May 1, 2018

Axios Vitals

Good morning ... You may see some reports about congressional Republicans wanting to try again to repeal the Affordable Care Act before the midterms. And you may ask yourself, "Wait, didn't this already fail, multiple times? Don't Republicans have even fewer Senate seats now? Wouldn't it almost certainly just fail again?" Yes, yes and yes.

My colleague Caitlin Owens asked a senior GOP aide what it would be like to go through all this again: "Like having a root canal, a prostate exam, and Lasik surgery without anesthetics all at the same time in front of your high school crush."

1 big thing: Pharma gets more blame on opioids
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SurveyMonkey poll conducted April 9–13, 2018. Poll Methodology; Chart: Axios Visuals

Pharmaceutical companies are shouldering a greater share of the blame for the opioid crisis, according to a new Survey Monkey/Axios poll, although individual users are blamed most often.

Why it matters: This shift in blame mirrors a change in Washington policymakers' thinking. Some lawmakers — particularly liberal Democrats — have introduced legislation punishing drug companies, while the Department of Justice is backing lawsuits against drug manufacturers and distributors.

2. The uninsured rate is rising again
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Reproduced from Commonwealth Fund's Affordable Care Act Tracking Surveys; Note: Surveys conducted July–Sept. 2013, April–June 2014, March–May 2015, Feb.–April 2016, March–June 2017, Feb.–March 2018. Chart: Axios Visuals

The number of Americans without health insurance is creeping back up, after seeing a big drop once the Affordable Care Act took effect, according to the latest tracking survey from the Commonwealth Fund.

The numbers that matter: About 15.5% of adults are uninsured, by Commonwealth’s count, up roughly 3 percentage points from the same time in 2016. That represents an increase of about 4 million people, the organization said.

  • Lower-income families saw the biggest coverage losses. Families making more than about $60,000 per year saw relatively stable coverage levels.

The context: Commonwealth attributes the increase largely to the way Congress and the Trump administration has handled the ACA.

Yes, but: Roughly 11.8 million people selected insurance plans through the ACA’s exchanges in the most recent open enrollment period — only about 1 million lower than the number who bought coverage for 2016.

3. Trump may cut Planned Parenthood funding

The Trump administration is debating whether to cut off abortion providers such as Planned Parenthood from Title X family-planning funding, Caitlin and Jonathan Swan report.

What we're hearing: While some conservative leaders are blaming Ivanka Trump for the indecision inside the White House, a source familiar with her thinking said she has not been advocating against the policy to the president. The source said it was Trump who said in a meeting he wanted to know what Ivanka thought of the policy.

How it works: Title X has a budget of $286 million and provides funding for around 4,000 clinics that serve about 4 million women. Planned Parenthood says it makes up about 500 of the clinics, and serves about 1.5 million of the patients. 

4. How cities are getting better data on opioids

CityLab has a really interesting story about how local governments are trying to come up with better data to help them get a fuller picture of opioid abuse in their communities, and the new treatment tools they’re developing in the process.

The problem: The most comprehensive opioid-related record-keeping is about overdose deaths, but that data set doesn’t tell the whole story.

Some solutions, per CityLab:

1. Cary, N.C., is planning to “deploy small robots into the sewage system to collect samples of the city’s waste."

  • The samples will be measured for their concentration of opioid metabolites, which get flushed out of bodies after opioid consumption.”
  • That will help the city gain a better understanding of which types of drugs people are using, in which parts of the city.

2. In the Baltimore/Washington area, first responders enter suspected overdoses immediately into a mobile app, color-coded for fatalities and whether they administered naloxone, giving health officials the ability to almost immediately spot spikes and redirect their resources accordingly.

What’s next: First responders in and around Annapolis, Md., are also using new tools to help find open treatment beds.

  • Because overdoses outnumber available beds, “teams would have to call as many as 30 different centers” to find an opening.
  • With the new tool, treatment centers update their availability twice a day into an app, which then feeds into a “dashboard” that first responders can search, based on a specific patient’s needs.

The catch: “Ideally the national government would set a framework so that we get consistent data, and cities will implement those frameworks,” University of Virginia economist Christopher Ruhm told CityLab.

  • But in the absence of such a program, he said, cities are filling the gaps themselves.
5. LePage sued over Medicaid resistance

Health care advocates in Maine yesterday sued Gov. Paul LePage over his administration's foot-dragging on the state's Medicaid expansion.

  • Voters in Maine approved the Medicaid expansion through a ballot initiative last year, but LePage's administration hasn't yet submitted an actual expansion proposal to the federal government.

Between the lines: LePage was expected to drag his feet even before the ballot initiative passed, and advocates were expected to sue in response.

  • This will most likely be resolved when Maine elects a new governor later this year (LePage is term-limited).

Quick take: It's a reminder about the limits of expanding Medicaid through a ballot initiative. Even when you win, opponents often can still stand in the way.

Meanwhile: Advocates say they've gathered enough signatures to get Medicaid expansion on the ballot this fall in Idaho.

6. The Cadillac tax's biggest enemies

Congress delayed the ACA’s “Cadillac” tax earlier this year, meaning the excise tax on high-cost employer plans won’t go into effect until 2022. Many companies lobbied to get that done, and groups are still pushing for the tax to get repealed completely, Bob Herman reports.

Be smart: Republicans and many Democrats hate the Cadillac tax because it would chip away at workers’ benefit packages, but health economists think it’s necessary to control the untaxed wilderness that is employer-based health insurance. Companies and unions want the tax gone forever, and likely won’t rest until it is.

Groups that specifically lobbied on the Cadillac tax in the first quarter of this year, per filings reviewed by Bob:

  • U.S. Chamber of Commerce
  • Boeing
  • Dow Chemical
  • General Motors
  • National Association of Manufacturers
  • United Brotherhood of Carpenters and Joiners of America

Flashback: The policies that made the ACA more affordable are the ones Congress has managed to repeal or delay.

Go deeper: Employer coverage isn’t all it’s cracked up to be.

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