CBO report on pulling Obamacare payments due today Presented by

CBO TO RULE ON COST-SHARING REDUCTIONS TODAY — The report due this afternoon will analyze the effect of pulling the subsidy, and it comes as the White House weighs whether to keep paying the CSRs or halt the payments, which would throw a major wrench into the Obamacare markets.

Insurers, business groups and governors have urged the administration to keep paying the subsidies, which they say are crucial to making the Obamacare markets work. A bipartisan group of lawmakers have asked the White House to pay the CSRs for now while Congress hammers out a long-term funding solution — but President Donald Trump is leaning toward ending the payments, advisers have told POLITICO.


… Insurance experts expect the CBO report to suggest that ending the payments could backfire. One Kaiser Family Foundation report projected that the federal government could effectively spend an additional $2.3 billion on ACA marketplaces as insurers raise prices -- and more customers receive income-based premium subsidies -- to cover the lost payments.

It "seems like they will end up saying [today] that not paying CSRs costs the government more," RWJF's Kathy Hempstead told PULSE. "I am curious to see how that piece of news is consumed."

TRUMP'S ATTACKS ON MERCK ILLUSTRATE PRESSURE ON CEOs — The president's assault came after Merck CEO Kenneth Frazier on Monday morning announced he was leaving a White House advisory council apparently as a protest of Trump's weak initial response on Charlottesville — and the attacks put industry executives on edge.

— What the president said on Monday: "Now that Ken Frazier of Merck Pharma has resigned from President's Manufacturing Council, he will have more time to LOWER RIPOFF DRUG PRICES!" Trump tweeted at 8:54 a.m." Trump attacked Frazier again about nine hours later, writing: [Merck] Pharma is a leader in higher & higher drug prices while at the same time taking jobs out of the U.S. Bring jobs back & LOWER PRICES!"

— What the president said on July 20. Trump was effusive at a White House event with Frazier, calling him a "business genius" and praising the company for investing in U.S. jobs.

“I especially want to thank Ken Frazier … along with all the great people at Merck … for believing in America and the American workers," he added.

— Why the timing is so fraught. The president's attack carried particularly ominous implications for Frazier since Trump campaigned against pharmaceutical industry practices, and the White House is expected to soon release its long-promised executive order to rein in drug prices. That order, despite the president's campaign rhetoric, is expected to be industry-friendly.

— But Merck an odd target for Trump's drug price attacks. The company "hasn't been among the drugmakers called out for hiking the price of prescription drugs and has taken steps to be more transparent about how it sets prices," Lydia Ramsey writes at Business Insider. More.

… Frazier also has a history of taking difficult stands: He once worked with a team of lawyers to exonerate an innocent man on death row, CNBC's Meg Tirrell points out.

The difficult choice facing CEOs. Pressure built on the dozens of executives that continue to participate in the councils, with a wave of protesters asking companies like Johnson & Johnson and Cleveland Clinic why their leaders were still serving on the voluntary forums. Some activists called for boycotts. The dust-up illustrates the peril for those CEOs: stay and get excoriated by protests, or leave and get tongue-lashed by POTUS. More.

Meanwhile: Merck stock price unaffected. While the pharmaceutical sector has taken significant dips after previous Trump attacks — the sector was sharply down on Jan. 11, when the incoming president claimed that drug companies were "getting away with murder" — Merck's stock price closed up 0.5 percent on Monday.

THIS IS TUESDAY PULSE — Tips to [email protected] or @ddiamond on Twitter.

With help from Renuka Rayasam (@RenuRayasam), Victoria Colliver (@vcolliver) and Brianna Ehley (@briannaehley).

The White House is weighing whether to stop key Obamacare payments. | Getty

Enrollment groups say the White House has severed their relationship. "Dozens of organizations say the federal government has abandoned the collaborative outreach and education work they have pursued since 2013, putting the viability of the individual market in jeopardy," Talking Points Memo's Alice Ollstein reports.

Ollstein contacted groups like the National Partnership for Women and Families — which worked with the Obama administration to promote enrollment — and companies like Lyft that partnered on transportation initiatives last year. But the organizations said they've received total radio silence from the White House, less than three months before enrollment is supposed to begin.

“It feels like someone has slammed on the brakes and we’re all lurching forward,” said Amanda Hooper of the National Women’s Law Center, which had worked with the government on enrollment since 2013. More.

