Trump taunts Senate over repeal failure Presented by

TRUMP KEEPS UP ATTACKS ON SENATE — President Donald Trump continues to taunt the Senate for its failure to pass legislation repealing and replacing Obamacare. "Senator Mitch McConnell said I had 'excessive expectations,' but I don't think so," Trump tweeted Wednesday afternoon. "After 7 years of hearing Repeal & Replace, why not done?" The latest rebuke follows McConnell’s remarks earlier this week suggesting that the president didn’t understand how long it takes to get things done in Washington.

Sen. Lindsey Graham (R-S.C.), a frequent Trump antagonist, sided with the president, calling it “ridiculous” to blame the president’s impatience for the widespread public perception that Congress can’t get anything done. "I like Mitch, but for eight years we've been saying we're going to repeal and replace Obamacare. It's not like we made this up overnight," Graham said during a radio interview with Fox News’ Brian Kilmeade. "There is no way to sugarcoat this: The Republican Party promised for eight years to repeal and replace Obamacare. We failed, and if we give up, shame on us." More from POLITICO’s Nolan McCaskill and Elana Schor here.


MARKET UNCERTAINTY DRIVING BIG RATE HIKES — Steep rate hikes and less competition is expected in many Obamacare markets for 2018, according to a study of rate filings in 21 states by the Kaiser Family Foundation. In 15 of 21 major cities in those states, premiums for the benchmark silver plan is expected to increase by at least 10 percent, and in more than a third of those cities premiums are poised to spike by more than 20 percent. A major reason for the big rate hikes: uncertainty about whether the Trump administration will continue making cost-sharing subsidy payments or enforcing the individual mandate. Many insurers indicated in filings that uncertainty about those Obamacare provisions is responsible for double-digit premium increases beyond what they otherwise would have sought.

Competition continues to erode. Consumers in most markets will also have fewer options when shopping for coverage. In the 21 states Kaiser scrutinized, an average of 4.6 carriers filed exchange products to sell for next year, down from an average of 5.1 participants this year. Market participation peaked in 2015, with an average of 6.7 insurers selling products, but has steadily declined over the last three years.

Uncertainty about Obamacare’s future. “Insurers attempting to price their plans and determine which states and counties they will service next year face a great deal of uncertainty,” the Kaiser report concludes. “They must soon sign contracts locking in their premiums for the entire year of 2018, yet Congress or the Administration could make significant changes in the coming months to the law — or its implementation — that could lead to significant losses if companies have not appropriately priced for these changes.” Read the full report here.

WELCOME TO THURSDAY PULSE — Where we're a little late to the news that the mayor of Jackson, Mississippi has vowed to go vegan for a month after his city received the dubious distinction of being named the fattest in the country. Send vegan recipes and tips to [email protected] or @pauldemko on Twitter.

With help from Brianna Ehley (@briannaehley) and Dan Diamond (@ddiamond)

PULSE CHECK: Andy Slavitt thinks HHS is 'executing in bad faith.' — Appearing on POLITICO’s "Pulse Check" podcast, the former CMS administrator says he was “wrong” to hope that the Trump administration would pursue coverage expansion, which the president promised on the campaign trail last year.

"I think they've been executing in bad faith. I think they've turned [HHS] into more of a political operation, a legislative strategic shop than a focus on doing what's right for people," Slavitt argued on the podcast, which was recorded in late July. "They're willing to sacrifice some of their own credibility at times to carry out policies that the White House wants."

… One area where Slavitt is bullish: Continued Medicaid expansion in the states. He pointed to Kansas and North Carolina as two holdout states where there's been momentum this year. "There's not [a] Republican governor in the country that we didn't have a conversation [with] about Medicaid expansion, even during the Obama years," Slavitt added. Listen to the podcast.

DOCS GET PAID MILLIONS BY OPIOID MANUFACTURERS — One in 12 physicians received payments – totaling $46 million — from opioid manufacturers during a 29-month period from 2013 to 2015, according to a study published in the American Journal of Public Health. The bulk of the payments, 82 percent, were funneled to the top 1 percent of doctors who received disbursements. The top beneficiaries of payments from opioid manufacturers? Anesthesiologists. Read the study here.

