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The Impact of the Great Debate, SCOTUS Decisions on Healthcare: Four Key Takeaways

By July 1, 2024No Comments

In 126 days, U.S. voters will settle Campaign 2024 choosing the winners for 435 House seats, 34 Senate seats, 13 Governors and the White House. When final votes are counted, the last week of June, 2024 will be seen as the tipping point when much about politics and policy was re-set as the result of two events:

1-The ‘Great Debate’: Thursday’s standoff between President Biden and former President Trump drew 51.3 million viewers across 17 networks that carried it. That’s well below previous head-to-head debate match-ups i.e. 84 million for Clinton-Trump in 2016, 73 million for Trump and Biden in 2020. Perhaps more telling, only 3.9 million of these were adults 18-34– 7.6% of debate viewers but 22.9% of U.S. population.

While pundits debated the fitness of the President to continue and speculated about alternative candidates over the weekend, the majority of Americans paid no attention—especially young adults. They think both candidates are old.

In 2020, 57% of 18–34-year-olds voted for a Presidential candidate vs. 69% of 35–64-year-olds and 74% of voters 65+. Polls show young adults think the political system is fundamentally flawed and partisanship harmful to policies that advance the well-being of the population. They also show their declining trust and confidence in America’s institutions—the press, big business, Congress, organized religion and the medical system.

Young adults get their information from social media and friends and they’re tuning out spin in politics.

2-Supreme Court decisions impacting healthcare: As is customary for the high court, many of its rulings are handed down in the last week of June before it adjourns for the summer. Only one case remains in limbo: Presidential immunity with a decision expected today. Of the 61 cases SCOTUS has heard in its 2023-2024 term, these four decisions are the most significant to the health industry:

  • Power of federal agencies (Loper Bright Enterprises v. Raimondo and Relentless, Inc. v. Dept. of Commerce): By a vote of 6-3, SCOTUS ruled that judges no longer have to defer to agency officials when interpreting ambiguous federal statutes about the environment, the workplace, public health and other aspects of American life overturning a 40-year-old legal precedent known as “Chevron deference.” The court’s decision will significantly curtail the power federal agencies have to regulate thousands of private companies, products, industries and the environment.
  • Emergency room abortions (Idaho v. U.S): SCOTUS ruled 6-3 that hospitals in Idaho that receive federal fundsmust allow emergency abortion care to stabilize patients — even though the state strictly bans the procedure.
  • Opioid lawsuit settlement (Harrington v. Purdue Pharma): By a vote of 5-4, the justices blocked a controversialPurdue Pharma bankruptcy plan that would have provided billions of dollars to address the nation’s opioid crisis in exchange for protecting the family that owns the company from future lawsuits. The majority found that the plan was invalid because all the affected parties had not been consulted on the deal
  • Abortion medication restrictions (FDA v. Alliance for Hippocratic Medicine): By a vote of 9-0, the justices maintained broad access to mifepristone, unanimously reversing a lower court decision that would have made the widely used abortion medication more difficult to obtain. The decision was not on the substance of the case, but a procedural ruling that the challengers did not have legal grounds to bring their lawsuit.

Based on these events last week, healthcare organizations and their trade groups making plans for 2025 and beyond should consider:

  1. Young adults. Out of Sight, Out of Mind: Polling data shows young adults think the health system is broken and alternatives worth considering. Affordability, equitable access and price transparency matter to them. Their finances are stretched as inflation (housing, energy, food et al), their medical debt prevalent and mounting and their employers are cutting their health benefits and forcing them to assume more out-of-pocket responsibility. Hospitals, insurers, physicians and drug companies pay close attention to older working age consumers and seniors. They pay little attention to younger adults, and the reverse is true. But history teaches that social movements originate from disenchanted youth and young adults who feel taken for granted, abused by corporate greed and unheard. Might the healthcare status quo be a target?
  2. The federal administrative state in flux: The ripple effect of the court’s Chevron decision is equivalent to its decision ending Roe v. Wade (June 2022). The latitude afforded key federal agencies i.e. CDC, CMS, OSHA, CMMI, FDA, HRSA et al will be revisited. States will be forced to step in where federal guidance is in jeopardy. Governors and the White House will face more frequent court challenges on their Executive Orders and agencies for their Administrative Actions as government oversight of healthcare evolves. For investors, safe bets will be targets. For hospitals, insurers and physicians, federal advocacy will require recalibration.
  3. The administrative state flux means state legislatures and ballot referenda will play a bigger role in healthcare. States already have enormous responsibilities for healthcare:
  • Medicaid coverage determination
  • Retail Health i.e. services (efficacy), truth in advertising, consumer safety et al
  • Public health services i.e. STDs, disease surveillance, immunization policies et al.
  • Prescription Drug Affordability (in 11 states)
  • Health Insurance Marketplaces
  • Healthcare workforce scope of practice
  • Medical Malpractice and consumer protections
  • Abortion Rights: as a result of the 2022 Supreme Court ruling that Roe v. Wade
  • Behavioral health, substance abuse workforce adequacy, licensure, scope of practice et al.
  • Certificate of Need Programs
  • Use Medical Marijuana (Cannabis) for Therapeutics and/or Recreational Use.
  • Health Insurer Licensing, Network adequacy and Liquidity
  • Quality and patient safety inspection in post-acute & home-based settings.
  • Workers’ compensation eligibility, administration use and funding.
  • Formulary design and expense control.
  • School clinics
  • Prison health
  • And others

