Oct 9, 2018

Axios Vitals

Good morning ... You won't want to miss this: 📺 Axios on HBO premieres at 6:30pm on Sunday, Nov. 4.

Catch all four episodes at the same time — 6:30pm, Eastern and Pacific — every Sunday in November. On HBO. If you're in D.C. and you have Comcast, that's channel 300. You have no excuse not to watch.

1 big thing: Millennials are ditching primary care


First they came for chain restaurants, then golf, and now millennials are turning their backs on another old institution: primary care. Younger patients are increasingly turning away from primary care doctors and toward clinics or urgent care centers, the Washington Post reports.

By the numbers: In a Kaiser Family Foundation poll, 45% of 18-to-29 year-olds didn't have a primary care provider. That number was significantly lower for older respondents.

Waiting several days for an appointment, when you're sick, is not super attractive to young people.

  • “These trends are more evident among millennials, but not unique to them. I think people’s expectations have changed," Harvard professor Ateev Mehrotra told the Post.
  • "Now people say, ‘That’s crazy, why would I wait that long?’" Mehrotra said.

Theoretically, primary care providers are supposed to be the people at the center of our care, keeping tabs on patients' health and helping to coordinate our various needs.

  • But if you're only using the health care system when something's acutely wrong, a walk-in clinic might seem more logical — and it's certainly more affordable than the emergency room, which used to fill those after-hours needs.

Yes, but: The care may not be as good.

  • In a recent study, almost half the people treated for a simple cold or flu at an urgent care clinic "left with an unnecessary and potentially harmful prescription for antibiotics," compared with just 17% of those treated by a primary care doctor, per the Post.
2. Insurers are doing just fine

Turns out the individual insurance market actually isn’t imploding, even as the Trump administration and Congress keep taking whacks at the Affordable Care Act.

What's new: A Kaiser Family Foundation analysis of individual market performance found that insurers have become profitable again in 2017 and the first half of 2018, Axios' David Nather reports.

  • Insurers' gross margins are getting better. The margins — which measure how much their income from premiums exceeds their costs — are far higher than at any time in the history of the ACA.
  • Their second-quarter loss ratios for 2018 averaged 69%, lower than at any point since the earliest years of the ACA.

Between the lines: Premiums went up a lot between 2017 and 2018 (an average of 23% per member for the second quarter of each year).

What to watch: There are signs that the ACA population may be getting sicker — they spent more days in the hospitals than in the past 3 years. If so, that could be a sign that healthier customers are dropping out.

3. Short-term plans in the crosshairs

Industry and advocacy organizations are lining up to file amicus briefs opposing the Trump administration’s expansion of “short-term” insurance plans, and Senate Democrats will also take their own swipe at the policy this week.

What they’re saying: The administration’s rules, which allow consumers to keep bare-bones “short-term” plans for up to 3 years, “will be devastating to the health, well-being, and pocketbooks of millions of Americans,” the American Medical Association and other physician organizations said in their brief.

  • They're urging a federal court to temporarily bar the new rules from taking effect.

What’s next: Oral arguments on that request for an injunction are scheduled for Oct. 26.

  • The Senate will have its say a little earlier — it’s expected to vote this week on a resolution disapproving of the new rules for short-term plans. Two Republicans would need to support the resolution for it to pass.
4. Maybe the Apple EKG isn’t so great, after all

Health care economist Aaron Carroll is here to rain on the parade surrounding the new Apple Watch and its heart-monitoring features.

The details: Writing in the New York Times, Carroll says the risk of false positives — the watch telling people they have a heart irregularity that isn’t really there — is too high.

  • Experts have previously recommended against widespread heart monitoring, Carroll notes.
  • And the Apple Watch will primarily appeal to a low-risk population to begin with.

“This is one of the major problems with such a device. The people most in need of it, those who might benefit from tests and distance monitoring, are the least likely to get it. If we truly believed this was a medical test beneficial to the general population, insurance should pay for it. No one is suggesting that should happen,” he writes.

5. While you were weekending ...
  • Sen. Claire McCaskill’s campaign is launching a new online quiz today to highlight the implications of the lawsuit aiming to strike down the ACA. Her opponent, Missouri Attorney General Josh Hawley, is among the GOP officials who brought that suit.
  • House Speaker Paul Ryan delivered a broadside against “Medicare for All” during a speech yesterday. “Everyone — no matter how much you like your plan — would have their plan taken away,” he said. “Instead, you will be put into a government-run plan where you will have no say in the cost or the coverage.”
  • Health care is the dominant theme in 6 of the 10 House races where Democrats have spent the most money on advertising, according to CNN’s David Wright.