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Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join editors from Health Affairs, the leading journal of health policy research, and special guests as they discuss this week’s most pressing health policy news. All in 15 minutes or less.
00;00;09;03 - 00;00;18;02
Jessica Bylander
Hello, everyone. You're listening to Health Affairs This Week, the weekly podcast where the editors at Health Affairs talk about the latest in health policy news. I'm Jessica Bylander.
00;00;18;24 - 00;00;40;20
Leslie Erdelack
And I'm Leslie Erdelack. Before we get into today's episode, a reminder to check out Health Affairs Scholar. We are now accepting submissions for our new open access journal that just launched. Also this week, we released an article ahead of print on the U.S. supply of generic drugs. And don't forget to join us on February 28th for a virtual happy hour for Health Affairs Insiders.
00;00;41;10 - 00;01;06;11
Jessica Bylander
Lots going on, Leslie, and I'll be sure to check out that virtual happy hour. So last week, I'm sure some of our listeners tuned into President Joe Biden's second State of the Union address on February 7th. It was certainly one of the more raucous state of the unions with its fair share of heckling from the crowd. But aside from that, the speech was notable in that it was pretty heavy on health policy.
00;01;07;05 - 00;01;27;02
Jessica Bylander
President Biden focused on many health care topics, including cancer care, veterans health, mental health, prescription drugs and the opioid epidemic. Now, Leslie, you've done this before on the podcast, but we thought we'd hone in on some of the health topics from Biden's speech that most caught our interest. So what would you highlight for our listeners first?
00;01;28;09 - 00;01;54;18
Leslie Erdelack
Yeah, so President Biden spent much of his speech talking about different accomplishments from the first couple of years of his presidency. Bipartisanship was, of course, a recurring theme, but he also called repeatedly on Congress to do one thing: finish the job. He kept coming back to those three words throughout the night, which, as you mentioned, featured some combative exchanges between the president and members of Congress.
00;01;54;19 - 00;02;18;09
Leslie Erdelack
And there was a moment when President Biden was talking about the opioid epidemic in the U.S. that was really indicative of the divide over some of these issues. Now, one of the president's guests at the State of the Union was a father from New Hampshire who lost his daughter to a fentanyl overdose. Deaths involving drugs laced with fentanyl and other types of synthetic opioids have increased dramatically.
00;02;18;09 - 00;02;46;24
Leslie Erdelack
You've probably seen it in the news. Fentanyl overdoses are killing more than 70,000 Americans every year, as Biden noted in his speech, which prompted an outburst from some lawmakers who say it's a law enforcement issue, alleging the administration isn't doing enough to stop Mexican drug cartels from bringing fentanyl into the U.S.. But the president went on laying out a plan to disrupt the trafficking of fentanyl by inspecting more packages and cargo at the border and instituting tougher penalties on suppliers of fentanyl.
00;02;47;22 - 00;03;15;16
Leslie Erdelack
And I found this decision to go after the drug traffickers in his speech interesting, because the Biden administration's response to the opioid crisis historically has focused so heavily on public health interventions, getting more people access to addiction treatment, to naloxone, for example. And while these strategies have generally enjoyed bipartisan support, there hasn't really been a sustained push to target global fentanyl production and the supply chain abroad.
00;03;15;29 - 00;03;43;03
Leslie Erdelack
So there's no indication that the administration intends to move away or de-prioritize any of the investments in opioid prevention and treatment programs. But I think what we're seeing is this question again resurfacing, which is how do we frame our response to this crisis? Is it a law enforcement and Border Patrol issue or a public health problem? So both Democrats and Republicans can agree that America's opioid epidemic is a national crisis.
00;03;43;03 - 00;04;05;06
Leslie Erdelack
And it's no surprise that it came up during the State of the Union for that reason. But as a writer covering the story for the Associated Press pointed out, the range of reactions clearly illustrates how preventing drug deaths dredges up some very deep political, practical and philosophical differences. So that was the one thing that really stood out for me.
00;04;05;07 - 00;04;06;12
Leslie Erdelack
Jess, what about you?
00;04;06;27 - 00;04;27;01
Jessica Bylander
Yeah, I mean, that's a really interesting point about the changing ways the administration is framing the opioid crisis and bringing in more of a focus on Border Patrol. I think I read something that most of the fentanyl that comes in does come in through legal crossings, but definitely something to watch. For me, I have to circle back to drug prices.
00;04;27;13 - 00;04;51;24
Jessica Bylander
President Biden spent a chunk of time detailing the way his administration is working to lower the cost of prescription drugs to consumers, again, largely highlighting his accomplishments, but also calling on Congress to do more. Of course, the president had to tout the sweeping Inflation Reduction Act signed into law last August, which contained several provisions aimed at reducing how much consumers spend on prescription drugs.
00;04;52;13 - 00;05;13;05
Jessica Bylander
First, he emphasized the $35 a month cap on the cost of insulin for seniors on Medicare, which took effect in January of this year. And he went on to say he wants to see the cost of insulin capped at $35 a month for everyone, including children and folks with private insurance. Analysts by the way, note that that proposal doesn't have much of a chance.
00;05;14;01 - 00;05;37;15
Jessica Bylander
Then Biden also highlighted Medicare's new authority to negotiate prescription drug prices, saying it will cut the federal deficit by hundreds of billions of dollars. Now, his statements about the new authority lacked some context, as Medicare is limited to negotiating the cost of only ten Part D drugs starting in 2026. But the number will increase by another 15 to 20 drugs each year.