The court decisions last week open the door to additional actions by state agencies and elected officials in areas where federal policies are in limbo:

  • Tax exemptions for not-for-profit health systems
  • Hospital consolidation and price transparency,
  • Accessibility of hospital emergency services for abortion,
  • Insurer prior authorization and network adequacy
  • Minimum staffing requirements,
  • Telehealth use and payment
  • Restrictive drug formulary
  • And more.

For every healthcare organization and trade group, vigilance about pending legislation/action at the state level will take on added importance.

  1. The U.S. health system’s future is not a repeat of its past: The week’s events lend to the health industry’s uncertain future. Today, strategic planning in most U.S. healthcare organizations i.e. insurers, hospitals, physician organization, device and drug manufacturers, et al is based on incremental changes forecast 3-5 years out. While consideration is given “transformational” changes 10-15 years out, it is under-studied by planners and rarely included on board agenda dockets. Yet, signal detection of disruptive shifts in financial services, higher education and other industries predict winners and losers. The U.S. system is change-averse because it benefits its self-interests. Outsiders do not share this view. No trade group or organization in healthcare can afford to bet its future on incrementalism in healthcare. These court decisions and the pending election results suggest that healthcare’s future is not a repeat of its past: new rules, new players and new critical success factors are inevitable.

It was a big week for U.S. politics and perhaps a bigger week for healthcare. Stay tuned.




  • Quotables
  • Congress
  • Courts
  • Demographics
  • Hospitals
  • Insurers
  • Polling
  • Prescription Drugs
  • Private equity
  • Public Health

Medicaid for Millions in America Hinges on Deloitte-Run Systems Plagued by Errors – KFF Health News

When Hospital Prices Go Up, Local Economies Take a Hit – WSJ

Oscar, Centene, Highmark see opportunity in exchange-based ICHRAs | Modern Healthcare



Re: SCOTUS’ Chevron ruling: “Regulation is a double-edged sword. Regulations can be expensive and difficult for businesses to keep up with, but they have also been credited with keeping people safe and ensuring business dealings are competitive and fair. Regulations can also be updated as time goes on and standards change without having to go through the much longer legislative process. For example, if a federal statute passed in 1970 codified a fine for noncompliance, that amount likely would not be much of a deterrent today. And if detailed laws about AI or cryptocurrency were put on the books now, they likely would not be relevant in a few years’ time.

How this decision will affect federal government regulations—and in turn businesses—is yet unknown, but it will impact regulations that every business has abided by. It is not immediately retroactive and for now, only applies to the case that was argued.”

Supreme Court Strips Power from Federal Agencies—Overturning Chevron Precedent (

Re: UK election: “The British general election, which will take place on July 4th, was over before it began. Five and a half weeks ago, under a merciless shower of cold spring rain, the Prime Minister, Rishi Sunak, who is doomed to defeat, stood outside 10 Downing Street and said that he had asked the King to dissolve Parliament. “Now is the moment for Britain to choose its future…

The British political system gives incumbent governments a clear advantage, allowing them to choose when to call an election, as long as it happens at least every five years….”

Britain Awaits a Wipeout Election | The New Yorker

Re: French election: “The National Rally party on Sunday won a crushing victory in the first round of voting for the French National Assembly, bringing its long-taboo brand of nationalist and anti-immigrant politics to the threshold of power for the first time.

Official results published by the Interior Ministry showed that the party and its allies won about 33 % of the vote, far ahead of President Emmanuel Macron’s centrist Renaissance party and its allies, which took about 20% to end in third place.

