payments Mr. Trump is ending, while also providing states some flexibility under the ACA. (son and Armour, 10/13)

The Associated Press: Collins: Trump Should Back Effort To Resume Health Subsidy
A key moderate Republican is urging President Donald Trump to support a bipartisan Senate effort to reinstate insurer payments, calling his move to halt the subsidies an immediate threat to millions of Americans who could now face rising premiums and lost health care coverage. "What the president is doing is affecting people's access and the cost of health care right now," said Sen. Susan Collins of Maine, who has cast pivotal votes on health care in the narrowly divided Senate. "This is not a bailout of the insurers. What this money is used for is to help low-income people afford their deductibles and their co-pays." (Yen, 10/16)

Politico: Collins And Pelosi Disappointed That Trump Ended Obamacare Subsidies
A pair of key lawmakers on each side of the aisle criticized President Donald Trump on Sunday for ending subsidies that help low-income Americans afford health care under the Affordable Care Act. Sen. Susan Collins (R-Maine) said she was “disappointed” by the president’s actions and urged Congress to “step in” with its own plan for Obamacare. (Klimas, 10/15)

The Hill: Dem Senator: Trump 'Is Setting The Entire Health Care System On Fire'
Sen. Chris Murphy (D-Conn.) on Sunday ripped President Trump's decision to end key ObamaCare payments known as cost-sharing reduction (CSR) benefits, comparing the decision to "arson." "This is the equivalent of health care arson. He is literally setting the entire health-care system on fire just because the president is upset that the United States Congress will not pass a repeal bill that is supported by 17 percent of the American public," Murphy said on "Fox News Sunday." (Manchester, 10/15)

The Hill: Retiring GOP Lawmaker: Republicans Now 'Own' ObamaCare 
Rep. Charlie Dent (R-Pa.) argued Friday that President Trump was “ill-advised” to end key ObamaCare payments, warning that the GOP now “owns” whatever happens to ObamaCare. “I think the president is ill-advised to take this course of action because … we, the Republican Party, will own this,” Dent, a key House moderate who is retiring from Congress at the end of his term, said on CNN. (Carter, 10/13)

The Washington Post: Partisan Clash On Obamacare Raises Specter Of Government Shutdown
Democrats accused President Trump of trying to sabotage the nation’s health-care system through his decision to halt payments to insurers meant to shore up the system, while Republicans countered Sunday that Trump is just pushing for a hard bargain. Trump’s decision, announced Friday after months of criticizing the payments as an insurance industry bailout, will throw in doubt the private insurance exchanges that are part of the Affordable Care Act. Democrats vowed to use year-end negotiations on the federal agency budgets as a leverage point to reinstate the payments, vowing to pin the political blame on Republicans if premiums skyrocket next year. (Kane, 10/15)

The Hill: Dems Float Putting ObamaCare Money In Funding Deal 
Senate Minority Leader Charles Schumer (D-N.Y.) is signaling Democrats will try to get ObamaCare's insurer subsidy payments included in a December funding deal, adding another legislative item to an already packed end-of-the-year schedule. "I think we're going to have a very good opportunity in the omnibus to get this done in a bipartisan way, if we can't get it done sooner," Schumer told reporters during a conference call on Friday. (Carney, 10/13)

The Hill: Dems Eye Emergency Spending Bills To Restore ObamaCare Subsidies 
House Minority Leader Nancy Pelosi (D-Calif.) on Friday urged Republicans to act immediately to restore ObamaCare insurance subsidies newly withheld by the Trump administration, saying Democrats may use emergency spending bills to secure the payments. She added that restoring the subsidies was a "matter of life and death." (Lillis, 10/13)

9. It's Not Likely Court Will Order Administration To Pay Subsidies, But That Hasn't Stopped States From Suing

Nearly 20 states have sued over President Donald Trump's decision to stop the insurer subsidies. But, “Forcing an administration to continue making payments when the president believes there is no appropriation, and when Congress believes there’s no appropriation, would be a pretty extreme move by the court," said Nicholas Bagley, a professor at the University of Michigan Law School.

Politico: Epic Legal Battles Shaping Up Over Trump's Scrapping Of Obamacare Subsidies
President Donald Trump's move to cut off critical Obamacare subsidies will almost surely be tied up in the courts for years as Democratic-led states seek injunctions, while insurers seek to recover payments they say they’re owed. It's impossible to predict whether a judge might order the administration to continue the payments while the lawsuits are heard, but at least some legal experts express doubts. (Demko and Pradhan, 10/13)

The Associated Press: Many States, Consumers Alarmed By Trump's Health Care Order
President Donald Trump's decision to end a provision of the Affordable Care Act that lowered out-of-pocket medical costs brought swift reaction Friday from the states, as health officials and consumers said they feared the action could chase millions of Americans away from coverage. Attorneys general in nearly 20 states filed a lawsuit against the Trump administration to keep the money flowing, contending that the president is not following a legal requirement to pay the subsidies. (Mulvihill and Kennedy, 10/13)

The Hill: 18 States Sue Over Trump-Halted ObamaCare Payments
A new multi-state lawsuit has been announced to stop President Trump from halting key ObamaCare payments to insurers. Eighteen states and Washington, D.C., signed onto the lawsuit filed Friday in federal court in California, according to Sarah Lovenheim, a spokeswoman for California Attorney General Xavier Becerra (D). (Roubein, 10/13)

NPR: Swift Reaction To White House's Move To End Insurance Subsidies
New York Attorney General Eric Schneiderman says he is joining peers in California and several other states in filing a lawsuit to protect the subsidies. Schneiderman says the lawsuit will argue that the subsidies are codified under the ACA, and therefore, they must be paid as long as the health care law remains in force. Eliminating the subsidies is "breathtakingly reckless," he said. "This move is unacceptable, it's cruel, and it is unlawful." (Kodjak, 10/14)

The Oregonian: Oregon Will Join Lawsuit Against Trump's Plan To Stop Obamacare Insurance Subsidies
Oregon health officials are still scrambling to respond to President Donald Trump's decision to cut off payments to insurers under the Affordable Care Act. But one thing is clear: The state plans to fight the president's plan. State Attorney General Ellen Rosenblum said Friday that Oregon is joining California's lawsuit to protect the subsidies that reduce insurance costs for low- and middle-income households. Fifteen other states have already signed on, according to Rosenblum.  (Borrud, 10/13)

The Baltimore Sun: End Of Obamacare Subsidies Creates An Uproar 
The announcement prompted an almost immediate reaction Friday. Maryland Attorney General Brian Frosh announced that the state was joining 17 other states and the District of Columbia in a class-action lawsuit against the Trump Administration. CareFirst Blue Cross BlueShield, which has about 75 percent of the exchange market in Maryland, said it plans legal action, too. (McDaniels, 10/13)

Pioneer Press: Minnesota Sues Over Trump Stopping Health Insurance Payments
Minnesota will sue the Trump administration over its plans to stop federal payments that have reduced the cost of health insurance, Attorney General Lori Swanson said Friday. Through legal filings and a late Thursday night announcement, President Donald Trump’s administration said that the payments were illegal because they had not been approved by Congress. But Swanson and other Democratic attorneys general say the payments are in federal law and insurance companies are owed them to keep state residents’ costs down. (Stassen-Berger, 10/15)

