Good morning … So long to the dumpster fire of 2017; hello, soon-to-be dumpster fire of 2018!
We're trying something a little bit different to help you get smarter, faster as you settle back into work today. 2018 is going to be a long year, and probably a hard one to keep up with. So my colleague Bob Herman and I thought we'd step back from the minute-by-minute onslaught and take stock more broadly of the big, overarching trends that will animate this year in health policy.
The most consistent theme in the politics of health care last year was uncertainty, and that seems highly unlikely to change in 2018.
And that's just the individual market. Open gubernatorial races in this year's midterms will have an enormous effect on health policy for years to come. Medicaid expansion will be explicitly on the ballot in a handful of states. House Speaker Paul Ryan wants to take another crack at Medicare and Medicaid cuts.
Buckle up. These are just the battles we already know about, barely 24 hours into the year.
The health care industry is consolidating rapidly — hospitals are merging with each other and with insurers; pharmacies are buying insurance companies; and drug companies are snapping up other drug companies.
The big question: Are these deals good for consumers?
What's next: Regulatory reviews of all these mega-mergers will fall to the Federal Trade Commission — which already has limited resources — and the Department of Justice.
Don't forget: Many people have overlooked the part of President Trump's health care executive order that said his administration will "focus on promoting competition in health care markets and limiting excessive consolidation."
This year will see crucial clinical trials — and potentially FDA approval — for a host of drugs, including highly watched therapies in oncology and immunology.
Retail drug spending growth has actually been mild over the past two years, but the pending arrival of expensive new treatments, including CAR-T therapies, will add new fuel to the drug-pricing fire, much like expensive new hepatitis treatments helped blow the issue open in 2014 and 2015.
The impact: This isn't just a political debate: These products can place a real strain on insurance premiums, and could cripple taxpayer-funded health care programs.
What to watch: Policymakers, including HHS secretary nominee Alex Azar, have supported some proposals to crack down on price-inflating tactics, including drugmakers' patent strategies and the secretive rebate system used by pharmacy benefit managers.
The Trump administration has barely gotten started on what might end up being one of its biggest health care legacies — a new, more conservative vision for Medicaid. But those changes are just around the corner.
The opioid crisis is so bad, nationwide, that Americans' life expectancy is going down, despite myriad advances in medical technology.
Yes, but: There's no coordinated national strategy to try to get this crisis under control, much less reverse the rising tide of addiction, overdoses and death.
What else will shape the year in health policy? I'd love to know what's on your mind in the (relative) calm of these early days. Drop me a line and let me know: firstname.lastname@example.org.