Sep 10, 2018

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning ... 2 New Things we're excited to add to the Axios newsletter family:

Axios Edge, Felix Salmon's must-read weekly newsletter covering the big stories that will drive the business world, launches this Sunday. Don't miss out — sign up here

And on FridaySeptember 21, we'll launch Axios Autonomous Vehicles, a weekly analysis of autonomous tech, and its impact on cities, policy and the economy. It'll be worthy of your time — sign up here

1 big thing: Dems campaign on Medicaid expansion
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Data: Kaiser Family Foundation, The Cook Political Report; Chart: Andrew Witherspoon/Axios

Democratic gubernatorial candidates are making the Affordable Care Act's Medicaid expansion a central part of their campaigns, my colleague Caitlin Owens reports this morning.

What we're watching: Democrats in competitive races in non-expansion states — including Florida, Georgia, Kansas and Wisconsin — are making it a point of contrast with their Republican opponents.

  • Democrat Tony Evers, who is challenging Republican Scott Walker in Wisconsin, addressed the issue in his first TV ad of the general election.
  • In Georgia, Stacey Abrams brings up her support for Medicaid expansion often, and includes it in advertising.
  • Even in states that have adopted the expansion, Democrats are touting their support and arguing that Republican opponents would scale back the program. (Michigan's Gretchen Whitmer has an ad making that point.)

The other side: Medicaid expansion is typically pretty popular, and Republicans have been struggling with how to handle the issue, the Washington Post reported in July.

  • Most are quiet about the issue, preferring instead to launch their own offensives about Democrats' increasing embrace of "Medicare for All."

Why it matters: Democrats up and down the ballot are focused on health care. But while congressional races are largely debates about the Trump administration's ACA agenda or "Medicare for All," Medicaid expansion is an issue that gubernatorial candidates would actually have a lot of power to influence.

Don't forget about ballot initiatives, which have the power to expand Medicaid this year even in states without competitive governors' races.

2. Kaiser Permanente will go carbon-neutral

Kaiser Permanente, the multi-state network of hospitals, doctors and health insurance, is buying significant amounts of renewable energy and building solar and wind farms in an effort to be carbon-neutral by 2020, CEO Bernard Tyson tells my colleague Bob Herman in an interview.

The big picture: The health care industry will have to be part of climate solutions, given that it accounts for about 10% of U.S. greenhouse gas emissions.

Reality check: While Kaiser is a large system with more than 75 million square feet of hospitals and other real estate, that's a relatively small footprint. The land area of Kaiser's headquarters in Oakland, Calif., is about 1.6 billion square feet.

  • However, shifting to renewable energy at hospitals would be particularly beneficial because they are intensive energy hogs.

Why now: "The massive fires that we're dealing with in California — I don't need to debate whether that's a climate issue," Tyson says, adding that climate change has direct and indirect effects on people's health.

3. When doctors' conflicts aren't disclosed

"One of the world’s top breast cancer doctors failed to disclose millions of dollars in payments from drug and health care companies ... omitting his financial ties from dozens of research articles in prestigious publications like The New England Journal of Medicine and The Lancet," the New York Times and ProPublica reported on Saturday.

The details: The NYT/ProPublica investigation focuses on José Baselga, the chief medical officer at Memorial Sloan Kettering Cancer Center.

  • He has received almost $3.5 million from drug, device and diagnostics companies, just over a 4-year period, according to the investigation. And that doesn't include any payments from startups that don't have to meet the same federal reporting requirements.
  • Those payments weren't disclosed in articles he wrote for prestigious journals, including NEJM.

“The matter of disclosure is serious,” Memorial Sloan-Kettering's chief executive, Craig Thompson, wrote in an email to hospital staff after the initial story was published, saying they “need to do a better job” of disclosing financial conflicts.

4. While you were weekending ...
  • The Food and Drug Administration is cracking down on drug compounding, the Wall Street Journal reports.
  • One generic competitor for high-priced products like the EpiPen won't deliver real savings, according to a STAT News opinion piece. Big discounts require two generics.
  • Tobacco companies are spending millions to try to defeat a Montana ballot initiative that would use tobacco taxes to maintain the state's Medicaid expansion, per KRTV.
  • The NYT explores Sen. Joe Manchin's use of heath care in what should be one of the most competitive re-election campaigns of the year.
Caitlin Owens

What we're watching this week: The Senate is slated to vote on a bill to address the opioid crisis. House Energy and Commerce hearings on value-based care and maternal mortality.

What else is going on? I always welcome your tips and comments: