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Top Senate negotiators said an effort to renew expired healthcare subsidies had effectively collapsed, likely ending the hopes of 20 million Americans that the tax-credit expansion could be revived and lower their monthly insurance premiums. Talks had centered on a proposal from Sens. Bernie Moreno (R., Ohio) and Susan Collins (R., Maine) to extend a version of the enlarged Affordable Care Act subsidies for at least two years, while cutting off higher-income people from participating and eventually giving enrollees the option of putting money into health savings accounts. It also would eliminate zero-dollar premium plans. But lawmakers from both parties now say the chances of a deal have all but evaporated. “It’s effectively over,” Moreno said Wednesday. Sen. Bill Cassidy (R., La.)—the architect of an adjacent plan—agreed. While Collins declined to be as definitive, she did say that it was “certainly difficult.” (Hughes and Bhutani, 2/4)

Huge premium increases on the health insurance exchanges mean opportunity for companies selling cheaper, skimpier plans. Companies such as UnitedHealth Group, Medi-Share, CrowdHealth and LendingTree flooded social media platforms, advertised on radio and promoted products such as short-term, limited duration plans and Christian sharing ministries. The campaigns targeted consumers, especially young adults, who found they couldn’t afford exchange coverage or don’t perceive value in comprehensive medical insurance. (Tepper, 2/3)

The next big thing in health insurance might be stymied by the last big thing in health insurance. Insurers such as Centene and Oscar Health and venture capital-backed startups have been aggressively promoting individual coverage health reimbursement arrangements, or ICHRAs, as a solution to rising employer health benefit costs over the past several years. But while companies like those are outwardly confident about the market’s prospects, there’s reason to believe they should be more worried. (Tong, 2/4)

Prices rose 11% at ambulatory surgery centers after they were bought by Optum, probably because the newly acquired providers were able to negotiate higher prices with insurers, according to a new study highlighting how vertical consolidation drives up healthcare spending. (Parduhn, 2/3)

The Federal Trade Commission announced on Wednesday that it had reached a settlement with Cigna’s Express Scripts, one of the nation’s largest pharmacy benefit managers, over its role in driving up insulin prices. Express Scripts will not pay a fine or face a financial penalty as part of the deal and did not admit to any wrongdoing. But the company agreed to a range of changes to its business model. (Robbins and Abelson, 2/4)

The pharmacy benefit manager reforms that President Trump signed into law on Tuesday could lead to employers buying drugs directly from drugmakers, just like the administration is encouraging individual consumers to do through its pending website TrumpRx. (Wilkerson, 2/4)