Is CDC in for a paradigm shift?

The Atlanta-based CDC has always prided itself at being outside the Washington bubble and above the town politics. But with the anticipated appointment of former North Carolina health secretary Mandy Cohen as the agency's next director, supporters say the president is calling in an official with know-how to navigate the political battles ahead, STAT's Helen Branswell writes.

Cohen, a former CMS adviser, already has White House connections. She is close to Biden's current chief of staff, Jeff Zients, having volunteered to help him when the 2013 rollout of the Affordable Care Act's website failed spectacularly and Zients was drafted to fix the problem. She also was chief of staff and chief operating officer for CMS acting administrator Andy Slavitt, another Biden adviser, who told Helen that Cohen's not afraid to take on tough tasks.

While Biden hasn't announced Cohen as his CDC pick yet, sources tell D.C. Diagnosis that the White House has already vetted her for the role, which doesn't require Senate confirmation (…yet. That starts in 2025.) Read more on Cohen's political chops and public health work from Helen.

medicare

People are using Medicare more – and insurers are stressed

Health insurance stocks tumbled Wednesday after a UnitedHealth Group executive said the company has noticed "a meaningfully higher number" of doctor visits from Medicare enrollees in the past few months. The trend suggests a lot of older adults are now getting care they put off – which eats into insurers' earnings, STAT's Bob Herman writes.

A big chunk of that care was for seniors getting hip and knee replacements or heart procedures, UnitedHealth CFO John Rex said at a health care conference, calling it "a little bit like pent-up demand." Wall Street reacted swiftly: UnitedHealth's stock price plunged 8% when markets opened Wednesday, while Humana, the second-largest Medicare Advantage insurer by enrollment, saw its stock drop 13%. Those for other major insurers followed suit. Meanwhile, large providers' stock prices ticked upwards.

But UnitedHealth was at least a little prepared for this trend, Bob notes. The company's actuaries built estimates of higher care costs (due in part to more usage) into the bids of their 2024 Medicare Advantage plans, which were due to the federal government earlier this month. More from Bob here.

medicare

Thanks to the IRA, Medicare spending will surge next year

Government spending on the Medicare program will hit $1 trillion this year, a 8% leap in growth as the program picks up more of the tab on costly drugs and more baby boomers enroll, according to projections by CMS actuaries published in Health Affairs late Wednesday. Last year's Inflation Reduction Act is helping Part D enrollees pay less out-of-pocket for their prescriptions, shifting those costs to Medicare instead.

Even the second leg of IRA — price negotiation on certain drugs, starting in 2026 — won't totally abate the rise, at least not in the program's first few years, the actuaries said. Medicare spending is projected to grow roughly 7.5% on average through 2023, outpacing both commercial and Medicaid spending growth during the same time.

And while economic growth has outpaced health spending growth lately (consistent with CMS's pre-IRA projections) that is expected to reverse again soon, with health spending hitting 19.6% of GDP by 2031. Dive into CMS's figures here.

Congress

House panel debates gender-affirming care bill

Republicans in Congress are pushing a controversial new bill that would pull federal funding from children's hospitals that provide gender-affirming care for minors — a move that public health experts and pediatricians warn could have a seismic impact on transgender children's mental health and those hospitals' services overall.

The otherwise bipartisan hearing on a pack of bills got ugly fast. Rep. Anna Eshoo (D-Calif.) said the legislation "subject[s] children's hospitals to a manufactured culture war." Sponsor Dan Crenshaw (R-Texas) fired back that Democrats were making this a culture war — even though a provision like this has never been attached to children's hospital reauthorizations before.

The committee heard from Yale doctor Meredithe McNamara, who sought to tamp down on misinformation about gender-affirming care and stress its benefits, and Miriam Grossman, a psychiatrist who has argued against transgender care. The bill — which the panel will markup before any votes — is one of the first federal attempts to bar transgender care amid a storm of state bans and limits in the past year.

drug industry

Pharma's next frontier is IP

The pharmaceutical industry seems to be gearing up for its next big fight in Washington — and Eli Lilly CEO David Ricks is betting that it's going to center on IP. He's already seeing "attacks" on the industry's intellectual property rights, he said on a call with J.P. Morgan analysts and other pharmaceutical industry leaders on Wednesday, my colleague Brittany Trang reports. (Worth noting: Sens. Richard Blumenthal (D-Conn.) and John Cornyn (R-Texas) are working on a bipartisan patent bill that takes aim at "product hopping," which might get wrapped up in a Schumer package that caps private insurance insulin costs at $35, per Axios.)

It's clear he's especially worried about so-called march-in rights, which he called "a shortcut that will have much more expensive long term consequences."

"I see that as a priority over the next five years," he said. "There's nothing imminent, but that's really the backbone of what we do. If we can't rely on that system…then we're in real trouble."

Ricks' comments about "nothing imminent" may be news to Sen. Bernie Sanders, who's currently pushing the Biden administration to break Biogen and Eisai's patents if they don't agree to lower prices for Alzheimer's drug Leqembi. Earlier this week, the Washington Post reported that Sanders is vowing to withhold support for any Biden health nominee — including nominated NIH head Monica Bertagnolli — if the White House doesn't put out a "comprehensive" plan on lowering drug prices.

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What we're reading

Federal advisory group rejects proposal to make medical device tracking easier, STAT
Thousands mistakenly lose Medicaid in Arkansas: Is this America's future? Politico
Biogen's boardroom scandal saddles CEO with first crisis, STAT
Planned Parenthood begins staff layoffs ahead of Dobbs anniversary, The Boston Globe