A coalition of left-wing parties, called the New Popular Front, won about 28% of the vote. Ranging from the moderate socialists to the far-left France Unbowed, the coalition was boosted by strong support among young people.

Turnout was high at about 67%, compared to 47.5% in the first round of the last parliamentary election in 2022, reflecting the importance accorded by voters to the snap election. To many it seemed that no less than the future of France was on the line with a far-right party long considered unelectable to high office because of its extreme views surging…”

France’s Far Right Scores Big in First Round of Elections, Polling Suggests – The New York Times (

Re: Gen Z Habits: “A lot of folks would love to know. Social networks want young usersMedia outlets want subscribersPoliticians want votes. Professors want to know why their students won’t read books. Everyone, it seems, has a stake in understanding Kids These Days…

Jigsaw’s findings offer a revealing glimpse into the digital mindset of Gen Z. Where older generations are out there struggling to fact-check information and cite sources, Gen Zer’s don’t even bother. They just read the headlines and then speed-scroll to the comments, to see what everyone else says. They’re outsourcing the determination of truth and importance to like-minded, trusted influencers. And if an article’s too long, they just skip it. They don’t want to see stuff that might force them to think too hard, or that upsets them emotionally. If they have a goal, Jigsaw found, it’s to learn what they need to know to remain cool and conversant in their chosen social groups

Gen Z’s Most Trusted Source for News: Online Comments Sections – Business Insider

Re: Leadership (Korn Ferry): “To gauge sentiment on leadership behavior, leaders were asked three questions: whether the executive team models the right culture and behaviors, whether they work together effectively, and whether they effectively embrace change.

Only 53% of leaders agreed that their executive team models the right culture and behavior. And, when considering executive team effectiveness, only 56% of leaders felt that their executive team works together effectively, and 59% felt their leadership team effectively embraces change. To be a high-performing leadership team that inspires confidence, role modeling the right culture…

How confident leaders are in the behavior of their effective team varies greatly by level and role. Next-generation leaders are particularly lacking confidence in the executive leadership team’s behavior—only 51% feel their ELT embraces change, 43% feel their ELT works together effectively as a team, and 38% think that they role model the right culture and behaviors.

Leadership Confidence Falls to Three Year Low | Russell Reynolds Associates



Politico: Retirements, Close Races in Campaign 2024: Key retirements include House Energy and Commerce Chair Cathy McMorris Rodgers (R-Wash.) and E&C Health Subcommittee ranking member Anna Eshoo (D-Calif.) aren’t seeking reelection, nor are Reps. Michael Burgess (R-Texas), Larry Bucshon (R-Ind.) and Brad Wenstrup (R-Ohio).

Incumbents facing Close races:

  • Jon Tester (D-Mont.) chairs the Veterans’ Affairs Committee and has served in the chamber since 2007.
  • David Schweikert (R-Ariz.), who chairs the Ways and Means Oversight Subcommittee, is expected to face a close race in his Phoenix-area district after a primary next month. He’s been a leading voice on artificial intelligence in health care and is the co-chair of the Telehealth Caucus.
  • Donald Davis (D-N.C.), whose district includes part of the Research Triangle, has been one of the lone Democrats pushing to blunt the Inflation Reduction Act’s drug-pricing negotiation power.
  • Tammy Baldwin (D-Wis.) and Bob Casey (D-Pa.), who serve on the Senate Health, Education, Labor and Pensions Committee, face tight races. Casey also chairs the Aging Committee and serves on the Finance Committee, and Baldwin chairs the Appropriations Subcommittee for HHS.
  • Sherrod Brown (D-Ohio), who serves on the Finance and Veterans’ Affairs committees, has also attempted to get cannabis banking legislation signed into law as chair of the Banking Committee.
  • Michelle Steel (R-Calif.), who serves on the Ways and Means and Education and the Workforce committees’ health subcommittees, faces a lean Republican race in her Orange County area district. She’s been a leader in a bid to extend eased telehealth rules for high-deductible health plans ahead of their expiration at the end of the year and serves on the House’s bipartisan AI task force

Musical chairs for health policy leaders in Congress – POLITICO

Proposed Legislation: Medicare bumps payment for drugs used with scans: Sen. Marsha Blackburn (R-Tenn.) is sponsoring a bipartisan group of 15 senators to ask Medicare officials to bump payment for drugs paired with diagnostic scans that are used for, among other things, assessing patients’ eligibility for a new class of Alzheimer’s drugs. Medicare last year relaxed restrictions that limited Medicare patients to one PET scan in their lifetimes, and only in the context of a clinical trial. is asking Medicare to pay for the drugs used with the scans separately, instead of having them bundled in with other services. If Medicare goes along with the plan, it would likely be a boon for health care providers.


