Axios Vitals

A briefcase with a red cross on the front.
September 06, 2017

Good morning … Many thanks for all of your warm welcomes yesterday! For any of you who might have missed the memo, I'll be your new host for Vitals, while David Nather takes on a new role overseeing a much broader swath of Axios' policy coverage. Again, please don't hesitate to reach out with your tips, feedback, questions, or comments: [email protected]

Let the great stabilization debate begin

The Senate HELP Committee kicks off a series of hearings today about how best to stabilize the Affordable Care Act's most fragile insurance markets. Yet, before the process has even begun, it seems like almost everyone — Hill staff, industry, K Street, and even some lawmakers — is on the same bleak page: Some sort of stabilization effort is necessary but it's hard to see Congress actually doing it.

What we're hearing:

  • "No one seems to think this HELP Committee thing is passable before the end of the year," a well-placed GOP lobbyist told my Axios colleague Caitlin Owens.
  • Sen. Roy Blunt told Caitlin he wasn't sure this could get done on HELP Chairman Lamar Alexander's ideal timeline — before the end of the month — given the slew of other priorities the Senate also has to deal with in September (like funding the government, raising the debt ceiling, and Harvey relief).

Even so, among more moderate Republicans, there's at least some willingness to buckle down and try to make something work.

  • "I'd like to think we're all just going to put the gum down so that we can walk straight together...We've been accused of not being able to walk and chew gum at the same time. So let's put the distractions aside, let's focus, we've got some really serious stuff to do," Sen. Lisa Murkowski, who helped kill the repeal-and-replace bill, told Caitlin last night.

What they’ll say...

We kinda already know how this would have to shake out in order for something to pass. Alexander's opening statement today will sum it up pretty well:

  • "To get a result, Democrats will have to agree to something – more flexibility for states – that some are reluctant to support. And Republicans will have to agree to something – additional funding through the Affordable Care Act – that some are reluctant to support."

Some combination of those two recommendations is the common refrain we can expect to hear from witnesses, too, over the course of these hearings. But it seems like it'll take lawmakers a while to get there, if they get there at all.

What we're seeing already:

  • Sen. Patty Murray, the committee's top Democrat, opened with an op-ed yesterday that extolled, among other potential solutions, the return of the public option. Which, c'mon – that's barely plausible even as a negotiating position.
  • The conservative advocacy group Freedom Partners is already out with a digital ad opposing the stabilization effort, slamming it as a "bailing out the failing law." It's just one digital ad (for now, anyway), but it's another sign of just how difficult this road will be.

The other high-stakes Senate meeting today

While we're all watching the HELP Committee's hearing this morning, the Finance Committee will be making some big moves of its own. It's expected to advance a slate of nominees that includes Robert Charrow, President Trump's choice for general counsel for the Department of Health and Human Services.

The general counsel is one of those officials who generally stays out of the spotlight but wields enormous power behind the scenes. Charrow, if he's ultimately confirmed, would have a hand in every HHS regulation, and in guiding the department's biggest policy choices — no small tasks for a department that seems to be looking for ways to chip away at a system it oversees.

Flashback: "I am a firm believer in applying the law as written and passed by Congress. And if an action is inconsistent with the law, I will not approve it," Charrow told the committee during his confirmation hearing last month.

A look at mental health disparity

People who get their insurance through the ACA's exchanges, and who need mental health care services, don't have many options to choose from.

A new study in this month's Health Affairs journal looked at more than 500 provider networks, all for insurance plans sold through the exchanges. The upshot: There are very few mental health professionals in those networks.

Some of the study findings:

  • On average, exchange plans cover just 11% of all mental health providers in their states.
  • More than 50% of psychiatrists aren't part of a single exchange plan. Among mental health providers who aren't doctors, less than 20% were part of any plan's network.
  • All of that is considerably lower than the number of primary care providers who participate in exchange plans — and those networks are also pretty narrow.

Why it matters: Congress has tried several times to equalize insurers' coverage of mental health and physical health services. But the rules for how certain services are covered only make a difference if patients can find a doctor in the first place.

Hungry hungry hospitals

Another nugget from the new Health Affairs: One study that caught my colleague Bob Herman's eye explains how hospitals have been able to get away with buying so many doctors' practices.

  • The gist: Hospitals have acquired doctors' offices at a breakneck pace, and there's evidence those deals create local monopolies and lead to higher health care prices.
  • Antitrust authorities haven't fought these types of deals because they're too small. But they add up.

Kaiser Health News

has a deeper dive.

U.S. shows big racial gaps in infant mortality

Bob also dove into the latest infant mortality data from the Centers for Disease Control and Prevention, and noticed some eye-opening results.

  • There is, as you'd expect, a big difference between rural and urban areas. (Rural areas tend to have higher mortality rates because mothers are farther from hospitals.)
  • But a big racial disparity persists across geographic lines: The infant mortality rate for babies born to black mothers was twice as high as the death rate for babies with white or Hispanic mothers.

What we're watching today: HELP Committee stabilization hearing, 10 am Eastern. Livestream here. Finance Committee nominations hearing, 10 am Eastern. Livestream here. Senate Appropriations Committee's health subcommittee marks up its annual HHS spending bill, 11 am Eastern. Livestream here.

What we're watching this week: HELP Committee hearings continue Thursday with governors. Finance Committee hearing Thursday on CHIP. MedPAC meeting Thursday and Friday.