From Health and Fitness

Modern Love Podcast: Alex Karpovsky Reads ‘Uh, Honey, That’s Not Your Line’

Modern Love
By THE NEW YORK TIMES

On this week’s podcast, the actor Alex Karpovsky reads the essay “Uh, Honey, That’s Not Your Line,” in which Matteson Perry learns that the Manic Pixie Dream Girl is nothing more than a trope.

Mr. Perry is a screenwriter and performer living in Los Angeles. Find him on Twitter.

Mr. Karpovsky played Ray Ploshansky on the HBO series “Girls.” Stay tuned after his reading for a conversation with Mr. Perry and a reflection from the Modern Love editor Dan Jones.

Repeal-And-Delay Proposal Fails In Senate, 45-55

Jul 26 2017

As senators continue to debate health care legislation, a plan to repeal most of the Affordable Care Act in two years, without replacing it, fails to garner enough votes to pass.

The Hill: Senate Rejects Repeal-Only ObamaCare Plan
A vote on the amendment, which was widely expected to fail, was originally scheduled for late Wednesday morning but was delayed as senators tried to get clarity on a provision tied to abortion. It was the second ObamaCare plan rejected after the Senate voted down a separate repeal-and-replace amendment on Tuesday night. (Carney, 7/26)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Quantifying the Benefits of Owning a Dog

Just how good is dog walking for you? Older dog owners who walked their dogs at least once a day got 20 percent more physical activity than people without dogs, a British study found, and spent 30 fewer minutes a day being sedentary, on average. Regular exercise has well-known benefits for health and longevity.

For the study, published in the Journal of Epidemiology and Community Health, researchers used data from 3,123 men and women, median age around 70, living in Norfolk who wore an activity monitor for seven days. The data recorded was crosschecked against meteorological information.

All participants tended to be less active on short winter days when it was cold and wet. But regular dog walkers experienced less of a dip in physical activity and got more exercise on bad weather days than those who were not dog owners did on the warmest days of the year.

“There might be two-way causality here, where people who want to be physically active get dogs,” said Andy Jones, a professor of public health at University of East Anglia and the study’s senior author. “But qualitative studies have shown that having a dog gives you incentive to get out, when the easier option is to stay indoors.”

How an American in London Learned to Fear the ASBO

First Person

LONDON — Dogs cannot safely bark in this city.

This troubling piece of information first came to my attention after I read an article in The Times of London that ran under the headline “Dogs That Bark at Strangers Could Face Canine ASBO.”

I was a newcomer to the city at the time and had no idea what an ASBO was. But it sounded bad.

The article was accompanied by a fearsome image of a Cujo-like creature, his head tilted as if in midroar. The first paragraph warned: “Dog owners who let their animals growl at strangers or bark in gardens could be ordered to control their pets or face fines” — of roughly $4,000 at the time — “under new laws coming into force on Monday.”

As the owner of a lightly trained golden retriever, I was concerned.

The article never explained what ASBO was, since only an American expat like myself would have to ask. I learned that it stood for “antisocial behavior order,” and it had come in with Tony Blair’s Labour government in the late 1990s.

While ASBOs were officially renamed in England and Wales in 2014, the term has lived on, particularly in tabloid headlines, to refer to actions governed by the Antisocial Behavior, Crime and Policing Act. Expanded and streamlined as part of these recent changes, it is aimed at preventing people over 10 years of age, and their pets, from behaving badly.

There is something particularly British about it, coming from a society that likes to throw back a pint but also to keep things orderly and proper. The act has civil and criminal elements but is often exercised as a threat. Warning letters hold up the possibility of an ASBO, or, as the civil version is now technically called, an injunction.

Over time, the term ASBO took on a grammatical life of its own. ASBO can be a noun, as in “Stop being an ASBO.” It can appear as an adjective, with one woman on Twitter describing her dog as “slightly ASBO-ish.” It even comes in gerund form: “My crazy neighbors need ASBO-ing so bad,” another Twitter commenter wrote.

The tabloids called a family of marauding swans in Cambridge “Mr. Asbo” (the grandfather), “Asboy” (the son) and “Asbaby” (the grandson).

The Daily Mail has referred to a “moaning wife” as “Nagsbo.” Martin Amis titled his 2012 novel “Lionel Asbo.”

“If you’re young and a bit mouthy, you would get an ASBO,” said Davide Wheller, an editor of a London-based fashion and music magazine called ASBO. “It’s a term that’s used against young people. It brands a certain class that gets the ASBO, so we’ve taken this word and turned it on its head.”

That’s not to say social behavior injunctions are aimed only at the young.

Actions that fall under the antisocial behavior act have run the gamut. There was the hotelier in Blackpool who received a warning letter early this year after renaming his bed-and-breakfast the Viagra Hotel. Before that, a couple in Hampshire were fined more than $2,600 because their bichon frisés barked 150 times in 51 minutes. The Mirror reported on an ASBO-prone cat named Rocky. A farmer got an ASBO for his unruly pigs.

“I think it’s misused,” said Anne Maple, 62, who is sort of a celebrity among the London tabloids. She said in an interview that she has received 11 warning letters from her landlord, Lewisham Homes, the company that manages public housing for her local council.

The letters have included warnings about the condition of a fence on her property and the amount of cat feces in her trash bins. She says the threats have come in retaliation for her own complaints about the management company, which did not respond to a request for comment.

“The people it was intended for, like kids graffiti-ing up a wall, they just turned it around, and they wear the ASBO like a badge,” she said. “They actually call me Granny ASBO! The local kids do, ever so nicely. They say, ‘You’re one of us now, Gran.’”

A favorite ASBO-receiving subtype are those who are vocal during sex. An amorous Newcastle couple was reportedly cited twice, even after they had moved their bed into their dining room. Neighbors had claimed they “were watching television when they were disturbed” after “they heard screaming from the defendant next door,” according to The Telegraph. The presiding judge reportedly told the offenders, “You have made your neighbors’ lives thoroughly miserable.”

Far more disturbing is the classic rock ASBO that befell grandparents in the suburbs of Plymouth, who were written up for playing Fleetwood Mac and Roy Orbison too loudly in their garden.

This seemed a bridge too far. I also enjoy Fleetwood Mac. Who among us hasn’t done something that could have earned an ASBO at one time or another?

This would never fly back home, I thought. Then I talked to Craig Johnstone, a principal lecturer in criminology at the University of Brighton.

“The Blair government was seduced by what was happening in New York, and what Bratton and Rudy Giuliani had been doing with broken windows,” he said, referring to the controversial strategy of aggressively policing minor offenses. Mr. Giuliani enacted the “broken windows” policy when he was mayor of New York with help from his police commissioner at the time, William J. Bratton.

“I think there was a little bit of ‘What could we do as a British broken windows?’” Mr. Johnstone added.

My real concern was parochial. If you read through the legislation, you find penalties for dogs “that people say are causing distress or threatening their cats.”

Ruh-roh. The postage-stamp-size yard behind our flat is a way station for cats, pigeons and foxes, and my golden retriever has been known to exercise his vocal cords.

By the letter of the law, you must keep your dog under control “anyplace in England or Wales (whether or not a public place).” Theoretically, I could get an injunction if my dog was causing distress in my own home.

I may as well turn myself in.

How to Be Mindful When It’s Hot Outside

Meditation for Real Life
By DAVID GELLES

“The high heat and sultry air of summer can exact a toll on mood and physical well-being. Meeting steamy conditions with mindfulness may help us discover that peace and joy are possible, even under the sun’s most unforgiving rays.” — Breon Michel, a mindfulness teacher from Phoenix.

As you notice the sun tingling on your back, the beads of sweat between your brows, or a sticky residue on your skin, try to do so with nonjudgmental awareness. Can you feel those sensations without getting swept away by a commentary on how awful it seems?

See if you can detect any pleasant sensations. Is there a pleasant warmth inside your body? Is a cool breeze on the skin refreshing?

As you bring this gentle acceptance to your sensations, both good and bad, notice what happens when your experience is not colored by judgment. Are you more tolerant, curious or open?

If the heat is making you restless, bring your awareness into your feet. Find a shady spot outdoors and kick off your shoes. Feel the soil, sand or blades of grass tickle your toes. Take a few mindful steps, paying close attention to each sensation as you walk gently across the earth.

If you can, take a rest in the middle of the day. As the heat peaks, our energy may plummet. Meet these natural shifts with openness and acceptance. Rather than fighting fatigue, use it as an opportunity to slow down and breathe. See if the breath can offer a momentary burst of coolness or revitalization, even on a muggy day.

When your thoughts return to the unpleasantness of the heat, just notice that. Observing how our minds work is part of the practice. Just use it as an opportunity to let go and begin again.

Practicing mindfulness is a way to practice being right where you are, with heightened sensitivity, in order to allow peace and joy to arise naturally.

Viewpoints: Applause For Push To Rescue Mo.’s In-Home, Nursing Care For Senior Citizens, Disabled People; Moving Toward Medical Quality

Here’s a review of editorials and opinions on a range of public health issues.

The Kansas City Star: Don’t Give Up On Restoring In-Home And Nursing Care In Missouri
Kudos to those Democratic Missouri lawmakers who still have not given up on trying to stop Gov. Eric Greitens from single-handedly taking in-home and nursing care away from 8,300 seniors and disabled people. On Monday, several legislators asked the state to drop plans to request a federal waiver from the Centers for Medicare and Medicaid Services that would allow them to cut the program. (7/25)

KevinMD: 5 Steps To Create Medical Quality Without Trying
The need for what we are calling medical “quality” is acute, yet the strategies employed to obtain it are destroying medicine. Patient outcomes are inconsistent, care varies depending on many factors outside of disease state, and the cost of our medical system is not sustainable. But to fix this, most health systems employ non-clinicians to audit charts while checking boxes such as “A1C<8%?” and “DVT prophylaxis ordered within 24 hours?” These non-providers then send threatening letters and cut salaries with “pay-for-performance.” Unsurprisingly, such efforts are not working, and only end up creating distorted physician-patient relationships. Yet, obtaining improved quality requires only a few key steps. (Kjell Benson, 7/25)

Stat: Doctors Have The Power To Help Their Patients Thrive Financially
StreetCred’s formula is simple. It takes advantage of the trusting relationships that families have with their pediatricians and makes productive use of the time typically wasted in doctors’ waiting rooms. In partnership with the IRS-sponsored Volunteer Income Tax Assistance program and other government agencies, StreetCred uses trained volunteers and staff to help families file taxes, attain tax refunds, and apply for anti-poverty government programs. (Andrea Levere, 7/25)

Stat: Human Trafficking Must Be Officially Recognized As A Medical Diagnosis
Early this week, nearly 100 people were found trapped in a sweltering tractor-trailer in San Antonio, Texas. Ten have died and others are in critical condition. Many were sent to local hospitals for treatment of severe dehydration and shock, medical conditions that are common in the emergency department. What may not be as obvious to emergency physicians is that these people are possibly victims of human trafficking. As physicians who have treated victims of human trafficking and research this scourge, we believe that this form of severe exploitation is under-recognized in health care settings and live are being lost because of that. (Abraar Karan and Hanni Stoklosa, 7/25)

Los Angeles Times: The ‘it’s All In Your Head’ Diagnosis Is Still A Danger To Women’s Health
TV personality Maria Menounos stunned fans when she announced this month that she was in recovery from surgery for a nonmalignant brain tumor, which she discovered while her mother was battling brain cancer. Perhaps most surprising was how quickly Menounos was treated. She explained to People magazine that when she told her mother’s doctor about her symptoms — headaches, dizziness, slurred speech — he immediately investigated what was wrong. (Emily Dwass, 7/26)

The Des Moines Register: Attorney General Sessions Should Not Re-Escalate War On Drugs
Attorney General Jeff Sessions has apparently learned nothing regarding the War on Drugs. He wants to re-escalate this failed policy at a time when many states are realizing its futility and trying to move in different directions. Drug treatment doesn’t work 100 percent of the time, but it is certainly more effective (and less costly) than incarcerating people with this illness. And as long as there are addicts, there will always be dealers, so incarcerating dealers has little long-term impact on the drug problem. (Allen Hays, 7/25)

Boston Globe: Mass. Should Pass Gun Restraining Order Bill
Representative David P. Linsky, a Natick Democrat, has filed legislation that would allow family and household members, police, district attorneys, and health care providers to go to court and seek “extreme risk protective orders” for individuals who pose a significant danger to themselves or others. The bill, which has raised the hackles of gun rights groups, stands up to constitutional scrutiny and builds in an important hearing mechanism before long-term restrictions can be imposed. (7/26)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Analyzing The Issues: Cadillac Plans, The ‘Single-Payer Trap’, Health Care Appropriations And Medicare’s Future

Opinion writers offer their takes on health policies that operate as context to the current congressional debate.