Lawmakers want limits on use of AI in MA: In a letter sent Tuesday from Sen. Elizabeth Warren (D-Mass.), Rep. Jerry Nadler (D-N.Y.), and Rep. Judy Chu (D-Calif.) and co-signed by 52 lawmakers, including Sen. Mike Braun (R-Ind.), lawmakers urged the Biden administration to prohibit Medicare Advantage insurers from using artificial intelligence tools to deny care until it completes a systematic review of their accuracy and effects on patients

“These tools apply a generalized need for care to an individual beneficiary’s situation, resulting in generalizations instead of person-centered approaches to care, which is antithetical to the mission of the Medicare program.”

The letter called on CMS to establish a process for reviewing AI products used to make coverage decisions, instead of deferring to insurers’ own internal assessments about the accuracy and validity of tools they are using to issue denials.

UnitedHealth and its subsidiary, NaviHealth, are facing a class-action lawsuit stemming from their use of the algorithm to deny care, as is Humana, another large Medicare Advantage insurer that has used the UnitedHealth-owned algorithm. Meanwhile, UnitedHealth has eliminated the NaviHealth name and rebranded the company as Optum Home & Community Care.

Stop letting MA plans deny care using AI tools, lawmakers urge CMS (

340B Access Act Proposed: Three Republican House members have introduced the 340B Access Act, which would impose tougher rules for participating in a federal program that allows hospitals to buy some drugs at lower prices. The sponsors say the bill would impose new eligibility requirements for hospitals who want to participate in the 340B drug pricing program. Lawmakers say the legislation is needed to ensure that the program is helping hospitals who are truly serving large populations of disadvantaged patients…. Hospitals are pushing back against a measure that would reduce the number of hospitals participating in the program.

Changing hospital eligibility for the 340B drug program | Bills and Laws (



PBMs: Last Monday, the Attorney General of Arkansas filed suit against two pharmacy benefit managers (Express Scripts, Optum) accusing them of fueling the opioid crisis in the state. The lawsuit alleges the companies benefited from the opioid crisis “by negotiating favorable deals with opioid manufacturers and by not taking sufficient action to curb excessive opioid prescriptions…For at least the last two decades, defendants had a central role in facilitating the oversupply of opioids… the Defendants ignored the necessary safeguards in order to ensure increased opioid prescriptions and sales. “According to the lawsuit, opioids were the most commonly prescribed class of controlled substances in Arkansas in 2022, and Arkansas had the second-highest opioid prescribing rate in the nation that year. In recent years, opioid overdoses have been linked to about 80,000 deaths annually in the U.S. The majority of those lately have involved fentanyl and other potent drugs produced illicitly in labs and often used to lace other illegal drugs

State Sues Two PBMs, Accusing Them of Fueling Opioid Epidemic | MedPage Today

AHA joins AHCA, THCA in opposition to nursing home staffing bill: In late April, the Centers for Medicare & Medicaid Services (CMS) established new staffing standards for long-term care (LTC) facilities, mandating a minimum of 3.48 hours of nursing care per patient per day, with 33 minutes of that care from a registered nurse, at least one of whom must be always on site. Last week, the American Hospital Association announced its opposition to the rule joining the American Health Care Association and the Texas Health Care Association in litigation against the rule citing the risk of mass closures from facilities unable to comply,

AHA backs bid to repeal nursing home staffing rule | Modern Healthcare



Census Report: Economic status of seniors: “Many older adults rely heavily on Social Security, the largest anti-poverty program in the United States, and research shows it was the sole source of income for 28% of adult recipients in 2021.But not all older adults get Social Security benefits, for reasons such as insufficient or no work history. In 2021, older adults — defined here as those age 65 and over — who were living in poverty were less likely than their counterparts not in poverty to receive income from programs such as Social Security

Profile of Older Adults by Poverty Status: 2021 (

Census Bureau: Hispanic population growth: Between 2022 and 2023, the Hispanic population accounted for 71% of the overall growth of the United States population, driven primarily by Hispanic birth. Hispanics of any race grew to 65 million, an increase of 1.16 million (1.8%) from the prior year. This growth significantly contributed to the nation’s total population gain of 1.64 million in 2023.

Reflecting this growth, Hispanics of any race made up almost one-fifth (19.5%) of the U.S. population in 2023, making it the second largest group after the non-Hispanic White population. Although the Hispanic population continued to grow, its yearly growth of 1.8% between 2022 and 2023 is slower than it was in previous decades: 2.0% between 2012 and 2013, and 3.7% between 2002 and 2003.

