The era of annual eye-popping Obamacare rate hikes appears to be over.

Premium increases in the law’s marketplaces are on track to be relatively modest for the second straight year, according to the first batch of 2020 rates proposed by insurers. The rate filings are an early indication that this year’s small rate hikes weren’t a fluke and that other Trump administration policies — including support for a lawsuit that could torch the Affordable Care Act — have proven less disruptive than some experts feared.

Widescale drug importation from Canada, is not a practical solution to the problem of high drug costs. It is a distraction from efforts to address the real prescription drug cost drivers. Perhaps conflating its geographic size, importation proponents seem to overlook Canada’s small population, which is less than California’s. There’s no way that our neighbors to the north could supply the U.S. market—or even a handful of states—with all of its prescription drug needs.  President Trump and legislators should redirect their efforts to proposals that could actually make a difference short term and long term in lowering costs.

Even when the Supreme Court tells a government labor union that it can’t do something, there’s no guarantee that the union will comply. In its 2014 Harris v. Quinn decision, the Court ruled that an Illinois law forcing home health-care workers—paid with Medicaid funds—to shell out cash to labor unions was unconstitutional. That should have ended unions’ ability to collect fees from these workers—many of whom were not really professionals but were receiving a small subsidy from Medicaid to care for disabled family members at home—unless the workers agreed to join the union.  The administration announced it will enforce the ruling.

The U.S. House put to a vote this week a bill that would threaten the health coverage of 1.5 million people. H.R. 987 would overturn a Trump administration regulatory-relief policy while wastefully allocating new taxpayer money to programs proven to fail. Among other changes, the bill would block the Trump administration’s relief efforts that help consumers access “short-term, limited-duration” insurance. While these plans were unnecessarily restricted by the Obama administration, the Trump administration has eased regulations to make incremental progress toward expanded affordable health coverage choices. The House bill would reverse this progress, capping duration of the plans at 90 days, and stripping consumers of the right to renew their coverage.

Democrats pushed through the House Thursday legislation that they say fortifies the ACA and also curbs prescription drug prices.  The bill seems engineered with next year’s elections in mind since it has no chance of surviving in the Senate or getting President Trump’s signature. The measure forced Republicans into the uncomfortable political position of casting a single vote on legislation that contained popular bi-partisan drug pricing restraints they support, but also language they oppose about the Affordable Care Act.  [The bill would undo many of the consumer-friendly changes the Trump administration has made through its regulatory authority]. In the end, all but five voting Republicans opposed the overall package; the measure passed by a mostly party-line vote of 234-183.

By all accounts, Robert Pear of the New York Times was one of the most relentlessly probing journalists on the healthcare beat, enlightening readers and rankling partisans with the clarity of his reportage and his savantlike understanding of the federal government and its arcana. With a seemingly ever-present byline on Page One of the Times, Mr. Pear was a constant and authoritative presence in Washington for four decades. He died May 7 at 69 at a hospice center in Rockville, Md. The cause was complications from a severe stroke that he suffered April 29, said his brother, Doug Pear. [Robert was the quintessential journalist who was always fair and thorough.  We will miss Robert’s kindness and his incredible devotion to informing the health reform debate. RIP.]

Americans pay a lot for pharmaceuticals, and politicians of all stripes are offering prescription drug price-relief proposals to force prices downward. Top-down approaches, though, carry a high chance of failure. The astronomical price incorporates the massive up-front costs of testing and gaining FDA approval. The often erratic and unpredictable process can take 15 years and $1.5 billion. Most prospective drugs never make it to market. That’s much of what you’re paying for. Second, despite popular perception, drug manufacturers are only middle-of-the-road among American industries in terms of profitability. Employ blunt price controls, and you’ll likely cut industry profitability, drive investors away, and discourage development of new drugs.

Pharmacists and some health experts are opposing a legislative proposal to permit the wholesale bulk importation of drugs from Canada to Maine, arguing that it could result in unsafe drugs coming in to Maine and drug shortages in Canada. Kenneth McCall, past president of the Maine Pharmacy Association, said that trying to import Canadian price controls is a flawed model that would lead to drugs of dubious quality coming fromoverseas countries and unscrupulous sellers.

What is a more limited-government, pro-market (not simply pro-business) health policy reformer supposed to do? There are plenty of other short-term poses one might adopt. Accept a lot of givens as too politically difficult to challenge and then suggest quarter-way compromises that slow the pace of retreat. Or try procedural sidesteps that alter the venue of policy development (let the states do it!), without greater guarantees than what shuffling a somewhat altered deck of cards with a different set of political intermediaries offers. Or propose new tricks of manipulating magic money from somewhere else (reinsurance, reshuffled subsidies, formulaic reimbursement and benefit cuts) in the further away future.

The Trump administration has been pushing for lower drug prices, and some drug manufacturers have responded by lowering prices and providing greater access to life-saving treatments. However, there is a growing concern among health care providers that the middlemen who negotiate drug prices on behalf of insurers—known as pharmacy benefit managers (PBMs)—are actively working to keep prices high for consumers, presumably in an effort to increase their own profits. I run a free cardiovascular risk reduction service at a local clinic where we see many patients either suffering from, or at high risk for, heart disease. In collaboration with providers, I work to apply evidence-based medicine in the clinical setting and ensure any new treatment is financially sustainable for a patient—a task that can be made difficult by profit-driven insurance companies denying medication access and PBMs that keep treatment costs high.