Jun 25, 2018

Axios Vitals

Good morning ... I'm not the world's biggest fan of Eminem, but am considering trying to catch him live just to see this incredible sign language interpreter.

1 big thing: GOP torn between cost control and ACA repeal


The Senate health committee will kick off a series of hearings this week about health care costs, and the House isn’t far behind, now that it has wrapped up its marathon of opioids bills. The focus makes sense — health care costs are one of voters’ top issues in the midterms.

So, does this mean the GOP is moving on from its repeal-and-replace agenda? Not so fast.

  • "I think if you address health care costs you’re basically repealing and replacing Obamacare. It’s really one and the same," Sen. Mike Rounds told Axios’ Caitlin Owens.

Reality check: Rising ACA premiums are a real issue for millions of people, but they’re a tiny fraction of the health care system. Drug prices, rising deductibles and a burgeoning backlash over surprise hospital bills are all animating the cost debate — and none of them are products of the ACA.

The bottom line: Republicans clearly don’t feel that they can say they’re moving on from ACA repeal, and that could complicate any serious effort to address health care costs — an area where bipartisan agreement may not be easy, but is at least not beyond the realm of possibility.

  • "I think we can find more common ground there and get more done there for consumers, and that’s where we should focus,” Energy and Commerce Chairman Greg Walden said.

Go deeper: Read the whole story.

2. Gawande talks about his goals

Atul Gawande in 2015. Photo: Lisa Lake/Getty Images for Geisinger Health System

Atul Gawande, the newly minted CEO of the health care project from Amazon, Berkshire Hathaway and JPMorgan Chase shared some initial thoughts about the venture at the Aspen Ideas Festival this weekend.

His priorities: "Better outcomes, better satisfaction with care, and better cost efficiency, with new models that can be incubated for all."

The challenges: “What they're saying for me is, resources won't be the problem. Human behavior will be, and achieving scale will be."

The targets: "There are three sources of waste and they each require different work."

  • “There are a lot of middlemen in the system and there have to be solutions that simplify that, take some of the middlemen out of the system.”
  • “There has to be solutions around pricing.”
  • “The biggest bucket is misutilization — meaning, the wrong care at the wrong time in the wrong way”

🙏🏻: "By the way, we’re going to come up with a name. It’s one of my first jobs."

The big picture:

  • Even though Gawande will be working for several large employers, he said employer-based coverage doesn't make much sense any more: "Tying how you get your health [care] to your place of employment is going to become less and less tenable."
  • But some form of single-payer does: “I’d say it's urgent if you care about human lives," Gawande said.

More: JPMorgan CEO Jamie Dimon tells Fortune how Gawande got the job. ("He’s got a big brain and a big heart.")

3. Walmart wants more hospital contracts

If you’re looking for more proof that employers are fed up with high health care prices, Axios' Bob Herman recommends paying attention to what Walmart is doing.

Driving the news: Walmart executives were making the rounds last week at a conference hosted by Premier, a health care software and group purchasing company that is part-owned by hospital systems. Why?

  • “The retailer was there to talk with health systems about their interest in directly contracting to provide care to its employees,” Jamie Stockton of Wells Fargo said in a note to Wall Street investors.

Why it matters: Walmart is one of the biggest names that has frequently used direct contracting — a process in which a company acts as an insurance negotiator by promising to send its employees to a specific hospital for certain procedures in exchange for discounted rates.

  • The concept restricts choice, but potentially saves money for companies and employees. Expect more of this.
4. It's the Senate's turn on opioids

The House on Friday passed the vehicle that contains almost 60 standalone bills to address the opioid epidemic.

  • The omnibus measure would, among other things, lift the so-called "IMD exclusion" that limits Medicaid payments to larger mental health treatment facilities, expand the use of medication-assisted therapy, and explore new approaches to prescribing and packaging prescription opioids.

What's next: The Senate is working through its own process, and several of its committees have been working on their own bills.

  • The Republican and Democratic leaders of the commerce, finance, health and judiciary panels "are now working on an agreement for floor consideration of the package of bills," which should happen "soon," said Don Stewart, a spokesman for Majority Leader Mitch McConnell.

Between the lines: The House and Senate packages won't be identical, but reconciling them doesn't seem like it should be very difficult.

5. While you were weekending ...
  • 23andMe has been donating DNA kits to help reunite migrant children and their parents, the San Jose Mercury News reports. But, as Mother Jones notes, that comes with some serious privacy risks.
  • The Atlantic interviews Arkansas' director of human services about Medicaid work requirements.
  • Both CNN and Mediaite published new details Friday about an HHS official who promoted the Pizzagate conspiracy theory and made many disparaging comments about Muslims.

What we're watching this week: HHS Secretary Alex Azar testifies Tuesday at a Finance Committee hearing on drug prices. Senate HELP committee hearing Wednesday on health care costs. Senate oversight committee hearing Wednesday on Medicaid fraud and overpayments.

What are you watching? I alway want to hear your questions, tips, ideas, criticisms, etc. baker@axios.com.