National

An emerging fungal infection that can prove fatal in communal health settings spread further and became more drug-resistant during the pandemic, a Centers for Disease Control review of surveillance data found.

Why it matters: The timing suggests the spread of Candida auris could have been exacerbated by COVID-related stresses like staff and equipment shortages, increased antimicrobial use and changes in patient movement.

The increase in cases underscores the importance of infection control in hospitals and long-term care facilities, researchers said.

What they found: The number of C. auris clinical cases tripled from 2019 to 2021, to 1,471 in 2021.

Most U.S. cases are found in post–acute settings, especially long-term acute care hospitals.

While many early cases were contracted abroad, C. auris has been detected in more than half of the states and is endemic in some areas.

There were 3,270 clinical cases in the U.S. through 2021, along with 7,413 detected through screening.

Between the lines: The CDC is still studying how the fungus spreads, but it's been primarily detected in sick patients, particularly those with weaker immune systems or in need of catheters or feeding tubes.

Drug-resistant varieties varied by region, but the number of cases resistant to the first-line therapy echinocandins substantially increased in 2021, researchers said.

"Several new antifungal medications are in development, but more research is needed to understand outcomes for patients with these highly resistant strains and to guide treatment," they wrote in the Annals of Internal Medicine.

Drug-resistant fungus gained strength during pandemic: CDC

An emerging fungal infection that can prove fatal in communal health settings spread further and became more drug-resistant during the pandemic.

Illustration of a hand holding a petri dish with a shield made from fungi in the dish. 

Fungus

Public health

An emerging fungal infection that can prove fatal in communal health settings spread further and became more drug-resistant during <a class="gtmContentClick" data-vars-link-text="the pandemic" data-vars-click-url="https://www.axios.com/health/coronavirus" data-vars-content-id="1eeaf01c-0148-459b-a8fa-fd256e636860" data-vars-headline="Drug-resistant fungus gained strength during pandemic: CDC" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/health/coronavirus" target="_self">the pandemic</a>, a Centers for Disease Control <a class="gtmContentClick" data-vars-link-text="review" data-vars-click-url="https://www.cdc.gov/media/releases/2023/p0320-cauris.html" data-vars-content-id="1eeaf01c-0148-459b-a8fa-fd256e636860" data-vars-headline="Drug-resistant fungus gained strength during pandemic: CDC" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.cdc.gov/media/releases/2023/p0320-cauris.html" target="_blank">review</a> of surveillance data found.Why it matters: The timing suggests the spread of Candida auris could have been exacerbated by COVID-related stresses like <a class="gtmContentClick" data-vars-link-text="staff and equipment shortages" data-vars-click-url="https://www.axios.com/2022/05/11/staffing-shortages-slam-hospitals" data-vars-content-id="1eeaf01c-0148-459b-a8fa-fd256e636860" data-vars-headline="Drug-resistant fungus gained strength during pandemic: CDC" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/05/11/staffing-shortages-slam-hospitals" target="_self">staff and equipment shortages</a>, increased <a class="gtmContentClick" data-vars-link-text="antimicrobial use" data-vars-click-url="https://www.axios.com/2023/01/19/struggle-superbugs-antimicrobial-resistance" data-vars-content-id="1eeaf01c-0148-459b-a8fa-fd256e636860" data-vars-headline="Drug-resistant fungus gained strength during pandemic: CDC" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/01/19/struggle-superbugs-antimicrobial-resistance" target="_self">antimicrobial use</a> and changes in patient movement.

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

State efforts to control health costs through public options are stalling in the face of resistance from providers and lackluster enrollment, even as talk of a federal version recedes.

Why it matters: The states' underwhelming attempts offer an ominous warning for lawmakers seeking to lower health costs: Insurers and providers aren't going to willingly cooperate with programs that threaten their profits and revenues. 

And lower health care costs are, in the end, a hit to someone's profits and revenue.

The big picture: The public option was supposed to resemble government-run health care for moderates uncomfortable with "Medicare for All." But it flopped on the first try in Washington state and is drawing meager interest there and in Colorado.

Nevada, New Mexico, Minnesota and Connecticut are among the other states either weighing bills to create public options or nudging similar plans forward.

A key will be whether they can attract more consumers and save money through partnerships with insurers or whether they'll have to force the carriers to participate, a recent Commonwealth Fund comparison found.

Public options are state-administered health plans that offer a defined set of services at a discounted price to promote access and affordability.

But while President Biden campaigned on a federal version, there's been little follow-up — and in states it's "one of many choices" to expand coverage and lower costs, Christine Monahan, an assistant research professor at the Georgetown University Center on Health Insurance Reforms, told Axios.

Where it stands: Washington state's first-in-the-nation public option launched in 2019 but hit obstacles when insurers didn't voluntarily contract with the state and offer plans in each county. That was partly because hospitals also balked at a program they said made low payments and policies that tied reimbursements to Medicare rates.

