Oct 18, 2019

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning.

📺 Situational Awareness: "Axios on HBO" returns this Sunday!

  • This week: Sen. Lindsey Graham and Sen. Mitt Romney talk impeachment, and then the economists behind Sen. Elizabeth Warren's "ultra-millionaire tax" give us an inside look into the plan. Plus, we take a dive into the future of esports. Tune in at 6pm ET/PT on HBO. 🎉

Today's word count is 836, or ~3 minutes.

1 big thing: Why we're failing to stop teen suicide
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Data: CDC; Chart: Naema Ahmed/Axios

Parents, teachers and lawmakers are grappling with the worst teen suicide rate in U.S. history, despite a spate of state laws and training programs designed to help, Axios' Marisa Fernandez reports.

By the numbers: The number of suicides from people ages 10 to 24 increased 56% fr0m 2007 to 2017, the fastest rate of any age group, a new CDC report shows.

  • Suicides are disproportionately affecting people of color and those in the LGBTQ community.

Teachers in some school districts are scouring Google for mental health advice because they don't know how to help their students, Sam Brinton, the head of advocacy and government affairs for the Trevor Project, tells Marisa.

Intervention and prevention plans are either mandatory or strongly encouraged in 42 states, but there are still pleas for more inclusive programming.

  • The number of black teens attempting suicide surged 73% since 2007, according to recent study.
  • Out of the 22 suicide-prevention laws passed in 2019, only Nevada's specifically mentions LGBT youth. This group is 5 times more at risk of suicide than their straight peers, according to the Trevor Project, a crisis and suicide prevention center LGBTQ youth.
  • Suicide is the second-most common cause of death among teenagers and young adults, overtaking homicides and outpaced only by accidents.

The bottom line: "If you had kids suddenly dying at these rates from a new disease or infection, there would be a huge outcry. But most people don’t even know this is happening," Lisa Horowitz, a pediatric psychologist at the National Institute of Health, told the Washington Post.

2. Big Pharma's giant payouts to doctors

More than 700 doctors were paid at least $1 million by drug and medical device companies between 2014 and 2018, ProPublica reports. More than 2,500 received at least half a million dollars.

Why it matters: Many drugs that are heavily promoted have strong competition. "Promotional spending is a major way that manufacturers in these situations distinguish themselves from each other — not by conducting comparative studies or by engaging in substantial price reductions," said Aaron Kesselheim, a professor of medicine at Harvard Medical School.

Between the lines: The Affordable Care Act required such payments to be made public. While some experts thought transparency may cause companies and doctors to rethink the payments, that doesn't seem to have been the case.

  • Doctors were paid for activities like dinner talks, sponsored speeches or consulting on products.

By the numbers: In each of the 5 years, drug and device companies spent between $2.1 billion and $2.2 billion paying doctors. Around 600,000 doctors received payments each year.

Read the investigation.

3. Health benefits won't change for GM workers

The tentative deal between General Motors and the United Auto Workers includes an agreement to keep the same health care plans "with no additional costs to members," according to a summary of the deal.

Why it matters: Most employer health plans are getting more expensive and less comprehensive.

  • The UAW is ensuring GM's benefits stay comprehensive for workers — a move that competing automakers Ford and Fiat Chrysler likely will adopt in their negotiations — but the coverage itself remains pricey and chips away at funds that could go toward wages, Axios' Bob Herman writes.

Details: GM wanted unionized workers to pay for 15% of their health care costs through premiums and deductibles, up from 3%, and it wanted to allow its pharmacy benefit manager, CVS Health, to exclude certain medications from its approved list of drugs.

  • Those changes were rejected, and GM's benefits instead got friendlier for workers and the health care industry.
  • For example, workers will be protected from any surprise medical bills that come from air ambulances, according to another summary of the deal.
  • GM also agreed to "increased reimbursement rates for non-participating hospitals" — essentially providing an incentive for facilities to go out-of-network, where they charge higher prices.

The big picture: GM's health care tab in 2018, just for hourly unionized workers and their families, hit approximately $900 million. Ford's annual health care expenses similarly are expected to top $1 billion. New union contracts with the same terms would instantly balloon those figures.

4. UnitedHealth steering patients to cheaper care

Insurance giant UnitedHealthcare is strengthening its effort to steer patients receiving outpatient surgery away from hospitals and toward cheaper physician offices or ambulatory surgery centers, Modern Healthcare reports.

  • Beginning in November, in most states, United won't pay for certain planned surgeries performed in an outpatient hospital setting unless they've been reviewed and the location deemed necessary.
  • "There is considerable excess spending on care delivered in sub-optimal, high-cost settings that can and should be provided in higher quality, consumer responsive and more cost-effective sites," CEO Dirk McMahon said in an earnings call on Tuesday.

The big picture: This is part of a growing effort to address the fact that hospitals charge higher prices for the same outpatient services than other facilities.

  • A rule by the Trump administration that would require Medicare reimbursement for a procedure to be the same regardless of the site of care was recently overturned in court.
  • Hospitals hate such efforts, which threaten their revenue, and are fighting them tooth and nail.

Go deeper: Hospitals' increasing revenue from outpatient testing

5. Juul to halt online sales of flavored pods

Photo: Scott Olson/Getty Images

Juul will stop selling flavored e-cigarette cartridges online, after halting brick-and-mortar sales last year, in response to criticism from schools, parents and regulators who have said the flavored products contributed to the spike in teen vaping.

Where it stands: The self-imposed limits don't apply to menthol or tobacco flavors, Marisa writes. The Food and Drug Administration is also still investigating Juul's advertising practices.

Go deeper: Juul faces first lawsuit over a death linked to vaping illness

Caitlin Owens