More than 600,000 people signed up last week for health insurance under the Affordable Care Act, significantly beating the pace of prior years as consumers defied President Trump’s assertion that the marketplace was collapsing.

In a report on the first four days of open enrollment, the Trump administration said Thursday, 601,462 people selected health plans in the federal marketplace, HealthCare.gov. Of that number, 137,322 consumers, or 23 percent, were new to the marketplace and did not have coverage this year through the federal insurance exchange.

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The Senate GOP tax bill will retain a key deduction for qualified medical expenses that was excluded from the House version, according to a Republican senator on the Senate Finance Committee.

Sen. Bill Cassidy (R-La.) told reporters that the deduction will remain in the initial version of legislation the Senate is set to unveil today. “I think there’s always a sense that it’s a good thing to continue,” Cassidy said.
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If you were deliberately trying to design the most arbitrary, painful and pointless tax possible, how would you go about it?

First, you would structure it to inflate the cost of an essential product. Then, you’d create exemptions so vast that only 5% of taxpayers were subject to it. You might even ensure that it hit people only when they were particularly vulnerable—like when they’d lost a job. Finally, you would use it to drive enrollment in entitlements, so that it increased the federal deficit by $338 billion.

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Uncertainty over the future of the Affordable Care Act was a challenge for insurers and state regulators as they prepared for the 2018 plan year. Various insurers exited or reduced service areas in the health insurance marketplaces, while others threatened exits or delayed participation decisions. In several states, some or all counties seemed likely to have no insurance plan available for residents seeking marketplace coverage. But as of the start of open enrollment, no states had counties without an insurer for plan year 2018

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Since the Affordable Care Act health insurance marketplaces opened in 2014, there have been a number of changes in insurance participation as companies entered and exited states and also changed their footprint within states. Our earlier analyses of insurer participation and some notable company exits can be found here.  Note that we consider affiliated insurers serving the same areas as one insurer.

In 2014, there were an average of 5.0 insurers participating in each state’s ACA marketplace, ranging from 1 company in New Hampshire and West Virginia to 16 companies in New York. 2015 saw a net increase in insurer participation, with an average of 6.0 insurers per state, ranging from 1 in West Virginia to 16 in New York. In 2016, insurer participation changed in a number of states due to a combination of some new entrants and the failure of a number of CO-OP plans. In 2016, the average number of companies per state was 5.6, ranging from 1 in Wyoming to 16 in Texas and Wisconsin.

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Republicans in Congress are plowing ahead on tax reform, and one obstacle is the complexity of Senate budget rules that limit how much taxes can be cut. The good news is that for once Washington’s fiscal fictions could be deployed to improve policy by repealing ObamaCare’s individual mandate as part of tax reform.

The Senate Finance Committee on Thursday released the details of its tax proposal, which includes a permanent 20% corporate rate and more. Senators Pat Toomey and Bob Corker cut a budget deal to allow for $1.5 trillion in net tax cuts over 10 years without accounting for faster economic growth (and more revenues) as a result of reform.

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President Trump has selected Alex Azar, a former pharmaceutical executive and a top health official during the George W. Bush administration, to lead the Health and Human Services Department.

In announcing that he is nominating Azar to be secretary of the government’s largest civilian department, the president turned to a health-policy insider and conservative thinker. Azar spent a decade at Eli Lily and Co., including five years as president of Lilly USA, its biggest affiliate, before stepping down in January to work as a health-care consultant. He previously was HHS general counsel, then served for two years as the department’s second-in-command.

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The Trump administration will encourage states to pursue work requirements for certain Medicaid beneficiaries, a top official said Tuesday.

The remarks by Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma would signal a significant departure from the Obama administration’s approach to such requests.

Several states have already proposed work requirements, and Verma’s comments indicate a willingness to fast-track those approvals.

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Repealing ObamaCare’s individual mandate will save $338 billion over 10 years, according to a new analysis from the Congressional Budget Office. The CBO said Wednesday it is changing the way it analyzes the mandate (and likely reducing the assumed cost impact) but said it is holding off on making those changes because the work is not complete.

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Emboldened by election wins, Democrats are starting to see a political edge in health care, particularly widening Medicaid access for more low-income people.

In Virginia, Democrat Ralph Northam promised a vigorous push as governor to expand Medicaid. Voters who said health care was important went decisively for Northam, according to political analysts. In Maine, voters defied Republican Gov. Paul LePage’s determined opposition by passing a referendum to expand Medicaid to cover an estimated 70,000 more residents.

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