Jul 9, 2019

Axios Vitals

Good morning. Today's Vitals is 857 words, or ~3 minutes.

1 big thing: Child migrants' mental health crisis

Illustration: Aïda Amer/Axios

The children who have been detained in overcrowded, squalid migrant camps at the border aren't just facing poor living conditions. They are also facing higher risks of serious mental health problems, some of which could be irreparable, Axios' Bob Herman reports.

The big picture: Children are fleeing life-or-death situations in their home countries, and instead of healing their psychological and emotional trauma, federal officials are exacerbating the damage through means that the medical community views as flagrant violations of medical ethics.

The literature is clear: People who seek asylum and are detained in immigration camps, especially children, suffer "severe mental health consequences." Those include detachment, depression and post-traumatic stress disorder, which put them at higher risk for committing suicide.

  • The conditions of today's U.S. detention centers — sleeping on concrete floors, a lack of basic necessities, unsanitary cage holdings and family separations — compound the trauma of migrant children who have witnessed violence and death back home and have endured arduous journeys to escape, according to interviews with pediatricians, child psychiatrists, medical ethicists and researchers.

What they're saying: Medical professionals remain appalled at what they've seen and are raising alarms the U.S. immigration system is still needlessly hurting the already vulnerable mental health of these kids.

Between the lines: Parents and other adult caregivers are usually the only source of stability for children. Every expert interviewed said separating them in any capacity is psychologically damaging and morally intolerable.

The bottom line: "Most kids will have lasting scars from what they have seen or are enduring right now," said Wes Boyd, a psychiatrist and bioethicist at Harvard Medical School who has evaluated more than 100 asylum seekers in the past decade. "They're going to need as much medical help as they do legal help."

2. Judge halts Trump's drug pricing rule

Health and Human Services Secretary Alex Azar. Photo: Bastiaan Slabbers/NurPhoto via Getty Images

A federal judge yesterday blocked the implementation of the Trump administration's new rule requiring drug companies to include the list prices of drugs in TV ads, a blow to the Trump administration's drug pricing agenda.

The big picture: The rule was set to take effect on Tuesday, but U.S. District Judge Amit Mehta sided with drugmakers Merck & Co, Eli Lilly and Co. and Amgen to halt the HHS rule, Axios' Rebecca Falconer writes.

What she's saying: Mehta said in his ruling that the court does not question the motives of HHS in adopting the rule, but it doesn't have the authority to drug firms to disclose prices, according to The Hill.

  • "No matter how vexing the problem of spiraling drug costs may be, HHS cannot do more than what Congress has authorized. The responsibility rests with Congress to act in the first instance."

The other side: "We are disappointed in the court's decision and will be working with the Department of Justice on next steps related to the litigation.... We are not surprised by the objections to transparency from certain special interests," HHS spokesperson Caitlin Oakley said.

My thought bubble: This is the largest drug pricing policy enacted by the Trump administration so far. Although experts are skeptical that it'd do much to lower prices, the ruling leaves the president with little to point to on drug prices, so far, heading into 2020.

Go deeper: New rule on drug prices is asking for lawsuits — literally

3. ACA's fate will be argued in court today

Republican attorneys general and the Trump administration will make their case in court today for striking down the entire Affordable Care Act.

What we're watching, courtesy of Axios' Sam Baker, who will be attending today's oral arguments before the 5th Circuit Court of Appeals:

  • Severability: It wouldn't be too hard to throw out what remains of the ACA's individual mandate but leave the rest of the law intact. That outcome didn't seem to interest Judge Reed O'Connor, the lower-court judge who said last year the whole law had to go, but it could get a second chance today.
  • Congressional intent: Congress said in 2010 that the individual mandate was intertwined with the law's other coverage provisions, most notably its protections for people with pre-existing conditions. But it was also Congress that redesigned the law, keeping those protections in place but nullifying the mandate. Does the 111th Congress' intent override the 115th's?

Why it matters: If all of this ends with the Affordable Care Act being struck down, it'll kick millions of people off their coverage, upend the health care system and force the political debate about health care back into 2010-level intensity.

  • That hasn't happened yet and it may not happen, but the 5th Circuit is the last stop before the Supreme Court, so buckle up.

Stay tuned to Axios.com for updates after today's hearing.

4. Doctors don't make better patients

Doctors — which are the best-informed patients out there — don't receive significantly more high-value care than non-doctors, according to a new National Bureau of Economic Research paper.

  • "Our results suggest that physicians do only slightly better than non-physicians — but not by much and not always," the authors write.

Why it matters: Many policies are designed based on the idea that if people have more information, they'll be better health care consumers.

  • For example, this is the theory behind high-deductible insurance. One possible explanation for why it hasn't been very effective in improving patient health is because consumers aren't knowledgeable enough to steer themselves toward high-value care.

The bottom line: "These results provide a rough boundary on the extent to which additional information disclosure (beyond prevailing levels) can be expected to improve the delivery of health care in the U.S.," the authors write.

5. Amazon fading from health care supply chain

Hospital purchasing managers aren't buying as many medical supplies from Amazon as they did last year, Bloomberg reports.

  • But they're increasing their purchases of office supplies, according to a survey by UBS Group AG.
  • Respondents said that they were seeing less discounts for medical supplies on Amazon, but it's unclear whether Amazon's offering smaller discounts or wholesalers have begun offering better deals in response.