Could quick Obamacare repeal sink the individual market? Presented by

Pharma gets a break on funding Cures, and top thinkers tell PULSE how they expect health care to change under the Trump administration. But first: Why Republicans' plan to quickly strike down the ACA has some insurance officials very nervous.

OBAMACARE REPEAL PLAN STOKES FEARS OF MARKET COLLAPSE — Republicans warned for years that Obamacare would collapse the nation's individual insurance market. Instead, it could be the rush to repeal the health care law that finally does the job, Pro's Adam Cancryn and Paul Demko report.

Why GOP lawmakers are pushing for quick repeal. After years of campaigning on anti-Obamacare messages, Republicans finally have the power to do away with the law — and they could face the wrath of supporters if they don't follow through. An immediate repeal also would provide the GOP with an early political victory when President-elect Donald Trump takes office.

But Republicans are coalescing around a transition period of undetermined length to let millions of Obamacare customers move into a new coverage scheme without losing their insurance; this would buy them more time to craft a replacement plan.

View from the states: Don't rush to strike down the law. State commissioners worry that even a staggered repeal would collapse the individual market.

"The discussion right now about repeal and replacement is making the market very, very nervous," Washington Insurance Commissioner Mike Kreidler said, adding that companies only have six months to decide whether they'll continue selling Obamacare coverage in 2018. "I would not be surprised to see the potential for a stampede to exit the market."

Keep reading: More for Pros.

Which Obamacare replacement plan will win out? Vox's Sarah Kliff has a roundup of the seven different plans put forward by conservative lawmakers and think tanks in recent years, from House Speaker Paul Ryan's "Better Way" and Rep. Tom Price's "Empowering Patients First Act" to President-elect Trump's own bare-bones proposal. More

Dems: None of these plans are viable. "The top contender causes 4 MILLION Americans to lose healthcare coverage?" incoming Senate Minority Leader Chuck Schumer tweeted. "That’s not a healthcare replacement plan."

PULSE CHECK

The Trump era: Where health care goes from here. Doug Holtz-Eakin and Avik Roy joined POLITICO's "Pulse Check" podcast to discuss Republicans' strategies around health reform, Roy's Obamacare replacement plan, clues on how Trump will govern and more.

Also discussed:

— Holtz-Eakin on what it was like to lose a presidential election. "It was the most empty feeling I've ever had in my life … for six weeks, I drank and watched 'Law and Order' … I literally had no idea to do with myself."

— Holtz-Eakin on whether Mitt Romney would've been HHS Secretary in a McCain administration. "He would not have been."

— Roy on whether Trump is good for health care. "The playing field for reforming the health care system is much broader than it would've been under Hillary Clinton."

Listen here.

THANK GOODNESS IT'S FRIDAY PULSE — Where your author is amusingly included on this ballot of top digital health reporters. (It's a nice honor, but the polls predict he's not going to win.) Send tips and consolation prizes to [email protected] or @ddiamond on Twitter.

With help from Adam Cancryn (@AdamCancryn)

FROM THE WHITE HOUSE

Barack Obama on Obamacare under Donald Trump. In a wide-ranging profile in the New Yorker, the president said that the ACA is the "most vulnerable" of his accomplishments because it’s been a "unifying bogeyman for Republicans" for six years.

But the president urged the president-elect and the GOP to tread carefully on repeal, because he said the ACA's beneficiaries include millions of Trump voters, "even if [the voters] don’t make the connection." And Obama said that the legacy of the law will remain if the GOP maintains "a commitment to provide health insurance for the people who received it … then a whole bunch of stuff hasn’t gone out the window."

A message from PhRMA: Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. More.

ON THE HILL

Pharma off the hook for Cures pay for as lawmakers come closer to deal. Pharma money will no longer be used as an off-set to help pay for Democrats' priorities in the 21st Century Cures bill, multiple lobbyists close to the issue tell Pro's Sarah Karlin-Smith and Brianna Ehley.

The CREATES Act, which was designed to increase access to cheaper generic drugs, will no longer be a part of the Cures bill. It would have made it harder for brand drug companies to use FDA-mandated safety programs to stop generic companies from accessing the product samples they need to develop copycat medicines. The Act would have been an indirect measure to tackle the hot issue of high drug prices. More for Pros.

American Diabetes Association calls for congressional hearings on insulin pricing. Thursday's request by the ADA, accompanied by a resolution and petition that calls for increased transpa rency in the insulin supply chain, is an unusual move for a patient advocacy group, Pro's Sarah Karlin-Smith writes. These types of groups have traditionally been silent in the drug pricing debate due to their ties to the pharma industry — from which they receive direct contributions and, they hope, new innovative treatments. More for Pros.

— PhRMA's reaction: This isn't the right approach. PhRMA's Holly Campbell says the organization shares the ADA's goal of ensuring patient access, but calls for "common-sense" and "pragmatic" solutions. "Government mandates and interventions are not the solution for patients," she said.

Flint funding: Can it hitch a ride? Aid to address lead contamination in Flint, Mich., will most likely be added to a lame duck spending package rather than the Water Resources Development Act that is currently being negotiated, House Energy and Commerce Chairman Fred Upton tells Pro's Annie Snider.

