Amazon announced Tuesday that it will join with J.P. Morgan Chase and Berkshire Hathaway to wade into the jungle of U.S. health care, and the news slashed billions in stock-market value from health-care companies in mere hours. American health care could benefit from creative destruction, though this would be Amazon’s toughest fixer upper to date.

The announcement offered no details—nothing on if the companies will set up provider networks or walk-in clinics or what. But an early red flag: The press release says the group will form an “independent company that is free from profit-making incentives and constraints.”

The problem with U.S. health care is not an incentive for profit, which has driven innovation and cures for diseases like hepatitis C. The fundamental problem is that the cost of a service is disconnected from underlying value. Patients don’t know the price of services and consume health care as if it’s free since government or employers are the third-party payers for most Americans.

A growing number of mostly Republican-led states are rushing to follow Kentucky’s lead in requiring thousands of people on Medicaid to work or lose health coverage.

The governors of South Dakota, Alabama, Louisiana and South Carolina have said in recent weeks that they plan to pursue work requirements for their Medicaid programs, following the Trump administration’s release of guidelines for the concept in January.

“Whenever possible, we should always endeavor to help South Carolinians in need find their path to gainful employment and away from temporary assistance of government,” South Carolina GOP Gov. Henry McMaster tweeted Jan. 11, the same day federal officials announced the new guidance.

. . .

Obamacare’s insurance rules represent the beating heart of the law, necessitating a massive system of subsidies and tax increases to make this newly expensive coverage “affordable.” Because Democrats used the “Biden precedent” to impose some of those rules through budget reconciliation, Republicans have every opportunity to repeal these requirements outright through a reconciliation bill. They should take that opportunity, for removing the regulatory regime would effectively repeal Obamacare—and permanently restore health care freedom to the American people.

. . .

Oregon voters recently upheld a myriad of new taxes that were passed as part of a major health-care law last summer. The state government is planning to use the estimated $320 million in revenue to cover hundreds of thousands of residents who have enrolled through the Affordable Care Act. The outcome of this vote has serious implications anyone enrolled in a health-care plan in Oregon.

The referendum was on sections of House Bill 2391, which imposes a 0.7 percent tax on small hospitals as well as a 1.5 percent on individual and family health-care premiums. These revenue raisers are intended to generate more tax dollars for the state. But they also allow Oregon to receive $630 million to $960 million in federal Medicaid matching funds.

. . .

President Donald Trump vowed Monday that his new health-care chief Alex Azar — a former top drug-company executive who raised prescription prices — is “going to get those prescription drug prices way down” as Azar was sworn in for his job.

“It’s doing to come rocketing down,” Trump said as Azar, 50, stood at his side in the White House before taking his oath as secretary of the U.S. Health and Human Services Department from Vice President Mike Pence.

“We have to get the prices of prescription drugs way down, and unravel the tangled web of special interests that are driving prices up for medicine, and are really hurting patients,” Trump said.

“And nobody knows that process better than Alex.”

A House committee voted Tuesday to impose work requirements on Medicaid recipients, something Republicans are seeking as a precondition to expanding the health-care program to more low-income, uninsured Virginians. It was not clear how many of the state’s 1 million Medicaid recipients would be affected if the bill becomes law because the majority are children, the elderly, pregnant women and people with disabilities, all of whom would be exempt under the plan because they are considered to face some barrier to work.

. . .

  • HHS on Friday released a report touting its 2017 accomplishments, including regulatory rollbacks and cost savings.
  • The 37-page report highlighted some actions that are priorities for the Trump administration, but which have sharply divided the healthcare industry. It said 70 regulatory actions were withdrawn last year and more than $3 billion was recovered through efforts to stop waste, fraud and abuse.
  • It also pointed to a final rule that cuts hospital payments from the 340B Drug Pricing Program, saying it will save $3.2 billion. Hospitals fiercely oppose the cut and are challenging the rule in court.

. . .

Using 2017 dataOut of 9,201,805 healthcare.gov enrollees, here’s how many would win and lose if the insurer subsidies were now funded:

  • Winners: 682,712 unsubsidized exchange enrollees enrolled in middle-of the-road “silver” plans
  • Losers: 1,621,325 enrollees who receive premium subsidies and don’t have silver plans
  • Likely losers: 1,706,780 enrollees with silver plans and incomes between 200%-400% of the federal poverty level.

. . .

American workers have not seen their wages grow in tandem with the success of their employers.

Meanwhile, health spending has been growing faster than the broader economy. Health benefits consequently are getting more expensive for employers to offer, and companies are responding by making employees shoulder more of their own health care costs — either through higher premiums or higher out-of-pocket costs, like deductibles and copays.

. . .

Across plans and states, the expansion population experienced high disenrollment rates, indicating that, as in other Medicaid eligibility groups, there is substantial churn in this population.

• Even after adjusting for age and gender, claims costs increased steadily over time, suggesting that expansion enrollees have complex and/or chronic conditions.
— For some enrollment cohorts, average claims costs decreased modestly in the second half of the first year of enrollment, suggesting some initial pent-up demand for services, though claims costs increased steadily from that point forward.
• Across enrollment groups, per member per month spending on prescription drugs increased with enrollment duration.
— Among enrollees who remained enrolled the longest, inpatient claims initially made up the largest share of claims costs, but were surpassed by prescription drug claims by month 8 of enrollment, on average.

. . .