From Health Care

Even People With Employer-Sponsored Plans Are Spending A Big Chunk Of Income On Health Insurance

“The affordability trends in the employer market are driven by healthcare costs rising a lot faster than the median income,” said Sara Collins, vice president of healthcare coverage and access at the Commonwealth Fund. The trends may be fueling some of the “Medicare for All” interest, experts say.

Even People With Employer-Sponsored Plans Are Spending A Big Chunk Of Income On Health Insurance

“The affordability trends in the employer market are driven by healthcare costs rising a lot faster than the median income,” said Sara Collins, vice president of healthcare coverage and access at the Commonwealth Fund. The trends may be fueling some of the “Medicare for All” interest, experts say.

Changes To CMS Readmission Penalties Appear Effective In Addressing Unique Challenges Of Rural, Teaching Hospitals

The changes were made to address complaints from hospitals—safety-net hospitals in particular—that they are unfairly penalized in the readmissions program because of their complex patient case mix. For rural hospitals, their average penalties are estimated to decline from $55,268 to $53,633; while average penalties for teaching hospitals will drop from $287,268 to $283,461. Other news from CMS looks at accountable care organizations and primary care accounts.

Changes To CMS Readmission Penalties Appear Effective In Addressing Unique Challenges Of Rural, Teaching Hospitals

The changes were made to address complaints from hospitals—safety-net hospitals in particular—that they are unfairly penalized in the readmissions program because of their complex patient case mix. For rural hospitals, their average penalties are estimated to decline from $55,268 to $53,633; while average penalties for teaching hospitals will drop from $287,268 to $283,461. Other news from CMS looks at accountable care organizations and primary care accounts.

‘Born-Alive’ Measure Passes North Carolina Senate, But Faces Possible Veto From Democratic Governor

The legislation would punish doctors who fail to treat babies who are born as part of a failed abortion attempt. Critics of the measure say that it’s attempting to fix a nonexistent problem, and that there are already penalties for doctors who do not treat babies who are born alive. Abortion news comes out of North Dakota, Alabama, Ohio and Kansas, as well.

‘Born-Alive’ Measure Passes North Carolina Senate, But Faces Possible Veto From Democratic Governor

The legislation would punish doctors who fail to treat babies who are born as part of a failed abortion attempt. Critics of the measure say that it’s attempting to fix a nonexistent problem, and that there are already penalties for doctors who do not treat babies who are born alive. Abortion news comes out of North Dakota, Alabama, Ohio and Kansas, as well.

Behind The Scenes, Three Key Figures Are Helping Shape The Democrats’ Strategy On Reducing Drug Prices

Stat offers a closer look at Richard Frank, Lauren Aronson and Gerard Anderson–three of the key figures and Democratic health-policy thought leaders who have been working closely with Wendell Primus, a top adviser for House Speaker Nancy Pelosi (D-Calif.). In other pharmaceutical news, the Supreme Court dealt pharma a loss by rebuffing Allergan’s efforts to shield patents by transferring them to a Native American tribe.

Behind The Scenes, Three Key Figures Help Shape The Democrats’ Strategy On Reducing Drug Prices

Stat offers a closer look at Richard Frank, Lauren Aronson and Gerard Anderson — three of the key figures and Democratic health-policy thought leaders working closely with Wendell Primus, a top adviser for House Speaker Nancy Pelosi (D-Calif.). In other pharmaceutical news, the Supreme Court dealt pharma a loss by rebuffing Allergan’s efforts to shield patents by transferring them to a Native American tribe.

In Midst Of Disaster Funding Stalemate, Rick Scott’s Campaign Promises To Stand Up For Puerto Rico Put Him In Tough Spot

Democrats are seizing the opportunity to blast Sen. Rick Scott (R-Fla.) for taking President Donald Trump’s side in the battle of disaster relief. But Scott is fighting back. “This is a great example of why people hate politics. Not only did @SenSchumer block a bipartisan bill, now he’s lying about it,” Scott tweeted Sunday evening. “Our bill doesn’t strip funding for P.R. It includes $600 mil in nutrition assistance funding for P.R. that I fought to get in the bill.” As the bickering in Washington continues, many in Puerto Rico are left uncertain and worried about the future.

