While speculation swirls around key cabinet appointments in the incoming Trump administration, much is being written about how things might change for industries and the companies that compose them. Healthcare is no exception.
Speculation about possible changes originates from media coverage, healthcare trade associations, law firms, consultancies, think tanks and academics. Their views are primarily based on Trump Healthcare 1.0 initiatives (2017-2021), presumed Trump 2.0 leverage in the U.S. Senate, House and conservative Supreme Court and a belief by the Trump-team leaders that their mandate is to lower costs for “everyday Americans” and tighten border security.
Thus, Trump Healthcare 2.0 policy changes will be extensive, leveraging legislation, executive orders, agency administrative actions, court decisions and appropriations processes to reset the U.S. health system.
Context:
The red shift that enabled the 45th President to regain the White House was fueled by discontent and fear: discontent with prices paid by ordinary consumers and fear that illegal immigration was an existential threat. Abortion was an important concern to women but inflation and prices for gas, groceries, housing and healthcare mattered more. Exit polls indicate voter concern about how Trump 2.0 economic policies (tariffs et al) might inflate consumer prices or add up to $7 trillion to the national debt was low. And the fate of the Affordable Care Act was a non-issue: assurance about protection for pre-existing condition coverage neutered attention to other elements of the ACA that will get attention in Trump Healthcare 2.0 (i.e. subsidies, short-term plans, et al).
The Four Pillars of Trump Healthcare 2.0 Policy Changes
The new administration is inclined toward a transactional view of the U.S. health system. It does not envision transformational change; instead, it sees opportunity for the system to perform significantly better. Its policies, leadership appointments and actions will be predicated on these four pillars:
- Access to the U.S. healthcare system is a right to be earned. Fundamentally, Trump Healthcare 2.0 builds on its moral conviction that there should be NO FREE LUNCHES whether it’s illegal immigrants or patients who use the health system without doing their part. Trump Healthcare 2.0 will advance mechanisms to enable self-care, increase personal responsibility, promote cheaper/better alternatives to traditional insurance and health delivery and challenge lawmakers to limit financial support to free-loaders. The fundamental notions of public health and community benefit will be revisited and restrictions enacted.
- The status quo is not working. Change is needed. Polls show the majority of Americans are dissatisfied with the health system. Affordability is their major concern: escalating, inexplicable costs are forcing their employers to share more responsibility. Trump Healthcare 2.0 will implement changes that lower spending and costs for consumers and employers. They’ll leverage coalitions of working-class voters and businesses to enact policies that expose waste, fraud and abuse in the system and direct the U.S. Department of Health & Human Services to streamline its structure and prioritize cost-effectiveness (the HHS Strategic Plan for 2022-2026 is up for review).
- Private solutions solve public problems better than government. Trump Healthcare 2.0 posits that government is broken including the federal and state agencies that control healthcare oversight and funding. Reducing regulatory barriers to consolidation and innovation and lessening risks for private investors whose ventures align with Trump Healthcare 2.0 priorities will be foci. Fundamentally, Trump Healthcare 2.0 believes the private sector is better able to address problems than government bureaucrats: key Trump Healthcare 2.0 leadership positions will be filled by successful private sector operators instead of re-cycled DC luminaries desiring attention.
- Price transparency fuels competition and value. Trump Healthcare 1.0 mandated hospital price transparency via its 2019 Executive Order: Trump Healthcare 2.0 will expand the scope and usefulness of price transparency mandates in hospital, ancillary and outpatient services, physician services, insurance and others. It will facilitate accelerated use of Artificial Intelligence in decision-making by consumers, providers and payers. It will expand timely access to data on prices, direct costs, overhead, executive compensation, outcomes, user experiences and other elements of care management provided by hospitals, physicians and other providers. And it will move quickly to implement site neutral payments in the 119th Trump Healthcare 2.0 holds that providers, insurers and drug companies are not inclined to transparency despite strong support from elected officials and voters. They’ll advance these policy changes anticipating pushback from industry insiders. Trump Healthcare 2.0 believes price transparency in healthcare will produce transformational changes that enable more competition and lower costs.
Looking ahead:
The Trump 2.0 team’s immediate task is to assemble its Cabinet: that’s taken prior administrations 38 days on average to complete. In tandem, temporary fixes for CMS’ pending Physician Pay Cut and telehealth expansion will pass as Congress’ lame duck session begins this week.
Looking to 2025, the Trump Healthcare 2.0 team will focus initially on issues in Congress where Bipartisan support appears strong i.e. regulation of PBMs, implementation of site neutral payment policies, expansion of drugs subject to Inflation Reduction Act’s pricing limits and perhaps others. It will plan its legislative agenda coordinating with key committees (i.e. Senate HELP, House Ways and Means et al) and outside groups that share its predisposition. And it will use its political clout to build popular support for healthcare reforms that respond directly to consumer (voter) concern about affordability.
Trump Healthcare 2.0 will bring heightened transparency to the health system and be premised on pillars that are popular with working class voters. It will not be a duplicate of Trump Healthcare 1.0: it will be much more.
Paul
Resource
FY 2025 Annual Performance Plan and Report https://www.hhs.gov/sites/default/files/fy2025-performance-plan.pdf
Sections in Today’s Report
- Quotables
- Care Management
- Economy
- Employers
- Hospitals
- Insurers
- Investors
- Management
- Physicians
- Polling
- Prescription Drugs
- Public Health
Quotables
Re: 2024 healthcare industry introspection: “A national election is a kind of national CT scan, deeply revealing what’s important to our communities today and what communication strategies work (and don’t work) now. The challenge for healthcare is not that the environment in which we serve is changing.
It always changes.
The risk is that we don’t learn the lessons it has to teach. The risk is that we don’t tell our powerful, compelling story because our strategies and our message remain frozen in what worked in the past.”
Keckley note: Jarrard’s entire post is must reading for healthcare leaders. Messaging matters, and it’s about more than words.
Election Lessons for Healthcare David Jarrard November 10, 2024
Re: election polling accuracy: “For the third presidential election in a row Donald Trump has stumped America’s pollsters. As results came in on election night it became clear that polls had again underestimated enthusiasm for Mr. Trump in many states. In Iowa, days before the election a well-regarded poll by Ann Selzer had caused a stir by showing Kamala Harris ahead by three percentage points. In the end, Mr. Trump won the state by 13 points.
