Jan 29, 2019

Axios Vitals

Good morning ... Here’s some health care news I sincerely hope you cannot use: The CDC does not want you to snuggle your pet hedgehog.

1 big thing: Soaring spending on seniors
Screenshot of CBO's Budget and Economic Outlook

More than half of federal spending will soon be dedicated to seniors, according to the latest estimates from Congress’ official budget scorekeeper.

Why it matters: That spending will be driven largely by the steadily rising cost of health care. And futzing around the edges of the system won’t change that trend.

Between the lines: Medicare and Social Security alone cost the federal government roughly $1.3 trillion last year, according to the Congressional Budget Office’s latest estimates.

  • CBO expects those 2 programs to reach $2.7 trillion by 2029.
  • Throw in a handful of other programs that Congress funds each year, and federal spending on people over 65 is expected to account for more 10% of the total U.S. economy in a decade.
  • Once you subtract the money the government spends on interest payments on the debt, programs for seniors would take up 50% of all remaining spending.

Aging baby boomers and rising health care costs are the main drivers of that spending. Per-person health care costs “are projected to grow faster than the economy over the long term,” CBO said.

2. Opioid makers' first day in court

For the first time, a pharmaceutical CEO is officially on trial for charges related to the opioid crisis. Opening arguments began yesterday in the trial of former Insys CEO John Kapoor, who — along with 4 other Insys executives — faces racketeering charges over the marketing of Subsys, a prescription fentanyl product.

Driving the news: Kapoor's lawyer sought to shift the blame to other Insys employees, Bloomberg reports, telling the jury during her opening statement that one of those employees hid payments to doctors from the CEO.

Why it matters: The judge in the Insys case told jurors yesterday not to let it become a “referendum on U.S. health-care policy," per Bloomberg.

  • But as the first trial of its kind, lawyers will inevitably be scrutinizing this case for signals and lessons that could inform future legal proceedings. That includes Massachusetts’ lawsuit against Purdue Pharma, the maker of OxyContin, and members of the Sackler family, who ran the company and oversaw its aggressive marketing.

Speaking of which: A Massachusetts judge ruled yesterday that Massachusetts' full, un-redacted complaint against Purdue must be released publicly. Purdue had fought the full release of the complaint, pitting it against the state attorney general as well as several news outlets.

3. ER "facility fees" strike again

Kaiser Health News and NPR are back with another installment of their “Bill of the Month” series: This time, it’s a guy who fainted after getting a flu shot, was taken to the ER, and ended up with a $4,692 bill.

The biggest culprit, at almost $3,000 of the total bill, was the ER’s “facility fee” — a charge just for walking in the door, not for any particular services.

  • Hospitals code each ER visit on a scale of 1 to 6; a 6 is supposed to be reserved for the most critical care, like a gunshot wound. The higher the number, the higher the facility fee.
  • The patient in this case was coded as a 5. The hospital, run by Atrium Health, said that’s because he received more than 3 tests.

"It's not a perfect system. Hospitals have an incentive to do a CT exam, and taxi drivers have an incentive to take the long way home,” the David McKenzie, reimbursement director at the American College of Emergency Physicians, told NPR.

Go deeper: Vox did a good rundown of rising facility fees as part of its own series on hospital billing.

4. Congress gets to work

Sen. Chuck Grassle (R-Iowa). Photo: Bill Clark/CQ Roll Call via Getty Images

The shutdown is over, and the new Congress is getting down to business with a slew of health care hearings. Axios' Caitlin Owens rounds them up:

  • The Senate Finance Committee is holding a hearing on drug prices. This one is worth watching for clues on what legislation has momentum and how far congressional Republicans are willing to go.
  • The House Oversight Committee is also holding its first hearing on drug prices. Chairman Elijah Cummings has been clear that he wants to be aggressive when it comes to pharma oversight.
  • The House Ways and Means Committee is holding a hearing on pre-existing conditions. Expect Democrats to beat up Republicans over their 2017 repeal and replace bill and the pending GOP lawsuit that would wipe out the entire ACA.
  • And for the wonks who are not interested in drug prices, the Senate HELP Committee is holding a hearing on community health centers.

What we're watching: This will probably be a lot of posturing, with Democrats talking tough, Republicans straddling a line between tough talk and a light touch when it comes to actual legislation, and pharma trying to keep Republicans in its corner.

  • The most interesting person to watch may be Finance Chairman Chuck Grassley, who has at times been harder on the industry than his fellow Republicans. But he has already laid out a relatively modest agenda on drug prices.
5. Harris sticks with "Medicare for All"

Sen. Kamala Harris (D-Calif.) sure doesn't sound like she's planning to soften her support for Sen. Bernie Sanders' version of "Medicare for All."

CNN's Jake Tapper asked Harris about the Sanders bill during an interview last night, specifically asking whether people who like their existing plans could keep them. Here's what she said:

"The idea is that everyone gets access to medical care, and you don't have to go through the process of going though an insurance company ... going through the paperwork ... Let's eliminate all of that. Let's move on."

Between the lines: Harris cosponsored Sanders' bill, so in one sense this isn't surprising. So did fellow 2020 candidates Sen. Kirsten Gillibrand (D-N.Y.) and Sen. Elizabeth Warren (D-Mass.), and potential candidate Sen. Cory Booker (D-N.J.).

  • But even Sanders' bill is not necessarily a complete legislative package; it doesn't include measures to pay for its coverage expansion.
  • So it wouldn't be shocking to see some other Democratic candidates treat Sanders' bill as a jumping-off point and lay out their own version. But Harris seemed to be sticking with the most dramatic consequence of Sanders' proposal — the likely end of private health insurance.
6. Measles are back

Illustration:Aïda Amer/Axios

After having practically eradicated measles from the U.S. almost two decades ago, a growing anti-vaccination movement has led to a resurgence of cases, currently concentrated in the Pacific Northwest and New York.

Public health officials are concerned the pro-vaccination message isn't getting through.

  • Unless doctors and the public step up to counteract the vocal opposition to vaccines with evidence and facts, there is a serious concern that infectious diseases like measles could return full-force, public health officials and scientists tell Axios' Eileen Drage O'Reilly.

What they're saying: "When we see outbreaks of measles like this one, it’s a reminder to parents that many diseases rarely seen in the United States can affect their unvaccinated children," said Nancy Messionnier, the director of the CDC's National Center for Immunization and Respiratory Diseases.

Go deeper.