In Midst Of Disaster Funding Stalemate, Rick Scott’s Campaign Promises To Stand Up For Puerto Rico Put Him In Tough Spot

Democrats are seizing the opportunity to blast Sen. Rick Scott (R-Fla.) for taking President Donald Trump’s side in the battle of disaster relief. But Scott is fighting back. “This is a great example of why people hate politics. Not only did @SenSchumer block a bipartisan bill, now he’s lying about it,” Scott tweeted Sunday evening. “Our bill doesn’t strip funding for P.R. It includes $600 mil in nutrition assistance funding for P.R. that I fought to get in the bill.” As the bickering in Washington continues, many in Puerto Rico are left uncertain and worried about the future.

Officials Report 90 New Cases Of Measles All But Guaranteeing 2019 Will Be Worst Year This Century Has Seen

While 20 states have reported cases, New York — in particular, ultra-Orthodox Jewish community that lives in Brooklyn — has been the epicenter of the outbreak. The infections test the boundaries between religious freedom and protection of public health. Meanwhile, the boom in cases in America is mirrored worldwide: globally there are four times as many measles cases so far this year as there were at the same time last year.

Town Hall Audience Erupts In Cheers When Asked About Support For Sanders’ ‘Medicare For All’ Plan

The slice of public opinion at the town hall for 2020 hopeful Sen. Bernie Sanders (I-Vt.) reflects broader polling that shows support for a system that guarantees universal coverage. However, when details about paying for the plan are revealed, that support has, in the past, dropped.

‘Heartbeat Bills’ Give State Lawmakers Pause On Anti-Abortion Tactics

In anticipation of a new anti-abortion tilt on the Supreme Court bench, some states are moving to further restrict the procedure during the first trimester of pregnancy or to outlaw abortion entirely if Roe v. Wade ever falls. But the rush to regulate has exposed division among groups and lawmakers who consider themselves staunch abortion opponents.

On Thursday, Ohio became the latest state to ban abortions after a fetal heartbeat can be detected. For a long time, Ohio Right to Life supported a more gradual approach to restrict the procedure and deemed what’s come to be called a “heartbeat bill” too radical — until this year. Restricting abortions after a fetal heartbeat can be detected basically bans the procedure after six weeks of gestation — before many women know they’re pregnant.

“We see the court as being much more favorable to pro-life legislation than it has been in a generation,” spokeswoman Jamieson Gordon said. “So we figured this would be a good time to pursue the heartbeat bill as the next step in our incremental approach to end abortion-on-demand.”

The Ohio law contains no exception for pregnancies that are the result of rape or incest; it does have an exception for the life of the mother.

Some say the rush to pass these bills is about lawmakers competing to get their particular state’s law before the Supreme Court. The state that helps overturn Roe v. Wade would go down in history.

More than 250 bills restricting abortions have been filed in 41 states this year, according to the Guttmacher Institute, a reproductive rights research and advocacy group.

“After the appointment of Justice [Brett] Kavanaugh, there really is just an environment in state legislatures to roll back abortion rights. And so we’re seeing these bans just fly through,” said Elizabeth Nash, who monitors state laws at Guttmacher.

But the speed of passage of some of these laws masks divisions about strategy and commitment to the cause within the anti-abortion movement.

Tennessee Infighting Over ‘Heartbeat Bill’

In Tennessee, for instance, there’s a philosophical split between pragmatists and idealists.

A “heartbeat bill” in the state has had high-profile support, including from the Tennessee’s new governor. But the Republican attorney general warned such a law would be difficult to defend in court. And several Republicans, swayed by that logic, voted no for the legislation.

“This is an issue that is extremely important to me. It’s the reason I got into politics many years ago,” Republican state Rep. Bill Dunn said as the House approved the measure over his objection earlier this year. Dunn has said he wants to stop abortion, but that will require strategy. He pointed out that no heartbeat bill has ever been enforced. And recent laws in Iowa and Kentucky have been immediately blocked in court. The same is expected for Ohio.