Overall, the polling miss was far smaller. Polls accurately captured a close contest in the national popular vote and correctly forecast tight races in each of the battleground states. National polls erred by less than they did in 2020, and state polls improved on their dismal performances in 2020 and 2016. Yet this will be little comfort to pollsters who have been grappling with Mr. Trump’s elusive supporters for years…
If there is a lesson from this year’s election, it could be that there is a limit to what weighting can solve. Although pollsters may artificially make a sample “representative” on the surface, if they do not address the root causes of differential response rates, they will not solve the underlying problem. They also introduce many subjective decisions, which can be worth almost eight points of margin in any given poll.”
Opinion polls underestimated Donald Trump again
Re: Post-election reflection: “After months — even years — of frenzied campaign activity, nonstop ads and raucous campaign rallies, comes a day when the nation looks into the mirror and into its future…
This is a country going through a big change.
It will be a long time before we can say exactly why a country that decisively rejected Trump four years ago welcomed him back last night — and the answer is going to be complicated. But it is possible, I think, that the same thing that cost Trump the presidency in 2020 played at least some role in clearing a path for his return in 2024: the pandemic.
In 2020, Covid-19 upended American life, killing 385,000 people in a year and sending the American economy into a recession. Trump’s chaotic and dismissive handling of a public health crisis that had made life almost unrecognizable is part of why voters rejected him that year…
In 2020, as voters put on masks and cast ballots by mail, the effects of the pandemic were obvious, and Biden promised to offer change.
But maybe 2024 unfolded in a country just as upended by the pandemic, even if it was less obvious to the naked eye. This time, though, Biden — and then Harris — represented the status quo, offering little in the way of transformative ideas that would fix what four years of malaise had wrought.
This time, Trump was able to run as the candidate of change.”
The Second Pandemic Election NY Times November 6, 2024 https://messaging-custom-newsletters.nytimes.com/dynamic/render?campaign
Re: Trump durability “He overcame seemingly fatal political vulnerabilities — four criminal indictments, three expensive lawsuits, conviction on 34 felony counts, endless reckless tangents in his speeches — and transformed at least some of them into distinct advantages.
How he won in 2024 came down to one essential bet: that his grievances could meld with those of the MAGA movement, and then with the Republican Party, and then with more than half the country. His mug shot became a best-selling shirt. His criminal conviction inspired $100 million in donations in one day. The images of him bleeding after a failed assassination attempt became the symbol of what supporters saw as a campaign of destiny.”
NYTimes Nov 7, 2024 https://www.nytimes.com/2024/11/07/us/politics/how-trump-won-and-how-harris-lost.html
Re: Trump inclination toward business regulation: “Trump will likely take a business-friendly approach to federal oversight of artificial intelligence. Big Tech and startups alike have pushed for a light touch on AI safety and transparency rules, which they say would keep innovation flowing. The Biden administration last year issued an executive order on AI, which Trump has said he would dismantle. The order covered things like monitoring the training and outputs of AI models.”
Trump Inc.: How a Second Administration Could Rewrite the Way America Does Business – WSJ
Re: corporate regulation in Trump 2.0: “A Trump administration 2.0 is expected to have some big bright spots for corporations — namely, those bristling under the weight of government regulations.
During his first term in office, Trump added annual net regulatory costs of $10 billion, down from $43 billion under former President George W. Bush and $111 billion under former President Barack Obama, the American Action Forum said in 2021. The government eliminated $198.6 billion in overall regulatory costs between 2017 and 2020, with agencies issuing 538 deregulatory actions and 97 “significant” regulatory actions.
While many of those actions were later withdrawn or struck down, some companies and executives hope Trump will pick up where he left off, saving them money and time. Tesla (TSLA) and SpaceX CEO Elon Musk is likely to have a major role in this through a proposed Department of Government Efficiency, which aims to slash about $2 trillion in federal spending and tackle what businesses see as overregulation.”
Corporate America braces for Trump’s tariffs, tax cuts — and revenge
Re: health policy in Vermont: “Vermont consistently ranks among the healthiest states, and its unemployment and uninsured rates are among the lowest. Yet Vermonters pay the highest prices nationwide for individual health coverage, and state reports show its providers and insurers are in financial trouble. Nine of the state’s 14 hospitals are losing money , and the state’s largest insurer is struggling to remain solvent. ..
Rising health costs are a problem across the country, but Vermont’s situation surprises health experts because virtually all its residents have insurance and the state regulates care and coverage prices…
Health experts say some of the state’s health system troubles are self-inflicted.
Unlike most states, Vermont regulates hospital and insurance prices through an independent agency, the Green Mountain Care Board. Until recently, the board typically approved whatever price changes companies wanted, said Julie Wasserman, MPH, a health consultant in Vermont…
The state’s strict regulations have earned it an anti-housing, anti-business reputation, he said. “The cost of healthcare is a symptom of a larger problem.”
In Vermont, Where Almost Everyone Has Insurance, Many Can’t Find or Afford Care | MedPage Today
Care Management
Study: Bariatric Surgery vs. GLP-1 Use for Obesity Management: “During the study period, 81 092 patients were prescribed GLP-1 RAs (9.6% aged 18-35 years) and 5173 patients underwent metabolic bariatric surgery (17.5% aged 18-35 years). Patients with metabolic bariatric surgery were more medically complex than those prescribed GLP-1 RAs or no treatment (18.8% vs 8.2% vs 11.1% with ≥4 comorbidities).
We identified a 132.6% increase in patients prescribed GLP-1 RAs between the last 6 months of 2022 vs the last 6 months of 2023 (1.89 vs 4.41 patients per 1000 patients). In contrast, there was a 25.6% decrease in patients undergoing metabolic bariatric surgery comparing the same periods (0.22 vs 0.16 patients per 1000 patients).
This cross-sectional study of privately insured patients found a more than 2-fold increase in use of GLP-1 RAs as antiobesity medications from 2022 to 2023, with a 25.6% decrease in the rate of metabolic bariatric surgery during the same period. Our results provide a national contemporaneous estimate of the decline in metabolic bariatric surgery associated with the era of GLP-1 RAs.
Although GLP-1 RAs are effective for the treatment of obesity and related comorbid conditions, such as diabetes, the high cost and high rates of gastrointestinal adverse effects can lead to treatment cessation and subsequent weight regain… Our findings also suggest a remaining large addressable market for obesity treatment, with less than 6% of our study population receiving GLP-1 RAs or surgery. Limitations of this study include its cross-sectional nature, changing population denominator secondary to insurance status, and potential confounding from variations in patient adherence to GLP-1 RAs. Policymakers and clinicians should continue to closely monitor trade-offs between pharmacologic and surgical management of obesity to ensure optimal access to effective obesity treatment.”
