Axios Vitals

A briefcase with a red cross on the front.

September 13, 2017

Good morning ... Take your pick today: A small group of Republicans is set to introduce a repeal-and-replace bill that won't pass, and a small group of Democrats is set to introduce a single-payer bill that won't pass. Only one thing is certain: Nobody seems to like the health care system we have.

Is single-payer ready for its close-up?

Single-payer isn't going to pass anytime soon, obviously. But after today, it's unlikely to go away anytime soon, either.

What's happening: Sen. Bernie Sanders, who published an op-ed piece in the NYT this morning, will introduce his "Medicare for All" legislation today. In addition to Sanders, four more of Democrats' top 2020 prospects — Sens. Cory Booker, Kirsten Gillibrand, Kamala Harris and Elizabeth Warren — have already signed on as cosponsors.

Quick take: Support from the 2020 crowd is legitimately a big deal.

  • Even if some of them are only doing it because they think they have to, that's still a huge political shift within the party. It wasn't that long ago you had to say you opposed single-payer if you wanted to be taken seriously as a presidential candidate.

Yes, but: It may be time for mainstream Democrats to reckon with the left's power. But that means it's also time for everyone to reckon with just how difficult single-payer is — both the policy and the politics.

  • No one has a clear vision of what "single-payer" actually means.
  • Even "Medicare for all" isn't true single-payer. Most Medicare beneficiaries buy private supplemental coverage to fill in gaps the government program doesn't cover. Its drug benefit is largely privately administered.
  • Sanders is one of the few who really cares how Sanders' bill answers those questions. His cosponsors almost certainly will treat it as a political proxy — a broad statement of support for a vaguely defined goal rather than as a specific policy endorsement.

Between the lines: Single-payer feels like it has momentum right now because Democrats with presidential aspirations are signing on. And, again, that matters. But Democrats aspiring to keep their Senate seats next year, or to win some House races, haven't yet shown they are on board.

The bottom line: Single-payer — whatever it looks like — has a long way to go before truly becoming a position that Democrats want to run on, never mind before becoming law. But it's undeniably moving in that direction.

There’s a deal on CHIP

Sens. Orrin Hatch and Ron Wyden — the chairman and ranking member of the Senate Finance Committee — announced last night that they've struck a deal to extend the Children's Health Insurance Program. Federal CHIP funding expires at the end of this month.

The details:

  • The deal would extend CHIP for five years.
  • A Senate aide told me the Affordable Care Act's 23% increase in federal CHIP funding would remain in place through 2019, then drop to 11.5% in 2020, and then will level off to its pre-ACA funding by 2021.
  • Legislative text "will be released in the coming days," the pair said in a statement.

The odds: If Hatch and Wyden can get a deal on this, they can probably sell it to the rest of the Senate, and maybe the House too. But they still need a legislative vehicle to get it passed and signed into law.

Medicaid expansion has lowered the number of uninsured

It's obvious that the ACA is driving the reduction in the number of uninsured Americans — now down to 8.8% of the country. Take a closer look at the new data the Census Bureau released yesterday, as Axios' Bob Herman did, and it's also obvious that, for all the time we spend talking about the exchanges, the ACA's Medicaid expansion has been the key factor in driving that reduction.

The states with the highest percentage of uninsured residents are all non-expansion states: Texas (16.6%), Oklahoma (13.8%), Georgia (12.9%), and Florida (12.5%).

Wait, is that the sound of optimism?

Michael Neidorff, CEO of health insurer Centene, made some interesting — and surprisingly optimistic — comments at an industry conference yesterday. Centene is a major player on the ACA's marketplaces, and Neidorff believes Congress may come to an agreement to fund the ACA's cost-sharing reduction subsidies.

  • "As I have been telling senators and congressmen, if you don't keep the CSRs, we still have premium subsidies," Neidorff said. "So it's not going to kill us, but it's going to cost you a whole lot more money. And so they said, 'We're hearing that, and we know that.' So I'm still confident that we will see some important movement there."

Bob's thought bubble: Centene is well-connected in D.C., so Neidorff's optimism isn't coming out of thin air. And he's correct that not funding cost-sharing subsidies will cost the federal government more money. But it's still going to be tough for Republicans to fund the subsidies.

Cutting the orphan drug backlog

FDA commissioner Scott Gottlieb wants you to know he's on the case with that backlog of "orphan drug" designations — that special status that rewards drug makers for developing treatments for rare diseases.

In a blog post yesterday, Gottlieb said the Food and Drug Administration has finished all reviews of orphan drug designation requests that had been around for more than 120 days. He also said the FDA is working out a system so there won't be another backlog like that. The new goal is to finish all reviews within 90 days.

What to watch: The program is supposed to encourage drug makers to tackle rare diseases by giving them tax credits and other incentives. Now's our chance to find out whether clearing the backlog really improves the lives of the patients who need new treatments.

What we're watching today: Sens. Bill Cassidy and Lindsey Graham unveil their health care bill at an 11:30 a.m. press conference. Sanders unveils his single-payer bill at 2 p.m. House Ways and Means Committee marks up a handful of Medicare-related bills, beginning at 10:30 (details here).

What we're watching this week: HELP Committee wraps up its hearings on ACA stabilization Thursday.

Get in touch: What health care stories am I missing? Let me know: [email protected]