Bloomberg: Democrats And The Single-Payer Trap
For seven and a half years, Republicans have campaigned and voted to replace the Affordable Health Care Act. When given a real chance at success, with governing control, they were impeded by a president who’s ignorant on the issue. Then, after Republican senators slipped behind closed doors to come up with their own plans, they provided products that voters, even some Trump supporters, overwhelmingly spotted as frauds. (Albert R. Hunt, 7/25)

Huffington Post: A Message For House Republicans: Actions Speak Louder Than Words
Republicans on the House Appropriations Committee offered some promising phrases when describing their fiscal year 2018 Labor-HHS budget: “Invest in essential health,” “focus investments in programs our people need the most,” and “targeting investments in … public health. ”House LHHS Subcommittee Chair Tom Cole concluded, “This bill is one that reflects the priorities that Americans value, and will continue to support the well-being of Americans through funding these vital programs.” (Clare Coleman, 7/24)

The Wall Street Journal: The Deadline To Kill The Death Panel
All eyes are on the Senate as it debates what to do about ObamaCare. But the House has a last chance this week to abolish one of the law’s most dangerous creations: a board with sweeping, unchecked power to ration care. The Independent Payment Advisory Board—what critics call the death panel—would be an unelected, unaccountable body with broad powers to slash Medicare spending. But the law contains a living will for IPAB. If the president signs a congressional resolution extinguishing the panel by Aug. 15, it will never come into existence. (Grace-Marie Turner and Doug Badger, 7/25)

Milwaukee Journal Sentinel: Medicare Cuts Are A Raw Deal For Wisconsin Seniors
Unfortunately, a federal advisory panel is urging lawmakers to cut Medicare Part B, the program that covers chemotherapies, immunotherapies and other advanced drugs that must be administered by doctors. If Congress implements this recommendation, these trends could reverse, as Wisconsin seniors would lose access to life-saving medications. (Sandra Gines and Carrie Riccobono, 7/25)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

How It’s Playing On the Ground: A ‘Farce’ Not A Plan? Scolding A Senator

News outlets beyond the beltway offer their perspectives on the Senate’s replacement for Obamacare and what lawmakers should be doing.

San Jose Mercury News: Republican Health Care Is No Plan, It’s A Farce
Americans are divided on what to do about health care, but they should be united in this conclusion: Senate Republicans’ manic approach to reforming a sector that represents one-sixth of the U.S. economy and determines life or death for millions of people is utterly craven and irresponsible. …This is how Republicans are going to determine how Americans get their health care? (7/25)

Arizona Republic: ‘Obamacare Lies’ Or Trump Lies: Which Would You Rather Have?
President Donald Trump raged against what he called “Obamacare lies” Monday, urging Senators to move forward on a repeal and replace plan for the Affordable Care Act. …But the proposals put forth so far by Republicans, and backed by Trump, are estimated to leave tens of millions of Americans without health care and put tens of millions more with very limited coverage and at risk for bankruptcy should anyone in the family contract a major illness. (EJ Montini, 7/25)

Cleveland Plain Dealer: Sen. Rob Portman Must Stand Against Rush To Flawed Senate Health Care Vote
As Sen. Susan Collins, a Maine Republican, said Sunday, if the Senate does open floor debate, it’s unclear whether senators would be dealing with Paul Ryan’s House-passed bill, Mitch McConnell’s first, second or (unseen) third plan – or an ACA repeal, with a Senate promise to replace the law, eventually. …That’s also why Sen. Rob Portman, a suburban Cincinnati Republican who has spelled out his own careful stance on protecting Ohioans that he says will guide his vote, must vote “no” on moves by McConnell to force Senate action on an ill-considered, narrowly partisan package that would devastate health care in Ohio. (7/25)

Cleveland Plain Dealer: Sen. Rob Portman, You Just Let Ohio Down
Sen. Rob Portman cast the wrong vote Tuesday in supporting a hasty, politically motivated effort to allow Senate debate and, presumably, a vote on one or a series of ill-considered, narrowly partisan measures likely to devastate health care in Ohio. …As Sen. Susan Collins, a Maine Republican who cast one of only two Republican “nos” on the Senate floor, said before the vote, no one even knew exactly what senators were being asked to debate and maybe vote on. (7/25)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Different Takes On Senate Health Care Votes And Strategies: ‘Zombie Trumpcare’ And A ‘Gallows Reprieve’

Editorial pages offer mostly harshly words but some positive thoughts on the Senate’s continuing effort to replace the Affordable Care Act.

Bloomberg: Zombie Trumpcare Still Threatens The Health Sector 
Anyone who’s attempted to read the tea leaves on this bill has long since smashed their cup against the wall. The Senate voted to debate a bill; we just don’t know what will be in it. There’s no full text. There’s been no Congressional Budget Office score of a final proposal. There hasn’t been a single public hearing. And there’s no certainty Senate Majority Leader Mitch McConnell can get 50 votes together on anything other than a discussion of an intentionally amorphous bill. We’re in the health-care twilight zone. (Max Nisen, 7/25)

The Washington Post: Congress Continues To Degrade Itself
In January 1988, in Ronald Reagan’s final State of the Union address, he noisily dropped on a table next to the lectern in the House chamber three recent continuing resolutions, each more than a thousand pages long. Each was evidence of Congress’s disregard of the 1974 Budget Act. (George F. Will, 7/25)

The New York Times: The Senate’s Health Care Travesty
Ignoring overwhelming public opposition to legislation that would destroy the Affordable Care Act, Senate Republicans voted on Tuesday to begin repealing that law without having any workable plan to replace it. The majority leader, Mitch McConnell, browbeat and cajoled 50 members of his caucus to vote to begin a debate on health care without even telling the country which of several competing bills he wanted to pass. Vice President Mike Pence provided the tiebreaking vote. (7/25)

Los Angeles Times: In The Absence Of An Actual Obamacare Replacement Plan, The GOP Votes To Debate … No Bill At All
Mitch McConnell, the Senate Republican leader, proved an old adage wrong on Tuesday. Sometimes, it turns out, you can beat something with nothing. After weeks of negotiations toward a Senate bill to repeal Obamacare, Kentucky Sen. McConnell was at an impasse. He couldn’t amass a majority for any of several competing proposals to replace Obamacare. Nor could he attract a majority for “repeal and delay,” a punt that would declare the program dead, but leave it in place for two years. (Doyle McManus, &/25)

USA Today: The Senate’s Health Care Sham
In 2009 and 2010, Republicans complained bitterly that a major health care overhaul was being rammed through Congress without their input. Their objections were somewhat off base. The Affordable Care Act, which came to be known as Obamacare, borrowed heavily from a 1990s Republican bill, included multiple GOP amendments, and sprang initially in the Senate from a bipartisan group of six. (7/25)

USA Today: Our Plan Replaces Failing Obamacare
We recognize that securing Americans’ health care future is absolutely paramount. The Senate can now vote on a variety of bipartisan proposals and amendments to ensure that every American has access to quality, affordable care. The process of repealing the Affordable Care Act began in November 2010, when voters across the country rejected the bill and sent the largest freshman class since World War II to the House of Representatives. (Sen. Tim Scott, R-S.C., 7/25)

The Wall Street Journal: A GOP Gallows Reprieve
Louisiana Republican John Kennedy cracked to Politico this week that “the sight of the gallows focuses the mind,” and perhaps that explains why after months of group therapy Senate Republicans finally voted Tuesday to open debate on repealing ObamaCare. Whatever the impetus, the vote kept GOP reform hopes alive and may have saved the GOP Congress. (7/25)

RealClear Health: It’s Still Mission Impossible For The Senate GOP’s Health Plan
Yesterday, Senate Majority Leader Mitch McConnell did the seemingly impossible and got the votes he needed to proceed to consideration of the House-passed plan for repealing and replacing the Affordable Care Act (ACA). At this point, it’s hard to tell what exactly will happen in the coming days, but there is one thing that is fairly certain: if the current Republican effort succeeds in passing a bill, the legislation will make the individual insurance market less stable than it is under current law. (James C. Capretts, 7/26)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Perspectives: Too Often In U.S. Profit Comes Before Public Interest

Read recent commentaries about drug-cost issues.

The New York Times: The Tasmanian Hep C Buyers’ Club
In 2014, when Greg Jefferys’s urine started smelling like dead meat, he knew there was something seriously wrong. For weeks, Jefferys, an Australian then 60 years old, had felt fatigued and noticed that just a slight bump would leave a dark purple bruise on his skin. Blood tests revealed to Jefferys that he had chronic hepatitis C – a disease he’d never heard of. (Sophie Cousins, 7/25)

Forbes: When It Comes To Abusive Drug Pricing, Don’t Confuse Shkreli With Hep C Drugs
Drug pricing is a topic commanding a lot of attention these days, particularly as healthcare in the U.S. is a national focus. The debate isn’t simple. The ways that drugs are distributed and paid for in this country can be best described as convoluted. Froma Harrop, a nationally syndicated, award-winning columnist who focuses on the financial world, has recently weighed in on this discussion with her op-ed “America’s addiction to abusive drug pricing.” Given her reputation, one would expect that her views would add substance to the debate. Instead, her op-ed is fraught with inaccuracies. (John LaMattina, 7/19)

Los Angeles Times: Shining A Light On Prescription Drug Pricing
After years of failed efforts, the California Legislature may finally pass a bill that responds to the problem of rising prescription drug costs. But temper your enthusiasm: Though this measure (SB 17) has been fiercely resisted by the pharmaceutical industry, it wouldn’t actually stop manufacturers from raising their prices as high as they think the market will bear. It would just make them reveal more about the cost and value of their drugs as they do so. (7/24)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Democrats Announce Three-Pronged Plan To Tackle High Drug Prices

News outlets report on stories related to pharmaceutical pricing.