“No. 1, it’ll probably never save a life if we go by what’s happened in the past,” Dunn argued on the Tennessee House floor.

But it was money that ultimately stopped the heartbeat bill this year in Tennessee. (It stalled in committee last week, though the state’s Senate Judiciary Committee agreed to review the bill this summer.)

Senate Speaker Randy McNally, who also opposes abortion, said he has no interest in wasting tax dollars to make a point.

Even worse, in the view of Republicans who voted against the heartbeat bill, the state could end up paying the legal fees for groups that defend abortion.

“That is a big concern,” McNally said. “We don’t want to put money in their pockets.

The last time Tennessee had a case that went to the U.S. Supreme Court, it cost roughly $1.9 million. The experience was enough to give a few anti-abortion crusaders some pause. They voted last week with Democrats for a one-year delay on a heartbeat bill, vowing to study the issue over the summer.

Name-Calling In Oklahoma

Even if it doesn’t result in a case that upends abortion law, heavily Republican legislatures like Oklahoma’s want to be ready.

“If Roe v. Wade ever gets overturned, we won’t be prepared,” Republican Senate Pro Tempore Greg Treat said while explaining his so-called trigger bill at a committee hearing in February.

Treat’s legislation, modeled after existing laws in a handful of states, would “trigger” a state ban on abortion and make it a felony if Roe were overturned. A handful of states, including Arkansas, Kentucky, Louisiana, Mississippi, North Dakota and South Dakota, already have trigger laws on the books.

Oklahoma has some of the strictest abortion laws in the nation, such as mandatory counseling and a 72-hour waiting period. But the most conservative anti-abortion activists in the state want more immediate action. So they targeted Treat and other self-described “pro-life” Republicans with protests, billboards and flyers, accusing them of not being anti-abortion enough.

“I’ve been called every name in the book these past few weeks,” Treat said. “I’ve had my Christianity questioned. I’ve had a member of my own caucus hold a press conference and call me a hypocrite.”

In response, Treat abandoned the trigger bill.

Now he’s trying something else — an amendment to the state constitution that would reinforce that nothing in Oklahoma law “secures or protects” the right to abortion. But that’s still not anti-abortion enough for some.

“It’s going to add on to that legacy that we have of death and just status quo pro-life policy that does nothing,” said Republican state Sen. Joseph Silk.

Not Far Enough In Georgia

In Georgia, a “heartbeat bill” passed the legislature, but has paused at Republican Gov. Brian Kemp’s desk. Supporters of abortion rights don’t want him to sign it, of course, but some anti-abortion activists aren’t happy either.

“It really just does not go far enough in the protection of innocent human life,” said Georgia Right to Life executive director Zemmie Fleck. Fleck argued that certain exceptions in his state’s bill — for abortions after rape or incest if the woman makes a police report — weaken it.

Gov. Kemp has until May 12 to sign or veto the measure.

Cost As No Object In Kentucky

The American Civil Liberties Union in Kentucky sued the day after a “heartbeat bill” was signed into law by Republican Gov. Matt Bevin. But even during his annual speech to the Kentucky legislature in February, Bevin acknowledged his intent to challenge Roe v. Wade.

“Some of these will go all the way to the U.S. Supreme Court. But at the end of the day, we will prevail because we stand on the side of right and we stand on the side of life,” Bevin said.

Kentucky has become accustomed to defending abortion restrictions in court. Currently, one law that makes it a felony for a doctor to perform a common abortion in the second trimester has been suspended indefinitely.

It is unclear how much it costs Kentucky to defend abortion laws that are immediately challenged. In an emailed statement, Bevin administration spokesman Woody Maglinger wrote that the state is using in-house lawyers, and hasn’t hired outside counsel. He declined to provide a cost estimate on hours spent on these cases.

“It is impossible to place a price tag on human lives,” Maglinger wrote.

