1 big thing: Health costs hit Americans' wallets

2. Dems move to protect access to IVF

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3. Tougher marketing rules for Medicare Advantage plans

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Just 14% of diagnosed cancers are found through screening

4. Just 14% of cancers found through screening

Non-profit hospitals' staffing woes ease

5. Non-profit hospitals' staffing woes ease

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6. Catch up quick

Situational awareness: The Biden administration is relaunching the free at-home COVID tests program in preparation for a wintertime surge of cases.

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Thanks for reading, and thanks to senior editor Adriel Bettelheim and senior copy editor Bryan McBournie for the edits. Did someone forward this email to you? Here's how to sign up.

Vitals

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Keep up with health care politics, policy and business

Axios Vitals

1 big thing: Get ready for a drug importation revival

2. America's attention problem

3. Brooks-LaSure's grim winter warning

4. Quote du jour: No abortion-rights bill

5. Catch up quick

Happy Tuesday, Vitals gang. I'm filling in for Tina, who's at the HLTH 2022 health tech conference.

Today's newsletter is 839 words or a 3.5-minute read.

Thanks for reading, and thanks to copy editor Nick Aspinwall for the edits. Did someone forward this email to you? Here's how to sign up.

Plus: Prescriptions for stimulants skyrocket

1 big thing: SCOTUS' latest health care tempest

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2. Biden revives nutrition summit 

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3. A "clean" deal to fund the FDA

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4. Cancer screening risks not well documented

Happy Tuesday, Vitals fam. Today's newsletter is 896 words or a 3-minute read.

Thanks to Bryan McBournie for copy editing the newsletter.

1 big thing: Flu cases flood hospitals

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2. Protecting Merck's franchise

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False holiday suicide myth is driven by media, analysis says

3. The myth of suicide and the holidays 

4. China begins loosening COVID restrictions

5. While you were weekending

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Up and at 'em, Vitals gang. Tina's away, so it's on us to get the new week out of first gear.

Join Tina and Caitlin Owens in Washington, D.C., at 8am ET on Wednesday for an Axios event looking at the top priorities, issues and challenges shaping the post-midterm health policy landscape. Guests include Rep. Brett Guthrie (R-Ky.), Rep. Robin Kelly (D-Ill.), and White House deputy assistant for Health and Veterans Affairs Christen Linke Young. Register here to attend in person or virtually. 

 Today's newsletter is 1,018 words or a 4-minute read.

Thanks for reading, and thanks to senior copy editor Bryan McBournie for the edits. Did someone forward this email to you? Here's how to sign up.

Plus: Protecting Merck's blockbuster drug

1 big thing: Few COVID worries for the holidays

Biggest for-profit hospital chains' operating margins surpass pre-COVID levels

2. Big hospital chains' good fortune

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3. Health inequities and climate disasters

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4. COVID clinical trials lacked diversity 

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Tuesday's here, Vitals readers. Guesses on what time AP calls Georgia's Senate runoff?

Join Axios' Tina Reed and Caitlin Owens in Washington, D.C., at 8am ET on Wednesday for an event looking at the top priorities, issues and challenges shaping the post-midterm health care policy landscape. Guests include Rep. Brett Guthrie (R-Ky.), Rep. Robin Kelly (D-Ill.), and White House deputy assistant for Health and Veterans Affairs Christen Linke Young. Register here to attend in person or virtually. 

Today's newsletter is 971 words or a 3.5-minute read.

National

Data: AP Norc; Chart: Madison Dong/Axios Visuals 

America appears to be resetting its priorities when it comes to health care as inflation and talk of a recession loom larger on voters' minds. 

Driving the news: A shrinking percentage of Americans across the ideological spectrum view abortion as a top priority heading into 2023, according to a new poll from the Associated Press-NORC Center for Public Affairs Research.

Independents are the only group that still views health care reform as a top-five issue.

By the numbers: The nationwide poll of 1,124 adults conducted Dec. 1–5 asked what the government should work on in 2023 and found only 11% considered abortion to be a top priority, down from 16% in June. 

18% of Democrats said they considered abortion a priority, down from 23% in June, while just 5% of Republicans did, compared to 9% in June.

