Oct 4, 2019

Axios Vitals

Good morning.

Heads-up: Every quarter Axios journalists highlight the trends they are watching in politics, energy, science, technology, business and more. As a subscriber to this newsletter, you'll see that in your inbox from Mike Allen tomorrow. The topic: "A brewing storm for big tech."

Today's word count is a mere 712 words, or <3 minutes.

1 big thing: Trump doesn't have an alternative to Medicare for All

Illustration: Lazaro Gamio/Axios

What the White House billed yesterday as a high-profile counterpunch to "Medicare for All" turned out to be much less significant — a fairly normal, fairly vague policy statement with no real implications for 2020.

Between the lines: Trump is promoting Medicare Advantage over traditional Medicare, and that does matter for the program and the federal budget.

  • But it's not a new position, and not one that has much to do with the broader debate over the American health care system.

What they're saying: "Proposals like 'Medicare for All,' as well as the public options, are not just impractical, they are morally wrong because they would demote American seniors to little better than second-class status," Medicare and Medicaid administrator Seema Verma told reporters yesterday.

Reality check: Plenty of what the Trump administration has said is hyperbole, untrue or unknowable. And the policy the administration rolled out has little to do with these big-picture issues.

  • "I think this is the shapings of a political argument for why 'Medicare for All' is bad, not an alternative to 'Medicare for All,'" said a health insurance executive familiar with GOP politics.

Details: Yesterday's executive order requires regulatory changes advantageous to Medicare Advantage, which is run by private insurers.

  • "This is not any radical change by the administration, just a continuation of their push to increase flexibilities in MA and increase the supplemental benefits offerings for beneficiaries," said Avalere's Chris Sloan.

Go deeper: How seniors are being steered toward private Medicare plans

2. Hospital merger race continues

The hospital industry isn't just consolidating among the titans. Deals are happening frequently at the local level, too, Axios' Bob Herman reports.

Why it matters: Smaller hospital deals are just as important as large system mergers because local market power is paramount in health care — people usually get care close to where they live.

  • A combined entity reduces competition, which could give it the upper hand in negotiations with commercial health insurers in its area.

The big picture: The number of hospital mergers and acquisitions in the first half of this year tracked in line with 2018 and featured deals with big players, according to an analysis from Kaufman Hall. Plenty of smaller transactions are rolling out now, too.

Between the lines: Hospitals contend their deals are about improving patient care. But their press releases and executives rarely, if ever, talk about the financial benefits of their new enhanced negotiating power.

  • If hospitals in smaller communities combine, commercial insurers will have a harder time excluding any one of them from their networks, even if a hospital has poorer quality or higher prices. This is commonly called "all-or-none" contracting, and it's been cited in the pending Sutter Health case.

State and federal antitrust officials also have fewer resources to investigate these kinds of regional deals, making it easier for those with antitrust issues to go forward.

Bob has more here.

Go deeper: A reality check on hospital mergers

3. Lifesaving drugs could be missing on planes

It's illegal for U.S. airlines to take off without a kit of lifesaving drugs on board, but the Federal Aviation Administration has been handing out exemptions because some of those drugs are facing shortages, the New York Times reports.

Domestic and international flights must carry drugs for severe allergic reactions, cardiac arrest, irregular heart rhythm, slow heart rates and low blood sugar, Axios' Marisa Fernandez writes.

  • In 2016 more than 50 airlines were granted 4-year exemptions from the requirement to carry all 5 drugs in the medical kit, per NYT. Narrower exemptions are more common.

Health officials are especially concerned about epinephrine or adrenaline, which can be life savers for the tens of millions of people with food allergies.

Yes, but: Fainting, near-fainting and gastrointestinal problems are more common in flight than other emergencies, the Times reports.

4. U.S. likely to retain measles elimination status

Illustration: Sarah Grillo/Axios

New York says it has reached a "milestone" in halting the measles outbreak that started in October 2018, and U.S. public health officials now believe the U.S. has retained its measles elimination status — just barely meeting the year deadline, a spokesperson for the Centers for Disease Control and Prevention said Thursday.

Yes, but: Recent cases reported from returning international travelers demonstrate the danger of new outbreaks when there are still pockets of communities with low vaccination rates, Axios' Eileen Drage O'Reilly reports.

Related: "Thousands of individual schools in the U.S. don't have high enough immunization levels to meet the threshold considered adequate to protect a population from measles," the Wall Street Journal reports.

5. 1 stressful thing

Wonder what it must be like to be the ER doctor who's in charge of making sure Bernie Sanders' heart is healthy (or being in charge of any presidential candidate's health, for that matter)?

Some actual ER docs have wondered the same thing, Axios' Sam Baker writes.

Their thoughts.