Politico: Democrats’ ‘Better Deal’ Would Penalize Drug Price Hikes
Democrats are going straight at one of the top concerns of voters, using the rising cost of drugs to strike a more populist tone and counter President Donald Trump, who campaigned hard against the power of the drug industry, but took a friendlier stance after taking office. Congressional Democrats [on Monday] laid out a three-pronged approach to lower the cost of prescription drugs in the United States that aims to stop large price increases and give the federal government more power to influence what Medicare pays for medicines. (Karlin-Smith, 7/24)

CNBC: Democrats Take Aim At Big Business, Drug Prices, In Economic Campaign
Democrats are proposing an independent agency to tackle the high cost of prescription drugs. The director would be appointed by the president and confirmed by the Senate, charged with investigating drug manufacturers and able to slap fines on companies with exorbitant rate hikes. Pharmaceutical companies would also be required to notify the government of substantial price increases. (Mui, 7/23)

Stat: How Pricey Is Your Drug? These 10 Sold The Most In The U.S. Last Year
Awhopping $450 billion was spent in the United States on prescription drugs last year. Topping the list, perhaps unsurprisingly, are medications whose patents were still in force or had recently expired. When a patent expires, generic versions — or biosimilar versions of biologic drugs — can become available, driving down costs that in turn make them accessible to more patients. (Blau, 7/25)

Stat: FDA May Publicly Shame Drug Makers For Thwarting Generic Rivals
The idea is to break a logjam caused by an FDA program that is designed to boost safety. Typically such a program, known as a Risk Evaluation and Mitigation Strategy, requires drug makers to develop a plan to educate doctors and monitor distribution. But generic companies claim they have been denied samples of brand-name drugs needed to conduct product testing in order to win FDA approval. Brand-name companies argue that REMS programs do not permit such sharing. (Silverman, 7/19)

FierceHealthcare: Democrats Revive Calls For Medicare To Negotiate Drug Prices
As part of their newly unveiled “Better Deal” agenda, congressional Democrats are pledging to tackle one of healthcare’s thorniest issues—the high cost of prescription drugs. “Right now, there’s nothing to stop vulture capitalists from egregiously raising the price of life-saving drugs without any justification,” Senate Minority Leader Chuck Schumer, D-N.Y., said during a press conference Monday. (Small, 7/25)

Stat: Ohio Places Drug Pricing Measure On Its November Ballot
In a blow to the pharmaceutical industry, Ohio state officials have approved a controversial initiative designed to lower drug prices for the November ballot. Known as the Ohio Drug Price Relief Act, the ballot measure would require state agencies to pay no more for medicines than the Department of Veterans Affairs. The agency currently gets a 24 percent federally mandated discount off average manufacturer prices. (Silverman, 7/21)

The Blade: Television Ads Clash Over Ohio Drug Price Relief Act
The conflicting claims in the prescription drug issue that will be on the Ohio ballot in November are enough to cause a headache. Or even something requiring a prescription. The most recent flurry of ads last week on broadcast television attacked the previous flurry of TV ads, each accusing the other of deceptive tactics to manipulate Ohio voters. What to believe? (Troy, 7/24)

The Associated Press: ‘Pharma Bro’ Won’t Stop Talking, Except To Jury In Trial
“Pharma Bro” Martin Shkreli has kept up his trademark trolling on social media during his securities fraud trial — calling the case “bogus” — but the jury won’t hear him defend himself in court. The government’s last witness testified on Tuesday, a day after a lawyer for the former biotech CEO told the court that his client had chosen not to take the witness stand. Closing arguments are expected later this week. (Hays, 7/26)

Stat: Proposed Rule To Bolster Safety Data On Generic Drug Labels May Be Dead
Once again, a controversial rule for updating generic drug labeling is being postponed, but this time, its chances of being implemented appear slimmer than ever, according to consumer advocates. The rule was proposed four years ago by the Food and Drug Administration in an effort to bolster patient safety. Specifically, the rule would allow generic drug makers to independently update safety warnings, something only brand-name drug makers can currently do before receiving FDA permission. (Silverman, 7/24)

Marketplace: Drug Prices: How Generics Changed The Game
For a time, high drug prices made headlines, and it looked like the issue could be tackled by the Trump administration. But as we all know, efforts to repeal Obamacare have consumed Republicans much of this year. The drug problem hasn’t gone away; it’s just lingering in the background. Even the cost of some generic drugs are rising. (Gornstein, 7/25)

CQ Roll Call: FDA Notice Buys Senate More Time On User Fee Bill
The Food and Drug Administration will delay issuing furlough notices to employees whose salaries depend on congressional action renewing the agency’s fee-collection authority, FDA Commissioner Scott Gottlieb announced Monday in an email obtained by CQ. Gottlieb’s announcement effectively gives Congress until Sept. 30 to pass a bill that would provide the agency with about $1.4 billion in annual funding through fiscal 2022 from the prescription drug and medical device industries. That money mostly goes to the salaries of employees who review medical product applications. Lawmakers previously believed the agency would begin issuing furlough notices 60 days before funding lapsed on Sept. 30, and were aiming to finish work on the bill by late July. (Siddons, 7/24)

Stat: How Do You Measure Value In A Drug — Or Anything Else In Medicine?
At a swanky hotel in the Theatre District, about a dozen health policy experts and drug development academics gathered Wednesday to talk drug pricing. Speakers on the Manhattan Institute-curated panel see a future where the amount of money people pay for pharmaceuticals has something to do with how much “value” they provide — but seemed to have more questions than answers about what that actually means. (Swetlitz, 7/19)

The New York Times: Celgene To Pay $280 Million To Settle Fraud Suit Over Cancer Drugs
The pharmaceutical company Celgene has agreed to pay $280 million to settle claims that it marketed the cancer drugs Thalomid and Revlimid for unapproved uses, the company said on Tuesday. Under the terms of the settlement, which resulted from a lawsuit filed by a whistle-blower — a former sales representative at Celgene — the company will pay $259.3 million to the United States and $20.7 million to 28 states and the District of Columbia. (Thomas, 7/25)

Stat: A New HIV Drug’s Strong Results Give A Big Boost To Gilead Sciences
An experimental HIV pill from Gilead Sciences suppressed the virus in newly diagnosed patients at a rate statistically equivalent to that of a similar, rival drug from GlaxoSmithKline, according to results from a late-stage clinical trial presented Monday. The positive data supporting Gilead’s new HIV pill, a second-generation integrase inhibitor called bictegravir, are vitally important to the Foster City, Calif.-based biotech company. Sales of Gilead’s hepatitis C drugs are falling and its oncology pipeline has largely disappointed, so the company is once again reliant on its HIV business for the majority of its profits. (Feuerstein, 7/24)

Stat: AbbVie Must Pay $150 Million For Misleading AndroGel Marketing
In a split decision, a federal jury in Chicago ordered AbbVie to pay $150 million in punitive damages for fraudulently misrepresenting the risks of its AndroGel testosterone replacement drug. But at the same time, the jury decided the drug maker was not liable for a heart attack that the plaintiff, Jesse Mitchell, suffered after taking the medication. The trial was the first in an estimated 6,000 lawsuits that the drug maker faces over its controversial marketing, which warned that low testosterone can interfere with sex drive, moods, and energy levels. However, the increased usage was accompanied by dueling medical studies — and subsequent debate — over the extent to which AndroGel and other such drugs could increase cardiovascular risks. (Silverman, 7/24)

Boston Globe: Vertex Reports Strong Findings From Cystic Fibrosis Drug Trials
Vertex Pharmaceuticals Inc. on Tuesday released clinical findings showing its new approach to combating cystic fibrosis substantially improved lung function in patients, lifting hopes for a treatment that could be used by about 68,000 people worldwide — including 24,000 who don’t respond to any existing medicines. The results prompted Boston-based Vertex to say it plans to launch one or two late-stage clinical trials of the biotech’s three-drug combination in the first half of next year. (Weisman, 7/18)

Stat: Merck: Keytruda Trial Comes Up Short In Head And Neck Cancer, But FDA Approval Stays
Merck’s checkpoint inhibitor Keytruda doesn’t help patients with advanced head and neck cancer live longer, but the failed phase 3 clinical trial, announced Monday night, won’t compel the FDA to rescind the drug’s conditional approval, the company said. And with that, the pile of evidence pointing towards FDA’s extreme flexibility when it comes to easy drug approvals grows even larger. (Feuerstein, 7/24)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Audit Of Colo. Insurance Exchange Still Finds Deficiencies; Indian Reservation Declares Public Emergency Over Opioid Crisis

Media outlets report on news from Colorado, Missouri, Minnesota, California, Florida, Massachusetts, Texas, Kansas and Wisconsin.

Denver Post: Connect For Health Colorado Is Making Progress To Fix Accounting Troubles
Colorado’s health insurance exchange has made progress in addressing repeated accounting troubles but still fails to always follow its own policies when it comes to contracts and purchases, according to a state audit released Tuesday. The audit of the exchange, known as Connect for Health Colorado, found that 11 percent of payments analyzed — which came out to about $50,000 — did not have the proper documentation. The same was true for nearly $4 million in contract costs. In one instance, the audit found that Connect for Health’s general counsel signed off on a nearly $3 million database contract despite not having the authority to do so for contracts that big. (Ingold, 7/25)

The Star Tribune: Red Lake Indian Reservation Declares Public Health Emergency Over Drug Epidemic
A rampant heroin and opiate epidemic on the Red Lake Indian Reservation has prompted tribal leaders to declare a public health emergency, seek outside help in addressing the crisis and consider the extraordinary step of banishing tribal members involved in drug dealing. … Overdoses on the northern Minnesota reservation have increased significantly in the past few months, tribal leaders said, adding that the problem has worsened with the arrival of more heroin and more of it laced with deadly fentanyl. (Smith, 7/26)

Los Angeles Times: Pasadena Officer Who Investigated Overdose Was Skeptical Of USC Med School Dean’s Story, Recording Shows
The police officer who last year questioned the then-dean of USC’s medical school about his role in the drug overdose of a young woman expressed skepticism at Dr. Carmen Puliafito’s account, according to an audio recording that was made by the officer and released Tuesday. Puliafito told the officer he was at the Pasadena hotel room where the overdose occurred as a family friend to help the woman, who was later rushed to Huntington Memorial Hospital. (Elmahrek, Pringle, Parvini and Hamilton, 7/25)

Miami Herald: Jackson Health Proposes $1.9 Billion Spending Plan For 2018
Jackson Health System is counting on growth in its core operations — plus an estimated $442 million from Miami-Dade taxpayers — to break even on a proposed $1.9 billion spending plan for 2018 approved by hospital trustees on Tuesday. Salaries and benefits for Jackson’s 12,000 full-time employees, who will receive an average 2 percent pay raise next year, tops the hospital system’s list of expenses for next year at about $1.1 billion or 59 percent of the total. (Chang, 7/25)

The Star Tribune: Minneapolis Menthol Tobacco Sales Restriction Vote Delayed Until Aug. 2
Opponents of restricting menthol tobacco sales in Minneapolis claimed victory Tuesday after a City Council committee failed to vote on the ordinance and send it to the full council, though members will vote on the proposal Aug. 2. An already-depleted Health, Environment and Community Engagement Committee fell to three members and lost its quorum when Council Member Alondra Cano stepped out near the end of a lengthy public hearing, delaying the vote. (Belz, 7/25)

St. Louis Public Radio: Missouri Doctor Grapples With State’s High Rate Of Deaths In Childbirth
Twice as many United States women are dying in childbirth today as in 1990, even though all other wealthy nations have seen declines in maternal mortality rates. …Dr. Shilpa Babbar, who specializes in high-risk pregnancies at SSM Health St. Mary’s Hospital in St. Louis County, said that rising rates of obesity and women having children later in life may help explain these figures. (Bouscaren, 7/26)

