Sep 25, 2019

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. A lot of the time we reporters can feel like our words are disappearing into the void, but sometimes those words have an impact.

  • ProPublica headline: We Reported on a Nonprofit Hospital System That Sues Poor Patients. It Just Freed Thousands From Debt.

Today's word count is 888, or 3 minutes.

1 big thing: How a public option could benefit employees
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Data: The Commonwealth Fund; Chart: Axios Visuals

Democratic presidential candidates' proposed changes to the Affordable Care Act could be a particularly big relief to low-wage workers.

Between the lines: These effects would be especially noticeable in some politically important states — including Florida, North Carolina and Texas.

How it works: In addition to creating a public insurance option, former Vice President Joe Biden and South Bend, Indiana Mayor Pete Buttigieg have proposed changes to the ACA's system of subsidies.

  • Today, those subsidies aren't available to people who have the option of getting coverage through their jobs, and the least generous subsidy caps a person's premiums at 9.9% of their income.
  • Biden and Buttigieg would require that no one pays more than 8.5% of their income on premiums, and they'd let people forego employer insurance and get coverage through the exchange — or at least through the public option.
  • They'd also peg those subsidies to more generous policies with lower deductibles.

And a public plan would likely be cheaper than most private coverage, creating a more affordable option and, supporters argue, bringing down prices throughout the market.

What they're saying: Many low- and moderate-income workers would likely choose those options, said Matthew Fiedler of the Brookings Institution, because premiums for employer insurance often eat up more than 10% of poorer workers' incomes.

Employers — especially in low-wage, high-turnover industries — could also end up benefiting.

  • "Many employers would undoubtedly like to be out of the health insurance business if they could be guaranteed their employees could find comparable affordable coverage elsewhere," Avalere director Chris Sloan said.
2. The downside of the cancer drug explosion

Pharmaceutical investment in cancer treatments has risen drastically over the past decade, as has spending on cancer drugs, but the results have been comparatively small, UC Hastings law professor Robin Feldman argues in a WashPost op-ed.

  • U.S. law — including law designed to increase investment in rare diseases — incentivizes companies to invest in cancer, she adds.
  • "By classifying so many cancers as rare diseases afflicting under 200,000 people each, this regulatory setup has unleashed a veritable tidal wave of oncology drugs," she writes.

By the numbers: Since 2013, cancer drug spending as a proportion of all U.S. drug spending has increased by nearly 60%, but the overall death rate from cancer has decreased by only 5% since 1950.

  • Cancer drugs approved between 2003 and 2013 increased survival by an average of 3.4 months.

Why it matters: Every dollar invested in cancer is a dollar that isn't invested elsewhere — for example, in antibiotics.

  • "The greatest risk is not only that our moonshot may fail, but that the nation’s other public health needs will be left in the dust," Feldman writes.

Go deeper: Pharma goes all in on cancer treatments

3. Amazon Care isn't that exciting

Amazon is working with a physician practice in Seattle to provide virtual care as well as in-person care at home or the office for certain local employees, CNBC reports.

  • A noteworthy exclusion: People who have Kaiser Permanente insurance through Amazon are not eligible for this.

Between the lines: If this concept sounds familiar, it is. On-site clinics run by employers have been around for decades, Axios' Bob Herman writes. Walmart also operates its own clinics

  • Amazon is pretty much doing that, except it's adding a telemedicine app and home-delivered medications.

The bottom line: Amazon's experiment is small, targets a healthier working-age population, and borrows existing ideas (telemedicine and employer-managed clinics) that have had negligible effects on the health care system. This isn't transformational.

  • And if Amazon employees have a heart attack, they will still need to go to a hospital — where care is significantly more expensive than video visits or text chats, and where quality and billing practices are all over the place.
4. Massachusetts winning the vaping ban contest

Photo: Yui Mok/PA Images via Getty Images

Massachusetts Gov. Charlie Baker declared a statewide public health emergency on Tuesday and called for a 4-month ban on all vaping products, AP reports.

Why it matters: This is the farthest-reaching ban yet by any state, as it is the only restriction in the country that forbids all vaping products, Axios' Fadel Allassan writes.

  • Massachusetts' ban also goes beyond President Trump's proposal to pull all flavored e-cigarette cartridges from the market, leaving just the tobacco flavor — effort to discourage youth vaping.

The big picture: The CDC reported 530 possible cases of severe respiratory illnesses among people who vaped nicotine or cannabis products as of Sept. 19. Nine people have now died from vaping-related lung illnesses.

Go deeper: U.S. investigates fatality from vaping as lung-related illnesses rise

5. 1 sleep thing

CVS Health is encouraging employers to cover an insomnia app — "Sleepio" — as an employee benefit, the New York Times reports.

The big picture: CVS Health's promotion of the app could help boost digital therapeutics, which use apps to help connect people with mental health treatment, my colleague Marisa Fernandez writes.

  • The apps are made for conditions ranging from insomnia to schizophrenia and multiple sclerosis, and use both established and new treatment methods.
  • Digital therapeutic startups collected $293 million globally from 22 deals in Q2 2019, which was more than double the $107 million and 11 deals in Q1, Business Insider reports.

Researchers are still looking into how effective medical apps are at treating diseases, and some experts say they're not ready for mass adoption. Most just vaguely label themselves as wellness apps.

  • CVS told NYT it is carefully reviewing the scientific literature on various digital therapies.

The bottom line: The internet + health care = a giant experiment.

Caitlin Owens