• Trump's Hidden War on Medicaid  Vox by Dylan Scott — A dozen states are applying for or entertaining work requirements and other restrictions on Medicaid — putting the lifeline for millions of poor Americans at risk. The story of Medicaid so far has been of gradual expansion, from the absolutely most vulnerable Americans to a broader social safety net for all Americans in or near poverty. But now, under Trump, the Centers for Medicare and Medicaid Services have signaled that they are open to unprecedented policy changes, most notably requirements that many Medicaid beneficiaries either work or look for work. The Trump administration could initiate the most dramatic reductions in Medicaid enrollment and spending since the program began, even though Trump as a presidential candidate promised he would not cut Medicaid.
  
  
• Work Requirement Approved for Arkansas's Medicaid Expansion  Associated Press by Andrew DeMillo — The Trump administration on Monday approved Arkansas's plan to require thousands of people on its Medicaid expansion program to work or volunteer, making Arkansas the third state allowed to impose such restrictions on health care coverage for the poor. Gov. Asa Hutchinson announced that the requirement for Arkansas' program, which uses Medicaid funds to purchase private insurance for low-income residents, had been approved by the Centers for Medicare and Medicaid Services. More than 285,000 people are on the Arkansas program, which was created as an alternative to expanding traditional Medicaid under the federal health law….Arkansas's proposal will not affect people on its traditional Medicaid program, which covers about more than 645,000 people statewide.
  
  
• Fallin Seeks Work Requirement for Medicaid in Oklahoma  Associated Press — Gov. Mary Fallin is ordering the state's Medicaid agency to develop a requirement that certain able-bodied participants work in order to keep receiving benefits. Fallin issued an executive order on Tuesday directing the Oklahoma Health Care Authority to submit recommendations to the governor and Legislature within the next six months. Fallin suggested exemptions for children, pregnant women, the disabled, caretakers of young children and those participating in substance abuse programs, among others. The federal Centers for Medicare and Medicaid Services has approved work requirements in Arkansas, Indiana and Kentucky, but all three of those states expanded their Medicaid eligibility. Oklahoma did not. Oklahoma currently has about 798,000 Medicaid recipients, about 66 percent of whom are children. More than half of adult recipients are elderly, blind, or disabled.
  
  
• Hospital Groups — Leaders in Last Year's Medicaid Battle — Stay Mum on Controversial Work Requirements  Modern Healthcare by Harris Meyer — Politically powerful state hospital associations and their members spent most of last year battling congressional Republican's efforts to sharply cut Medicaid spending and roll back its expansion to low-income adults. In fact, they're widely credited with playing a key role in blocking those changes.  Now they're nervously facing narrower but still significant GOP Medicaid moves that are projected to push tens of thousands of low-income people out of the program by imposing work requirements, premium payments, rigorous income reporting rules, and benefit lock-outs for failure to comply. Republican leaders in Kentucky, Indiana, and Arkansas recently won approval from the Trump administration to establish these new waiver conditions for Medicaid eligibility. Eight other GOP-led states have submitted similar Medicaid work requirement proposals, and nine others have indicated interest in doing so.  But state hospital association leaders have been quiet in their responses so far, with some even offering tepid support. That contrasts with their intense lobbying last year to maintain and expand Medicaid coverage. Some observers say their political calculations may change when they see how the waiver changes actually play out.

• Health Groups Push for Obamacare Funding in Omnibus Package  The Hill by Nathaniel Weixel — A coalition of health care providers and insurers on Tuesday called on House and Senate leaders to include additional funding for Obamacare programs in the upcoming omnibus package to fund the government. "Immediate action is necessary to reduce premiums for individuals and families that purchase coverage on their own," the groups wrote in the letter. The coalition, which includes America's Health Insurance Plans, the American Hospital Association and the American Medical Association, said Congress should approve multiple years of funding for Obamacare cost sharing-reduction (CSR) payments.
  
  
• Lawmakers Soldier on With Insurance Stabilization After White House Memo  Modern Healthcare by Susannah Luthi — Lawmakers are moving forward with final negotiations on an individual market stabilization measure despite the Trump administration's latest requests in exchange for its support. In a memo leaked Tuesday, the Trump administration suggested it would support funding cost-sharing reduction payments for insurers if Congress includes several other provisions in the upcoming spending omnibus, including anti-abortion language and expanding access to health savings accounts….The White House memo came as a surprise as House and Senate lawmakers put the final touches on a stabilization effort that includes a reinsurance fund and cost-sharing reduction payments that the Trump administration halted last October.
  
  
• Planned Parenthood Defunding Threatens Government Spending Package  Politico by Jennifer Haberkorn and Sarah Ferris — House Republicans are demanding a series of controversial abortion and health care policies in the annual health spending bill, setting up a showdown with Democrats and threatening passage of an omnibus spending package to keep the government open. Democrats are vowing to block the slew of long-sought conservative priorities. The riders would cut off federal funding to Planned Parenthood, eliminate a federal family planning program and ax the Teen Pregnancy Prevention Program, according to sources on Capitol Hill. Republicans also want to insert a new prohibition on funding research that uses human fetal tissue obtained after an abortion.
  
  
• Premiums for ACA Health Insurance Plans Could Jump 90 Percent in Three Years  Washington Post by Amy Goldstein — Insurance premiums for Affordable Care Act health plans are likely to jump by 35 to 94 percent around the country within the next three years,  according to a new report concluding that recent federal decisions will have a profound effect on prices. The nationwide analysis, issued Thursday by California's insurance marketplace, finds wide variations state to state, with a broad swath of the South and parts of the Midwest in danger of what the report calls "catastrophic" average rate increases by 2021. According to the analysis, the largest single impact will come from eliminating, starting in 2019, the ACA's penalty for Americans who violate the law's requirement that most people in the United States carry health coverage.
  
  
• Trump Administration Blocks Idaho's Plan to Circumvent Health Law  New York Times by Robert Pear — The Trump administration rejected on Thursday Idaho's plan to allow the sale of stripped-down, low-cost health insurance that violates the Affordable Care Act. The 2010 statute "remains the law, and we have a duty to enforce and uphold the law," Seema Verma, the administrator of the federal Centers for Medicare and Medicaid Services, said in a letter to the governor of Idaho, C. L. Otter. While rejecting Idaho's plan in its current form, Ms. Verma encouraged the state to keep trying, and she suggested that, "with certain modifications," its proposal might be acceptable.
  
  
• Dem AGs Rip Proposed Trump Rule on Health Plans  The Hill by Nathaniel Weixel — A coalition of 17 Democratic state attorneys general is blasting a proposed Trump administration rule to allow health plans to circumvent certain Obamacare rules. The group, led by New York Attorney General Eric Schneiderman and Massachusetts Attorney General Maura Healey, said the proposal is a thinly veiled attempt to undermine the health-care law. The proposal "is nothing more than an unlawful end run around the consumer protections enshrined in the Affordable Care Act, part of President Trump's continued efforts to sabotage the ACA," Schneiderman said in a statement. In a formal comment letter, the group called on the Labor Department to hold public hearings on the impact of the proposal before finalizing any changes. Under the proposal released in January, small businesses and self-employed individuals would be allowed to join together in what are known as "association health plans" (AHPs).

• Cigna Agrees to Buy Express Scripts In Major Health Care Deal  New York Times by Chad Bray & Katie Thomas — The health insurance giant Cigna said on Thursday that it had agreed to buy Express Scripts, the largest pharmacy benefit manager in the United States, in a $52 billion deal that would further reshape the health care industry. The deal is the latest in a recent wave of consolidation across the health care sector, which has been marked by spiraling costs and roiled by Amazon's announcement in January that it was teaming up with Berkshire Hathaway and JPMorgan Chase to try to simplify coverage, a move that unsettled established industry players. The changes across the health care landscape come amid widespread frustration among American businesses and individuals over the complexity of a system in which doctors, hospitals, insurers and pharmaceutical companies have different, often competing, interests. Express Scripts is the largest pharmacy benefit manager in the United States, responsible for the drug plans of more than 80 million Americans, including on behalf of large employers like the Department of Defense.

• Trump Promising Consumers Digital-Age Health Care Approach  Associated Press by Ricardo Alonso-Zaldivar — A smartphone app that lets Medicare patients access their claims information. Giving consumers a share of drug company rebates for their prescriptions. Wider access to websites that reliably compare cost and quality of medical tests. The Trump administration is taking a pragmatic new tack on health care, with officials promising consumer friendly changes and savings in areas from computerized medical records to prescription drugs. New Health and Human Services Secretary Alex Azar has been rolling out the agenda, saying it has the full backing of President Donald Trump. "They are taking a page out of smart policymaking 101 and hitting on themes that everybody cares about," said Kavita Patel, a health policy expert at the Brookings Institution and a veteran of the Obama administration. "But there is not a lot of detail on how they're going to do it." The first year of the Trump administration was marked by Republicans' unsuccessful struggle to repeal the Affordable Care Act. With Azar installed as Trump's second health secretary, the administration is shifting to issues of broader concern for people with Medicare and employer-provided coverage. Many of the ideas have bipartisan support and can be advanced without legislation from Congress.

Editor: Peter Van Vranken