The drumbeat for the federal government to step in and negotiate the price of specialty drugs for patients gets louder and louder. Health and Human Services Secretary Sylvia Burwell told the Atlantic’s Washington Ideas Forum on Thursday that, “One of the most important tools that we could gain would be an ability to negotiate.”

UnitedHealth Group and the University of California Health System announced yesterday that they will be forming an accountable care organization (ACO) that they hope to keep operational over the next 10 years, Kaiser Health News reports. The ACO will be offered to large, self-insured employers throughout the state. As part of the effort, UnitedHealth Group plans to open a research lab in San Francisco next year that will give the the University of California Health System access to a huge amount of patient data.

The Obama administration failed to adequately compensate the Treasury Department, instead favoring insurers under a program called “transitional insurance,” the Wall Street Journal reports. The 2010 health law required federal health officials to collect fees from unions, employers and insurance companies to reimburse health plans that sustained a heavier burden of medical claims during the first few years of the law’s life because they treat patients with catastrophic medical problems.

MediMedia Research Survey
Forty-seven percent of the 432 respondents to our online survey said they plan to vote for Clinton, and the exact same percentage said they intend to vote for Trump. Most respondents thought Trump would do a better job making the system more efficient. A clear majority said that Clinton would do better job limiting cost shifting to consumers.

Unless more states expand income eligibility for Medicaid, 604,000 veterans might be without health coverage next year, according to a report by the Urban Institute. Researchers looked at data from the 2011–’15 National Health Interview Survey and 2013–’14 American Community Survey. They found that the uninsurance rate among nonelderly veterans fell during the early years of the ACA, and there was a noticeable improvement in access to care. “Veterans’ uninsurance declined between 2013 and 2014 in 9 of the 10 states examined, and uninsurance also fell among veterans’ family members.

No wonder a lot of doctors aren’t too thrilled about installing and managing health care IT tools, including the much touted electronic health record: It costs too much. This, according to a survey by the Medical Group Management Association (MGMA), that shows that medical groups must spend more than $32,500 annually per full-time physician to integrate and operate IT tools.

The high cost of drugs worries Americans so much that a majority would favor polices that would give the federal government more control over the situation, according to a poll released this morning by the Kaiser Family Foundation. Two-thirds of Americans (66%) would like to see the creation of an independent group that would oversee prescription drug prices, and about 8 in 10 Americans (82%) say that the federal government should negotiate directly with drug companies for drugs provided under Part D plans.

Medicaid managed care plans have been the main driver of an increase in enrollees, according to a study by PricewaterhouseCoopers. Enrollment in Medicaid managed care plans increased by 3.4 million over the last year. That means the 54.7 million of the 75.2 million Medicaid beneficiaries in the country are enrolled in a privately run health plan.

It’s all about the risk pools. One of the problems with Obamacare so far is the lack of enrollment of younger, healthier beneficiaries who offset the costs of caring for older, sicker adults. The Obama administration yesterday unveiled a campaign that will use “targeted, digital messages and online networks such as Twitter,” aimed to encourage those aged 35 and under to sign up for the ACA coverage in the fall open enrollment period scheduled to begin November 1, the Wall Street Journal reports.

Q&A with Scott Gottlieb, MD
Interview by Peter Wehrwein

Scott Gottlieb, MD

Medicaid expansion often means a hollow benefit, says this resident fellow at the American Enterprise Institute. There will be some reluctance for sweeping reform, but the exchanges are in trouble and have little political support. Expect some movement there.

When it comes to customer satisfaction, prevention, and treatment, only about 10% of the 1,012 of the commercial, Medicare, and Medicaid plans obtained top quality ratings in the NCQA Health Insurance Plans Rating report. Plans participating in the ACA were not rated because the ACA rates them. Some familiar names in the top finishers in the NCQA report, including Blue Cross Blue Shield of Massachusetts, the Kaiser Foundation Health Plan, the University of Pittsburgh Medical Center, Capital District Physicians, and Tufts. Each has at least two plans that received the highet 5.0 rating.

One plan provides bus passes so people without cars can get to see their doctor nonetheless. Another offers valet cart service at community health centers so the homeless don’t have to worry about losing their possessions when they visit the doctor. It’s little details like this that could make Medicaid managed care plans boost the recently sagging fortunes of the Obamacare exchanges, the Hill reports. Nearly three-fourths of Medicaid enrollees Nearly 55 million people—about 55 million people—are now covered under managed care, a sharp increase even in the past three years.

The pharmaceutical company had been toying with the idea of splitting into two entities, one focused on patent-protected drugs, the other on older products that bring in a lot of revenue, the Wall Street Journal reports. Pfizer had spend about $600 in preparation for the split; small potatoes for a company that’s expected to rake in at least $51 billion this year.

The concussion rate for children and teens 10 to 19-years-old soared 71% from 2002 to 2015, according to a report this morning by the Blue Cross Blue Shield Association. Girls are being encouraged to participate in sports and it shows: The concussion rate for girls and young women rose 118%; it was 48% for boys and young men. And school sports usually start off in the fall, another factor that seems to show in the data.

Q&A with Paul Starr
Interview by Peter Wehrwein

Paul Starr

The Princeton sociologist and Pulitzer Prize winner says that the law left the health care system largely intact. A Clinton presidency could mean important adjustments to the law, including addressing the omission of a public option. Trump’s proposals would effectively end regulation of insurance.

