From Health Care

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.

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)

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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)

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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)

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

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)

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

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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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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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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Viewpoints: Talking About Suicide; Military Life’s Toll On Women; Listening To Patients

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

The New York Times: Let’s Talk About Suicide
Chester Bennington, the lead singer of the band Linkin Park, was found dead on Thursday in his home near Los Angeles. The coroner’s office has confirmed that the 41-year-old died of suicide. That’s something I — and so many millions of other Americans suffering from mental illness — have considered. … more often than not, we don’t talk about mental health. And shows like Netflix’s “13 Reasons Why” or artists like indie pop singer Lana Del Rey have sensationalized or glamorized mental illness and suicide rather than taking it seriously. Worldwide, 350 million people (that’s 5 percent of the population) suffer from depression every day. And they are suffering – and sometimes dying – in silence because we can’t seem to talk openly about mental health. (Robert Rigo, 7/24)

Stat: Protecting Interns And Other Physicians From Depression And Suicide
This month, more than 25,000 medical school graduates will begin working at hospitals and medical centers across the United States. By the end of September, nearly one-third of these new doctors could become depressed and 24 percent could have thoughts of suicide. First-year interns often move away from family and friends to start the next chapter of intensive training. It is an exciting time, but also a difficult time. A recent study in Academic Medicine confirms that their suicide risk is highest in the early months of training. (George Keepers and Mary Moffit, 7/24)

Los Angeles Times: What Military Recruiters Aren’t Telling Women: You’ll Face Disproportionate Health Risks
Recently, 18 brave women graduated from the U.S. Army Infantry School, pioneers headed for fully gender-integrated “ground close-combat” units. Women have long served valiantly and effectively in almost every military role, but now they are tackling extremely physical combat jobs that, until recently, were designated men-only. … In this push for more female recruits, it’s not at all clear that young women — or the civilian population in general — understand the unique, disproportionate health risks women face in combat roles. The dangers, which have been known for decades, will undoubtedly be exacerbated as women serve in the most physically demanding units. (Julie Pulley and Hugh P. Scott, 7/25)

Bloomberg: Trump’s Quiet Progress On Veterans Affairs
[I]n one area, Veterans Affairs, there actually has been progress. Since the Senate approved his appointment unanimously in February, Secretary David Shulkin has sought to improve accountability at hospitals by publicly posting wait times and care-quality data, and has extended much-needed mental health services to veterans with less-than-honorable discharges. Even Congress has made a contribution, passing a bill to streamline the agency’s hiring and firing processes — legislation that Trump signed and tweeted about three times. (Mark Whitehouse, 7/24)

WBUR: Against Medical Advice: Sometimes, When Patients Defy Accepted Wisdom, So Must Doctors
Keeping the whole patient in view, including the social challenges they will return to after their short stint in a hospital, is as much a part of medical decision-making as the understanding of disease, or selection of the right medication. While this lesson is far from new — you’ll hear it taught to every medical student across the country — it is much harder to apply it in practice than to learn in principle. (Abraar Karan, 7/24)

Cincinnati Enquirer: Heroin Epidemic Must Be A Priority
Currently, human services funding is allocated towards increasing gainful employment, reducing homelessness, and preventing violence, all in need of our attention. Heroin is often a component of these other issues but the acute nature of this crisis demands prioritized attention not secondary. (Amy Murray, 7/24)

RealClear Health: Ending The Opioid Epidemic: Only The US Can Stop China’s Counterfeit Pharmaceutical Trade
The United States is facing an explosion of counterfeit opioids from China. Illegal synthetic opioids like carfentanil and fentanyl are being packaged as legal prescription opioids (like oxycodone) and sold on the black market. The US has dealt with counterfeit drug scandals before, notably in 2008 when 149 Americans died from a counterfeit blood thinner found to have originated in China. Today, counterfeit opioid compounds with carfentanil and fentanyl are blamed for the sudden increase in overdose deaths in the United States, making drug overdoses the current leading cause of death for Americans under age 50. (Emily Foecke Munden, 7/25)

Sacramento Bee: Reparations For Drug War? Consider It California
The same people who went to prison in disproportionate numbers for selling marijuana are on the verge of being cut out of California’s multibillion-dollar legal marijuana industry – and, without help, could even become victims of it. …Together, they are demanding that local governments adopt a reparations strategy that would begin to repair the damage done to communities of color. (Erika Smith, 7/24)

