Happy Friday! It seems we have a new example of just how broken the health system is every week, and here’s today’s: A school superintendent was arrested after allegedly using her insurance to cover a sick student. She took him to the clinic after noticing he had signs of strep throat, and then filled a prescription for him. The total cost of the claim? $233. Now she’s facing felony charges.
(It should be noted, though, that she is being put on a pretrial diversion program, so the charges may be expunged from her record.)
Here’s what else you might have missed this week:
While health care has been somewhat insulated from the shutdown, the industry hasn’t been immune — and insurers, providers and others are starting to fret. For one, the standoff could rock the (just-starting-to-stabilize) health law marketplace because IRS staffing shortages may jeopardize tax credits for people who rely on them to subsidize their care. On top of that, it could delay application reviews for people eligible to sign up for coverage outside of open enrollment. What’s more, we’re nearing the time when insurers need to make crucial decisions on participating in the exchanges next year, but rule-making delays leave them without any guidance.
New polling shows the country’s uninsured rate has climbed to a four-year high, and, as you can probably imagine, both sides of the aisle were eager to point fingers at each other. The talking points were similar to the messaging we’ve heard for years: Republicans said it’s the fault of the health law being inherently unsustainable, while Democrats blamed the administration’s “sabotage” efforts.
The idiom “the devil’s in the details” was never more true than in this week’s poll gauging what Americans think of “Medicare-for-all.”
The majority of people support the idea in theory (56 percent, which shoots up higher when framing MFA as a guarantee of health insurance as a right). But when the cons were laid out (it could lead to delays in care and an increase in taxes, for example) that number plunged.
The results seem to reflect the core debate that’s been going on within the Democratic Party in general: Everyone deserves health care, progressives say. The moderates respond: Yes, but how do we pay for it?
Whatever the mixed messages from the public are, 2020 contenders certainly see it as a winning issue.
As you Breeze readers know, insulin has become the poster child for the outrage over high drug costs (it’s an old drug that shouldn’t be expensive, lots of people need it, patients can die if they have to ration it).
Well, a new study gives some hard numbers to back up that anger. The average cost per patient for insulin nearly doubled over a five-year span — even though there haven’t been improvements to justify that increase. In a quote that sums it up (from Stat’s coverage): “It must be nice to be part of the American economy where you can raise the price of your product almost 100 percent over five years,” said Niall Brennan, who heads the Health Care Cost Institute.
If consumers are dinged for buying a brand-name drug when a generic version is available, will it change their patterns of behavior? That’s what a new strategy from the Trump administration could be relying on. Under the new proposal, if a person filled a prescription for a brand-name drug with a $25 copayment, rather than using a generic medicine with a $5 copayment, the consumer might get credit for only $5 in out-of-pocket spending. That means they would have to pay more out-of-pocket before hitting their annual limits.
And in a sign that Big Pharma is reading the tea leaves and starting to sweat a bit, the industry’s big trade group, Pharmaceutical Research and Manufacturers of America, of PhRMA, disclosed that it spent a record amount in 2018.
How does a midlevel executive who’s never even met the CEO of a company spark a trade secrets lawsuit? By joining the health venture led by Dr. Atul Gawande and launched by Amazon, Berkshire Hathaway and JPMorgan. The lawsuit filed by Optum is a glimpse into how worried the health industry is about this new potential threat, which has been mostly shrouded in secrecy.
The Supreme Court lifted an injunction against the Trump administration’s restrictions on transgender troops as the case continues to work its way through the courts. Court watchers suggest that the conservative justices may have been swayed by the complaint that injunctions coming from lower courts (which, according to the solicitor general, were “previously rare”) have become a growing trend.
President Donald Trump plucked at some low-hanging fruit this week by announcing he wants to eliminate surprise medical billing. The topic has garnered a lot of attention lately with eye-popping personal stories about bills north of $100,000. The good news for Trump is that there’s already bipartisan legislation that’s been introduced in Congress.
Meanwhile, Vox’s Sarah Kliff has spent the past year investigating emergency room billing, and she breaks down why it can be such a nightmare.
(P.S. Make sure to check out KHN and NPR’s excellent “Bill of the Month” series on just this topic.)
In the miscellaneous file for the week:
• Have you ever gotten the flu shot, felt proud of yourself for being a responsible adult and then … gotten the flu anyway? It used to be that doctors said the vaccine must have been a bad match for the strain going around, but the problem really might be … you.
• The Los Angeles Times follows an abortion doctor in California who travels to Texas once a month to perform the procedure.
• Anti-rejection medicines have undoubtedly saved many lives — before the drugs, organ transplants were nearly impossible. But they do take an enormous toll on the body. Within 10 years of a liver transplant, 35 to 40 percent of patients will die, in part from the anti-rejection meds. Scientists are hoping there’s a better way.
• A Chinese scientist’s decision to edit human embryos’ genes may have sent shock waves through the research world, but the announcement didn’t come as a surprise to everyone. In fact, others knew about the work, warned him off of it and were left with nowhere to turn to stop the rogue scientist.
• Kalief Browder was a young man from the Bronx when he was arrested over accusations that he stole a backpack. He was detained on Rikers Island for three years without being tried or convicted of a crime — and spent two of those years in solitary confinement. Now his suicide is shining a light on the mental health crisis in prisons.
• A new study finds a link between gum disease and Alzheimer’s. Scientists have to dig deeper whether its correlation or causation, but it never hurts to floss in the meantime!
Have a great weekend!