What we know about the virus that's spreading across the globe.

Coronavirus

What's ahead in a post-Roe v. Wade world.

Axios Explains: Abortion

The developments that matter in how Americans are paying for drugs, treatment, insurance and more.

Health care costs

Opioids

The developments that matter in the fight over Obama's landmark health care law.

Affordable Care Act

The latest in the debate over whether the U.S. should shift to government-funded health care.

Medicare for All

The developments that matter in the fight over e-cigarette use.

Vaping

The developments that matter on issues that affect our immediate safety and health.

Public health

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

National

Some Americans will be required to start paying for coronavirus tests and treatments when the federal government's COVID-19 public health emergency declarations expire this spring.

State of play: The White House announced Monday that after three years, it will end the COVID-19 public health emergency and national health emergency designations on May 11, bringing about policy changes, new health care costs and existential questions about the nation's pandemic response.

What they're saying: "People will have to start paying some money for things they didn’t have to pay for during the emergency," Jen Kates, senior vice president at the Kaiser Family Foundation said, per CNN. "That’s the main thing people will start to notice."

Vaccines: COVID-19 vaccines, including boosters, will remain free to virtually all those with public and private insurance in most cases, per the Kaiser Family Foundation (KFF).

Access to free vaccines will be limited for uninsured adults.

Treatments: Currently, individuals on Medicare do not pay for some COVID-19 treatments, but once the public health emergencies end, some will be required to pay a portion of costs out of pocket.  

There is no federal law specifically addressing how COVID-19 treatment should be covered by private insurance, so there would be no change with the end of the emergency order, per KFF.

But as the supply of treatments purchased by the government is depleted, private insurers will take on more of the cost of medications to treat the virus, which could increase premiums. So patients receiving COVID-19 therapeutics may have to pay some of the costs.

All drugs for the treatment or prevention of COVID–19 have out-of-pocket costs for full-benefit Medicaid enrollees through June 2024. After that, treatments that have FDA approval will be covered but some patients may have to pay.

Treatments for uninsured individuals will be free as long as government-purchased supplies remain available. When that supply is depleted, uninsured people will have to pay the full cost of the medications.

Tests: Previously, those with private health insurance or Medicare were eligible for eight free coronavirus tests per month.

When the emergency declaration ends, Medicare beneficiaries will face the full cost of at-home tests. But, they'll continue to get free clinical diagnostic testing for COVID-19.

State Medicaid programs will continue covering COVID-19 testing, including at-home tests for full-benefit enrollees through a mandated coverage period. After that time, tests ordered by a physician may be free. 

Those who have private insurance could be charged for lab tests, even when ordered by a provider. 

When the federal supply of tests is depleted, uninsured individuals will generally have to pay the full cost of COVID-19 tests.

Of note:  Hospitals will no longer receive higher Medicare payment rates for treating patients with COVID-19.

How COVID-19 costs will change when national health emergencies end

Costs for COVID-19 vaccines, tests and treatments will be affected.

Illustration of a vintage cash register with covid cells on the display.

COVID-19

President Biden has made the COVID-19 crisis and a post-Trump return to national unity and traditional democratic ideals his top priorities. From vaccinations to stimulus to schools, Biden is seeking bipartisan compromise while showing a willingness to use executive authority and bare Democratic majorities in the U.S. House and Senate to implement his policies. Republican leaders are navigating deep party divisions over if and how to move beyond former President Trump.

Politics & Policy

Vitals

Axios Vitals

Share of GDP spent on health, by select country

Data: Gunja, et al., 2023, "U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes," OECD Health Statistics 2022; Chart: Axios Visuals

The U.S. continues to far outspend other developed nations while seeing worsening health outcomes.

Driving the news: A report from the Commonwealth Fund today shows poorer U.S. health outcomes — such as Americans being more likely to suffer from multiple chronic illnesses, die from avoidable causes including maternal mortality and assault, and having a shorter life expectancy — all while America pays the most per capita for those outcomes.

"The problem is getting worse," Munira Gunja, senior researcher at the Commonwealth Fund's International Health Policy Program. 