This story is part of a partnership that includes Nashville Public RadioNPR and Kaiser Health News.

Mulvaney: Trump Brought Down Drug Prices For The First Time In 50 Years

President Donald Trump announced last month that the GOP will become “the party of health care,” and news reports suggest he intends to make it a top issue in his reelection campaign.

So when Mick Mulvaney, the acting White House chief of staff, touted the administration’s work on prescription drug prices — a hot-button issue that has drawn scrutiny from across the political spectrum, and one that voters say should be a top priority — we were intrigued.

On “Fox News Sunday” April 7, Mulvaney said: “Drug prices in this country actually came down last year for the first time in 50 years. That’s because Donald Trump’s president.”

This statement is particularly hard to prove affirmatively. Drug prices are measured through a host of metrics and affected by all sorts of political and economic forces.

We reached out to the White House for more explanation. Its staff directed us to a report published last October by its Council of Economic Advisers, as well as to data suggesting the consumer price index for prescription drugs declined in January 2019 compared with January 2018.

But experts who reviewed that data said it doesn’t necessarily support Mulvaney’s claim — and certainly not by the magnitude he suggests.

A Broad Brush, And Some Missing Data

We interviewed five experts who all agreed that, no matter which metric was used, evidence is lacking to unequivocally say drug prices decreased last year. The most generous reading came from Matthew Fiedler, a health economist at the Brookings Institution: It’s “within spitting distance of something that’s true.”

But with more examination, the claim’s veracity became murkier.

“Drug prices” can refer to many things: a list price, a net price (what is paid after rebates, or the discounts negotiated by insurers or other payers), the pharmacy’s price or total national spending on prescription drugs.

Let’s start with the latter. Data from the Kaiser Family Foundation shows total spending on prescription drug prices has climbed during the past several years. (KHN is an editorially independent program of the foundation.) In 2018, total spending continued to grow, just at a slower pace. That’s a positive trend, experts noted, but it isn’t the same thing as spending going down.

“It doesn’t mean we’re spending less money on drugs than before,” said Stacie Dusetzina, an associate professor of health policy at Vanderbilt University.

We also examined the CPI data the White House provided. It could suggest that in the past year prescription drugs’ list prices have indeed dropped, and even by a meaningful amount.

But the CPI data doesn’t account for whether manufacturers lowering their list prices have also changed the size of the rebates they provide. That’s essential information in understanding if the real price of a drug — what insurance pays and, ultimately, what consumers pay — has actually changed.

These trend lines also vary depending on the 12-month period they cover, argued Walid Gellad, an associate health policy professor at the University of Pittsburgh. January to January could show a list price decrease, but July to July could show an increase.

Plus, the CPI data includes only drugs sold through retail, or about three-fourths of all prescriptions. That excludes many high-priced specialty meds sold only via mail order, argued Michael Rea, who heads Rx Savings Solutions, a consulting firm.

It also paints with a broad brush — obscuring, many said, just how many list prices are continuing to climb.

This year, the list price of more than 3,000 drugs went up, while the price of only 117 went down, according to data compiled by Rx Savings Solutions. Last year, an analysis by the Associated Press revealed that, from January to July, 4,412 branded drug prices went up, while 46 were cut.

So, Mulvaney’s downward price claim didn’t come out of thin air. But interpreting the data to mean that drug prices are down ignores crucial parts of the prescription drug marketplace.

The White House’s Work

Mulvaney also said Trump has played a key role in bringing down drug prices. When we asked the administration what he meant, a spokesman pointed to their efforts to bring more generic drugs to market — a boost the White House said has fueled competition and helped make lower-price alternatives available to consumers.

But there’s no evidence yet to suggest that the boost in generic drug approvals has that effect. Experts said it takes time for these products to reach the marketplace, create competition and demonstrate a measurable impact on prices.

Indeed, many of those generics, while approved, never went to market. This White House assertion also doesn’t account for high-priced, branded drugs that lack a generic counterpart.