Study: Improvements in OUD treatment in Medicaid Section 1115 waiver states: “A long-standing policy prohibits the use of federal funds for Medicaid services in Institutions for Mental Diseases (facilities with more than sixteen beds that specialize in mental health or substance use disorder treatment). Beginning in 2015, states could apply for Section 1115 Medicaid waivers, which permit federal funding for Institutions for Mental Diseases services and require improvements in opioid use disorder (OUD) treatment. Using 2016–20 Medicaid data, we compared changes in the use of medications for OUD and nonfatal overdoses in seventeen states with waivers approved during 2017–19 to changes in eighteen states without waivers. Waiver implementation was not associated with improvements in overall medication treatment, buprenorphine and naltrexone prescribing, or rates of nonfatal overdoses among Medicaid enrollees with OUD. Waiver implementation was associated with a 2.3-percentage-point increase in the use of methadone with waiver implementation, as a result of coverage changes, and a 3.7-percentage-point increase in any medication treatment among Medicaid enrollees diagnosed with severe OUD who had an inpatient or residential stay. Our findings suggest that such waivers adopted by states during 2017–19 were not associated with significant improvements in medication treatment or reductions in nonfatal opioid-related overdoses among Medicaid enrollees with OUD. However, they may have moderately improved the use of medication treatment for those with severe OUD.”
Economy
Federal Reserve Interest Rate Cut: “Last Thursday, the Federal Reserve approved a quarter-point interest rate cut but signaled uncertainty over how quickly it would continue lowering rates, as it seeks to prevent large rate increases of the prior 2½ years from unnecessarily slowing the economy.
Thursday’s rate decision followed an initial cut of a half-point in September and will bring the benchmark federal-funds rate to a range between 4.5% and 4.75%. All 12 Fed voters backed the cut
Since the Fed cut rates in September, longer-dated bond yields have climbed notably… Yields have increased in large part because better economic data has led investors to reduce their worries about a recession…But some analysts think the bond-market selloff may also reflect concerns by some investors about higher deficits or inflation in a second Trump administration.
Either way, the market has generated an unusual result: Borrowing costs rose after the Fed cut rates. The average 30-year mortgage rate has jumped since mid-September, to 6.8% this week from 6.1%, according to Freddie Mac.
The election result—which sent stock markets to new highs while raising the prospect of stronger growth, higher inflation and better labor-market outcomes—boosted the odds that the Fed forgoes a cut next month.”
Federal Reserve www.federalreserve.gov
Study: Tariff impact on economy: Per the National Retail Federation study:
- “The proposed tariffs would have a significant and detrimental impact on the costs of a wide range of consumer products sold in the United States, particularly on products where China is the major supplier.
- The increased costs as a result of the proposed tariffs would be too large for U.S. retailers to absorb and would result in prices higher than many consumers would be willing or able to pay.
- Consumers would pay $13.9 billion to $24 billion more for apparel; $8.8 billion to $14.2 billion more for toys; $8.5 billion to $13.1 billion more for furniture; $6.4 billion to $10.9 billion more for household appliances; $6.4 billion to $10.7 billion more for footwear, and $2.2 billion to $3.9 billion more for travel goods.
- For all categories examined, total average tariffs would exceed 50% in the extreme tariff scenario, up in most cases from single or low double digits currently. “
Gallagher:” Top Three Market Headlines for week ending November 1, 2024”
- Turbulent Month Tempers Job Market Growth: The U.S. Department of Labor reported last week that the U.S economy added just 12,000 jobs in October, missing economists’ expectations of 100,000. Employment conditions across the country were impacted by a series of external events during the month, including Hurricanes Helene and Milton along with strike activity among dockworkers and at Boeing. The report also noted that the number of job additions over the prior two months was revised down by a combined 112,000. Average hourly earnings in October were up 4.0% from a year ago, the fastest pace in five months, while the unemployment rate was unchanged at 4.1%.
- S. GDP Expands 2.8% in Q3: The U.S. Bureau of Economic Analysis reported last week that real (inflation-adjusted) U.S. gross domestic product (GDP), a measure of all goods and services produced, grew in the third quarter of 2024 at an estimated annual rate of 2.8%. Combined with the 3.0% pace of growth in Q2, this provided further evidence that the economy strengthened over the course of the year from the tepid 1.6% rate in Q1. Categories that contributed to growth in Q3 included federal government spending, exports, and consumer spending in both goods and services.
- Home Price Gains Slow: Home prices across the U.S. rose once again in August, hitting new highs for the 15th consecutive month, though the pace of growth continued to decelerate. The S&P CoreLogic Case-Shiller 20-City Composite Home Price Index increased 0.4% on the month and 5.2% versus the prior year. This was the 14th straight month of year-over-year price gains, but the slowest rate of growth in 10 months. New York posted the highest annual gain in August at 8.1%, followed by Las Vegas and Chicago with increases of 7.3% and 7.2%, respectively.
Weekly Financial Markets Update November 04, 2024 | AJG United States
Employers
KPMG Business optimism about growth: KPMG surveyed 621 leaders of US-based companies, including those that intend to remain private, those with plans to go public in the next few years, and a subset that have recently gone public, May 29-June 10, 2024 re perspectives on growth. Highlights:
- 72% of respondents say they feel prepared to capitalize on major growth opportunities today
- 67% of respondents say that the deal market will increase in the next 18 months
- Comparing 6 industries, healthcare, healthcare is the optimistic about growth (93%) and consumer and retail the least (79%).
- AI relevance will increase over time.
Disruption Decoded: Private company survey results
Studies: Employer expectations about employee health costs in 2025:
- National Alliance of Healthcare Purchaser Coalitions: from its Pulse of the Purchaser 2024 survey: “The majority of employers believe that increases in health care expenses often lead to trade-offs with salary or wage increases. This sentiment is echoed by 74% of respondents, who agree that higher health care costs will result in further cost-shifting to employees…Actions being implemented: 55% are reducing risk of neonatal intensive care unit (ICU) claims, 45% are prioritizing enhanced screening measures to catch health issues early,40% are considering redirecting care to more cost-effective settings, such as home infusion services and 52% are considering changing their pharmacy benefits manager (PBM).
- KFF: “..employers have seen the total annual costof premiums for family coverage rise 24% over the past five years, the amount that workers pay rose 5%, or less than $300 on average. Workers contribute about a quarter of the average $25,572 annual family premium, or about $6,300. About 154 million Americans rely on their employers for health insurance.”
- Aon: “… while employers’ health plan costs rose 6.4% from 2023 to 2024, employees paid 3.4% more in premiums. “
- Business Group on Health:”… large employers had found expect their costs to rise about 8% in 2025–, the highest jump in more than a decade.”
