Tagged Health Care Costs

New Algorithm Lets Scientists Better Calculate Person’s Chances Of Getting Five Serious Health Conditions

The researchers are now building a website that will allow anyone to upload genetic data. Users will receive risk scores for heart disease, breast cancer, Type 2 diabetes, chronic inflammatory bowel disease and atrial fibrillation. But scientists emphasize that DNA is not destiny, and that the results don’t account for a healthy diet and exercise.

Amid Giddiness Over First-Ever Gene-Silencing Drug’s Approval Is An Acknowledgment Of Its Limitations

Right now, the RNAi drug is limited to cells that go through the liver, which is — in relative terms — easy to target. Getting the drug to other tissue, like the skin or brain, is more challenging. “It’s always been the same problem. And it’s delivery, delivery, delivery,” Steven Dowdy, a cancer biologist at the University of California, San Diego’s school of medicine, tells Stat. “It’s always been the 800-pound gorilla in the room.”

First Gene-Silencing Drug Approved By FDA — And It Comes With An Eye-Popping Price Tag

Slicing genes with drugs is the latest in a wave of hot new treatments geared toward fighting diseases in unique ways. But the price on innovation is steep. In other news, the FDA plans to streamline drug safety evaluations and a super PAC goes after Rep. Anna Eshoo (D-Calif.) over the money she’s taken from the pharmaceutical industry.

Must-Reads Of The Week From Brianna Labuskes

The next time I even hint that we’re drifting into a slow news period, feel free to remind me not to jinx things: This week was bursting with industry moves, health law attacks, midterm strategizing, and, oh yeah — an indictment.

A quick programming note before we dive into all that: The Breeze is going on hiatus as I breeze out of town for a bit. But I’ll be back Aug. 31, just as we really start heading into midterm season, so look for me again then.

Now for the news you may have missed:

This week’s swipe at the health law focused on accountable care organizations (shorthand explanation: a program that took a carrot-and-stick approach to getting hospitals, doctors and other providers to coordinate, with the end result of higher-quality, more efficient care). They were supposed to save the government billions of dollars, but data show they’ve failed to measure up to the promise, so the program is being overhauled.

The Washington Post: Trump Administration Proposes Further Dismantling of Affordable Care Act Through Medicare

Rep. Chris Collins (R-N.Y.) was charged with fraud in connection to alleged insider trading after an investigation into his ties with Innate Immunotherapeutics, an Australian biotech firm.

Politico: GOP Rep. Chris Collins Charged With Securities Fraud

If that all sounded vaguely familiar, it’s because back when then-HHS secretary nominee Tom Price was being vetted for any possible ethics violations, his connection to both Innate and Collins was put in the spotlight. And just a small plug: KHN did deep reporting on this, and you can read the stories here.

Medicare Advantage got some leverage to curb drug costs this week by way of “step therapy” (or, as it’s known to critics, “fail first”). Essentially, the private plans will be able to require that patients try cheaper versions of drugs before moving on to more expensive ones. To be clear: This is a pretty distant cry from campaign promises to let Medicare negotiate drug prices, and there’s no guarantee patients will actually see any savings from this move.

Stat: Private Medicare Plans Will Be Able to Use a New Tool to Lower Drug Costs

Would a Netflix model work for drugs? That’s what Louisiana wants to find out. Under the proposal, the state would pay a subscription-type fee to be able to cover all of its Medicaid patients who need hepatitis C treatment. Beyond the click-baity notion, though, experts warn that because drug prices are such a moving target (with some costs coming down quickly) the state may not actually save money.

Stat: Louisiana Explores a ‘Netflix’ Subscription Model for Buying Hepatitis C Drugs

For even some moderate Democrats, “Medicare-for-all” is a pipe dream involving all sorts of politically unpopular complications like trillions of dollars in government spending (the current point of contention). But on the trail, it’s a rallying cry. Gubernatorial candidates, especially, are embracing it, suggesting their states become early testing grounds for universal coverage plans that have been more rhetoric than action so far.

The Washington Post: Tossing Aside Skepticism, Democratic Candidates for Governor Push for State-Based Universal Health Care

The Hill: Ocasio-Cortez: ‘Medicare for All’ Is ‘Not a Pipe Dream’

Apart from “Medicare-for-all,” Democrats could have a winning health issue with drug prices. The problem? They can’t really coalesce behind a plan, all these “concessions” as of late are making it harder to attack the administration, and, uh, there may be a lack of interest in cutting off campaign cash this close to the elections.