17% of Americans said they considered health care reform a priority, which is higher than the 6% who thought so in June, but down from 18% in December 2o21.

Only 5% thought COVID-19 should be a priority, which is hardly changed from June and sharply lower than the 33% who thought so at the same time in December 2021.

Yes, but: 37% put personal financial issues as a pressing matter for 2023, with both Republicans and Democrats responding similarly.

16% called crime and violence as a top priority, up from 11% in June and 10% in December 2021.

The big picture: The reordering of the public's priorities comes after two-and-a-half years of pandemic tumult — and arguably the most consequential burst of health care legislation since the passage of the Affordable Care Act. 

With a divided Congress, there will be more partisan fights over government funding, the likelihood of a government shutdown in the fall — and regulatory efforts by the Biden administration to further its drug pricing agenda and make changes to Medicare Advantage.

Between the lines: The Republican-led House will focus on investigations into the Biden administration's COVID-19 response. 

Democrats could use their narrow Senate majority to seek to address mental health legislation and expand telehealth policies. They've also signaled plans to build off Inflation Reduction Act wins. For instance, Sen. Raphael Warnock said he's pushing for expanding a Medicare cap on out-of-pocket costs for insulin to the privately insured, Politico reported.

Both parties have signaled an interest in addressing the nursing shortage

What we're watching: The most consequential health system reforms could come from the unwinding of the COVID public health emergency and the shift of vaccines and treatments to the private market.

Biden antitrust officials, with some in Congress, also are taking a harder look at anticompetitive behavior in health markets, including hospitals.

America's health care focus shifting in 2023

America appears to be re-setting its priorities when it comes to health care as inflation and talk of a recession loom larger on voters' minds.

Congress

Health

Data: National Center for Health Statistics; Note: "Recent" applies to any time in the last 12 months; Chart: Madison Dong/Axios Visuals

Medical debt may still plague millions of American families, but the pandemic years brought a marked decline in the number of people struggling to cover their health costs, the Centers for Disease Control and Prevention reported today.

By the numbers: 10.5 million fewer people were in families having problems paying medical bills in 2021 than in 2019 — amounting to a 3.2 percentage point decline, according to National Health Interview Surveys.

Women were likelier to have problems paying medical bills, and the percentage of people in families struggling with bills was higher among those with children aged 0–17 years (11.5%) and adults aged 18–64 (11.3%) than in adults 65 and over (7.7%).

The uninsured were more likely than those with Medicaid or private coverage to be in families that had problems in the previous 12 months.

The percentage of people in families having problems paying bills was higher among non-Hispanic Black people (15.8%) compared with Hispanic (12.8%), non-Hispanic white (9.4%), and non-Hispanic Asian (6.1%) people.

Between the lines: Researchers said the CARES Act, American Rescue Plan Act, and other pandemic relief legislation may have indirectly softened the blow of medical debt by providing direct monetary payments, increasing the percentage of people covered by insurance using COBRA premium subsidies and expanding eligibility for subsidies in Affordable Care Act markets, among other things. 

People in all age groups living in Medicaid expansion states also were less likely than those living in non-expansion states to have problems paying medical bills.

The dropoff in doctors visits, elective procedures and outpatient care early in the pandemic also may have reduced the odds of incurring debt through fewer copays, deductibles, and coinsurance, the researchers said.

Yes, but: Medical debt still is a major factor in overall debt in the U.S., and can increase the risk for eviction, food insecurity and bad health outcomes.

Pandemic years saw a reduction in medical debt

Medical debt may still plague millions, but the pandemic saw a drop in the number of people struggling to cover costs, the CDC said today.

COVID-19

Health care costs

Medical debt may still plague millions of American families, but the pandemic years brought a marked decline in the number of people struggling to cover their health costs, the <a class="gtmContentClick" data-vars-link-text="Centers for Disease Control and Prevention reported" data-vars-click-url="https://www.cdc.gov/nchs/data/nhsr/nhsr180.pdf" data-vars-item="in_content_link" href="https://www.cdc.gov/nchs/data/nhsr/nhsr180.pdf" target="_blank">Centers for Disease Control and Prevention reported</a> today.By the numbers: 10.5 million fewer people were in families having problems paying medical bills in 2021 than in 2019 — amounting to a 3.2 percentage point decline, according to National Health Interview Surveys.

