As part of a sweeping tax overhaul bill, House Republicans on Thursday proposed eliminating billions of dollars in corporate tax credits that have played a key role in the booming industry to develop drugs for rare diseases.

For more than three decades, pharmaceutical companies have claimed a 50 percent tax credit for the cost of clinical trials of orphan drugs, medicines intended to treat diseases affecting fewer than 200,000 people.

Sales of orphan drugs hit $36.1 billion last year, according to a report released last month by QuintilesIMS and the National Organization for Rare Disorders. And, according to EvaluatePharma’s 2017 Orphan Drug Report, orphan drugs will account for nearly 22 percent of global prescription sales, excluding generics, by 2022

Companies whose drugs are deemed orphans by the Food and Drug Administration get a package of financial incentives, including tax credits and seven years of market exclusivity.

The credits were approved as part of the 1983 Orphan Drug Act, which has been under scrutiny in the past year as the country grapples with skyrocketing drug prices. Orphan drugs routinely carry five-digit price tags and have become a lucrative market for pharmaceutical companies.

In 2018, the U.S. is expected to grant nearly $2.8 billion in orphan drug tax credits to companies, according to estimates from the Treasury Department. And the reduced tax revenue for the U.S. government under the current law would increase every year, to a projected total of $75 billion from 2018 to 2027.

As sales rise, so does the cost of the orphan drug tax credits to the U.S. government. “A billion here and a billion there and eventually it’s real money,” said Nicholas Bagley, a law professor at the University of Michigan who has studied the credits.

The National Organization for Rare Disorders said in a statement that there would be 33 percent fewer orphan drugs coming to market if the tax credit vanishes, calling it “an unprecedented decrease in the development of these life-improving therapies.” NORD said advocates for people with rare diseases had sent over 500 letters to Congress in support of the credit.

The Biotechnology Innovation Organization, a trade group, and 20 individual drug companies, including Novo Nordisk, Horizon and Sanofi, wrote to Congress late last month urging legislators to keep the credit in the tax overhaul bill. BIO vowed Thursday to work with lawmakers to save the credit.

Yet James Love of the think tank Knowledge Ecology International welcomed the potential repeal as a way to begin a conversation about “deeper reform” in the financial incentives for rare diseases. He said that cancer drugs and “huge blockbuster drugs [have] qualified for orphan tax credit[s] … and certainly provided no relief from high prices.”

Earlier this year, former Rep. Henry Waxman, one of the Orphan Drug Act’s creators and champions, co-wrote a report on high drug prices for the Commonwealth Fund that suggested restricting or replacing the tax credit. The authors of the report said they don’t take a position on the Republican tax bill.

A Kaiser Health News investigation in January, which was published and aired by NPR, found that many drugs that now have orphan status aren’t entirely new. Of about 450 drugs that have won orphan approval since 1983, more than 70 were drugs first approved by the Food and Drug Administration for mass-market use. These medicines include cholesterol blockbuster Crestor, Abilify for psychiatric disorders and rheumatoid arthritis drug Humira, one of the world’s best-selling drugs.

In March, the Government Accountability Office confirmed it would investigate potential abuses of the Orphan Drug Act after receiving a letter from Sens. Orrin Hatch, R-Utah, Chuck Grassley, R-Iowa, and Tom Cotton, R-Ark., that asked if the law needed to be changed.

This summer, the FDA announced a plan to overhaul how it handles orphan drugs and promised to eliminate a backlog in applications for drugs’ rare disease status. In a September update, FDA Commissioner Scott Gottlieb wrote he wants to ensure financial incentives are granted “in a way that’s consistent with the manner Congress intended” when it passed the law decades ago.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

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NPR’s Ari Shapiro discusses anti-drug campaigns with Keith Humphreys a professor of psychiatry at Stanford University and a former drug policy adviser to presidents George W. Bush and Barack Obama.

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White House Opioid Commission member Bertha Madras, PhD., speaks with NPR’s Mary Louise Kelly about the recommendations she presented to President Trump today for ameliorating the nation’s opioid epidemic.

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Former President Barack Obama took to Twitter Wednesday morning to encourage people to shop for Affordable Care Act health insurance.

Obama’s rare appeal comes as his signature health care law is under attack by his successor, President Trump, and Republicans in Congress.

Obama’s tweet to his more than 95 million followers includes a short video, set to jaunty music, where the former president urges people to log on to the federal insurance exchange, HealthCare.gov, and sign up for coverage for next year.

“It’s November 1, which means today is the first day to get covered for 2018,” Obama says. It’s not clear where he’s standing, but the ocean is in the background.

While the point of the video, which is on Obama’s Facebook page, too, is clearly to gin up business for HealthCare.gov, Obama takes the opportunity to defend his signature achievement. He mentions two of the law’s most popular provisions, both of which have been threatened by Republicans.

