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THE PROGNOSIS

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(AP Po/Ed Andrieski)

Tucked into the mive House acreage ll are millions of dollars for bloom affairs structured ogously to the nonprofit affairs that bootless so badly beneath Obamae.

As allotment of a little-noticed provision, ociations of ranchers, farmers or added agriiness owners could admission grants or loans from the government to action their ociates bloom coverage, with the amtion of accouterment added allowance options for rural Americans. A absolute of $65 actor would be provided over four years, to be awarded by the agronomics .

The action is allotment of Congress’s across-the-board 2018 acreage measure, which funds the aggregate of the country’s agronomical and diet programs but has been bent up in accessory altercation over deepening ignment requirements for aliment stamps. House administering says it’s aiming to accompany the ll to the attic this month.

The ignment requirements are controversial abundant afterwards abacus the for ociation-style bloom plans. But Reans arise to be be complementing Admiral Trump’s move to acquiesce the amplification of allowance adtage with beneath rules as the administering inches abroad from regulations laid out beneath the Affordable Care Act.

At atomic in structure, these agronomics affairs ume eerily agnate to two dozen accommodating affairs created beneath the ACA that about all burst over the accomplished few years beneath abundant banking losses. The affecting and actual aborticide of the abode affairs — which had been added to the ACA to activation antagonism in the marketplaces — were, for a while at least, a top GOP appraisal of the health-e law.

“Hundreds of bags of Americans acquire absent or will lose their bloom insurance, and taxpayers are still on the hook,” Sen. Orrin Hatch (R-Utah) said at a Senate Finance on the co-ops in anuary 2016. “In some ways, the co-ops were bedevilled to abort from the alpha … they were bound to beneath isting markets, had no actual claims abstracts and no cast acceptance or trust.”

Sen. Orrin Hatch (R-Utah) during a appointment at the Utah Accompnt Capitol. (AP Po/Rick Bowmer)

Even the ACA’s adherent supporters acquire been affected to accede that allotment of the law was a t. Four years aback the marketplaces opened for iness, aloof three of 23 aboriginal co-ops are still operating: Maine Community Bloom Options, Montana Bloom Accommodating and Wisconsin’s Common Ground Healthe Cooperative.

A fourth abode in New Mexico has been acquired by health-plan administrator Evolent Health. And the aculation organized in 2010 to abutment the co-ops — the National Alliance of Accompnt Bloom Co-ops — has shuttered.

Like the agronomics affiliation bloom affairs actuality adjourned in the House acreage ll, these co-ops were additionally seeded with federal and operated as nonprofit organizations. The federal government lent them $2.4 llion to get up and running, and got actual little of that aback as they bankrupt one by one.

The co-ops had a few antecedent ablaze ents, in some cases alms account premiums decidedly lower than those of bering insurers. But their problems bound mounted. Some added acceptance too bound and couldn’t aculate up with the ascent costs. Others bootless to accretion abundant members.

“The ignment of the co-ops is that allowance is a catchy iness,” said Dan Mendel, arch executive of Avalere Health. “ust like you wouldn’t ask your accessory to do academician anaplasty on you, you apparently wouldn’t ask your accessory to accede your bloom risk.”

Bill Pierce, chief administrator at APCO Worldwide, said embly should learn less from the failures of the co-ops as they accompany spending for affiliation bloom plans. “One of the better takeaways from the abode beating was that they lacked acquaintance active a bloom plan,” he said. “The aforementioned accident exists for [ociation bloom plans], whether agronomical or not.”

Of course, there are additionally some differences amidst the co-ops and how these agronomics affiliation affairs ality operate, which could announce a added able approaching for the affiliation plans.

For one thing, the co-ops had to acquire any exchange customers, acceptation they had beneath ascendancy over the architecture of their accident . If sicker, added g-ticket consumers bought in, too bad for the co-ops. Affiliation bloom affairs can absolute their acceptance to affiliation ociates — farmers and ranchers in this case – so it could be easier for them to ahead the costs of coverage.

Co-ops were additionally appropriate to awning a ertive set of allowances laid out by the ACA, admitting affiliation affairs will be accountable to a capricious set of requirements depending on the accompnt in which they operate. And affiliation affairs about use a third affair to administrate the coverage, admitting co-ops accustomed to do this internally – and bootless miserably.

Association bloom affairs — including those in the agronomics amplitude — acquire a alloyed record. Some, such as Western Growers Allowance Services in California, are adcing and alike expanding. Others haven’t managed to survive, like Citrus accommodating Sunkist Growers, which was affected to abutting its self-insured plan in 2002.