- WTW: “…a third of employers said they will shift costs to workers through higher premium contributions. More than half said they would look for other ways to rein in costs, like networks that steer employees to lower-cost providers or by changing pharmacy benefits.”
Employers Shift to Equity-Focused Strategies as Health Costs Outpace Wages
Expect Higher Costs for Your Health Care Benefits Next Year – The New York Times
Hospitals
OIG Audit of Hospital Price Transparency compliance: Per an audit of hospital compliance conducted by CMS’ Office of the Inspector General released last week:
“Not all of the selected hospitals made their standard charges available to the public as required by Federal law. Of the 100 hospitals in our stratified random sample, 63 complied with the HPT rule requirements; however, 37 did not comply with 1 or both of the following HPT rule requirements:
- 34 hospitals did not comply with 1 or more of the requirements associated with publishing comprehensive machine-readable files.
- 14 hospitals did not comply with 1 or more of the requirements associated with displaying shoppable services in a consumer-friendly manner.
On the basis of our sample results, we estimated that 46 percent of the 5,879 hospitals that were required to comply with the HPT rule did not comply with the requirements to make information on their standard charges available to the public.”
Not All Selected Hospitals Complied with the Hospital Price Transparency Rule Issued on 11/05/2024 | Posted on 11/08/2024 | Report number: A-07-22-06108
Study: variability in hospital charity care policies: “US nonprofit hospitals are required by law to have a charity care policy, but hospitals have significant discretion in determining specific eligibility criteria. Using a novel national database, this analysis revealed that nonprofit hospitals have chosen widely varying charity care eligibility guidelines. Among hospitals that offered free care, income limits ranged from 41% to 600% of the federal poverty guideline. Many hospitals considered assets when determining eligibility for charity care, and a significant minority also had residency requirements and restrictions for insured patients. Hospitals generally allowed charity care in cases of hardship, with a median cutoff of a given hospital bill being 20% of the patient’s income…
Recent analyses demonstrate that private nonprofit hospitals are particularly miserly in their charity care spending. Ge Bai and colleagues used data from the 2018 Medicare Hospital Cost Reports to show that private nonprofit hospitals spent 2.3% of total expenses on charity care, which is less than either government hospitals (4.1%) or for-profit hospitals (3.8%).”
Hospitals in counties with lower levels of poverty and uninsurance had more generous eligibility policies. The wide variation in requirements for hospital financial assistance poses barriers to equitable access to care…. “
Keckley Note: The methodology used in this study—particularly its dependence on the Dollar For database and its correlation to reported income specifications for charity care eligibility– merits more study.
Site Neutral payments legislation proposed: “Sens. Bill Cassidy (R-La) and Maggie Hassan (D-NH) are set to release a framework for Medicare site-neutral payment reforms : Site-neutral proposals address the way hospitals charge Medicare more for the same services that independent doctors deliver in their offices. The framework is slated to be more expansive than some previous site-neutral policies and could look similar to what’s been proposed in the June 2023 MedPAC report. MedPAC recommended that for certain services, Medicare payments to hospital outpatient departments, ambulatory surgery centers and freestanding physician offices should be more closely aligned. That means this policy would apply to a number of outpatient services that could be provided in each type of setting. The savings from the site-neutral policy could then be reinvested into certain hospitals. Hassan has previously been a leader on site-neutral payments with her SITE Act, but Cassidy’s involvement adds an influential Republican, who could potentially be HELP chair next year. The health cost transparency bill that the House passed last year only applied site-neutral payments to physician-administered drugs. Any site-neutral bill still faces an uphill climb this year given hospital opposition, and many expect a smaller policy like the House measure to have the best chance if anything makes it.”
Scoop: Hassan, Cassidy prep site-neutral framework
Price transparency: “It is well-established that the United States has, by far, the highest per-capita health care spending in the world, about twice that of similarly developed countries. The primary factor contributing to high US spending is higher prices. Price growth in the US has been fueled by a growing trend of market consolidation, with about 90% of American hospital markets now considered to be highly consolidated. Increased market power allows dominant hospitals, health systems, and large provider groups to command higher prices for their services without an associated increase in quality. In addition, as hospitals increasingly purchase free-standing medical practices, they define them as hospital facilities and bill for the same services at higher hospital rates. This creates an incentive for further provider consolidation and fuels price inflation. The burden of high hospital prices, and high overall health care costs, is clear. It makes health insurance coverage less affordable, particularly for the privately insured as they tend to pay the highest prices in the US. High prices and costs also hinder consumer choice about whether, how and where to seek necessary care, and result in people delaying or not getting needed health care due to cost. Moreover, they affect employer decisions about whether to offer health insurance and force a continued trade-off between wage increases and employee health insurance as businesses struggle to manage rising health care costs
The-Price-Isnt-Right-Policy-Options-to-Strengthen-Health-Care-Price-Transparency.pdf Alliance for Fair Health Pricing
Report: hospital consolidation and prices: “Hospitals in the United States face multiple challenges, and their success in meeting those challenges varies considerably. Understanding this variation is essential to the policy goal of helping all hospitals succeed. For example: Consolidation from mergers and acquisitions has limited competition. Hospital markets with less control by hospital chains have lower prices. Hospitals that have higher management and administrative costs charge higher prices. Hospitals that are inclusive of everyone in their community tend be smaller and charge lower prices.”
Lowering Prices and Six Other Big Challenges for US Hospitals – Third Way October 30, 2024
Study: Facility fee comparisons—hospitals vs. freestanding ASCs: Using Turquoise Health data, researchers analyzed negotiated facility fees with 4 national insurers for 10 high-volume procedures. The analysis included 55 payers and 4,950 total facilities, of which 3,254 (65.7%) were ASCs and 1,696 (34.3%) were hospitals. Results:
“For all procedures, mean facility fees were significantly higher at hospitals compared with ASCs. The mean facility fee difference between ASCs and hospitals ranged from $1515 (arthrocentesis) to $5717 (knee arthroplasty). Mixed-effects modeling revealed that, on average and independent of procedure type, facility fees are $3077 higher at hospitals compared with ASCs. Hospital fees on average were more than double ASC fees; mean hospital markup relative to ASCs ranged from 101% (tendon sheath incision) to 167% (blepharoplasty).”