With big geographic gaps in plan availability, the state put more requirements on hospitals to contract with plans. But only 27,000 residents selected a public option plan for the 2023 plan year.

Washington's Health Care Authority late last year recommended forcing insurers and health providers that participate in other state health programs to also participate in the public option. 

Colorado tried to avoid the Washington experience by launching a public option this winter and requiring insurers to offer three tiers of service in all counties where they offer individual or small-employer plans.

About 35,000 residents enrolled so far. Next year, the Division of Insurance will begin holding insurance companies accountable to meeting premium reduction targets.

The Colorado Association of Health Plans estimates the lion's share of its members won't meet those targets, and that insurance regulators set too generous benefits as the standard package, driving up premiums. 

Insurers are set to go before the Division of Insurance this summer for hearings and there are proposed changes to the public option law pending in the Colorado General Assembly.

The Colorado Association of Health Plans is concerned about the Democratic-led changes, noting in a statement to Axios that "the policy goals are now moving from affordability to value." The association is also concerned about an accelerated timeline to comply with the program.

The intrigue: Nevada's public option isn't due to take effect for another three years but already is in limbo after newly elected Gov. Joe Lombardo (R) said the state legislature should repeal or significantly revise the Democratic-driven legislation that created it.

Nevada structured its public option in a way that forces hospitals and insurers to participate. 

The goal is to insure more than 55,000 Nevada residents in the first year and more than 90,000 by its fifth year while saving the state as much as $464 million over that period.

Yes, but: The state's big health care players were not on-board.

The Nevada Hospital Association and Nevada Association of Health Plans both oppose the legislation, and they expect new legislation to be introduced this year to alter the law.

The bottom line: Early results cast doubt on whether public option plans will achieve their goals if they depend on providers and insurers to willingly take a pay cut.

"I don't think it's like the hot, flashy thing that states are going to try," Monahan said.

State public option plans keep hitting obstacles

State efforts to control health costs through public options are stalling in the face of resistance from providers and lackluster enrollment.

Illustration of a construction barrier and traffic cones in front of a broken up dollar bill.

Health insurance

State efforts to control health costs through public options are stalling in the face of resistance from providers and lackluster enrollment, even as talk of a federal version recedes.Why it matters: The states&#x27; underwhelming attempts offer an ominous warning for lawmakers seeking to lower health costs: Insurers and providers aren&#x27;t going to willingly cooperate with programs that threaten their profits and revenues.

Food and Drug Administration advisers will meet May 9 and 10 to weigh making a contraceptive pill available without a prescription for the first time.

Why it matters: Health experts say making birth control pills available over-the-counter will reduce the number of unwanted pregnancies and could cut down on the need for abortions. But key questions remain over cost and whether insurers will cover them.

Reproductive rights groups, as well as the nation's largest physician groups, back making birth control available without a prescription.

Flashback: HRA Pharma, a French drug company owned by Perrigo, applied to switch its Opill pill from prescription-only to over-the-counter last July. 

The FDA in October postponed the meeting of outside experts to help decide the switch. 

The details: Opill could generate $100 million in peak sales, according to analysts.

"Just over 15% of women who walk into a pharmacy with a prescription for an oral contraceptive don't walk out with it filled," Raymond James analyst Elliot Wilbur wrote in a note. "This presents a unique capture opportunity since the potential user is already in [the] store."

Between the lines: If the FDA approves Opill for over-the-counter access, questions remain about access and affordability.

The Affordable Care Act requires insurers to cover contraception without cost sharing, but this has been interpreted to apply to prescriptions.

Reproductive health advocates have asked the federal government to clarify that the coverage should also apply to over-the-counter birth control options.

FDA advisers set new date to weigh over-the-counter birth control

Two FDA advisory committees will consider an application to make an oral contraceptive available over-the-counter instead of by prescription only.

Illustration of a magnifying glass with a round pill in place of glass

Birth control

Food and Drug Administration advisers will meet <a class="gtmContentClick" data-vars-link-text="May 9 and 10" data-vars-click-url="https://public-inspection.federalregister.gov/2023-06524.pdf" data-vars-content-id="4112ea3f-a9ba-4a0b-b6a8-e11c6770f2ff" data-vars-headline="FDA advisers set new date to weigh over-the-counter birth control" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://public-inspection.federalregister.gov/2023-06524.pdf" target="_blank">May 9 and 10</a> to weigh making a contraceptive pill available without a prescription for the first time.Why it matters: Health experts say making birth control pills available over-the-counter will reduce the number of unwanted pregnancies and could cut down on the need for abortions. But <a class="gtmContentClick" data-vars-link-text="key questions remain" data-vars-click-url="https://www.axios.com/2022/10/25/birth-control-prescription-fda-approval-hra-pharma" data-vars-content-id="4112ea3f-a9ba-4a0b-b6a8-e11c6770f2ff" data-vars-headline="FDA advisers set new date to weigh over-the-counter birth control" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/10/25/birth-control-prescription-fda-approval-hra-pharma" target="_self">key questions remain</a> over cost and whether insurers will cover them.