Denver Post: Trump Decision On Obamacare Subsidies Draws Criticism From States, Health Groups 
Gov. John Hickenlooper called the subsidy decision “cruel and irresponsible.” The attorneys general in at least a dozen states — Colorado is not one of them — said they plan to sue over the decision. Six physician groups, representing more than 560,000 U.S. doctors and medical students, issued a statement warning that cutting off the payments will cause “dramatic, if not catastrophic, increases in premiums across the country.” The announcement also brought immediate upheaval to Colorado’s insurance market. As a result of the subsidy payments being discontinued, the Colorado Division of Insurance announced premiums for people who buy health insurance on their own will rise next year on average by an additional 6 percentage points above previously announced increases. (Ingold, 10/13)

San Francisco Chronicle: California To Sue Trump Administration Over Health Insurance Subsidies
California Attorney General Xavier Becerra said Friday he will sue the Trump administration for halting billions of dollars in federal payments to health insurers that help low-income Americans afford health care under the Affordable Care Act. The payments, known as cost-sharing subsidies, were created under the ACA to help insurers lower out-of-pocket costs for millions of Americans who buy health insurance through the exchange. (Ho, 10/13)

Sacramento Bee: California Sues Trump To Preserve Obamacare
“Undermining the Affordable Care Act has been Donald Trump’s and many Republicans’ plans for a long time,” Becerra said. “It’s long past time that President Trump learned that he doesn’t get to just pick and choose which laws he’ll follow, and which bills he’ll pay.” (Hart and Ashton, 10/13)

10. Nearly 70% Of People Benefiting From Insurer Subsidies Live In States Trump Won

Media outlets report on the decision's effects out of California, Oregon, Washington, Iowa, Tennessee, Illinois, Florida, Ohio, Massachusetts, Nevada and Georgia.

The Associated Press: Pro-Trump States Most Affected By His Health Care Decision
Nearly 70 percent of those benefiting from the so-called cost-sharing subsidies live in states Trump won last November, according to an analysis by The Associated Press. The number underscores the political risk for Trump and his party, which could end up owning the blame for increased costs and chaos in the insurance marketplace. The subsidies are paid to insurers by the federal government to help lower consumers' deductibles and co-pays. People who benefit will continue receiving the discounts because insurers are obligated by law to provide them. But to make up for the lost federal funding, health insurers will have to raise premiums substantially, potentially putting coverage out of reach for many consumers. (Cassidy and Hoyer, 10/14)

The Washington Post: Timing Of White House Actions Unrolling Parts Of ACA ‘Couldn’t Be Worse,’ States Say
After threatening for months to end billions of dollars in payments promised to health insurers, President Trump finally dropped the ax with timing that could inflict maximal disruption on the Affordable Care Act enrollment season scheduled to begin in two weeks. The most immediate upheaval is playing out in a set of states where regulators had ignored the risk that the president might carry out his threat and told insurers not to include any cushion in their 2018 rates for ACA health plans. Officials in at least three states are now debating whether to delay the Nov. 1 start of enrollment as they rush to consider higher premiums to make up for the abrupt loss of federal money. (Goldstein, 10/14)

Los Angeles Times: Trump Healthcare Move Threatens Sharply Higher Premiums And Market Chaos
Caught in the middle are millions of Americans likely to see their insurance premiums shoot higher as the administration intensifies its effort to dismantle the 2010 healthcare law, often called Obamacare. Insurers have said that markets in some parts of the country could collapse, leaving many consumers who don’t get insurance on the job with no choices for health plans. And state insurance regulators predicted premiums in the individual market nationally would rise by 12% to 15% next year because of the cutoff. (Levey and Lauter, 10/13)

NPR: Health Insurance Premiums To Rise After Subsidies Stop
The decision will most directly affect middle-class families who buy their own insurance without financial help from the government. Consumers who earn more than 400 percent of the federal poverty level — an individual with income of about $48,000 or a family of four that makes more than $98,400 — will likely see their costs for coverage rise next year by an average of about 20 percent nationwide. People with lower incomes will be unaffected since the ACA, also known as Obamacare, provides government subsidies — in the form of tax credits — that ensure their out-of-pocket insurance costs remain stable. So when premiums rise, those tax credits rise in tandem. (Kodjak, 10/13)

The Oregonian: Oregon Officials Say They Sidestepped Trump's 'Sabotage' Of Health Insurance Market
By late Friday, though, Oregon insurance regulators said they had figured out a way to increase a different federal health insurance subsidy – premium assistance payments -- that could more than cover the loss of the cost-sharing payments for many Oregonians. The higher premium assistance payments won't come without some pain. The state said it will allow carriers a special, one-time 7.1 percent rate increase on silver plan policies. (Manning and Borrud, 10/13)

Seattle Times: 70,000 Washingtonians Face Higher Insurance Costs After Trump Order, Officials Say 
More than 70,000 Washingtonians will face higher health-insurance costs because of President Donald Trump’s decision to halt Affordable Care Act (ACA) subsidy payments to insurers, state officials said Friday. Trump’s orders, announced late Thursday, “are certain to result in higher premium payments for consumers and will force our insurers to determine whether they will remain in an unstable market,” said state Insurance Commissioner Mike Kreidler. (Young, 10/13)

Des Moines Register: Trump's Obamacare Cut Shouldn't Derail Iowa's Stopgap Insurance Plan
Iowans who buy their own insurance won’t be immediately affected by President Trump’s decision to cut off a major stream of Obamacare money because state regulators and the sole insurance carrier offering such policies had already assumed he would do so, officials said Friday. Trump decided Thursday to follow through on threats to cut off “cost-sharing” payments under the Affordable Care Act. Those payments reimburse insurers for reducing deductibles and other out-of-pocket costs for moderate-income Americans who buy their own policies. (Leys, 10/13)

Nashville Tennessean: President Trump's Decision To End ACA Subsidy Creates Fresh Uncertainty
Tennessee's individual health insurance market is entering uncharted territory after a pair of actions from President Donald Trump Thursday cast a heavy pall over the nearly five-year-old market only weeks before open enrollment begins. The White House announced via a late-night statement it will not continue to make cost-sharing reduction payments (CSRs) to insurers — a subsidy thrust into the spotlight as the administration wavered on the future payments, which had become a month-by-month decision. (Fletcher, 10/13)

Nashville Tennessean: What Is The ACA Subsidy Trump Is Ending? Here's What It Will Mean For You
At this point, insurers are committed to 2018 since they signed federal contracts on Sept. 27. BlueCross BlueShield of Tennessee will continue with its plans for 2018, said Roy Vaughn, chief communications officer. Insurers could try to use the court system to get out of the contracts now that it's clear the federal government won't pay the CSRs — unless Congress passes legislation to enforce it.  (Fletcher, 10/13)

Chicago Tribune: Trump's Plan To End Obamacare Subsidies Stirs Uncertainty In Illinois 
The state’s largest insurer, Blue Cross and Blue Shield of Illinois, said Friday it plans to remain on the state’s Obamacare exchange next year despite President Donald Trump’s decision to end subsidies to health insurers. Whether other Illinois insurers flee the state’s exchange is still unclear. President Donald Trump’s administration on Thursday night confirmed plans to stop making so-called cost-sharing reduction payments to insurers. (Schencker, 10/13)

Miami Herald: Florida Wins When Trump Scraps Obamacare Subsidies
By canceling Affordable Care Act subsidies for low-income Americans this week, President Donald Trump might be undermining the health law known as Obamacare in some states. But in Florida, the president’s executive order would lead to a financial windfall for Obamacare insurers and better coverage options for many of the 1.4 million Floridians with an ACA plan, health policy experts say. (Chang, 10/13)

