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If CVS really does acquire Aetna, the new company would be one of the largest in the U.S. — a health care powerhouse able to wield substantial purchasing power throughout the system. And yet the proposed deal is still, fundamentally, "more defensive than offensive," Leerink Partners analyst Ana Gupte told investors.
What CVS fears: Axios' Bob Herman walks us through what CVS is afraid of. (Spoiler alert: It's Amazon.)
The UnitedHealth angle: CVS also approached UnitedHealth about merging, the Wall Street Journal reported. It's easy to see why.
Enrollment through the Affordable Care Act's exchanges will fall by about 7%–13% during the upcoming open enrollment period, according to a new estimate from S&P Global.
Why it matters: Most experts are anticipating a drop in enrollment. It would be surprising not to see enrollment fall, given how little the Trump administration is doing to encourage people to sign up. But no one's quite sure how big a decline to expect.
If the number of people covered by the exchanges simply stays flat — the rosiest scenario in S&P's projections — the ACA's allies would count that as a major victory.
Sen. Tom Cotton is pushing his fellow Republicans to repeal the ACA's individual mandate as part of tax reform, according to Bloomberg.
What would happen: Premiums would likely skyrocket, insurers would bail on the exchanges in many places and the ACA would become much less stable.
My thought bubble: Isn't tax reform hard enough already, without throwing in the same health care policies that have already failed to get 50 GOP votes?
Maybe not, argues University of Michigan law professor and all-around ACA legal expert Nicholas Bagley.
What's happening: The Health and Human Services Department proposed new rules last week for the 2019 enrollment period, including changes to the ACA's requirement that insurance plans sold through the exchanges cover a set of "essential" benefits.
The issue: As an ostensible check against defining down these benefits too far, HHS said it would require the new standards to match a "typical" employer plan. But it's defining "typical" simply as any plan that covers at least 5,000 people — even if that one large plan is, in fact, not at all typical of what employers in a state offer.
House Republicans and the Trump administration jointly asked a federal court yesterday to keep their lawsuit over the ACA's cost-sharing subsidies on ice just a little while longer. The suit, which the House GOP initially filed against President Obama, has been frozen since Trump's victory, as the two sides looked for a way to climb down from an intra-party legal battle.
The latest: Both parties said in a new filing yesterday that they need a little more time to figure out their next steps, now that Trump has quit making the subsidy payments.
If you have an obsession with financial data, like Bob does, you're in luck: He created a spreadsheet that tracks the earnings of the major publicly traded health care companies, so you can literally follow the money with him. Earnings on tap today include: Pfizer, Aetna and HCA.
One quick takeaway: $27 billion — that's the third-quarter net profit cumulatively collected by 43 health care companies that have reported earnings thus far. That equates to an 8.5% profit margin.
Get in touch: Are there other companies or data points you want to see? Let Bob know: email@example.com
What we're watching today: Senate HELP Committee hearing on implementation of the 21st Century Cures Act. Aetna earnings call.
What we're watching this week: ACA open enrollment starts tomorrow. On Thursday, there is a House Energy and Commerce subcommittee hearing on federal oversight of dangerous pathogens.
Talk to me: I'd love to hear your questions, comments and feedback: firstname.lastname@example.org .