The Kansas City Star: Scrutiny Of Overland Park Pain Doctor Highlights Challenge Of Fighting Opioid Addiction
An Overland Park doctor is in the crosshairs of an expanding investigation into the business practices that are fueling American’s addiction to opioids. The records of Steven Simon of The Pain Management Institute have been seized by the FBI. He earns more than only a handful of other doctors in the U.S. from payments by drug manufacturers to promote both opioids and the medications that treat side effects of the drugs. It’s a revenue stream that can influence doctors to write more prescriptions. (7/23)

USA Today: Trump Budget Would Set Back Global AIDS Fight Just When We’re On Track To Win It
When we started our HIV/AIDS Initiative at Saddleback Church 13 years ago, we reminded our congregation, “If you’re going to be like Jesus, you have to learn to be compassionate toward people when they’re sick.” Even in this time of tight budgets, America’s leaders should show precisely this kind of compassion for our brothers and sisters living with HIV and AIDS in Africa and around the world. (Rick and Kay Warren, 7/25)

The New York Times: Fixes: 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)

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

Ideas About Issues: The Right Answers On Health Policy Are Beyond Politics; Could The Free Market Deliver A Solution?

Columnists offer thoughts on these issues as well as who has gained ground with Obamacare, how self-employed people are bracing for change and the future of single-payer concepts.

The Columbus Dispatch: Cast Aside Politics, Get Health Care Right
If you want to know what’s wrong with the never-ending political battle being fought in Washington to get rid of the Affordable Care Act, look no further than the lives, families, and communities that have been destroyed by opioid addiction all across America. Opioid addiction is a crisis ripping the heart out of our country. And every plan that’s been put forward by the Republican leadership in Congress takes a blow torch to the most important preventive care and treatment that’s currently covered by health insurance for those caught in the grip of addiction. If the Republicans get their way, that coverage goes away, and with it goes the best hope — and maybe the only real hope — that families and communities have to overcome the ravages of this terrible disease. (Joe Biden, 7/25)

Bloomberg: Obamacare’s Big Win: It Helps Some People Be A Little Less Poor
There are some eternal debates that may never be settled. If there is a God, why does God allow evil in the world? Great taste, or less filling? And of course, does Medicaid make people healthier? I’m not going to rehash that last debate here, which I have covered many times. Suffice it to say that while liberals insist that the evidence is clear that health insurance expansions improve physical health, at least modestly, I do not see that the evidence warrants the confidence they exude. The intuitive sense that this ought to be correct seems to me to be doing a lot of heavy lifting in these evaluations. In health care, our intuitions are often wrong. (Megan McArdle, 7/24)

Modern Healthcare: Self-Employed People Weigh Returning To Corporate Jobs If Senate Passes ACA Repeal Bill
Steven DeMaio of New York City has been happily self-employed as a writer and editor since 2008. At that time, he felt comfortable leaving a corporate job with health benefits and going out on his own because the state where he then lived, Massachusetts, had established a system guaranteeing affordable individual-market coverage without regard to health status. But DeMaio, 46, recently decided to look for a corporate job with health benefits because of uncertainty over the future of his health insurance posed by Republican efforts to repeal and replace the Affordable Care Act. As of Aug. 1, he will begin working for a company that offers a group health plan. (Harris Meyer, 7/24)

RealClear Health: Single-Payer Health Care Looms As 2020 Campaign Issue
With 115 co-sponsors, a House bill that calls for single-payer health insurance now enjoys majority Democratic support in the lower chamber. Paired with Bernie Sanders’ presidential campaign, which helped bring national attention to the issue, some observers say that a single-payer push may become part of Democrats’ platform in 2020. (Ford Carson, 7/25)

Los Angeles Times: Single Payer Can’t Happen In California. At Least, Not Right Away
Given the dismal state of healthcare reform in Washington, liberal Californians have rallied around the idea that the state should establish a single-payer program. Although in the future such a system would be workable and desirable, the reality is that at the moment a single-payer bill cannot pass. Fighting for one in the immediate term is a waste of time. Financing, first of all, is a heavy lift. In addition to higher state taxes, California would need to channel Medicare and other federal healthcare funding into the single-payer system. Before it can do that, Congress must pass a waiver and the president must sign it — which isn’t going to happen while Donald Trump is in office. (Steve Tarzynski, 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.

Tough Takes On The GOP’s Health Legislation Strategy: A New Level Of Cynicism; ‘A Tattered Band-Aid’

Opinion writers offer critiques of the GOP health plans, their strategies and how it could all play out for them in the next election.