Health News Florida: Nonprofit Group: HIV Infections Up In Florida
A nonprofit that serves Central Florida residents with HIV and AIDS says the rates are going up. …[Joshua] Meyers said the Ryan White figures show 600 new HIV infections in Orlando last year, which made Orlando the city with the sixth highest infection rate in the country – up from No. 8. (Aboraya, 7/25)

KQED: California Decides All Drinking Water Must Be Tested For A Toxin. But Who Pays?
The State Water Resources Control Board on July 18 adopted the strictest possible standard (5 parts per trillion or less) for the contaminant in public drinking water. …Statewide, the tap water of about a million Californians is known to contain TCP at levels higher than that, according to data from the state water board. (O’Neill, 7/25)

Minnesota Public Radio: Threats To Drinking Water Supplies Intensifying, Health Dept. Says
Minnesota’s public drinking water supplies are in good shape, according the state’s Department of Health, but a new report also warns agencies should remain prepared for that to change. …Minnesota also needs to be prepared to address other pollution in the water supply, including nitrate contamination, which the report states is an ongoing concern for a several areas of the state. (Richert, 7/25)

The Star Tribune: Baby Deliveries To End At St. Joseph’s Hospital In St. Paul
Facing changing demographics and a steep dropoff in demand, the state’s oldest hospital will discontinue maternity care this year. HealthEast Care System’s St. Joseph’s Hospital made the move because fewer women are choosing the St. Paul facility for their baby deliveries. Health system leaders announced the decision Tuesday, noting that women will still be admitted for maternity care through Sept. 7 and that babies will still be delivered until Sept. 10 at HealthEast’s flagship hospital — Minnesota’s first hospital when it was founded in 1853. (Olson, 7/25)

Texas Tribune: Texas Senate Approves Teacher Bonuses, Benefits — But Not Pay Raises
The Texas Senate on Tuesday approved legislation to give teachers bonuses and to improve retired teachers’ health benefits — but only after the bill’s author removed a controversial provision requiring school districts to cover the cost of teacher pay raises. The upper chamber voted 28-3 to give initial approval to Senate Bill 19, authored by Sen. Jane Nelson, R-Flower Mound, which would borrow money from the Texas Health and Human Services Commission to pay for $193 million in statewide teacher bonuses and inject $212 million into a faltering state-run health insurance program for retired teachers. (Swaby, 7/25)

Pioneer Press: St. Joseph’s Hospital Plans To Close Maternity Ward
Minnesota’s oldest hospital will no longer be a destination to deliver babies. St. Joseph’s Hospital in downtown St. Paul will close its maternity ward Sept. 10, according to Fairview HealthEast, which operates the 164-year-old downtown hospital. The decision comes after HealthEast merged with Fairview Health Services earlier this year and is the result of mothers choosing to give birth in the suburbs, according to a Fairview HealthEast statement Tuesday. (Orrick, 7/25)

Kansas City Star: Kansas City Chatbot To Help Prescription Filling
A Kansas City team this week won an award from the Robert Wood Johnson Foundation for developing a robotic chat app that could steer you to a place where that prescription won’t break your budget. Project Helix — a collaboration of KC Digital Drive and two consulting outfits — aimed to help patients navigate the dizzying worlds where prescriptions, pharmacy prices and often inscrutable insurance plans overlap. (Canon, 7/25)

Milwaukee Journal Sentinel: Wisconsin DNR Says Milwaukee Industrial Barrel Plants Broke Environmental Laws
Three Milwaukee-area industrial barrel refurbishing plants have been cited by state regulators for violating 19 environmental laws, including misrepresenting information and sending hazardous ash to a landfill not permitted to handle such waste. Inspectors found that the plants handled, stored and shipped hazardous waste without permits, failed to keep numerous required records, and continued to spew putrid odors over neighborhoods three years after similar smells were noted by inspectors. (Diedrich and Barrett, 7/25)

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Missouri Poised To Enact Stricter Abortion Regulations

Lawmakers approved a bill that provides the state’s attorney general with more power to prosecute abortion law violations and requires doctors to meet with patients three days before the procedure, among other rules. The bill has been sent to Republican Gov. Eric Greitens, who is expected to sign it.

The Associated Press: Missouri Sends Governor Law Tightening Abortion Regulations
Missouri lawmakers on Tuesday delivered Republican Gov. Eric Greitens a political win by sending him a wide-ranging bill tightening abortion regulations that would give the attorney general power to prosecute violations, prompting critics to say the changes are aimed at limiting access to abortion in a state that already has tough restrictions. (Ballentine, 7/25)

St. Louis Public Radio: New Abortion Regulations Headed To Missouri Governor, Ending 2nd Special Session
Physicians will have to meet with women seeking abortions three days before the procedure and Missouri’s attorney general will have the ability to enforce abortion laws under the bill headed to Gov. Eric Greitens on Tuesday. … Supporters say the legislation, sponsored by Sen. Andrew Koenig, R-Manchester, will make clinics safer, while critics contend it will make it harder for women to obtain abortions. (Rosenbaum, 7/25)

And in Texas —

Texas Tribune: Senate Approves Abortion-Related Bill In Overnight Vote
The Texas Senate gaveled in around 10 a.m. Tuesday, but it wasn’t until past midnight that lawmakers turned their attention to Senate Bill 4, an anti-abortion measure that was initially approved over objections from Democrats. Passed in a 21-10 vote, the measure prohibits local and state government agencies from contracting with abortion providers and their affiliates. (Smith and Najmabadi, 7/26)

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Male Reproductive Health On The Decline

The decline in quality and concentration of men’s sperm has been a matter of hot debate, but one comprehensive study hopes to put any doubts to rest. In other public health news: flesh-eating bacteria, medical ethics, boosting resilience in midlife, injuries in young athletes and stem cell clinics.

The Washington Post: Sperm Concentration Has Declined 50 Percent In 40 Years In Three Continents
The quality of sperm from men in North America, Europe and Australia has declined dramatically over the past 40 years, with a 52.4 percent drop in sperm concentration, according to a study published Tuesday. The research — the largest and most comprehensive look at the topic, involving data from 185 studies and 42,000 men around the world between 1973 and 2011 — appears to confirm fears that male reproductive health may be declining. (Cha, 7/25)

Stat: Flesh-Eating Bacteria: 5 Things To Know After A Hiker’s Almost-Fatal Infection
Last month, a few minor blisters turned into a flesh-eating nightmare for hiker Wayne Atkins, who developed a dangerous bacterial infection after climbing Mount Garfield, a 4,500-foot peak in New Hampshire. Atkins survived, but barely: He spent 2 1/2 weeks in a medically induced coma while doctors pumped him full of antibiotics and removed chunks of his flesh to get rid of the infection. And Atkins was lucky, relatively speaking: Infection with flesh-eating bacteria is considered a surgical emergency, and can require limb amputation. One in four people with necrotizing fasciitis dies. (Caruso, 7/25)

WBUR: Medical Ethics: In The Charlie Gard Case, Listen To The Nurses
The tragic spectacle of the legal battle over Charlie Gard, the 11-month-old British baby whose genetic disease has inflicted catastrophic and irreversible brain damage, appears to be drawing to a close. …<span>But perhaps most troubling of all for me is the abuse of the nurses and other medical staff caring for Charlie, who has lived nearly his all his days on life support and mechanical ventilation.</span> (McLean, 7/25)

NPR: Young Athletes Who Specialize Too Soon Risk More Injuries
If you’re involved in high school athletics, you know the scene. There’s increasing pressure to specialize in a single sport and play it year-round. The upside? Focusing on one sport can help give kids the edge they need to compete on elite club teams — or travel teams. Many athletes hope to attract the attention of college recruiters, or be offered a sports scholarship. This emphasis on competitive success has become widespread throughout the U.S., according to a consensus statement from the American Medical Society for Sports Medicine. (Aubrey, 7/25)

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Comprehensive Brain Injury Study Finds Extreme Prevalence Of Brain Injury In NFL Players

The study showed that 110 out of 111 brains had signs of chronic traumatic encephalopathy, causes myriad symptoms, including memory loss, confusion, depression and dementia.

The New York Times: 111 N.F.L. Brains. All But One Had C.T.E.
Dr. Ann McKee, a neuropathologist, has examined the brains of 202 deceased football players. A broad survey of her findings was published on Tuesday in The Journal of the American Medical Association. (Joe Ward, Josh Williams and Sam Manchester, 7/25)

Atlanta Journal-Constitution: Study: CTE Found In 99 Percent Of Former NFL Players’ Brains
In the 202 total brains belonging to men who played football on all levels, researchers found CTE in 177. Out of the 14 brains of men who only reached the high school football level, three brains were diagnosed with CTE. Forty-eight of 53 brains belonging to men who stopped playing football after the college level also were also diagnosed with CTE. (Culpepper, 7/25)

WBUR: Study: CTE Found In Nearly All Donated NFL Player Brains
“While we still don’t know what the incidence is in the general population or in the general population of football players,” [Dr. Ann McKee] says, “the fact that we were able to gather this many cases [in that time frame] says this disease is much more common than we previously realized.” (Goldman, 7/25)

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How Tattoos Might Affect Your Workout

By GRETCHEN REYNOLDS

Tattoos may permanently alter the physiology of skin in ways that affect sweating.

According to a small, new study, the amount and saltiness of sweat change after skin has been dyed, a finding that might have implications for athletes who ink large swaths of their bodies and maybe even for those of us who sport one or two discreet tattoos (such as the small one on my right shoulder, in case you were wondering).

Tattoos are decorative, often metaphoric, sometimes regrettable, but always injurious. To create a tattoo, the artist punctures the skin with dye-filled needles at a rate of up to 3,000 times per minute. The dye is injected into the skin’s dermal layer, which is also where most sweat glands are.

The body recognizes these injections as abnormal. They have slightly damaged the tissue and left behind a foreign substance, the ink. So the immune system gears up, sending a variety of cells to the site of the inking. Some cells carry off tiny amounts of the ink, primarily to the lymph nodes, where it dissipates. Other immune cells merge with the remaining ink, so that both become long-term residents of that portion of the skin. Still other cells initiate an inflammatory response, helping the injured tissue to mend, which it usually does within a few weeks.

As anyone who watches sports knows, tattoos are popular with athletes. By some estimates, at least half of collegiate and professional basketball players have tattoos that cover much of their chest and arms. The incidence seems to be equally high among football and soccer players and many other athletes.

But no one had studied whether tattoos might in any way affect the physiology of the skin and, in particular, the operation of the sweat glands. That possibility matters, since normal, healthy sweat glands are important for athletes (and everyone else). We cool our bodies in large part through sweating. Sweating also releases sodium and other electrolytes.

So recently, Maurie Luetkemeier, a professor of integrative physiology and health science at Alma College in Alma, Mich., and two of his undergraduate students, Joe Hanisko and Kyle Aho, decided to look closely at how tattooed skin sweats.

For their study, which was published recently in Medicine & Science in Sports & Exercise, they began by recruiting 10 healthy, young men with a tattoo on one side of their upper bodies. That tattoo had to be matched by an equal amount of untattooed skin on the other side. In other words, a heart, dragon or John Deere cap (yes, O.K., that is my tattoo) on the right shoulder would be balanced by untattooed skin at the same location on the left shoulder. Some of these tattoos were recent; others were three or four years old.

