THE PROGNOSIS

In its latest move to roll back Obamacare regulations, the Trump administration is ironically opening the door to more people buying….Obamacare plans.

This afternoon, President Trump will announce from the Rose Garden the final stage of his three-pronged executive order aimed at giving Americans more health insurance options. Trump issued the order back in October 2017, trying to show he was carrying out his promises to pull back on the Affordable Care Act even after Congress had spent the summer trying – and failing – to repeal it.

But unlike Trump’s first two regulations – which involved encouraging people to buy plans that might not fully comply with Affordable Care Act requirements – this latest rule would allow employers to send their workers into plans that do comply with the ACA.

Under the rule, which three federal agencies released yesterday, employers could opt out of providing workers with health coverage, instead giving them tax-free money to buy a health plan on their own. It lifts Obama-era restrictions from these tax-free accounts, known as Health Reimbursement Accounts, giving employers a way to ensure their workers get covered without having to actually administer a group health plan.

“The rule will provide hundreds of thousands of businesses a better way to offer health insurance coverage and millions of workers and their families a better way to obtain health coverage,” Joe Grogan, director of the White House Domestic Policy Council, told reporters.

From Seema Verma, administrator of the Centers for Medicare and Medicaid Services: 

Health and Human Services Secretary Alex Azar: 

House Minority Leader Kevin McCarthy (R-Calif.): 

Under the rule, employers could skip a traditional group plan and instead offer workers an HRA, from which they could withdraw funds to buy an ACA-compliant health plan in the individual market. Or, employers could continue to offer group coverage but also deposit money into a different type of HRA, one that could be used to buy additional benefits like vision or dental coverage. Under that second scenario, employees could choose to forgo the group coverage and use the HRA to buy a short-term health plan.

“This is the end and culmination of that executive order and closes out all the actions called for when President Trump signed the executive order,” Grogan said.

Of the 180 million Americans who get coverage from their employers, those who work for small firms are most likely to be affected by the new rule because they struggle the most to afford health coverage, officials said. Brian Blase, special assistant to the president on the National Economic Council, noted that there’s been a decline in small businesses that offer health coverage and pointed to data that even large employers are offering fewer insurance choices to their worker amid rising costs.

“We expect this rule will reverse those trends,” Blase said.

The Treasury Department estimates that 800,000 employers will eventually offer HRAs to more than 11 million workers and their families, although outside experts cautioned it’s hard to estimate how many firms might avail themselves of the new opportunity.

“This is really a very different way of doing things,” said JoAnn Volk, a research professor at Georgetown University’s Center on Health Insurance Reforms. “Instead of a group health plan the vast majority of Americans depend on, you could instead be given a fixed amount of money to go shopping on your own.”

The HRA rule has received much less attention from Democrats than the administration’s expansion of short term and association health plans. They’ve devoted much time and energy to blasting those plans, accusing the administration of allowing “junk” insurance that fails to cover many of the medical services consumers need. Last month, the House passed legislation reversing the expansion of short-term plans, using it as a fresh opportunity to highlight all the ways they say the administration is undermining the ACA.

From Rep. Lauren Underwood (D-Ill.):

Sen. Tammy Baldwin (D-Wis.):

In contrast, the HRA expansion has received mostly positive feedback. Employers and insurers have generally been in favor of it, although they’ve cautioned that without adequate protections it could result in employers sending their sicker, more expensive workers into the marketplaces while retaining group coverage for the healthier workers. That could in turn worsen the ACA marketplaces, driving up premiums for everyone.

The final regulation, which closely mirrors what the administration proposed last fall, tries to circumvent that problem by requiring that employers choose between offering a group plan or an HRA to all employees. If they choose the HRA option, they must offer it on the same terms to all employees within the same class, like full-term workers versus part time workers.

"We commend the administration for taking what we believe is an important step toward greater flexibility in health care coverage," said Jim Klein, president of the American Benefits Council, which represents large employers. "We now call on lawmakers to work together to stabilize the insurance marketplaces, including measures to address costs."

