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Brainstorm Health Daily: March 9, 2017

March 9, 2017, 5:33 PM UTC

Eight years ago, when a new American president swept into office with high hopes for health care reform, there was one cohort of citizens that public health experts were particularly worried about: people between the ages of 50 and 64.

Whichever sock-tongued epidemiologist out there christened this group “near elderly” is no friend of mine (I mean, don’t even…)—but we’ll leave that fight for another time. For now, let’s call them (er, us) “Generation Strong.”

Anyway, this group—who numbered around 55 million back then (accounting for nearly one-fifth of the U.S. population), and who likely total more than 63 million today—tend to be fairly robust consumers of health care services, but are too young to be covered by Medicare. During the Great Recession that began at the end of 2007, when many of Gen-Strong suddenly found themselves out of work—and, in some cases, unemployed for a frighteningly long time—a compounding fear for many was the loss of health coverage on top of everything else.

This was the harsh, unforgiving truth that greeted a not-yet-gray-haired President Obama as he took his oath of office. And the writers of the Affordable Care Act were especially mindful of protecting this group in their health reform plan.

So, yesterday, I asked the question, “What problem with Obamacare does the new GOP plan solve?” Today, I’m asking, “What happens to Generation Strong under Trumpcare?

Vox and others reported on Tuesday that annual premiums for people ages 55 to 64 would jump by $5,269 if the Republican plan were put in place immediately, and would rise to $6,971 in 2020. For those with incomes below 250 percent of the federal poverty line, premiums would increase by $2,945 today and by $4,061 in 2020. It’s also not clear from the rules, the way they’re written now, that insurers can’t raise premiums substantially more, or adjust copays and deductibles to put additional burden on consumers, or further restrict what they cover…or do all of the above.

Yet there’s an even bigger concern than these premium increases, as much of a hardship as they may be to some. And that’s the coverage “donut hole” penalty I mentioned in yesterday’s newsletter. Here’s the provision in the GOP bill: “If the applicant had a lapse in coverage for greater than 63 days, issuers will assess a flat 30 percent late-enrollment surcharge on top of their base premium based on their decision to forgo coverage.” (You’ll find this line under a subsection titled “Patient Relief…”)

First off, I’m hoping that the “based on their decision to forgo coverage” riff becomes a Twitter meme. And second, this line of potential law could be devastating to Gen-Strong, as many face longer periods out of work—or canceled employer coverage, forced-early retirement, COBRA expirations, or premiums that are simply too pricey to afford.

“More than one in four adults ages 50 to 64 spends at least 10 percent of their disposable income on health care,” says AARP. And this share includes those who are already insured. The Trumpcare provisions are likely only to add to that burden.

To be sure, this age cohort has always been a squeezed generation—the ones who take care of elderly parents and help their kids with a home downpayment or a job transition or a new baby. But this is one additional squeeze I don’t think Gen-Strong is going to take lightly.

That this group overwhelmingly voted Republican in the November election is beside the point. Honestly, ignore that fact. Forget I even mentioned it.

More news below.

Clifton Leaf


MD Anderson Cancer Center CEO resigns following rough audit, IBM Watson snafu. Ronald DePinho, who heads up the prestigious University of Texas MD Anderson Cancer Center, will step down after six years in the position. In an emotional video to employees, DePinho said it was time for new leadership that can inspire "greater unity" and reflected on what he considers his stumbles as chief executive. "I could have done a better job administratively; I could’ve done a better job listening; I could’ve done a better job communicating," he said in the video. "Forgive me for my shortcomings. I regret them." Last month, a harshly critical audit by the University of Texas System cited mismanagement in MD Anderson's partnership with IBM Watson, which has been frozen. The audited specifically pointed to contractual and transparency issues (DePinho's wife, Lynda Chin, initially oversaw the IBM Watson project). The timing of DePinho's departure is still being worked out. (Xconomy)

Apple stores are now selling this smart blood pressure cuff. You can now snag a high-tech blood pressure cuff that coordinates with your iPad, iPhone, and Apple Watch at the Apple Store. The device, Qardio's QardioArm, is FDA-approved and costs $99. And with it, users can monitor their blood pressure on a sleek interface. It also has a telemedicine component - by using the device and its connect iOS program, doctors can stay appraised of their patients' blood pressure without forcing them to come in for a visit. "We're thrilled to expand our global retail presence in collaboration with such a visionary retailer," said Qardio chief business officer Alexis Zervoglos in a statement. "We share with Apple an absolute belief that purity of design coupled with technological innovation drives change, as we focus on creating beautiful, accessible products that lead to a healthier world without compromising lifestyle." (Mac Rumors)


Bristol-Myers Squibb enlists some serious star power to lead R&D. Looking for a fresh set of eyes to oversee its R&D, pharma giant Bristol-Myers Squibb has snapped up Dr. Thomas Lynch Jr., a respected cancer doctor who is currently the CEO of the prestigious Massachusetts General Physicians Organization. The decision was lauded by investors and industry observers who say the firm needs to readjust after several big disappointments for its star cancer immunotherapy drug Opdivo, which failed to best standard chemotherapy in advanced lung cancer (and consequently sent Bristol-Myers shares plunging). Lynch's expertise as an oncologist could serve the firm well as it seeks out new immunotherapy combinations to try and recover from the recent stumbles. (Wall Street Journal)

Merck (the other one) wants to sell its biosimilars business. Germany's Merck KGaA (not to be confused with the U.S. company) is in "advanced" talks to sell its portfolio of experimental products that mimic blockbuster "biologic" drugs like AbbVie's Humira (the best-selling therapy in the world), according to CEO Stefan Oschmann. Biosimilars are a fledgling field in the U.S. but have already attracted plenty of interest from biopharma companies. (Reuters)


The House spent all night marking up its Obamacare replacement. Have you had your coffee fix for the day? I certainly have - mostly because I was up until 2:30 in the morning following the decidedly not exciting legislative scuffling over the GOP's Obamacare replacement plan in the House Energy and Commerce and Ways and Means Committees. The changes are still coming (although the House Ways and Means Committee did pass a version of the legislation in the wee hours of Thursday morning). But for now, it appears the GOP is hewing to its strategy of trying to get the legislation passed through the chamber as soon as possible, and before even more opposition to it can build. House Speaker Paul Ryan has said he wants the bill passed before the April recess.

A glimpse into the gender gap in health care. On the heels of International Women's Day, let's take a quick look into the state of the gender gap in health care: a $20,000 gap between male and female doctors; a widening chasm between how much women health IT workers are paid compared to men (78 cents on the dollar); and just a fraction of board seats and executive roles in an industry where 75% of health care jobs are held by women. One bright spot among the grim figures? Private biotech companies, in which there is virtually no wage gap between male and female CEOs. (Fortune)

Genentech breaks the top 10 in Fortune's Best Companies to Work For list. Biotech pioneer Genentech has nabbed the number six spot in Fortune's 2017 Best Companies to Work For list. The firm has a “casual intensity” vibe, according to one staffer, and celebrates milestones such as a new FDA approval with a company-wide ringing of bells. Genentech scored four marketing clearances from the FDA last year.


The 100 Best Companies to Work Forby Fortune Staff

Uber's AI Research Guru Steps Downby Reuters

Meet the Dutch Designer Who's Turning China's Smog Into Diamondsby Michelle Toh

IBM Says It Managed to Store Data on the Smallest Thing Possibleby Madeline Farber

Produced by Sy Mukherjee

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