The Washington Post: Senate Republicans Take Cynicism To A Horrifying New Level
We are hurtling toward a health-care disaster in the next 36 hours or so, for the worst possible reason. Cynicism is seldom completely absent from the operation of politics, but this is truly a unique situation. Republicans are set to remake one-sixth of the American economy, threaten the economic and health security of every one of us and deprive tens of millions of people of health-care coverage, all with a bill they haven’t seen, couldn’t explain and don’t even bother to defend on its merits. (Paul Waldman, 7/24)

The Wall Street Journal: Can Republicans Govern?
Mitch McConnell is scheduling another showdown vote in the Senate—the third attempt—as early as Tuesday on a motion to proceed to debate on health reform. Succeed or fail, the Republican Majority Leader is right to demand this moment of political accountability. (7/24)

The Wall Street Journal: If Mitch McConnell Fails To Repeal Obamacare, He Should Blame Himself First
Few people in America rode into 2017 higher than Senate Majority Leader Mitch McConnell (R-Ky.). After leading Republicans to the Senate majority in 2014 and blocking President Barack Obama from filling the late Justice Antonin Scalia’s Supreme Court seat, McConnell helped the GOP hold the Senate last fall to deliver the first unified Republican control of government in a decade. Just six months later, though, McConnell is staring at a dramatic reversal of fortunes, facing a full-blown rebellion among the Republican senators he leads and serious doubts about his leadership ability. (Adam Jentleson, 7/25)

The New York Times: How The Health Bill Could Cost Senators In The Next Election
One of the health care bills under consideration by Republican leaders would take health insurance away from 32 million people over the next decade, creating a cohort of Americans who could be motivated to vote against senators who approved the measure. The Senate could vote as early as Tuesday, but it is not yet clear which of the two bills in contention that the majority leader, Mitch McConnell, intends to bring up. The plan that would leave 32 million without coverage would repeal some of the most important parts of the Affordable Care Act without any replacement. (Vickas Bajaj and Stuart A Thompson, 7/24)

Los Angeles Times: A Tattered Band-Aid: Senate GOP’s $200-Billion Obamacare Cushion Would Run Out In Two Years
As Senate Republicans rush pell-mell toward a Tuesday vote on an Obamacare repeal bill that most, if not all, still haven’t seen, a new study examines one of the givebacks the GOP leadership has offered anti-repeal senators to bring them on board. The sweetener is a $200-billion fund for the 31 states that expanded Medicaid under the Affordable Care Act, to be paid out starting in 2022. Since the GOP bill would eliminate the Medicaid expansion, the ostensible idea is to help them cushion health insurance costs for those states and their Medicaid enrollees forced to transition to the ACA’s individual insurance exchanges. (Michael Hiltzik, 7/24)

The Washington Post: Every Republican Health-Care Plan So Far Would Cause Great Harm To The Nation
The Senate has been deadlocked on repealing and replacing Obamacare all month, but Majority Leader Mitch McConnell (R-Ky.) announced Monday afternoon that the chamber would vote Tuesday on . . . well, on something. The scrambling reflected a basic fact: Every major Republican proposal put forward so far would mean millions of Americans would lose access to health care. Each plan would theoretically fulfill a GOP campaign promise while inflicting serious harm on the nation. (7/24)

Los Angeles Times: Lessons From The GOP’s Mostly Dead Healthcare Plan
Hill-watchers say the Republicans so badly need to pass something that they might just surprise everyone and pass … something today. Maybe. But whatever the Senate passes will not be an actual repeal of Obamacare, never mind an actual replacement. (It can’t be. Since Senate Majority Leader Mitch McConnell [R-Ky.] and company can’t or won’t work with Democrats — and vice versa — they are trying to pass their bill using the budget reconciliation process, which is rather limited in scope, but only requires a simple majority.) And even if the miracle happens, the immensely unpopular legislation must then go to conference, and after that go back to both chambers for more voting. It will look less like sausage getting made and more like an elaborate, rolling, mortuary makeover. (Jonah Goldberg, 7/25)

USA Today: GOP Health Bill Pits Freedom Of Choice Against Freedom From Fear
What is the health care debate all about? Freedom. Specifically two different conceptions of freedom. One is freedom to buy what you want. In this view, the country is a collection of 325 million individuals, and freedom is everyone pursuing their lives without interference. The other is freedom from worry. It views America as a community, and freedom is knowing you can get help when you are sick and in need. (EzekielJ. Emanuel, 7/24)

