The Trump administration is poised to roll back the federal requirement for employers to include birth control coverage in their health insurance plans, vastly expanding exemptions for those that cite moral or religious objections.

The new rules, which could be issued as soon as Friday, fulfill a campaign promise by President Trump and are sure to touch off a round of lawsuits on the issue.

More than 55 million women have access to birth control without co-payments because of the contraceptive coverage mandate, according to a study commissioned by the Obama administration. Under the new regulations, hundreds of thousands of women could lose birth control benefits they now receive at no cost under the Affordable Care Act.

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Full-scale repeal of Obamacare has failed, at least for now. But there are still components of the law that can, and should, be rolled back immediately. The Independent Payment Advisory Board is a prime example.

Obamacare created the board of 15 unelected, presidentially-appointed bureaucrats to keep Medicare’s costs under control. If entitlement spending growth surpasses a specific target (currently, aggregate GDP growth plus 1 percent) the board must recommend Medicare cuts.

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Not even 24 hours after the latest “repeal and replace” proposal ran out of steam, Sen. Rand Paul (R-Ky.) ignited a new round of health policy speculation by predicting, during a cable news interview, impending Trump administration action on a longtime Republican go-to idea: association health plans.

“If [consumers] can join large groups, get protection and less expensive insurance … it will solve a lot of problems in the individual market,” Paul said last week on the MSNBC show “Morning Joe.”

Later, President Donald Trump told reporters that he would “probably be signing a very major executive order” that could affect “millions of people.”

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It’s sort of poetic, in a sad way, that the resignation of Health and Human Services Secretary Tom Price on September 29 coincided so closely with the expiration of the 2017 budget resolution on September 30.  Those two events signaled the end, at least for now, of Congressional Republicans’ efforts to repeal and replace Obamacare through reconciliation–that being the arcane process by which the GOP could have avoided a crippling Democratic filibuster in the Senate.

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Republicans have now failed twice to repeal and replace ObamaCare. But their whole focus has been wrong. The debate centered, like ObamaCare, on the number of people with health insurance. A more direct path to broadening access would be to reduce the cost of care. This means creating market conditions long proven to bring down prices while improving quality—empowering consumers to seek value, increasing the supply of care, and stimulating competition.

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People will be able to enroll in Obamacare plans directly through web brokers and health insurers for 2018, which will reduce the need for federal outreach funds.

That feature will likely be included in an upcoming Department of Health and Human Services proposed rule under review at the Office of Management and Budget, Joel White, president of the Council for Affordable Health Coverage (CAHC), told Bloomberg BNA Sept. 22. Congress isn’t likely to provide more funding for Affordable Care Act outreach activities, so “HHS is going to have to figure out ways to expand options for consumers to get enrolled,” White said HHS officials have told his group. The CAHC is a broad-based group of health-care industries.

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The actress Julia Louis-Dreyfus announced on Twitter that she has been diagnosed with breast cancer. We all wish her a speedy and complete recovery. Still, this would not normally be a topic for The Apothecary, except that in making her announcement, she used her diagnosis as a plug for “universal health care,” with the implication that universal health care would improve survival rates. Actual data from countries around the world, with and without so-called universal health care, do not support that contention.

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Republicans are willing to provide insurers with two years of ObamaCare subsidies under a bipartisan market stabilization bill, according to the Senate Health Committee chairman.

Sen. Lamar Alexander (R-Tenn.) said continuing cost-sharing reduction subsidies for two years is a key part of the stabilization package he is trying to negotiate with Sen. Patty Murray (D-Wash.).

Alexander and Murray are continuing to try to rally Republicans and Democrats around a short-term plan to lower ObamaCare premiums in 2018 and 2019.

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The #3 reason Medicare-for-All as conceived by Senator Sanders is a bad idea is because of the inevitable rationing it will produce. In other well-known single-payer systems, this rationing takes several forms, including restrictions on the availability of treatments or, more commonly, rationing by waiting.

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The #2 reason this plan is a bad idea is the enormous amount of waste it would create due to moral hazard. Moral hazard is the technical term used by health economists, but it refers to something every reader intuitively understand even if the term itself is unfamiliar.  If you give something to someone for free, they will use more of it and they also will be less likely shop vigorously for a lower price. In short, such consumers will typically use more and pay more (i.e., be willing to accept a higher price) for “free” services.

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