However, the Hispanic population still grew faster than the nation’s non-Hispanic population, which increased by 0.2% (just under one-half million) from 2022 to 269.7 million in 2023. The non-Hispanic population’s slower growth stemmed from natural decrease where it experienced 217,000 more deaths than births from 2022 to 2023. Despite this natural decrease, the non-Hispanic population experienced some growth due to a net gain of more than 700,000 people through net international migration.

Differences in Growth Between the Hispanic and Non-Hispanic Population (



Study: Effects of Hospital consolidation: Hospital mergers can mean rising prices for individual patients, but there also may be implications for the larger economy, including higher unemployment costs and reduced tax revenue, according to a study published Monday by the National Bureau of Economic Research.

The study analyzed data provided by independent research group Health Care Cost Institute, representing 28% of people in the U.S. with employer-sponsored insurance, and pulled information from Labor Department and Internal Revenue Service filings.

Here are five takeaways from the study.

  • Hospital mergers could lead to job losses.
  • Employers trim payrolls when premium costs rise.
  • Higher healthcare prices result in lower tax revenue.
  • The middle class is hardest hit when prices rise.
  • Rising healthcare prices are connected to suicide and overdose rates.

When Hospital Prices Go Up, Local Economies Take a Hit – WSJ

Vizient announces Kaufman Hall deal: Last Tuesday, Vizient announced its intent to acquire the remaining shares of Kaufman Hall from private equity firm and majority owner Madison Dearborn Partners. Pending regulatory review, the proposed transaction is expected to close in the second half of the year, Recent Vizient deals: a strategic partnership with Tiller-Hewitt HealthCare Strategies (2/23) and ShareMD Connect (5/23).

Vizient scoops up MDP-backed healthcare advisor Kaufman Hall | PE Hub

Epic-Oracle Update: Epic and Oracle Health made waves in the first half of 2024 by incorporating artificial intelligence further into their offerings and forging strategic partnerships with healthcare organizations and industry alike…

Over the last year Epic continued to increase its market share, now installed in 39% of acute care hospitals in the U.S. Oracle Health is in second place with 23.4% of hospitals and Meditech holds 16%. More than half of all hospital beds in the U.S. are covered by Epic, while Oracle Health has 23.8% of hospital beds. And Epic shows no signs of slowing down…

Larry Ellison, co-founder and chair of Oracle, said he thinks the company can surpass Epic by expanding its network beyond hospital and provider customers. He pointed to working with governments around the world, payers and medical device companies to automate functions and grow the company’s network.

Oracle extended its $16 billion EHR contract with the VA earlier this year, adding 11 months to the deal…In mid-June, Oracle rolled out a new AI-powered clinical documentation tool focused on its ambulatory care customers. The tool uses automation and voice commands to draft notes into the EHR, and was able to save an average of four and a half minutes per patient for physicians at Billings (Mont.) Clinic and Covenant Health in Tewksbury, Mass.

Epic vs. Oracle: Who is poised to win the next 6 months? (



Study: OOP for MA vs. TM enrollees: “Compared with traditional Medicare (TM), Medicare Advantage (MA) plans typically offer supplemental benefits and lower copayments for in-network services and must include an out-of-pocket spending limit. Researchers analyzed the financial burden of care for persons switching from TM to MA (TM-to-MA switchers) relative to those remaining in TM (TM stayers). Findings:

Compared with TM stayers, TM-to-MA switchers had small differences in out-of-pocket spending ($168 [95% CI, −$133 to $469]) and proportions of total health expenses paid out of pocket (cost sharing) (0.2 percentage point [CI, −1.3 to 1.7 percentage points]), families with out-of-pocket spending greater than 20% of their income (high financial burden) (0.3 percentage point [CI, −2.5 to 3.0 percentage points]), families reporting out-of-pocket spending greater than 40% of their income (catastrophic financial burden) (0.7 percentage point [CI, −0.1 to 1.6 percentage points]), families reporting paying medical bills over time (−0.2 percentage point [CI, −1.7 to 1.4 percentage points]), families having problems paying medical bills (−0.4 percentage point [CI, −2.7 to 1.8 percentage points]), and families reporting being unable to pay medical bills (0.4 percentage point [CI, −1.3 to 2.0 percentage points]).”