“Thanks to the Affordable Care Act, insurance companies can no longer charge you more just for being a woman, or having a preexisting condition — and that’s a good thing,” he says.

Republicans in Congress have tried over and over this year to repeal the Affordable Care Act and replace it with an alternative plan. Those efforts have failed in large part because most of the alternative ideas would end with millions fewer people having health coverage.

Still, President Trump has repeatedly said the Affordable Care Act markets are collapsing. Critics say Trump’s actions have weakened those markets because they’ve injected uncertainty into the system, leading companies to either raise premiums or pull out of the system altogether.

Average premiums for 2018 will be higher than in 2017, according to the Department of Health and Human Services. But those higher premiums are more than offset by higher government subsidies, for the 85 percent of consumers who buy insurance on the ACA exchanges and qualify for financial assistance.

An HHS analysis released this week shows the average premium for a 27-year-old making $25,000 a year is 37 percent higher, but the average subsidy rises by 73 percent.

One of Trump’s actions was to cut the budget for outreach and education surrounding this open enrollment season by 90 percent.

The Obama Twitter video is part of an effort by nonprofit groups to make up for that loss. A group of former Obama administration officials launched a campaign called Get America Covered to get the word out that open enrollment begins November 1 and runs for six weeks.

Using Obama’s star power to spread the word could be pretty effective. But it’s far from certain that a Twitter video can make up for the millions of advertising and outreach dollars cut by the Trump administration.

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About a third of Latinos in America say they’ve been personally discriminated against when it comes to applying for jobs, being paid equally or considered for promotions — and when trying to rent a room or apartment or buy a house. Slightly more (37 percent) say they’ve personally experienced racial or ethnic slurs because of their race or ethnicity.

These are some of the key findings NPR is releasing Wednesday from a poll done with the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. The survey of 3,453 adults looked at a wide range of issues in many groups and included 803 adults identifying as Latino or Hispanic. The poll also surveyed African-Americans, white Americans, Native Americans, Asian-Americans and LGBTQ adults. We are releasing data by each of these groups on a weekly basis.

Overall, Latinos reported substantial and significant discrimination in their day-to-day lives. In addition to those who said they’d been slurred, 33 percent say they’ve experienced offensive comments or negative assumptions about their race or ethnicity at some point in the past. Nonimmigrant Latinos and Latinos with a college degree are both more likely to report various forms of one-to-one personal discrimination.

When we drilled down into the data, we found that the experience for immigrants and nonimmigrants varied significantly in employment as well, with immigrant Latinos experiencing discrimination on the basis of race and ethnicity more than twice as often as nonimmigrant Latinos. There were also divides based on what kind of neighborhood people live in.

The survey was a large, nationally representative sample, conducted from Jan. 26 to Apr. 9. The findings on Latino Americans have a margin of error of plus or minus 4.5 percentage points at the 95 percent confidence level. The poll is part of a larger NPR project, “You, Me and Them: Experiencing Discrimination in America.”

Our poll has its roots in research showing disparities in the health and life expectancies of minorities in America. There is a growing body of research showing that day-to-day exposure to discrimination increases the risk of various diseases, raises the rate of premature birth and may decrease overall life expectancy.

Dr. David Williams, a Harvard professor, put it this way in a recent interview with NPR’s Michel Martin:

“The research indicates it is not just the big experiences of discrimination, like being passed over for a job or not getting a promotion that someone felt they might have been entitled to. But the day-to-day little indignities affect health: being treated with less courtesy than others, being treated with less respect than others, receiving poorer service at restaurants or stores. Research finds that persons who score high on those kinds of experiences, if you follow them over time, you see more rapid development of coronary heart disease. Research finds that pregnant women who report high levels of discrimination give birth to babies who are lower in birth weight.”

This extends even to doctors’ offices, our poll finds. In particular, 25 percent of Latina women told us they had been personally discriminated against when going to a doctor or health clinic.

“A substantial share of Latinos, particularly Latina women, report they have been discriminated against in trying to seek medical care — and when they need it, they often avoid getting it,” says Robert J. Blendon, the director of our poll and professor of health policy and political analysis at the Harvard Chan School. “And that can create major health problems when people are so anxiety-ridden about how they were treated that they don’t seek care when they think they actually need it.”

Another major factor in people’s daily environment is the intersection between their perception of safety and their fear of discrimination. While there have been many reports over the years maintaining that Latinos, in particular, are afraid of calling the police when in need, our poll found wide regional and age variations on this score.

Other reports in the coming days will focus on the relatively low rate of college enrollment and more on the generation gap in the kinds and amount of discrimination experienced by millennials versus people in other age groups.

Our series on discrimination, “You, Me and Them,” will continue through December. Last week we presented the results for African-Americans. In coming weeks, we will look at results from white Americans, Native Americans, LGBTQ adults, and Asian-Americans, as well as look at gender discrimination as it affects all races, ethnicities and identities.