The regulation could be helpful to some American workers whose employers offer coverage that’s still unaffordable, Volk said.

“There may be individuals that are better off if their employer was offering coverage that was widely too expensive,” she said. “And it might be good for the marketplaces because they’ll get a lot of new bodies.”

AHH, OOF and OUCH

AHH: The House voted 225 to 193 to amend an HHS spending bill to block the Trump administration’s move to end federal funding of medical research using fetal tissue by government scientists. But the Republican-led Senate is sure to block the amendment.

The amendment, sponsored by House Progressive Caucus co-chair Mark Pocan (D-Wis.) “targets President Trump’s policy requiring federally funded research using fetal tissue from elective abortions to undergo separate screenings by an ethics advisory board,” our Post colleague Colby Itkowitz reports. “Pocan’s measure restricted funding to set up such panels.”

“I get it. You’ve got to make your base happy, especially in the era of Donald Trump,” Pocan said during floor debate. “But the bottom line is, you are hurting your constituents by trying to place politics over medical science. That’s just a really bad idea.”

The House's only three antiabortion Democratic, Reps. Daniel Lipinski (Ill.), Ben McAdams (Utah) and Collin C. Peterson (Minn.), joined their colleagues across the aisle in voting against the measure.

OOF: Gov. Andrew M. Cuomo (D) signed into law yesterday legislation to repeal religious exemptions for school vaccines in the state, which has been at the epicenter of the measles outbreak.

The governor signed the bill just after the final vote by state lawmakers.

 “The law gives unvaccinated students up to 30 days to show they’ve started their required immunizations,” our Post colleague Eli Rosenberg reports. He writes bill opponents protested outside of New York’s capitol in Albany before the vote over concerns that it impedes religious freedom.

“The science is crystal clear: Vaccines are safe, effective and the best way to keep our children safe,” Cuomo said in a statement. “While I understand and respect freedom of religion, our first job is to protect the public health and by signing this measure into law, we will help prevent further transmissions and stop this outbreak right in its tracks.”

Meanwhile on Thursday, the New York Health Department announced it had closed two private schools in Williamsburg for failing to comply with a health order issued amid the current measles outbreak.

OUCH: Actress Jessica Biel insisted in an Instagram post that she supports vaccination for children after she joined anti-vaccination activist Robert F. Kennedy Jr. in California to lobby against legislation that would restrict vaccine exemptions.

She said she did so because she believes the California measure is too strict.

“That’s why I spoke to legislators and argued against this bill,” Biel wrote. “Not because I don’t believe in vaccinations, but because I believe in giving doctors and the families they treat the ability to decide what’s best for their patients and the ability to provide that treatment.”

“The vaccinations bill, SB 276, would create a standardized medical exemption request form that the state’s public health officer or someone they designated would have to approve,” our Post colleague Marisa Iati reports. “The health officer would decide whether the request provides enough medical evidence to establish that the vaccination would be ill-advised based on guidelines from the Centers for Disease Control and Prevention. The state also would keep a database of approved exemption requests.”

Kennedy told the Daily Beast in an interview that he and Biel were concerned about how the bill could require children to be vaccinated even if doctors say they are “too fragile.” “She’s upset about this issue because of its particular cruelty,” Kennedy told the publication. “She has friends who have been vaccine-injured who would be forced to leave the state.”

HEALTH ON THE HILL

— The Congressional Budget Office has reportedly warned in a preliminary assessment that a set of Senate proposals to tackle surprise medical bills could lead to hospital consolidation.

“The Senate package would save a combined $54 billion over the next decade, according to a Republican staffer, but not all of those components may move forward,” Bloomberg’s Shira Stein reports. “The CBO said all three proposals to stop surprise medical bills could lead to provider consolidation, but the specifics have not yet been explained publicly because these are preliminary scores that were leaked before CBO wrote a formal analysis, a Senate aide said.”