Association of Medicare Advantage Enrollment with Financial Burden of Care: A Retrospective Cohort Study: Annals of Internal Medicine: Vol 0, No 0 (

United (Optum) pulls out of Steward deal: Last Friday, Optum  told regulators it is no longer working to finalize its agreement to acquire the  physician group owned by Steward . Dallas-based Steward, which operates 31 hospitals in addition to the physician group, filed for Chapter 11 bankruptcy protection in May

Status: As part of the sale proceedings in the U.S. Bankruptcy Court for the Southern District of Texas, potential buyers have until July 15 to submit offers for Stewardship, Steward hospitals in Arizona and Massachusetts and St. Joseph Medical Center in Texas. The bid deadline for Steward’s eight Florida hospitals, four Texas hospitals and any other assets is Aug. 12.

On June 11, Steward secured an additional $225 million in debtor-in-possession financing from some of its existing lenders. In May, Medical Properties Trust approved $75 million in debtor-in-possession financing.

UnitedHealth Group’s Optum drops Steward physician group bid | Modern Healthcare

OOP for high deductible plans across calendar year: using Health Care Cost Institute commercial claims data, researchers studied the out-of-pocket costs for those with annual high-deductible commercial insurance plans when an episode of maternity care spans 2 years, exposing patients to their cost-sharing limits twice during their episode of care. Results:

“For each of the 3 episode measurements, mean out-of-pocket spending is highest among those who deliver in January and declines in each subsequent month until August and September (the delivery months with most pregnancy and postpartum periods within the same year), then flattens for the remainder of the year.

Mean cost sharing for the maternity episode was $6308 in January and $4998 in December, a difference of $1310. Patients delivering in January also had mean out-of-pocket costs $1491 greater for delivery hospitalization and $1005 greater over the 3-year period than patients delivering in December.

Higher out-of-pocket spending is observed when patients face their cost-sharing limits twice within an episode of maternity care, and this difference persists even when evaluating 3 calendar years of patients’ out-of-pocket spending.”

Deductible Double Jeopardy: Patients May Pay More Out of Pocket When Pregnancy Crosses 2 Years (

JD Power report: According to the J.D. Power 2024 U.S. Commercial Member Health Plan Study, “there is a notable gap in customer satisfaction separating the top-performing health plan from the bottom-ranked plan of 79 points (on a 1,000-point scale), with the top-ranked insurers significantly outperforming on cost, access to care and trust. Key findings in report:

  • Large gap emerges between top- and bottom-ranked health plans.
  • Cost, access to care and trust drive biggest gaps in customer experience.
  • Increasing wait times to see providers:The average wait time to see a specialist is now 22 days, and the average wait time to schedule an annual physical exam is 15 days.

2024 U.S. Commercial Member Health Plan Study | J.D. Power (



ASEC Poll: Opinions about retirement preparedness: Results from Public First survey commissioned by BPC’s American Savings Education Council (ASEC) (Note: ASEC) was formed in 1994 by the U.S. Department of Labor and the Employee Benefit Research Institute. Acquired by the Bipartisan Policy Center in 2022, ASEC relaunched activities in support of approximately 100 partner organizations and agencies across the nonprofit, academic, trade, corporate, and government sectors.). The survey polled 2,024 U.S. adults from March 28 to April 7, 2024:

  • 49% of non-retired respondents expect Social Security to be a major source of their income vs. 82% of retired respondents report that Social Security doesmake up a major source of income. Among the non-retirees aged 55–64, 71% report expecting Social Security to make up a major source of retirement income vs. 33% for adults aged 18–24.
  • Adults age 45-54 feel the least prepared to retire.
  • 76% believe that saving for retirement is important.
  • 39% of respondents have a plan in place that will allow them to retire when they want to.

New Survey: Retirement Expectations Don’t Match Reality | Bipartisan Policy Center

KFF Survey: Loneliness: Based on 2023 KFF Racism, Discrimination and Health Survey, of 6292 adults conducted June 6-August 14, 2023.

Background: Loneliness and social isolation are associated with a number of poor mental and physical health conditions. For example, recent research suggests a causal relationship between loneliness and the onset of depression. Social isolation can also be linked to riskier substance use and is a risk factor for suicide and selfharm. In addition to mental health conditions, loneliness and social isolation are associated with cardiovascular disease and cognitive decline.


  • 15% adults report feeling always or often lonely in the past year, rising to 31% among young adults ages 18-29.
  • Black (44%), Hispanic (50%), and Asian (50%) adults are somewhat less likely than White (56%) adults to report having a robust local support network.
  • There is a strong relationship between feelings of loneliness, local support networks, and physical and mental health and well-being.

Loneliness and Social Support Networks: Findings from the KFF Survey of Racism, Discrimination and Health | KFF


Prescription Drugs

State Prescription Drug Affordability Boards: The median price of a newly launched drug in 2023 was $300,000 a year , up from $2,115 in 2008 …Some states are taking matters into their own hands with prescription drug affordability boards, or PDABs. So far, 11 states can assemble these boards to provide an added layer of oversight  for prescription drug costs

States that have established PDABs so far include Colorado, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Ohio, Oregon, and Washington.

Companies who profit from high drug costs may invoke the Commerce Clause of the U.S. Constitution, which prevents states from impairing interstate commerce. PDABs, however, are only designed to deal with in-state transactions.

Another potential challenge facing the boards is engaging all players in the prescription drug payment pipeline — including pharmacy benefit managers, which have received extensive criticism  for driving prescription drug costs up.”

Can Individual States Effectively Cap Prescription Drug Costs? | MedPage Today


Private Equity, Venture Capital

Pitchbook: 2024 outlook:

  • “Positive economic signals through 2023 will spur a comeback in IPOs in 2024.
  • US VC fundraising is expected to increase, making it stronger than 2023 but comparable with 2020.
  • The number of insider-led rounds as a proportion of all US VC deals will be on par with or exceed the 2023 annual level.
  • US active unicorn count and aggregate post-money valuation will decline in 2024.
  • Flat or declining interest rates in 2024 will lead to an increase in US VC deal activity with nontraditional VC investor participation.
  • Accelerators will play an increasingly important role with increased dealmaking momentum in 2024.
  • The average US VC fund size will decline in 2024.

There does seem to be a higher degree of desperation from the market. With more than 55,000 companies currently VC-backed, many companies are facing last-ditch options for continuing growth and development. Many of the M&A exit transactions we have collected in 2024 are small, even to the size that transaction values have gone unreported. Down rounds continue to pick up as well, as companies concede with investors to secure funding. Venture market resets take time. Valuations remain relatively high, especially for AI companies, and the aggregate value of unicorns is higher than ever. However, one of the consequences of the slowdown now adding excessive pressure to the market is the lack of returns. Our data shows that the rate of distributions back to LPs is at its lowest since 2009. The market is exponentially larger than it was back then, making the exposure of the LP community to VC that much higher.”

ahead.2024_US_Venture_Capital_Outlook_Midyear_Update.pdf (

Bain Outlook 2024: “Given that 2024 deal value will likely approach that of the buoyant years preceding 2021’s anomalous post pandemic spike, it’s tempting to assume that normal isn’t so far off. But activity relative to the mountain of dry powder available remains stunted by historical standards. For comparison, 2024 deal value is on track to roughly match 2018’s total, yet there is more than 1.5 times as much buyout dry powder today as there was back then. With the exception of very large headline deals like the $15.5 billion acquisition of Truist Insurance led by Stone Point Capital and Clayton, Dubilier & Rice or Permira’s $6.9 billion bid to take Squarespace private, there’s little empirical evidence that the market is truly on the upswing.

How soon that might change is the million-dollar question.

Searching for Momentum: Private Equity Midyear Report 2024 | Bain & Company


Public Health

Wellness market: “We knew that consumers were increasingly treating wellness as a priority. What surprised us and continues to surprise us every year is how much of a priority it is. Just to give you some numbers against it, this year, 82% of consumers in the US, 73% in the UK, and 87%in China reported wellness as a top or very important priority in their lives. And what we find even more striking is that the focus keeps increasing. More than half of consumers say they prioritize wellness more than they did a year ago.”

What’s new in consumer wellness trends? | McKinsey

Alcohol consumption: “Experts are currently evaluating the scientific evidence on alcohol’s health effects. The 2025 Dietary Guidelines for Americans are due at the end of next year, and could change what people in the U.S. are told about drinking. But controversy has surrounded the guidelines process for decades, and this time around is no different when it comes to alcohol.

When zooming out to alcohol consumption in the past year, over 60% of U.S. adults said they drank, according to the 2022 National Survey on Drug Use and Health. And nearly 80% of people over age 11 reported having drunk at some point in their lives.”

By the numbers: America’s alcohol-related health problems rising fast (

Re: Women’s Health: Heart disease disparity: “Cardiovascular conditions in the United States make up at least a third of the women’s health gap because of inequities between women and men in care delivery, efficacy, and data availability.

Addressing heart health at every life stage can improve a woman’s quality of life and overall health. It could lead to at least 1.6 million years of higher-quality life and boost the US economy by $28 billion annually by 2040.