Privately Negotiated Facility Fees at Ambulatory Surgery Centers and Hospitals
Insurers
Study: OOP costs MA vs. Traditional Medicare: “We used Centers for Medicare and Medicaid Services (CMS) data on projected out-of-pocket costs for the period 2014–20; these data estimate total spending on premiums and cost sharing fora representative Medicare beneficiary. Exhibit 1 shows that mean monthly out-of-pocket costs were approximately 18–24 percent lower for beneficiaries in MA relative to fee-for-service Medi-care. Our results also provide additional context to the policy debate around the fiscal costs of MA, which the Medicare Payment Advisory Commission has estimated to be around 17% higher than for an equivalent fee-for-service Medicare beneficiary in 2019. “
Sherlock: Economies of scale in health insurance- 2024 results: Analysis of administrative cost data covering 16 functions:
- “Enterprise total expenses (excluding miscellaneous business taxes) were significantly subject to economies of scale only for Blue Cross Blue Shield Plans. They were not significant for universes of Independent / Provider – Sponsored Plans or the combination of Blue and IPS plans…
- Using the combined universe slopes to an administrative cost assumption of $69 PMPM, we calculate savings to be $1.79 from doubling plan size, or by 2.6%. However, because health insurance has low margins, the effect on combined earnings is much greater, 18.2%.”
Economies of Scale November Navigator 2024.xlsx Sherlock Company
Report: MA denial rates: “The country’s three largest Medicare Advantage (MA) insurers obstruct seniors’ ability to receive post-acute care, a scathing report from the U.S. Senate Permanent Subcommittee on Investigations shows.
It outlines attempts from UnitedHealthcare, CVS and Humana—which collectively cover nearly 60% of all MA enrollees—to use technology to reject prior authorization claims, all while reaping profit.
Between 2019 and 2022, the three insurers denied claims for post-acute care at “far higher” rates than for other types of care, and, in 2022, Humana denials in post-acute care were 16 times higher than the companies’ overall denial rates, the report (PDF) says. UnitedHealthcare and CVS denials were three times higher in the same year.”
Insurers increasingly deploy AI and deny post-acute care: Senate
Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care U.S. Senate Permanent Subcommittee on Investigations October 17, 2024 https://www.hsgac.senate.gov/wp-content/uploads/2024.10.17-PSI-Majority-Staff-Report-on-Medicare-Advantage.pdf
Election impact on coverage: Millions of Americans risk losing subsidies next year that help them pay for health insurance following President-elect Donald Trump’s election win and Republicans’ victory in the Senate. The subsidies — which expire at the end of 2025 — came out of the 2021 American Rescue Plan, and increased the amount of assistance available to people who want to buy health insurance through the Affordable Care Act. The American Rescue Plan also broadened the number of people eligible for subsidies, extending them to many in the middle class. Key to that strategy, health policy experts said, is simple inaction. Major subsidies that lawmakers approved during President Biden’s term that have lowered the cost of plans are set to expire next year. Republicans could allow them to sunset, a move that could deprive roughly 20 million Americans of extra financial help for coverage on the Affordable Care Act’s marketplaces.
The subsidies, which are estimated to cost more than $300 billion if extended for a decade, helped Obamacare enrollment almost double during President Biden’s term, shattering records. The Congressional Budget Office estimates that 3.4 million people will lose insurance if the subsidies expire and the cost of plans rises. Lower-income Americans would still receive some federal assistance, while higher-income people would lose it altogether.
Federal health officials are also likely to once again encourage the use of short-term health plans that skirt Affordable Care Act regulations. Some health policy experts have also warned of potential cuts and changes to Medicaid, which the Affordable Care Act dramatically expanded to cover more adults…
The Biden administration published a report last week showing that nearly three million rural Americans had Obamacare plans, while more than 12 million had Medicaid coverage. Rural Americans who purchase coverage on the Affordable Care Act’s marketplaces would see costs go up by almost $90 on average every month if the enhanced subsidies expire, federal researchers wrote.
Will Trump Have a New Opening to Repeal the ACA? – The New York Times
Investors
Pitchbook: PE focus in healthcare: From Alex Kacik’s excellent summation “Private equity firms are shifting their focus from providers to healthcare information technology and pharmaceutical services.
State and federal regulatory scrutiny has deterred private equity investment in healthcare providers, PitchBook analysts said in the company’s latest healthcare services report. But regulatory oversight of healthcare-related private equity deals has slightly cooled as certain state bills stalled in the 2024 legislative session, and the report says analysts expect more private equity activity through the rest of the year.
Here are four takeaways from the report.
- Private equity-backed deals declined in the third quarter: There were an estimated 148 private equity-linked healthcare deals in the third quarter, down 25% from the 186 transactions in the third quarter of 2023. While analysts expect a modest end-of-year bump, deal volume is projected to drop 15% in 2024 compared with 2023.
- Healthcare IT, specialty pharmacy investment picks up: Private equity investors are more optimistic for deal activity to rebound in the second half of the year, with much of that optimism focused on healthcare IT and pharma, not on physicians.
- Private equity firms are holding onto physician groups longer: Private equity firms, which typically invest in physician groups through management services organizations, have been unable to find buyers for their physician practices. As a result, private equity companies are expected to hold onto those practices longer and grow them by rolling practices into other acquisitions, according to the report. For instance, there are 19 private equity-backed mental health practices that have remained in investors’ portfolios for at least seven years, Pitchbook data shows.
- Medicare Advantage market shifts hurt primary care companies: As insurers have droppedMedicare Advantage plans in some markets, value-based primary care companies have become less profitable…Value-based primary care companies often need to provide care for a large number of Medicare Advantage beneficiaries to remain profitable.
Private equity is curbing its provider investment: Pitchbook
Where private equity is curbing its investment – pkeckley@paulkeckley.com – PaulKeckley.com Mail
Retina Consultants of America: Last Wednesday, Webster Equity Partners announced drug distributor Cencora (previously known AmerisourceBergen) as will acquire 85% of Retina Consultants of America, or RCA, from Webster for $4.6 billion, plus up to $500 million of incentive payments. Per Pitchbook: “Many large-scale PE firms that historically were the primary buyers of those assets have shied away from healthcare provider deals, in part because of heightened regulatory scrutiny. The IPO market has been closed to such companies, leaving strategic sales the main exit option… with the US presidential election completed, there is a greater chance for PE firms to offload their PPM assets to strategic buyers. A future Republican administration is expected to be somewhat more lenient on antitrust policy, which would help PE firms to divest their PPM portfolio companies to strategic buyers.”
Specialty firm scores $4.6B deal in win for healthcare investors seeking exits Pitchbook November 6, 2024 https://pitchbook.com/news/articles/healthcare-pe-firm-nabbed-ppm-exit
Management
McKinsey: Board-CEO Collaboration: “We know that the board’s relationship with the CEO is especially critical, just one-third of respondents say their boards and CEOs collaborate very effectively. board members’ work is increasingly complex, and their time and expertise are increasingly in high demand. Not only is the business environment more unpredictable than before, but the range of topics that directors must prioritize continues to expand. Two-thirds of surveyed directors say the complexity of their boards’ role and responsibilities has increased in the past two years. What’s more, many of the topics on today’s board agenda, from generative AI (gen AI) and cybersecurity to the net-zero transition, were rarely discussed ten years ago.2 Meanwhile, directors are still responsible for the general oversight and strategic direction–setting aspects of their role.”