Stat: Drug Prices Could Be a Winning Issue for Democrats — If Only They Had a Plan

The idea to penalize legal immigrants’ use of Medicaid has been rumbling around for a bit now, but it picked up some speed in recent days. Though it could be a winning issue for Republicans on the trail, the argument isn’t really backed up by the data. It turns out that legal immigrants are likely subsidizing native-born Americans’ health care.

The New York Times: Plan to Punish Immigrants for Using Welfare Could Boost G.O.P. Candidates

The Hill: Study: Immigrants Have Lower Health-Care Costs Than People Born in US

Buckle up, there were industry moves galore this week. I’ll try to keep it quick:  Billionaire Carl Icahn came out against Cigna’s attempts to acquire Express Scripts, saying it is (in my favorite vocab usage of the week) a “$60 billion folly”;  Rite Aid called off its (unpopular) merger with Albertsons; the American Medical Association came out against CVS’ deal with Aetna; and GM signed an exclusive deal with a health system to provide care for its workers.

The Wall Street Journal: Carl Icahn Publicly Opposes $54 Billion Cigna-Express Scripts Deal

The Wall Street Journal: Rite Aid, Albertsons Call Off Merger Amid Investor Opposition

Reuters: American Medical Association Opposes Merger of CVS and Aetna

The Wall Street Journal: GM Cuts Different Type of Health-Care Deal

If that wasn’t enough news for you, here’s my miscellaneous file: A billionaire and his PTSD clinics have become entangled in the fierce debate over VA privatization; a look at how Zika babies are faring as they grow up is sobering in the breadth of damage the virus has done; an app can warn those recovering from addiction when they’re in neighborhoods or with acquaintances that could trigger a relapse; and a medical examiner is writing to doctors personally each time one of their patients dies from an overdose — and it’s working.

ProPublica: Steve Cohen Is Spending Millions to Help Veterans. Why Are People Angry?

The Washington Post: 1 In 7 Babies Exposed to Zika in U.S. Territories Have Birth Defects, Nervous System Problems

Stat: Can An App’s Warnings to Avoid Triggers Prevent Opioid Addiction Relapses?

Los Angeles Times: Coroner Sent Letters to Doctors Whose Patients Died of Opioid Overdoses. Doctors’ Habits Quickly Changed

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And don’t miss one of my favorite long reads of the week (which I got sucked into while on deadline, thank you very much) about an Appalachian odyssey and a hunt for ALS genes.

Stat: Appalachian Odyssey: Hunting for ALS Genes Along a Sprawling Family Tree

Have a great weekend, all!

Podcast: KHN’s ‘What The Health?’ Coming Soon: ‘Long-Term Short-Term’ Plans

The Trump administration’s new rule allowing “short-term” insurance plans to be used for up to three years has touched off a big reaction in health policy circles. Supporters of the change say those who can no longer afford comprehensive health insurance will have the ability to purchase lesser but cheaper plans. But opponents worry that consumers who fail to read the fine print will end up with plans that won’t cover care they need.

Reaction is similarly divided over an administration rule change that will make it easier for managed-care plans participating in Medicare to negotiate the price of drugs provided in doctors’ offices or hospitals. Insurance groups call it a small but positive step; patient groups worry it will make it harder for those with serious medical problems to get the medication their doctors recommend.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Anna Edney of Bloomberg News, Margot Sanger-Katz of The New York Times and Kimberly Leonard of the Washington Examiner.

