Top of the Funnel | Marco Data, Policy Position Monitor
Personal Consumption Expenditures. HCA (+), THC (+), CYH (+), ELV (-), HUM (-), CNC (-), UNH (-) The Fed’s favorite inflation measure, PCE rose 0.54% in October or 5.00% YoY% for health care. Both hospitals and physicians’ offices contributed. Meanwhile, PCE for laboratories continues its slow descent back to normal trend after the mother of all cash infusions from the federal treasury.
Employment. HCA (+), THC (+), SGRY (+) DVA (-) Coincident with that consumption trend, employment in the health care sector continues its march up and to the right. About 44k jobs were added in November. October data in this week’s print included good news on average hourly earnings which continue its deceleration to 5.42% YoY from 5.60% in September. Meanwhile, aggregate hours worked accelerated 2.78% in October from 2.55% in September.
In the not so good news department, ESRD employment continued its herky-jerky, dropping 0.54bps in October. With demand for health care services continuing is ascent, the employment churn at DVA is bound to continue.
JOLTS. Confirming all of the above, labor demand eased a bit in October but remains at elevated levels.
Health Care Inflation Chartbook here.
Employment Chartbook is here.
CONGRESS.
Boosters v Providers. Ranking and soon to be Chairwoman of the House Energy and Commerce Committee, Cathy McMorris Rogers and Rep. Tom Cole took issue with the administration’s decision to redeploy provider relief funds to pay for a fall booster campaign.
The problem, of course, is that providers are beating a path to Capitol Hill in need of relief from higher labor and supplies costs that have not been fully contemplated by the sclerotic Medicare payment systems. Meanwhile, interest in boosters is at a low ebb.
The White House has been unable to fully account for use of Provider Relief Funds which you can bet is going to be a hot topic in the 118th Congress.
Another Try at Mental Health Parity. Senators Wyden, Crapo, Benet and Burr released a discussion draft of a new mental health parity law. This potential bill is part of a series that has previously focused on telehealth services, youth mental health and workforce development.
THE WHITE HOUSE.
ACA Exchange Plans. ELV (+), UNH (+) The administration announced 3.4M plan selections since Open Enrollment began Nov. 1. New customers increased about 40%. The renewed popularity of the exchanges is probably the result of a couple short lived policy changes.
The Inflation Reduction Act extended premium subsidies for people making over 400% of the federal poverty level. New rules eliminate the “family glitch” that prohibited family members from enrolling in an ACA exchange plan.
The extension of the premium subsidies ends in 2023 unless extended by Congress and the family glitch issue is likely to be ruled out of bounds by the courts.
Nonetheless, another factor in the popularity of the exchanges could be the overall upward pressure on premiums in 2023. We have seen anecdotal reports of 2x and 3x increases in employer sponsored plans – enough to send eligible individuals seeking options.
Quality Measure Updates. From that sleepy corner of CMS where they try and establish quality measures for health care providers, the annual list of “Measures Under Consideration” includes metrics for Covid vaccinations of health care personnel and nursing home residents.
It may seem counterintuitive but moving a requirement for Covid vaccines may be a positive as it gives providers more flexibility. A poor showing on vaccination of personnel can be offset by other measures. In other words, if labor pressures demand it, then the requirement can be ignored.
Other Stuff.
Foot Dragging on OTC Birth Control. PRGO (-) HRA Pharma and Ibis Reproductive Health funded, led and released recently two separate studies that found the progestin-only pills could be effective even when taken outside the three-hour window for which they are currently indicated.
Still hard to know when the FDA takes up the issue. An advisory committee meeting was scheduled for Nov. 14 was delayed. Monograph reform may be creating some conflicts. The depopulation of Washington isn’t helping, with those remaining not inclined to break a sweat either.
An underappreciated factor is the readily available OTC birth control would have on OB/GYN practices that leverage a birth control script renewal into an annual pelvic exam. Doctor groups have tended to lobby hard against those sorts of disruptions in their practice patterns.
More Surprises in No Surprises Act. The Texas Medical Association has filed a new lawsuit challenging certain portions of the No Surprises Act regulation. It is their third.
This latest challenge focuses on the rules that define the Qualified Payment Amount used as a starting point for negotiation of out of network rates.
Long COVID, No COVID. PFE (-), MRNA (-), BNTX (-) Published in JAMA yesterday is a study that concludes "long-COVID" may not be a thing at all - or at least a thing that affects people who did not have COVID (i.e. the control group.) We have been skeptical because "Long COVID" never passed our "do you know anyone?" test. The results should be no surprise to anyone that wonders how a disease can be defined by statute before any clinical evidence emerges. It was also a little too enthusiastically embraced by the CDC which we suspect is looking for any excuse it can find other than its policies to explain the poor health of Americans.
On the Other Hand. PFE (-), MRNA (-), BNTX (-) The clinical evidence of myocarditis as an adverse event associated with COVID-19 vaccinations continues to build.
Let the hyperventilating Begin. Twitter has ended enforcement of its Covid-19 misinformation policy. If you are getting important health information from Twitter you probably have other issues so the change should not matter to overall public health.
It might scramble the minds of that small coterie of dialed-in health policy insiders. White House Covid Coordinator Dr. Ashish Jha was chosen for his position because of the things he posted on Twitter, according to White House Chief of Staff Ron Klain. If that isn’t a job recommendation, I do not know what is.
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Have a great weekend.
Emily Evans
Managing Director – Health Policy
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