The pace of sign-ups still isn’t fast enough for 2018 enrollment to reach 2017 levels, given the enrollment season is only six weeks this year instead of 12 weeks. At the end of last year’s open enrollment, 12.2 million people had signed up. As of yesterday, with just two days remaining, nearly 4.7 million had completed applications.

AD

AD

But the pace has still astounded pretty much everyone, considering the Trump administration canceled most of its advertising and whittled down funds for navigator groups.

The numbers are “defying expectations,” said Josh Peck, who served as Healthcare.gov’s chief marketing officer under President Barack Obama and now heads up the group Get America Covered.

The energetic pace of sign-ups raises questions about the role of marketing in this space. Even without seeing TV or online ads, Americans with lower incomes are flocking to buy coverage — probably because they are getting larger subsidies than last year, making even more cheap plans available to them (this is because of a complicated side effect of the Trump administration cutting off payments for extra cost-sharing subsidies; I explained it in this edition of Health 202).

AD

AD

We should note that for people earning too much to get subsidies, their situation is worse than last year because the underlying premiums have skyrocketed.

But nearly all U.S. counties with marketplaces operated by Healthcare.gov feature free bronze plan options for those earning 150 percent of the federal poverty level ($18,090 for an individual or $36,900 for a family of four), according to research by the firm Avalere. Eighteen percent of counties even have free silver plan options at that earnings threshold.

Andy Slavitt, former head of the Centers for Medicare and Medicaid Services under Obama:

Perhaps as a direct result of these lower price tags, enrollments are multiplying faster than last year in all but two states, according to data compiled by Get America Covered. In the 10 states with the most enrollment growth — which include Mississippi, Wyoming, Texas, North Dakota, Arkansas, Hawaii, Iowa, Oklahoma, Nevada and Alaska — sign-ups are between 22 percent and 37 percent greater than last year.

AD

AD

Here’s the bottom line: People will purchase a product they view as necessary and affordable, even if no one is prodding them to do so.

Of course, the sign-up surge is also causing advocates for the Affordable Care Act to lament the enrollment numbers that might have been had HHS spent the $100 million the Obama administration poured into advertising last year. A cheaper product means people will be even more motivated to buy it when they see an ad, Peck said.

“If we talk about the fact the product improved this year, that is precisely the time you would want to spend more money on advertising,” Peck said. “When you’re selling a great product, it’s easier to sell.”

AD

Senior VP of the Kaiser Family Foundation:

HHS is doing some low-cost promotion of Healthcare.gov, however. It's been sending reminder emails to sign up and tweeted this yesterday:

AHH, OOF and OUCH

AHH: Former Vice President Joe Biden and Sen. John McCain's (R-Ariz.) daughter, Meghan, shared an emotional moment on ABC’s “The View” yesterday as she described reading Biden’s book about the death of his son Beau from brain cancer. Meghan. whose father was diagnosed earlier this year with the same form of cancer as Beau, teared up as she told Biden she “couldn’t get through” the book.

AD

“I think about Beau almost every day, and I was told — sorry,” Meghan McCain said, choking up, “that it doesn’t get easier.”

AD

At this point, Biden switched seats to console McCain. “One of the things that gave Beau courage — my word — was John,” Biden told Meghan. “Your dad — you may remember, when you were a little kid, your dad took care of my Beau. Your dad...became friends with Beau. And Beau talked about your dad's courage.”

McCain was diagnosed with a glioblastoma, an aggressive and highly lethal malignancy, in July. Beau Biden died of a glioblastoma in 2015. Biden said a breakthrough on cancer treatment “can happen tomorrow.” “If anybody can make it, your dad” can, he said.

“Her dad is one of my best friends," Biden told the audience and the other hosts. "Her dad goes after me hammer and tong. We're like two brothers who were somehow raised by different fathers or something because of our points of view, but I know — and I mean this sincerely… I know if I picked up the phone tonight and called John McCain and said, 'John, I'm at Second and Vine in Oshkosh, and I need your help; come,' he'd get on a plane and come. And I would for him, too.”

AD

AD

John McCain tweeted to thank Biden following the segment:

--Yesterday, the Arizona Republican's office put out a statement saying he's been admitted to Walter Reed National Military Medical Center for side effects following chemotherapy and radiation, but hopes to return to work "as soon as possible." Our colleague Paul Kane reports that two friends close to the senator said he has no plans to resign.

OOF: Five years after the mass shooting at Sandy Hook Elementary School in Newtown, Conn., mental health care providers are still waiting for promised funding boosts. Policy initiatives -- such as the 21st Century Cures Act signed into law a year ago by Former President Obama -- have been stymied by a lack of funding, the Associated Press reports. Part of that law includes funding for early intervention for young children and infants who show signs of mental illness.

AD

AD

At a Senate Health, Education, Labor and Pensions Committee hearing yesterday, senators acknowledged many of the objectives from the 21st Century Cures Act had met roadblocks, Modern Healthcare reports. "A law is not worth the paper it's written on if it's not implemented properly," Chairman Lamar Alexander (R-Tenn.) said during the hearing. "I intend to ensure the 21st Century Cures Act is fully and properly implemented."

Lawmakers have put the task of authorizing funds for the law on the back burner as they've instead worked on budget bills, according to Modern Healthcare. Some of the provisions yet to be funded include $30 million for suicide prevention, $5 million to address maternal depression and $12 million to expand crisis response. The act also created a committee to advise lawmakers and federal agencies on the needs of adults and young people with mental illness, per the AP. That committee is scheduled to meet today.