Among the takeaways from this week’s podcast:

  • The Trump administration says its promotion of short-term health plans is designed to help people who don’t get government subsidies find more affordable health coverage and will provide some help to people who are not going to buy a plan on the federal health insurance marketplaces anyway. But the policies tend to limit many types of care, such as maternity expenses, prescription drugs and mental health issues.
  • In addition to concerns that these plans will destabilize the Affordable Care Act marketplaces, some consumer advocates say people looking at the plans don’t realize the extent to which they lack patient protections. For example, one may not cover hospital expenses if a patient is admitted over a weekend or pay for care needed for injuries if the patient was drunk.
  • As part of the administration’s effort to meet President Donald Trump’s promise to curb prescription costs, federal officials announced this week that private Medicare Advantage plans can require patients being prescribed drugs from a doctor or in a hospital to first try the cheapest drug options. But some patient advocates object, saying consumers and their doctors should be able to decide what is the best therapy.
  • The federal indictment announced this week against Rep. Chris Collins (R-N.Y.) renews questions about why a member of Congress with a large role in a biotech company was allowed to be a member of a House committee that oversees health issues. After the indictment, House Speaker Paul Ryan stripped Collins of his seat on the Energy and Commerce Committee.
  • New York Gov. Andrew Cuomo, a Democrat, surprised many people with his announcement that insurers would not be able to factor in to premium prices the expectation that fewer people will buy marketplace plans because the health law’s coverage penalties expire in 2019.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too:

Julie Rovner: NPR’s “Doctors With Disabilities Push For Culture Change In Medicine,” by Elana Gordon

Anna Edney: The Atlantic’s “Women More Likely to Survive Heart Attacks If Treated by Female Doctors,” by Ed Yong

Margot Sanger-Katz: ProPublica’s “The Shadow Rulers of the VA,” by Isaac Arnsdorf

Kimberly Leonard: The Washington Post’s “A Huge Clinical Trial Collapses, and Research on Alcohol Remains Befuddling,” by Joel Achenbach

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Democrats Tout $2 Trillion In Savings From ‘Medicare For All,’ But Author Of Cost Analysis Cries Foul

The Washington Post fact checks the notion that a recent working paper supports the idea that the proposal by Sen. Bernie Sanders (I-Vt.) would save $2 trillion in health care spending. To get to that number, one would need to make unrealistic assumptions, the report’s author says.

One Of Nation’s Largest Hospital Systems Agrees To $65M Settlement Over Medicare Overbilling Allegations

Prosecutors had alleged that Prime Healthcare Services unnecessarily admitted Medicare patients who were being treated at the emergency rooms of several hospitals in its system. Medicare pays more for patients who are admitted to hospitals than those who are treated as outpatients.

Must-Reads Of The Week From Brianna Labuskes

A slow health news week wrapped up with a flurry of movement over the Affordable Care Act in the past few days. As we drift into August, there are definitely a few stories to keep an eye on.

Here’s what you might have missed:

The Trump administration issued a final rule on short-term plans. (The highlights: Coverage can go for 12 months and be renewed for a max of 36 months; it doesn’t have to cover essential benefits; and there aren’t preexisting conditions protections.) Officials were surprisingly candid (“We make no representation that it’s equivalent coverage”) in acknowledging the skimpiness of these plans — which were only ever supposed to act as three-month stopgaps for people between jobs.

The New York Times: ‘Short Term’ Health Insurance? Up to 3 Years Under New Trump Policy

For Democrats in the Senate, there’s a silver lining: The move gives them an opportunity to try to force Republicans — just months before midterm elections, mind you — to go on record voting against those popular provisions that short-term plans strip away. There’s no chance such a measure would pass the House (much less be signed by President Donald Trump), but it puts their colleagues across the aisle in a tough spot.

The Associated Press: Dems Will Try Forcing Senate Vote Against Trump Health Plan

The latest attempt to unmoor the ACA is just one in a series of grenades the administration has lobbed at the health law. But premiums aren’t spiking as much this year, insurers are joining the marketplace instead of fleeing it, and public support for Obamacare is skyrocketing. Has the war been already won?

Politico: Trump’s Losing Fight Against Obamacare

And, that wasn’t the only hubbub over the health law this week. Four major cities are suing Trump, saying his multiple attempts to “sabotage” the legislation is a failure of his constitutional duty to enforce the laws of the land. (Spoiler: They’re unlikely to be successful.)

Reuters: Four U.S. Cities Sue Over Trump ‘Sabotage’ of Obamacare

Passion over HHS’ decision to separate children at the border continues to boil. The government is now making the argument that the burden of reuniting deported parents with their children should actually fall on the American Civil Liberties Union. The ACLU fired back saying that the government is the one that made the mess, and officials shouldn’t be able to foist it off now that it needs cleaning up.