"In these sorts of studies where we make cross-national comparisons, we can see we are still behind our peer countries and need to start implementing methods they've developed into our own system," she said.

By the numbers: The U.S. spends nearly $12,000 on health care per capita, including more than $1,200 in household out-of-pocket spending a year, according to a Commonwealth Fund study released today.

That's more than $4,500 than its nearest peer, Germany, which spends about $7,4000 on health care per person in a year. It's also more than three times what South Korea, New Zealand and Japan spend, respectively.

In 2021, the U.S. spent nearly 18 % of its gross domestic product on health care, nearly twice as much as the average country in the Organization for Economic Cooperation and Development, or OECD.

State of play: The report found more than 30% of Americans surveyed reported suffering multiple conditions. No other country reported more than 26% of its residents surveyed had multiple chronic conditions.

The U.S. had the highest rate of avoidable deaths in 2020 by far at 336 deaths per 100,000 people. The next closest comparison was Germany at 195 deaths per 100,000 people.

That included infant and maternal mortality rates, as well as deaths from assault which far outpaced other OECD nations.

In 2020, life expectancy at birth in the U.S. was 77 years, three years lower than the OECD average, per the report. Preliminary CDC data shows life expectancy in the U.S. fell again in 2021.

The big picture: The report comes on the heels of a Peterson-KFF Health System Tracker report out Monday showing the impact the cost of U.S. healthcare is having on access. 

At least one in 11 U.S. adults reported they delayed or did not get care because of cost reasons in 2021, per the tracker which used National Health Interview Survey data.

Adults who are in worse health were twice as likely as those in better health to delay or not get care due to cost reasons, the tracker found.

Between the lines: The U.S. is the only OECD nation not to have guaranteed health coverage. It also averages fewer primary care physician visits and fewer primary care physicians than most peer countries.

"Even though we have made some steps over the past decade to improve health access and coverage, the rates are getting worse," Gunja said. "It's a big wakeup call for the health policy and health care industry that we are in a crisis and we need to make changes."

America's worsening return on health investment

Money

HHS weighs abortion access actions, including possible health emergency declaration

Democratic lawmakers have urged the Biden administration to declare a Public Health Emergency on abortion.

Illustration of a red cross floating in a life preserver.

Abortion

Finish Line

Axios Finish Line

Americans are staying healthier longer than ever before — and they're transforming what older age looks like.

The big picture: "We have essentially created a new stage of life. Americans retire, on average, by their early to mid-60s, yet many now remain vibrant into their mid-80s," David Brooks writes in The Atlantic.

The 70s — a largely overlooked decade of life — can be some of our best years.

🧮 By the numbers: A recent study from AARP and National Geographic found that happiness dwindles in middle age but then spikes again in one's 70s and 80s, as people find themselves with more free time and less stress.

34% of adults in their 80s and 27% of those in their 70s say they're very happy, compared with 18% in their 50s.

And 51% of adults in their 70s say they're optimistic about their futures, compared with 44% in their 60s.

🧠 Reality check: There are, of course, stressors associated with getting older. The study found that independence, brain health and the strength of relationships were older adults' top concerns.

As we've reported, there's a growing population of seniors who are aging alone — without any close family around them. This lack of kinship can often contribute to deteriorating mental and physical health.

The bottom line: Many of us fear the prospect of aging, but this stage of life can be enjoyed — and celebrated. 

Axios Finish Line: Happiness spikes in our 70s

Illustration of a butterfly resting on a cane

Aging

Health Care Policy

The Biden administration on Monday finalized an oft-delayed plan to step up audits of Medicare Advantage insurers in order to identify and recover overpayments.

Why it matters: Studies and audits have identified billions of dollars of excess payments to health plans that weren't supported by patients' medical records, but federal officials in the past backed off many repayment demands. 

The final rule seeks to claw back $4.7 billion from 2023 through 2032. 

It comes as more seniors are choosing private Medicare Advantage plans over traditional Medicare and insurers are facing scrutiny for aggressive sales tactics and not delivering on pledges to lower health spending. 

