Sep 4, 2018

Axios Vitals

By Caitlin Owens
Caitlin Owens

Happy Tuesday, and hope you had a great long weekend. I, too, am confused about how summer is over and yet it's still so hot.

1 big thing: Big Tech steps up on opioids ...

Photo: Drew Angerer/Getty Images

Tech companies are cooperating with federal officials to crack down on illegal opioids being sold on the internet. But that doesn't mean congressional action on the issue is out of the question, Axios' David McCabe and I report this morning.

What we're watching: Silicon Valley is trying to defuse tensions with the Food and Drug Administration, and FDA Commissioner Scott Gottlieb's comments that tech is cooperating show their efforts may be working.

Members of Congress have put pressure on Silicon Valley over the issue. And in April, Gottlieb said in a speech that "internet firms simply aren't taking practical steps to find and remove these illegal opioid listings."

  • But last week, Gottlieb told Axios things have improved since then. “We are just beginning to learn how to work with them in a much deeper, more collaborative fashion."
  • He said some public actions have included platforms limiting the reach of certain websites implicated in the opioid trade and redirecting people to treatment sites.
  • “But they're also taking steps privately where they're helping us in some of our joint efforts and joint operations, and I'll just leave it at that."
2. ... but Congress may still go after Big Tech

While Gottlieb hasn't asked for any legislative action on the issue, Congress hasn't ruled out taking action in the future.

  • Lawmakers pointed to a possible model: legislation passed earlier this year that makes it possible for victims of sex-trafficking to sue online platforms that facilitated the crime.
  • "The harm caused to people through fentanyl, which is killing Americans in thousands, is arguably as great as the harm caused to people through human trafficking," Democratic Sen. Chris Coons told Axios.
  • Republican Sen. Thom Tillis said that "in the same way that we tailored it for human trafficking, I think that’s the way — that’s at least a part of what we have to do."

The other side: “Though evidence shows the epidemic is primarily an offline problem, internet companies are committed to playing an outsize role in fighting this tragedy," said Melika Carroll, SVP at the trade group Internet Association, whose members include Google and Facebook.

3. Middle class gets larger part of safety net
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Data: Congressional Budget Office; Chart: Chris Canipe/Axios

U.S. entitlement spending is increasingly going to the middle class, according to a Brookings Institution report. And health care is the main driver, Axios' Stef Kight reports.

Between the lines: Medicaid expansion has made more lower-middle income Americans eligible for the program, and now less than half of Medicaid spending goes to the lowest quintile.

  • Medicare Part D subsidies increased the share of health spending going to the middle class among the elderly.
  • Medicaid spending on elderly households (65 years or older) has tripled since 1979, and around 60% of it went to the middle class in 2014.
  • The Affordable Care Act's cost-sharing subsidies, designed to lower out-of-pocket costs, have contributed to the overall trend.

Why it matters: As wages have remained stagnant and income inequality grows, the middle class is increasingly relying on the federal safety net. Changes to the ACA or Medicaid would thus touch sectors of the electorate well beyond the poor.

4. Democrats' 2019 health care agenda

My colleague Mike Allen scooped yesterday that one of Democrats' first three legislative packages, should they win control of the House, will cover health care costs.

  • Health care would be divided into two buckets: cost containment, including reining in premiums, and lowering the cost of prescription drugs.
  • Of note: Prescription drug cost policy is already part of the Dems' "A Better Deal" platform, while the party hasn't yet put forward a premium reduction plan.

The drug price policies in "Better Deal" include:

  • Creating a new "price gouging" enforcer that would identify "unconscionable" price increases and fine the manufacturers responsible.
  • Allowing Medicare Part D to negotiate drug prices.
  • Requiring significant drug price increases to be accompanied by a public justification.
5. Major source of childbirth coverage: Medicaid
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Reproduced from a CDC National Center for Health Statistics report; Chart: Axios Visuals

Medicaid is the primary source of insurance in 43% of childbirths, and that percentage is much higher the younger the mother is, according to the latest numbers from the Centers for Disease Control and Prevention.

Why it matters: It's a reminder that women and children are among the most affected when state and federal lawmakers talk about cutting Medicaid funds, my colleague Bob Herman reports.

  • That's one reason there was such a backlash when Republicans tried to do it during their attempts to repeal the Affordable Care Act.

Bonus: In Ohio, 84% of employed Medicaid expansion beneficiaries said having Medicaid made it easier for them to continue working, and 60% of unemployed enrollees said having it made it easier to look for work, according to a report issued by the state last month.

  • As PwC's health care team pointed out last week, both Medicaid work requirements and Medicaid expansion in current non-expansion states are both big topics this year.
6. While you were weekending ...
  • Kaiser Health News looks at Democratic doctors running for office.
  • The American Academy of Pediatrics is advising parents to get their kids regular flu shots, not FluMist, per STAT.
  • Lanhee Chen and James Capretta point out in the New York Times that there's growing bipartisan consensus on how to increase the quality and lower the cost of medical care.
  • Microwave weapons may be responsible for the illnesses of 3 dozen diplomats and their family members in Cuba and China, per NYT.
Caitlin Owens

What we're watching today: The Senate Judiciary Committee hearing on Brett Kavanaugh's Supreme Court justice nomination.

What we're watching this week: Oral arguments in the Texas case challenging the ACA's pre-existing conditions protections begin Wednesday.

House Energy and Commerce Committee will hold a hearing Wednesday on opportunities to improve health care, Ways and Means will have a markup of several health care bills Wednesday, and MedPAC has a public meeting on Thursday and Friday.