Sep 18, 2019

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. RIP to "Bachelor in Paradise" Season 6, which got me through the August doldrums. Congrats to everyone who, like me, gets 4 hours of their life back every week.

Situational awareness:

  • Hospitals won a major victory in court last night: A federal judge threw out a regulation slashing Medicare payments for routine checkups in doctors' clinics that are owned by hospitals, Axios' Bob Herman reports.
  • New York has become the second state to ban flavored e-cigarettes, Axios' Orion Rummler reports.

Today's word count is 1,039 words, or ~4 minutes.

1 big thing: Tennessee block grant plan faces uphill battle

Illustration: Sarah Grillo/Axios

Tennessee's proposal to convert its state Medicaid financing into a block grant could become a landmark restructuring of the program.

The big picture: We don't yet know whether the Trump administration will approve the proposal, whether it'll hold up in court or what outcome it'd have on enrollees — but advocates are warning it's probably going to lead to benefit cuts.

Driving the news: Tennessee released its proposal yesterday, becoming the first state in the nation to put forward a block grant waiver plan.

  • Medicaid block grants have long been a conservative goal, but Republicans haven't been able to pass them into federal law.
  • The Tennessee plan would create a cap on federal funding for medical services, and would give the state additional flexibilities over the program's benefits.

What they're saying: "They want to have carte blanche to cut benefits going forward, without having to ask the federal government or letting anybody know they're doing it," said Joan Alker, the executive director of Georgetown's Center for Children and Families.

  • The state, however, writes that the proposal includes "no reductions in who is eligible for or what benefits are currently provided."

Medicaid funding is typically open-ended and split between the federal government and the state. The proposal asks for Tennessee to instead receive a fixed amount of federal dollars.

  • This shift in the relationship between state and federal Medicaid funding may be illegal, Nicholas Bagley, a law professor at the University of Michigan, writes in The Incidental Economist.
  • "[Y]ou can't use Medicaid waivers to change Medicaid's financing structure. And that's exactly what Tennessee is proposing to do," Bagley writes.

What we're watching: The proposal is open for public comment until mid-October, and the state must submit the plan to the Centers for Medicare and Medicaid Services by late November, per WashPost.

2. The anti-vaping tipping point

Illustration: Sarah Grillo/Axios

Our colleagues at Axios PM took a closer look yesterday at the sudden tidal wave of anti-vaping action nationwide, noting that the Trump administration's surprise announcement last week of a ban on most flavored e-cigarettes was just one data point.

Why it matters: Companies like Juul and others — which now market their vaping products around stopping smoking — suddenly face a nasty political climate based on fears of kids getting addicted.

  • Numerous states are pushing major anti-vaping efforts, testing everything from banning flavored cartridges to PSA messages aimed at teens that feel like rehashes of the anti-cigarette movement.
  • That now extends to local government: D.C. suburb Montgomery County is considering a rule that'd ban vape shops from within a half mile of public middle and high schools — effectively closing 19 of the county's 22 stores, WashPost notes.
  • Legal vaping manufacturers (particularly in the marijuana variety) are rushing to make sure their product doesn't get mistaken for the bootlegged cartridges that officials believe are causing some of the vaping-related lung illnesses.

The big picture: Hundreds of people nationwide have suffered vaping-related lung illnesses, with 7 deaths.

  • But it's still a mystery what exactly is causing the illnesses.
  • The FDA has pointed to vitamin E acetate in THC vaping cartridges, but "no candidate substances have consistently turned up across samples so far," Scientific American warns.
  • Although most "cases involve pods containing THC ... not all of them do."

Go deeper: Nicotine addictions increasingly driving vape users back to cigarettes

3. Millions of medical images susceptible to hacks

Illustration: Aïda Amer/Axios

The medical records of more than 5 million Americans and even more people globally — including X-rays, MRIs and CT scans — are vulnerable targets to even the simplest cybersecurity threats, ProPublica and German broadcaster Bayerischer Rundfunk found.

Why it matters: Because of the sensitivity of some of these records, patients face potential devastation if their images are hacked, Axios' Marisa Fernandez writes.

  • "Medical knowledge can be used against you in malicious ways: to shame people, to blackmail people," Cooper Quintin, a security researcher and senior staff technologist with the Electronic Frontier Foundation, told ProPublica. "This is so utterly irresponsible."
  • In some cases, a free software program or basic lines of computer code could access images and private data.

What they found:

  • More than 13.7 million medical tests in the U.S. were available online, including more than 400,000 from X-rays and other images that could be downloaded.
  • Large hospital chains and academic medical centers seemed to have better protections in place. Most of the cases of unprotected data the report found involved "independent radiologists, medical imaging centers or archiving services."

The bottom line: Patient data obtained by the health care industry has systemically had problems with hacking ever since it switched from analog to digital technology, including those stemming from basic human error or systems with known security weaknesses.

4. Workers unsure Medicare for All would raise wages

Illustration: Sarah Grillo/Axios

Advocates of a single-payer system may have a hard time persuading workers that their wages would go up if their employer-based health care went away, the Kaiser Family Foundation's Drew Altman writes in today's column.

Why it matters: "Medicare for All" would bring an enormous amount of change to the health system, and the disruption of employer-based insurance is already an important political flashpoint.

"For a socialist, you've got a lot more confidence in corporate America than I do," former Vice President Joe Biden said to Sen. Bernie Sanders at last week's Democratic debate, in response to Sanders' assurances that employers would raise wages if they were no longer paying for health benefits.

By the numbers: Sanders' view is an article of faith among most economists, but a majority of Americans aren't so sure.

  • In a new Kaiser Family Foundation poll, 63% of people surveyed said they thought their wages would stay the same if their employers' health costs went down; another 5% weren’t sure.
  • Just 32% said they thought their wages would go up.

Between the lines: It's likely true that employers would reap big savings if the government took insurance off their hands, and that many would funnel those savings back into wages.

  • It's just that workers don't necessarily believe those savings will end up in their paychecks, creating an additional challenge for selling Medicare for All.

The bottom line: One big knock on "Medicare for All" is voters' distrust of government. But distrust of employers could matter, too.

5. Most hospital markets are highly concentrated
Expand chart
Data: Health Care Cost Institute; Chart: Axios Visuals

Almost three-quarters of metropolitan areas had highly concentrated hospital markets in 2016, reflecting an era of rapid consolidation among hospital systems, according to a report from the Health Care Cost Institute.

Why it matters: The more hospitals that have monopolies or oligopolies in their markets, the higher the prices are for patients, which is reflected in the premiums everyone pays, Bob writes.

Caitlin Owens