Good morning ... If you have about 4 minutes to spare today, would you mind taking this brief Axios reader survey? We want to make sure we know our readers as well as possible, so we can serve you as well as possible. Thanks in advance.
Also: If you're in LA, join Axios' Ina Fried, the Chan Zuckerberg Initiative's David Plouffe, and a lineup of local leaders this Thursday for a conversation about California's housing crisis. They'll be discussing the economic impact and potential affordable housing solutions. RSVP here.
As in-the-weeds as a revised waiver process sounds, the practical effects of what the Trump administration announced yesterday could add up to one of its most substantive blows yet against the Affordable Care Act.
The big picture: These changes will likely cause more separation of healthy and sick people, but only in states that avail themselves of these new options — creating another level of segmentation between red and blue states.
How it works: Under the Obama administration, states seeking a waiver from the ACA’s rules had to show that their alternatives would cover just as many people as the ACA, with insurance that’s just as robust, for the same cost. That’s why only 8 waivers have ever been granted.
Between the lines: The Trump administration has often treated the ACA’s exchanges as a de facto high-risk pool. And that’s the best prism through which to understand these latest changes.
There are limits to how far that dynamic can go, because states' waivers still can’t add too much to the federal government’s costs. But that’s the basic dynamic at play here — and it’s one that will continue to move the larger individual market further and further away from the ACA.
On top of its ACA waiver rollback, the Trump administration will also release new rules today allowing employers to help their workers buy individual insurance coverage, rather than offering a full-fledged health benefit.
Health reimbursement arrangements, or HRAs, are usually a supplement to employer-sponsored insurance. But using them to pay for premiums could make them more of an alternative option.
Why it matters: Both single-payer advocates on the left and high-deductible advocates on the right would, in their own way, love to see health care coverage decoupled from employment.
This week will feature 26 major health care companies showering investors with third-quarter profits and initial outlooks for 2019.
The bottom line: Based on the first week of the Q3 earnings season, the health care industry is raking in record profits and is more powerful than ever, Axios’ Bob Herman writes.
What to watch: Centene, Gilead and Merck all report this week.
One of the Trump administration’s most concrete efforts to lower drug prices is an approach that’s been around for decades: approving more generic drugs. And it’s moving fast.
By the numbers: FDA approved 781 generic drugs in fiscal 2018. That’s 90% more than in 2014, when Congress provided new authorities designed to speed the approval process, according to a PwC report.
Between the lines: Some generics are more important than others.
Yes, but: The first generic competitor to a brand-name product often isn’t the one that brings prices way down. Generics can still make a lot of money by being just slightly cheaper than the product they’re copying, so the steepest discounts often don’t appear until multiple generics hit the market.
What’s next: FDA Commissioner Scott Gottlieb is trying to standardize key parts of the review process in the U.S. and Europe, so that generics could more easily seek approval in both regulatory systems.
A couple of blue states are trying to take over their own ACA exchanges, rather than continuing to outsource them to HealthCare.gov.
That’s a good idea, Georgetown University researcher Rachel Schwab argues in a blog post.
Where it stands: Only 11 states do everything themselves — operating their own exchange and running their own enrollment websites.
States can save money in the long run by running their own systems, Schwab writes.
Here’s who wants a piece of North Carolina’s soon-to-be-privatized Medicaid program, Bob reports:
Why it matters: $12 billion annually will be up for grabs.