Axios

Utah Republican Senator Orrin Hatch said Tuesday that the process of repealing and replacing the Affordable Care Act in the Senate might be complicated because:

Let's face it, once you get them on the dole, they'll take every dime they can. — Sen. Orrin Hatch

Why this matters: As a key Senator who has jurisdiction of Medicaid and other health issues that will appear in the GOP's new health care bill, Hatch's remarks suggest that Republicans are wary Americans will refuse to give up the benefits they receive under the Affordable Care Act.

The backlash:"People who are getting access to health care are not on the dole. They are working families... This is America. Certainly, we don't call people who need health care people who are on the dole," said Democratic Senator Patty Murray, per CNN.

Confirming yesterday's buzz, PhRMA, the pharmaceutical industry's primary lobbying group, announced changes to its membership structure today that include stricter membership requirements and the elimination of its "associate" category. As a result, 22 companies lost their membership or associate membership status. The new requirements, based on a three-year average:

• At least $200 million per year spent on research
• Research expenditures equal to at least 10% of global sales

Why it matters: As we said yesterday, this is PhRMA's way of trying to get rid of smaller companies that engage in the controversial practice of buying older drugs and jacking up the prices. Read on to see who's out.

Blue Cross and Blue Shield of Tennessee will sell health plans on the Affordable Care Act exchange next year in the 16 counties near Knoxville that were left without an insurer after Humana bailed, Sarah Kliff at Vox reports. But those plans could be expensive. J.D. Hickey, CEO of the Tennessee Blues, told the state insurance commissioner that his team will price in the risks surrounding the cost-sharing subsidies, individual mandate and health insurance tax.

However, Hickey mentioned that Blue Cross and Blue Shield of Tennessee's financial performance has improved so far in 2017 after shouldering major losses in the first few years of the ACA exchanges. Financial documents obtained by Axios show the company produced a small overall profit in 2016, although it still had a $14.7 million gross loss on its individual-market plans.

The bottom line: This is an important development and again shows why the Blue Cross and Blue Shield plans are vital to the ACA individual marketplaces. But it also shows that the unclear signals from the Trump administration about whether it will pay insurers' subsidies, and whether it will enforce the individual mandate, are already forcing insurers to charge more for coverage.

French drug company Sanofi will limit all of its drug price hikes in the United States to the health care inflation rate and will disclose both its list and net pricing rates, marking the most aggressive decision of any pharmaceutical company in the debate over high drug prices. National spending on health care in 2017 is projected to increase by 5.4%.

Why this matters: Several other drug companies have vowed to keep price increases below double-digit growth, but that's relatively meaningless if the price still rises faster than the broader health care economy. Sanofi is making a big jump to stanch public criticism and keep drug pricing in check. However, Sanofi gave itself some wiggle room by saying, "We may at times have a sound reason for a higher increase."

Politico has a roundup of the shocking protest tactics that activists on the left — frustrated with the conventional actions of the Democratic machine — hope to use to send a more visceral message to Republicans planning the repeal of the Affordable Care Act.

The methods: Mock funerals, staged die-ins, and shipping the ashes of those who die without health care access, all directed toward the offices of Republican lawmakers around the country.

How one organizer sees it: "In age the of Trump, nothing short of blunt and brute force will work as a counterweight…We can't win based on the merit of our ideas, but rather, on the way in which we deliver that message."

Only two health insurers sell Affordable Care Act plans on Connecticut's individual exchange, and premium rates could go up by a lot next year for the 86,000 people in the market. Anthem asked regulators for a 33.8% average rate hike to its 2018 individual plans, and ConnectiCare requested a 15.2% average increase. Both cited "increasing medical costs and greater demand for medical services."

Rates for policies sold off the exchange and for plans sold to small employers also could go up well above 10% on average. Connecticut's preliminary rates mirror the rate requests in Maryland last week, which were also high.

Our thought bubble: These are requested rates, not approved rates. But the Connecticut proposals assumed that the cost-sharing subsidies would be in place and that the individual mandate would be enforced — indicating health insurers are still recovering from underpricing their plans and are expecting more costly medical bills.

PhRMA, the pharmaceutical industry's primary lobbying group, is expected to institute new membership rules designed to force out smaller companies that don't invest in drug research, per Bloomberg.

The new rules: In order to remain a part of PhRMA, drug companies will have to spend at least $200 million per year on research over a three-year average. They'll also have to spend at least 10% of their annual global sales on research.

Why it matters: This is PhRMA's way of trying to get rid of smaller companies that mostly buy older drugs and jack up the prices. You might remember the controversy surrounding Marathon Pharmaceutical's choice earlier this year to charge $89,000 for a muscular dystrophy drug that cost less than $2,000 abroad.