The researchers then applied small chemical patches to both the tattooed and untattooed skin. These patches contained pilocarpine nitrate, a substance that initiates sweating. (It is commonly used to test for cystic fibrosis.)

Immediately after the skin had been exposed to the pilocarpine, the scientists swapped the patches for small spiral-shape discs designed to absorb the resulting perspiration. The volunteers wore these discs for 20 minutes, while their skin obediently sweated.

It did not sweat evenly on each side, however, the scientists soon discovered, after they had removed, weighed and examined the discs. The discs that had been situated above the tattooed skin were much lighter, it turned out. In fact, each man’s tattooed skin had produced barely half as much sweat as his untinted skin.

The composition of this sweat also was different, the scientists found. The perspiration from the tattooed skin contained nearly twice as much sodium as sweat from the corresponding, untattooed side.

Interestingly, the results were the same, whatever the age of the tattoo. Older tattoos altered sweating in the same way as newer tattoos did.

That finding suggests that the underlying cause of the shift in sweat probably involves permanent changes within the skin after tattooing, Dr. Luetkemeier says. Perhaps bits of the remaining dye block some of the sweat glands. But more probably, he says, lingering inflammatory cells change the chemical environment within that area of the skin in ways that slow the response of the glands and affect how much sodium is incorporated from nearby cells into the sweat.

Of course, this was a very small study and involved chemically induced perspiration. The men were not exercising to create body heat and sweat. They also were not women or elderly. Dr. Luetkemeier and his students plan to study more expansive groups of volunteers in more real-world situations soon.

Perhaps most important, the study does not indicate that those of us with tattoos should sweat too much about our lack of sweat, Dr. Luetkemeier says. It is “unlikely,” he says that tattoos would impede perspiration enough to contribute to overheating or other problems in most people, even during exercise.

“In other situations,” he says, “such as where someone has been severely burned” and lost the sweat glands in the affected skin, “the body compensates,” he says, by increasing sweating from uninjured skin.

First Edition: July 26, 2017

Jul 26 2017

Today’s early morning highlights from the major news organizations.

Kaiser Health News: Postcard From Capitol Hill: What YouTube Didn’t Show You In Senate Health Care Vote
You had to be there. After days of uncertainty about whether Senate Republicans would vote to begin debating a bill to repeal the Affordable Care Act, it boiled down to a few tense minutes on the Senate floor. As the vote started shortly after 2 p.m. ET, 30 reporters crammed into the small hallway in front of the chamber, waiting for Arizona Republican Sen. John McCain’s dramatic arrival on the elevator. (Bluth, 7/25)

Kaiser Health News: Paid Parental Leave May Be The Idea That Transcends Politics
Tameka Henry takes care of her disabled husband, her 87-year-old grandfather and her four children, ages 10 to 16. Two of her kids have asthma. Her husband has a chronic intestinal condition, diabetes and congestive heart failure. He’s unemployed. Henry, who makes around $30,000 a year as a case administrator for a behavioral health care provider, saves up sick days and vacation time to use when someone in the family is sick or needs help. Her husband, she said, often needs hours of daily care. (Findlay, 7/26)

The Associated Press: Senate Opens ‘Obamacare’ Debate At Last But Outcome In Doubt
Prodded by President Donald Trump, a bitterly divided Senate voted, at last, Tuesday to move forward with the Republicans’ long-promised legislation to repeal and replace “Obamacare.” There was high drama as Sen. John McCain returned to the Capitol for the first time after being diagnosed with brain cancer to cast a decisive “yes” vote. The final tally was 51-50, with Vice President Mike Pence, exercising his constitutional prerogative, breaking the tie after two Republicans joined all 48 Democrats in voting “no.” (7/25)

The New York Times: Senate Health Care Decision: Pence Breaks Senate Tie
Senators Shelley Moore Capito of West Virginia, Dean Heller of Nevada and Rob Portman of Ohio, three Republicans who have expressed profound doubts about legislation to repeal and replace the Affordable Care Act, announced Tuesday they will vote to begin debate on the future of health care. (Kaplan, Abelson and Pear, 7/25)

The Wall Street Journal: Senate Health Debate Rolls On After First Option Fails
Even with their surprise win on the procedural motion, which seemed a long shot just last week, Republicans were subdued Tuesday about their prospects of passing a sweeping overhaul of the ACA by week’s end. “We knew this wasn’t going to be easy, and there’s a lot of work ahead of us,” said Sen. John Thune of South Dakota, a member of the Senate GOP leadership. (Armour, Peterson and Hackman, 7/25)

Politico: McConnell Gets A Win In Obamacare Repeal Opening Round
The Senate faces several days of heated debate and tough votes, with the final outcome in doubt. Can Republicans actually repeal and replace Obamacare? Or simply repeal it? Can they roll back the expansion of Medicaid under the Affordable Care Act, which resulted in millions of more enrollees? What about eliminating Obamacare taxes? And defunding Planned Parenthood? What about a “skinny repeal” bill that would get rid of the employer and individual mandates under Obamacare while leaving almost all the rest of the legislation in place? All this is still up in the air. (Bresnahan, 7/25)

Los Angeles Times: With Pence Breaking A Tie, Senate Votes To Begin Debate On Obamacare Repeal Bill
To get to this point, McConnell had to abandon the customary legislative process, forgoing public hearings and committee debate in a way almost never seen for major legislative proposals. And he left Republican lawmakers with a series of legislative options — which polls show are deeply unpopular with Americans — that would leave as many as 32 million more people without health coverage and weaken health protections for tens of millions more. (Levey, 7/25)

Politico: How The GOP Brought Obamacare Repeal Back From The Dead
As Mitch McConnell strode to the Senate floor on Tuesday, with no votes to spare to keep the GOP’s Obamacare repeal campaign alive, he knew where everyone in his conference stood. Everyone, that is, except for Ron Johnson. (Everett, Kim and Haberkorn, 7/25)

The New York Times: Senate Votes Down Broad Obamacare Repeal
The Senate voted narrowly on Tuesday to begin debate on a bill to repeal major provisions of the Affordable Care Act, but hours later, Republican leaders suffered a setback when their most comprehensive plan to replace President Barack Obama’s health law fell far short of the votes it needed. The Tuesday night tally needed to reach 60 votes to overcome a parliamentary objection. Instead, it fell 43-57. (Kaplan and Pear, 7/25)

The Associated Press: Republicans Collins, Murkowski Oppose GOP Health Vote
Two Republican senators — Susan Collins of Maine and Lisa Murkowski of Alaska — broke with their party and opposed the Senate vote to move ahead on a health care overhaul. The votes by the two women drew criticism from President Donald Trump, who said, “So we had two Republicans that went against us, which is very sad, I think. It’s very, very sad for them.” (7/25)

The Wall Street Journal: Trump Is Optimistic Senate Will Vote To Begin Debate On Bill To Repeal Obamacare
Mr. Trump, in a 45-minute interview with The Wall Street Journal, said he has been working to secure the 50 votes needed to pass the measure, which he described as a difficult but crucial step toward ultimately putting in place a health-care system that would replace former President Barack Obama’s Affordable Care Act. “I think we’re doing pretty well on health care,” the president said in the Oval Office interview. “We’ll see.” (Nicholas, 7/25)

The Associated Press: McCain Delivers A Key Health Care Vote, Scolding Message
The maverick stood with his party on Tuesday, casting a crucial vote in the Republican drive to repeal “Obamacare.” But then, like an angry prophet, Sen. John McCain condemned the tribal politics besetting the nation. Confronting an aggressive brain cancer, the 80-year-old Arizonan served notice he would not vote for the GOP legislation as it stands now. McCain’s impassioned speech held the rapt attention of his colleagues in the Senate chamber. (7/26)

The New York Times: McCain Returns To Cast Vote To Help The President Who Derided Him
He said that although he had voted to begin debate on repealing the Affordable Care Act, he would definitely not vote for a Senate health care bill without major changes. As it turned out, however, Mr. McCain did side late Tuesday with most Senate Republicans who voted — unsuccessfully — to replace the health care law with the most comprehensive plan his party has offered so far. (Steinhauer, 7/25)

The Washington Post: ‘We’re Getting Nothing Done’: McCain, In Emotional Return, Laments What The Senate Has Become
“Let’s trust each other. Let’s return to regular order. We’ve been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle,” McCain told his colleagues, who gave him the floor for an unusual address usually reserved for a retiring senator. “We’re getting nothing done, my friends. We’re getting nothing done.” (Kane, 7/25)

The Wall Street Journal: McCain Returns To Senate With Calls For Bipartisanship
The senator spared no one—not himself, not Senate Majority Leader Mitch McConnell (R., Ky.). “Sometimes I made it harder to find common ground because of something harsh I said to a colleague,” Mr. McCain said. “Sometimes I wanted to win more for the sake of winning than to achieve a contested policy.” (Hughes, 7/25)

Politico: McCain Returns — Backing And Blasting His Own Party
Trump hailed McCain in not one but two Tuesday tweets. The president called McCain an “American hero,” apparently changing his mind two years after declaring on the campaign trail that “he’s not a war hero” and “I like people who weren’t captured.” McCain spent more than five years as a prisoner of war in Vietnam, earning several medals for valor. (Schor, 7/25)

The Wall Street Journal: Health-Care Bill: What’s Next?
Under the procedural rules Senate Republicans have adopted to pass health-care legislation with a simple majority, rather than the 60 votes usually needed, they are limited in how much of the ACA they can repeal. Any measure must be generally related to taxes or spending. So only parts of the ACA can be knocked down, and only certain kinds of replacements can be proposed. (Armour, 7/26)

The Associated Press: Vote Shows GOP’s Problems In Replacing Obama Health Law
Senators planned to vote Wednesday on a Republican amendment repealing much of President Barack Obama’s law and giving Congress two years to concoct a replacement. A combination of solid Democratic opposition and Republicans unwilling to tear down the law without a replacement in hand were expected to defeat that plan. (7/26)

USA Today: The Senate Agreed To Debate A Health Care Bill. Now What?
But even with conservative support, the clean repeal is not likely to pass because at least three Republican senators — Susan Collins of Maine, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia — have all said they wouldn’t vote for a repeal without a replacement. Other lawmakers have also expressed concern. (Collins and Shesgreen, 7/25)

Politico: What’s Next In The Senate Repeal Saga? Good Question 
Once the Senate burns through its 20 hours of debate, split among Republicans and Democrats, it goes to a vote-a-rama, which at this point looks like it will be late Thursday. Theoretically that allows for unlimited amendments as long as they are relevant. But probably a few dozen will be voted on. (Demko, 7/25)

The New York Times: ‘Skinny’ Obamacare Repeal Would Clash With Republicans’ Health Care Promises
If the current options for overhauling the health care system can’t get a majority of Senate votes, the majority leader, Mitch McConnell, has a new backup plan, according to senators and lobbyists: a simple bill that eliminates three of Obamacare’s least popular provisions. The plan, which has been nicknamed “skinny repeal,” would eliminate the Affordable Care Act’s individual mandate, the employer mandate and a tax on medical devices, at least for a few years. (Sanger-Katz, 7/25)

The Washington Post: ‘Skinny Repeal’ Could Be The Senate’s Health-Care Bill Of Last Resort
In substance, this plan would repeal just three parts of the ACA, according to several sources familiar with the approach. It would eliminate the requirement that most Americans carry health insurance as well as the requirement that employers with at least 50 full-time employees offer coverage to their workers. Both are central elements of the 2010 health-care law and its least popular aspects with the public. The “skinny” plan also would rescind the tax on medical devices, one of several taxes the ACA created to help pay for other elements of the law. A close variant of this surfaced two years ago in the House, as part of the GOP’s strategy back then to lower federal deficits. Congressional budget analysts estimated at the time that 15 million fewer Americans would have insurance coverage “most years” as a result. (Goldstein, 7/25)