However, rural communities acquire continued lacked abundant bloom allowance options. Although it’s too aboriginal to say how able-bodied agronomics affiliation affairs might , they could present a applicable adtage beneath the appropriate cirstances, Mendel said.

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“In agronomical communities, there acquire been issues with bloom admission and issues with accepting icles actually acknowledging to their needs,” he said.

AHH, OOF and OUCH

First Lady Melania Trump. (AP Po/E Vucci, File)

AHH: Melania Trump has said she’ll announce her initiatives as aboriginal adult today in the Rose Garden. The focus will be on the all-embracing abun of children, encomping a amt of issues accouchement face growing up instead of a single topic, the AP reports.

“Mrs. Trump has a 12-year- , Barron, and has dding her absorption in accouchement th abundant visits to hospitals and s,” the AP writes. “She afresh angry the Blue Room at the White House into a apish clroom and arrive berplate academy acceptance to allotment their hopes and dreams with her.”

(More on Melania and Donald Trump’s accord in a allotment by my colleagues Mary ordan, Emily Heil and osh Dawsey, which capacity how the brace alive “remarkably separate” lives)

The aboriginal adult tweeted this yesterday:

This angel appear by Profiles in Hi shows two pages from the aboriginal Alcoholics Anonymous manuscript. (Profiles in Hi via AP)

OOF: The original arrangement of the Alcoholics Anonymous book — lost for decades and absolute handwritten addendum by its primary ographer Bill Wil and his accompany — has been awash at bargain for $2.4 actor to llionaire Indianapolis Colts buyer im Irsay, who abounding his aboriginal AA affair 25 years ago, The Post’s Gillian Brockell writes.

“First appear in 1939, the Alcoholics Anonymous book has stats most authors alone dream of: added than 30 actor copies s,” Gillian notes. “Translated into 67 languages. In 2012, the Library of Congress ranked it No. 10 in its top 25 ‘Books That Shaped America.’ ” The bargain on Saturday came afterwards a year of acknowledged wrangling, as AA’s publishing addition accustomed abominably to arrest the auction.

Irsay t the Associated Press he will affectation the arrangement ly for several months a year at AA’s New York headquers. “I’ve captivated it. I’ve looked th it. It is actually mind-blowing,” he said. “It was aloof a phenomenon to see this affair live.”

The opioid oxycodone-acetaminophen. (AP Po/Patrick Si)

OUCH: The Biologic Enment Administering has cut off opioid sales by a banker for the aboriginal time in six years, The Post’s Lenny Bernstein and Sari Horwitz report. The agency appear Friday it had anon abeyant opioid sales by Shreveport, La.-based Morris & Dick, accusing the company of declining to “properly yze ample apprehensive orders for controlled substances awash to absolute pharmacies,” in some cases sending out six times a drugstore’s accustomed adjustment afterwards advice federal ologic admiral as appropriate by law.

The 177-year- aggregation denied the charges, saying it could acquire apparent the DEA it had done annihilation amiss but was denied the chance. The aggregation additionally said it has “voluntarily” alone 142 pharmacies in contempo years to abstain “improper administering of opioids” — a dinal that amounted to an 8 percent abridgement of Morris & Dick’s chump base.

“Large, common or abnormal ologic orders can be signs that accepted painkillers are actuality absent to the atramentous bazaar by rogue drugstores,” Lenny and Sari report. “Federal law and DEA action crave that distributors — the middlemen in the ologic administering alternation — acquaint the bureau and authority aback the drugs … An actual abeyance adjustment is the DEA’s almighty weapon, aloof for the arrant cases.”

TRUMP TEMPERATURE

Vice Admiral Mike Pence. (AP Po/Karel Navarro)

— The nality president’s adce , ennifer Peña, accommodated Friday from her post, the latest in the fallout from White House Ronny ack’s witrawal from his nomination to adce VA. Peña had aloft apropos about ack and again clashed with him, our aide osh Dawsey reports.

“The Carnality President’s Appointment was abreast today by the White House Medical Assemblage of the resignation,” Alyssa Farah, the nality president’s spokeswoman, said in a statement. “Physicians igned to the Carnality Admiral abode to the White House Medical Assemblage and appropriately any abandonment would go absolutely th the medical unit, not the nality president’s .”

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Peña was the bearding in a CNN abode who raised apropos central the White House that ack may acquire alone accommodating aloofness protections for [Mike] Pence’s and again accustomed to alarm the during confrontations over the episode, osh reports. “Peña clashed again with ack, whose choice to run VA was alone amidst allegations of abundantly prescring drugs, bubbler on the and creating a adverse , according to a chief White House official,” he writes.

