Nov 5, 2018

Axios Vitals

Good morning ... One of the only interesting press releases I've ever seen came yesterday from the Secret Service, about needing to run the New York City marathon in order to protect the Estonian president, who was in New York and running the marathon. As last-minute assignments go, a marathon is pretty intense.

1 big thing: Trump talks pre-existing conditions

Trump with Missouri Attorney General Josh Hawley, who sued to toss out the Affordable Care Act. Photo: Scott Olson/Getty Images

In an exclusive interview for "Axios on HBO," President Trump said Attorney General Jeff Sessions didn't give him a heads up before urging a court to throw out the Affordable Care Act's provisions on pre-existing conditions. But Sessions has said Trump signed off on the move.

  • “No, he didn’t, actually,” Trump said.
  • But Sessions has said he took this politically explosive position “with the approval of the President of the United States.”
  • “Litigation decisions are typically handled through the White House Counsel’s office on behalf of the President,” White House press secretary Sarah Sanders said when asked about the conflicting answers. “The issue presented in this case is a technical constitutional issue and does not represent the Administration’s general position on pre-existing conditions.”

“It wouldn’t matter” if the ACAs protections for pre-existing conditions are struck down, Trump said, “because pre-existing conditions, on anything we do, will be put into it.”

  • “I support terminating Obamacare, but if we terminate it, we will reinstitute pre-existing conditions in whatever we do,” he said.

Trump has said this throughout the midterm campaign season. But in the 8 years since the ACA passed, Republicans have never proposed an alternative that would offer the same level of protection.

  • Their proposals have either been underfunded or have left gaps that would still expose some people to higher costs and denied coverage.

Watch the exchange.

2. Insurers’ crusade against ACA tax

The health insurance industry is lobbying yet again for a delay of the ACA's tax on insurers, but experts tell Axios’ Bob Herman and Caitlin Owens that a delay wouldn't benefit consumers as much as it might seem.

What they're saying: "All taxes, just like sales tax for example, are passed through to consumers in the form of higher premiums," Kristine Grow, spokesperson for America's Health Insurance Plans, said in a statement.

Between the lines: Insurers do pass on the cost of the tax through higher premiums, when it’s in effect: Actuaries say the tax leads to premiums being 1%–3% higher than they would be otherwise.

  • When the tax is paused, consumers avoid that premium increase, but insurers don’t pass on all of the tax savings through lower premiums. They keep a lot as profit.

Insurers should be able to handle the tax now that the ACA markets, in particular, have stabilized, former Medicare and Medicaid administrator Andy Slavitt said.

  • "There was at least a decent argument to be made in 2015, 2016 that maybe you delay it until the markets are at some equilibrium where they're competitive and profitable," he said. "Now that they're competitive and profitable, that argument isn't as strong."

Go deeper.

3. Health care gives Dems an edge with seniors
Expand chart
Adapted from a Kaiser Family Foundation column based on a poll conducted Sept. 19–Oct. 2 of 313 registered voters ages 65 and older with a margin of error of ±7 percentage points; Chart: Harry Stevens/Axios

Seniors prefer Democratic positions on enough health care issues to give them a slight edge with older voters in tomorrow’s midterm elections, the Kaiser Family Foundation’s Drew Altman writes in today’s column.

Why it matters: Seniors always vote.

The other side: It doesn’t mean they’ll automatically tip the elections to Democrats. But it doesn’t hurt Democrats to have reliable voters siding with them on most health care issues.

  • The big exception: Seniors are more evenly split on whether they trust Democrats or Republicans more on Medicare (45% vs. 41%). But Medicare, the health issue seniors care about most, has not been in play in these midterms.
  • What to watch: Republicans haven’t convinced them yet that “Medicare for All” will destroy Medicare. But keep an eye on it.

Read the column.

4. Why the FDA approved a powerful new opioid

The Food and Drug Administration took some heat on Friday for approving Dsuvia, a new opioid painkiller that’s up to 10 times more powerful than therapeutic fentanyl.

  • “Clearly the issue of the safety of the public is not important to the commissioner, despite his attempts to obfuscate and misdirect,” said Raeford Brown, a University of Kentucky professor who chairs an FDA advisory committee that reviewed the drug.

Yes, but: That committee ultimately recommended approving the drug.

What they’re saying: FDA Commissioner Scott Gottlieb acknowledged the criticism in a statement about the approval, and said it may be time for the agency to think differently about the standards for approving opioids. He said:

  • “We generally consider each new drug approval — and each new opioid drug approval — largely on its own merits. As part of our review, we ask whether the individual drug meets the standard for safety and effectiveness, and whether additional controls are needed to ensure safe use of that specific drug.”
  • “Looking beyond this particular drug approval, I believe that we should consider whether we should be doing more to evaluate each candidate opioid, not just as an independent review decision, but rather also to consider each novel opioid drug in the context of the overall therapeutic armamentarium that’s available to patients and providers.”
5. While you were weekending ...
  • In his latest piece for the New Yorker, Atul Gawande looks at the downsides of electronic medical records.
  • Hospitals are working hard to kill a proposal in North Carolina that would tie the state's payment rates to Medicare's rates, the Wall Street Journal reports.
  • Commonwealth Fund experts argue in the Harvard Business Review that employers should form purchasing alliances to bring down their costs.
  • HuffPost's Jonathan Cohn looks at the midterm elections' very big stakes for Medicaid.