The House and Senate both approved aid packages for Flint in their WRDA bills, although the packages differed significantly, with the Senate measure spending $220 million on Flint and infrastructure programs for other communities, and the House provision offering a $170 million authorization to aid communities with a lead-contamination crisis.

… Upton said House Speaker Paul Ryan has reiterated his commitment to getting Flint aid done, "probably" at the House funding level. "Flint's going to get their money, that's the bottom line," Upton said.

EYE ON INDUSTRY

How the health care sector is grappling with the Trump administration. Ten days after the election's surprising outcome, analysts say the possible repeal of Obamacare is overshadowing many other significant changes that are looming for health care. Here's a quick roundup of three areas where the Trump administration could shake up the industry.

Pharma: Signs of optimism. On balance, Trump's victory is good for the biotech sector, former FDA commissioner Andy von Eschenbach told PULSE at the Milken Institute's "Faster Cures" event this week. He pointed to three major positives: the possibility of repatriating offshore assets for infrastructure in the biomedical space; a more favorable investment climate for biotech, which could fuel R&D; and a regulatory environment that will encourage domestic startups.

Providers: Concerned they'll take a financial hit. The Republican sweep last week was "the worst of all possible worlds for hospitals," Mizuho analyst Sheryl Skolnick wrote in an investor's note. She pointed out that hospital chains have already taken $155 billion in pay-for cuts tied to the ACA — and some of the law's new fees and taxes may persist, even if Republicans repeal major parts of the law. Meanwhile, coverage cuts would likely lower hospital revenue and raise the risk of bad debt.

Public health: Significant trepidation. Prabhjot Singh of Mount Sinai's Arnhold Institute is concerned that the president-elect's rhetoric of isolationism could lead to the nation pulling back from global threats like Ebola and Zika. He's also worried that possible restrictions on immigration will hurt current programs like the Conrad 30 waiver program, which places immigrant physicians in typically rural, medically underserved counties.

EYE ON THE HUMPHREY BUILDING

CMS releases Quality Payment Program data tool. CMS is making its list of Quality Payment Program measures available as an Application Program Interface, in a bid to make it easier for clinicians to manage their work within the program. The API makes it easier to write software that incorporates the measures, allowing clinicians to digitally select the measures that fit their practice, assemble them in groups and store them. The agency is hosting its API on the standalone site it launched alongside publication of the MACRA rule.

EYE ON MEDICAID

S&P: Medicaid's status as 'open-ended entitlement' is 'on life support. ' The ratings agency is warning that the program is in line for significant changes. "Considering that key congressional leaders as well as President-elect Trump have consistently expressed their intent to repeal the [Affordable Care Act], we believe Medicaid will come under significantly greater scrutiny," S&P said in a new brief.

And given the possibility of reforms to block-grant the program or institute other spending caps, "the overall direction of these changes would be to incrementally weaken Medicaid as a payor to health care providers." See the brief.

GOP governors concerned about Medicaid expansion: Four. That's the latest count from Georgetown's Center for Children and Families, which notes that New Mexico Gov. Susana Martinez, Arkansas Gov. Asa Hutchinson, Michigan Gov. Rick Snyder and Arizona Gov. Doug Ducey — who all expanded Medicaid in their states — have all expressed concerns that repealing the ACA would hurt the program. More.

AROUND THE NATION

Obesity rates among low-income toddlers drop in several states. Obesity rates for young, low-income children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children declined in 34 states and U.S. Territories between 2010 and 2014, according to federal data released on Thursday.

The more you know, the more likely you're insured. A RAND study found a significant link between being able to understand financial and insurance concepts and actually gaining coverage. For instance, a typical uninsured individual in 2013 was 9.2 percentage points more likely to be insured in 2015 if that person had high health insurance literacy.

“It is remarkable that the association between financial literacy and people’s insurance decisions is similar in size to things we normally associate as being a key to someone having health insurance, such as education levels and whether someone is employed,” RAND co-author Katherine Carman said. See the study.

AROUND TOWN

Health reform summit on the Hill at noon. The summit will be in room 325 of the Russell building and hosted by Sen. Mark Warner, the University of Virginia's policy school and Powers Pyles Sutter & Verville. Speaking: Obamacare CEO Kevin Counihan, Urban Institute's Bob Berenson, RAND's Christine Eibner and more.

Taylor Booth to BIO. Booth, a former staffer for Rep. Ed Whitfield and Sens. Mel Martinez and George Lemieux, will focus on federal health care policy and advocate on behalf of BIO's member companies before Congress.

WHAT WE'RE READING

Lessons from military medicine could make civilian care better, Dhruv Khullar writes in the New York Times. A prominent example: The aftermath of the Boston Marathon bombing. More.

U.S. attorneys on Thursday arrested a pair of Valeant and Philidor executives over an alleged multimillion dollar fraud and kickback scheme, detailed in the Wall Street Journal. More.

Local health outcomes — and specifically, Americans' bad public health — help predict the counties that went for Trump, the Economist reports. More.

At Talking Points Memo, Josh Marshall argues that Republicans' efforts to reform Medicare will be stymied without some bipartisan support from Democrats. More.

Blue Shield of California is expecting to lose money on Obamacare this year. But the CEO tells Kaiser Health News that the insurer isn't pulling out of Obamacare — and he thinks Trump's call to allow plans to be sold across state lines will be a "race to the lowest common denominator." More.

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