Wall Street, K Street step up criticism of 'Medicare for All' Presented by

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— Wall Street firms are trying to calm investors' fears after a new 'Medicare for All' proposal helped strip tens of billions of dollars of value from private health insurers' stock prices.

— CMS issued a final rule for the Obamacare marketplace that trims subsidies for some customers and reduces the use of drug industry coupons.

— CBO unveiled more details about its new health insurance model, which is poised to play a key role in how Congress' next health legislative proposals are received.

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THANK GOODNESS IT'S FRIDAY PULSE — Rest easy this weekend: There's been a lot of news to Muell over. Tips to [email protected].

WALL STREET, K STREET STEP UP CRITICISM OF MEDICARE FOR ALL — Sen. Bernie Sanders’ ambitious plan to effectively replace private insurance with “Medicare for All” has sent health care stocks plummeting since the Vermont independent unveiled his latest version last week. (UnitedHealth, Anthem and Cigna alone have lost more than $40 billion in market value.)

But Wall Street analysts have a message for nervous investors: Don’t panic, POLITICO's Dan Diamond reports.

— Wall Street firms said there's just a one-in-10 chance — at best — that Sanders' Medicare for all idea will become a reality. “[W]e believe that the fear [of] M4A happening is completely overblown,” Capital Alpha Partners wrote in a note to investors on Thursday. “We give 10 percent or less odds that M4A could be enacted, even in the event of a Democratic sweep.”

Analysts at Raymond James went further, telling clients on Thursday that the odds are less than 1 percent that Medicare for All will be a reality. More for Pros.

— Washington firms also joined the pile-on, with many scoffing at the tall legislative odds, and Sanders' strategy for surmounting them.

"Bernie wants to change Senate rules to allow an idea to pass with a simple majority that historically is far short of votes in either chamber," Brian Fortune, president of Farragut Square Group, told PULSE. "Good luck with that."

— And new opponents are coming out of the woodwork, with the Massachusetts Hospital Association declaring it's now against Medicare for All, Michael Jonas reports for CommonWealth Magazine.

That pits the association — which represents power players like Partners HealthCare's Mass. General and Brigham and Women's — against most of the state's congressional delegation, which includes Medicare for All proponents like Sen. Elizabeth Warren and Rep. Joe Kennedy.

— PULSE's take: Even though Medicare for All is unlikely and faces serious headwinds, the enthusiasm for coverage expansion is real — and will likely continue through the Democratic primary, at minimum.

Meanwhile, insurers are facing months of renewed scrutiny from lawmakers and activists. That sort of climate has a way of accelerating policy changes.

MEANWHILE: CMS FINALIZES RULES FOR 2020 OBAMACARE MARKET — HHS issued the final payment and benefit rules, which include a series of changes that mirror two Trump administration priorities. First, create incentives to steer consumers off ACA marketplace plans. Second, put new pressures on high drug prices.

— The rule would raise insurance costs for some customers and likely shrink ACA enrollment. CMS expects the changes will result in $980 million less in federal financial assistance in 2020 and 70,000 fewer Obamacare customers, POLITICO's Paul Demko reports.

The administration also is finalizing its proposal to reduce the exchange fee that insurers pay by half a percentage point. That should reduce premiums slightly, since insurers typically add that fee into their rates. More for Pros.

— The rule also would limit the use of drug industry coupons. Insurers in 2020 would be able to exclude manufacturer coupons from counting toward patients' annual cap on cost sharing if a medically appropriate generic drug is available, POLITICO's Sarah Karlin-Smith reports.

The rule applies to individual market, small group, large group and self-insured group health plans to the extent permitted by applicable state laws, and may affect more than 13 million people. More for Pros.

CBO explains new health insurance model. The office posted four reports that shed light on its new approach for projecting health insurance coverage and premiums. "We have incorporated new data and completely revamped the way that we model consumers’ and employers’ behavior," Director Keith Hall wrote in a post accompanying the reports.

— Gary Claxton of the Kaiser Family Foundation commended CBO for increasing its transparency. "It all looks like they're doing a really thorough job," he said.

But Claxton offered a caveat: The model is only as good as its assumptions. "Like all models, it has the issue that we really don't know the distribution of people's health, and health insurance, and incomes, and assets and future needs for health care," he said. "Maybe they get that right and maybe they don't."

— The revised model is a wonky change with supreme legislative importance: How CBO projects the impact of legislation on health care coverage can make or break a bill — as PULSE readers who lived through the 2017 Obamacare repeal fight will recall.

The new model will likely come into play if Republicans mount another effort to replace the Affordable Care Act — or when Democrats push their coverage expansion bills.

ICYMI: HHS announces more than $350 million for opioid pilot. The Trump administration awarded grants on Thursday to institutions in four states — Kentucky, Massachusetts, New York and Ohio — as part of a project to fold addiction prevention and treatment into primary care settings, mental health services and the criminal justice system.

— The goal: To reduce overdose deaths in targeted communities by 40 percent within three years through the HEALing Communities Study.

"We believe this effort will show that truly dramatic reductions in overdose deaths are possible, and provide lessons and models for other communities to adopt and emulate," HHS Secretary Alex Azar said in remarks.

Spending leaders want to shield Native American services from shutdowns. The 35-day federal shutdown hit hard for providers that rely on federal money from the Indian Health Service. That's prompted high-ranking lawmakers to rally behind plans that would insulate those clinics and other tribal services by essentially laying out two years of funding rather than one, Supriya Sridhar writes for POLITICO.

— TOM COLE's take: “Indian Tribes, their health care should not be dependent on whether or not Congress gets its other work done,” said the Oklahoma Republican, who's co-chair of the Native American Caucus and a longtime leader on the House Appropriations committee. “We have a treaty obligation to the Native Americans, and we ought to protect them from being caught in the dispute that they didn’t cause.”

Judge hears arguments in Title X lawsuit. Plaintiffs on Thursday asked District Court Judge Edwin Chen to stop the Trump administration's new family planning rules from going into effect on May 3 while their lawsuits work their way through the courts, POLITICO's Victoria Colliver reports from San Francisco. Chen did not issue an immediate ruling.

Attorneys representing the state and Essential Access Health, which administers its Title X funds, have argued that clinics and health programs would shut down or cut services — limiting access to reproductive care for patients and leading to increased costs to the state due to unintended pregnancies. They also contended the new rule violates the law. More for Pros.

With help from Mohana Ravindranath

"Now is our time": Anti-abortion groups are pushing strict new bans on the procedure as the Supreme Court math has changed, the NYT's Sabrina Tavernise reports.

Stat’s Rebecca Robbins writes about a team of researchers who think they’ve built a genetic model forecasting a person’s risk of becoming obese.

"The rise of useless health insurance": Splinter's Libby Watson questions the purpose (and growing popularity) of high-deductible health plans.

Tony Bizjak writes in the Sacramento Bee about a “toxic cocktail” of gases, created by the devastating Camp Fire, that are contaminating a local water supply.

Lydia Ramsey investigates for Business Insider why health tech startups such as Oscar and Flatiron use similar serif fonts in their marketing materials.

Artificial intelligence can help doctors make decisions quickly, but shouldn’t replace nuanced human decision-making, Elisha Waldman writes in Scientific American’s blog.

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