Axios Vitals

A briefcase with a red cross on the front.

September 19, 2022

Welcome back from the weekend, Vitals readers. Today's newsletter is 902 words or a 3-minute read.

👋 Say hello! We've got some new additions to our health care team: Victoria Knight (from Kaiser Health News) and Peter Sullivan (from The Hill) are covering health care policy. Sabrina Moreno (from the Richmond Times-Dispatch) is covering public health and equity.

  • Please make them all feel welcome with emails of your best scoops!

1 big thing: Employers' coming health care crunch

Illustration of a briefcase being broken by an oversized medical red cross symbol

Illustration: Annelise Capossela/Axios

All signs are pointing toward significantly higher health costs in the employer market next year, which will translate into larger-than-normal premium increases, Axios' Caitlin Owens reports.

Why it matters: Employers will have to choose between taking the hit or passing the added cost to employees — a decision that's particularly difficult in a tight labor market.

Driving the news: Seven in 10 employers expect moderate to significant increases in the cost of health benefits over the next three years, according to a Willis Towers Watson survey.

  • “There’s this terrible reality that they’re trying to increase affordability at the same time the actual total cost is going up more than they expected," said WTW's Jeff Levin-Scherz.
  • More than half of survey respondents said they plan to address rising costs through programs or vendors to reduce total spending. Less than a quarter said they will shift costs onto employees through higher premium contributions, and 14% said they'll shift costs through out-of-pocket expenses.

Between the lines: Part of the reason why health costs haven't risen in tandem with general inflation this year is that payers have pricing contracts — often multi-year — with providers, drug manufacturers and medical device makers.

  • But hospital groups have been telling anyone who will listen how much their costs have gone up in the past few years. It stands to reason that those complaints loom large in negotiations with insurers.
  • "There are signs everywhere that hospital price increases are coming, and that's going to push insurance premiums for employer-provided health benefits higher next year," said Kaiser Family Foundation's Larry Levitt.

The big picture: Employers overwhelmingly responded to rising health prices for more than a decade by offering plans with higher deductibles and out-of-pocket spending.

  • But are signs that employers have maxed out their ability to shift those costs.

Keep reading.

2. Study: Medical debt threatens people's health

Illustration: Aïda Amer/Axios

Soaring medical debt is setting U.S. adults up for higher risks of eviction, food insecurity and bad health outcomes regardless of insurance or income, Axios' Sabrina Moreno reports from a new study.

Why it matters: Uninsured or middle-to-low-income patients are more likely to get stuck with medical debt while the rich are largely spared.

  • But even private insurance offers little protection against unaffordable bills, according to the study published in JAMA Open Network on Friday.

The big picture: More than 100 million Americans live with medical debt, per an investigation by Kaiser Health News and NPR.

Of note: In April, the Biden administration announced a push to lessen the medical debt burden on Americans.

  • But it doesn't address the impact of not having national health insurance or expanding Medicaid and letting wages determine the level of benefits, said Wes Yin, an economics professor at UCLA who was a co-author of the Stanford study.
  • "The price of health care keeps on rising at dramatic rates and that has to do with provider consolidation and mergers and acquisition. That really hasn't been shown to benefit health outcomes," Yin told Axios.

Read the rest.

3. Monkeypox vaccines eligibility varies greatly

Confirmed monkeypox cases per 100k residents
Data: CDC, U.S. Census; Chart: Erin Davis/Axios Visuals

While the supply and distribution of monkeypox vaccine has ramped up since June, there's "substantial variation" in states' criteria for who is eligible, Axios' Arielle Dreher writes about a Kaiser Family Foundation analysis.

Why it matters: Eligibility requirements might be limiting who is getting shots, including health care workers who could get exposed on the job or people with HIV.

In many states, it's still unclear exactly who is eligible for the preferred Jynneos vaccine.

  • Discrepancies or incomplete criteria were found on front-facing websites and other materials, emphasizing the importance of messaging as on-the-ground health staff work to get vaccines out to communities that need them most.

4. The growing health threat from climate change

Illustration: Sarah Grillo/Axios

Climate change is scrambling the way we fight infectious diseases and adding a stealthy public health threat to the heat waves, droughts, wildfires and other physically observable hazards, Axios' Oriana Gonzalez writes.

By the numbers: In a study of 375 infectious diseases, 58% have at some point been aggravated by climatic hazards, researchers wrote last month in the scientific journal Nature Climate Change.

Driving the news: Extreme weather events and changes in land cover disrupt habitats and redistribute mosquitoes, ticks, fleas, mammals and birds that have been connected to outbreaks of conditions like dengue, chikungunya, Lyme disease and West Nile virus.

  • "We need to stop thinking about it as something that affects forests and resources and understand that it affects our health," said Erik Franklin, co-author of the Nature study and an associate research professor at the University of Hawaii.

What we're watching: The COVID-19 pandemic may have slowed some disease spread through masking and social distancing.

  • But there's concern among some public health and infectious diseases experts that the relaxation of those precautions now could set up a disease resurgence in communities that aren't prepared.

🌎 Read more in our latest Climate Truths series: A new health crisis

5. While you were weekending

Illustration of a desk on a beach under a palm tree.

Illustration: Aïda Amer/Axios

💉 COVID shots for the youngest kids arrived in June. But few have received them. (Washington Post)

🦷 There's a high-stakes war to straighten Americans' teeth being waged between oral health companies, orthodontists, dentists and regulators. (Axios)

🧠 Some digital gaming companies have made dubious claims about their value in fighting dementia, and researchers are studying which kinds of "brain training" work. (Wall Street Journal)

🚨 President Biden told CBS' Scott Pelley that "The pandemic is over," despite the ongoing public health emergency and his administration’s pressure on Congress to make more funding available to fuel the nation's response to the virus. (Axios)

⭐️ A big thank you, as always, to our all-star team including Adriel Bettelheim for editing the newsletter and Bryan McBournie for his copy edits.