Good morning ... Hope y'all are enjoying the pace of all this, because there's no end in sight. Incidentally, if you have any suggestions for what to do after becoming immune to coffee, I'm all ears.
Yes, the Senate's bipartisan Affordable Care Act stabilization bill ran into some political roadblocks yesterday. The White House said President Trump, who had taken several positions over the course of the day, is against it. House Speaker Paul Ryan is also against it. And conservatives are against it.
Why it doesn't matter: The story of the Alexander-Murray bill likely won't be over until December, when Congress has to take care of several must-pass bills, in negotiations where Democrats have a lot of leverage.
The catch: The Alexander-Murray bill would guarantee funding for the ACA's cost-sharing reduction (CSR) subsidies, but it doesn't provide for retroactive payments. So if the bill did pass in December, insurers wouldn't get any help with the financial hit they'll take between now and then. And those losses alone could total $1 billion.
In the meantime: Look for Alexander and Murray to roll out a new, bipartisan roster of cosponsors soon, along with the official introduction of their bill.
Attorneys general from 18 states and D.C. want a federal court to issue a ruling today that would keep the CSR payments flowing, at least temporarily. They're asking a federal court in California to issue a short-term order, similar to the early rulings against Trump's first travel ban, that would force him to keep making the payments while the states' broader legal challenge works its way through the courts.
The odds: They're not great, according to legal experts I contacted.
What's next: The states have asked for a decision by the end of the day today, because the next round of CSR payments had been scheduled to go out on Friday.
Open enrollment for ACA coverage begins in two weeks, and the smart money says we'll see a drop this year in the number of people with coverage. The only question is how big it'll be.
Why enrollment is likely to drop:
The other side: A drop-off in ACA enrollment could be good news for private portals that compete, to some extent, with HealthCare.gov. The WSJ reports that eHealth, for example, is hoping to pick up new business for the cheaper, less comprehensive plans it offers, especially from the wealthier consumers who would only get a small subsidy — or no subsidy at all — to help cover the rising premiums for ACA plans.
Insurance giant Anthem will start its own pharmacy benefit manager in 2020, the company said yesterday, partnering with CVS in an effort to squeeze both savings and new revenues out of the rising costs of prescription drugs.
Why it matters: PBMs, which act as middlemen between pharmaceutical companies and insurance plans, are under fire from all sides in the national fight over drug costs. UnitedHealth Group, the country's largest health insurer, already runs its own pharmacy management arm, and Anthem's move will put even more pressure on PBMs — especially Express Scripts, which is losing its largest customer.
Flashback, courtesy of my colleague Bob Herman: Anthem used to have its own PBM, but sold it to Express Scripts in 2009 for $4.7 billion. What's old is new again.
Cases of Hepatitis C have almost tripled in the past few years, according to the Centers for Disease Control and Prevention — an effect of the opioid crisis and the unsanitary use of needles by drug users. There were 2,436 reported cases of the liver disease in 2015, up from 853 cases in 2010.
Why it matters: As my colleague Stef Knight reports this morning, Americans will be paying for the opioid crisis for years. Hepatitis C treatments are wildly expensive. New breakthrough drugs that can cure the disease cost tens of thousands of dollars. Many patients won't be able to get those drugs: Managing the disease over the course of a lifetime, including the end-stage liver failure it causes, also isn't cheap.