Cleveland Plain Dealer: Cleveland Hospitals Gauging Effect Of Trump Ending Insurance Subsidies
The decision late Thursday by President Donald Trump's administration to end cost-sharing subsidies for insurers is leaving area hospitals scrambling to determine what that means for patients locally. The payments were established under President Barack Obama's Affordable Care Act and reimburse insurers for covering out-of-pocket healthcare costs for lower-income Americans. (Christ, 10/13)

The Hill: GOP Governor: Trump Halting ObamaCare Payments Is ‘Devastating’ 
Nevada's Republican Gov. Brian Sandoval ripped President Trump's decision to end key payments to insurers selling ObamaCare plans on Friday, calling the move "devastating." The payments help low-income people afford co-pays, deductibles and other out-of-pocket costs associated with health insurance policies. (Manchester, 10/13)

California Healthline: Impact Of Trump Subsidy Decision Blunted In California — For Now
Unable to get Congress to “repeal and replace” the Affordable Care Act, President Donald Trump this week took matters into his own hands. Late Thursday evening, the White House announced it would stop paying key subsidies, known as “cost-sharing reductions,” that compensate insurers for providing discounts on deductibles, copays and other out-of-pocket costs to low-income consumers. (Rovner, Bazar and Terhune, 10/13)

Georgia Health News: Trump’s Latest Move Shakes ACA, But Effect Was Foreseen In Georgia
On one level, the White House’s pledge late Thursday to stop cost-sharing payments to health insurers under the Affordable Care Act won’t make a major difference in Georgia. That’s because three of the four health insurers offering coverage on the state exchange have already factored in the likely elimination of the payments in their huge 2018 premium increases. ... But on the heels of his executive order to ease rules on association health plans and short-term policies, Trump has shown that he’s willing to make a variety of moves to unravel the ACA as much as he can, after Republicans in Congress failed to repeal it, as they had long pledged. (Miller, 10/13)

11. Trump Touts Own Executive Order As Health Stocks Plunge On News

President Donald Trump also says he wants Democrats to "get smart" and "deal."

The Hill: Trump: I'm 'Very Proud Of My Executive Order' On Health Care
President Trump tweeted Saturday he is "very proud" of his recently-signed executive order on health care. “Very proud of my Executive Order which will allow greatly expanded access and far lower costs for HealthCare,” Trump tweeted. “Millions of people benefit!” Trump also claimed that health insurance stocks fell after his decision to end key ObamaCare payments was announced. (Carter, 10/14)

The Hill: Trump: ‘Dems Must Get Smart And Deal’ On Health Care 
President Trump on Friday ripped Democrats critical of his move to end key payments to insurers selling ObamaCare plans, saying lawmakers from the opposing party must "get smart & deal." "Money pouring into Insurance Companies profits, under the guise of ObamaCare, is over. They have made a fortune. Dems must get smart & deal!" Trump wrote on Twitter. (Manchester, 10/13)

The Hill: Trump Gambles With ObamaCare Moves 
Frustrated by Congress’s inaction on ObamaCare repeal, President Trump is taking a big political risk in using his authority to dismantle the health-care law piece by piece. Democrats say Trump now owns ObamaCare, bearing responsibility for any problems that arise in the system, including higher premiums and insurer exits. (Hellmann and Roubein, 10/15)

12. 'We Anticipated This': Insurers Not Exactly Floored By Trump's Decision

It could be hard for insurers to pull their plans off the market for next year, but most companies say they were prepared for the money to evaporate anyway and had baked the contingency into their 2018 premium increases. However, the industry is calling on Congress to fund the payments.

The Wall Street Journal: Major Health Insurers Anticipated End Of Subsidies
Several major insurers said they intend to provide health plans on the Affordable Care Act’s exchanges for the rest of this year and for 2018, despite a financial blow from President Donald Trump’s cancellation of federal cost-sharing payments. The payments, which had been expected to total $7 billion this year, will be “discontinued immediately” because their continuation violates federal law, the Department of Health and Human Services said Thursday. Payments due to go out on Wednesday will be canceled, the administration said in a legal filing. (Wilde Mathews, 10/13)

Bloomberg: Obamacare Insurers, States Rush To React To Trump's Latest Move 
States regulators and health insurers are rushing to react to the latest move by the Trump administration to dismantle parts of the Affordable Care Act, less than three weeks before their citizens and customers start signing up for coverage. President Donald Trump’s administration said this week it wouldn’t pay subsidies to insurers that are used to help lower-income people with medical costs. In response, some regulators say they’ll need to reconsider the rates health insurers can charge -- a move that could lead to sharp increases in states such as Colorado, Oregon and Maryland. (Tracer, 10/13)

The Hill: Insurers Push Back Against Trump's Cuts To ObamaCare Subsidies 
Health care consumers will suffer from President Trump's decision to cut off ObamaCare's cost-sharing reduction (CSR) subsidies, two of the largest insurance trade groups said in a statement Friday. “This action will make it harder for patients to access the care they need. Costs will go up and choices will be restricted,” the Blue Cross Blue Shield Association and America’s Health Insurance Plans said in a joint statement. (Weixel, 10/13)

The Hill: Insurers Call On Congress To Act On ObamaCare Payments
Several health groups, including insurers and hospital associations, signed a joint letter to House and Senate leadership on Saturday, urging Congress to fund cost-sharing reduction (CSR) benefits, following President Trump's decision to halt the key ObamaCare payments. "There will be serious consequences without Congressional action: millions will face higher premiums, fewer choices, and less access to the medical care they need. Let’s work together on solutions that deliver the access, care, and coverage that the American people deserve," the letter said. (Manchester, 10/14)

Bloomberg: Centene, Hospitals Slide On Trump's Plan To Stop Subsidies 
Insurer Centene Corp. fell the most in almost a year and hospital operators including Tenet Healthcare Corp. dropped after President Donald Trump cut off Obamacare subsidies, a move that could destabilize the market and hurt company earnings, credit ratings and dealmaking. The announcement is fueling fears that the payments, known as cost-sharing reduction subsidies, may end immediately, which could hurt hospitals and those insurers still in the marketplace. Fourth-quarter and 2018 earnings for hospitals are “now at risk” and current estimates are probably too high, Mizuho Securities analyst Sheryl Skolnick wrote in a note to clients. (Flanagan and Rausch, 10/13)

13. Will My Insurance Now Be More Expensive?: Questions Abound After Busy End Of The Week

There's lots of confusion for consumers about exactly what all this news about the health law means. A handful of different media outlets try to break it down for people.