Better together: Three ways to boost board–CEO collaborationhttps://www.mckinsey.com/capabilities/strategy-and-corporate-finance/our-insights/better-together-three-ways-to-boost-board-ceo-collaboration
Pitchbook: Venture capital market pullback: “The near-three-year slowdown has focused the market’s ire on the mechanics of VC that have shifted over the past decade. Prices paid are higher. Time spent private, longer. Ability to convert those factors into strong returns, more difficult.
The fact is that US venture basically 10x’d in a decade. During the GFC, annual deal value was $30 billion to $40 billion—$350 billion was invested in 2021. That took the number of VC-backed companies from around 10,000 to more than 57,000, and the number of active investors moved from single-digit thousands to more than 25,000. Growing pains were a natural side effect.
Companies that previously raised in the high-priced market of 2021 are raising again. Outside of high-performing companies in select industries, valuation growth has been at decade lows, however, which adds further dilution to existing investors and dampens return expectations. What the high prices paid haven’t done is turn into high returns over the past couple of years, and now the market is dealing with the fallout. Exits have been incredibly slow, whether due to high prices, broader economic conditions, or an amalgamation of factors.
As the market has grown, so has the remaining value in VC portfolios, some of it aging beyond the standard 10-year fund cycle. For many LPs, this leaves them overweight to VC, or without the liquid capital they expected to recycle into VC or other strategies”
VC market reckons with the side effects of 2021’s boom my.pitchbook.com/viewnewsletter/F23OB-MUKN4/pevc
Gallagher: 2024-2025 executive compensation: Gallagher researchers analyzed 2024-2025 data for 2,892 companies in the Russell 3000 Index which allows for breakdowns by industry, company size and other factors. “Data in this report are descriptive, not prescriptive.” Excerpts:
“Executive compensation follows the stock market. When stock performance is strong, executive compensation tends to increase, and vice versa. The S&P 500 has experienced an incredible 53% bounce from the 2022 low point as of the end of June 2024, coinciding with reduced fears of a recession and the easing of post-pandemic inflation. This led to a recovery in 2023 as executive compensation grew to 5.3%, which is reasonable relative to inflation.
… CEO pay increased 5.3% and 5.8% for the overall Russell 3000 and S&P 500 indexes. This rise contrasts with the decrease of 5.7% and 2.0% for 2022, compared with the large post-pandemic increases of 29.9% and 16.2% for 2021. Since 2019 (pre-pandemic), CEO pay for Russell 3000 companies increased 32.4%, 27% for CEOs at S&P 500 companies, and 38.6% at Russell 3000 companies, excluding S&P 500 companies. Over that same period, the Consumer Price Index increased 19.2% and the gross domestic product (GDP) implicit price deflator increased 15.3%. From this comparison, we see that CEOs generally received pay well above the rate of inflation since 2019, due in large part to the explosion of pay in 2021.
Note: The Gallagher analysis across 11 industries indicates healthcare and financial institutions reported the highest increases in CEO compensation from 2024 to 2025 (+18%). The 2019-2023 CAGR for CEO compensation is 7.6%–5th highest of industry increases that ranged from 0.5% (consumer staples) to 10.9% (utilities).
CEO and Executive Compensation Trends Based on disclosure by Russell 3000® and S&P 500®
Physicians
Proposed legislation to “fix” physician pay cut: “Lawmakers from both sides of the aisle are trying to block proposed 2.93% cuts to Medicare physician payments next year.
The Medicare Patient Access and Practice Stabilization Act, introduced Tuesday by Reps. Dr. Greg Murphy (R-N.C.) and Jimmy Panetta (D-Calif.), would eliminate cuts included in the 2025 final rule and provide a small payment increase to account for inflation.”
Note: The pay cut is the fifth consecutive annual reduction to the “conversion factor” that sets the fees Medicare pays doctors. The conversion factor in 2025 will be 2.83% less than in 2024 ($32.35 in 2025 vs. $33.29 in 2024). Per HHS, physician pay was cut by 1.25% for 2024, and cuts averaged 2.3% per year 2005 and 2021 when accounting for inflation. Per a study by the Harvey L. Neiman Health Policy Institute, physician pay was cut by 1.25% for 2024, and cuts averaged 2.3% per year 2005 and 2021 when accounting for inflation.
The Medicare physician fee schedule uses three factors: Relative value units, which are based on the cost of procedures; geographic price indices, which adjust RVUs using local cost data; and the conversion factor, which translates those numbers into dollar amounts. The conversion factor has to be recalculated annually based on the previous year’s conversion factor, then adjusted to keep it budget-neutral.
Medicare Patient Access and Practice Stabilization Act October 29, 2024 https://murphy.house.gov/media/press-releases/murphy-introduces-bipartisan-legislation-protect-medicare-physicians
Continued Medicare Reimbursement Declines Could Threaten Access to Physicians April 26, 2024https://www.neimanhpi.org/press-releases/continued-medicare-reimbursement-declines-could-threaten-access-to-physicians/
WSJ: Medical profession: a job or a calling? “There’s a question dividing the medical practice right now: Is being a doctor a job, or a calling?
For decades, the answer was clear. Doctors accepted long hours and punishing schedules, believing it was their duty to sacrifice in the name of patient care. They did it knowing their colleagues prided themselves on doing the same. A newer generation of physicians is questioning that culture, at times to the chagrin of their older peers….
Changes in healthcare mean a growing number of physicians now work as employees at health systems and hospitals, rather than in private practice. Electronic paperwork and other bureaucratic demands add to the stress and make the profession feel less satisfying, they say. More physicians are pursuing temporary work…
Physicians work an average of 59 hours a week, according to the American Medical Association, and while the profession is well-compensated—the average physician makes $350,000, a recent National Bureau of Economic Research analysis found—it comes with high pressure and emotional strain…
More young doctors are choosing to join healthcare systems or hospitals—or larger physician groups. Among physicians under age 45, only 32% own practices, down from 44% in 2012. By comparison, 51% of those ages 45 to 55 are owners…”
Young Doctors Want Work-Life Balance. Older Doctors Say That’s Not the Job. – WSJ November 3, 2024
USA Today: Physician pay: “Question: What is America’s 20 highest-paid jobs? Answer: Doctor. It’s pretty much true: Of the 20 U.S. occupations with the highest average pay, according to the Bureau of Labor Statistics, 16 are some kinds of doctor.
Pediatric surgeons earn $449,320 a year, on average, as of 2023, according to federal data. Cardiologists make $423,250. Orthopedic surgeons get $378,250.
Only four of the 20 highest-paid professions are not doctors. They are dentists. (And orthodontists, dental surgeons and specialists.)
Doctors earn more than any other broad category of worker, according to federal data: More than engineers. More than computer scientists. More, even, than lawyers. To find a better-paid group than doctors, economists say, you have to drill down to elite subcategories, such as corporate CEOs and law partners. The average partner at a large firm earns more than $1 million a year. The typical S&P 500 CEO collected $16.3 million in 2023, according to the Associated Press.
American doctors are so conspicuously well-paid that a group of economic researchers spent years trying to figure out why…”
What are the 20 highest-paying jobs in America? Doctors, doctors, more doctors. USA Today November 6, 2024 https://www.usatoday.com/story/money/2024/11/06/doctor-physician-salary-high-why/75969535007/
McKinsey Physician Shortage: “Healthcare organizations are grappling with the increasingly difficult—and urgent—task of attracting and retaining physician talent to meet increasing patient demand for care. By the end of this year, the United States is expected to have a shortage of up to 64,000 physicians. The COVID-19 pandemic exacerbated the already substantial burnout among physicians and contributed to an unprecedented departure of physicians from the clinical workforce. Looking ahead, physicians’ desires to step back from clinical care show no signs of abating, with current projections indicating the physician deficit could grow to up to 86,000 by 2036.
One reason for the expected shortage is that some 20% of clinical physicians are aged 65 years or older, putting organizations in the position to soon lose a substantial number of physicians to retirement. The expanding gap in the physician workforce is particularly consequential given the projected growth in patient demand: the number of people aged 65 and up—an inherently higher-need patient group—is expected to rise to 23% of the population, from 17% by 2050.
Approximately 35% of physician respondents indicate they are likely to leave their current roles in the next five years, of which roughly 60 % say they are likely to leave clinical practice entirely….”
Why the physician shortage in the US is getting worse | McKinsey
Polling
AP-KFF Election Polling: Per the AP VoteCast poll of more than 115,000 voters conducted nationally and in 48 states, fielded between Oct. 28 and concluding as the polls close on Nov. 5:
- “Abortion drove many voters to turn out for Tuesday’s election, but not always for Vice President Kamala Harris, while concerns about the economy weighed more heavily on voters’ minds About a quarter of voters said abortion was the “single most important” factor in their vote, about 4 in10 said it had a major impact on their decision to turn out (similar to the shares who said so in the 2022 midterm elections), and over half said it had a major impact on which candidates they supported.
- 40% of voters said high prices for gas, groceries and other goods was the single most important factor to their vote, including 51% of Republicans, 41% of independents, and 28% of Democrats.
- On abortion, Trump managed to garner small but important shares of votes among those who voted in favor of abortion ballot measures in their state, winning 4 states where voters also chose to expand or protect abortion access. Trump won support from about 3 in ten voters who voted in favor of abortion access in the battleground states of Nevada and Arizona, a similar share in Missouri, and about a quarter in Montana. “
Abortion Was a Motivating Factor for Many Voters in Tuesday’s Election But Ranked Lower Than Concerns About the Economy https://connect.kff.org/abortion-was-a-motivating-factor-for-many-voters-but-ranked-lower-than-the-economy
Abortion referenda in states: “Voters in 10 states decided whether to enshrine abortion access to their constitutions. Abortion-rights groups spent more than $161 million, compared to $24 million from anti-abortion groups. Spending on abortion-related ballot measures outpaced spending on measures related to all other issues. Americans have voted for abortion rights every time it’s been on the ballot since the Supreme Court overturned Roe v. Wade.
Note: “Voters in half of U.S. states aren’t able to support abortion access in direct-democracy ballot measures because their states lack the process for citizen-led initiatives…Abortion rights were bolstered even in Republican-led states during 2023’s off-year elections. “
Abortion-rights groups spend big on ballot measures Axios https://www.axios.com/2024/11/04/abortion-campaign-spending-election-2024
Nielson: Election TV viewership: “Bottom of Form
An estimated 42.3 million viewers watched the returns on Tuesday night across 18 networks. That’s a 25% drop compared to the 2020 election, which drew 56.9 million prime-time viewers.
It‘s not clear how many of those viewers turned to streaming services or social media for their news—known as “cord cutting”—versus how many tuned out altogether. Some experts speculate viewership was down in part because this year’s race was nowhere near as close as 2020.
Fox News Channel led among viewers, with an average of 10.3 million people tuning in between 8 p.m. and 11 p.m. ET. Next was MSNBC, which clocked an average of 6 million viewers, followed by ABC (5.7 million), NBC (5.5 million), CNN (5.1 million), CBS (3.6 million) and Fox broadcast network (2 million).
It was the first time MSBNC has ever beaten out CNN on a presidential election night. The Atlanta-based broadcaster’s viewership was down almost 50 percent compared to the 2020 election, when 9.6 million people tuned in.”
CNN Down 50 Percent as Americans Switch Off Election Coverage
Reuters/Ipsos poll: voter expectations: “Most Americans believe President-elect Donald Trump will push the U.S. government deeper into debt in his new term, though most Republicans do not share Democrats’ concerns over his fiscal stewardship, according to a new Reuters/Ipsos poll.
The two-day poll, which closed on Thursday, showed that 62% of respondents – including 94% of Democrats and 34% of Republicans – said it was likely Trump’s policies “will push the U.S. national debt higher.
Republicans appear set to possibly win control of both chambers of Congress, giving them sweeping powers for the first time since 2017 to ram through a broad agenda which also includes spending cuts and energy deregulation. This will also force them to confront the dilemma of pursuing policies that could undermine the party’s long-proclaimed goal of reining in the government’s $35 trillion in debt.
Trump’s tax cut proposals could add $7.5 trillion to the nation’s debt over the next decade, according to the nonpartisan Committee for a Responsible Federal Budget.
Democrats are more worried about the fiscal outlook under Trump, the poll showed. Some 89% of Democratic respondents said they were concerned by the prospect of Trump pushing the debt higher, compared to 19% of Republicans. Republicans in Congress point to buoyant gains in federal tax receipts since 2017 as proof that Trump’s tax cuts raised revenues and say his current agenda will bring more of the same.”
