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Trump has found another way to undermine Obamacare

The Senate HELP Committee is in the midst of a fast-paced, good-faith effort to pass a bill that will stabilize the Obamacare marketplaces in 2018.

Enter Orrin Hatch. The Utah senator who chairs the powerful Senate Finance Committee weighed in on their efforts today to make clear he is not a fan of what he's seen.

"The solutions proffered thus far would do little more than shore up the bad policies already in place with another slate of bad policies. We need legitimate, long-term reforms," Hatch writes in an op-ed for the Washington Post.

Hatch coming in so critical of the current bipartisan work does not bode well for a fix moving through the Senate. His committee has jurisdiction over many health care issues, and his views are going to be taken quite seriously. Read the full op-ed here.

More navigator groups shut down "effective immediately" as Trump abruptly halts all funding

Obamacare outreach groups across the country have begun shutting their doors, as the Trump administration has stopped funding the program entirely.

The Trump administration announced last week it would cut the in-person outreach program's budget by 41 percent. But what actually happened is much different: The Trump administration hasn't sent out those smaller grants, even though last year's grants ran out on September 1.

This means that, for the past week, these navigator groups have operated with no budget. I reported earlier today for Vox that some have resorted to layoffs to stay afloat. They were still managing to run a bare-bones operation (keeping the appointments they have, employing some staff at half time) using funding from other sources, like private grants or local government dollars.

Since that story ran, I've learned that some navigator groups are going even further and shutting down entirely. The Epilepsy Foundation of Florida, which had a $640,000 enrollment grant last year, sent this note to its staff early this morning:

As you all know, we expected a smooth transition from OE4 to OE5. Unfortunately, this year has begun with uncertainty, as we do not currently have a contract for the 2017-2018 ACA navigation contract year that was to begin on September 2, 2017.

After weighing all options, with none being encouraging, we are forced to make the very difficult decision of cancelling all navigation services effective immediately. I expect all sites to be closed with the help of the Navigation management team.

Furthermore, after discussion with our Board's Executive Committee, we have made the even more difficult decision to terminate the employment of Navigation employees effective immediately.

I've heard the same from Community Action of Nebraska, which had a $560,000 grant last year. Their executive director Amber Hansen sent me a note late yesterday saying that, after speaking with the Center for Medicare and Medicaid Services, they were going to suspend all operations.

"We were initially told we could use remaining funds from the previous grant year to cover expenses incurred now," Hansen said over email. "Today we were told we cannot. It is too big a risk to incur expenses without a guarantee of funding."

To be clear: This is not the funding cut the Trump administration promised. The federal government has stopped funding the navigator program entirely. Officials that oversee the program have not made clear when they will begin to fund it again, or advised how navigators are meant to handle this interim period where they have no funding at all.

All of this is happening 53 days before Obamacare's open enrollment period begins — a moment when navigator groups say they're typically making ad buys and setting up enrollment events.

Now, much of that work has come to a halt as these groups have no clear information about when the government will award their new funding.

Democrats are starting to ask questions — Rep. Sandy Levin (D-MI) is sending a letter to the Center for Medicare and Medicaid Services seeking more information about how the decision to cut the navigator budget was made and when the new funding will be released.

"News reports indicate that CMS's failure to provide funding to the Navigator organizations is having an immediate negative impact, with some Navigators finding themselves forced to lay off experienced staff," Levin writes in his letter. "Navigators report that they have yet to receive clarification regarding the extent to which expected funding will be available for the coming year."

Levin is asking when the administration intends to provide navigator organizations with their 2018 budgets — and a justification for the new funding formula, which tethers grants to whether a navigator group met a self-imposed enrollment goal.

Read the full letter here.

Map of the Day

The Rand Corporation

What hospitals really charge for health care, in a map. I'm excited about this new project from Chapin White at RAND, who looks at what prices different hospitals across the state charge the insurance companies they contract with. Usually this data is difficult to get — you only see Medicare prices or a chargemaster, which has the hospital's base price. Rarely do you get much data like White's, which looks at the actual prices negotiated with hospitals. Read the paper and explore his map here.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

  • “House Freedom Caucus chair open to ObamaCare deal”: “House Freedom Caucus Chairman Mark Meadows (R-N.C.) said Friday that he could support a bill aimed at stabilizing ObamaCare and making key payments under the law if conservatives got enough in return.” —Peter Sullivan, the Hill
  • “Plan to Fund Health Insurer Payments Coalesces”: “The contours of a deal to fund insurer payments critical to the Affordable Care Act took shape Thursday, even as conservative lawmakers and the White House pushed an alternative plan to repeal parts of the law.” —Michelle Hackman, the Wall Street Journal
  • "What's next in the Senate's search for an ACA compromise": "All things considered, the HELP Committee's hearings this week about stabilizing the Affordable Care Act went incredibly well ... but it's easy to have a good hearing. There's still a long way to go before the finish line. Here's what's ahead, both short-term and longer term." —Caitlin Owens, Axios

Analysis and longer reads

  • The Ground Has Shifted on U.S. Health Care”: “Republicans should take note: Another stab at destroying Obamacare is not what voters want. Instead, both parties should dedicate themselves to building on it -- and, to that end, work is needed by the end of this month, when insurers are due to sign contracts to sell policies on the state exchanges next year.” —Bloomberg Editorial Board
  • “Chris Murphy’s stealthy single-payer pitch”: “While Bernie Sanders readies a single-payer health care bill that the GOP is itching to attack, one of his Democratic colleagues is proposing a step toward that goal that could give cover to the party’s vulnerable incumbents. Sen. Chris Murphy, a potential presidential contender, is working on legislation expected this fall that would let every individual and business buy into Medicare as part of Obamacare’s exchanges.” —Elana Schor, Politico
  • "The Case For Confronting Long-Term Opioid Use As A Hospital-Acquired Condition": “Many times, doctors could avoid opioid overprescription by setting realistic pain management expectations or by considering alternative analgesics or non-pharmacologic approaches. Prolonged narcotic usage that stems from these clinical decisions could properly be termed a hospital-acquired condition and should be considered a question of patient safety, instead of the result of moral weakness among patients.” —Michael Schlosser, Ravi Chari, and Jonathan Perlin, Health Affairs
  • "Single-payer isn't the only progressive option on health care" "America’s unique history and politics make the successful promotion of a single-payer system an unlikely pathway to universal health coverage. There are three reasons. The first involves the inevitable strong and well-funded opposition of special-interest groups." —Ron Pollack, Vox