BIG COVERAGE GAINS FOR WOMEN UNDER OBAMACARE — The uninsured rate has dropped in half for non-elderly women since full implementation of the Affordable Care Act, according to a new analysis by researchers at The Commonwealth Fund. In 2016, 11 percent of 18-to-64-year-old women reported being uninsured, compared to 20 percent who lacked coverage in 2010. The study also found that fewer women reported barriers to accessing medical care. In 2016, nearly half of non-elderly women reported that they did not pursue treatment because of financial concerns. That figure fell to 38 percent last year.

HEALTH INSURANCE TAX WILL SPIKE PREMIUMS — The return of the Affordable Care Act's health insurance tax next year will cause premiums to spike far beyond the Obamacare markets, impacting people covered by all types of health insurance, according to an analysis by Oliver Wyman. Large employers will see costs for family coverage increase by $540 in 2018 due to the tax, while small employers will have to pay $500 more to provide family coverage. In addition, individuals enrolled in Medicare Advantage plans can expect premiums to increase by $145. Congress passed a moratorium for the HIT for this year, but it’s set to blink back on for 2018, raising roughly $14 billion. Insurers are pushing for Congress to delay enforcement of the tax again. Read the study here.

CONSERVATIVES CALL FOR DELAYING OBAMACARE TAXES — A coalition of conservative groups is calling on Congress to scrap Obamacare’s health insurance and medical device taxes for 2018. In a letter to GOP congressional leaders, they argue that the taxes will hurt the economy and should be delayed while Congress tries to reach agreement on a broader plan to dismantle Obamacare. Americans for Tax Reform, FreedomWorks and the American Legislative Exchange Council are among the groups that signed the letter.

City officials blast White House cuts to Teen Pregnancy Prevention Program — The Big Cities Coalition — comprised of city health commissioners from some of the country's largest metropolitan areas — is asking the Trump administration to reconsider its decision to wind down the Teen Pregnancy Prevention Program two years early. The $214 million program, created under the Obama administration, provides 81 grants to cities and institutions across the country for teen pregnancy prevention and other reproductive health initiatives.

Grant recipients received a letter last month outlining the new grant termination date, which provided no explanation for the program's blunted timeline, Baltimore City Health Commissioner Leana Wen said Wednesday during a call with reporters. “No reason was given for this and no alternatives were proposed,” she said, adding that wrapping up the program two years early would mean a $3.5 million dollar loss in federal funding for Baltimore. The group sent a letter to HHS Secretary Tom Price urging him to reconsider ending the program early.

N.H. Gov urges funding for Obamacare subsidies — The Trump administration should commit to funding Obamacare’s cost-sharing subsidies through 2018 in order to help stabilize the exchange markets, New Hampshire Gov. Christopher Sununu argues in a letter to President Trump. Sununu also calls for extending the deadlines for rate filings and funneling additional dollars to states for stabilization efforts. Read the letter here.

Oregon toughens restrictions on tobacco sales — Oregon became the fifth state to prohibit the sale of tobacco products to anyone under the age of 21 on Wednesday. California, New Jersey, Maine and Hawaii are the other states that have raised the age threshold. Numerous cities also prohibit selling tobacco products to individuals under the age of 21, including New York, Chicago and Boston.

There’s an easy way to bolster competition in the Obamacare markets, argue Gerard Anderson, Jacob Hacker and Paul Starr in Health Affairs: allow Medicare to compete for customers. More.

Hospitals are acquiring ambulatory surgery centers to prepare for the migration of lucrative hip and knee replacement procedures to outpatient facilities, reports Modern Healthcare’s Harris Meyer. More.

Some doctors are helping patients eat healthier by handing out recipes, starting food pantries and even providing cooking lessons, reports Donna De La Cruz in The New York Times. More.

President Trump is making a mistake by ignoring the advice of his own commission on the opioid epidemic, argues The Washington Post’s editorial board. More.

Writing in NEJM, Adrianna McIntyre, Allan Joseph and Nicholas Bagley examine "partial Medicaid expansions" through the ACA and how the issue could shape the Trump administration's looming plans. More.

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