How it works: The Centers for Medicare and Medicaid Services does audits called risk adjustment data validation, or RADV, to identify improper payments.

The inability to catch the biggest overpayments stirred a push for enhanced audits that would extrapolate results over a Medicare Advantage plan's entire patient population.

The pandemic and insurance industry pushback delayed the final rule multiple times.

Top Medicare Advantage insurers affected by the rule include UnitedHealthCare, Humana and CVS Health/Aetna.

The details: Under the plan finalized Monday, CMS will collect extrapolated audit findings starting with the 2018 plan year, and non-extrapolated overpayments from 2011 through 2017. 

CMS originally proposed collecting extrapolated overpayments from as far back as 2011. 

CMS will also not adjust Medicare Advantage payments to account for the difference in documentation standards between Medicare Advantage diagnosis data and traditional Medicare diagnosis data, which is not audited. The agency cites a 2021 court decision as the rationale. 

What they're saying: "For years, federal watchdogs and outside experts have identified the Medicare Advantage program as one of the top management and performance challenges facing HHS, and today we are taking long overdue steps to conduct audits and recoup funds," said Health and Human Services Secretary Xavier Becerra. 

"This rule is unlawful and fatally flawed, and it should have been withdrawn instead of finalized," Matt Eyles, president and CEO of the insurers' lobby AHIP,  said in a statement on the policy. "The rule will hurt seniors, reduce health equity and discriminate against those who need care the most." 

“This rule comes with enormous costs and fails to target the most egregious diagnosis coding violations,” Alliance of Community Health Plans President and CEO Ceci Connolly said in a statement. 

What we're watching: Insurers have questioned whether parts of Medicare's methodology are legal and could challenge the rule in court.

The higher costs to plans could lead some insurers to pull out of markets — and beneficiaries could face higher costs, fewer plan choices or reduced supplemental benefits under the Medicare Advantage program, per an Avalere analysis.

CMS will also release an advanced notice of Medicare Advantage rates for 2024 soon. The payment notice could offset some market concerns raised for health plans by the RADV proposal, said Raymond James analyst Chris Meekins. 

Reality check: The real impact on plans will likely be quite small. CMS's annual payments to Medicare Advantage plans are expected to increase to $943 billion by 2031, the Kaiser Family Foundation estimated.

Biden administration seeks to recoup $4.7 billion from Medicare Advantage plans

Illustration of stacks of one hundred dollar bills laid in a medical cross shape

Medicare Advantage

The Biden administration plans to end the COVID-19 public health emergency and national health emergency designations on May 11, the White House announced Monday. 

The state of play: The move shifts the debate around GOP resolutions ending the two emergencies, which were set to be voted on in the House this week as a referendum on the incompatibility between President Biden’s statements on the pandemic and the administration’s policy.

Instead of acting as a check on sweeping emergency powers and the administration’s COVID posture, the votes are now a question of whether the emergencies should be ended immediately or several months from now — likely limiting the prospect of bipartisan support.

The Office of Management and Budget (OMB), in its statement announcing the plan to end the two emergencies, argued they should be phased out with advanced warning rather than terminated suddenly.

“An abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty throughout the health care system,” the OMB said.

Zoom in: The Biden administration is also accusing Republicans of contravening their party’s support for Title 42, a Trump-era policy facilitating the expedited expulsion of migrants that has been kept in place by the Supreme Court despite the administration’s attempts to end it.

Voting to terminate the public health emergency immediately, the OMB claimed, “would lift Title 42 immediately, and result in a substantial additional inflow of migrants at the Southwest border.”

Rep. Brett Guthrie (R-Ky.), who introduced the bill ending the public health emergency, told Axios, "It absolutely does not end Title 42. That's just not accurate."

The other side: House Speaker Kevin McCarthy (R-Calif.) told Axios the House will move forward with the votes.

“Why would you allow 47% of the government to stay home for another five months,” he said, adding, “The president said in September [the pandemic] was over.”