The Associated Press: Key Questions And Answers About Trump's Health Care Move
President Donald Trump's move to stop paying a major "Obamacare" subsidy will raise costs for many consumers who buy their own health insurance, and make an already complicated system more challenging for just about everybody. Experts say the consequences will vary depending on how much money you earn, the state you live in, and other factors. (Alonso-Zaldivar, 10/14)

Politico: Trump Scraps Obamacare Payments. What Happens Now?
President Donald Trump’s decision to eliminate a key Obamacare insurance subsidy amounted to one of his fiercest attacks yet on his predecessor’s health care law. But it could still be weeks or even months before it’s clear whether the move will be the decisive blow that brings down Obamacare’s insurance marketplaces. (Millman, 10/13)

The Washington Post: Trump Scrapped A Key Obamacare Payment. Here’s What Comes Next.
The decision triggered sharp condemnations from major players across the American health-care system. But while the payments to insurance companies do benefit lower-income Americans, taking these payments away will have some counterintuitive effects — and likely won't hurt the poorest the most. Here's how the effects could play out. (Johnson, 10/13)

The Hill: Five Things To Know About Trump’s Controversial ObamaCare Decision 
The Trump administration’s decision to end payments to insurers meant to help low-income people afford their insurance has set off a battle in the courts and new fears about the possible collapse of former President Obama’s health-care law. Ending the payments is the most dramatic step taken to date by President Trump, who has been frustrated with the GOP Congress’s inability to repeal the law. (Weixel, 10/14)

Bloomberg: Is Trump Replacing Obamacare Or Trying To Gut It? 
U.S. President Donald Trump spent much of the year seething as his Republican allies in Congress failed to pass legislation to repeal and replace the Affordable Care Act, as Trump had promised during his campaign. On Thursday, he took a flurry of steps that he said were meant to replace “piece by piece” what he called “a broken mess.” Democrats call his actions just the latest in a series of efforts to sabotage Obamacare, as the ACA is called. Insurers and health-care groups say Trump’s moves will lead to higher costs for consumers and could potentially destabilize the marketplaces Obamacare created to serve millions of Americans. (Rausch and Tracer, 10/16)

Bloomberg: Trump's New Obamacare Killer To Cost Uncle Sam $194 Billion
President Donald Trump is halting some Obamacare subsidies. A big money saver for taxpayers, right? Wrong. The move could actually force the government to dole out almost $200 billion more on health insurance over the next decade. Here’s why: The insurer payouts Trump cut off aren’t the only government funds financing the program. Consumers also can get help with their insurance premiums. When the insurer subsidies are discontinued, those premiums are pushed higher -- and because the consumer subsidies are far bigger than those given to insurers, that’s a costly trade. (Tracer, 10/13)

And KHN helps you make sense of what's going on —

Kaiser Health News: Trump Acting Solo: What You Need To Know About Changes To The Health Law
Apparently frustrated by Congress’ inability to “repeal and replace” the Affordable Care Act, President Donald Trump this week decided to take matters into his own hands. Late Thursday evening, the White House announced it would cease key payments to insurers. Earlier on Thursday, Trump signed an executive order aimed at giving people who buy their own insurance easier access to different types of health plans that were limited under the ACA rules set by the Obama administration. (Rovner, Carey and Appleby, 10/13)

Kaiser Health News: Facebook Live: Trump Ends Payments For Cost-Sharing Reductions. What’s Next?
President Donald Trump has followed through on a long-standing threat. His administration announced late Thursday it will halt federal payments for the Affordable Care Act’s cost-sharing reductions. This is the latest blow to the stability of the ACA’s insurance marketplaces, and it is triggering significant confusion among consumers and insurers. This live chat features KHN senior correspondent Jay Hancock answering questions about what it might mean for the upcoming open enrollment period and beyond. (10/13)

Kaiser Health News: Podcast: ‘What The Health?’ Let’s Blow It Up
With Congress having given up on repealing and replacing the Affordable Care Act, at least for now, President Donald Trump stepped in to try to make some changes himself. On Thursday, he signed an executive order aimed at making insurance cheaper for some people, but in ways that could make it more expensive for others. (10/13)

Administration News

14. VA Secretary Shulkin Has White House Interview To Head HHS

David Shulkin, a physician and a holdover from the Obama administration at the Department of Veterans Affairs, is believed to be one of several candidates to replace former Health and Human Services Secretary Tom Price.

The Wall Street Journal: Veterans Affairs Head Interviews For Health And Human Services Post
David Shulkin, the current U.S. Secretary of Veterans Affairs and a holdover from the Obama administration, has been interviewed by the White House for the top job at Health and Human Services, according to sources familiar with the meetings. He is one of a number of leading contenders for the position, which has been vacant since late September when former HHS Secretary Tom Price resigned over criticism of his use of private and military planes. (Armour, Kesling and Nicholas, 10/13)

In other news from the administration —

Kaiser Health News: Stunner On Birth Control: Trump’s Moral Exemption Is Geared To Just 2 Groups
Few people were surprised last week when the Trump administration issued a rule to make it easier for some religious employers to opt out of offering no-cost prescription birth control to their female employees under the Affordable Care Act. But a separate regulation issued at the same time raised eyebrows. It creates a new exemption from the requirement that most employers offer contraceptive coverage. This one is for “non-religious organizations with sincerely held moral convictions inconsistent with providing coverage for some or all contraceptive services.” (Rovner, 10/16)

Veterans' Health Care

15. Investigation Finding VA Conceals Shoddy Care, Staff Mistakes Prompts Action At The Agency

A USA Today investigation found that Veterans Affairs managers do not report troubled practitioners to the National Practitioner Data Bank, and that the agency failed to ensure that VA hospitals report disciplined providers to state licensing boards.

USA Today: VA Conceals Health Care Workers' Mistakes And Misdeeds
Behind the walls of the nation's oldest veterans’ hospital, the reports were grim. Medical experts from the Department of Veterans Affairs blamed one botched surgery after another on a lone podiatrist. They said Thomas Franchini drilled the wrong screw into the bone of one veteran. He severed a critical tendon in another. He cut into patients who didn’t need surgeries at all. Twice, he failed to properly fuse the ankle of a woman, who chose to have her leg amputated rather than endure the pain. (Slack and Sallah, 10/13)

USA Today: Veterans Affairs Overhauls Policies On Poor Medical Care Providers
The Department of Veterans Affairs is pledging to overhaul its reporting policies for bad medical workers and a group of lawmakers is introducing legislation following a USA TODAY investigation that found the VA has routinely concealed shoddy care and staff mistakes. VA Secretary David Shulkin directed agency officials to expand a nearly 30-year-old policy that limited what medical providers the agency would report to a national database created by Congress to prevent problem medical workers from crossing state lines to escape their pasts and keep practicing. (Slack, 10/12)


16. When Maine Voters Decide Whether To Expand Medicaid, Other States Will Be Watching

Health law advocates in Utah are also proposing a referendum on the issue, and the outcome in Maine could influence other states that have put the decision on hold. Meanwhile, in Louisiana, critics of the expansion program point to signs the state budget is in trouble, and a commission in New Hampshire looking at the insurance marketplace there is considering whether the state should move more people with serious medical issues into Medicaid to make the health law's marketplace plans more stable.