Yes, Trump’s tough talk — accusing pharma companies of “getting away with murder” — may have persuaded some drug manufacturers to hold off on increasing their prices — at least temporarily, or until after the government releases key stats on how many prices have gone up, Dusetzina said. But it’s hard to separate that phenomenon from the pressure also levied by Congress and state legislatures.

For what it’s worth, the administration has proposed many new policies meant to curb drug prices, many noted, such as eliminating some kinds of rebates, or changing how Medicare Part B pays for drugs. But none of those have taken effect — so they haven’t brought prices down.

Our Ruling

Mulvaney said, “Drug prices in this country actually came down last year for the first time in 50 years. That’s because Donald Trump’s president.”

At first glance, CPI data could conceivably support the argument that the list prices for some prescription drugs dipped. But that data doesn’t include many high-priced specialty drugs that drive costs up, and the pattern it illustrates can change based on the time frame selected.

The CPI data set obscures the individual drugs for which the list prices have increased — with far more going up than down. It also does not account for a drug’s true “net price.”

Mulvaney’s statement also does not reflect trends showing that, nationally, spending on drugs has continued to climb, even if that growth has slowed. There is also no evidence to support the argument that Trump himself is responsible for changes in drug pricing.

This claim has an element of truth, but it ignores key facts and context that would give a very different impression. We rate this claim Mostly False.

Calif.-Based Sutter Health Agrees To $30M Settlement Over Allegations Of Submitting Inflated Diagnosis Codes To CMS

The Department of Justice alleged that Sutter and its affiliates had submitted diagnosis codes that inflated the risk scores for certain beneficiaries in their care. “With some one-third of people in Medicare now enrolled in managed care…plans, large health care systems such as Sutter can expect a thorough investigation of claimed enrollees’ health status,” said Steven J. Ryan, special agent in charge with the Office of Inspector General for the U.S. Department of Health and Human Services.

Calif.-Based Sutter Health Agrees To $30M Settlement Over Allegations Of Submitting Inflated Diagnosis Codes To CMS

The Department of Justice alleges that Sutter and its affiliates submitted diagnosis codes that inflated the risk scores for certain beneficiaries in their care. “With some one-third of people in Medicare now enrolled in managed care…plans, large health care systems such as Sutter can expect a thorough investigation of claimed enrollees’ health status,” said Steven J. Ryan, special agent in charge with the Office of Inspector General for the U.S. Department of Health and Human Services.

Before New Artificial Intelligence Can Start Making Diagnoses, The FDA Demands A Broad Range Of Requirements

Michael Abramoff, an ophthalmologist, spent years developing a computer algorithm that could scan retina images for early signs of diabetic retinopathy. It made better calls than he did, he said, but convincing the FDA that it was safe and effective took extra work. News on technology also looks at health breaches in government databases and a new online forum for innovation.

Before New Artificial Intelligence Can Start Making Diagnoses, The FDA Demands A Broad Range Of Requirements

Michael Abramoff, an ophthalmologist, spent years developing a computer algorithm that could scan retina images for early signs of diabetic retinopathy. It made better calls than he did, he said, but convincing the FDA that it was safe and effective took extra work. News on technology also looks at health breaches in government databases and a new online forum for innovation.

Obesity Poised To Take Spot Of No. 1 Preventable Cause Of Cancer, Kicking Smoking Out From The Top Position

Within five to ten years, smoking may no longer be the top preventable cause for cancer. Being obese and overweight — long implicated in heart disease and diabetes — has been associated in recent years with an increased risk of getting at least 13 types of cancer. In other oncology news: multiple cancers in one patients, breast implants, miracle treatments and their complications, survivors helping others, and the HPV vaccine.

Obesity Poised To Take Spot Of No. 1 Preventable Cause Of Cancer, Kicking Smoking Out Of Top Position

Within five to ten years, smoking may no longer be the top preventable cause for cancer. Being obese and overweight — long implicated in heart disease and diabetes — has been associated in recent years with an increased risk of getting at least 13 types of cancer. In other oncology news: multiple cancers in one patients, breast implants, miracle treatments and their complications, survivors helping others, and the HPV vaccine.