Feb 3, 2017

Axios Vitals

Happy Friday, all. The rush to repeal Obamacare has turned into more of a slow, relaxing stroll through the park, but health insurance executives aren't that relaxed about it. And the Trump administration's first Obamacare rule may be coming soon, so fire up that Federal Register site and start hitting "refresh."

Have a great weekend, and please remember to check out the Axios health care news stream for all the latest in health care politics and business news. We tested out our new health care alerts yesterday, so let me know what you thought and what we can do to make them better. And don't forget to like Axios on Facebook and follow us on Twitter,

The two big things about Obamacare repeal

These are the two most important things happening right now, and they're going to lead to big problems if the tension isn't resolved:

  • Republicans are increasingly saying they're not in a rush to replace Obamacare — because it's more important to get it right.
  • Insurers really, really want to know what's coming next.

You could hear the new, laid-back pace in the way committee chairmen talked about Obamacare this week. "We're going to take the time to get this right," House Energy and Commerce Committee chairman Greg Walden said at a subcommittee hearing yesterday. And in an interview with Caitlin Owens this week, House Ways and Means Committee chairman Kevin Brady said only that "the bulk of the changes in law and the bulk of regulatory changes must occur this year."But top execs at the big health insurance companies, including Anthem and Cigna, have been saying this week that they can't commit to staying in the marketplaces in 2018 until they get some better signals. Cigna CEO David Cordani told analysts and investors yesterday that the company will make its Obamacare decisions this spring, but that the markets remain "fragile at best." If the Trump administration and Congress don't get them some answers soon, that's a recipe for meltdown.Don't forget: It's not as if there's a lot of agreement among Republicans about how to proceed, even if they wanted to move faster.FWIW: House Speaker Paul Ryan told reporters yesterday that "we want to be moving our Obamacare legislation by the end of the first quarter."

Kaiser Permanente CEO: Seriously, we need to know

A good example of the health insurer anxiousness comes from Kaiser Permanente CEO Bernard Tyson, who talked to Bob Herman about Obamacare and other issues. "Our hope and commitment is to be there," Tyson said about the insurers' plans for the marketplaces. But he says he needs to know what the replacement plan is, and "what I don't know is where the new administration is in helping to answer those questions." Read the interview here.

What to watch for in Trump's first big Obamacare rule

One immediate thing the insurers can look forward to: the Trump administration has sent a "market stabilization" rule to the Office of Management and Budget for review. It won't be released until OMB clears it, but Edmund Haislmaier, a senior research fellow at the Heritage Foundation who worked on Trump's Health and Human Services transition team, has pretty good idea of what's likely to be in it.

Most likely, it will be the quickest fixes the Trump administration can make to tighten the Obamacare enrollment rules. The leading options: narrowing the reasons to let people sign up outside of the regular enrollment season, making people prove they're eligible for those special enrollment categories, and cracking down on people who haven't paid their premiums. Those are all issues that are "fairly easy to fix" and could convince insurers to be "less defensive" in their pricing, Haislmaier said.

Former Obamacare official predicts big enrollment drop

We still don't have any official enrollment numbers from the end of Obamacare signups, but Joshua Peck, the former chief marketing officer for HealthCare.gov, estimates that President Trump's opposition probably cost the program almost 500,000 signups. In a Medium post, he wrote that the pulling of TV ads likely caused enrollment to drop by 350,000 people, while his executive order may have discouraged another 130,000 people by suggesting the new administration wouldn't enforce the individual mandate.

It's impossible to know for sure, of course, until the administration releases the numbers. But as Peck notes, enrollment as of mid-January was slightly ahead of last year at the same time. The age mix didn't change, as we've written, but the overall trend was up despite the rise in Obamacare premiums. So if the final enrollment numbers fall short of last year, it will be hard for the Trump administration to pin the blame on anyone else.

Yes, but: Enrollment didn't fall short in Washington state, at least. Signups were up 13 percent over last year, the state announced — the biggest year yet.

First drug prices bill may start moving soon

And it's going to be about getting more generic drugs to market, a relatively safe topic. Caitlin Owens reports that Walden announced the Energy and Commerce committee will start working on the bill next week. It's by Reps. Gus Bilirakis, a Republican, and Kurt Schrader, a Democrat, and it would call for faster review for generic versions of drugs that are in short supply or don't have a lot of competition.

Walden also may have shed some new light on what Trump's talk of drug price negotiations really means. In an interview with the Oregonian that was making the rounds yesterday, Walden, who was at Trump's meeting with drug company executives this week, said the group talked about Congress passing legislation to let the government and private insurers negotiate "value-based payments" for expensive drugs. "Right now they're prevented from having those negotiations by law. We would fix that," Walden told the Oregonian.

Lambrew on essential benefits: Leave them alone

Late to this one, but Jeanne Lambrew, President Barack Obama's former health care adviser, wrote a defense of Obamacare's essential health benefits this week for her new gig at the Century Foundation. Republicans and health insurers have criticized them for making individual health insurance too expensive, and some customers have complained that they don't want or need all of the benefits. But Lambrew gives a good reminder of why they were put in the law:

  • Individual health plans used to lack a lot of basic benefits (62 percent didn't have maternity coverage).
  • A standard benefit package makes it harder for insurers to avoid expensive customers.
  • It reduces confusion about what's covered and what's not.

Yes, but: This was the thinking of everyone who worked on the law, but the piece never really grapples with the lesson they learned after Obamacare passed: A lot of individual market customers didn't want all of those benefits, and would rather have had cheaper plans.

What we might be watching today: The release of final Obamacare signup numbers — but only if the schedule set by the Obama administration hasn't changed.

What we're watching next week: Senate confirmation vote on Tom Price, expected Thursday or Friday. (He cleared a procedural vote yesterday.)

Thanks, and please keep the feedback and news tips coming: david@axios.com.