Axios Vitals

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June 29, 2018

Good morning ... Situational awareness: All eyes today are on Judge James Boasberg, who has said he’d rule on Kentucky’s Medicaid work requirements before the end of the month. Unless Boasberg stops them, the new rules are slated to take effect Sunday.

1 big thing: Public wants to keep Roe v. Wade

Data: Kaiser Family Foundation Health Tracking Poll; Chart: Andrew Witherspoon/Axios
Data: Kaiser Family Foundation Health Tracking Poll; Chart: Andrew Witherspoon/Axios

Abortion rights are in the balance with Justice Anthony Kennedy's retirement from the Supreme Court, but most voters want the high court to keep abortion legal, according to polling from the Kaiser Family Foundation. The survey was conducted before Kennedy announced his retirement.

Why it matters: The Supreme Court isn't responsive to public opinion in the same way the elected branches are, but it does often try not to get too far ahead of public opinion — especially under the leadership of Chief Justice John Roberts, who's known for his concern for the court's institutional standing.

  • Abortion rights will also be the No. 1 issue for the Democrats gearing up to fight President Trump's nominee, even without enough votes to block him or her.

Between the lines: Public support for abortion rights helps explain why a post-Kennedy court is likely to chip away at abortion rights incrementally, rather than immediately taking on Roe v. Wade.

  • If a more conservative court does begin to roll back abortion rights, it would almost certainly start by upholding state-level restrictions like bans on abortion after a certain point in a pregnancy, or prohibiting specific types of abortion procedures.

Go deeper: This isn't really about health care, but The New York Times has a good story on the family connections and not-so-subtle lobbying the White House deployed to push Kennedy toward the exit.

2. Amazon makes its move

Data:; Chart: Harry Stevens/Axios
Data:; Chart: Harry Stevens/Axios

Pharmacy stocks took a beating yesterday after Amazon formalized its move into their industry, announcing that it will buy the online pharmacy PillPack.

Threat level: Picking up a prescription is about as close as the health care system ever gets to a traditional retailer-consumer interaction. That's part of the reason it has seemed like such a natural fit for Amazon, which has already cannibalized a lot of the other shopping people do at places like CVS and Walgreens.

  • The hard part for Amazon was breaking into a highly regulated market. But that's not as big a challenge when you can simply buy an operation that's already licensed in 49 states.

Behind the scenes: Walmart had been in talks to buy PillPack. But Amazon was able to swoop in after Walmart "dragged its feet" on a final deal, CNBC reports.

3. “Trauma fees” cost patients thousands

Vox and Kaiser Health News pull back the curtain on yet another way hospitals and insurers stick patients with expensive and surprising bills: trauma fees.

How it works: These fees were initially intended to cover the cost of having a trauma unit on call at all times, which is an expensive proposition. When ambulance EMTs radio ahead that they’re bringing in a trauma patient, those teams activate.

  • Medicare will only pay trauma fees for patients who receive at least 30 minutes of critical care, and there are supposed to be two tiers of fees, depending on what the patient needs.

Yes, but: Vox and Kaiser tracked down multiple patients who were charged thousands of dollars in trauma fees even though they weren’t actually treated for trauma. One family got an $18,000 bill after a hospital told them their baby didn’t need any treatment at all.

  • Medicare pays less than $1,000 for trauma fees, on average. So hospitals charge private insurers as much as $50,000. But insurers will sometimes only pay the portion they deem “reasonable,” and then hospitals bill patients for the difference.

The other side: “We are the trauma center for a very large, very densely populated area. We deal with so many traumas in this city — car accidents, mass shootings, multiple vehicle collisions,” one hospital told Vox. “It’s expensive to prepare for that.”

4. Some good news about death

More people are dying at home, rather than in a hospital, and end-of-life health care spending may not be as wasteful as we once thought, according to a pair of new studies.

More people are dying at home. The number of Medicare beneficiaries who died at home or in their community rose by about 10 percentage points from 2000 to 2015, according to a study published in the Journal of the American Medical Association.

  • Why it matters: Home care tends to cost less than inpatient hospital care, and is often much more comfortable for patients.

Defining "wasteful" spending: A separate study, published in Science, challenges the conventional wisdom about wasteful spending at the end of patients' lives.

  • "That one-quarter of Medicare spending in the United States occurs in the last year of life is commonly interpreted as waste. But this interpretation presumes knowledge of who will die and when," the authors wrote.
  • In reality, they found, we're pretty bad at predicting who will die, and when. So the system isn't necessarily directing a lot of expensive care toward patients it can't help.
  • “We spend money on sick people — some of them die, some of them recover,” one of the study's authors told Stat. “Maybe some recover, in part, because of what we spent on them.”

5. California bans soda taxes

This is a wild one: Democratic California Gov. Jerry Brown signed a bill yesterday that bars local governments from taxing soda and sugary drinks.

Why now: Because several California cities were passing soda taxes, and the industry didn't like it.

The intrigue: The bill to ban soda taxes was first introduced less than a week ago, and state lawmakers say they were "blackmailed" by the beverage industry.

  • According to the Los Angeles Times, as more California cities started to consider soda taxes, the industry spent millions to support a ballot initiative that would have made it significantly harder for cities to ever raise any taxes.
  • That initiative was removed from the ballot in exchange for the statewide ban on soda taxes.

Quick take: The soda industry's initiative might be off the ballot, but the proposal to break California up into three smaller states is still on there. California, it might be too easy to get things on your ballot.

Have a great weekend. As always, send me your tips, questions and feedback: [email protected].