Politico: Trump Administration Tells ACLU to Find Deported Parents

An eye-popping price tag for a “Medicare-for-all” proposal dominated headlines early this week, but experts are saying there’s more to that $32.6 trillion than it might seem. Essentially, the plan would actually save money in overall national health care spending, but shift it over to the government — which means higher taxes.

Modern Healthcare: Libertarian Think Tank: Providers Would Pay for Medicare for All

Rebates are being painted as the new villain in the blame game that is the conversation around lowering high drug prices. Here’s a primer on what they are — but don’t get too attached, they might not be around for long.

The New York Times: Meet the Rebate, the New Villain of High Drug Prices

Bloomberg: Secret Drug Price Rebates Will Go Away, Pfizer CEO Predicts

If that’s not enough news for you, my miscellaneous file is chock-full: New VA Secretary Robert Wilkie is planning on reassigning the officials who have been at the heart of the morale crisis plaguing the agency; Medicare could save nearly $3 billion in a single year if it were able to negotiate drug prices as other agencies can; the FDA put the companies that were selling a dangerous class of opioids in charge of monitoring abuse of said opioids — and then did little to intervene over poor prescribing practices; and the drug industry is pumping millions in charity money into those very towns that are suing the companies over their role in the opioid crisis.

The Washington Post: New Veterans Affairs Chief Plans to Reassign, Sideline Trump Loyalists Now in Power

Stat: Medicare Could Save $2.8 Billion in a Single Year if Prices Could Be Negotiated

The New York Times: F.D.A. Did Not Intervene to Curb Risky Fentanyl Prescriptions

Bloomberg: Facing Wave of Opioid Lawsuits, Drug Companies Sprinkle Charity on Hard-Hit Areas

And as if childbirth wasn’t hard enough, this woman says she had to have a C-section without anesthesia.

Have a great weekend!

Podcast: KHN’s ‘What The Health?’ Let’s Talk Politics

It seems increasingly likely that health care politics will play an important role in the midterm elections come November. But unlike every election since 2010, this year finds the Democrats playing offense and the Republicans back on their heels.

There is one health proposal most Democrats and Republicans agree is a good idea — providing “reinsurance” to help insurers pay for their sickest patients, thus enabling them to lower premiums for everyone. This week, the Trump administration approved reinsurance plans requested by Maine and Wisconsin. But legislation in Congress that would extend those programs nationwide failed to get a vote in either the House or Senate earlier this year — another casualty in the partisan fight over health care.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Anna Edney of Bloomberg News, Alice Ollstein of Talking Points Memo and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • Congressional Democrats are making preexisting conditions a key debating point, including Senate candidates running in deep-red states, such as Missouri and West Virginia. The guarantee of coverage even when a person has a medical problem is one of the most popular provisions in the Affordable Care Act. Democrats are playing up the Trump administration’s contention in a lawsuit that since the Congress got rid of the penalty for people who don’t get health coverage, insurers don’t need to cover preexisting conditions.
  • Republicans are seeking to prove that they care about health care too, by pointing to their efforts to cut taxes on health care industries and to expand health savings accounts that allow consumers to set aside money for medical bills in tax-free accounts. But the GOP is in a bind because often if people don’t feel the direct benefits of a policy — such as the industry savings from the tax changes — politicians may not reap much benefit.
  • A growing number of Democrats in the House and Senate are also expressing support for a “Medicare-for-all” health care system. Although some may be more interested in skirting the complex details of such a transition in favor of backing a policy that appeals to Democratic voters.

Rovner also interviews KHN’s Emmarie Huetteman, who wrote the latest Bill of the Month. It features a very expensive surgical bill and a very persistent patient. You can read it here.

If you have a medical bill you’d like NPR and KHN to investigate, you can submit it here.

And if you have a question for the podcast, you can send it to whatthehealth@kff.org.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too:

Julie Rovner: The New York Times’ “Meet the Rebate, the New Villain of High Drug Prices,” by Katie Thomas

Anna Edney: USA Today’s “Hospitals Know How to Protect Mothers. They Just Aren’t Doing It,” by Alison Young

Alice Ollstein: Politico’s “Trump Policy Shop Filters Facts to Fit His Message,” by Dan Diamond

Rebecca Adams: The Atlantic’s “Being Black in America Can Be Hazardous to Your Health,” by Olga Khazan

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.