"If association health plans ever become widely popular, small businesses will either be forced to buy plans that offer less comprehensive coverage or pay much more than they do now for higher-quality insurance." - Jonathan Oberlander, Ph.D.

In several states this year, the march to bring health care benefits to more low-income residents came with the insistence that able-bodied adults — who are just a fraction of all Medicaid recipients — put in hours of work or volunteer time each month to retain the assistance. The politics worked: Many Democratic lawmakers went along as assurance that more people could reap benefits from the Affordable Care Act, while Republicans were able to show their base that they were holding people accountable for receiving aid. As a result, Republican-led states have increasingly expanded coverage with such restrictions, and some red states that had already expanded Medicaid are opting to add them. Although a court has temporarily halted Kentucky’s plan, three other expansion states – Arkansas, Indiana, and New Hampshire — have federally approved work requirement waivers in place. Another three expansion states — Arizona, Ohio, and Maine — are seeking permission to do the same. (Christine Vestal, Stateline)

The Trump administration on Thursday said it would continue approving Medicaid work requirement requests from states, despite a district court ruling last month that blocked such requirements in Kentucky. Health and Human Services Secretary Alex Azar said the ruling was a "blow" to the administration's efforts to encourage work among "able-bodied" adults in the Medicaid program, but said he is "undeterred" and “proceeding forward."  (Jessie Hellmann, The Hill)

Ignoring the binding vote, Gov. Paul LePage has refused to expand the program, blasting it as a needless, budget-busting form of welfare. He vetoed five expansion bills before the issue made the ballot, plus a spending bill this month that provided about $60 million in funding for the first year. Earlier this month he went so far as to say he would go to jail “before I put the state in red ink” by adding at least 70,000 more low-income adults to the state’s Medicaid population of 264,000.  The showdown is on the extreme end of tensions playing out this election year in a number of Republican-controlled states that have resisted expanding Medicaid under the ACA. Following Maine’s lead, advocacy groups in Idaho, Nebraska, and Utah have gathered enough signatures to get Medicaid expansion measures on their state ballots this November, although Nebraska’s have yet to be certified. (Abby Goodnough, New York Times)

The Trump administration, in an abrupt reversal, said Tuesday that it would restart a program that pays billions of dollars to insurers to stabilize health insurance markets under the Affordable Care Act (ACA). The administration suspended the program less than three weeks ago, saying it was compelled to do so by a federal court decision in New Mexico. But the administration said Tuesday that it would restore the program because otherwise health plans could become insolvent or withdraw from the market, causing chaos for consumers. In adopting a new rule, the administration essentially accepted the arguments of critics, including consumer groups, health insurance companies and Democrats in Congress, who said that suspending the payments would cause turmoil in insurance markets. (Robert Pear, New York Times)

Two states so far have taken advantage of the federal government's decision to give them more leeway in defining the essential health benefits that individual and small-group insurers must offer consumers. Those states — Alabama and Illinois — diverged significantly in how they responded to that flexibility. In April, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that would allow states to determine the minimum essential health benefits that individual and small-business health plans operating in the state are required to cover, beginning in 2020. While the agency said the extra flexibility would let insurers create plans more tailored to members' needs, policy experts warned the rule could lead to skimpier coverage if states chipped away at benefit requirements.  (Shelby Livingston, Modern Healthcare)

Twelve Democratic attorneys general sued the Trump administration Thursday to block a new rule making it easier for small firms and individuals to band together in association health plans free from many ACA market rules. The suit, filed in U.S. District Court for the District of Columbia, alleged the final rule issued by the U.S. Department of Labor last month violated the Administrative Procedure Act, the ACA, and the Employee Retirement Income Security Act. This represents the latest legal effort to block Trump administration moves to roll back coverage expansions and consumer protections under the ACA. Last month, advocacy groups won a federal ruling invalidating CMS's approval of Kentucky's Medicaid waiver requiring beneficiaries to work, go to school or participate in volunteer activities. (Harris Meyer, Modern Healthcare)

Last May, in a highly anticipated speech in the sun-drenched White House Rose Garden, President Trump laid out his long-awaited plan to lower drug prices. Democrats dismissed the proposals as toothless and well short of the president’s campaign promises to allow the government to negotiate drug prices for Medicare while promoting the importation of medicines from abroad. But chief executives of drug companies are not so sanguine. Administration officials “want a win, they want a victory,” said a person at the Pharmaceutical Research and Manufacturers of America (PhRMA) meeting, who reported that the administration “went ballistic” when Pfizer increased prices a few weeks ago. Pfizer deferred the price increases after Mr. Trump criticized the company and put pressure on its chairman and chief executive, Ian C. Read (Robert Pear, New York Times)

Prescription drug prices were soaring. Angry policymakers swore they’d take action. Pharma giant Merck responded by promising to address the problem voluntarily, vowing to keep price increases under the overall rate of inflation. “We believe these moderate increases are a responsible approach, which will help to contain costs,” the Merck CEO said at the annual shareholders meeting. That assurance wasn’t made last week, when multiple drug companies offered similar pledges amid similar criticism. It was nearly three decades ago, in 1990. (Jay Hancock and Sarah Jane Tribble, Kaiser Health News)

An increasingly popular culprit in the debate over high drug prices is the pharmaceutical rebate, the after-the-fact discounts that form the heart of the nation’s arcane — many would say broken — market for prescription drugs. Now, a growing chorus wants to get rid of them, or at least change the way they are applied after drug companies have already set their prices. Rebates, critics say, have pushed up the list price of brand-name drugs, which consumers are increasingly responsible for paying. Insurers generally get to keep the rebates without passing them along to their members. Last week, the drug industry’s largest trade group, the Pharmaceutical Research and Manufacturers of America, took aim at the rebate system, proposing a change to the way middlemen handle rebates, and how those companies are paid. (Katie Thomas, New York Times)

Health care is shifting in a fundamental way for millions of Americans. Some insurers are paying for rides to fitness centers and checking in with customers to help ward off loneliness. Hospital networks are hiring more workers to visit people at home and learn about their lives, not just their illnesses. The health care system is becoming more focused on keeping patients healthy instead of waiting to treat them once they become sick or wind up in the hospital. This isn’t a new concept, but it’s growing. Insurers are expanding what they pay for to confront rising costs, realizing that a person’s health depends mostly on what happens outside a doctor’s visit. (Tom Murphy, Associated Press)

The Trump administration’s Medicare chief on Wednesday slammed Sen. Bernie Sanders’ call for a national health plan, saying “Medicare for All” would undermine care for seniors and become “Medicare for None.” The broadside from Medicare and Medicaid administrator Seema Verma came in a San Francisco speech that coincides with a focus on health care in contentious midterm congressional elections. Sanders, a Vermont independent, fired back at Trump’s Medicare chief in a statement that chastised her for trying to “throw” millions of people off their health insurance during the administration’s failed effort to repeal the ACA. (Ricardo Alonso-Zaldivar, Associated Press)