The Trump administration is estimating there are now only 700 issuers in the individual and small group markets, which is down from 2,400 in an earlier estimate.

The CMS cited the updated figure in an information collection notice posted Jan. 8. The agency is seeking permission from the White House’s Office of Management and Budget to continue collecting data annually from exchange plans about their enrollees’ risk profiles.

In an earlier version of the request submitted to the executive branch last month, the agency estimated there were 2,400 issuers in the individual and small group markets.

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Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) met Wednesday to discuss the path forward for their bipartisan legislation aimed at stabilizing ObamaCare, aides in both parties said.

The legislation’s future has been thrown into question after it was punted at the end of last month. Alexander is now pushing for the legislation to be included in a government funding package when a long-term deal on that measure is reached.

Murray and other Democrats, though, want significant changes to the bill, saying that it needs to be redone now that Republicans have destabilized health insurance markets by repealing ObamaCare’s individual mandate in the tax-reform bill last month.

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In “Is Obamacare Harming Quality? (Part 1),” Michael Cannon explains that new research shows that Obamacare is not working how it is supposed to work in theory: The law’s preexisting conditions provisions create perverse incentives for insurers to reduce the quality of coverage; those provisions are reducing the quality of coverage relative to employer plans; and the erosion in quality is likely to accelerate in the future. In this post, he explains why regulators cannot fix this problem, and why providing sick patients secure access to quality health care requires allowing consumers to purchase health plans not subject to Obamacare’s preexisting conditions provisions.

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Cannon offers new research showing that Obamacare’s preexisting condition provisions create perverse incentives for insurers to reduce the quality of coverage, reducing the quality of coverage relative to employer plans.  The erosion in quality is likely to accelerate in the future. In a follow-up post, he explains why regulators cannot fix this problem and why providing sick patients secure access to quality health care requires allowing consumers to purchase health plans not subject to Obamacare’s preexisting conditions provisions.

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Congress has no choice but to revisit the issue of health reform, and leaders have the greatest opportunity by tackling Medicaid. In 2016 the federal government spent $42 billion on ObamaCare’s exchanges. It spent $358 billion on Medicaid. States and localities pitched in another $208 billion, for a total national Medicaid expenditure of $566 billion in 2016. The growth in spending on health-care entitlements like Medicaid and Medicare threatens to overwhelm the Treasury, starving the federal government of the funds it needs to pay for everything else, including education, welfare and national defense.

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In a major policy shift that could affect millions of low-income people, the Trump administration said Thursday it is offering a path for states that want to seek work requirements on Medicaid recipients.

Seema Verma, head of the Centers for Medicare and Medicaid Services, said work and community involvement can make a positive difference in people’s lives and in their health.

The administration’s latest action spells out safeguards that states should consider to obtain federal approval for waivers imposing work requirements on “able-bodied” adults. Technically, those waivers would be “demonstration projects.” In practical terms, they would represent new requirements for beneficiaries in those states.

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In a letter to President Trump, Leader McConnell, and Speaker Ryan, a dozen health policy leaders recommend that health reform continue to be a top priority in 2018.  Insurance premiums continue to soar, and millions of people have little or no choice of health insurers. The group says individuals need to be empowered with greater flexibility and choice and that states are better equipped than Washington to oversee their health insurance markets. This requires legislative action from Congress to redirected resources and provide them with greater regulatory flexibility.

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In a bid to expand access to affordable healthcare coverage, the Trump administration early Thursday rolled out proposed rules that would allow more small businesses and self-employed workers to band together to buy insurance.

The rule is part of the administration’s objective to encourage competition in the health insurance markets and lower the cost of coverage. But some experts say expanding access to these “association health plans,” which aren’t subject to many of the same regulations and consumer protections as other health plans sold under the Affordable Care Act, could weaken the individual health insurance market.

Mississippi has received the first-ever 10-year extension of a Medicaid Section 1115 demonstration waiver, allowing the state to continue providing family planning services for people with income of up to 194% of the federal poverty level.

The CMS said the 10-year extension is part of the agency’s effort to give states greater flexibility in running their Medicaid programs, without having to ask the government for frequent approvals. Up to now, the agency typically granted Section 1115 waivers, which are supposed to be budget-neutral for the federal government, for five-year periods.

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Whether it was bracing for a possible repeal of Obamacare or pondering an ambitious single-payer program that would overhaul how California provided medical care to its residents, the issue of healthcare kept politicians and policy wonks busy in 2017.

That’s not likely to let up in 2018.

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