Dec 12, 2019

Axios Vitals

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Today's word count is 793, or a 3-minute read.

1 big thing: Azar and Verma, still employed

HHS Secretary Alex Azar, President Trump and CMS Administrator Seema Verma. Photo: Alex Wong/Getty Images

Health and Human Services Secretary Alex Azar and Centers for Medicare and Medicaid Services Administrator Seema Verma both still have their jobs after last night's White House meeting, but that doesn't mean all is well.

Details: The meeting was in Vice President Mike Pence's office. Pence, acting chief of staff Mick Mulvaney, Azar, Verma and Pence's chief of staff, Marc Short, attended, two sources familiar told Axios' Jonathan Swan.

  • One of the sources said the message conveyed to Azar and Verma was that the president likes both of them, but they need to cut out the fighting and work together.
  • "The ball's in their court," the source added. "There are no more conversations to be had."

The bottom line: The pair's scorched-earth tactics have made it hard to imagine them having a productive working future, but both have strong allies — and enemies — inside the administration, making it equally difficult to predict whether either will be forced out.

The latest: Politico published a deep dive into the Azar and Verma's relationship, reporting that things began to really tank this fall after the duo fought over prescription drug policies and how to replace the Affordable Care Act.

  • With their futures on the line, the two have taken to Twitter, television and op-eds to praise President Trump and their own work for him.
  • The Washington Post also published a report last night on how the departmental infighting — along with Trump's own shifting demands — has impeded President Trump's health care agenda.
2. Employers skeptical of insurer merger savings

Photo: Illustration: Sarah Grillo/Axios

Mergers between health insurers and pharmacy benefit managers have been billed as a way to save employers money. But half of employers don't expect that to happen, according to a new JPMorgan survey.

Driving the news: In JPMorgan's survey of top human-resources executives from 50 companies, exactly 50% said they don't think integrating medical and drug benefits under one roof will "drive overall health care savings," Axios' Bob Herman reports.

What they're saying: Here are some of the anonymous quotes JPMorgan gathered from respondents on the skeptical side:

  • "There's too much money to be made. They're not offering integrated services to give up revenue."
  • "I am not sure why going back to how it was will magically result in overall savings."
  • "More ways to hide money."

The other side: Even among the other 50% — the executives who were more optimistic about savings — that optimism was tempered.

  • "Conceptually, this should mean greater influence over prescribing patterns. To date, in my opinion, it hasn't," one executive said.

Between the lines: As we wrote last year, this spate of consolidation among insurers and PBMs would not have happened unless those companies were pretty sure they could hang on to a lot of the savings they produced.

  • Employers can always switch insurance carriers if they think they are getting overcharged. But they rarely do so, because they don't want the employee backlash that's associated with overhauling health benefits.

Go deeper: Health insurance is as big as Big Tech

3. Pharma's pollution problem

Contaminants from drug manufacturing facilities have been tainting wastewater with dangerously high concentrations, according to an investigation from STAT.

Why it matters: Polluting rivers and lakes with pharmaceutical runoff is not illegal, but can be harmful to wildlife and the environment, Axios' Marisa Fernandez writes.

  • Wastewater treatment plants also don't have the ability to remove pharmaceuticals.

The findings:

  • The U.S. Geological Survey found that discharges from seven treatment plants had "very high levels of some drugs."
  • Downstream from a plant in Morgantown, West Virginia, an anti-seizure medication was measured at nearly 90 times the amount considered safe for wildlife.
  • Hospitals also contribute to drug pollution, releasing antibiotics and cancer drugs into the water.
4. Partisanship is awfully powerful

A new Gallup survey shows that Republicans have gotten a whole lot happier about the cost of health care since President Trump took office, while Democrats' satisfaction has plummeted, Axios' Sam Baker reports.

Our thought bubble, via Sam: There is very little reason for anyone to be satisfied with the cost of health care in the U.S. And that has been true for a very long time.

This chart shows that partisanship colors people’s view of health care costs, with Republicans prone to bigger mood swings than Democrats.

  • The Affordable Care Act did attempt some cost control within Medicare, and it did make insurance more affordable for many people. But those policies, good or bad, have been humming along relatively unchanged while partisan attitudes have changed around them.
  • And, in the big picture, while Democrats' and Republicans' attitudes have been shifting, health care spending has steadily increasing every year  — from about $2.7 trillion in 2011 all the way up to roughly $3.6 trillion last year.
5. Where Americans die

More Americans are dying at home than in hospitals for the first time in more than a half century, according to a new study in the New England Journal of Medicine.

Why it matters: "Americans have long said that they prefer to die at home, not in an institutional setting. Many are horrified by the prospect of expiring under florescent lights, hooked to ventilators, feeding tubes and other devices that only prolong the inevitable," NYT writes.

By the numbers: In 2017, 29.8% of deaths by natural causes occurred in hospitals, and 30.7% were in people's homes.

Go deeper: The looming crisis in long-term care