The Kansas City Star: Pat Roberts, Nancy Pelosi And Passing A Health Care Bill To Find Out What’s In It
Kansas Sen. Jerry Moran has been lavished with attention lately. Which is what happens when you buck your party to save Obamacare one day and the very next time the sun comes up, announce that you support a doomed GOP plan to kill the Affordable Care Act and replace it with nothing but hearty best wishes for all Americans. If Moran now sticks with his party after all and green-lights legislation he has said would hurt his constituents, he’s going to wish he hadn’t distinguished himself in the first place. (Melinda Henneberger, 7/24)

Arizona Republic: John McCain Hands Gov. Doug Ducey His Health Care Vote
Until McCain’s tweet, [Doug] Ducey was nothing more than an observer in the health care debate going on in Washington. He could – if he chose to do so – complain about what senators might do in restructuring or abolishing the Affordable Care Act, but he would bear no measure of blame for their work. Now, he has a say. (EJ Montini, 7/24)

New Orleans Times-Picayune: Health Care Speech Might Be Donald Trump’s Most Cynical One Yet
Trump, certainly the most prolific prevaricator who has ever rested his head at the White House, says that the Democrats’ promises regarding the Affordable Care Act all amount to a “big, fat lie.”If the Republicans had presented anything to make it easier for those families Trump trotted out, then maybe it would be fair to accuse the Democrats of overselling the Affordable Care Act.  But the Republicans aren’t really offering much – if anything — to help those who are struggling to pay their medical bills. (Jarvis DeBerry, 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: In Special Session, Texas Senate Takes Up Abortion Bills; Ohio’s Cost Transparency Law Stalls Amidst Strong Opposition

Media outlets report on news from Texas, Ohio, Pennsylvania, Minnesota, California, Tennessee, Florida, Maryland and Kansas.

Texas Tribune: Texas Senate Tackles Special Session Abortion Bills
Under state Sen. Donna Campbell’s Senate Bill 10, in procedures where complications occur, physicians would be required, within 72 hours, to submit reports to the state health commission that include detailed information like the patient’s year of birth, race, marital status, state and county of residence, the date of her last menstrual cycle, the number of previous abortions, and the number of previous live births. Physicians who failed to comply with the reporting requirements would face a $500 fine for each day of each violation. (Smith, 7/24)

Texas Tribune: Texas Senate OKs Maternal Mortality Task Force
State senators on Monday tentatively approved a bill that would give a state task force more time to study why an alarming number of Texas mothers are dying less than a year after childbirth. Under Senate Bill 17, the state’s Task Force on Maternal Mortality and Morbidity would be able to continue its work until 2023. (Evans, 7/24)

Kaiser Health News: Price Transparency In Medicine Faces Stiff Opposition — From Hospitals And Doctors
Two years after it passed unanimously in Ohio’s state Legislature, a law meant to inform patients what health care procedures will cost is in a state of suspended animation. One of the most stringent in a group of similar state laws being proposed across the country, Ohio’s Healthcare Price Transparency Law stipulated that providers had to give patients a “good faith” estimate of what non-emergency services would cost individuals after insurance before they commenced treatment. (Bluth, 7/25)

The Philadelphia Inquirer/Philly.com: New Five-Year Contract Between Independence And Jefferson
Independence Blue Cross is pushing for new contracts with area health systems that accelerate the hoped-for transition from paying for volume of services to paying for positive results. But it is not taking a one-size-fits-all approach. “We need to adapt to different providers” because they have “different states of readiness,” Anthony V. Coletta, president of Facilitated Health Networks at Independence, said Monday after the announcement of a contract with Jefferson Health that starts Sept. 1 and will last five years. (Brubaker, 7/24)

The Star Tribune: Minneapolis Proposal To Restrict Menthol Tobacco Sales Sparks Debate
While public health advocates pushed for the restrictions at a packed public hearing — arguing that tobacco companies target black smokers and young people with menthol products — Minneapolis store owners said it’s the latest example of City Hall overreach and would devastate their livelihoods. …The City Council heard from dozens of speakers Monday in crowded council chambers and is expected to vote on the policy in August. (Belz, 7/24)

San Francisco Chronicle: Jahi McMath’s Family Wins Backing For Argument That She’s Alive
It’s been more than three years since 13-year-old Jahi McMath was declared dead after something went terribly wrong following throat surgery at Children’s Hospital Oakland. Her family has never accepted the declaration and has kept her on life support ever since — and in a new twist, a prominent neurologist says recent videos of the girl show she is alive, with a partially functioning brain. (Johnson, 7/24)

