Jan 31, 2020

Axios Vitals

Good morning. Congrats, we've made it to Friday.

Today's word count is 685, or a 3-minute read.

1 big thing: Trump vs. Medicaid

Illustration: Sarah Grillo/Axios

It may not get the most attention, but Medicaid is the prime target of the Trump administration's health care agenda, Axios' Sam Baker reports.

Why it matters: Medicaid covers about 70 million people — which is more than Medicare. It's the biggest item in many states' budgets.

  • It is a huge part of the health care system, and the Trump administration has been fully committed, since day one, to shrinking it.

Driving the news: The Centers for Medicare & Medicaid Services yesterday laid out a plan to let states convert part of the program into a system of block grants — a deeply controversial move that would ultimately cut federal spending and likely prompt states to cover fewer people.

It's the latest step in a consistent effort to pare back Medicaid.

  • Republicans' 2017 bills to "repeal and replace" the Affordable Care Act proposed much deeper cuts to Medicaid than to the Affordable Care Act.
  • CMS, under Trump, has approved work requirements for Medicaid recipients. Those rules removed thousands of people from the rolls before they were frozen in court.
  • States' work-requirement plans have also often required Medicaid enrollees to pay a small premium.
  • More technical regulatory changes to the program could cut federal funding and weaken some consumer protections.

What's next: Work requirements are held up in court. A federal judge has ruled that CMS violated the requirements of the Medicaid statute when it approved them, and stopped states from enforcing the rules. The administration has appealed.

  • There's no question that Thursday's block-grant proposal will face immediate legal challenges, as well.

The bottom line: The courts will ultimately decide how much of this agenda survives, but within the administration, it's been full steam ahead since the beginning.

Go deeper.

2. Opioid death rate decreased in 2018
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Data: Centers for Disease Control and Prevention and National Center for Health Statistics; Chart: Danielle Alberti/Axios

Some good news: Opioid deaths in the U.S. decreased in 2018 after years of steady increases, while the U.S. life expectancy ticked up for the first time in four years, the Centers for Disease Control and Prevention announced yesterday.

Between the lines: The effort to combat the opioid epidemic appears to be working, although the problem is far from solved.

  • More naloxone, fewer opioid prescriptions, higher treatment rates and a strong economy have all contributed to the declining death rate, HHS Assistant Secretary for Health Brett Giroir said.

By the numbers: Life expectancy rose from 78.6 years in 2017 to 78.7 years in 2018.

Yes, but: There's also some bad news.

  • The rate of drug overdose deaths from synthetic opioids — like fentanyl — increased by 10% between 2017 and 2018.
  • Cocaine and meth overdose deaths are also on the rise.
3. An estimate on Biogen's Alzheimer's spending

Biogen executives didn't provide any clues yesterday about when the company would submit an approval application to the FDA for its controversial Alzheimer's drug, but the company appears ready to invest a pretty penny around it, Axios' Bob Herman reports.

By the numbers: Biogen estimates its general administrative and marketing expenses will rise by more than $450 million this year.

  • Essentially, Biogen is "baking in [Alzheimer's] commercial spend" into those 2020 projections, according to Evercore ISI analyst Umer Raffat. 

Between the lines: There are many reasons to be skeptical the FDA will approve this Alzheimer's treatment — we don't even know if the drug works, or if the company is dressing up its data.

  • But it's also difficult to believe a company will invest hundreds of millions of dollars to get a drug ready for sale if it doesn’t think it’ll get a friendly decision from the FDA.
4. Coronavirus update

Illustration: Sarah Grillo/Axios

The State Department advised Americans not to travel to China on Thursday and recommended that those currently in the country consider leaving, following the World Health Organization's global public health emergency declaration, Axios' Orion Rummler reports.

As of Thursday, six Americans — in Arizona, California, Illinois and Washington state — have the coronavirus, according to the CDC.

"To scientists, the work to create a vaccine against the new coronavirus is advancing with a speed they could barely have imagined a decade ago.

  • "At the same time, it's not even close to quick enough to contain the spreading infection — and in many ways, the outbreak will test the capacity of science to react in real time to a new and unknown 'pathogen X' that takes the world by surprise," the Washington Post reports.
5. Johnson & Johnson's latest legal woes

A San Diego Superior Court judge ordered Johnson & Johnson to pay $344 million for misrepresenting the risks of vaginal-mesh implants, Bloomberg reports.

The big picture: The fine isn't very large in the grand scheme of things, and although California was only the first state to bring its claims against J&J to trial, the company previously resolved similar claims by 41 other states for $117 million.

Flashback: Johnson & Johnson's legal bills keep mounting