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CMS expands waiver letting states rewrite Obamacare rules. The Trump administration is letting states rewrite Obamacare rules to expand access to cheaper plans. The administration issued regulatory guidance Monday that will allow for a range of changes to the Obamacare markets, billed as an opportunity to give people more options and to “mitigate the damage done by Obamacare.” “Premiums are still much too high and choice is still too limited,” Centers for Medicare and Medicaid Services Administrator Seema Verma said in a statement. “This is a new day – this is a new approach to empower states to provide relief. States know much better than the federal government how their markets work.” The guidance from CMS and the Treasury Department would expand the flexibility of Obamacare waivers that let states make changes to health insurance people buy when they don’t get coverage through work or a government program. Giving states more flexibility on their healthcare markets increases the prospects that people could get subsidies to buy short-term or association healthcare plans through the Obamacare exchanges. Both are less expensive than Obamacare plans, but also cover fewer benefits.

States could consider new arrangements for their Obamacare markets. States may be able to make changes to the market that they have sought since President Trump took office. For instance, certain states have asked the Trump administration to allow them to move people from the Medicaid program onto the exchanges. Other states have said that they preferred setting up high-risk pools that would fund medical care for the sickest customers in order to not have an effect on the rest of the Obamacare market and decrease premiums. Verma, on a phone call with reporters Monday, declined to specify which proposals from states might be approved, but said states could make changes to how the subsidies under Obamacare are allocated and to whom. She cited one example in which a state might give subsidies to younger people, who are more price-sensitive and likely to be healthier, so that they would enroll in the exchanges. Having more people from this group participate in the exchanges could help premiums go down for others. Verma said the administration would provide “a menu of potential options” in the coming weeks for the types of changes states might consider. “We will be outlining some options for states around how they can address high-risk individuals,” she said.

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Critics slam the guidance as a way to attack pre-existing conditions. Democrats and pro-Obamacare groups bashed the guidance, saying it is the latest assault from the administration on eroding protections for people with pre-existing conditions. “Allowing states to permit residents to buy these plans further destabilizes the health care market and drives up prices for people with pre-existing conditions,” said Democratic Reps. Frank Pallone, Richard Neal and Bobby Scott. The lawmakers were referring to short-term and association health plans. Democrats have charged the plans are “junk insurance” that could destabilize Obamacare’s exchanges because people will buy the cheaper plans and leave the exchanges causing costs to rise for those who remain, which would include people with pre-existing conditions. “The only thing more insistent than President Trump and Republicans’ false promises to protect pre-existing conditions are their sabotage efforts to do the exact opposite,” added Sen. Patty Murray, D-Wash., in a statement.

Administration also releases new guidance to let employers contribute to short-term plans. The Trump administration moved Monday to make cheap Obamacare alternatives eligible for employer-based subsidies, the latest in its efforts to increase access to insurance plans that do not comply with Obamacare’s regulations. Administration officials announced a regulation Tuesday that would let large employers make tax-free contributions to employees that purchase cheaper short-term health plans, which offer fewer benefits than plans sold on Obamacare's exchanges. The goal behind the employer regulation is "empowering workers and employers to make their own decisions with more options,” a senior administration official told reporters on Monday.

The next big test for Obamacare's Medicaid expansion. Obamacare allies aim to expand Medicaid, the low-income government health program, in a handful of states via ballot measures. But they face staunch opposition before Election Day and no guarantee of success after it even if they win over voters. On Nov. 6, voters in Idaho, Nebraska, and Utah will decide through ballot measures whether to allow more people on the Medicaid program, a move already advanced by 33 states and the District of Columbia. Voters in a fourth state, Montana, will decide whether to make the expansion permanent. Obamacare advocates and healthcare groups, including hospitals, hope to use the ballot measures to circumvent entrenched Republican lawmakers. Yet, as November approaches, they face powerful opponents rallying opposition. And in Nebraska and Idaho, success would result in an immediate legislative funding battle, because the states don't have plans for how they would pay their share of expansion.

Stronger Obamacare markets boost revenue at health-insurer Centene. Signs of stability in the Obamacare market after years of turmoil helped boost sales at Centene in the three months through September. Revenue at the St. Louis-based insurer, which operates largely in the federal insurance business, grew 36 percent to $16 billion in the third quarter. The company had 2 million commercial customers at the end of the quarter, a 24 percent year-over-year increase. Centene also reported 12 percent growth in its Medicaid expansion business, to 1.2 million customers. The company's stock climbed 1.2 percent to $143 in New York pre-market trading.

FDA considers requiring co-prescribing overdose antidote to go along with opioids. The Food and Drug Administration is considering requiring doctors to prescribe an overdose reversal drug with prescription painkillers such as OxyCodone, Commissioner Scott Gottlieb announced Tuesday. The overdose antidote, known as naloxone, can save the lives of people who've suffered overdoses. The FDA may require the drug to be prescribed every time a patient receives an opioid to treat pain, or only if they receive a particularly high dose. The move has been pushed by the makers of Narcan, a nasal spray version of the drug that people can use at home.  A growing number of states already have the co-prescribing requirement. Under the laws, doctors are to prescribe naloxone when they give patients a certain dose of pills for drugs such as Percocet, Vicodin, OxyContin, and Tramadol or if patients have ever overdosed before. Advocates of giving more people access to naloxone point out that sometimes people take too many doses because they have lost track of their medications, or children get into their parents' medicine cabinet. The FDA will hold a meeting Dec. 17-18 to discuss other ways to make the antidote more available.