Politico: McConnell’s Fallback: A ‘Skinny’ ACA Repeal
The plan wouldn’t touch Obamacare’s Medicaid expansion, making it more palatable to Senate moderates. But it could trigger significant resistance by preserving the ACA’s insurance regulations, which senators like Mike Lee of Utah and Rand Paul of Kentucky have insisted need to be struck down. “How do the ultra-conservatives vote for it?” asked one former Senate Republican aide. (Diamond, 7/25)

Reuters: Factbox: What Might Be In U.S. Senate’s Mystery Healthcare Bill
U.S. Senate Republicans were expected to vote on Tuesday for opening debate on a healthcare bill without knowing what is in it, but the potential components of the legislation were clear. Approaches hammered out by Republicans in recent months were expected to be in the mix, with Senate Majority Leader Mitch McConnell making key choices about what is in and what is out, based on how much support a given combination can attract. (Abutaleb, 7/25)

The Washington Post: The GOP Plan To Protect Medicaid Recipients Could Run Out Of Money After 2 Years
Republicans are scrambling to forge a health-care compromise after their effort to undo the Affordable Care Act, also known as Obamacare, fell apart in the Senate last week. One particularly thorny issue is the plight of people in the lower middle class who have benefited from an expansion of Medicaid under the Affordable Care Act, but who might go without that coverage under past versions of the GOP bill. (Ehrenfreund, 7/25)

The New York Times Fact Check: For Trump’s ‘Victims’ Of Obamacare, Senate Bill May Be Worse
Ahead of a Senate vote to begin debate over health care, President Trump pressed Republicans on Monday afternoon to fulfill their seven-year promise to repeal and replace the Affordable Care Act, surrounded by families whom he characterized as “victims” of the law.“ For 17 years, Obamacare has wreaked havoc on the lives of innocent, hard-working Americans,” he mistakenly said of the law, passed in 2010, before listing “terrific reforms” in the Senate bill. Here’s an assessment. (Qui, 7/25)

The Wall Street Journal: Shifting Views On Health Law Challenge GOP
Obamacare had been unpopular for at least the past four years, opinion surveys shows, suggesting that their move to change the law would draw public support. But the Senate action comes amid increased public backing for the 2010 health law—as well as for the idea that the government should play a role in helping people obtain health insurance. That is one reason that moving an overhaul of the law through Congress has been so balky for the GOP. (Chinni, 7/25)

The Associated Press: Key ACA Insurer Urges Gov’t To Keep Customer Subsidies
One of the biggest insurers in the Affordable Care Act’s marketplaces is warning the federal government that it must preserve cost-sharing payments for low-income customers to avoid hurting millions of people. Centene Corp. said Tuesday that a better-than-expected performance in those individual insurance markets prompted it to beat Wall Street expectations in the second quarter and raise its forecast for 2017. (7/25)

The New York Times: Celgene To Pay $280 Million To Settle Fraud Suit Over Cancer Drugs
The pharmaceutical company Celgene has agreed to pay $280 million to settle claims that it marketed the cancer drugs Thalomid and Revlimid for unapproved uses, the company said on Tuesday. Under the terms of the settlement, which resulted from a lawsuit filed by a whistle-blower — a former sales representative at Celgene — the company will pay $259.3 million to the United States and $20.7 million to 28 states and the District of Columbia. (Thomas, 7/25)

Los Angeles Times: Pasadena Officer Who Investigated Overdose Was Skeptical Of USC Med School Dean’s Story, Recording Shows
The police officer who last year questioned the then-dean of USC’s medical school about his role in the drug overdose of a young woman expressed skepticism at Dr. Carmen Puliafito’s account, according to an audio recording that was made by the officer and released Tuesday. Puliafito told the officer he was at the Pasadena hotel room where the overdose occurred as a family friend to help the woman, who was later rushed to Huntington Memorial Hospital. (Elmahrek, Pringle, Parvini and Hamilton, 7/25)

The Washington Post: Sperm Concentration Has Declined 50 Percent In 40 Years In Three Continents
The quality of sperm from men in North America, Europe and Australia has declined dramatically over the past 40 years, with a 52.4 percent drop in sperm concentration, according to a study published Tuesday. The research — the largest and most comprehensive look at the topic, involving data from 185 studies and 42,000 men around the world between 1973 and 2011 — appears to confirm fears that male reproductive health may be declining. (Cha, 7/25)

NPR: Young Athletes Who Specialize Too Soon Risk More Injuries
If you’re involved in high school athletics, you know the scene. There’s increasing pressure to specialize in a single sport and play it year-round. The upside? Focusing on one sport can help give kids the edge they need to compete on elite club teams — or travel teams. Many athletes hope to attract the attention of college recruiters, or be offered a sports scholarship. This emphasis on competitive success has become widespread throughout the U.S., according to a consensus statement from the American Medical Society for Sports Medicine. (Aubrey, 7/25)

The Associated Press: Missouri Sends Governor Law Tightening Abortion Regulations
Missouri lawmakers on Tuesday delivered Republican Gov. Eric Greitens a political win by sending him a wide-ranging bill tightening abortion regulations that would give the attorney general power to prosecute violations, prompting critics to say the changes are aimed at limiting access to abortion in a state that already has tough restrictions. (Ballentine, 7/25)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Obamacare’s History Littered With Near-Death Experiences

Few laws have defied as many existential threats as the Affordable Care Act. In seven years, it has been to the brink of elimination nearly a dozen times, only to rally back from seemingly impossible odds. Efforts to kill it have come from Congress (including one in 2015 that made it all the way to President Barack Obama’s desk before being vetoed), the White House and the courts. So far, the law continues.

As the Senate continues its latest effort to remake the law, here is a timeline of the ACA’s “near-death” experiences, which occurred before the bill passed, during its implementation and after benefits began to flow.

Categories: Courts, Multimedia, Repeal And Replace Watch, The Health Law

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Paid Parental Leave May Be The Idea That Transcends Politics

Tameka Henry takes care of her disabled husband, her 87-year-old grandfather and her four children, ages 10 to 16. Two of her kids have asthma. Her husband has a chronic intestinal condition, diabetes and congestive heart failure. He’s unemployed.

Henry, who makes around $30,000 a year as a case administrator for a behavioral health care provider, saves up sick days and vacation time to use when someone in the family is sick or needs help. Her husband, she said, often needs hours of daily care.

“I haven’t had a vacation in over 10 years,” said Henry, who lives in Las Vegas. “But I know I’m lucky because my employer understands my situation and does give me some time off.”

The problem is that she can’t afford to take much time off without pay. “Money is way too tight for that,” she said.

What Henry’s employer does not provide, nor does her state or the federal government, is paid family or medical leave. Indeed, the U.S. is the only wealthy industrialized country that does not guarantee paid leave to care for a new or adopted child, an ill family member or to address an individual’s own serious health condition.

Both Republicans and Democrats may be moving to change that.

In its 2018 budget, the Trump administration included a national paid leave plan for parents after the birth or adoption of a child. It’s a rare call for a new entitlement program from the administration and not yet been endorsed by GOP leaders on Capitol Hill. Those lawmakers are weighing options to rein in spending on other entitlements, including Medicaid.

First daughter Ivanka Trump heads up the initiative at the White House. Proposed are six weeks of paid leave for mothers and fathers at an estimated annual cost of $25 billion, funded by restructuring the federal unemployment insurance system.

Congressional Democrats, meanwhile, have reintroduced the Family and Medical Insurance Leave, or FAMILY, Act, which they first submitted in 2013. It would permit all workers to take up to 60 individual days of paid leave per year to care for a new child, a sick family member or one’s own illness. Workers would receive up to 66 percent of their regular wages to a maximum $1,000 per week. The program, initially introduced in 2013, would be funded by a 0.4 percent payroll tax on workers’ wages, split evenly between employers and employees.

“We strongly believe this is the right thing to do,” says Vicki Shabo, vice president of the National Partnership for Women & Families in Washington, D.C., which supports the Democrats’ bill. “Why should some people have this benefit and not others based on where they live or the job they have, when it’s clear everyone needs it?”

Republican lawmakers have countered this year with the Strong Families Act. That bill would give employers offering at least two weeks of paid family or medical leave a 25 percent tax credit for wages paid to workers taking up to 12 weeks of leave. The credit would be capped at $3,000 per employee per year. The credit would cease entirely two years after enactment.

Opponents of such government programs don’t dispute the benefits of paid leave. Instead, they argue, it’s best left as a voluntary choice by businesses, which can tailor their policies to the needs of their workforces.

Ivanka Trump recently acknowledged that argument and said any national plan should encourage private companies to provide paid-leave benefits to employees. In a letter to The Wall Street Journal this month, she said a government-run paid-leave program for new parents was necessary for those “who need it the most and are least likely to receive it from their employer.”

“The reality is that in 63% of American homes with children, all parents work. Providing a guaranteed paid-leave program — with a reasonable time limit and benefit cap — isn’t an entitlement, it’s an investment in America’s working families,” Trump wrote. “We see a national paid-leave benefit as the necessary floor from which private sector companies and state governments can build.”

She said the White House was “working with lawmakers on both sides of the aisle to design a paid-leave policy.”

Rush Back To Work

Shifting trends in the economy and increased support for better work-life balance are driving forces behind the interest in paid leave. Just half of new mothers take paid time away from their jobs to care for a new child, and about one-quarter of mothers are back at work within two weeks of giving birth.

As a result, paid leave now has broad public support. According to a Pew Research Center survey of 2,029 adults released in March, 82 percent support paid maternity leave, 69 percent support paid paternity leave, 67 percent support paid family care leave (for an illness in the family), and 85 percent support paid leave to deal with one’s own serious health condition.

“This is an idea whose time has absolutely come,” said Aparna Mathur, an economist at the conservative American Enterprise Institute and co-director of a joint project on paid leave with the liberal Brookings Institution. “But, of course, there’s disagreement about how best to do it. And, yes, it will be an uphill political battle.”

Proponents view paid leave as a win-win for businesses and workers, and the economy as well. They cite research showing that worker retention and loyalty is improved and that abuse of the benefit is rare in states that have enacted paid leave.

States As Testing Ground

Five states and the District of Columbia have enacted paid parental and medical leave laws to date. California, Rhode Island and New Jersey have implemented their programs. New York, Washington, and the District will implement programs in coming years.

The laws require all but the smallest employers to offer between four and 12 weeks of leave after the birth or adoption of a child or to care for a sick family member. Workers are guaranteed from 50 to 90 percent of their income, up to a per-week cap that varies by state. In 2017 for example, that cap was $1,173 in California and $633 in New Jersey.

In April 2016, San Francisco became the first U.S. city to mandate that businesses provide paid leave.

Most U.S. firms do not offer any paid parental or medical leave. That’s especially the case for firms with fewer than 100 workers, which employ about a third of the workforce. All told, about 40 percent of workers have access to some paid leave for the birth of a child, including saved-up sick days. But only an estimated 15 to 18 percent have access to both paid parental leave and medical leave of some sort.