OUCH: A broad section of the District of Columbia east of the Anacostia River will lack a hospital where women can give birth and seek prenatal care, after the board of the city's public hospital voted yesterday to permanently close the facility's nursery and delivery rooms, The Post's Peter Jamison reports.

AD

AD

"The obstetrics ward at United Medical Center has been closed since Aug. 7, when regulators shut it down after uncovering what they said were serious medical errors in the treatment of pregnant women and newborns," Peter writes. "However, elected officials, maternal-health advocates and residents of Southeast Washington had expressed hope that it would reopen."

But in a session closed to the public, the hospital board voted on a resolution not to reopen the labor and delivery ward. Members said the choice stemmed from both financial challenges and questions about whether the hospital could safely provide obstetrics care to patients.

"UMC delivered a relatively small number of babies — roughly several hundred a year — and most women in Wards 7 and 8 give birth at hospitals in other parts of the city," Peter notes. "However, the hospital provided a setting where women in Southeast D.C. could give birth in emergencies, and also served as a de facto clinic providing prenatal care to walk-ins."

AD

HEALTH ON THE HILL

--Senate Majority Leader Mitch McConnell (R-Ky.) has said definitively the ACA's individual mandate to buy health insurance will be repealed in the final tax overhaul that House and Senate negotiators are finalizing this week and next.

The bill will “repeal Obamacare’s individual mandate tax, delivering relief to low- and middle-income Americans who have struggled under an unpopular and unworkable law,” the Kentucky Republican told Bloomberg in an emailed statement.

Democrats are now calling on Republicans to hold off on a final tax bill until senator-elect Doug Jones (D) is seated, after his surprise victory in Alabama on Tuesday. But the GOP ain't goin' for it. "Republicans, however, ignored the Democrats and said they did not expect any slowdown in the tax push, citing a Christmas deadline for action that had been set months in advance," our colleagues Mike DeBonis, Ed O'Keefe and Robert Costa report. The House and Senate plan final votes by the end of next week.

REPRODUCTIVE WARS

--California lawyers urged a federal judge on Tuesday to block the Trump administration from allowing many more employers to be exempted from a requirement under the ACA to provide no-cost birth control coverage to female employees. New rules the Trump administration announced in October would broaden the number of employers that could opt out of the requirement by allowing them to simply cite religious or moral objections.

U.S. District Judge Haywood Gilliam in California was the first to hold a hearing on whether to issue a preliminary injunction on the rule. Washington, Massachusetts and Pennsylvania have also filed suits against the administration for its proposed rule change.

At Tuesday's hearing, Deputy Assistant Attorney General Ethan Davis told Gilliam it wasn't clear that women would lose free birth control coverage due to expanding the exemption, according to the Associated Press. Davis said California hadn't provided proof of any woman who would be affected. But lawyers for California said they don't need to.

“When the cost of contraception increases, women are more likely to use less effective methods of contraception or none at all,” replied Julie Weng-Gutierrez, a lawyer with the California attorney general’s office. “The court does not need to wait for the ax to fall here. There is sufficient harm.”

MALPRACTICE

— Late-night host Jimmy Kimmel stepped into the political arena for his Monday night show, chiding Congress for failing to reauthorize the Children's Health Insurance Program as he introduced the audience to his son, Billy, who has a serious heart issue. Because Kimmel's presentation was a bit one-sided, The Washington Post's fact-checker extraordinaire Glenn Kessler dissects where Kimmel went a bit wrong in pinning the blame on Republicans.

What Kimmel said: CHIP “always had bipartisan support. But this year, they let the money for it expire while they work on getting tax cuts for their billionaire and millionaire donors ... Now CHIP has become a bargaining chip. It’s on the back burner while they work out their new tax plans, which means parents of children with cancer, diabetes and heart problems are about to get letters saying their coverage could be cut off next month. Merry Christmas, right?”

Where Kimmel misleads: He suggests CHIP is no longer bipartisan, but it is. “The stopgap spending bill approved in early December included a provision that permits the Department of Health and Human Services to shift funds internally to help states whose CHIP programs are running out of money,” Glenn writes. “Congressional leaders are expected to continue negotiating a long-term reauthorization of the program in the coming weeks.”

Kimmel also falsely suggests that CHIP has become bargaining chip as part of the negotiations over the tax plan. It’s actually part of the usual year-end negotiations in Congress. And lawmakers aren't disagreeing over whether to reauthorize CHIP; the disputes are over how to pay for it.

“The GOP-led House of Representatives on Nov. 3 passed a CHIP reauthorization bill by a vote of 242-174, with most Democrats voting against it because of funding offsets,” Glenn notes. “In particular, they objected to shortening the grace period for Obamacare enrollees who fail to make premium payments. House Republicans have complained that Democrats have not countered with their own funding proposals, while Democrats have said offsets should not be necessary when the tax bills will add to the federal budget deficit.”

--A few more good reads from The Post and beyond:

MEDICAL MISSIVES

STATE SCAN

DAYBOOK

Today

The Medicaid and CHIP Payment and Access Commission holds a public meeting.

SUGAR RUSH

President Trump has catapulted Sen. Kirsten Gillibrand into the spotlight:

Samantha Bee reacts to the results of the Alabama Senate special election:

Former "Apprentice" star Omarosa Manigault Newman is out at the White House: