| | | | | | | Presented By PhRMA | | | | Axios Vitals | | By Tina Reed · May 05, 2023 | | Happy Friday and Cinco de Mayo, Vitals readers. Today's newsletter is 1,148 words or a 4½-minute read. 📈 Catch up quick: Kenvue, the consumer health products business being spun out of Johnson & Johnson, raised $3.8 billion as it went public yesterday after selling more shares than originally anticipated, Axios' Dan Primack reports. | | | | | | 1 big thing: The health care dangers of a debt default |  | | | Illustration: Annelise Capossela/Axios | | | | If the federal government breaches the debt ceiling, Medicare wouldn't be able to pay providers — and states wouldn't get their federal Medicaid funding, experts tell Axios' Maya Goldman and Victoria Knight. Why it matters: Losing out on those payments, even for a short time, could be disastrous for providers' bottom lines — and the effects could trickle down to patients. - An extended default could have broad consequences for Americans' health care, potentially reaching not just Medicare and Medicaid, but the Affordable Care Act as well — and making providers more reluctant to treat Medicare and Medicaid patients.
What they're saying: "There is no separating the failure to raise the debt limit from health system collapse," said Sara Rosenbaum, a health law and policy professor at George Washington University. - "Get your health care now. Don't wait until June 1," Rosenbaum said. "My message to the world is, don't wait on that orthopedic surgery."
What to watch, if President Biden and House Speaker Kevin McCarthy don't get it together pretty soon: 💊 Medicare: In the event of a debt limit breach, the money withdrawn from payroll taxes for Medicare could sustain the program for a bit, said Joseph Antos, a health care scholar at the American Enterprise Institute. - But: "You can't really go too long with Medicare being late paying the bills" — because it would make it hard for hospitals and doctor's offices to meet their bottom lines, Antos said.
🩺 Medicaid: One big uncertainty is how states would reimburse providers without getting their federal Medicaid matching funds, Hoagland said. - Managed care, which provides coverage to most Medicaid beneficiaries in the country, won't provide a backstop, either. Plans get paid from the government on a month-to-month basis, Rosenbaum noted.
🏥 Providers: The big risk is that a debt ceiling breach could make providers reconsider treating Medicare or Medicaid patients at all. Reality check: Experts seemed optimistic that they would take action before reaching the deadline. - "I've been through a number of these," said Bill Hoagland, senior vice president at the Bipartisan Policy Center and a former Senate Budget Committee staff director. "I still will take the speaker's word that he does not want there to be a default."
Read the rest. A version of this story was published first on Axios Pro. Get news like this by subscribing. Use code POLICY100 which gives you $100 off. |     | | | | | | 2. U.S. death rate drops |  Data: National Vital Statistics System. Note: 2022 data is provisional, based on death certificate data to the NCHS; Chart: Axios Visuals Death rates in the U.S. dropped an estimated 5.3% in 2022 compared to the previous year as the overall number of COVID-19 deaths fell, according to provisional data released by the CDC on Thursday. Why it matters: Even though the data is incomplete and not yet finalized, the estimates provide an "early signal" about shifts in mortality trends, the CDC said. - COVID-19 slipped from the top three causes of death and overall death rates fell, but cancer deaths and deaths from heart disease both rose last year, the data showed.
- The shift comes after consecutive drops in U.S. life expectancy during the pandemic.
- About 3.3 million Americans died in 2022, down from 3.5 million deaths in 2021. The age-adjusted death rate was 832.8 deaths per 100,000 people in 2022, down 5.3% from 879.7 in 2021.
Go deeper. | | | | | | | | 3. Immigrants a disproportionate share of uninsured |  | | | Illustration: Annelise Capossela/Axios | | | | Immigrant under the age of 65, including those who are undocumented, account for 8% of the U.S. population but make up nearly 32% of the uninsured population in the country, according to a new report from the Urban Institute and the Robert Wood Johnson Foundation, Axios' Arielle Dreher writes. Why it matters: During the pandemic, states were required to keep residents on their Medicaid rolls. But as they reassess who is eligible, the number of uninsured people nationwide will likely increase. - Despite tax credits being available for Marketplace coverage through 2024, the majority of immigrants who are uninsured still won't be able to access coverage "solely because of their immigration status," the report says.
