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Illustration: Sarah Grillo/Axios
This will likely be a wild year for the policy, politics and business of health care. Here are the big trends the Axios health care team — Bob Herman, Caitlin Owens and me — will be watching in 2019.
The pharmaceutical industry has a lot to fear from Washington this year.
What had once looked like a friendly administration has taken a more combative turn. The security blanket of a Republican House majority is gone, and the Senate may not offer as much protection as it used to.
A sweeping bill to cut drug prices remains a long shot, but legislation isn’t the only consequence of divided government.
Adding fuel to the fire, drugmakers are poised to resume the price hikes they partially paused last year, and new therapies are expected to come to market with seven-figure price tags.
All of that can contribute to a political environment that's already looking less friendly than anything pharma is used to.
The Affordable Care Act is almost a decade old, and yet we'll spend 2019 still wondering whether it's here to stay, after a federal judge ruled last month that the ACA's individual mandate is unconstitutional — and that the entire law must fall as a result.
Why it matters: The scope of Judge Reed O'Connor's ruling is staggering.
What's next: That ruling will be appealed to the 5th Circuit Court of Appeals — the most conservative appeals court in the country. From there it would go to the Supreme Court. Again.
The same question we posed at the start of 2018 is just as relevant going into this year: Is the never-ending cycle of health care consolidation good for patients — for their wallets and the quality of their care?
The big picture: A persuasive body of research shows that hospital system mergers and hospital acquisitions of doctor practices raise costs, although the American Hospital Association argues otherwise.
The bottom line: Lingering concerns over costs and quality won’t slow down the deal-making. Many other major hospital mergers are pending, more local consolidation is expected, and drug companies are sitting on piles of cash, waiting to spend it on M&A.
What we’re watching: Democratic lawmakers are cracking their knuckles. Rep. David Cicilline (D-R.I.), the incoming chair of the House Judiciary antitrust subcommittee, told Axios he will “launch an investigation into monopoly power in health care markets” this year.
More than 72,000 people died of drug overdoses in 2017. The best-case scenario this year is probably for that number to stay the same.
The medical community is focused on treatment, and on new ways to limit the use of prescription painkillers, where addiction often begins. That could include new packaging, shorter prescriptions and more targeted doses.
What we’re watching: Congress may provide more money for treatment programs, but the most serious opportunity for substantial treatment funding may come from the massive lawsuit that’s pending in a district court in Ohio.
Go deeper: How to change treatment for opioid addiction
Like a piece of modern art, “Medicare for All” means different things to different people. And Democrats haven’t had to settle on any one policy so far. But that will likely change as the 2020 presidential primary heats up.
Where it stands: Sen. Bernie Sanders (I-Vt.) popularized the term “Medicare for All,” and though he’s not the first member of Congress to support a single-payer health care system, his bill is the most prominent proposal out there.
What we’re watching: Health care propelled Democrats’ wave in 2018, and it’s one of the issues Democratic voters care about the most. Even though the dream of “Medicare for All” won’t be realized this year, expect it to play a dominant role as Democrats select their next leader.
Go deeper: What “Medicare for All” could look like