House Democrats ask GAO to probe mandate compliance. Reps. Frank Pallone and Richard Neal, the ranking members of Energy & Commerce and the Ways & Means committees, requested that the Government Accountability Office examine whether Trump's administration is enforcing the requirement for most individuals to have insurance. The senior Democrats pointed out that Trump's first executive order instructed agencies to find ways to increase waivers and exemptions from the financial burden of the ACA.

“The Trump Administration has sent strong signals about its intent to reduce or even eliminate enforcement of the individual mandate,” Pallone and Neal wrote. “We believe that these signals are contributing to higher health insurance premiums and increased instability in the Marketplaces." Read the letter.

Centene fills the last potentially bare Indiana county. The insurer is stepping in to serve Wayne County, which was at risk of having no ACA insurers in 2018 after Anthem and MDWise pulled out. It's the latest Obamacare expansion from Centene, which has reported significant profits from the health law; the insurer now plans to sell in 49 Indiana counties next year, up from 32 in 2017, Bloomberg reports. More.

… One sign of Centene's bullish approach to Obamacare: They hired Kevin Counihan, the former HealthCare.gov CEO, as a senior leader this month.

Current count: 8,429 enrollees are in potentially bare counties. That's according to Bloomberg's Hannah Recht, who notes that there's one potentially bare county in Ohio, one in Wisconsin, and parts of rural Nevada. All told, less than 0.1 percent of ACA enrollees are in potentially bare counties now, Hannah points out.

Tomas Philipson named to Council of Economic Advisers. Philipson, a University of Chicago economist, previously served as the senior economic adviser to the FDA commissioner and CMS administrator during the George W. Bush administration. Philipson last year had also joined Trump's transition team to work specifically on HHS issues.





Gallup: McCain has 58 percent nationwide approval. That's the highest level for the Arizona senator since November 2008, when he lost the election to Barack Obama, and it's driven by surging support from Democrats after the health care vote. About 71 percent of Democrats say they approve of McCain, according to a survey conducted in early August, compared to just 51 percent of Republicans. More.

Texas: State passes another abortion reporting requirements measure. Lawmakers approved a measure that would require doctors performing abortions on minors to report how the patient received consent for the procedure. If the patient received a judicial bypass, allowing her to waive parental consent, the report would have to include whether a doctor or another advocate helped her through the process. In case of an emergency abortion, the doctor would have to report whether there was time to obtain consent.

The requirement is one more abortion restriction that Texas lawmakers are passing in the special session without fireworks or potential legal challenges, POLITICO's Renuka Rayasam reports from Austin. More for Pros.

California: Study finds risks for women who travel for abortion. Women who travel long distances for abortion services are more likely to end up in emergency departments if they need follow-up care, according to a study released today. It's considered the first to look at the relationship between how far women traveled for an abortion and where they sought care for complications or other issues, POLITICO's Victoria Colliver reports from San Francisco.

UCSF researchers examined data from nearly 40,000 abortions covered by Medi-Cal in 2011 and 2012 and found women who traveled 100 miles or more for the procedure were more than twice as likely to turn to the emergency department for subsequent care than women who traveled less than 25 miles. The cost difference is significant: care at emergency departments cost about $961 per visit, while the same care at abortion providers was $536 per visit.





By Jennifer Haberkorn

The promising early looks at drug trials are giving investors whiplash because they rarely live up to the hype in later stages, The Wall Street Journal's Peter Loftus and Diane Roland report. More.

Citing concern about antibiotic resistance, medicine is second guessing the age-old advice that patients finish their full round of antibiotics, the WSJ's Sumathi Reddy reports. More.

It’s unclear who exactly is paying to try to block an Ohio ballot measure on drug prices, Stat's Rebecca Robbins reports. More.

Emma Sandoe looks at the financing policies that she says are deliberately confusing — and could hamper Medicaid expansion across the country. More.

The WSJ editorial board is pushing HHS to allow temporary health insurance plans — limited to 90 days by the Obama administration — to last nearly a year. More.

BPC's Anand Parekh says that HRSA is positioned to play a larger role in public health and urges HHS Secretary Tom Price to elevate the agency . More.

Two House Republicans from Kansas on Monday urged Sen. Pat Roberts to support changing Senate filibuster rules, according to the Associated Press. Roberts warned against it. More.

In Iceland, there are only about two babies born each year with Down Syndrome — in large part because nearly 100 percent of the women who get positive prenatal screening test results terminate the pregnancy. More from CBSN.

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