00;05;37;23 - 00;06;01;26
Jessica Bylander
And we know that a lot of Medicare drug spending is attributable to just a few drugs. So Biden is not likely overstating the potential impact of the law some years down the line. You know, he went on to say, if you try anything to raise the cost of prescription drugs, I will veto it. Referring there to efforts from some Republicans to repeal the Inflation Reduction Act, which also would be unlikely to be successful at any rate.
00;06;02;26 - 00;06;31;19
Jessica Bylander
And relatedly, on the prescription drug price front. The administration proposed three new pilot projects this week aimed at lowering prescription drug costs for people in Medicare and Medicaid. So in one model, Medicare Part D plans would cover a list of about 150 common generic drugs at a $2 co-payment. Another model would allow state Medicaid agencies to test new ways to pay for cell and gene therapies based on health outcomes.
00;06;32;07 - 00;06;57;28
Jessica Bylander
And the third model would develop a mandatory model for paying for drugs approved under FDA's accelerated approval program, with the goal of incentivizing drug makers to actually complete their follow up clinical trials, which are required after those faster approvals based on less evidence. And as we've talked about on the podcast and in the Journal, those follow up trials are often not completed or take much longer than expected.
00;06;58;15 - 00;07;14;25
Jessica Bylander
So the administration is certainly not letting up on its focus on reducing prescription drug costs. And later this year, actually, we'll see the list of the first ten drugs selected for the price negotiation program. So stay tuned. What else caught your attention during the State of the Union speech, Leslie?
00;07;15;18 - 00;07;52;27
Leslie Erdelack
Well, President Biden also called out noncompete agreements, and this comes after the Federal Trade Commission issued a proposed rule in early January that would generally prohibit employers from using non-compete clauses. And companies use non-compete for workers across different industries and job levels. And it's very common to see these kinds of things in health care. Physicians and nurses will often sign non-compete agreements, which, if they want to leave their job or they want to switch employers, essentially prevents them from practicing medicine for a certain period of time or within a defined geographic area.
00;07;52;28 - 00;08;22;25
Leslie Erdelack
It's a way of sort of keeping physicians from going to work for a competing practice and taking patients with them. So I read another good article from a reporter with NBC News that explains why the Biden administration's push to ban non-compete agreements could have big implications for health care. And, you know, people who support these agreements say that they are necessary to protect hospitals and medical practices that make these investments in recruiting and training doctors.
00;08;22;25 - 00;08;49;24
Leslie Erdelack
But on the flip side, the opponents will say that non-compete suppress wages and limit competition, which can have a cascade of different effects, including contributing to doctor shortages in rural areas. So it's a major issue right now in the health care industry, especially as large health systems and private equity firms are increasingly buying up smaller practices and requiring their new employees to sign non-compete agreements.
00;08;51;00 - 00;09;17;07
Leslie Erdelack
Biden's State of the Union didn't explicitly talk about non-competes in the context of health care, but I know a lot of people are keeping an eye on the FTC rulemaking process because it has the potential to dramatically alter the way that those relationships look between physicians and their employers. Okay. So we've covered opioids, drug pricing, labor market competition.
00;09;18;05 - 00;09;18;22
Leslie Erdelack
What else?
00;09;19;06 - 00;09;45;02
Jessica Bylander
Yeah, another item Biden mentioned that caught my interest was the focus on children's mental health and especially the administration's efforts to protect kids mental health online. So Biden said we must finally hold social media companies accountable for what they're doing to children in the name of profit. His administration has warned that social media platforms can be harmful to mental health, especially for children, adolescents and teens.
00;09;45;09 - 00;10;07;07
Jessica Bylander
And a fact sheet released ahead of the State of the Union address, the Biden administration said it would build on, among other things, a new HHS (Health and Human Services) Center of Excellence on social media and mental wellness. So social media use is definitely something I'll worry about as my kids get older. So I wanted to learn more about what the administration is doing and what this new center is all about.
00;10;07;24 - 00;10;34;28
Jessica Bylander
So last September, HHS ordered a 2 million per year grant to the American Academy of Pediatrics to establish that National Center of Excellence. And the plan is they will develop information, guidance and training on the risks and benefits of social media use on children and young people, and especially focusing on the risks to their mental health. It will also examine clinical and social interventions that can mitigate those risks.
00;10;35;15 - 00;10;46;17
Jessica Bylander
So that's something I'll be keeping an eye on to see if they do identify ways to protect kids from the potential harms of social media use. Because, you know, social means is certainly not going away anytime soon.
00;10;47;02 - 00;11;23;29
Leslie Erdelack
Yeah, and that makes me think about sort of the formula that goes into writing the State of the Union. You know, the speechwriters have these two distinct audiences in mind, right? So there's the people in the House chamber and then there's the people at home. And for the parents at home in particular, I think the president's call to expand these protections for kids online is likely one that resonated, right, because it's an issue that is really part of our daily lives in terms of how kids are interacting with social media platforms and the kinds of personal data that these tech companies are able to collect.
00;11;24;00 - 00;11;48;13
Leslie Erdelack
So I was glad to see it mentioned in such a high profile public address, along with all of the other items that we covered today. So another year, another State of the Union health policy recap. We hope you enjoyed it. Thanks for listening to the show and make sure you subscribe to Health Affairs This Week if you haven't already.
00;11;48;13 - 00;11;52;11
Leslie Erdelack
And tune in next week for another episode. Thanks, Jess.
00;11;52;24 - 00;12;13;10
Jessica Bylander
Thanks, Leslie.