The Wall Street Journal: In Maine, Medicaid Expansion Goes Before the Voters
As the Trump administration takes steps to weaken provisions of the Affordable Care Act, voters in Maine are being asked whether the state should embrace a central plank of the 2010 law. The November statewide ballot measure proposes the state accept enhanced federal funding available under the health law to extend Medicaid health benefits to low-income adults, over the strong opposition of the state’s Republican governor, Paul LePage. Mr. LePage argues that the expansion would deplete state coffers. Advocates elsewhere are also seeking to put the question to voters. (Levitz and Hackman, 10/16)

The Associated Press: Analysis: Booming Medicaid Growth A GOP Target In Louisiana
Louisiana's Republican elected officials have targeted the Medicaid program as a behemoth that will suck up every available dollar if the state, which is struggling with continuing financial problems, doesn't get it under control. By fulfilling one of his major campaign promises, Gov. John Bel Edwards has given them more ammunition for their grousing, by boosting the program's costs dramatically with his Medicaid expansion. As in most budget debates, the numbers are complex — and can be bent to fit multiple narratives, depending on who's doing the talking. (Deslatte, 10/15)

Concord (N.H.) Monitor: N.H. Commission Looks To Iowa And Arkansas For Guidance On Medicaid
With some New Hampshire health care premiums projected to spike more than 50 percent, policymakers tasked with stabilizing the state’s individual insurance market are facing a steep climb. But weeks into the creation of a study commission of legislators and stakeholders, one idea is gaining broad support. If the Department of Health and Human Services can identify high-risk and high-cost patients and move them off the individual market and into more stable state-run insurance programs, policymakers say, those remaining on that exchange could see their costs stabilize. (DeWitt, 10/16)

Public Health And Education

17. How Industry-Friendly Lawmakers Undermined DEA's Power At Height Of Opioid Crisis

Members of Congress pushed through a law to weaken aggressive Drug Enforcement Administration efforts against drug distribution companies that were supplying corrupt doctors and pharmacists who peddled narcotics to the black market. The Washington Post and "60 Minutes" investigate.

The Washington Post: The Opioid Epidemic: How Congress And Drug Company Lobbyists Worked To Neutralize The DEA
In April 2016, at the height of the deadliest drug epidemic in U.S. history, Congress effectively stripped the Drug Enforcement Administration of its most potent weapon against large drug companies suspected of spilling prescription narcotics onto the nation’s streets. By then, the opioid war had claimed 200,000 lives, more than three times the number of U.S. military deaths in the Vietnam War. Overdose deaths continue to rise. There is no end in sight. (Higham and Bernstein, 10/15)

The Washington Post: Who Is Joe Rannazzisi: The DEA Man Who Fought The Drug Companies And Lost
Joe Rannazzisi is a man of strong passions who admits that he has a temper. For more than a decade, he was the frontman in the government’s war against opioid abuse. As head of the Office of Diversion Control for the Drug Enforcement Administration, he was responsible for cracking down on doctors, pharmacies, drug manufacturers and distributors who did not follow the nation’s prescription drug laws. He said he worked hard to uphold the law, until he was pushed out by members of Congress and an industry campaign that he says has resulted in a weakening of the nation’s drug laws at a time of unprecedented crisis. (Higham and Bernstein, 10/15)

The Washington Post: Rep. Tom Marino: Drug Czar Nominee And The Opioid Industry’s Advocate In Congress
Tom Marino is a four-term Republican member of the House who represents a district in northeastern Pennsylvania that has been hard-hit by the opioid crisis. Yet Marino also has been a friend on Capitol Hill of the giant drug companies that distribute the pain pills that have wreaked so much devastation around the nation. Marino was the chief advocate of the Ensuring Patient Access and Effective Drug Enforcement Act, which requires the government to meet a higher bar before taking certain enforcement actions. (Higham and Bernstein, 10/15)

In other news on the epidemic —

Stat: Teamsters Urge Cardinal Health Shareholders To Take Action In Wake Of Opioid Crisis
In another effort to hold drug distributors accountable for the opioid crisis, the International Brotherhood of Teamsters is urging Cardinal Health shareholders to appoint an independent chairman, the second such time the union has taken this type of step against a wholesaler in recent months. The union sent a letter on Friday arguing for the move in light of successive settlements the wholesaler reached in the past year with state and federal authorities. A $20 million deal was reached with West Virginia for failing to prevent the diversion of opioid painkillers and a $44 million agreement was concluded with the U.S. Department of Justice for failing to report large amounts of suspicious orders. (Silverman, 10/13)

Columbus Dispatch: Ohio State Gets $3 Million To Combat Drug-Related Child Abuse
[Bridget] Freisthler, a professor and associate dean at Ohio State University’s College of Social Work, led a team that recently won a $3 million federal grant — one of the largest in the college’s history — to address drug-related child-abuse and neglect cases by working with central Ohio’s Fairfield and Pickaway counties. The award will provide “much-needed financial support for services for these children and families,” Freisthler said, at a time when addiction’s effects on children often are overshadowed by the effort to reduce overdose deaths. (Price, 10/16)    

18. Before They Were Perpetrators They Were Victims: Why More Experts Are Looking At Criminals' Histories

Childhood trauma plays a large role in the path someone might take in life. Experts think it might be time to start taking that into account when looking at criminals. In other public health news: tuberculosis, fertility, diabetes, cancer and anxiety, breastfeeding, stem cells and more.

The New York Times: A Gun To His Head As A Child. In Prison As An Adult.
Rob Sullivan still remembers the gun and the sound of his mother’s high-pitched pleas. Two thieves had burst into his parents’ Hartford home. Demanding his father’s dope stash, one of the men placed a gun to Rob’s right temple. “Just give it to them,” his mother begged his father. He was 6 years old. (Burch, 10/15)

The New York Times: In Early Results, Shorter Treatment For Tuberculosis Proves Effective
Taking the right antibiotics for just nine months may be as effective against drug-resistant tuberculosis as taking them for two years, as is currently recommended, according to preliminary findings from an international study. Results from the trial, which is overseen by the International Union Against Tuberculosis and Lung Disease and UCL (formerly the University College London), were released at a conference in Mexico. (McNeil, 10/13)

The Washington Post: Is Egg Freezing Safe For Me And My Future Baby?
If you work at such places as Google, Facebook and Apple, your health insurance includes an unusual feature: coverage for egg freezing. Oocyte preservation, touted as a form of fertility insurance for women who want to delay childbearing, has grown in popularity since its “experimental” label was removed in 2012. But as it moves into the mainstream, is it really producing healthy kids? (Blakemore, 10/15)

The New York Times: How Do People Die From Diabetes?
People who have diabetes cannot regulate their blood sugar levels and if the disease isn’t tightly controlled, blood sugar can spike to abnormally high levels, a condition called hyperglycemia, or dip below normal, a condition called hypoglycemia. Both conditions are potentially life-threatening and can lead to coma and death if not promptly treated. But complications resulting from the disease are a more common cause of death. (Rabin, 10/13)

Los Angeles Times: How Guilt, Anxiety And Distress May Help Fight Cancer
Having cancer would make anyone scared, stressed and angry. In some cases, that might be a good thing. Recent research suggests that negative emotions may improve the health of cancer survivors by motivating them to behave in healthier ways. "Negative emotions get a bad rap," says Andree Castonguay, who studies the psychological factors that influence health and make people want to be physically active. "If they're used in the right way, by helping someone set a new goal, they can act as a driving force." (Brown, 10/13)

The Washington Post: Breastfeeding Your Child May Reduce Your Risk Of Breast Cancer
For babies, the benefits of breast-feeding are clear: a stronger immune system, reduced risk for some chronic health conditions and a closer bond with mom. But does breast-feeding also protect women against breast cancer? Nursing has been linked to a reduced risk of breast cancer risk in both pre- and post-menopausal women. But, says Virginia Borges, director of the University of Colorado Cancer Center’s young women’s breast cancer program, “it gets complicated from here.” (Blakemore, 10/15)

NPR: Floating Away Your Anxiety And Stress
When I mentioned to a friend that my baseline neurosis has evolved from daily stress into anxiety, her response was – "Go for a float!" A float? Yes — spend an hour in a dark, soundproof room floating in a body-temperature warm pool. "The heavy salt concentration does the work for you," my friend told me. "You just lie there and meditate." (Schumann, 10/16)

