Nov 6, 2018

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning ... How much do I love you, Vitals readers? Enough that I'm going to miss Kentucky basketball tonight — and they're playing Duke! — to bring you everything you need to know from election night. (The scheduling here does feel like it was engineered to punish me, specifically.)

1 big thing: What matters in the midterms

Photo: Joe Raedle/Getty Images

Medicaid, Medicaid, Medicaid. It hasn’t been the dominant national theme, even in an election season dominated by health care, but Medicaid has more on the line tonight than any other area of health policy.

By the numbers: 17 states haven’t adopted the Affordable Care Act’s Medicaid expansion.

  • 3 of those 17 states (Idaho, Nebraska and Utah) have initiatives on the ballot today to expand Medicaid.
  • 6 more have gubernatorial races rated as toss-ups by the Cook Political Report (Florida, Georgia, Kansas, Oklahoma, South Dakota and Wisconsin).
  • If all 9 of those states ended up expanding Medicaid, more than 1.6 million people would be newly eligible for coverage, according to the Kaiser Family Foundation’s estimates.

That’s an upper bound, obviously — it’s by no means safe to assume all of these states will end up expanding. But Florida alone could cover more than 700,000 new people; the universe of possible coverage gains here is large, even without a clean sweep.

Two expansion states also face big decisions tonight.

  • Maine’s gubernatorial race could determine whether it actually implements the expansion voters approved last year.
  • Montana voters will decide whether to retain the Medicaid expansion, relying on a tobacco tax to pay for the state’s share of the costs. Tobacco companies have spent millions urging Montanans to not to renew the expansion.

The bottom line: Expanded Medicaid coverage, much of it in red or purple states, is one of the most consequential on-the-ground changes these midterms could produce.

2. What else we’re watching tonight

The balance of power in Congress (duh):

  • Significant Democratic gains would take ACA repeal even further off the table, and would vindicate Democrats' relentless focus on health care throughout the campaign season.
  • It would also put more pressure on industry groups to get their small-but-significant lobbying priorities, like pharma's "donut hole fix," done in the lame-duck session.
  • But nothing major is likely to happen in the next 2 years.

California's dialysis initiative: The dialysis industry has raised a record $110 million to defeat a ballot initiative that would cap its profits.

  • Even in a state as liberal as California, cutting into the health care industry's bottom line is no easy task.

Other ballot initiatives:

  • Ohioans will vote on a constitutional amendment that would classify offenses related to drug possession as misdemeanors — largely in response to the state's opioid epidemic.
  • A ballot measure in Massachusetts would enforce a new ratio of nurses to patients in some hospital facilities.
  • The soda industry is spending millions to support ballot initiatives in Oregon and Washington state that would ban local governments from enacting soda taxes, as the New York Times explained. (A similar approach has already worked in California.)
3. Industry bets on Republicans
Expand chart
Data: OpenSecrets; Note: Based FEC data from Oct. 26; Chart: Andrew Witherspoon/Axios

Political action committees for health care companies have mostly donated to Republicans in this cycle, according to the Center for Responsive Politics. That's true across multiple sectors — including doctors, pharmaceutical companies and insurers.

Hospitals are the exception. The American Hospital Association's PAC had given significantly more to Democratic candidates, as of Oct. 26. Individual hospital systems' PACs break in both directions.

Between the lines: A whole lot of Democratic candidates have sworn off corporate PAC money.

Flashback: Trump pits Republicans against their donors

4. Health care’s golden parachutes

LifePoint Health has made waves among investors who think the hospital company’s $120 million golden parachute pay packages — spread across 4 executives as part of the company’s buyout from private equity firm Apollo Global Management — are inappropriate.

By the numbers: LifePoint's payouts have been higher than other companies that have been acquired over the past 2 years, according to federal proxy disclosures reviewed by Axios' Bob Herman:

  • TeamHealth: $46 million (5 executives)
  • Envision Healthcare: $44 million (6 executives)
  • Kindred Healthcare: $42 million (5 executives)
  • Cotiviti: $25 million (6 executives)
  • Air Methods: $21 million (6 executives)

The big picture: More health care executives are primed for huge paydays if their own respective deals go through, thanks to the frenzy of dealmaking in the industry.

  • Aetna CEO Mark Bertolini stands to make almost $500 million by himself if CVS finishes its deal for Aetna. Express Scripts executives could make at least $102 million if their deal with Cigna closes.
5. Rapper Mac Miller died of opioid overdose

Mac Miller died from an overdose of fentanyl, cocaine and alcohol, the Los Angeles County Medical Examiner-Coroner announced yesterday.

  • He joins a list of celebrities who have died from an opioid overdose, including Prince and Tom Petty. These deaths have elevated awareness of the epidemic.

Why it matters: Opioid addiction isn't just a problem in rural America, Axios' Caitlin Owens notes. It's impacting lives across the country, among diverse communities and demographics. 

Caitlin Owens