Guthrie said the House should still pass it so Congress can be prepared to push back "if for some reason [the White House's plans] don't come to fruition."

Where it stands: For health care providers, ending the public health emergency will bring big changes. 

They've had significant leeway on reporting requirements, physical environment standards, patients’ rights and other policies over the last three years due to the emergency. 

Congress extended telehealth flexibilities in December and laid out a plan for states to start removing ineligible people from Medicaid. But unless lawmakers or regulators act, plenty of other policies will expire with the emergency designation.

Go deeper: The Centers for Medicare and Medicaid Services doesn’t have data on how many providers currently use the flexibilities, as providers don’t need to notify the agency to use them, a spokesperson told Axios last week. 

CMS is encouraging providers to begin preparing for the end of pandemic-era flexibilities as soon as possible, the spokesperson said prior to the White House’s announcement. 

COVID-19 health emergencies to end in May, White House says

The move shifts the debate around GOP resolutions ending the two emergencies, which were set to be voted on in the House this week.

President Joe Biden leaves Holy Trinity Catholic Church after attending Mass on March 27 in Washington, D.C. 

President Biden leaves Holy Trinity Catholic Church after attending Mass on March 27 in Washington, D.C. Photo: Samuel Corum/Getty Images

Closer

Axios Closer

Mental health professionals are seeing an increase in requests from companies for trauma support training.

Why it matters: From self-care practices to recognizing the physiological impacts of trauma, more organizations have realized that workers can't just be expected to handle the trauma on their own, according to Ruth Yeo-Peterman, a resilience programming trainer with the Center for Victims of Torture.

By the numbers: An overwhelming majority of employers (91%) surveyed through wellness management platform Wellable say they expect to invest more in mental health programs for employees this year. 

That's up from 66% pre-pandemic, in 2018.

State of play: Sources of stress on U.S. workers go well beyond the pandemic.

The country has seen more than 39 mass shootings so far this year in fewer than 30 days. 

And last week provided yet another example of police brutality with the release of a video showing the "inhumane" and fatal beating of 29-year-old Tyre Nichols.

What they're saying: "We're experiencing a lot of compounded trauma," says Nicole Weis, director of community training and empowerment at the Lyda Hill Institute for Human resilience.

"We're also still reacting from the pandemic. We're reacting from global climate crises. We're reacting from the economy ... the war in Ukraine — there's all of these compounding stressors on us," says Weis.

Between the lines: Trauma is defined by an experience — isolated or ongoing —that impacts someone's sense of control and quality of health, Yeo-Peterman explains.

Secondary, or vicarious trauma, is a unique experience of taking on someone else's trauma through exposure to or information about it.

Injustices within workplaces and organizations can compound traumatic stress, as well, so it's important to build in ways to deal with trauma on all those levels, she adds. 

For people experiencing trauma, Yeo-Peterman advises taking to self-care with "little sips of practice."

 "You don't have to drink the whole cup of tea at one time," she says. Taking little sips of care throughout the day can help make self-care sustainable.

Finding even small ways to feel like you can participate and take action within an organization, or in your life, can also help protect against the effects of trauma and help process it as well, she adds. 

Managers and employers, Weis says, can offer space and boundaries, stay updated on resources for employees, and harness social support.

For example, giving time back to employees for their mental health by cancelling meetings; communicating when new therapy services become available; and getting teams together for fun outings or activities. 

What to watch: "It's completely normal to feel distracted, to have trouble sleeping, to feel a little anxious" for a few days or weeks after an event has taken place, says Weis.

If it’s been more than three or four weeks and things are still not feeling better or have gotten worse, you or your team may want to seek professional help, she adds. 

Our thought bubble: Not all companies have the resources for employee mental health support. Not all managers are empathetic. If you're lucky enough to have either or both, please consider reaching out or placing yourself in the shoes of  people who don't — especially as you interact with them.  

