Good morning. Today is the New Hampshire primary, and we should all cross our fingers and hope it goes much more smoothly than Iowa did.
Today's word count is 818, or a 3-minute read.
Illustration: Aïda Amer/Axios
President Trump's 2021 budget proposes massive reductions in Medicare and Medicaid spending, which would be felt most acutely by hospitals and Medicaid beneficiaries.
Why it matters: Budget proposals are more about messaging than policies that have any chance of becoming law, but it's still a good indication of the direction the administration would like to head in if Trump wins re-election.
Details: The budget would reduce Medicare and Medicaid spending by hundreds of billions of dollars each over the next decade.
Between the lines: These huge Medicare savings come at the expense of hospitals, including through site-neutral payment policies and reduced uncompensated care payments.
My thought bubble: It's extremely hard to see Congress legislating these kind of cuts to hospitals, no matter who's in charge. But if Republicans are in control after the election, it's pretty easy to see them at least trying to pass these large-scale Medicaid reforms again.
Trump's budget calls for "comprehensive drug pricing reform" but doesn't mention the biggest drug pricing policy left on the administration's table.
What they're saying: When I asked HHS why the administration's international pricing index (IPI) wasn't included in the budget, a spokesperson said that "we have taken a sweeping series of administrative actions towards [our drug pricing] goals, and we are supportive of bipartisan, bicameral legislative efforts that will further these goals and lower drug prices for American patients."
Flashback: Trump didn't mention the international pricing index — which would tie what Medicare pays for some drugs to what other countries pay — during the State of the Union last week, either, instead calling out a bipartisan drug pricing bill sponsored by Sens. Chuck Grassley and Ron Wyden.
Between the lines: The Grassley-Wyden bill is by no means a pharma giveaway, but it's much more palatable to the industry than the huge cuts that would come under IPI.
Illustration: Sarah Grillo/Axios
A new study found that experimental drugs made by Eli Lilly and Roche didn't help people with a rare, inherited form of Alzheimer's, the Wall Street Journal reports.
Why it matters: Alzheimer's is a devastating disease, and drug after drug keeps failing to do more than temporarily alleviate its symptoms.
Yes, but: The prevalence of the disease, combined with how it has become somewhat of a holy grail for drugmakers, means that the industry has far from given up on it.
Many experts have questioned the FDA's drug approval standards over the past few years, as several controversial drugs have gotten the green light despite less rigorous testing, Axios' Bob Herman writes.
What they're saying: Peter Stein, the head of the FDA's office that analyzes new drugs, sat down with Zachary Brennan of Regulatory Affairs Professionals Society and said the only thing that's changed with the FDA's approval process is a shift in the types of drugs the agency is reviewing.
The bottom line: There's no doubt biotech startups and drug companies have invested more time and money in treatments that go after cancers or conditions that treat a very small subset of people. Those kinds of medicines usually command the highest prices.
Transporting kidneys on commercial flights for transportation can put the organs in jeopardy, thanks to delays and logistical problems, Kaiser Health News and Reveal report.
Why it matters: Organs can only be outside of the body for a certain number of hours before doctors will refuse to put them inside patients, Axios' Marisa Fernandez writes.
By the numbers: More than 8,800 organ and tissue shipments were collected voluntarily between 2014 and 2019 from the United Network for Organ Sharing.
The bottom line: Organ distribution lacks a centralized system, relying on multiple partners like non-profits, doctors, career services and several domestic airlines to transport a kidney. It can lead to confusion and logistics problems where in the end, the patient suffers.
Editor's note: The first item in yesterday's Vitals has been corrected to say that the House Energy and Commerce Committee's surprise billing legislation would use a blend of benchmark rates and arbitration to resolve surprise billing disputes (not decide payment rates based on a benchmark).