Aug 8, 2017

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning ... Hope you're catching your breath on health care. The one thing you shouldn't do is worry about all of the action going away. If you don't believe me, listen to Sam Baker. He may be vacationing, but his memory lives on.

Axios Sourced: What happens next on health care

Not all of us can have the pleasure of discussing health care over drinks with Sam, but here's the next best thing: You can watch a video of him having drinks and discussing health care. His main takeaways on what's next:

  • President Trump could cut off the Affordable Care Act's cost-sharing payments to insurers at any time. (This is a possible panic scenario, he says).
  • The health insurance markets want stability, and we don't have it right now.
  • Everyone will be watching the Senate bipartisan talks on an ACA stabilization package, but there aren't enough likely supporters to pass it by themselves.

The bottom line: The health care battle may be taking a break, but it never ends. Check out the Axios Sourced video here.

How HHS wants to reinvent itself

Health and Human Services secretary Tom Price has been gathering suggestions from agency employees about how to "Reimagine HHS" — and now he's announced the goals HHS officials have selected for changing the department.

The themes, per an email Price sent to HHS employees obtained by Axios:

  • Restoring market forces — or "doing a better job of being catalysts for state and local partners, the private sector, and civil society."
  • Putting people at the center of HHS programs — or "empowering individuals and focusing on their unique needs and situations."
  • Leveraging the power of data — or making better use of the information HHS generates.
  • Turning HHS into a more innovative and responsive organization.
  • Generating efficiencies through streamlined processes.
  • Moving to a 21st century workforce — or recruiting the best talent and rewarding "growth and excellence."

Between the lines: It's not surprising that Price, who's strongly devoted to conservative ideology, would draw lessons like "restoring market forces" from the HHS suggestion box. But this initiative is giving us a better sense of how he wants to transform the department from the inside.

What to watch: The question is whether he can turn the broad goals into concrete initiatives — and whether career HHS employees will be enthusiastic about carrying them out.

The genes that help immunotherapy work

There's always been a big problem with using immunotherapy to fight cancer: not everyone responds to it, and it's not always clear why. Yesterday, scientists announced a significant new development, Axios Science editor Alison Snyder reports: They've figured out which genes in cancer cells have to be present for immunotherapy to work.

How they did it: They used the CRISPR gene editing technology to find 100 genes that help patients respond to immunotherapy, which uses the body's immune system to destroy tumors.

Why it matters: Immunotherapy is considered one of the most promising new approaches to fighting cancer, but its potential will always be limited until scientists can improve its track record.

The Medicaid waiver Maine wants

Now that the ACA repeal effort collapsed, the role of HHS waivers will become a lot more important in letting states change their Medicaid programs. Maine has filed a proposal that asks for federal permission to impose work requirements, make "able-bodied" adults pay monthly premiums, and charge $10 copayments to use the emergency room for non-emergency care.

The goal: Maine officials say they want to rewrite their Medicaid program to give top priority to children, the elderly, and people with disabilities, rather than serving as "an entitlement program for working-age, able-bodied adults."

Why it matters: These are the kinds of changes the Centers for Medicare and Medicaid Services has encouraged under the new agency chief, Seema Verma. Sen. Susan Collins, who opposed the GOP health care bill in part because of its Medicaid cuts, may not have a problem with all of these changes — she has said she could support requiring premiums and copayments.

Medicare Advantage: Spending less on care but costing more

Economist Austin Frakt takes a good look at the Medicare Advantage program in his The Upshot piece in the New York Times — specifically, at the question of why it isn't saving taxpayers money like it was supposed to. He cites research finding the program — which provides Medicare coverage through private health plans — spends less on medical care than traditional Medicare, but government payments were way higher.

The big reason: The payment formula was purposely designed by Congress to encourage the private market.

Why it matters: The ACA was supposed to reduce the payments, which was hugely controversial and one of the reasons Republicans accused the law of "cutting Medicare." But Frakt says the government payments still outweigh the plans' costs. That means the program still isn't achieving its goal of saving money.

Caitlin Owens

What we're watching today: Trump briefing with Price on the opioid crisis, 3 pm Eastern, Trump National Golf Club, Bedminster, N.J.

What we're watching this week: National Association of Insurance Commissioners summer meeting in Philadelphia, through Wednesday.

What we're watching in September: Senate HELP Committee hearings on bipartisan ACA stabilization bill, week of Sept. 4. Also, Senate Finance Committee hearing on CHIP reauthorization, same week.

Health care world doesn't stop just because Trump and Congress are on break, so let me know what we're missing: david@axios.com.