The Biden administration on Wednesday gave states more leeway to cover services addressing health-related social needs under their Medicaid programs.

Why it matters: Addressing "social determinants" like housing, transportation and food security could reduce hospital admissions and overall health spending. But researchers have questioned whether the cost of such interventions may eclipse the potential savings.

Driving the news: The Department of Health and Human Services issued guidance letting states use Medicaid managed care to offer alternative benefits addressing unmet needs, and outlined requirements for showing the efforts are cost-effective.

Services could include special meals for people with chronic health conditions made worse by poor diet, or for those without access to nutritious food choices, per the Centers for Medicare and Medicaid Services.

Zoom out: Some states already use alternative benefits under Medicaid to increase access to inpatient mental health and substance use disorder services.

The new flexibilities would encourage medically appropriate substitutes for state-covered services and would augment the Biden administration's ongoing efforts aimed at reducing hunger and diet-related diseases by 2030.

Background: North Carolina's approach to Medicaid has been held up as an example of how to address social determinants of health, Politico previously reported. 

The state launched an online social service referral program in some counties to help social workers and health care case workers get people help, per the report.

CMS allows Medicaid to address unmet social needs

The Biden administration gave states more leeway to cover services addressing health-related social needs under their Medicaid programs.

Illustration of a key ring hanging on an IV pole. 

Health care

The Biden administration on Wednesday gave states more leeway to cover services addressing health-related social needs under their Medicaid programs.Why it matters: Addressing &quot;social determinants&quot; like housing, transportation and food security <a class="gtmContentClick" data-vars-link-text="could reduce hospital admissions and overall health spending" data-vars-click-url="https://www.axios.com/2022/07/05/addressing-social-determinants-in-health-care-effective-but-expensive" data-vars-content-id="98cc9ae6-61d7-40dc-969d-4606876c7b85" data-vars-headline="CMS allows Medicaid to address unmet social needs" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/07/05/addressing-social-determinants-in-health-care-effective-but-expensive" target="_self">could reduce hospital admissions and overall health spending</a>. But researchers have questioned whether the cost of such interventions may eclipse the potential savings.

The federal health department's framework for monitoring high-risk research on viruses and other agents that can cause pandemics doesn't meet key criteria for effective oversight, a new watchdog report concludes. 

What they found: The Government Accountability Office found HHS has an unclear policy for reviewing and approving research involving pathogens that are altered to make them more transmissible or deadly — and that other policy gaps may allow the research to occur without appropriate oversight.

The report faults HHS for not fleshing out what work "reasonably anticipated to create, transfer, or use enhanced potential pandemic pathogens" under a 2017 framework should be referred for extra reviews of risks and benefits.

That could leave HHS without assurance it is reviewing all necessary research proposals, GAO says.

Don't forget: The report comes as House Republicans plan to ramp up oversight of federal health agencies' response to COVID-19 — long a front-burner issue for the GOP.

Background: HHS does its own research to identify and prepare for public health threats. But it also funds and reviews work at universities, medical schools, biotech companies and other research institutions.

The department has reviewed three research proposals under the 2017 framework, per the GAO report. Two studies involving highly infectious avian influenza have concluded while a third influenza proposal was revised so that didn't involve enhanced pathogen research.

The report recommended that HHS set a standard to ensure consistency in identifying high-risk research for departmental review and identify and share non-sensitive information with researchers, Congress and the public about the review process.

Watchdog faults HHS oversight of research on possible pandemic pathogens

The federal health department's framework for monitoring high-risk research on viruses and other agents that can cause pandemics doesn't meet key criteria for effective oversight, a new watchdog report concludes.

The Department of Health and Human Services building in Washington D.C. Photo: Saul Loeb/AFP via Getty Images

Department of Health and Human Services (HHS)

Coronavirus

The federal health department&#x27;s framework for monitoring high-risk research on viruses and other agents that can cause pandemics doesn&#x27;t meet key criteria for effective oversight, a <a class="gtmContentClick" data-vars-link-text="new watchdog report" data-vars-click-url="https://www.gao.gov/assets/gao-23-105455.pdf" data-vars-content-id="b1459e07-ce60-42f9-baa8-a431d2bbdd59" data-vars-headline="Watchdog faults HHS oversight of research on possible pandemic pathogens" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.gao.gov/assets/gao-23-105455.pdf" target="_blank">new watchdog report</a> concludes. What they found: The Government Accountability Office found HHS has an unclear policy for reviewing and approving research involving pathogens that are altered to make them more transmissible or deadly — and that other policy gaps may allow the research to occur without appropriate oversight.