Stat: Doctors Fear Mental Health Disclosure Could Jeopardize Their Licenses
Medicine is grappling with rising levels of physician burnout, one of the factors driving high rates of depression and suicide in the profession. But physicians who suffer from mood disorders are often reluctant to seek treatment — in part because it might jeopardize their license to practice. For instance, in one survey, around 1 in 15 surgeons said they’d recently had suicidal thoughts, but more than 60 percent were reluctant to seek help because of concerns that it might affect their license. Now, a new study shows, those concerns break down along geographic lines — and in those states whose licensure applications ask the most sweeping questions about mental illness, physicians are most likely to be reluctant to seek treatment. (Samuel, 10/16)

NPR: Mindfulness Apps Turn Device Obsession Inside Out
From fires and hurricanes, to confrontational politics — with all that's been going on, it's no wonder the American Psychological Association found an increase in Americans' stress levels over the last year. Our constant checking of smartphones — with the bombardment of news and social media — can amp up our anxiety. So, why not use your device to help you disconnect? (Aubrey, 10/16)

The Philadelphia Inquirer/ Stem Cells To Fix Aching Knees, Backs: Promising, But No Panacea
A vast stem-cell industry has exploded in the United States in recent years, promising to fix everything from autism to blindness. Orthopedic applications are the fastest-growing segment, according to a study published last year. None of these treatments has been proven safe or effective by rigorous studies, and none has been approved by the U.S. Food and Drug Administration, which is facing increasing pressure to crack down. (McCullough, 10/13)

State Watch

19. State Highlights: After Public Squabble, N.Y. To Release $360M To Hospitals; States Cracking Down On Fake Service Animals

Outlets report on news from New York, California, Texas, Puerto Rico, Arkansas, Louisiana, Arizona, Colorado, Maryland, Wisconsin and Kansas.

The New York Times: New York State To Release $360 Million Withheld From City’s Hospitals
After threats of a lawsuit and accusations of bad faith, the administration of Gov. Andrew M. Cuomo announced late Friday afternoon that it would release some $360 million it had withheld from the city’s public hospital system. The money was a large portion of the $380 million that NYC Health & Hospitals said it was owed in federal aid to help cover the costs of caring for uninsured patients and those on Medicaid. (McKinley, 10/13)

Stateline: Tightening The Leash On Fake Service Dogs
Supporters of the new laws compare those misbehaving dog owners to people who acquire handicap signs so they can park in spaces intended for disabled people. The laws make it a misdemeanor to represent an untrained dog as a service animal, and usually come with fines of no more than $500 for an incident. But because there is no certification or official national registry of legitimate service dogs, there is no way to verify whether a dog has undergone rigorous training to become a service animal. (Ollove, 10/16)

Stat: California Wildfires Blanket Region In Smoky Pollutants, Raising Health Risks
The raging Northern California wildfires that have burned thousands of structures and caused the deaths of at least 31 people are also fouling the air across the region, driving a significant uptick in hospitalizations and keeping many residents cooped up indoors. Acrid air quality extends throughout the greater San Francisco Bay Area — well beyond the immediate fire zones — according to the Bay Area Air Quality Management District. Particulates and smoke have seeped into buildings in Oakland, Silicon Valley, and other areas well outside the fire zone. Homes and offices dozens of miles from the flames smell like campfires, and the air outside is thick with pollutants. (Piller, 10/13)

The Hill: Puerto Ricans Pump Drinking Water From Hazardous-Waste: Report 
Some Puerto Rico residents are turning to a hazardous waste site for drinking water as the island continues to reel from Hurricane Maria. More than three weeks after Hurricane Maria tore across the island, many residents – U.S. citizens – remain without access to clean drinking water. As of Saturday evening, service had been restored to about 64 percent of the island. (Greenwood, 10/14)

The Wall Street Journal: New York HIV Nonprofits Expand Services To Other Health Issues
Organizations working with AIDS and HIV patients are a well-established presence in New York City. But as infection rates have dropped and improved medicines have enabled people with the virus to live longer, some groups are adapting their service models and expanding their reach, taking on new health issues from heart disease to heroin addiction. Until recently, Manhattan-based nonprofit Alliance for Positive Change was known as the AIDS Service Center NYC, with a mission to provide New Yorkers with HIV prevention, treatment and support services. (West, 10/15)

The Associated Press: Appeals Court Keeps Arkansas Abortion Pill Limits On Hold
A federal appeals court on Friday prevented Arkansas from enforcing restrictions on how the abortion pill is administered while Planned Parenthood asks the nation's highest court to review a ruling in favor of the law. A three-judge panel of the 8th U.S. Circuit Court of Appeals granted a request by Planned Parenthood Great Plains to not allow an earlier ruling in favor of the restrictions to take effect yet. (10/13)

New Orleans Times-Picayune: Bogalusa Hospital Patients Notified Of Patient Data Breach 
LSU Health Care Services Division has notified some patients of the former Bogalusa Medical Center that a former hospital employee may have inappropriately accessed their protected patient information. In a recent news release, the agency said it was informed on Aug. 11 by Our Lady of the Angels Hospital in Bogalusa that an employee had inappropriately accessed patient information. The time frame included the period from February 2003 to March 17, 2014, when the facility was operated by LSU Health Care Services Division as Bogalusa Medical Center. (Warren, 10/13)

San Jose Mercury News: Jerry Brown Vetoes Bill Easing Permits On Cell Phone Towers
A bill co-authored by a Bay Area assemblyman that would have blocked the ability of cities and counties to control the installation of microwave radiation antennas was vetoed just before midnight Sunday by Gov. Jerry Brown. In a signing statement, Brown wrote: “There is something of real value in having a process that results in extending this innovative technology rapidly and efficiently.” (Seipel, 10/16)

Arizona Republic: Burials, Cremations On Hold As Arizona Launches A New Death Database
Arizona funeral homes have delayed burials and cremations, and some say they can't take in any more bodies, amid a bureaucratic logjam caused bythe bumpy rollout of a new state database of births and deaths. The Arizona Department of Health Services went live with its new database Oct. 2, seeking to streamline how doctors, medical examiners and funeral directors submit and process records — things like death certificates and disposition permits that allow them to do their work on behalf of grieving families. (Alltucker, 10/13)

Denver Post: Veteran’s Death Spurs Creation Of A Peer Mentor Program To Curb Suicide 
In 2014, the risk for suicide was 22 percent higher among veterans compared to adults who had not served in the military, according to the latest available data from the U.S. Department of Veterans Affairs. An average of 20 veterans died by suicide each day that year, although Ehle thinks the number is low. The suicide rate is especially high in the western U.S. and rural areas. In 2014, 178 veterans in Colorado took their own lives. (Worthington, 10/14)

The Baltimore Sun: Maryland Among Worst In Nation In Investigating Nursing Home Complaints On Time, Feds Say 
Maryland lags most of the nation in inspecting high-priority nursing home complaints — a problem past administrations have promised to fix, but that continues to vex state health officials — a federal inspector general has found. The state failed to investigate nearly 650 allegations of harm at Maryland nursing homes within a required 10-day window, meaning the state missed the federal deadline 74 percent of the time, the inspector general for the U.S. Department of Health and Human Services reported. (Fritze, 10/12)

Kansas City Star: Gun Thefts On The Rise In Kansas City
The number of annual firearms thefts rose from 496 to 588 between 2008 and 2015, but it exploded in 2016. Thieves stole 804 a year ago — a 37 percent increase. And they are on pace to steal some 830 firearms in 2017. (Robertson, 10/15)

Editorials And Opinions

20. Tough Talk: Trump's Open Warfare Against Obamacare; Ideas That Deepen Health Care 'Inequality'

Across the country, editorial and opinion writers offer tough talk about the Trump administration's actions last week to loosen some health insurance restrictions and to stop federal payments for cost-sharing reductions under the Affordable Care Act.

