Axios Vitals

A briefcase with a red cross on the front.

August 20, 2019

Situational awareness: Juul and Philip Morris have been sued in federal court for allegedly illegally marketing nicotine devices to minors, Bloomberg reports.

Today's word count: 1,029 words, or <4 minutes.

1 big thing: Trump's shrinking health care legacy

President Trump at an event on advancing kidney health.

President Trump at an event on advancing kidney health. Photo: Cheriss May/NurPhoto via Getty Images

President Trump came into office in 2017 with big ambitions on health care. But he’ll end this term with a lot less to show, Axios' Sam Baker reports.

The big picture: If Trump ends up being a one-term president, his health care legacy would be pretty modest.

Where it stands:

  • The administration scrapped its own plan to overhaul drug rebates. Its proposal to tie some drug prices to the prices European countries pay may not be finished by January 2021, leaving it in the hands of whoever wins in 2020.
  • A Democratic successor could stop approving Medicaid work requirements — one of Trump's most impactful health policies — and perhaps even pressure states to ditch the requirements Trump approved. And that's assuming the courts don't put a definitive stop to work requirements first.

On the Affordable Care Act front, both Barack Obama and Trump changed the rules dictating how long consumers can keep short-term insurance plans; another Democrat could probably change them again. Actions like promoting ACA enrollment would be easy to resume.

Yes, but: Price transparency could become an exception.

  • New rules require drugmakers to list their prices in their TV ads, and the administration has also proposed new price-disclosure rules for hospitals.
  • Those requirements would have to survive lawsuits from their respective industries, but they’re one of the few Trump initiatives a Democratic administration might not want to reverse.
  • On the other end of the "Yes, but" spectrum is the lawsuit aiming to get the entire ACA struck down. As long as the odds may be, if the Trump administration gets its way, that would certainly count as a health care legacy.

Go deeper.

2. Doctors flood Congress with lobbyists on surprise bills

Physician outsourcing companies and private equity firms are enlisting new groups to lobby Congress as it considers how to protect patients from receiving large bills from out-of-network doctors who are at in-network facilities, Axios' Bob Herman reports.

The big picture: Physician groups who most often mail out surprise medical bills are fighting proposals that take a bite out of their incomes to ease patients' financial burdens.

Driving the news: A group called US Physician Partners just hired Akin Gump to lobby over surprise bills, the coalition's third lobbying hire of the year.

  • US Physician Partners is affiliated with 3 physician staffing companies: US Acute Care Solutions, US Anesthesia Partners and US Radiology Specialists. Many surprise bills come from emergency room doctors, anesthesiologists and radiologists.
  • These same organizations funded another group that aired ads with false statements about a congressional proposal to cap doctors' out-of-network charges, PolitiFact and Kaiser Health News reported.
  • Private equity firm Welsh, Carson, Anderson & Stowe has an ownership stake in all of those companies.
  • US Acute Care Solutions did not address the lobbying in a statement, but said it supports legislation that would "incentivize all providers and insurers to negotiate in good faith." None of those companies or firms immediately responded to questions.

Private equity has gravitated toward specialties like emergency medicine and anesthesia because a few companies wield enormous market power. Now they and their portfolio companies are ratcheting up their lobbying presence as Congress gets closer to hammering out a final bill.

3. Drugmakers looking at opioid settlement

Two drug companies — Endo and Allergan — are in discussions about a settlement that would allow them to avoid participating in a massive opioids trial set to occur this fall, the Wall Street Journal reports.

  • Endo is working on a $10 million deal, while Allergan is negotiating a $5 million deal that may not completely remove it from the trial.

Why it matters: These 2 companies are relatively minor players in the trial, especially compared to drugmakers like Purdue Pharma and Johnson and Johnson. But this would still be a significant development, especially if other drug companies end up following Endo and Allergan's lead to avoid going to trial.

4. The internet's accessibility reckoning

Illustration of a computer wrapped in ropes.

Illustration: Axios/Rebecca Zisser

A years-long legal battle over whether Domino's Pizza must to make its website accessible to the disabled could make it all the way up to the Supreme Court this year, my colleague Sara Fischer reports.

Why it matters: Should the case go that far, its outcome could forever change the way the internet is regulated — and determine how accessible the internet will be for the roughly 20% of Americans with a disability.

Driving the news: Domino's is petitioning the Supreme Court to take up the case after a federal appeals court sided in 2016 with Guillermo Roble, a blind man who sued the company.

  • The pizza giant argues that compliance with the American Disabilities Act (ADA) is costly and unnecessary, because the law doesn't explicitly include internet provisions.
  • The disability community argues that online coverage is implied in the ADA.

Businesses often need to update their website's software code to work with screen readers and other technologies to make their websites more accessible to people with disabilities.

What's next: The Supreme Court will decide whether to take up the case after its new term begins in October.

5. Brand drug prices still increasing

Brand-name drugs' list prices are still going up, but not as much or as often as they have in the past, AP reports.

By the numbers: Drugmakers increased the list prices of branded medicines by a median of 5% over the first 7 months of 2019, down from 9% or 10% over the same period the prior 4 years.

  • Although some big drugmakers declined to raise prices mid-year, there were still 37 price increases for every price decrease over these 7 months.

My thought bubble: It's kind of hard to imagine that this would decrease any of the pressure on Congress to do something about drug prices.

6. The consequences of a hospital closure

The closure of a rural hospital can have a devastating impact on access to emergency care, as Kaiser Health News and NPR report in their latest installment of a series following the closure of the hospital in Fort Scott, Kan.

Background: The hospital closed at the end of 2018, but its emergency department has remained open and switched management. However, it closed for 2 weeks in February for renovations.

  • Emergency care is, of course, unplanned, so patients who needed to visit the ER during that time had to be driven or airlifted by ambulances to hospitals in other communities.
  • One patient had to wait as a dispatcher checked with four air ambulance bases before finally finding a pilot to take the flight.

The big picture: One analysis found that the average ambulance transport time for a rural patient rose from 14.2 minutes to 25.1 minutes after a hospital closed.

  • That extra time can have consequences for patients' health.

Go deeper: Rural hospital closures also deprive many communities of their biggest employers, as Bob chronicled when Community Health Systems closed a Missouri facility.