Axios Vitals

A briefcase with a red cross on the front.

October 26, 2017

Good morning … Sens. Lamar Alexander and Patty Murray got some good news yesterday from the Congressional Budget Office. But, for the time being, the real action is in the administration.

​What to expect from open enrollment

The Affordable Care Act's fifth open enrollment period begins in less than a week. And it's going to be a wild one.

  • As the graphic above indicates, based on data from Avalere Health, premiums are up substantially. Nationwide, premiums for so-called "benchmark" plans will be 38% higher, on average, than last year. Those are the plans the federal government uses to determine the size of your premium subsidy.
  • Those benchmark plans are supposed to fall roughly in the middle of the options available through the exchanges. But because of the way states and insurance companies dealt with the uncertainty around the ACA's cost-sharing subsidies, many people will now be able to get more comprehensive "gold" plans for a lower premium than the middle-of-the-road benchmark.
  • When you shop around on, it now organizes plans based on your total monthly premium, after accounting for subsidies. This is a change — and one that consumer advocates, including some Obama administration veterans, were happy to see.

Sea change: With a shorter open-enrollment window, fewer intermediate deadlines and barely any money for consumer outreach, this enrollment season will look a lot different from the four before it.

  • The Health and Human Services Department has not set a goal to get a certain number of people to sign up this year, administration officials told the Washington Examiner. (Most analysts expect enrollment to drop.)

The countdown: Six days.

​Judge has some tough words for states suing Trump

It was no big surprise when U.S. District Court Judge Vince Chhabria ruled yesterday the Trump administration does not have to keep paying the ACA's cost-sharing subsidies. But Chhabria didn't only side with President Trump. He also took to task the 18 state attorneys general who brought the case.

Key quote: "If the states are so concerned that people will be scared away from the exchanges by the thought of higher premiums, perhaps they should stop yelling about higher premiums. With open enrollment just days away, perhaps the states should focus instead on communicating the message that they have devised a response…that will prevent harm to the large majority of people while in fact allowing millions of lower-income people to get a better deal on health insurance in 2018."

The issue: The states wanted Chhabria to force Trump to immediately reinstate the cost-sharing payments, arguing that without them, premiums would rise and their insurance markets could plunge into a death spiral. But, as Chhabria noted, at length, the states spent a lot of time planning for this contingency.

  • "Although you wouldn't know it from reading the states' papers in this lawsuit, the truth is that most state regulators have devised responses that give millions of lower-income people better health coverage options than they would otherwise have had," he wrote.

​The pace of health care mergers

Health care mergers and acquisitions have kept bankers and consultants busy since the ACA went into effect. The health care industry has initiated more than 200 deals per quarter for 12 straight quarters, including 211 in the third quarter of 2017, according to a report from PwC.

A few additional highlights, courtesy of Axios' Bob Herman:

  • A third of the health care deals in the third quarter involved long-term care facilities, like nursing homes.
  • Buyers are paying more for most health care companies, especially labs and imaging centers.
  • Thad Kresho, who tracks health care deals for PwC, expects even more transactions by the end of the year, partially due to increasing interest by private equity investors.

When hospice isn't there

People count on hospice care in their most difficult moments, but caregivers are often unreachable or inattentive, even in crisis situations, according to a new investigation from Kaiser Health News and Time magazine.

The findings:

  • 12% of hospice patients didn't receive a visit from a doctor, nurse, therapist or social worker in the last two days of their lives.
  • A survey of some 20,000 government records found more than 3,200 complaints over the past five years, and inspectors found issues in more than 750 hospice programs. Yet discipline was rare.

Why it matters: Patients and families turn to hospice when they think death is near — a time when people need a lot of help, both practically and emotionally. And Medicare pays hospice programs roughly $16 billion per year.

Go deeper: Read the investigation.

​Gottlieb embraces medication therapy in opioid crisis

Scott Gottlieb, the commissioner of the Food and Drug Administration, is already winning praise from public health advocates on both sides of the aisle for embracing medication-assisted treatment as a solution to the opioid crisis.

Buzz: He's stated that position before, but made waves at a House committee hearing yesterday with an especially vigorous defense of the policy. Medication-assisted therapy would allow people who have abused or overdosed on opioids to be treated with less potent, less addictive drugs as part of their recovery, rather than requiring them to abstain from all painkillers.

  • "I know this may make some people uncomfortable," Gottlieb said yesterday, but "FDA will join efforts to break the stigma associated with medications used for addiction treatment…This stigma serves to keep many Americans who are seeking a life of sobriety from reaching their goal."

Correction: An item in yesterday's newsletter, in the second story, mentioned a letter from House lawmakers about the medical device tax. It was signed by more than 175 House members, including 43 Democrats. I regret the error.

What we're watching today: Trump makes an announcement about the opioid crisis.

What we're watching this week: Former HHS secretary Sylvia Mathews Burwell gives a speech on health care Friday.

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