The New York Times: How To Fight The New Trumpcare
Since Donald Trump’s election, a loose coalition of citizens, doctors, nurses, activists and others have rallied together to prevent their fellow Americans from losing health insurance. They won a big victory last month when Congress set aside its efforts to pass a destructive bill. But now the coalition has a new fight. Trumpcare has begun, not through legislation but through executive action. (David Leonhardt, 10/15)

Los Angeles Times: Trump Has Declared Open War On The ACA. We'll All Get Hurt
The Trump administration has declared open war on the Affordable Care Act. With its abrupt decision to terminate critical subsidies, it has thrown the exchanges into chaos on the eve of open enrollment; it has imperiled the full faith and credit of the United States; and it will cause a massive increase in federal spending. This is no way to run a healthcare system, and no way to run a government. (Nicholas Bagley, 10/13)

The New York Times: Trump Is Trying To Gut Obamacare. Here’s Why His Plan May Fail.
President Trump’s decision to stop paying subsidies to insurance companies that cover many low-income Americans is his most overt action so far to undermine the Obamacare markets, which reopen for sign-ups on Nov. 1. But the timing of the announcement, late Thursday night, means the ending of subsidies may be less disruptive than it might have been months ago, when he began threatening such action. It still could cause insurers to leave some Obamacare markets and places where customers have no insurance choice, but it probably won’t cause the widespread meltdown it might have, if it had happened earlier this year. (Margot Sanger-Katz, 10/13)

San Francisco Chronicle: Trump Declares War On Health Care
Most of Congress’ remarkable streak of failed attempts to “repeal and replace Obamacare” at least pretended to follow through on the “replace” half of the promise. President Trump’s administrative ambush of the law this week dispensed with that pretense and laid bare his ill will: to dismantle President Barack Obama’s health care reform without regard for what follows. (10/13)

The New York Times: Trump’s Obamacare Moves Will Deepen Health Inequality
President Trump’s actions on Obamacare will accelerate a recent trend toward dividing the individual health insurance market between the healthy and those with chronic illness and between the wealthy and the poor. The immediate elimination of cost-sharing-reduction subsidies will have a great impact. These subsidies lower the out-of-pocket expenses for individuals who earn between 100 percent and 250 percent of the federal poverty level. About seven million people qualified for C.S.R.s, according to the Kaiser Family Foundation. (David Anderson, 10/13)

The Washington Post: Trump’s Not Going To Be Able To Avoid Blame For Kneecapping Obamacare
Let’s set aside for the moment President Trump’s decision to end Obamacare’s cost-sharing reduction payments (CSRs) to insurers, a system under which insurers are subsidized to help keep costs low for low-income insurance recipients. Let’s also set aside the other ways in which the Trump administration has been deliberately undermining enrollment in the Obamacare marketplaces. We’ll set aside that the administration has slashed funding to outreach programs by as much as 92 percent, ended partnerships with state groups aimed at getting people enrolled, cut funding for advertising the enrollment period and even decided it would shut down the enrollment website for 12 hours a week for maintenance. (Philip Bump, 10/13)

Chicago Tribune: Will Congress Now Override Trump's Obamacare Moves?
President Donald Trump issued a sweeping executive order on Thursday that may help lower costs and create more options for many Americans who struggle to find health insurance. But we learned later Thursday that he also is poised to halt billions in subsidy payments to insurance companies that help cover medical costs for millions of low-income Americans. (10/13)

Health Affairs Blog: Administration’s Ending Of Cost-Sharing Reduction Payments Likely To Roil Individual Markets
Yesterday, October 12, 2017, the White House press office announced that the administration will no longer be reimbursing insurers for the cost-sharing reductions they are legally required to make for low-income individuals. The Affordable Care Act requires insurers to reduce cost sharing for individuals who enroll in silver plans and have household incomes not exceeding 250 percent of the federal poverty level. These provisions reduce the out-of-pocket limit for these enrollees—particularly for those with incomes below 200 percent of poverty—and sharply reduce deductibles, coinsurance, and copayments. The reductions cost insurers around $7 billion a year currently. (Timothy Jost, 10/13)

The Washington Post: States Have Already Tried Trump’s Health-Care Order. It Went Badly.
Even after Republicans in Congress failed three times to rid themselves of the Affordable Care Act, President Trump has proved that there is no shortage of ideas for how to disrupt the health-care system. The president signed an executive order Thursday that will allow small employers to join associations of small business — such as farm bureaus or chambers of commerce — that provide health coverage to their members. If such associations self-insure, existing law might enable them to avoid both state insurance regulations and the core of the ACA. Thus, a simple turn of the regulatory dials could free up a large portion of the most heavily regulated parts of the health-insurance market. (Mark A. Hall, 10/13)

Detroit Free Press: Bleeding The Base: Why Is Trump Targeting His Voters' Health Care?
The conventional wisdom is that Donald Trump's decision to suspend the federal subsidies insurers say are vital to the survival of Obamacare is simply the latest manifestation of the current president's contempt for everything associated with his predecessor. Haters gonna hate, after all. And who hates anything more passionately than 45 hates 44? (Brian Dickerson, 10/16)

USA Today: Trump Sells Out Your Health Insurance
Donald Trump and fellow Republicans spent much of the Obama administration complaining about how the president was legislating by the fiat of executive order, bypassing Congress and undermining existing law. So what has President Trump done with his latest actions on the Affordable Care Act? Legislate by fiat, bypass Congress and undermine existing law. (10/15)

The New York Times: Not Dead Yet: Obamacare Insurers Are Hanging In There
Despite President Trump’s best efforts, the Obamacare market hasn’t imploded yet. While Thursday’s decisions to cut off government funding and invite competition from flimsier, cheaper plans will jostle a vulnerable market, many of the major insurance companies say they will remain in the state marketplaces next year. (Reed Abelson and Margot Sanger-Katz, 10/13)

21. The Other Side Of The Story: Trump's Executive Order Is 'Modest Step' Forward; It's Not The 'Obamacare Apocalypse'

Some opinion writers defend the White House's actions last week regarding the Affordable Care Act -- both in terms of the executive order and the announcement that federal payments for cost-sharing subsidies under the ACA will be halted.

