Four health policy stories to watch in 2018

Leah Rosenbaum is currently a graduate student at the University of California, Berkeley, studying journalism and public health. Her work has been featured in STAT, Vice (Tonic), and other outlets. Follow her on twitter: @leah_rosenbaum.

With Thanksgiving in the rear view mirror and the new year on the horizon, it’s not too soon to look forward to reporting on health care stories in 2018.

In the world of health policy, the fate of the Affordable Care Act and one of its key provisions – the individual mandate — will likely continue to dominate headlines for the foreseeable future. But that doesn’t mean it’s the only policy story worth paying attention to. If you’re looking for a fresh angle on a health policy story, we’ve got you covered: Check out Trudy Lieberman’s recent take on hospital stories, or read on to learn about four more health policy stories that are worth keeping tabs on in the coming year.

opioid crisis

How policy is shaping the opioid epidemic

A lot of news coverage has been given to the opioid epidemic in America over the past few years, but relatively little of that reporting has examined policy-level interventions. German Lopez at Vox recently looked at one of the states that is taking the opioid epidemic seriously: Vermont. Lopez explored the successes and failures of the state, which legislated a “hub and spoke” model of addiction treatment in 2012. Five years later, Vermont has an overdose death rate that is lower than the regional and national average, and has shorter wait times for people to get into treatment. Lopez reported that the success of the Vermont program, which takes an integrative approach to care, is prompting other states including California and Washington to consider similar interventions. At a time when it can seem hard to find a fresh angle on the opioid crisis, the impacts of these new policies may be worth examining.

Conflicts of interest in healthcareThe biggest policy debate you haven’t heard of

There’s a war happening between two of the biggest players in the health care world: the pharmaceutical industry and the hospital industry. As David Pittman of Politico recently reported, they’re fighting tooth and nail over an obscure law, more than two decades old, which could substantially change the price of prescription drugs for hospitals in low-income communities. The 340B Drug Pricing Program, started in 1992, requires drug makers to give substantial discounts to hospitals and health clinics serving low-income populations. Yet now pharmaceutical companies (with the backing of the Trump administration), contend that hospitals are taking advantage of this program and pocketing extra cash.

In mid-November, the Centers for Medicare & Medicaid Services (CMS) issued a ruling in favor of the pharmaceutical companies, calling for substantially lower hospital reimbursements next year. But the fight isn’t over yet: hospital advocacy groups, including the American Hospital Association (AHA), have already filed an injunction against the ruling. Expect this legal battle to continue into the New Year, and follow it closely: this could have major impact on low-income communities across the country

Regulating CRISPR embryos

This past summer, I wrote about Shoukhrat Mitalipov, PhD and his team at Oregon Health and Science University, reportedly the first lab in America to use the CRISPR-Cas9 system to edit the genes of human embryos.(CRISPR is short for “Clustered Regularly Interspaced Short Palindromic Repeat.”) While human embryos have been genetically modified in China since 2015, Mitlipov and his team used a more precise method of human germline engineering to fix an embryonic mutation that can lead to hypertrophic cardiomyopathy, an inherited heart disease, later in life. Some scientists rejoiced at this feat of genetic manipulation, while others pointed out that US policy may be unequipped to deal with new advances in embryo editing. More than 20 countries around the world have an outright legal ban on human germline editing, while still others have suggested that bans be put in place. But the United States is a special case: although human embryo editing is regulated by the FDA and NIH, there is no law against it. Mitalipov’s breakthrough has caused some scientists to worry that without a policy change, editing of human embryos in America could get out of hand. Ethics aside, it will be interesting to watch if and how the United States decides to deal with this scientific advance, and whether or not the policies surrounding human embryo editing will change.

Will Amazon be the new pharmacy giant?

Let’s wrap things up with some juicy speculation. For the past few months, the Internet has been abuzz with reports that the online retail giant is going to shake up the pharmaceutical industry. Rumors started this past summer after Amazon acquired Whole Foods, and past employees have been quoted as saying that an expansion into the pharmacy business is likely. In addition, last month it was revealed that Amazon received approval for wholesale pharmacy licenses in at least 12 states.

The rumors may lead nowhere. But analysts say the online powerhouse has the potential to profoundly disrupt the current pharmacy system—possibly fostering more price competition on drugs. The mere threat of Amazon entering the arena caused drugstore stocks to fall at the end of October. There are several ways that Amazon could enter the pharmacy business, including as a mail-order pharmacy, as a pharmacy benefits manager, or a provider of specialized services to doctors. Although whether or not Amazon will join the pharmacy business is still up in the air, the implications of such a move make this a crucial health economy story to watch unfold in the coming months.

Do you have another tip for health policy stories to watch? Mention it below in the comments.

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