Multiple economists disagreed with the budget office’s preliminary analysis of proposals from the Senate Health, Education, Labor and Pensions Committee. Ben Ippolito, an economic policy research fellow at the conservative American Enterprise Institute, for one, told Shira it’s not likely that the proposed measures could “meaningfully increase the kind of consolidation that we worry about the most,” which is when hospitals acquire other medical facilities.

REPRODUCTIVE WARS

— Rep. Pramila Jayapal (D-Wash.) opened up in a New York Times op-ed about having an abortion more than two decades ago.

She detailed a first pregnancy with her child she calls “a miracle.” Janak was born unexpectedly at 26.5 weeks and weighed just 1 pound 14 ounces, surviving after multiple blood transfusions and struggling with underdeveloped organs. Years later, she said doctors told her another pregnancy would be very high-risk. But despite efforts to prevent it, Jayapal said she became pregnant again.

“I wanted children, but I wasn’t ready, nor was I fully recovered. I was so grateful that Janak had survived, but I could not tempt fate again,” she wrote. “I decided I could not responsibly have the baby. It was a heartbreaking decision, but it was the only one I was capable of making.”

The Washington Democrat said she has never spoken publicly about having an abortion but she has become “deeply concerned about the intensified efforts to strip choice and constitutional rights away from pregnant people and the simplistic ways of trying to criminalize abortion.”

— A 20-year lease extension on a Planned Parenthood clinic in Austin can’t be undone by a new state law that blocks local governments from doing business with the organization.

Texas Gov. Gregg Abbott (R) signed a bill into law last week that bans cities from “any transaction” with the organization or its affiliates. That includes leases, sales and donations of real estate, services and goods, the Austin American Statesman’s Chuck Lindell reports.

But since the bill is not retroactive, that means a $1-a-year lease extension for a city-owned building can continue until 2039.

Austin Mayor Steve Adler, who has defended the clinic and its lease, said it is “imperative that the city of Austin and other governmental entities maintain the ability to meet the health care needs of their communities, and that’s what Austin is doing.” Adler has said the clinic “does not provide abortions, instead offering subsidized health care — including contraceptives, testing for HIV and sexually transmitted infections and cancer screenings,” Chuck writes.

— And here are a few more good reads: 

TRUMP TEMPERATURE
AGENCY ALERT
The agency said two patients received donated stool that had not been screened for drug-resistant germs, leading it to halt clinical trials until researchers prove proper testing procedures are in place.
New York Times
Juul Labs Inc. and other e-cigarette makers would face a 10-month deadline to submit applications for U.S. government clearance to keep their products on the market under a proposal that accelerates the deadline for federal review of the growing industry.
Bloomberg
STATE SCAN
National
Officials effectively rebooted a criminal investigation that began in 2016.
Mark Berman and Brady Dennis
Maryland Politics
Some said they were confused by the board’s decision to welcome back four members who had contracts.
Rachel Chason
Morning Mix
The city council in Waskom, Tex., voted unanimously to outlaw abortion, commandeering the language of the movement for immigrant rights to counter the reproductive freedom of women.
Isaac Stanley-Becker
Colorado Gov. Jared Polis, who opposed legislation earlier this year that would have made it harder for parents to get vaccination exemptions for their children to attend public school, announced a…
Denver Post
Opposition to vaccines on the left is increasingly worrying the authorities. At one progressive school, 60 percent of the 300 students were not vaccinated against measles and other diseases.
New York Times
INDUSTRY RX
Technology
Two decades after Congress tried to wall off the worst of the Internet in hopes of protecting the privacy and innocence of children, the ramparts lie in ruins.
Craig Timberg
MEDICAL MISSIVES
Health
Enrique Galvan, a 27-year-old from Paraguay, had surgery in California to remove large, heavy tumors caused by a rare genetic disorder.
Lindsey Bever
DAYBOOK

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the Lower Health Care Costs Act on June 18.
  • The Washington Post will host leading health policymakers, top doctors and researchers for a live event examining the latest developments in cancer prevention, detection and treatment on June 18.
SUGAR RUSH

Here's a look at how the 'Handmaid's Tale' costume became a symbol of the abortion rights movement: