Sep 9, 2019

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning, again from New York City. Ethical debate aside, the fact that this 74-year-old woman could give birth to twins proves that there truly is no rush to have children these days.

Today's word count is 707 words, or ~3 minutes.

1 big thing: Trump's make-or-break moment on drug prices

Illustration: Sarah Grillo/Axios

Congress returns this week from its August recess, and health care will dominate a huge part of the fall agenda, Axios' Sam Baker reports.

Driving the news: Striking a big, bipartisan deal this year on drug prices is probably President Trump's last chance to leave a major mark on health care before the election. And Trump himself is the biggest X factor.

  • House Speaker Nancy Pelosi is expected to release her drug-pricing plan soon. It will likely allow the Health and Human Services Department to negotiate the price of certain expensive drugs with little or no competition, while also redesigning Medicare's prescription drug benefit.
  • People following the legislative debate suspect that normal partisan politics will take control over this particular plan — "except if the president is for it. That will change everything," an industry lobbyist told Sam.

Industry has been working overtime and spending mightily to try to pull rank-and-file Republicans back into their historical friendship.

  • There are signs it's working — several GOP senators have watered down their own proposal or expressed misgivings about the bipartisan bill that narrowly passed the Senate Finance Committee just before recess.
  • And trade has eclipsed drug prices as the White House's top legislative priority, further dimming its outlook.

If anything happens, it'll likely be as part of a bigger end-of-year package. Which means the politics of drug pricing will be wrapped up with a bunch of other issues, and with whatever the general political climate is in December.

Surprise billing is still out there, too. It's lost some steam in the face of aggressive industry lobbying, but Sam's sources say a deal may still be possible — though likely on more industry-friendly terms (an arbitration arrangement to settle billing disputes, rather than a pricing mandate).

2. Health care keeps adding jobs
Expand chart
Data: BLS; Chart: Andrew Witherspoon/Axios

The health care industry added almost 24,000 jobs in August, helping to buoy overall employment growth amid economic fears associated with the U.S.-China trade war, my colleague Bob Herman reports.

Almost 1 out of every 9 Americans works in health care, and the industry has not seen a net loss of new jobs in any month since January 2014. But everyone's insurance premiums and tax dollars are funding this swelling workforce.

Between the lines: More than half of all health care job additions occurred in ambulatory settings, like doctors' offices, outpatient centers and home health agencies.

The bottom line: Health economist Uwe Reinhardt famously said, "Every dollar of health spending = someone else's dollar of health care income." A consistently growing workforce means it'll be that much more difficult to control the country's ballooning health care spending.

3. The segregation of emergency care

Ambulances are more likely to take black and Hispanic seniors to a safety-net hospital, compared to white enrollees in the same zip code, according to a new study in JAMA Network Open.

Yes, but: The same was generally true for walk-in patients.

  • Regardless, this study shows that patients aren't always taken to the closest emergency room.

Why it matters: Other studies have found that hospitals that see disproportionate numbers of minority patients offer worse care, the authors said.

4. Specialty drug costs vary by location

The cost of specialty drugs varies significantly based on the setting in which they're administered, according to a new brief by United Health Group.

  • The drugs are most expensive when administered in a hospital outpatient setting, and cheaper in independent doctors' offices and patients' homes.
  • Per capita spending on administered specialty drugs has increased by 14% annually, on average, since 2013.

Shifting specialty drugs away from hospital settings could save billions of dollars a year, UHG found.

The big picture: This isn't an accident. Hospitals acquire doctors' practices, in part, because they can then charge more for the same services.

5. While you were weekending...
  • The Wall Street Journal outlined the 2020 candidates' different approaches to improving mental health care.
  • Five people have now died from vaping-related lung illnesses, my colleagues Rashaan Ayesh and Orion Rummler reported on Friday. But health officials have offered differing advice on what products to avoid, per CNBC.
  • Google will no longer allow advertisements for unproven or experimental treatments, including most stem cell, cellular and gene therapies, the Washington Post reports.
Caitlin Owens