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It’s time to start shopping for health insurance if you’re one of the millions who buys it on an Affordable Care Act exchange.

Open enrollment for 2018 starts Wednesday, and new numbers released by the Trump Administration show that the average cost of a benchmark policy will be about 27 percent higher next year.

But that’s just the headline. The details suggest there’s good news for lots of people who are willing to shop around a bit for insurance.

“In theory anyone who gets a subsidy should do better next year,” says Charles Gaba, an analyst who runs the web site ACASignups.net. “I have one piece of advice: Shop around.”

An analysis released Monday by the Department of Health and Human Services shows that while the average premium is going up, the average subsidy to help defray that cost is going up even more. The average tax credit offered to people to cut the price of their insurance will rise in 2018 to $555 — up 45 percent from this year’s average credit of $382.

That means many people can take that larger tax credit and buy better insurance for less money. The HHS report shows that about 80 percent of people who buy insurance on the federal exchange could get a policy for $75 a month or less. Last year, policies that cheap were available to only about 71 percent of enrollees, the study shows.

And many people who didn’t qualify for subsidies in past years might get one for 2018, Gaba says. That’s because the subsidies are based on two things — the federal poverty level and the insurance policy’s sticker price — and both of those are going up.

People with gross incomes between 138 percent and 400 percent of the federal poverty level qualify for subsidies to help pay their premiums. That means, for 2017 policies, an individual with a gross income below $47,520 (or a family of four whose income is less than $97,200) can get a subsidy. Because of inflation, those numbers rise to $48,240 and $98,400 for policies sold this fall for 2018.

“There are people who didn’t qualify for a subsidy last year who won’t even log on and try again,” he says. “That could mean thousands of dollars” in discounts that they forego just because they don’t expect to qualify.

The analysis by HHS shows that the number of insurance companies selling plans on the exchanges will drop from 167 for 2017 policies to 132 for 2018. That means about 30 percent of consumers, particularly in rural communities, will have only one company offering a handful of policies to choose from this fall.

But the individual experiences of shoppers will vary widely.

For example, a 35-year-old woman in Ames, Iowa who earns $35,000 a year and wants to buy insurance for herself on Healthcare.gov will qualify for $445-a-month in premium subsidies. The website shows five policies available with varying levels of benefits, and prices ranging from $155 a month to $351.

The same woman in St. Petersburg, Fla., by contrast, has no fewer than 56 different policies available on the federal exchange ranging in price from $222 a month to $716.

The headline premium increases are due in part to market factors and in part to recent actions by the Trump administration.

HHS earlier this month said it will no longer reimburse insurance companies for discounts they are required by law to offer to lowest-income policy holders. The discounts are known as cost-sharing reductions because they reduce the amount people have to spend on co-payments and deductibles.

The president has been threatening all year to cut off those payments because Congress never appropriated money for them.

Insurance companies responded to those threats by raising rates in many states to make up for the lost revenue.

Blue Cross and Blue Shield of North Carolina boosted premiums on average by 14 percent.

“The biggest single reason for the sharp increase in rates is the lack of federal funding for cost-sharing reductions,” Briand Tajlili, the company’s director of actuarial and pricing services, said in a blog post.

Oscar Health added a surcharge of 10 percent to its benchmark plans in California at the direction of that state’s insurance commissioner, says spokesman Khan Shoieb. But in New York — which has a basic health plan for low-income residents, so very few people get the cost-sharing discounts — the company raised premiums by only one-tenth of one percent.

The co-founders of Oscar, Mario Schlosser and Josh Kushner (brother of Trump’s son-in-law and adviser Jared Kushner), said in an opinion piece published by Axios that they expect many policies to be more affordable in 2018.

As premiums rise, subsidies to pay those premiums also rise for the 85 percent of people who buy insurance through the ACA exchanges and qualify for subsidies. So many people will see little change in their own costs.

And some will see their costs decline.

“Because insurers increased premiums to compensate for the loss of CSR payments, exchange customers who are eligible for premium subsidies will actually see more affordable options than they otherwise would have,” says Dianna Welch, an actuary at the consulting firm Oliver Wyman who did an early study showing the effect.

A report by the Kaiser Family Foundation shows that many companies only raised rates on their so-called silver plans, which are the policies that the ACA subsidies are based upon. But consumers are free to use their subsidies to buy any policy sold on the exchange. So a customer could take their bigger subsidy and buy a policy whose price hasn’t done up.

The Urban Institute, a left-leaning think tank in Washington, D.C., says those deals may attract more people into the marketplace. As many as 600,000 more people might buy insurance next year, the institute estimates.

By most accounts, however, that estimate is optimistic. Throughout the year, the Trump administration and Republican leaders in Congress have talked about repealing the Affordable Care Act, and the president himself has repeatedly declared Obamacare “dead.”

Those pronouncements, combined with news that insurance premiums (before subsidies) are going up, could scare lots of people away from the marketplaces.

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