CVD makes up over a third of the health gap between US men and women, as measured in potential years of healthy life. Analysts have quantified this gap in terms of disability-adjusted life years…the United States has the potential to gain an additional $28 billion in GDP by 2040 by closing the gap in heart health between men and women.

The state of US women’s heart health: A path to improved health and financial outcomes | McKinsey

Surgeon General: Firearm safety is public health issue: “Firearm violence in America is a public health crisis. a Since 2020, firearm‑related injury has been the leading cause of death for U.S. children and adolescents (ages 1–19), surpassing motor vehicle crashes, cancer, and drug overdose and poisoning. In 2022, 48,204 total people died from firearm‑related injuries, including suicides, homicides, and unintentional deaths.2 This is over 8,000 more lives lost than in 2019 and over 16,000 more lives lost than in 2010.

A recent nationally representative survey (n=1,271) found that the majority of U.S. adults or their family members (54%) have experienced a firearm-related incident. Among all respondents, 21% have personally been threatened with a firearm, 19% have a family member who was killed by a firearm (including by suicide), 17% have witnessed someone being shot, 4% have shot a firearm in self-defense, and 4% have been injured by a firearm. Nearly 6 in 10 U.S. adults say that they worry “sometimes,” “almost every day,” or “every day,” about a loved one being a victim of firearm violence. Such high levels of exposure to firearm violence for both children and adults give rise to a cycle of trauma and fear within our communities, contributing to the nation’s mental health crisis.”

Firearm Violence in America |

Report: Covid relief funds for schools: Background: “During 2020 and 2021, the federal government approved three aid packages totaling nearly $190 billion for elementary and secondary schools, 90% of which was provided directly to local school districts with little federal or state oversight…the grants were provided proportional to each districts’ funding under the federal Title I program in fiscal years 2019 and 2020. Because Title I funding is based on local poverty rates for school-age children, the federal relief went primarily to higher poverty districts. “Two studies of the impact were conducted:

  • Researchers from Harvard, Stanford and Dartmouth, compared two sets of school districts. Both groups had similar academic results before the pandemic and then similar drops in learning through 2022. One set of schools received much more Covid aid, in part due to quirks in the funding formula. The schools—which spent nearly $3,000 more in Covid money per student—recovered at a faster rate. The higher-spending districts made up 50% of math learning loss through the spring of 2023, compared with less than 15% in the districts that got less money. Test scores at high-poverty school systems remained behind their prepandemic levels, but the results would have been worse without the federal aid.
  • Researchers at the University of Washington found a link between learning gains in math and Covid funding.  Some school systems are still determining how steep the funding falloff will be as the federal aid ends. Officials at the school district in Harrisburg, Pa., are hoping for more money as state lawmakers hash out a budget. The district is currently moving forward under the assumption that it will receive half of what the governor has proposed

Per the Wall Street Journal review of the studies: “The money helped students gain some academic ground and made the biggest difference for the nation’s poorest schools, which received the most money, according to two studies released Wednesday. Schools spent on summer programming, tutoring, additional staff, and building upgrades, among other things. But the overall impact of the federal money was modest, and the remaining dollars won’t be enough to get students back to where they were before the pandemic, the researchers projected. The findings come as the money is running out and some schools are cutting academic-recovery programs

Education Recovery Scorecard

What Did $200 Billion in School Covid Money Do for Students? – WSJ

Fentanyl deaths and social media: ”Between 2019 and 2021, the number of teen deaths from fentanyl tripled — and the driver of that plague, per the cops and feds I talked to, was fake pills sold online. Phony opioids that looked like Oxycontins but were cut with fentanyl, not oxycodone; bogus Xanax but with fentanyl, not alprazolam, on board. Name any pharmaceutical with a foothold on campus — Adderall, Valium, Suboxone, what-have-you — and it was instantly available via social media and delivered to your door like Papa John’s…

To be sure, dealers hawk their poisons on all the social apps, but, law-enforcement sources say, they commonly sealed the deal on their Snapchat account because of its clandestine features…

By the start of the pandemic, per Tech Policy Press, 92% of Snap’s user base was between the ages of 12 and 17. Riding that demographic, Snap aimed for the stars and achieved escape velocity fast. It went from 20,000 users in those first few months to more than 140 million in five years. (Mark Zuckerberg offered Spiegel $3 billion to take Snap off his hands in 2013. Spiegel turned him down.) Per Reuters, last year, Snap earned $4.6 billion; Spiegel’s net worth was $3.6 billion at press time, according to Forbes.

Inside Snapchat’s Teen Opioid Overdose Crisis (