E-cigs: An industry Trump doesn't mind regulating. Trump routinely boasts of unshackling the economy by cutting red tape. But one industry may be about to face an onslaught of regulations, as senior members of his administration discuss a crackdown on electronic cigarettes.

CDC director calls for destigmatizing addiction to confront opioid crisis. The head of the Centers for Disease Control and Prevention stressed Tuesday that it was necessary to remove the stigma around addiction in order to confront the opioid crisis. "Addiction is a medical condition, not a moral failing," said CDC director Robert Redfield. The comments from Redfield came as his agency released data earlier in the day showing a slight dip in opioid overdose deaths for six months in a row.

CDC is monitoring more possible cases of rare, polio-like illness. At least 155 people are being monitored that showed symptoms of a polio-like illness known as acute flaccid myelitis. Sixty-two are confirmed to have the illness, the same number as previously reported, but the number of monitored cases has climbed. Redfield said that the CDC was working hard to find out the source of the illness, and that officials still suspect it could be linked to a virus. He added that there was no evidence that the illness had spread from person to person, saying that it had not spread within households.

Chuck Schumer slams McConnell on healthcare in op-ed. Senate Minority Leader Chuck Schumer, D-N.Y., implored voters to elect Democrats in the November midterm elections by warning that they could see their healthcare coverage repealed under a Republican-controlled Congress. In an op-ed published in USA Today on Tuesday, Schumer argued that Senate Majority Leader Mitch McConnell, R-Ky., has given Democrats an edge by admitting Republicans would try again to repeal Obamacare if they maintain control of Congress. “In short, Leader McConnell is promising to take away Americans’ health care any way he can, and believes hard-earned benefits need to be cut as well,” Schumer wrote.

Report: Quarter of millennial students exhibited PTSD symptoms after Trump's election. A newly released psychological study shows that some students are exhibiting symptoms associated with post-traumatic stress disorder following the 2016 election. The study revealed that of 769 students at Arizona State University studying psychology in January and February 2017, 25 percent of them reported experiencing “clinically significant” levels of stress after completing a psychological assessment known as the the Impact of Event Scale. The assessment, which had been adjusted to take into account the 2016 election, indicated that students’ average stress score was similar to those of witnesses of a mass shooting seven months after the incident. The study was released Monday by the Journal of American College Health.

Federal watchdog: Trump administration hasn’t used full authority to combat opioid epidemic. The Trump administration declared a public health emergency on the opioid crisis last October, but it hasn’t used the full power of that declaration, according to a report from the federal watchdog Government Accountability Office. The agency has used three authorities since the declaration: one to reduce paperwork, another to waive a public notice period for two states to test new approaches to delivering treatment and another to expedite research on opioid use disorder treatments. But there are 14 other authorities that became available through the public emergency declaration that haven’t been used, the report found. “According to HHS officials, these additional authorities have not been used for a variety of reasons,” GAO said. “For example, HHS officials determined that many are not relevant to the circumstances presented by the opioid crisis. Some of these authorities have been used during previous public health emergency declarations for infectious disease outbreaks, such as the Zika virus, and for public health emergencies resulting from hurricanes, such as Hurricane Maria in Puerto Rico.”

Democrats pounced on the report, saying that Trump hasn’t done enough to combat the crisis. Democrats have previously slammed the administration for not committing enough funding to the epidemic. “This report is more evidence that while President Trump has made big promises to score headlines about the fight against opioid addiction, he doesn’t care enough to follow through on them with the sweeping actions needed to address the crisis with all the tools available,” said Sen. Patty Murray, D-Wash., in a statement.

RUNDOWN

Forbes Drug companies, not middlemen, are responsible for high drug prices

Axios Why the new ACA waivers matter

STAT News PhRMA on track to spend a record sum on lobbying this year

CNBC As vaping surges, teen cigarette smoking ticks up after decades of decline

Politico HHS reviews refugee operations as Trump calls for border crackdown

The Hill Majority of Republicans supports ‘Medicare for all,’ poll finds

Roll Call November elections bring high stakes for Medicaid

Calendar

TUESDAY | Oct. 23

Oct. 23-24. Milken Institute Future of Health Summit. Details.

6 a.m. Centene third quarter earnings call. Details.

WEDNESDAY | Oct. 24

White House to host event commemorating “a year of historic action to combat the opioid crisis.” President Trump expected to sign the SUPPORT for Patients and Communities Act.

THURSDAY | Oct. 25

Oct. 25-26. Ronald Reagan Building and International Trade Center. 1300 Pennsylvania Ave. NW. Medicaid and CHIP Payment and Access Commission October meeting. Details.

MONDAY | Oct. 29

National Press Club. Book event on “Bad Advice” by Dr. Paul Offit. Details.