Trauma support in high demand from companies amid relentless wave of tragedies

More organizations have realized that workers can't just be expected to handle the trauma on their own.

abstract illustration of two hands holding one another

Mental health

After a record economic expansion, the coronavirus pandemic sent the U.S. economy into a recession as unemployment soared to staggering heights. The country now faces urgent questions about how much stimulus is needed for reeling consumers and businesses, and what a recovery might look like.

Economy & Business

The Biden administration on Monday moved to reverse a Trump-era policy that made it easier for employers to refuse to offer birth control coverage in company-sponsored health plans.

The big picture: The Trump administration's rollback of the Affordable Care Act's contraceptive mandate allowed organizations to opt out of coverage, citing moral objections. Before that, exemptions were limited to religious grounds.

The Trump administration rule was challenged in court on the grounds it could cause irreversible harm to women but took effect in 2018.

Driving the news: The new rule — proposed by the Health and Human Services, Treasury and Labor departments — would get rid of the "moral" exemption and retain the "religious" one.

It would also create an "independent pathway" for people who have insurers with religious exemptions to access birth control through a "willing contraceptive provider" at no cost, according to an HHS press release.

What they're saying: "If this rule is finalized, individuals who have health plans that would otherwise be subject to the ACA preventive services requirements but have not covered contraceptive services because of a moral or religious objection, would now have access," said Chiquila Brooks-LaSure, administrator for the Centers for Medicare and Medicaid Services.

By the numbers: HHS estimates that the proposal could affect over 100 employers and 125,000 workers, CNN reports.

What's next: The public has a 60-day window to comment on the rule.

Biden administration proposes strengthening health law's contraception mandate

The proposed rule reversed a Trump-era policy that rolled back the ACA.

Birth

The number of women who died during pregnancy or shortly after giving birth jumped in the first year of the pandemic, a study in JAMA Network Open shows.

Why it matters: While pregnancy-associated causes were still the leading cause of death, the jump in mortality between 2019 and 2020 was largely not related to the pregnancies themselves.

By the numbers: The study, led by the University of Texas at San Antonio, found mortality rates increased by 22%, from 27.5 deaths per 100,000 live births in 2019 to 33.6 deaths per 100,000 live births for pregnancy-associated causes in 2020. 

They jumped 36%, from 26.4 to 36 per 100,000 live births for nonpregnancy causes over that time.

Mortality rates increased "significantly" for drug poisoning, motor vehicle collisions and homicide, but did not increase due to suicide.

What they're saying: "One of the main messages, I think, from this is really that there's a much bigger societal problem facing pregnant women and new mothers who are in that postpartum period where, you know, that's a very stressful time of life," Jeffrey Howard, an author of the study and associate professor of public health at the University of Texas at San Antonio told CNN.

Deaths jump among pregnant women

The jump in mortality between 2019 and 2020 was largely not related to the pregnancies themselves.

An IV bag hangs as surgeons conduct an operation.

Health care

Pro Rata

Axios Pro Rata

Paradigm, a New York-based clinical trial tech platform, raised $203 million in Series A funding and acquired an oncology patient recruitment startup called Deep Lens.

Why it matters Clinical trial recruitment is a costly bottleneck for drug development, yet many patients struggle to access relevant trials. Thus a new class of matchmaking infrastructure startups like Paradigm, whose outsized bankroll could help it quickly catch rivals.

Details: Arch Venture Partners and General Catalyst co-led the round, and were joined by F-Prime Capital, Lux Capital, GV, Magnetic Ventures, Mubadala Capital and the American Cancer Society. 

Deep Lens, based in Columbus, Ohio, had raised over $17 million from firms like Rev1.

More, per Digital Health Biz & Tech: "There were 17 deals for digital health companies developing clinical trial tech, collectively valued at nearly $300 million, last year. This potential has drawn interest from drugmakers such as GSK, the British pharmaceutical giant, which signed a four-year deal in September with Medable, a clinical trial software unicorn."

Paradigm raises $203 million to improve clinical trial recruitment

This is a giant round for the latest upstart seeking to fix the broken clinical trials system.

Illustration of a line of people waiting at a red cross-shaped door.

Health

All Health stories