A 1993 law, the Family and Medical Leave Act (FMLA), gives some workers 12 weeks of unpaid parental or medical leave, with a federal guarantee of job protection. But, with eligibility restrictions, it covers only 60 percent of the workforce. About half of people eligible for FMLA leave use the benefit, according to the National Partnership for Women & Families.

Katie Rock, 32, of Des Moines, Iowa, had her third child on June 30. She works at a university that offers no paid parental leave. She plans to use almost all of her 2017 paid sick and vacation days for her first month off and then take the full 12 weeks of FMLA, unpaid.

“Of course, it would be much better if that was paid time,” Rock said. “It’s definitely a hit on the finances.”

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Obamacare’s History Littered With Near-Death Experiences

Few laws have defied as many existential threats as the Affordable Care Act. In seven years, it has been to the brink of elimination nearly a dozen times, only to rally back from seemingly impossible odds. Efforts to kill it have come from Congress (including one in 2015 that made it all the way to President Barack Obama’s desk before being vetoed), the White House and the courts. So far, the law continues.

As the Senate continues its latest effort to remake the law, here is a timeline of the ACA’s “near-death” experiences, which occurred before the bill passed, during its implementation and after benefits began to flow.


November 2009 — Abortion Nearly Stalls House Bill

In order to get the Affordable Care Act passed by the House, then-Speaker Nancy Pelosi (D-Calif.), an abortion-rights backer, had to give in to anti-abortion Democrats and include language expanding federal limits on the procedure, over the opposition of a majority of her colleagues.


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December 2009 — Democrats Forced To Drop ‘Public Option’

Independent Sen. Joe Lieberman of Connecticut refused to become the 60th vote needed to break a GOP filibuster unless Democratic leaders eliminated a provision to allow some people younger than 65 to opt in to Medicare rather than buy private health coverage.


January 2010 — Scott Brown Upsets Democrats’ Strategy

Brown, a Republican, unexpectedly won the seat left empty by the 2009 death of Sen. Edward Kennedy, depriving Senate Democrats of 60 votes, the number needed to force a vote on the bill. Backers of the bill moved to a complicated Plan B. That involved requiring the House to pass the Senate bill without any changes. Compromises were worked out through the budget reconciliation process that enabled Senate passage with only 51 votes.


March 2010 — Abortion Again Threatens Passage

House leaders still did not have the numbers needed for passage and had to negotiate with anti-abortion Democrats to gain enough votes. Those members forced more changes to the bill to get it across the finish line.


March 23, 2010 — Milestone: Bill Signed Into Law


June 2012 — High Court Upholds Health Law Mandate

Supreme Court Chief Justice John Roberts wrote in a 5-4 ruling that the requirement for most Americans to either have insurance or pay a fine constitutes a tax — and therefore is constitutional. In a separate decision, however, the justices in a 7-2 ruling said that the expansion of Medicaid had to be voluntary for the states.


November 2012 — Barack Obama Re-Elected President

Obama’s opponent, Republican Mitt Romney, had promised to undo the health law.


October 2013 — Healthcare.gov Fails To Launch

The health insurance enrollment website failed repeatedly in its debut. The technical difficulties made the law’s rollout a laughingstock. Only six people were able to sign up the first day. It took several weeks to make the site useable for large numbers of customers.


Jan. 1, 2014 — Milestone: Most Of Law’s Benefits Take Effect


June 2014 — Supreme Court Saves Health Law Again

The high court ruled that subsidies to help people afford coverage should be available in states that ran their own insurance exchanges and those that had defaulted to using the federal government’s website. The case centered on imprecise language in the law.


December 2015 — Repeal Passes Both Houses Of Congress

The House and Senate pass a bill that would have repealed major parts (although far from all) of the ACA, delaying most of the changes for two years to give themselves time to come up with a replacement plan. This was not really an existential threat to the bill, however, because lawmakers knew President Obama would veto the measure, which he did in January 2016.


March 2017 — House Stumbles In First Repeal Effort

With a president ready to make repeal a reality, the GOP-led House’s first try at an ACA overhaul ends in humiliating defeat when the measure cannot muster support from both conservatives and moderates. A subsequent version, however, designed to bring down premiums by loosening some consumer protections, passed the House in May.


June 2017 — Senate Stumbles In Effort To Pass Repeal

After Senate leaders had met behind closed doors for weeks to draft a bill, Majority Leader Mitch McConnell (R-Ky.) postpones the vote when it becomes clear he doesn’t have enough support. He had hoped to have it pass before Congress’ July Fourth recess.

Categories: Courts, Repeal And Replace Watch, The Health Law

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Rural Californians Want Price Relief From GOP Health Bill, But Unlikely To Get It

Aaron Albaugh peered out from under the brim of his cowboy hat, surveying the acres of hayfields in front of him. The fourth-generation rancher has raised about 450 cattle this year, in this remote corner of Lassen County, Calif.

His closest neighbor lives a half-mile away. “And that’s my brother,” Albaugh said.

“If I want to go see a movie, it’s 70 miles, round-trip,” he added. “If I want to go bowling, that’s 100 miles, round-trip.”

Living a half-day’s drive from civilization, you learn to do without, he explained. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it’s the same thing.

“Put a Band-Aid on it,” Albaugh said. “I was raised: ‘You don’t need to cry’ and ‘Suck it up, buttercup.’ That’s the way I still live, and I try to treat my kids the same way.”

For people who were already used to doing without health coverage, it was quite a culture shock when the Affordable Care Act came along and they were told they had to buy it. Residents complained that the premiums and deductibles were too high — and with only two insurers selling plans in their area, there wasn’t enough competition to bring down prices.

Many in this Republican corner of California are looking to the GOP majority in Congress to bring some relief. But for most of them, prices would jump even more under the main proposals the party has served up so far, and fewer services would be covered, according to analyses by the Kaiser Family Foundation. (Kaiser Health News, which produces California Healthline, is an editorially independent program of the foundation.)

“Being told you have to have insurance you can’t afford, and then that doesn’t cover what you need? You are stuck,” said Modoc County resident Althia Cline, who decided to forgo Obamacare coverage — and a surgery she needs to help with her asthma — when she couldn’t find a health plan that her doctors accepted.

Just like the movie theater and the bowling alley, most medical specialists are miles away. In Modoc County, there’s no hospital or birthing center where a woman can have a baby. Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half from home.

Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.

Tessa Anklin says Covered California health plans are too expensive for her family. (April Dembosky/KQED)

Two years ago, they bought a plan through Covered California. Their monthly premium was just $2 a month after the ACA subsidy, but their annual deductible was $10,000.

“We paid for all of our medical services and our prescriptions,” she said. “We had no help until we reached the $10,000 deductible. So really, we had nothing.”

Then, last year, their monthly premium jumped to $600. Anklin said she’s not sure what happened. It’s possible a technical glitch caused them to lose their subsidy. All she knew was that the plan was the same, their household income was the same, and they still faced the same hour-and-a-half drive to see doctors they almost never needed.

Anklin thought of all the other ways they could spend that money.

“It makes the car payment. Almost your mortgage payment. Groceries for at least four months,” she said. “That’s a big difference, when you think about how little you actually use the health coverage.”

That’s the reason they decided to cancel their health plan this year and go without insurance. But they’ll still have to pay a penalty when the next tax season comes around.

“It basically penalizes us one way or the other because we can’t afford the coverage,” she said. “So, that’s kind of difficult — to be that middle-class person.”

Anklin said she’d be happy to see Republicans get rid of Obamacare.

“To me, it’s no good, if you have to force people to pay yet another something out of their paycheck,” she said, “when they’re already trying to survive with what they have.”

But the Republican “repeal and replace” plan wouldn’t make things much better for Anklin and her neighbors. Average premiums in California would double under the   U.S. Senate plan, according to a recent analysis from the Kaiser Family Foundation. Anklin could end up paying roughly $2,000 more per year for the cheapest individual plan than under Obamacare, according to Kaiser’s county-by-county projections.

That’s not the kind of fix she had in mind.

“I’d love that insurance could be more affordable for families that need it, for families that work hard for it,” Anklin said.

With Republican health care plans in flux, Democrats have been more willing to admit to Obamacare’s flaws. The Dems agree that the rising costs of marketplace plans are the chief complaint they hear about, too.

Democrats have also said if the Republican repeal effort fails, they’d be willing to work together on solutions. But it’s not clear the parties could agree on one that would help people like Anklin.

If they can’t, Anklin said, she has no choice but to continue to go without coverage. Financially, it makes sense in the short term, but she still worries about an unforeseen surgery, serious illness or accident.

“If I ever have a problem,” she said, “I know I will be paying for the rest of my life.”

This story is part of a partnership that includes KQED, NPR and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Categories: Cost and Quality, Insurance, Repeal And Replace Watch, The Health Law

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How to Boost Resilience in Midlife

Much of the scientific research on resilience — our ability to bounce back from adversity — has focused on how to build resilience in children. But what about the grown-ups?

While resilience is an essential skill for healthy childhood development, science shows that adults also can take steps to boost resilience in middle age, which is often the time we need it most. Midlife can bring all kinds of stressors, including divorce, the death of a parent, career setbacks and retirement worries, yet many of us don’t build the coping skills we need to meet these challenges.

The good news is that some of the qualities of middle age — a better ability to regulate emotions, perspective gained from life experiences and concern for future generations — may give older people an advantage over the young when it comes to developing resilience, said Adam Grant, a management and psychology professor at the Wharton School of the University of Pennsylvania.

“There is a naturally learnable set of behaviors that contribute to resilience,” said Dr. Grant, who, with Sheryl Sandberg, the chief operating officer of Facebook, wrote the book “Option B: Facing Adversity, Building Resilience and Finding Joy.” “Those are the behaviors that we gravitate to more and more as we age.”

Scientists who study stress and resilience say it’s important to think of resilience as an emotional muscle that can be strengthened at any time. While it’s useful to build up resilience before a big or small crisis hits, there still are active steps you can take during and after a crisis to speed your emotional recovery.

Last year Dr. Dennis Charney, a resilience researcher and dean of the Icahn School of Medicine at Mount Sinai in New York City, was leaving a deli when he was shot by a disgruntled former employee. Dr. Charney spent five days in intensive care and faced a challenging recovery.

“After 25 years of studying resilience, I had to be resilient myself,” said Dr. Charney, co-author of the book “Resilience: The Science of Mastering Life’s Greatest Challenges.” “It’s good to be prepared for it, but it’s not too late once you’ve been traumatized to build the capability to move forward in a resilient way.”

Here are some of the ways you can build your resilience in middle age.

■ Practice Optimism. Optimism is part genetic, part learned. So if you were born into a family of Eeyores, you can still find your inner Tigger.

Optimism doesn’t mean ignoring the reality of a dire situation. After a job loss, for instance, many people may feel defeated and think, “I’ll never recover from this.” An optimist would acknowledge the challenge in a more hopeful way, saying, “This is going to be difficult, but it’s a chance to rethink my life goals and find work that truly makes me happy.”

While it sounds trivial, thinking positive thoughts and surrounding yourself with positive people really does help. Dr. Steven Southwick, a psychiatry professor at Yale Medical School and Dr. Charney’s co-author, notes that optimism, like pessimism, can be infectious. His advice: “Hang out with optimistic people.”

■ Rewrite Your Story. When Dr. Charney was recovering from the shooting, he knew that his life was forever changed, but he reframed the situation, focusing on the opportunity the setback presented. “Once you are a trauma victim it stays with you,” he said. “But I knew I could be a role model. I have thousands of students watching my recovery. This gives me a chance to utilize what I’ve learned.”