Telemedicine keeps making inroads. A program at the University of Pittsburgh Medical Center connects skilled nursing facility nurses with the hospital’s geriatricians during off-hours. The goal is to reduce hospital admissions among nursing home residents, according to the Pittsburgh Tribune-Review.

It’s not often in health care that prices for anything actually go down. It’s usually big news when the rate of increases slow. But premiums for seniors in Medicare Advantage will go down 3.6%, CMS announced. The agency estimates that the average Medicare Advantage monthly premium will decrease by $1.19 in 2017, from $32.59 on average in 2016 to $31.40. This would be 13% lower than the average Medicare Advantage premium prior to passage of the ACA. Sixty-seven percent of Medicare Advantage enrollees will see no premium increase.

Aetna CEO Mark Bertolini just got a second letter from Senate Democrats on September 23, which asks him to detail while the health insurer has exited Obamacare exchanges. The lawmakers sent a letter on September 8, but claim that Berolini did not answer questions, Morning Consult reports. Lawmakers wonder if Aetna’s pullout is connected to a Justice Department’s challenge of a proposed Aetna-Humana merger.

Screening for prostate cancer prostate-specific antigen (PSA) tests is again put under the microscope as the Philadelphia Inquirer reports why more health care providers are having second thoughts. There are about 180,000 new cases of prostate cancer diagnosed each year. Yet, “the PSA test can’t tell which cancers are aggressive. Moreover, there is no ‘normal’ level of the antigen, which is shed by the gland.

Big Data and artificial intelligence are likely to have the greatest impacts on how health care is delivered next year, according to a Silicon Valley Bank survey of 122 founders, executives and investors in health-tech companies. Forty-six percent of respondents went with Big Data; 35% said artificial intelligence.

The good news is that the maternal mortality rates around the world fell by more than a third from 2000 to 2005. The New York Times, citing data from the Institute of Health Metrics and Evaluation, reports that the maternal mortality rate in the United States rose from 23 per 100,000 births in 2005 to 28 per 100,000 in 2013. “The findings are part of a gathering body of evidence on the dismal numbers for maternal mortality among American women and how they keep getting worse.”

Pennsylvania has been one of the states hardest hit by the opioid epidemic, with more than 3,500 people dying from the drugs last year. Michael Ashburn, MD, MPH, guest blogs today on the Philadelphia Inquirer’s health section and points out that the epidemic started with the best of intentions: relieve pain. 

Susan Ladika

Katherine Hempstead

Individual insurance policies purchased outside of state health insurance exchanges are not going to vanish any time soon. The 9 million Americans who buy such policies usually make too much money to be eligible for subsidies and can often get coverage with a broader network of providers.

Anthem and Cigna accused each other of violating the terms of their proposed merger in letters last month, and that’s one of the issues the government brought up in filing an antitrust lawsuit over the deal, Bloomberg reports. Big bucks are involved. There’s the $48 billion deal itself. And then there’s the$1.85 billion Anthem would owe Cigna if the government blocks the merger. Sometimes, it comes down to personalities.

Insurers picked up 30% of the $78.5 tab for battling opioid abuse in 2013, the CDC reports. Included in the calculation: direct health care costs, lost productivity and costs to the criminal justice system, HealthDay reports, citing a study published in Medical Care. Nearly 2 million Americans abused opioids that year, and about 16,000 people died from drug overdoses, a dramatic rise over 2007, the most recent year data were measured.

Heather Bresch had a rough day yesterday. The CEO of Mylan NV, the maker of the much-in-the-news EpiPen allergy shot, was grilled by the House Oversight and Government Reform Committee, Bloomberg reports. Committee members played hardball, questioning Bresch’s ethics and wondering just why she’s worth $19 million a year. At the center of it all: the $600 price for a two-pack of EpiPen, yet one more example of the public’s growing dismay over the cost of new therapies.

Election 2016: Seniors
Robert Calandra
Clinton wants to expand the program, while the Republican platform calls for replacing entitlements with premium support to buy insurance. Meanwhile, seniors have few complaints because the ACA actually sweetened the deal for Medicare beneficiaries in some respects. Most notably, it gradually eliminates the “donut hole.”

Anyone who’s had to care for an older person in the twilight years knows that the rough ride often starts with the falls. This hasn’t escaped the notice of experts, either, who are starting to refer to an epidemic of falling, the Milwaukee Journal Sentinel reports.

Obamacare could use a little good news right now. Everybody’s heard about the high-profile departures of some of the biggest health insurance companies from the ACA exchanges. But Molina Healthcare, a company that made its name as a Medicaid managed care plan, is cleaning up, the Hill reports. Molina always had to rein in costs and get the best quality bang for its buck, the plan’s CEO Mario Marino, MD, explains.

Thankfully, very few children aged 5 to 11 take their own lives, but attention deficit disorder (ADD) is the reason they do, according to a study in Pediatrics. Eight-seven children in that age bracket took their own lives between 2003 and 2012. Meanwhile, during the same period, depression was the leading cause for the 606 adolescents aged 12 to 14 who did.

Election 2016: Employers
Charlotte Huff
The Cadillac tax, which has drawn fire from both Democrats and Republicans, was initially slated to go into effect in 2018 but last year Congress delayed it until 2020. But it remains an election-year point of friction, with proposals ranging from repeal to modifications.
Election 2016: Hospitals
Robert Calandra
Passage of the ACA in 2010 led to some merger mania. Proponents of mergers and acquisitions say they can lower costs by creating economies of scale and smoothing the way for all kinds of clinical integration. But others say the fact that they can doesn’t mean they do.