Nonprofit and public hospitals charged commercially insured patients up to 25% more for brain scans with an MRI than for-profit facilities, a new JAMA analysis found.

Why it matters: It's one of the first comparisons using data from a Trump-era hospital price transparency law to show variations in what facilities negotiate with insurers for common services. 

"This one service gives us a lens to observe hospital's strategic pricing behavior because this is a lever they can pull to make money," Ge Bai, a Johns Hopkins professor and study co-author, told Axios.

What they found: Non-profits, teaching hospitals and hospitals in more affluent areas tended to have higher markups, a lower proportion of Medicare patients and a higher likelihood of employing clinicians in MRI departments.

The median commercial price of an MRI brain scan for all hospitals is $1,900, the study found. 

For-profit hospitals in the study charged a median price of $1,509, while nonprofit and government hospitals charged a median $1,938 and $2,149, respectively. Medicare pays $400 or less for the procedure, depending on the facility type.

Rural hospitals charged more for brain MRIs than urban hospitals in the same health system by $363.

The findings suggest that hospitals negotiate higher prices with commercial payers when they have market power in a region or area.

Nonprofit, government hospitals charge more than for-profit facilities for brain imaging: study

A new JAMA analysis found that nonprofit and government hospitals charge more for brain MRI scans than for-profit hospitals in the same state or region.

Illustration of a hundred dollar bill with a brain in place of Benjamin Franklin

Health care costs

Nonprofit and public hospitals charged commercially insured patients up to 25% more for brain scans with an MRI than for-profit facilities, a new <a class="gtmContentClick" data-vars-link-text="JAMA analysis" data-vars-click-url="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802683" data-vars-content-id="5e3f10e1-94e7-4fb1-902b-c3a91314622f" data-vars-headline="Nonprofit, government hospitals charge more than for-profit facilities for brain imaging: study" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802683" target="_blank">JAMA analysis</a> found.Why it matters: It&#x27;s one of the first comparisons using data from a Trump-era hospital price <a class="gtmContentClick" data-vars-link-text="transparency law" data-vars-click-url="https://www.axios.com/2023/01/19/hospitals-price-posting-cms" data-vars-content-id="5e3f10e1-94e7-4fb1-902b-c3a91314622f" data-vars-headline="Nonprofit, government hospitals charge more than for-profit facilities for brain imaging: study" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/01/19/hospitals-price-posting-cms" target="_self">transparency law</a> to show variations in what facilities negotiate with insurers for common services.

Data: NORC; Chart: Rahul Mukherjee/Axios

More than 4 in 10 U.S. adults are obese, with states in the South and Midwest showing some of the highest prevalence, a new analysis from NORC at the University of Chicago shows.

Why it matters: Obesity is associated with hypertension, cardiovascular disease, stroke and other conditions that are among the leading causes of preventable, premature death.

But strategies for treating obesity are changing, with doctors prescribing a new class of drugs in record numbers despite questions about their long-term effects and a hefty price tag.

The details: West Virginia and Mississippi have the highest obesity rates at 51%. The District of Columbia had the lowest obesity rate at 33%, followed by Colorado at 34%.

Obesity disproportionately impacts Black and Hispanic Americans, the analysis found.

Obesity rates are determined in part by using Body Mass Index ranges, which have been called into question for correlating weight and health too closely, the New Yorker reported.

Of note: The NORC analysis was produced with funding from Novo Nordisk, a company which produces both insulin and Ozempic, one of the popular weight-loss drugs.

42% Americans are living with obesity

A NORC analysis found that 42% of Americans are living with obesity, with higher rates in the Southern and Midwestern states.

Obesity

More than 4 in 10 U.S. adults are obese, with states in the South and Midwest showing some of the highest prevalence, a <a class="gtmContentClick" data-vars-link-text="new analysis" data-vars-click-url="https://obesitymap.norc.org/" data-vars-item="in_content_link" href="https://obesitymap.norc.org/" target="_blank">new analysis</a> from NORC at the University of Chicago shows.Why it matters: Obesity is associated with hypertension, cardiovascular disease, stroke and other conditions that are among the leading causes of preventable, premature death.

Arielle Dreher

Stories

FDA advisers set new date to weigh over-the-counter birth control

State public option plans keep hitting obstacles

42% Americans are living with obesity

Nonprofit, government hospitals charge more than for-profit facilities for brain imaging: study

Drug-resistant fungus gained strength during pandemic: CDC