Mar 1, 2018

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning … March is the worst month of the year. It’s long, there are no holidays (except St. Patrick’s Day, which is awful), and as much as we think of March as a part of spring, it always brings a last gasp of winter. So anyway, welcome to March.

Voters want to talk about costs, not coverage
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Cost is the No. 1 health care issue on voters’ minds in this election year. The latest Kaiser Family Foundation tracking poll finds that a plurality of all voters — 22% — rank costs as the health care issue they most want to hear candidates address in the midterms.

Between the lines: This is one of the only questions in the entire poll that unites Republicans and Democrats.

  • Partisan identification informs voters’ opinions about the Affordable Care Act, Medicaid work requirements and lifetime limits, and Medicaid expansion.
  • But pluralities of Republicans (22%), Democrats (16%), and Independents (25%) chose cost as their most important health care issue.
  • Overall, just 7% of those surveyed chose repealing the ACA as the thing they want to hear about in 2018, and just 5% said it was most important for candidates to talk about single-payer — a sign that both parties’ bases are focused on issues that don’t animate the rest of the electorate.
The cash price of drugs is still rising above inflation

The drug industry has recently extolled the slow growth in the net prices of medications. But a new analysis from GoodRx reminds us that list prices are still going up a lot — and those prices matter for people who are uninsured, face high deductibles or pay coinsurance rates based on a drug’s list price.

The numbers that matter: The increase in cash prices over the past 12 months, per GoodRx:

  • Diabetes medications: 15%
  • Birth control: 8%
  • Top 100 prescribed drugs: 6%
  • Generic drugs: 5%

Key quote, about diabetes drug prices in particular: “If prices continue to increase at this rate, we could be seeing more people unable to care for their illness.”

People with ACA coverage fear they’ll lose it

Well, there’s at least one constituency that’s focused on the future of ACA coverage: the people who have it. A new survey this morning from The Commonwealth Fund, a liberal think tank, finds that 36% of people covered through the exchanges, and 27% of people covered through the Medicaid expansion, are afraid their coverage won’t be there in the long run.

  • They’re more worried about the Trump administration refusing to implement the law than Congress repealing it.

Key point: Cost is still a huge barrier to coverage, even in a heavily subsidized market:

  • “71% of uninsured adults who were aware of the marketplaces did not intend to visit the marketplaces to shop for coverage this year because they did not think they could afford it,” Commonwealth reports.
Why the new ACA lawsuit is such a long shot
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Yes, the latest lawsuit over the ACA seems on its face like a long shot, not the kind of thing the Supreme Court would ultimately smile upon.

Yes, but: It was filed in Texas. It’s seeking the same type of nationwide injunction district courts handed down for President Obama’s immigration policies as well as President Trump’s travel ban. And the initial decision would be appealed to the very conservative 5th Circuit Court of Appeals.

So, could it do some damage in the short term, even if it’s on its way to an eventual loss?

What we’re hearing: I put that question to Jonathan Adler, a law professor at Case Western Reserve University who helped spearhead the King v. Burwell challenge to the ACA. He is … not impressed by this suit.

  • “Might they get something out of a district court? Maybe, but I can’t see it going anywhere, for lots and lots of reasons,” he says. “I have a hard time taking it seriously as a legal challenge.”

The problems are myriad:

  • Standing: You can only sue the government over a concrete injury. But when no one has to pay a penalty for being uninsured, it’s hard to see the injury.
  • The crux of this lawsuit is to reprise the argument, from the last big individual mandate lawsuit, that the law cannot function as intended without the individual mandate.
  • But it’s Congress that repealed the individual mandate. It’ll be pretty hard to argue that Congress believed the mandate was not “severable” from the rest of the law — and responded by severing it.
  • “If Congress chooses to enact a two-legged stool, Congress chooses to enact a two-legged stool,” Adler says.

The bottom line: “I think it's clever but I think it's too clever,” Adler tells me.

Caitlin Owens

What we’re watching today: Both the White House and the U.S. Chamber of Commerce hold events on opioids.