Most Americans expect Trump to increase US debt, Reuters/Ipsos poll finds November 6, 2024 https://www.msn.com/en-us/money/markets/most-americans-expect-trump-to-increase-us-debt-reuters-ipsos-poll-finds
Prescription Drugs
GLP-1 Demand, Market Impact: In 2023, 37 states spent $3.9B on GLP-1 medications for their Medicaid programs– up from $1.9B in 2022 and $597 million in 2019. The addition of the 13 remaining would expand access for the 40% of adults and 26% of children with obesity in Medicaid straining some state budgets. From WSJ reporting November 4, 2024
“In terms of recent stock-market frenzies, the Ozempic trade nearly tops the list, second only to speculation that artificial intelligence will soon be writing this column.
Powerful weight-loss drugs like Wegovy and Zepbound have driven nearly $1 trillion in market-capitalization gains, with most of those gains flowing to Eli Lilly LLY -1.56%decrease; red down pointing triangle and Novo Nordisk NOVO.B -0.88%decrease; red down pointing triangle, the dominant players in the obesity-drug market. Would-be challengers such as Amgen AMGN -0.72%decrease; red down pointing triangle and Viking Therapeutics VKTX -13.36%decrease; red down pointing triangle have also seen their shares surge on promising data.
Two major factors have powered these gains. First, the health benefits seem genuine: Clinical trial data for GLP-1 drugs have shown not only impressive weight loss but also potential reduced risk of heart attacks and sleep apnea. Second, there is exploding consumer demand, being driven in part by the psychological gratification that many people experience as their weight drops. That has fueled huge patient demand that, until very recently, has outstripped supply while creating a booming industry for compounders and telehealth companies.
But with so much optimism now priced into these stocks, further growth will be more challenging…The roster of companies vying for a place in this lucrative market is extensive. In the next few months, investors are anticipating updates from several other big players—AstraZeneca, Roche and Pfizer—as well as from smaller biotechs like Structure Therapeutics, Viking and Zealand Pharma. And investors are still waiting for Merck, which needs to find a way to replace the expected decline of its cancer blockbuster Keytruda, to write a big check to get in on the action. ”
Big Pharma’s Obesity Bonanza Faces New Tests – WSJ
Public Health
Make America Healthy Again (MAHA): RFK: Robert F. Kennedy Jr. is expected to play a key role in Trump Healthcare 2.0 public health strategy under the aegis of his “Make America Health Again” campaign.
“He has said he would like to upend public-health agencies and rid them of what he views as the corrupt influence of the food and pharmaceutical industries. He has said he would scrutinize microplastics, food additives, seed oils and pesticides that he has said lead to chronic disease and harm children.
He has said he wants to ban pharmaceutical advertisements on television and has made false claims about vaccine safety, including linking vaccines to autism and describing shots for Covid-19 as the deadliest ever made. “
Trump’s Win Gives RFK Jr. Chance to Steer Vaccine and Health Policy – WSJ
CDC: Diabetes prevalence, cost: Per the American Diabetes Association, it is the most expensive chronic condition in the U.S.:
- The cost of diagnosed diabetes in the U.S. in 2022 was $412.9 billion, including $306.6 billion in direct medical costs. Roughly a quarter of those with diabetes are undiagnosed.
- When adjusting for age, the prevalence of diabetes increased from 9.7% in 1999-2000 to 14.3% in the August 2021-August 2023 time period.
- Diabetes was most common in adults 60 and older (27.3%) followed by adults ages 40-59 (17.7%).
- Men had a higher prevalence diabetes (18%) compared with women (13.7%).
CDC www.cdc.gov
WSJ Editorial Board: Alternative treatment in Indian Health Service problematic: “The Biden Administration is trying to woo Native Americans whose votes could be pivotal in Western states. One pre-election gambit is to let Medicaid pay for Native American “traditional medicine.”
- The Health and Human Services Department last month approved requests by Arizona, California, New Mexico and Oregon to use federal Medicaid funds to cover “traditional health care practices” of indigenous people…
- HHS doesn’t plan to restrict the types of traditional medicine that Medicaid will cover, nor the types of “healers.” Each tribal “facility can tailor provider qualifications for their traditional health care practitioners,” HHS says.
- An American Medical Association brief on the state Medicaid proposals says “traditional healers are often identified in their Tribal community by their innate gift of healing” and “typically work informally.” Their “healing services” could include sweat lodges, prayers, purification rituals, songs, dance, herbal remedies and shamanism…
- Federal Medicaid spending totaled $617.5 billion in the last fiscal year, more than the $567 billion estimate in the President’s budget. States and the feds are spending $944 billion combined on Medicaid, up from $854 billion a year ago, despite the end of the pandemic emergency expansion. Insurers that manage state Medicaid programs say patients are getting sicker. Herbs and dance won’t help them or the program’s finances.”
Medicaid for Herbs and Housing – WSJ November 4, 2024
March of Dimes Report: Maternity Care Deserts. Per the March of Dimes 2024 report: “Nowhere to Go: Maternity Care Deserts Across the U.S.” i.e. areas without a single birthing facility or obstetric clinician:
- 35% of US counties are maternity care deserts*.
- More than 150,000 babies were born to birthing people living in maternity care deserts. An additional 200,000 babies were born to birthing people living in counties with limited maternity care access.
- More than 2.3 million reproductive aged women live in maternity care deserts. Living in a maternity care desert is associated with a 13% increased risk of preterm birth.
- Over half of counties in the US do not have a hospital that provides obstetric care.
- Nearly 70% of birth centers are located within just 10 states.
- 5 million reproductive aged women live in a county without an obstetric clinician.
- The average percent of uninsured women in maternity care deserts is 2 times the rate of those living in areas with full access.
- On average, birthing women in the US travel 16 minutes by car to their nearest birthing hospital without traffic. Driving time increases to 26 and 38 minutes, on average, for rural and maternity care desert residents, respectively.
March of Dimes, Nowhere to Go: Maternity Care Deserts Across the US 2024 Report, September 2024
Social media limitations for kids: “Australia’s parliament is about to look at a law that would keep kids off of social media until they turn 16. Evidence continues to mount that excessive screen time and social media are increasing anxiety and depression in kids. Many countries have taken on this issue, but Australia’s proposal is the most stringent yet. Australia’s proposal doesn’t allow exemptions for parental consent or kids’ preexisting accounts. Most social media companies don’t let kids under age 13 open accounts. But a 2022 U.K. study found 80% of 12-year-olds had accounts (CBS).
Australia plans “world-leading” social media ban for children under 16 https://www.cbsnews.com/news/australia-social-media-ban-children-meta-tiktok-youtube-