The Philadelphia Inquirer/Philly.com: Horizon Blue Cross Ordered To Turn Over Omnia Documents
The New Jersey Supreme Court on Monday ordered Horizon Blue Cross Blue Shield, the state’s largest health insurer, to turn over a McKinsey & Co. report and other documents it used to establish two tiers of health systems for an insurance plan introduced in 2015. Providers in the second tier, including Capital Health System Inc. and St. Peter’s University Hospital Inc., sued, alleging that Horizon treated them unfairly and breached their contracts when it set up the tiers for its Omnia insurance plan. At the seven Tier One health systems in the Omnia Health Alliance consumers have lower out-of-pocket costs. (Brubaker, 7/24)

Texas Tribune: Texas To Lose Galveston And Hill Country Children’s Therapy Providers
Children in the Galveston and Hill Country areas are going to be without state-funded speech, occupational and physical therapy services as two more providers prepare to leave the Early Childhood Intervention program. The Texas Health and Human Services Commission confirmed Monday that the University of Texas Medical Branch and Hill Country MHDD Centers are ending services through the program. (Evans, 7/24)

Nashville Tennessean: Children’s ER At TriStar Centennial Opens
A new children’s emergency room in Nashville — the city’s second — is now seeing patients. The first patient at The Children’s Hospital at TriStar Centennial arrived at 9:21 a.m. on July 24 to the new seven-bed, 6,000-square foot facility on the hospital’s campus in Midtown Nashville. (Fletcher, 7/24)

Columbus Dispatch: Mount Carmel Adding 80 Beds For Mental-Health Treatment
Mount Carmel Health System and Acadia Healthcare announced on Monday that they are teaming up to open an 80-bed inpatient behavioral health hospital in Columbus to replace a 20-bed hospital at Mount Carmel West hospital in Franklinton. Officials say they are still finalizing a site for the $26 million, 64,300-square-foot freestanding facility that will have units for adult and geriatric patients as well as for dual-diagnosis patients — those who are suffering from both mental-health and drug-addiction illnesses. (Viviano, 7/25)

The Baltimore Sun: CVS Opens First Maryland Hearing Center
CVS Pharmacy opened its first Maryland hearing center in an Ellicott City store, as part of the drug store chain’s move to capture more health related business in its retail outlets. The store, which sells and services hearing aids, is staffed by audiologists and can provide hearing screenings and fittings. Insurance is accepted for some services. (Cohn, 7/24)

Cleveland Plain Dealer: Johnson Amends Cleveland ‘Lead Safe’ Law Proposal To Exclude Owner-Occupied Homes
Cleveland City Councilman Jeff Johnson, after hearing from a slew of residents said today he’s changing the ‘Lead Safe’ ordinance he plans to propose next month so that it excludes mandatory compliance and fines for homeowners who live in their properties. The ordinance — which proposes that all city homes built before 1978 be certified safe from lead hazards by 2021 — would still apply to rentals and apartments, which comprise the majority of the city’s homes, as well as child care centers and schools constructed prior to 1978, Johnson said. (Dissell and Zeltner, 7/24)

KCUR: Safety Net Clinic To Reopen Facility In Quindaro Neighborhood 
Southwest Boulevard Family Health Care, a safety net clinic in Kansas City, Kansas, will reopen its Quindaro facility after several years’ hiatus. The satellite clinic will be located in a church building owned by Family Health Care. Initially, it will be open a couple of half-days per week and, depending on demand, may increase its hours of operation. (Margolies, 7/24)

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Prominent Psychiatry Group Relaxes Stance On Speaking About Mental Health Of Public Figures

The rule against psychiatrists offering their analysis of behaviors, such as ones exhibited by the president robs the public “of our professional judgment and prevents us from communicating our understanding” of the president’s mental state, one psychiatrist said. In other public health news: the next revolution in HIV treatment, Zika testing, ticks and disease, dental services, pollution and more.