A Food and Drug Administration expert panel this week will consider a process for updating COVID shots that resembles the annual strain selection process for seasonal flu vaccines, according to briefing documents released on Monday.  

The big picture: The agency is sketching out a long-term strategy that responds to new strains and shifting threats, replacing a system that's been largely drawn up and revised on the fly.

Advisers are due to meet on Thursday to discuss the state of the pandemic and whether COVID vaccines need to be modified again.

Details: FDA anticipates conducting an assessment at least annually starting in the spring, with advisers meeting around early June to discuss the strain selection process.

A decision on the recommended vaccine composition could be made in time for any updated vaccine to be in production in time to be deployed no later than September, according to the documents.

A more vaccine-resistant variant would likely trigger, on an as-needed basis, an ad-hoc strain selection meeting.

Public health officials have previously said they think COVID shots could be administered on an annual schedule, like for the flu.

Looking ahead:  After the panel meeting, the FDA will consider whether to change existing vaccine authorizations and the process to select strains.

FDA weighs process for annual COVID shots

A Food and Drug Administration expert panel this week will consider a process for updating COVID shots that resembles the annual strain selection process for seasonal flu vaccines, according to briefing documents released on Monday.

Tanvi Nayak, 22, receives a bivalent COVID-19 booster from pharmacist Morgan Murphy at a CVS store. Photo: Antonio Perez/Chicago Tribune/Tribune News Service via Getty Images

COVID-19 vaccines

A Food and Drug Administration expert panel this week will consider a process for updating COVID shots that resembles the annual strain selection process for seasonal flu vaccines, according to <a class="gtmContentClick" data-vars-link-text="briefing documents" data-vars-click-url="https://www.fda.gov/media/164699/download" data-vars-content-id="b951d415-4c67-4ba0-a632-c23ea8b1f386" data-vars-headline="FDA weighs process for annual COVID shots" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.fda.gov/media/164699/download" target="_blank">briefing documents</a> released on Monday. The big picture: The agency is sketching out a long-term strategy that responds to new strains and shifting threats, replacing a system that&#x27;s been largely drawn up and revised on the fly.<ul><li>Advisers <a class="gtmContentClick" data-vars-link-text="are due to meet on Thursday" data-vars-click-url="https://www.axios.com/2022/12/19/fda-meeting-covid-vaccine-future" data-vars-content-id="b951d415-4c67-4ba0-a632-c23ea8b1f386" data-vars-headline="FDA weighs process for annual COVID shots" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/12/19/fda-meeting-covid-vaccine-future" target="_self">are due to meet on Thursday</a> to discuss the state of the pandemic and whether COVID vaccines need to be modified again.</li></ul>Details: FDA anticipates conducting an assessment at least annually starting in the spring, with advisers meeting around early June to discuss the strain selection process.<ul><li>A decision on the recommended vaccine composition could be made in time for any updated vaccine to be in production in time to be deployed no later than September, according to the documents.</li><li>A more vaccine-resistant variant would likely trigger, on an as-needed basis, an ad-hoc strain selection meeting.</li><li>Public health officials have previously said they think COVID shots could be administered on an annual schedule, like for the flu.</li></ul>Looking ahead: After the panel meeting, the FDA will consider whether to change existing vaccine authorizations and the process to select strains.

Adriel Bettelheim

Stories

FDA weighs process for annual COVID shots

Watchdog faults HHS oversight of research on possible pandemic pathogens

Pandemic years saw a reduction in medical debt

CMS allows Medicaid to address unmet social needs

America's health care focus shifting in 2023

Newsletter editions

Axios Vitals: Pain in the wallet

Axios Vitals: No-worry holidays

Axios Vitals: Flu tightens grip

Axios Vitals: Drug importation revival

Axios Vitals: SCOTUS' new health tempest