Jan 21, 2020

Axios Vitals

Good morning. Should Peter be able to give the final rose to a woman competing on the show this season, and to a woman who is not competing this season but has clearly stolen his heart?

  • Reply to this email with your thoughts on whether the NYT editorial board's two-endorsement precedent extends all the way to Bachelor Nation.

Today's word count is 665 words, or a 3-minute read.

1 big thing: Employers have the most health insurance choices

Illustration: Sarah Grillo/Axios

Most people don't have nearly as much choice over their health insurance plans as Republicans and moderate Democrats sometimes suggest.

Between the lines: People who get their insurance from their employer — the majority of people with private insurance — are often given few plans to choose from, if they're given any choice at all.

What they're saying: This came up in former Vice President Joe Biden's interview with the New York Times' editorial board:

  • "If you like your plan, you can keep it, assuming — I should add the obvious — if your employer doesn't take it away from you," he said.

The comment is a nod to how much control employers have over their employees' health insurance.

  • Many workers are presented with just one plan option, meaning they don't have any choice at all. Others will have multiple plans, but all from the same insurance company.
  • And while competition is improving in the individual market, most people who buy insurance on their own still have only a handful of insurers to choose from.

Biden has proposed a public insurance plan that would be open to people with employer-based insurance — which experts say could lead to some employers deciding not to offer their own coverage.

  • For workers who have generous employer coverage now, a public option with limited provider participation would probably be a bad deal.
  • But if most doctors and hospitals participate in the public option, workers may not end up with any fewer choices than they have now.

Between the lines: Framing choice as being about insurance "in many ways obscures the choice that probably ultimately matters to most people, which is choice of doctor or hospital," the Kaiser Family Foundation's Larry Levitt said.

Go deeper: Employers aren't changing their health benefits

2. Tech's enormous access to patient data

It's not just Google — Amazon, IBM and Microsoft have also struck deals with hospitals across the country to gain access to patient data, the Wall Street Journal reports.

Why it matters: WSJ's reporting reveals just how expansive the relationship between tech companies and hospitals has become. And lawmakers have taken notice.

Details: There's no evidence of wrongdoing; hospitals can share patient data as long as they follow federal law.

  • The deals have the potential to yield information and products valuable to patients.
  • For example, Microsoft is partnering with Providence, a large hospital system, to create oncology algorithms using doctor's notes in medical records.

The big picture: "Digitizing patients' medical histories, laboratory results and diagnoses has created a booming market in which tech giants are looking to store and crunch data, with potential for groundbreaking discoveries and lucrative products," WSJ writes.

  • Hospitals can also benefit financially from the deals, some of which include intellectual property rights for the hospitals' contributions to new products.
3. Medicaid block grant guidance is on its way

CMS Administrator Seema Verma. Photo: Steven Ferdman/Getty Images

The Trump administration plans to issue guidance — potentially this month — on state waivers to change Medicaid funding into a block grant, WSJ scoops. (Bravo to the Journal's weekend health coverage.)

  • This is somewhat surprising, after the Office of Management and Budget indicated in November that the guidance was no longer happening.

Why it matters: Some red states have already expressed interest in block grants, and supporters say they give states more flexibility, but consumer groups argue that they could lead to thousands of low-income people losing health coverage.

Yes, but: Like work requirements and several other pieces of the Trump administration's health agenda, block grants are likely to be challenged in court.

Go deeper: Tennessee block grant plan faces uphill battle

4. When a generic doesn't do much

A generic version of Copaxone, one of the most popular drugs to treat multiple sclerosis, didn't do much to lower costs for patients, NPR reports.

The big picture: MS drugs cost $70,000 a year, on average, and some prices have increased to five times what they were when the drugs were first approved by the FDA.

  • The impact on MS drugs' prices after the generic was introduced was minimal, and Copaxone's price increased immediately.

The bottom line: "We've been, really been, looking to generics for some price relief, and we're probably not going to get it as quickly as we want," Stacie Dusetzina, a health policy professor at Vanderbilt University, told NPR.

5. While you were weekending...
  • The American College of Physicians yesterday endorsed either a single-payer system or a public option, AP reports, a good reminder that not all providers hate expanding government insurance.
  • The Supreme Court agreed on Friday to take up yet another case involving the Affordable Care Act's contraception mandate, Axios' Sam Baker writes.
  • President Trump told HHS Secretary Alex Azar last week that he regrets getting involved in the administration's policy on vaping, Axios' Jonathan Swan and I report.