Stat: Psychiatry Group Tells Members They Can Discuss Trump’s Mental Health
Aleading psychiatry group has told its members they should not feel bound by a longstanding rule against commenting publicly on the mental state of public figures — even the president. The statement, an email this month from the executive committee of the American Psychoanalytic Association to its 3,500 members, represents the first significant crack in the profession’s decades-old united front aimed at preventing experts from discussing the psychiatric aspects of politicians’ behavior. (Begley, 7/25)

The Washington Post: Monthly Shot Could Be The ‘Next Revolution’ In HIV Therapy, Replacing Daily Pills
HIV/AIDS is no longer the death sentence it once was, but maintaining the strict regimen required to keep the virus at bay — one or more pills daily — still poses a major challenge to many people who are infected. Adherence is low among some populations, given the effort that is required to obtain, keep and store the medications. That may soon change. On Monday, scientists reported an important advance in the development of a long-acting antiretroviral shot. According to an international study involving 309 patients, an injection that combines two drugs, cabotegravir and rilpivirine, appears to be as safe and effective at suppressing HIV as the daily oral regimen. (Cha, 7/24)

The Washington Post: New Zika Testing Recommendation Issued For Pregnant Women
Federal health officials are changing their testing recommendations for pregnant women who may be exposed to the Zika virus through travel or sex or because of where they live. In updated guidance released Monday, the Centers for Disease Control and Prevention is no longer recommending routine testing for pregnant women without any Zika symptoms but who may have been put at risk because they have traveled to a region where Zika is circulating. (Sun, 7/24)

The Washington Post: A New Way To Fulfill The Single Biggest Need Of Poor Patients: Teeth
Larry Bays has seen his share of hard times, but on this day he was blessed. The 71-year-old goat farmer from Gate City, Va., had come to the annual free medical clinic held over the weekend here in coal country so his wife, Joyce, could have her asthma and arthritis checked. When her doctor realized she had no teeth, he sent the couple over to a trailer operated by the Mission of Mercy dental team. (Schneider, 7/24)

ProPublica: Has The Moment For Environmental Justice Been Lost?
Given how President Donald Trump has taken aim at the Environmental Protection Agency with regulatory rollbacks and deep proposed budget cuts, it may come as no surprise that the Office of Environmental Justice is on the chopping block. This tiny corner of the EPA was established 24 years ago to advocate for minorities and the poor, populations most likely to face the consequences of pollution and least able to advocate for themselves. (Buford, 7/24)

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Physicians, Often In Fear Of Losing License, Know How To Hide Signs Of Addiction To Escape Notice

“Somehow they believe their knowledge is going to be more powerful than addiction,” said Dr. Marvin Seppala, an addiction expert. Meanwhile, FDA Commissioner Scott Gottlieb is looking to tap unlikely sources as allies in the battle against opioids: benefit payers and insurance administrators.

Los Angeles Times: Doctors And Drug Abuse: Why Addictions Can Be So Difficult
Allegations that Dr. Carmen A. Puliafito used methamphetamine and ecstasy while he was dean of USC’s medical school have opened a window into the pervasiveness of drug use and addiction among physicians and the challenges they face when confronting it. Experts say physicians become substance abusers at about the same rate as the general population. But they are often reluctant to seek treatment out of fear of losing their medical licenses and livelihoods. (Karlamangla, 7/24)

Bloomberg: Trump’s FDA Chief Takes Wide Aim At Opioid Addiction Crisis 
The Food and Drug Administration, as part of a sweeping overhaul in how it regulates opioid painkillers, plans to look to some unusual allies to limit the flood of the addictive pills — health insurers and companies that manage prescription drug benefits. Food and Drug Administration Commissioner Scott Gottlieb plans to meet in September with the benefit payers and insurance administrators, groups the FDA hasn’t typically worked with in its role as a drug regulator. The plan, Gottlieb said, is to stem the tide of addiction to the pills by limiting the number of people exposed to them in the first place. (Edney, 7/24)

And in other news on the epidemic —

The New York Times: Economy Needs Workers, But Drug Tests Take A Toll
Just a few miles from where President Trump will address his blue-collar base here Tuesday night, exactly the kind of middle-class factory jobs he has vowed to bring back from overseas are going begging. It’s not that local workers lack the skills for these positions, many of which do not even require a high school diploma but pay $15 to $25 an hour and offer full benefits. Rather, the problem is that too many applicants — nearly half, in some cases — fail a drug test. (Schwartz, 7/24)

Arizona Republic: Hepatitis C: The Public-Health Worry Lurking Behind The Opioid Crisis
Hepatitis C, a blood-borne virus that attacks the liver and causes inflammation, is so infectious it can spread through a few microscopic dots of blood. Intravenous drug users are among the most high-risk populations for infection because they share syringes, cookers, cotton, water, ties and alcohol swabs, according to the Centers for Disease Control and Prevention. (Stanford, 7/24)

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