Study after study has shown that we can benefit from reframing the personal narrative that shapes our view of the world and ourselves. In expressive writing studies, college students taught to reframe their college struggles as a growth opportunity got better grades and were less likely to drop out. A Harvard study found that people who viewed stress as a way to fuel better performance did better on tests and managed their stress better physiologically than those taught to ignore stress.

“It’s about learning to recognize the explanatory story you tend to use in your life,” Dr. Southwick said. “Observe what you are saying to yourself and question it. It’s not easy. It takes practice.”

■ Don’t Personalize It. We have a tendency to blame ourselves for life’s setbacks and to ruminate about what we should have done differently. In the moment, a difficult situation feels as if it will never end. To bolster your resilience, remind yourself that even if you made a mistake, a number of factors most likely contributed to the problem and shift your focus to the next steps you should take.

“Telling yourself that a situation is not personal, pervasive or permanent can be extremely useful,” Dr. Grant said. “There is almost no failure that is totally personal.”

■ Remember Your Comebacks. When times are tough, we often remind ourselves that other people — like war refugees or a friend with cancer — have it worse. While that may be true, you will get a bigger resilience boost by reminding yourself of the challenges you personally have overcome.

“It’s easier to relate to your former self than someone in another country,” said Dr. Grant. “Look back and say, ‘I’ve gone through something worse in the past. This is not the most horrible thing I have ever faced or will ever face. I know I can deal with it.’”

Sallie Krawcheck, a former Wall Street executive, said that after a very public firing, she reminded herself how fortunate she still was to have a healthy family and a financial cushion. While she has never studied resilience, she believes early challenges — like being bullied in middle school (“It was brutal,” she said) and going through a painful divorce — helped her bounce back in her career as well. “I just believe in comebacks,” said Ms. Krawcheck, who recently founded Ellevest, an online investment platform for women. “I see these setbacks as part of a journey and not a career-ending failure. There was nothing they could do to me on Wall Street that was as bad as seventh grade.”

■ Support Others. Resilience studies show that people are more resilient when they have strong support networks of friends and family to help them cope with a crisis. But you can get an even bigger resilience boost by giving support.

In a 2017 study of psychological resilience among American military veterans, higher levels of gratitude, altruism and a sense of purpose predicted resiliency.

“Any way you can reach out and help other people is a way of moving outside of yourself, and this is an important way to enhance your own strength,” said Dr. Southwick. “Part of resilience is taking responsibility for your life, and for creating a life that you consider meaningful and purposeful. It doesn’t have to be a big mission — it could be your family. As long as what you’re involved in has meaning to you, that can push you through all sorts of adversity.”

■ Take Stress Breaks. Times of manageable stress present an opportunity to build your resilience. “You have to change the way you look at stress,” said Jack Groppel, co-founder of the Johnson & Johnson Human Performance Institute, which recently began offering a course on resilience. “You have to invite stress into your life. A human being needs stress; the body and the mind want stress.”

The key, Dr. Groppel said, is to recognize that you will never eliminate stress from your life. Instead create regular opportunities for the body to recover from stress — just as you would rest your muscles between weight lifting repetitions. Taking a walk break, spending five minutes to meditate or having lunch with a good friend are ways to give your mind and body a break from stress.

“Stress is the stimulus for growth, and recovery is when the growth occurs,” said Dr. Groppel. “That’s how we build the resilience muscle.”

■ Go Out of Your Comfort Zone. Resilience doesn’t just come from negative experience. You can build your resilience by putting yourself in challenging situations. Dr. Groppel is planning to climb Mount Kilimanjaro with his son. Take an adventure vacation. Run a triathlon. Share your secret poetry skills with strangers at a poetry slam.

“There is a biology to this,” said Dr. Charney. “Your stress hormone systems will become less responsive to stress so you can handle stress better. Live your life in a way that you get the skills that enable you to handle stress.”

Postcard From Capitol Hill: What YouTube Didn’t Show You In Senate Health Care Vote

You had to be there.

After days of uncertainty about whether Senate Republicans would vote to begin debating a bill to repeal the Affordable Care Act, it boiled down to a few tense minutes on the Senate floor.

As the vote started shortly after 2 p.m. ET, 30 reporters crammed into the small hallway in front of the chamber, waiting for Arizona Republican Sen. John McCain’s dramatic arrival on the elevator. McCain had been out of Washington, D.C., since his recent diagnosis of brain cancer, but returned Tuesday to vote on the health care bill.

Reporters’ heads swiveled toward the doors each time they opened and when they weren’t doing that, they split their attention between watching the Senate floor action live-streamed on their phones and what they could glimpse through the chamber’s doors a few feet away.

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Inside, Health and Human Services Secretary Tom Price watched from near the entrance to the floor, talking with senators as they came over to him. Seema Verma, who heads the Centers for Medicare & Medicaid Services, made a brief appearance too.

When voting started, protesters in the gallery chanted “Kill the bill, not us!” — the sound of their shouts bouncing off marble steps to the floor below. They were dressed in white lab coats or in white clergy collars; all were dragged off by Capitol police.

Some had emergency bail money stashed in their pockets and emergency phone numbers written on their arms, just in case they were taken into custody without their phones. Police blocked reporters from talking to the protesters before their ejection from the gallery.

As “Yes” votes piled up from Republican senators, the outcome looked clear. “That’s it, they have the votes, they have the votes,” reporters murmured.

Then Sen. Lisa Murkowski (R-Alaska) voted no, joining Sen. Susan Collins (R-Maine). One more “No” vote from a Republican could defeat the GOP’s latest effort to repeal Obamacare.

Doubts revived.

Then in rapid succession — bam-bam-bam — Twitter erupted with announcements that Sens. Rob Portman (R-Ohio), Shelley Moore Capito (R-W. Va.), Dean Heller (R-Nev.) and Jerry Moran (R-Kans.) would vote yes.

By 2:45 p.m., the Republicans had 48 votes to proceed and only two senators left to vote. One was McCain. The other was Sen. Ron Johnson, a Wisconsin Republican who had been hesitant about the bill for weeks.

Johnson strode into the chamber after almost everyone else had voted and spent five tense minutes conferencing with Senate Majority Leader Mitch McConnell at the rear of the chamber. Hundreds of pairs of eyes were laser focused on the two men, standing close to one another, waving their hands and bobbing their heads.

Finally McCain appeared, accompanied by his wife, briskly walking 15 feet to the floor. One senator after another shook his hand and hugged him. Within minutes, both Johnson’s and McCain’s votes were known. The Republicans had 50 votes.

Afterward, McCain spoke simply and powerfully from Senate floor about the need for bipartisan cooperation to fix health care. “Our health care insurance system is a mess. We all know it, those who support Obamacare and those who oppose it. Something has to be done,” he said.

Vice President Mike Pence reminded the chamber to keep quiet, seconds before he cast the tie-breaking vote. The gallery, finally empty of protesters, heeded his words.

Categories: Repeal And Replace Watch, The Health Law

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Senate Votes To Move Ahead With Debate On Obamacare Replacement Bill

Jul 25 2017

Republican leadership secure the needed 50 votes — with Vice President Mike Pence casting the tie-breaking vote to reach 51 — to bring health care legislation to the floor.

Politico: Republicans Vote To Move Ahead On Obamacare Repeal
Senate Republicans voted Tuesday voted to open debate on repealing Obamacare, dramatically reviving an effort that many GOP lawmakers left for dead just a few days ago. The vote is a huge political win and turnaround for Senate Majority Leader Mitch McConnell and Republicans who’ve promised for seven years to repeal Obamacare if voters gave them control of Congress and the White House. (Haberkorn, Kim and Everett, 7/25)

Before the vote —

AP News: Mic Captures GOP Senator Ripping Trump, Mocking Lawmaker
Oh, that dreaded open microphone! Republican Sen. Susan Collins got caught Tuesday at the end of a hearing with a microphone that was still hot — and captured her ripping President Donald Trump and making fun of a fellow lawmaker who had been critical of her on health care. (Kerr, 7/25)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Who Knew Senate Health Bill Debate Could Be So Complicated?

So the Senate has voted to start debate on a bill to replace the Affordable Care Act. Now what?

Well, it gets wonky.

The rules for budget reconciliation, the process the Senate is using that limits debate and allows a bill to pass with only a simple majority, comes with a set of very specific rules. Here are some of the big ones that could shape whatever final bill emerges:

Matters Of Timing

Unlike most other Senate bills, where deliberation can last for days or weeks, budget reconciliation rules limit debate to 20 hours. While that 20-hour clock starts running as soon as the Senate votes to proceed to the bill, the debate can be paused. In other words, the Senate can recess for the night, then come back the next day and the clock would resume where it left off the day before. The 20 hours does not include time spent voting on amendments.

Near the end of the debate, Senate leaders could offer a substitute bill. It may incorporate some of the earlier amendments or not, and it is likely geared to attracting as many votes as possible.

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At the end of the 20 hours, there is potentially unlimited time for senators to vote on (but not debate) amendments. By tradition, the minority and majority party each gets one or two minutes to announce what the amendment is, and why it is good or bad. Unlike the initial debate, the clock does not pause for what is referred to as the “vote-a-rama.” That means voting goes only until members get too tired to continue. Vote-a-ramas in the past have often stretched for more than 12 hours, but rarely longer than 24.

Amendments

Senate leaders have for the past several weeks talked about starting debate and having an “open amendment process.” But under reconciliation, amendments are more constrained than under almost any other Senate rules.

According a report by the Congressional Research Service (a nonpartisan research group that provides background briefs to Congress), the Budget Act, which sets the reconciliation rules, “requires that all amendments be germane to the provisions in the bill.” What does that mean? Says CRS, “amendments cannot be used to introduce new subjects or expand the scope of the bill.”

Amendments also cannot add to the budget deficit or cause the bill to miss its overall budget targets.

Budget Targets

Reconciliation is designed to be a process to address the federal budget and is governed by the details set in a budget resolution passed by Congress. Even though congressional leaders have often used it to move legislation that has broader intent, the process has strict rules about spending or saving federal dollars. This year’s targets are modest by most budget resolution standards — each of the two health committees in the Senate were instructed to save $1 billion over 10 years.

But the Senate committees did not take up the bill to make changes or meet those targets on their own. As a result, the Senate is working from the bill passed by the House in May. It saved $119 billion, according to the Congressional Budget Office. Although the Senate is certain to make major revisions to the House legislation, any bill it passes must produce at least that much in savings.

And, of course, if the Senate passes a bill, it would have to be approved by the House or the House and Senate would have to work out differences and then pass that bill.

Byrd Rule

Both the underlying ACA replacement bill and its amendments must comply with the “Byrd Rule,” named for former Sen. Robert Byrd (D-W.Va.), which prohibits language that is “extraneous” to the federal budget from being included in the bill. In practice that means language must add to or subtract from federal spending and that the spending must not be “merely incidental” to a broader policy purpose.

Those determinations are made by the Senate parliamentarian. Last Friday, Senate Democrats released a list of initial decisions made by the parliamentarian’s office that found about 10 parts of the Senate- and House-passed health bills run afoul of the Byrd Rule. That list included a temporary defunding of Planned Parenthood and requirements that people with breaks in coverage wait six months before buying individual health insurance.

Republican leaders say they are working to rewrite the problematic provisions. Whether that will pass the Byrd Rule is one of many things no one knows yet in this very tumultuous debate.

Categories: Medicaid, Repeal And Replace Watch, The Health Law

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