Axios

Senate Democrats were noncommittal today when asked if the removal of ACA insurer subsidies was a deal-breaker for any spending bill ahead of this weekend's possible government shutdown. One common refrain on the Hill today: it's an executive branch issue — and it's up to the Trump administration to fund the subsidies.

Between the lines: The comments suggest that House Minority Leader Nancy Pelosi isn't getting a lot of support from her Senate colleagues as she tries to push the Trump administration to include the subsidies. Senate Democrats aren't voicing a willingness to trigger a shutdown over insurer subsidies. Their play right now looks to be to make it Trump's problem while avoiding getting the blood of a shutdown on their hands.

House Speaker Paul Ryan said this month's spending bill wouldn't include payments for insurers that would lower their additional ACA cost burden — by reimbursing them for lowering deductibles, copayments, and coinsurance — according to the WSJ.

Why it matters: This could cause a collapse in health plans this year, according to insurers. This move brings additional uncertainty to the healthcare marketplace, as insurers' deadlines to decide on the framework for 2018 plans looms in a few weeks.

Anthem CEO Joseph Swedish told investors Wednesday during the health insurer's first-quarter earnings call that the insurer will stay in the Affordable Care Act marketplaces for now, and that he expects Congress will fund the law's cost-sharing subsidies for low-income people. But Anthem, which has 1.6 million members with ACA-compliant health plans, also put Congress on the clock.

"We plan to file preliminary 2018 rates with the assumption that the cost-sharing reduction subsidies will be funded." — Anthem CEO Joseph Swedish.

The deadline: Early June. If Anthem doesn't find out about the cost-sharing subsidies by then, Swedish said Anthem will consider hiking premiums, reducing benefits or exiting some markets. Have fun, Congress.

Reminder the ACA is just a small slice of Anthem: The insurer posted a $1 billion profit in the first quarter on $22.3 billion of revenue and had 40.6 million health plan members — beating Wall Street's expectations. More than half of Anthem's revenue comes from Medicare and Medicaid.

At an Axios and HBO Documentary Films presentation of the documentary, "Warning: This Drug May Kill You," Dr. Andrew Kolodny of Brandeis University put the urgency of the opioid crisis in context: "It truly is the worst epidemic in United States history."

Senator Rob Portman said the solution must start with drug companies: "They need to come up with non-addictive pain medication."

How the epidemic started: According to Dr. Nora Volkow, director of the National Institute on Drug Abuse, the healthcare system doesn't train doctors on when to prescribe opioids, and "there is still very little recognition of addiction as a disease."

An amendment written by Rep. Tom MacArthur, the basis of a health care deal among House Republicans, allows states to get waivers from the Affordable Care Act's essential health benefit requirements as well as waivers to vary premiums based on health status in limited circumstances.

Both waivers have conditions. Read on for the details.

Michael Neidorff, CEO of health insurance company Centene, told investors Tuesday during a first-quarter earnings call that he doesn't think the Affordable Care Act's cost-sharing subsidies will get eliminated and that he expects to stay in the exchanges next year.

"We see nothing at this point to prevent us from proceeding from our 2018 marketplace participation." — Centene CEO Michael Neidorff

Why this matters: Anthem is one of the most important ACA health insurers right now, but Centene holds a lot of power as well. Centene had 1.2 million ACA exchange members as of March 31 (or about 10% of the individual market). However, as Duke University researcher David Anderson has pointed out, Centene uses a strategy that captures the healthiest, price-sensitive shoppers.

Just 37% of Americans want to repeal and replace the Affordable Care Act, while 61% say it should be kept and improved, per a new ABC News/Washington Post poll.

Don't blow it up: There's an ongoing lawsuit by House Republicans, which would defund the cost-sharing reductions of ACA, bringing the law's entire framework down. That's probably what Trump is referring to when he says ACA is in "serious trouble," but that'd be a terribly unpopular choice for the GOP as only 13% of Americans want to see the law fail.

The American public largely disagrees with the process President Trump and congressional Republicans are taking to repeal and replace the Affordable Care Act, according to a new Washington Post-ABC News poll.

The new flashpoint: The GOP's new proposal would let states decide whether to keep all of the law's insurance protections for people with pre-existing conditions, as well as determine whether to provide them with minimum coverage benefits.

• Let states decide on pre-existing conditions: 26%
• Require for all states: 70%
• Let states decide on minimum benefits: 33%
• Require for all states: 62%

Why it matters: The poll suggests that Republicans risk drifting farther away from public opinion in their latest health care compromise. It doesn't say states should decide whether to cover pre-existing conditions at all, but it would let them opt out of federal rules that ban insurers from charging more to sick people.

Fresenius Kabi, a U.S. subsidiary of German health care giant Fresenius SE & Co., is acquiring generic pharmaceutical company Akorn for $4.3 billion. However, Fresenius included a stipulation in the merger agreement that would allow it to back out of the deal if Akorn's generics business materially deteriorates.

Largest shareholder backs it: John Kapoor, an Akorn board member and former Insys Therapeutics CEO who owns 25% of the company, has "committed to supporting the transaction," which bodes well for the deal closing early next year. Kapoor would bank more than $1 billion alone if the deal closes.