What they found: Researchers estimate that after Medicaid redeterminations take place this year, 8.6 million of the 27 million people who will be uninsured will be noncitizens. What we're watching: The Biden administration has proposed offering coverage to undocumented children brought to the United States through the CHIP and the ACA Marketplaces. | | | | | | | | A message from PhRMA | | PBMs control your health care | | |  | | | | Middlemen like PBMs are charging fees tied to the price of medicines, which means they make more money when the price of a medicine goes up. This business model allows PBM profits to soar and can lead to higher costs for patients. It's time to break the link between PBM fees and medicine prices. | | | | | | 4. Fibroids linked to cancer risk in Black women |  | | | Illustration: Gabriella Turrisi/Axios | | | | Endometriosis and fibroids in both Black and white women are associated with a greater risk for ovarian cancer, a new study published in Obstetrics and Gynecology found, Arielle writes. Why it matters: It is the first study to include enough Black women to confirm the association between fibroids — noncancerous tumors that develop in the uterus — and a modestly increased risk of ovarian cancer in this group, the study's authors said. What they found: More than 8,500 women took part in the study, including more than 3,000 women diagnosed with ovarian cancer. - Of the study participants, 6.4% of Black women and 7% of white women experienced endometriosis, and 43.2% of Black women and 21.5% of white women experienced fibroids.
- While both Black and white women with endometriosis have a higher risk of ovarian cancer, receiving a hysterectomy — a surgery to remove the uterus — only modified the cancer risk in white women who had the procedure, not Black women.
What they're saying: "The historic underdiagnosis of endometriosis among Black women," combined with the study results, "highlight the impact of structural racism in medicine on individual health outcomes," Holly Harris, an epidemiologist at Fred Hutchinson Cancer Center and lead study author, told Axios in an email. | | | | | | | | 5. Tweet du jour: Guns and public health |  | | | Screenshot: @bfrist/Twitter | | | | Lawmakers should consider raising the legal age for purchasing guns and ban high-capacity magazines and assault-style weapons, former Republican Senate Majority Leader and physician Bill Frist wrote in Forbes. Why it matters: Frist used to be one of the top GOP leaders in the country — but now he sees gun-related injuries as a public health crisis. - He called for policy solutions including red flag laws and expanding who is restricted from purchasing or owning firearms.
What he's saying: "I am a gun owner and a hunter. I have always and will continue to strongly support Second Amendment rights," Frist wrote. - "But times are different today — misuse of guns has grown much worse, substantially worse — with markedly more death and tragedy in our neighborhoods, than even a decade ago," he added.
The big picture: The comments from the former Tennessee senator come in the wake of the deadly elementary school shooting in Nashville last month. Zoom in: Frist also recommended placing school resource officers at schools and funding more research into the drivers of gun violence. | | | | | | | | 6. Dog of the week |  | | | Cady. Photo: Bonnie Levin | | | | Meet Cady, a 9-year-old long-haired German shepherd who lives with her human Bonnie Levin in Washington, D.C. - She "protects us from all mail carriers, delivery trucks, rabbits and squirrels," Levin writes. "She is a loving dog who adores our toddler grandson."
| | | | | | | | A message from PhRMA | | Middlemen say they want lower prices | | | | | | | | Yet they often deny or limit coverage of lower-cost generics and biosimilars while giving preferential coverage to medicines with higher prices. This might be good for PBMs' bottom line, but it can lead to higher costs for patients. It's time to break the link between PBM fees and medicine prices. | | | | Thanks for reading, and thanks to Alison Snyder, David Nather, Laurin-Whitney Gottbrath and senior copy editor Bryan McBournie for the edits. |  | | Dive deeper into the future of health care | | | | | | Axios thanks our partners for supporting our newsletters.
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