Axios Vitals

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January 26, 2018

Good morning ... and happy Friday.

Voters don’t know what’s going on with the ACA

Reproduced from January Kaiser Health Tracking Poll; Chart: Axios Visuals
Reproduced from January Kaiser Health Tracking Poll; Chart: Axios Visuals

The public isn’t sure how much of the Affordable Care Act is still around, or how well it’s working, or how many people are signing up. More than any one preference or opinion, sheer confusion seems like the biggest takeaway from the Kaiser Family Foundation’s latest tracking poll.

By the numbers, based on KFF's Jan. 16-21 poll:

  • 36% of respondents knew that Congress has repealed the ACA’s individual mandate.
  • 40% either thought the entire law had been repealed or weren’t sure. (It’s still in effect.)
  • Asked how many people had signed up for coverage during the latest open enrollment period, 36% said more people than last year; 31% said fewer; 24% said about the same. (It was slightly fewer than last year.)
  • Voters are also divided roughly evenly over whether the law’s insurance exchanges are collapsing. (They’re not doing great, but they’re not collapsing.)

Yes, but: Voters are confident about one thing — who’s to blame for … whatever is happening. It’s the other guy.

  • 77% of Democrats said that because President Trump and congressional Republicans are in power and have made changes to the ACA, they’re responsible for its future. A plurality of Republicans said any future problems are still Democrats’ fault, because they wrote the thing.
  • Partisanship continues to drive not only voters’ opinion of the ACA, but their beliefs about its reality. Democrats thought this year’s enrollment was higher than last year’s; Republicans thought it was lower.

HHS touts regulatory rollbacks in 2017

HHS is set to release a 2017 wrap-up later this morning that ticks off its biggest accomplishments during Trump’s first year.

Key highlights:

  • “70 regulatory actions were withdrawn, and 68 deregulatory actions were included in the Fall 2017 Unified Agenda.”
  • The document will also tout the Food and Drug Administration’s approval of more than 1,000 generic drugs — a big jump that’s drawn praise from both sides of the aisle — and more than $800 million in grants to help combat the opioid crisis.

The other side: HHS did lose its secretary in 2017, after just a few months on the job amid an embarrassing scandal over private-jet travel. And the CDC director is still trying to untangle potential conflicts of interest that have kept her away from Capitol Hill and the public eye.

The bottom line: Some of what HHS plans to highlight today is legitimately very important — reducing the generics backlog is near the top of that list — but 2017 wasn’t all sunshine and rainbows inside the Hubert Humphrey Building.

Idaho flouts the ACA

Regulators in Idaho say they plan to start letting insurance companies sell plans that don’t comply with the ACA. It’s not even remotely clear they have the authority to do that.

The details, via the Wall Street Journal:

  • “Insurers would be able to consider enrollees’ medical history in setting their premiums … which isn’t authorized under the ACA. The new state-based plans could also include dollar limits on total benefit payouts, which the ACA banned.”
  • “Weston Trexler, a bureau chief in the Idaho Department of Insurance, said the state ... will continue to enforce the ACA’s rules for ACA plans … and the new products are ‘not conflicting with the ACA products.’”

What they’re saying:

  • “These Idaho guidelines for health insurers are crazypants illegal. It's not even close,” ACA legal guru Nicholas Bagley wrote on Twitter.
  • In addition to the legal questions, the policy risks to the state’s ACA exchange are obvious: If healthy people can slide over to a policy that only they can afford, then only sick people would be left in ACA-compliant plans, which would then become unaffordable or unavailable. That’s why Congress made ACA compliance mandatory.

The big questions: Who will try to stop this? Normally, that job would fall first to HHS, but it’s not clear whether the Trump administration will want to make much effort to enforce the ACA.

That leaves the courts — and raises the additional question of whether insurers will want to actually sell these products if they sense that doing so might have legal consequences.

How the new tax law helps for-profit hospitals

The lower corporate tax rate and cash repatriation provisions in the GOP tax overhaul will make publicly traded pharmaceutical companies and health insurers a lot wealthier. Axios’ Bob Herman notes that for-profit hospital chains could potentially benefit a lot, too — if they aren’t inundated with debt.

The big picture: Investor-owned hospitals pay close to the current 35% corporate tax rate and will pocket a lot of money when it gets lowered to 21%. Hospitals also will benefit from new “bonus depreciation” rules that essentially allow them to deduct larger portions of investments and assets.

  • One big number: HCA, the largest for-profit hospital chain in the country, likely will reap $500 million per year in tax savings, mostly due to the new depreciation rules, stock analysts at Robert W. Baird & Co. wrote to investors this week.
  • Key quote: “It is almost like HCA wrote the new tax code,” Baird researchers wrote.

What's on your agenda for next week? Let me know: [email protected].