Axios Vitals

A briefcase with a red cross on the front.
May 22, 2018

Good morning … An unexpected Medicaid/George Clinton crossover, via the New Funk Times: Parliament’s first new album in almost 40 years is called "Medicaid Fraud Dogg," and it’s available for streaming today. (h/t @emma_sandoe)

1 big thing: Uninsured rate unchanged in Trump's first year

Data: Centers for Disease Control; Chart: Chris Canipe/Axios

Data: Centers for Disease Control; Chart: Chris Canipe/Axios

The number of Americans without health insurance barely changed in 2017, according to new data from the Centers for Disease Control and Prevention.

The numbers that matter:

  • Of the nearly 80,000 people the CDC interviewed, 12.8% were uninsured at the time of the interview. That's the same as the uninsured rate in CDC's 2015 survey, and not significantly different from 2016's numbers.
  • The number of people covered by the Affordable Care Act was also largely unchanged.
  • More Hispanic people were uninsured in 2017 than 2016; coverage among the other racial groups remained steady.

But, but, but: A lot of the administration's most significant changes to the ACA weren't in effect in 2017. In fact, a lot of them still aren't in effect.

  • We might not see the full effects of repealing the individual mandate and expanding access to skimpy, short-term insurance plans — the two biggest policy changes since Trump took office — until 2019.
  • A smaller but more current tracking survey from the Commonwealth Fund recently found that the uninsured rate had ticked up early this year.

2. House expected to pass "right to try"

Sen. Ron Johnson with a mother and small child advocating for "right to try."
Sen. Ron Johnson sponsored the "right to try" bill. Photo: Tom Williams/CQ Roll Call via Getty Images

The House is likely to pass the Senate's "right to try" bill today (or if not today, at least this week). The measure would expand terminally ill patients' access to unproven therapies.

The bill passed the Senate last year without objection; it should have an easy time in the House, as well, and President Trump is expected to sign it.

3. Michigan drops Medicaid work exemption

State lawmakers in Michigan have abandoned an effort to exempt some residents from proposed work requirements in the state's Medicaid program, AP reports.

  • Some Michigan lawmakers want to add work requirements to the state's expanded Medicaid program, but had proposed an exemption for people who live in counties with a particularly high unemployment rate.
  • Although that might seem like a common-sense exemption, in Michigan it would have disproportionately benefitted largely white, rural areas.
  • In cities like Detroit and Flint, with larger black populations, inner-city unemployment is high but suburban employment drives down the total rate for the county. So, poor people in those cities still would have been subject to the work requirements even though jobs are scarce where they live.

The impact: The aborted exemption was an effort to soften proposed work requirements. If those restrictions ultimately pass, there would be no exemption for anyone who might have a hard time finding a job in their area. The bill will likely include a temporary grace period as an alternative, per AP.

What's next: The same issue is playing out in Ohio.

4. Maryland's all-payer progress

Everybody has their eyes on Maryland, which caps total hospital spending and is looking to extend those caps to cover even more providers. California is eyeing something similar, and some experts believe various iterations of Maryland’s all-payer model will be the next big thing in cost control.

So, how’s it going in Maryland? A bipartisan trio of experts examines the available evidence in the Journal of the American Medical Association.

  • Admissions: Studies have generally found a drop in overall hospital admissions in Maryland, but an increase in emergency room visits.
  • Follow-up visits: The same studies found that Maryland’s spending caps did not change the number of follow-up visits within a week of a hospital discharge. That’s partially due to frequent follow-ups for patients with mental or behavioral health issues.
  • Savings: Per capita hospital spending in Maryland has grown far slower than the state’s overall economy, the JAMA authors report, and Medicare has saved $586 million compared with the national trend in spending growth.

5. Some seniors would pay more under Trump plan

The Trump administration's plan to move some number of drugs from Medicare Part B to Medicare Part D would be a mixed bag for seniors. Some would see their out-of-pocket costs rise, while others would see out-of-pocket savings, according to Avalere.

Who pays:

  • Most seniors in Part B buy supplemental insurance, which brings down their out-of-pocket costs. They would likely pay more if expensive drugs moved into Part D, Avalere said.
  • But seniors who don't buy supplemental coverage would likely pay less under the administration's plan.
  • Moving expensive drugs from Part B to Part D also could "put upward pressure on Part D premiums, which may not be fully offset by a decrease in Part B premiums," Avalere said.

Refresher: How this would work.

6. The power players in Medicare Part D

The Kaiser Family Foundation is out with an analysis showing just how consolidated the market is for Medicare’s prescription drug plans. This is especially relevant as the Department of Justice looks at the CVS-Aetna and Cigna-Express Scripts mergers — all four companies are big Part D players.

The bottom line: "If these mergers go through, four firms — the two merged firms plus UnitedHealth and Humana — would cover 71% of all Part D enrollees.”

Don’t forget: As we reported last year, concentration of power has existed for years in Medicare Part D while aggregate costs have gone up significantly. It’s important to keep this in mind as the Trump administration weighs giving more power to Part D plans.

What we're watching today: Senate HELP committee hearing on the health care workforce. (10am; livestream)

What we're watching this week: HELP will consider a bill Wednesday on pandemic preparedness. Energy and Commerce health subcommittee hearing Wednesday on reauthorizing the Children’s Hospital Graduate Medical Education program.

Senate Finance Committee hearing Thursday on rural health care.

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