USA Today: Health Care Order Expands Insurance
For all the headlines about “dismantling Obamacare,” President Trump’s executive order will likely have less of an impact than its supporters hope or critics fear. Still, it represents a modest step toward giving consumers more choices and expanding millions of Americans’ access to lower cost insurance that better fits their individual needs. First, understand what this order is not. It neither takes anyone’s insurance away nor removes protections for people with pre-existing conditions. (MIchael D. Tanner, 10/15)

Forbes: Sorry Everbody, But Trump Hasn't Instigated The Obamacare Apocalypse
Given the President’s eagerness to wield his pen, you’d think that he would have a lot of options to push health care back in a more free-market direction. But he doesn’t. Eight years ago, much was made of the 2,000-plus page length of the Patient Protection and Affordable Care Act, now simply abbreviated as the “ACA.” But the reason Obamacare weighed in at 2,000 pages is because the law passed by Democrats detailed, in highly specific language, how Washington would run the health care system from here on out. (Avik Roy, 10/ 14)

National Review: Trump Faithfully Executes Obamacare; Media, Democrats Go Nuts
In report after sky-is-falling report, the journalism wing of the media-Democrat complex castigates the president over his decision to — as the New York Times put it — “scrap subsidies to health insurance companies that help pay out of pocket costs of low-income people.” ... What Trump has actually done is end the illegal payoffs without which insurance companies have no rational choice but to jack up premiums or flee the Obamacare exchanges. The culprits here are the charlatans who gave us Obamacare. To portray Trump as the bad guy is not merely fake news. It’s an out-and-out lie. (Andrew C. McCarthy, 10/14)

The Wall Street Journal: The ObamaCare ‘Sabotage’ Meme
Mr. Trump continued the payments on the hope that Republican health-care reform would repeal ObamaCare and moot the subsidy dispute. That did not happen. Now the Administration has decided to follow the Constitution, and fidelity to the law should trump the policy merits or political risks. The left is accusing Mr. Trump of—this is a partial list—sabotaging the Affordable Care Act; conspiring to harm the poor; sending a wrecking ball into the American health-care system; killing people. One frequent citation is a Congressional Budget Office report from August that predicted premiums would increase if the subsidies ended, which is true. ... more uncertainty and turmoil could still drive some users from the exchanges, and the solution is straightforward: Congress can appropriate the money in a legal fashion. (10/13)

Bloomberg: Obamacare Was Built With The Flaws Trump Now Exploits
Like his predecessor, President Donald Trump has been frustrated by lack of action in Congress on Obamacare. Like his predecessor, he has resorted to executive fiat to get around that obstruction. Only instead of frantically trying to save the troubled program, he is yanking out the life-support cords installed by President Barack Obama. (Megan McArdle, 10/13)

22. Birth Control Backlash: Trump Should 'Rethink' Policy On Contraception Coverage

Editorial pages also take a tough stance on President Donald Trump's move last week to roll back Affordable Care Act provisions regarding birth control coverage.

St. Louis Post-Dispatch: Administration Should Rethink Bid To Deny Assistance For Birth Control Coverage.
President Donald Trump’s feelings about women are no secret. While saying that he loves them, Trump has demeaned women, objectified them, mocked them and been accused of assaulting them. So it comes as no surprise that he moved earlier this month to deny women federal assistance to pay for birth control and expand leeway for employers to withhold such coverage on religious grounds. (10/15)

Lexington Herald Leader: Trump’s No Prude But He Panders. So Keep Fighting For Birth Control, Science.
The new 163-page case against contraception, now part of federal regulations, is being used to justify President Donald Trump’s rollback of the low-cost access to contraceptives mandated by Barack Obama’s Affordable Care Act. Trump expanded an exemption to allow employers to cite moral, in addition to religious, reasons for refusing to pay for contraceptives in their employees’ insurance plans. (10/13)

23. Viewpoints: Heavy Drinking As A Public Health Crisis; Steps The Federal Gov't Should Take To Curb Opioid Crisis

A selection of opinions on health care from around the country.

RealClear Health: Treat Heavy Drinking Like The Public Health Epidemic It Is
Excessive alcohol consumption is very common in America, but quality treatment is scarce. It’s time we transform our current treatment system into a modern one that can sufficiently respond one of the largest public health problems we face. At a time when government leaders show little interest in increasing commitments to health treatments, doing so requires that business leaders step in. (Mark Willenbring, 10/16)

JAMA: Ten Steps The Federal Government Should Take Now To Reverse The Opioid Addiction Epidemic
The United States is in the midst of the worst drug addiction epidemic in its history. Prescriptions for and deaths from opioids both quadrupled between 1995 and 2010. ... There are no simple solutions to ending this epidemic. Effective programs need to address 2 separate priorities: (1) prevention of addiction among people not currently addicted, and (2) treatment and risk reduction to prevent overdose and death among the millions of individuals in the United States now addicted. In this Viewpoint, we suggest 10 steps that could accelerate progress; national declarations, state-specific emergency declarations, or both could potentially facilitate implementation of these steps. (Andrew Kolodny and Thomas R. Frieden, 10/13)

RealClear Health: Mixing Agenda And Science: A Formula For Public Misconception
October is Breast Cancer awareness month—a time to remember friends and loved ones that have passed and promote cutting-edge research and early screenings that will prevent future deaths. However, many are pushing an alternative agenda. Activist researchers and a variety of media sources are focusing on the recently conjured connection between consuming the slightest amount of alcohol and breast cancer. (Sarah Longwell, 10/16)

Richmond Times-Dispatch: People In Mental Health Crisis Should Have Viable Alternative To Police Transport, Report Concludes
A state study released this month calls for the agency overseeing public mental health services in Virginia to establish a statewide alternative system of transportation, which could serve adult patients who are mobile and not considered by a magistrate to be a flight risk or pose a danger to themselves or others. About 40 percent of people mandated to receive care under the terms of a temporary detention order met those conditions during a pilot program conducted in five Southwest Virginia counties between Jan. 1, 2016, and March 13, 2017. (Burnell Evans, 10/13)

Miami Herald: Never Again Will A Lack Of A Generator Kill Nursing Home Residents In Florida
In September, elected officials, long-term care center administrators, advocates, and influencers stood together before a standing-room only crowd at a town hall meeting in North Miami Beach City Hall to take a solemn vow. We pledged that we would never allow our senior citizens to be subjected to catastrophic conditions like the ones that occurred when the Rehabilitation Center at Hollywood Hills lost power during Hurricane Irma’s passage. (U.S. Rep. Frederica Wilson, 10/14)

Arizona Republic: VA Failings To Treat Vets Continue To Outrage
Now we’re once again confronted with a revelation that the VA has been covering up the abuses of many of its own health-care practitioners who have badly served patients. A USA TODAY investigation found that the VA has not only failed to report many of its poorly performing medical providers to state licensing boards, it has stood by quietly as they have taken up new practices beyond the VA system. (10/15)

Hackensack (N.J.) Record/New ‘Dangerous’ Doctors Have No Place Within The VA
When someone signs up to serve in the U.S. military, that person goes in with eyes open knowing they might be sent to a foreign field, unfriendly waters, or dangerous skies. These are our bravest citizens, and they go through extensive training. Still, once deployed they are never absolutely certain what challenge, obstacle or life-and-death circumstance awaits. That should never be the case when it comes to veterans and their health care. (10/11)

The New York Times: How To Win Against Big Soda
The soda industry won big in Chicago this week when county commissioners voted to scrap the 1-cent-per-ounce tax on sugary drinks that had been in place for just two months. This is a stark turn for the effort to tax these drinks, which has been making headway as voters and City Councils in at least a half-dozen other cities, including San Francisco and Philadelphia, in recent years approved measures in favor of soda levies. The sudden about-face in Chicago, after a battle in which both sides spent millions on TV and radio ads, offers an important lesson for advocates of these taxes, ourselves included, as the industry we call Big Soda takes aim at other communities: We can’t forget the grass roots. (10/15)