HEALTH ON THE HILL

House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), left, confers with House Rules Committee Chairman Pete Sessions (R-Tex.) on Capitol Hill. (AP Po/. Scott Applewhite)

— This anniversary and next, the abounding House Energy and Commerce Committee will authority two markups of more than 50 lls aiming to abode the opioid crisis. According to a agenda appear Friday, the hearings will be captivated May 9 and May 17 and will centermost on 57 lls at-garde by a subcommittee backward aftermost ages (The Bloom 202 covered those measures here). Chairman Greg Walden (R-Ore.) has said his amtion is to get opioids legislation to the House attic by the Mrial Day holiday.

The dozens of lls anesthetized in Energy and Commerce’s health subcommittee in April accomplish baby — but cogent — changes to the means federal agencies regulate, baby-sit and accomplish rules on opioid painkillers; how states and localities try to abate ae; and how Medicaid handles patients disturng with addiction.

INDUSTRY RX

The Cigna Corp. myCigna appliance is displayed on a phone. (Andrew Harrer/Bloomberg)

— Cigna and CareFirst BlueCross BlueShield, two Obamae insurers in Virginia, acquire proposed above exceptional hikes for 2019. In filings on Friday, the companies cited policies by the Trump administering and Congress’s accommodation to abolition Obamae’s alone authorization as some of the affidavit for the hikes, The Hill’s Nathaniel Weixel reports.

Cigna is calling for an berplate exceptional access of 15 percent for the company’s 103,264 ber in the state, adopting prices 6.4 to 40 percent depending on the plan. CareFirst proposed an average 64 percent access for its 4,500 ber in the state. The ante aren’t final, and both companies could adjudge to affluence aback if they feel abundant burden from regulators.

— Four above insurers — Cigna, Centene, Molina Healthe and Anthem – all appear gger profits in the aboriginal quer of 2018, but theor outlooks don’t accommodate moves to action concise bloom behavior proposed by the Trump administration, Forbes’s Bruce apsen reports. Instead, some of these insurers are because ading to the Obamae marketplaces in 2019 afterwards abandonment them this year.

“The Trump administering has said Americans charge added choices than Obamae, adage the amount of alone adtage offered on accessible exchanges beneath the Affordable Care Act is too g-ticket for an accretion dinal of people,” Bruce writes. “But Trump’s concise bloom plan account acquire yet to accretion abundant absorption in bloom plans’ accessible disclosures and statements to Wall Street ysts.”

REPRODUCTIVE WARS

Iowa Gov. Kim Reyns, center, signs a six-week aborticide ban ll into law during a commration in her academic . (AP Po/Charlie Neibergall)

— On Friday, Iowa’s Rean Gov. Kim Reyns active into a law a ban on abortions already a fetal baby can be detected. The “hebeat ll,” which prohits abortions as aboriginal as six weeks, is one of the country’s earliest-in-pregnancy bans on abortions and sets up for a acknowledged showdown. “This is gger than aloof a law, this is about life, and I’m not activity to aback down,” Reyns said about the law on Friday, acknowledging it would acceptable face litigation, the AP’s Barbara Rodriguez reports.

“The ll signing came anon afterwards the Iowa affiliates of Planned Parenthood and the American Civil Liberties Union warned that they would sue the governor if she active the ll, which the Rean-controlled Legislature bound accustomed in after-hours votes beforehand in the week,” Barbara writes.

“Backers of the alleged baby ll — which didn’t get a distinct Dcratic vote in the Legislature during final access — dding achievement it could claiming Roe vs. Wade, the battleground 1973 U.S. Supreme Court dinal that accustomed women acquire a appropriate to abolish pregnancies until a fetus is viable,” she continues. “Conservatives say an arrival of right-leaning administrative accessories beneath Admiral Donald Trump could accomplish it a possility.”

— A few added acceptable reads from The Column and beyond:

President Trump will lay out a plan this ages to accomplish acceptable on his affiance to lower decree prices. Biologic companies are accessible to resist.

New York Times

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STATE SCAN

PowerPost

The admiral has gone afterwards Sen. on Tester afterwards he batty the VA nominee, but it’s cryptic whether voters will respond.

Sean Sulli

Local

D.C. bloom admiral said the boutique bootless to accede with rules angry to -time sales reporting.

Susan Svrluga

National

Los Angeles Mayor Eric Garcetti alleged it “the greatest moral and altruistic crisis of our time.”

Scott Wil

MEDICAL MISSIVES

Health & Science

E-visits acquire been expanding, but there are lots of restrictions on what is covered.

Steven Findlay

DAYBOOK

Today

Coming Up

SUGAR RUSH

President Trump says the apple never accepted America:

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From the Fact Checker: Unraveling Admiral Trump’s top 5 claims:

Watch SNL’s Stormy Daniel’s algid open, annotated:

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