Good morning … Our thoughts are with the families whose children were killed in the horrific mass shooting yesterday in Florida. And they are still with the families devastated by so many other mass shootings, and will be with the families who lose loved ones in the next mass shooting. This is a really horrible routine.
Idaho Gov. Butch Otter said last month he would let insurance companies sell policies that do not comply with the Affordable Care Act. And yesterday, Blue Cross of Idaho took him up on it.
What they’re saying: I asked BCI officials yesterday how they decided it was safe to jump into this new arena — to go ahead and sell these plans, despite questions on whether they’re legal.
The other side: “There’s no question that these plans are illegal,” University of Michigan law professor and ACA legal guru Nick Bagley tells me. “It’s not that what they're doing is legal. They just think they're not going to get caught.”
The bottom line: This is a huge test for HHS secretary Alex Azar. And if he doesn’t enforce the ACA now, the Trump administration could ultimately find itself tied up in just as much ACA litigation as the Obama administration. Remember that the Medicaid work requirements are also being challenged in the courts.
Go deeper: Read more about Idaho's audacious experiment and the scrutiny it will face.
Americans spent $3.5 trillion on health care in 2017, according to new federal estimates. Health care spending grew faster than the broader U.S. economy, which is nothing new — and the federal actuaries who crunched these numbers expect health care spending to start growing even faster this year and beyond, Axios Bob Herman reports.
Some of the actuaries’ key projections, per Bob:
1. Prescription drugs: Retail drug spending is expected to rise 6.6% in 2018, compared with a modest 2.9% rate last year.
2. Doctors and hospitals: Projected to grow 5% in 2018, a return to the growth rates of prior years.
3. Medicare: Per-person Medicare spending is expected to grow 3% this year, the highest growth rate in a long time.
This is a really interesting project: The New York Times asked 30 experts how they’d spend $100 billion to help address the opioid crisis.
They were not all on the same page. “There was substantial disagreement about whether to focus on treating addiction or on trying to prevent the addiction from forming in the first place by addressing the underlying social issues that allow opioid addiction to thrive,’ the Times reports.
What’s next: My colleague Caitlin Owens reported yesterday that Sens. Lamar Alexander and Patty Murray are sitting down with insurers as they try to get a handle on the specifics of what can be done to address this large and growing crisis.
We told you about the California insurance commissioner’s investigation of Aetna after CNN reported that one of the insurer’s former medical directors testified that he didn’t look at patients’ medical records when making coverage decisions.
Yesterday, Aetna hit back with a statement saying the medical director’s deposition was taken out of context, and called it “a gross misrepresentation of how the process actually works.”
What’s new: The insurer cited a sworn statement by the former medical director, Dr. Jay Ken Iinuma, saying he reviewed “the relevant portions of submitted medical records” as well as “Aetna nurses’ summaries, notes, and the applicable Aetna Clinical Policy Bulletins” before deciding what treatments would be covered.
The big picture:
Between the lines: In his statement, Iinuma says he took the question about medical records to mean “the entirety of a patient historical file.” Per CNN, here’s how the exchange between the college student’s attorney and Iinuma went:
"Did you ever look at medical records?"
"No, I did not."
A panel of health care experts sounded the alarm yesterday about health care consolidation, during a hearing before the House Energy and Commerce Committee. Bob watched the whole thing so you didn’t have to.
Threat level: If there’s one area where politicians of all stripes are inclined to agree, it’s pharmacy benefit managers. Republicans and Democrats have both expressed concern about three companies controlling more than 75% of the market, and President Trump’s budget also suggested breaking up PBMs.
What we're watching today: Azar testifies before the Senate Finance Committee and the House Energy and Commerce Committee about the department's budget request. If his appearance yesterday before Ways and Means is any guide, don't expect much news.
What's good? Let me know: email@example.com.