Welcome to our inaugural issue of Headlines in Health Policy, a roundup of recent news about health coverage, health delivery system reform, and more.

• Mailings, Social Media Ads Woo Uninsured for Health Sign-Up  Associated Press—The Obama administration says it’ll send more than 10 million mailings to woo the uninsured for the final health care law sign-up season of President Barack Obama’s tenure.  Add to that countless email messages to both prospective and returning customers — and ads on social media platforms such as Instagram and Facebook.  Officials are outlining the marketing campaign for the next sign-up season, which runs from Nov. 1 to Jan. 31.

• CMS Details Open Enrollment Strategy. Health Affairs Blog by Timothy Jost—The marketplaces (and indeed the entire individual market) opens for the fourth open enrollment (OE4) period on November 1, 2016. A recent Commonwealth Fund survey found that nearly 40 percent of the uninsured did not know about the marketplaces and nearly 50 percent did not know about the financial assistance they offer. The Department of Health and Human Services (HHS) believes that 10.7 million uninsured individuals are eligible for marketplace coverage, and 9 million of them for tax credits.
  
  
• Can’t Find a Plan on HealthCare.Gov? One May Be Picked for You.  New York Times by Robert Pear—The federal government will choose health plans for hundreds of thousands of consumers whose insurers have left the Affordable Care Act marketplace unless those people opt out of the law’s exchanges or select plans on their own, under a new policy to make sure consumers maintain coverage in 2017.…That may make for a jarring start to the health law’s fourth annual open enrollment period, which starts Nov. 1, a week before Election Day, and runs through Jan. 31. 

• Transcript of the Second Debate.  QUESTION: The Affordable Care Act, known as Obamacare, it is not affordable. Premiums have gone up. Deductibles have gone up. Copays have gone up. Prescriptions have gone up. And the coverage has gone down. What will you do to bring the cost down and make coverage better?

• Trump, Clinton Clash Over Repealing ObamaCare  The Hill by Peter Sullivan—Hillary Clinton and Donald Trump sparred over ObamaCare at the presidential debate Sunday night, with Trump calling to repeal it entirely and Clinton acknowledging flaws but calling for improvements.  …Clinton, the Democratic nominee, agreed that premiums and healthcare costs in general are a problem but called for going forward, not starting over. “I’m gonna fix it because I agree with you — premiums have gotten too high,” Clinton said, also pointing to rising deductibles and prescription drug costs. But Clinton argued against repealing the gains the law has made, such as giving health coverage to 20 million new people and banning insurance companies from practices like putting lifetime limits on health insurance benefits….Trump was pressed by moderator Anderson Cooper on how his plan would allow for people with pre-existing conditions to get care, as he has promised. Trump pointed to his proposal to allow insurance to be sold across state lines.

• Final MACRA rule expands exemptions, flexibility Modern Healthcare by Virgil Dickson, Shannon Muchmore and Shelby Livingston—Nearly a third of physicians could be exempt from Medicare's new Merit-based Incentive Payment System under a final rule CMS issued Friday for implementing the Medicare Access and CHIP Reauthorization Act. CMS also signaled it would broaden the opportunities for physicians to participate in alternative models that make them eligible for bigger rate increases and bonuses. In April, CMS released the proposed rule on MACRA, which replaced the old and flawed sustainable growth-rate formula for physician pay with a new method meant to shift physicians away from the fee-for-service model and onto a value-based payment system. To avoid penalties under MACRA, physicians will participate in one of two reimbursement tracks: a merit-based incentive payment system or advanced alternative. Department of Health & Human Services (HHS) Press Release on MACRA
  
  
• Mixed Results For Medicare Experiment Milwaukee Journal Sentinel by Guy Boulton—Health systems and physicians throughout Wisconsin and the rest of the country are proving they can lower costs while improving quality. They are in the minority, though. That’s one of the takeaways so far from Medicare’s largest experiment to change the way hospitals and doctors are paid. The experiment involves what are known as "accountable care organizations," in which health systems, hospitals and groups of physicians receive bonuses if they provide care at a lower cost while meeting basic quality measures for a set group of Medicare patients. Slightly fewer than one in three—31%—of the 392 participating accountable care organizations last year received bonuses for their performance.

• A Promising Fiddling with Health Insurance Modern Healthcare EDITORIAL by Merrill Goozner—CMS announced without fanfare or opposition that it will allow some of the nation's leading insurers selling Medicare Advantage plans to use value-based insurance design (VBID) in as many as 10 states starting in 2018. OK, it's only a pilot. But VBID remains one of the most promising reforms to health insurance to come along in decades. Medicare beneficiaries in VBID-style plans will be paying lower co-pays and deductibles for high-value healthcare services. VBID is the antidote to the high-deductible plan trend among employers. Left on their own to pick up anywhere from $1,000 to $5,000 in first-dollar coverage, people inevitably make poor choices.

• Hospitals Are Taken Ill Over Rising Drug Prices STAT by Ed Silverman—The rising cost of medicines is making some hospitals feel ill. While much of the attention over prescription drug prices is focused on consumers, a survey released on Tuesday finds that hospitals are also spending much more than in the past. Between 2013 and 2015, the average annual drug spending for patients who stay in community hospitals increased by of 23.4 percent, from $5.2 million to $6.5 million. And on a per admission basis, hospital spending on drugs jumped nearly 39 percent, to $990. Moreover, the increase in prices outpaced reimbursement rates from payers, retail spending on medicines, and the pharmaceutical price inflation calculated by the U.S. Bureau of Labor Statistics. As a result, the survey found that more than 90 percent of the hospitals surveyed reported that recent price hikes for inpatient drugs had a moderate or severe effect on managing costs.

• W.H.O. Urges Tax on Sugary Drinks to Fight Obesity New York Times by Sabrina Tavernise—The World Health Organization on Tuesday urged countries to impose a tax on sugary drinks to battle the growing obesity epidemic and presented new data on the beneficial health effects of such a tax. A tax on sugary beverages raising their price 20 percent would result in a proportionate reduction in their consumption, the agency said. That would advance the fight against obesity, which has more than doubled since 1980. About half a billion adults were obese in 2014, roughly 11 percent of men and 15 percent of women.

"Ultimately, we believe that we're not looking to transform the Medicare program in 2017; we're looking to make a long-term program successful."