Feb 12, 2020

Axios Vitals

Good morning from San Francisco, where I'm attending my first-ever meeting with the Zetema Project.

Situational awareness: No major pharmaceutical company has come forward to say it would manufacture a vaccine for the novel coronavirus currently being developed by the National Institutes of Health, per STAT. Go deeper.

Today's word count is 898, about a 3-minute read.

1 big thing: One in seven Americans struggle to pay medical bills
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Data: NCHS, National Health Interview Survey, 2011–2018; Chart: Axios Visuals

The number of people struggling to pay medical bills has fallen by 5.5 percentage points since 2011, but more than 14% of Americans still had problems in 2018, according to a new report by the Centers for Disease Control and Prevention.

Why it matters: "Families with problems paying medical bills may experience serious financial consequences, such as having problems with paying for food, clothing, or housing, and filing for bankruptcy," the report's authors write.

Between the lines: Some groups of people are more likely to struggle to pay their bills than others.

  • Women, children and black Americans were more likely to struggle than males, adults and other racial and ethnic groups.
  • Among people under 65, the uninsured unsurprisingly were more likely to report problems paying medical bills than those with Medicaid or private insurance.
  • And among people over 65, people jointly enrolled in Medicare and Medicaid and those enrolled in traditional fee-for-service Medicare were more likely to struggle than those with Medicare Advantage or private coverage.
2. Where UnitedHealth is making its money
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Data: SEC Filings; Chart: Axios Visuals

UnitedHealth Group is mostly known as one of the country's largest health insurance carriers, but the massive conglomerate is increasingly making its money from things that have nothing to do with health insurance, Axios' Bob Herman reports.

The bottom line: UnitedHealth doesn't just want to be your health insurer. It wants to be your doctor, your outpatient surgery center, your mail-order pharmacy and your drug price negotiator.

By the numbers: UnitedHealthcare is still UnitedHealth's most profitable unit, generating more than $10 billion in operating earnings in 2019 as a major carrier of employer and Medicare Advantage plans.

  • But UnitedHealth's Optum subsidiaries are close behind. Optum collected more profit in the fourth quarter of 2019 ($3 billion) than UnitedHealthcare ($2.1 billion). And that's not new: Optum has had a stronger Q4 than UnitedHealthcare in each of the past five years.

Between the lines: The most profitable segment within Optum is OptumRx, which is part of the pharmacy benefit manager oligopoly that controls how drugs are paid for and which drugs are covered.

  • Rebates negotiated from drug companies and other behind-the-scenes fees have turned OptumRx into a cash cow — often at the expense of employers and their workers.
  • Optum's other units also are growing. They include a bank for health savings accounts, physician practices, urgent care clinics, surgery centers and almost any conceivable piece of technology and consulting used in health care.
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Data: SEC Filings; Chart: Axios Visuals

Go deeper: UnitedHealth's political and financial heft just keeps growing

3. Elective surgery's surprise medical bill risk

Even patients who plan elective surgeries with in-network doctors at in-network facilities have a pretty good chance of receiving a surprise medical bill, according to a new JAMA study.

Why it matters: Surprise bills are a problem for the patients who receive them, but also for the system as a whole, as they drive up overall health care costs.

The study found that 20.5% of elective surgeries — procedures like hysterectomies and knee replacements — performed at in-network facilities and by in-network primary surgeons resulted in an out-of-network bill.

  • These bills came from providers who patients usually have no hand in choosing, like surgical assistants, anesthesiologists and radiologists.

Details: These bills ranged, on average, from less than $100 to several thousand dollars, depending on the specialty and the procedure.

  • The average potential balance bill was $2,011.
  • The largest potential bills tended to be from surgical assistants and anesthesiologists, which also were the most frequent sources of out-of-network bills.
  • The South and Northwest had particularly high rates of these bills.

Go deeper: We all pay for surprise emergency room bills

4. Congress chugs along toward a brick wall

Senate Majority Leader Mitch McConnell told reporters yesterday that Senate Republicans are divided on bipartisan bills to address both drug costs and surprise bills, The Hill reports.

The big picture: The White House vocally supports the bipartisan drug pricing bill by Sens. Chuck Grassley and Ron Wyden.

  • And yesterday it waded into the slog over how to address surprise medical bills, appearing to side with the approach taken by multiple leading committees and favored by insurers, employers and unions.

Meanwhile, the House Education and Labor Committee passed its surprise billing legislation yesterday — over the objections of lawmakers concerned about its impact on doctors, as The Hill's Peter Sullivan tweeted.

  • The Congressional Budget Office found that both leading approaches to out-of-network payment disputes would save billions of dollars over the next decade, although the insurer-favored (and apparently White House-favored) one would reportedly save more than the one generally supported by providers.
5. Taking coronavirus fears too far

Photo Illustration: Eniola Odetunde/Axios; Photo: NurPhoto/Getty Images

Fear and misinformation surrounding the novel coronavirus have prompted unwarranted discrimination against Chinese-Americans who have nothing to do with the epidemic, Axios' Marisa Fernandez reports.

What they're saying: "We're already worried about [stigma] here in the U.S. and around the world, that somebody coming back from this community or that community may be treated differently ... and businesses in a certain neighborhood may be boycotted," Anne Schuchat, an official with the Centers for Disease Control and Prevention, said Tuesday.

What's happening: Chinese-Americans and other people of Asian decent admit to suppressing their coughs and runny noses in public to avoid unwanted stares or social isolation, the Los Angeles Times and NPR report.

  • On U.S. college campuses, some non-Asian students acknowledged avoiding Asian classmates for no other reason than the virus' surge in China.
  • The coronavirus has an unknown animal host, spurring comments on social media that revive racist tropes about food.

The bottom line: "It's definitely been an important message to point out that this outbreak is mostly in China and that's where the risk is," Nancy Messonnier, spokesperson on the coronavirus for the CDC, said Monday.

Flashback: The 2013–2016 Ebola outbreak also increased "stigma, discrimination and blame" toward communities perceived as African in non-African countries, the World Health Organization observed.

Go deeper: Coronavirus death toll tops 1,000