From Health Care

First Edition: February 23, 2017

Feb 23 2017

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

Kaiser Health News: KHN On Call: What’s Next For The ACA?
Health care under the Affordable Care Act is poised to change — again. The Republican-led Congress has vowed to “repeal and replace” the health law known as Obamacare. That has left many people anxious and confused about what will happen and when. So NPR’s Morning Edition asked listeners to post questions on Twitter and Facebook, and we will be answering some of them here and on the radio in the weeks ahead. (Rovner, 2/23)

Kaiser Health News: Sprint To Find Zika Vaccine Could Hinge On Summer Outbreaks
Carmen Heredia Rodriguez reports: “As warmer temperatures herald the arrival of pesky mosquitoes, researchers are feverishly working on several promising vaccines against Zika, a virus notorious for infecting humans through this insect’s bite. The speed and debilitating effects of last year’s Zika outbreak in the Western Hemisphere prompted a sprint to develop a vaccine. Just a little more than a year after the pandemic was declared a global health emergency, a handful of candidates are undergoing preliminary testing in humans.” (Heredia Rodriguez, 2/23)

Kaiser Health News: Geriatricians Can Help Aging Patients Navigate Multiple Ailments
Judith Graham writes: “For months, Teresa Christensen’s 87-year-old mother, Genevieve, complained of pain from a nasty sore on her right foot. She stopped going to church. She couldn’t sleep at night. Eventually, she stopped walking except when absolutely necessary. Her primary care doctor prescribed three antibiotics, one after another. None worked. “Doctor, can’t we do some further tests?” Teresa Christensen remembered asking. “I felt that he was looking through my mother instead of looking at her.” (Graham, 2/23)

Kaiser Health News: Popular Charity Heart Screenings For Teens May Cause More Problems Than They Solve
Mary Chris Jaklevic reports: “Dozens of not-for-profit organizations have formed in the past decade to promote free or low-cost heart screenings for teens. These groups often claim such tests save lives by finding abnormalities that might pose a risk of sudden cardiac death. But the efforts are raising concerns. There’s no evidence that screening adolescents with electrocardiograms (ECG) prevents deaths. Sudden cardiac death is rare in young people, and some physicians worry screening kids with no symptoms or family history of disease could do more harm than good. The tests can set off false alarms that can lead to follow-up tests and risky interventions or force some kids to quit sports unnecessarily. (Jaklevic, 2/22)

California Healthline: Alzheimer’s Looms Large For Latinos
Heidi de Marco reports: “The number of Alzheimer’s cases in the United States is rising, especially among Latinos — the fastest growing minority in the country. With no cure in sight, diagnoses among U.S. Latinos are expected to increase more than eightfold by 2060, to 3.5 million, according to a report by the University of Southern California’s Edward R. Roybal Institute on Aging and the Latinos Against Alzheimer’s network.” (de Marco, 2/23)

The New York Times: Repeal Of Health Law Faces Obstacles In House, Not Just In Senate
Ever since Republicans got down to the business of repealing the Affordable Care Act, the Senate has been singled out as the likely problem. Any plan that could zoom through the House would hit roadblocks among Senate Republicans, many of whom have resisted a wholesale repeal of the health law without a robust replacement plan. But after weeks of loud protests, boisterous town hall meetings and scores of quieter meetings with health care professionals, patients, caregivers and hospital managers in their districts, it is becoming increasingly likely that a consensus in the House may be just as hard to reach. (Steinhauer, 2/23)

Los Angeles Times: Obamacare 101: Are Health Insurance Marketplaces In A Death Spiral?
It’s been a rocky few months for the health insurance marketplaces created by the Affordable Care Act. Even if you’re not one of the roughly 11 million Americans who rely on these online exchanges to get your health insurance, you’ve probably seen the headlines about rising premiums and insurance companies pulling out of the system. (Levey, 2/23)

The Washington Post: Sen. Chuck Grassley, Once A Tea Party Target, Faces Off With The #Resistance
In the politest possible way, Sen. Chuck Grassley (R-Iowa) asked his constituents to keep their voices down. … It was Grassley’s second town hall of the day, the umpteenth of a political career that began with a 1958 race for state legislature. He wrote down each question as it was spoken to him. … And he faced round after round of questions on the Affordable Care Act, from people who sometimes choked up as they described their specific, positive interactions with the law. After one woman emotionally described how her family would have been “destroyed” had the ACA’s subsidies not defrayed the cost of her husband’s illness, Grassley assured her that the law would not simply be repealed. (Weigel, 2/22)

Politico: Raucous Crowd Rocks Cotton Town Hall
A combative crowd repeatedly challenged Arkansas Sen. Tom Cotton on Wednesday in the latest of a series of highly contentious Republican town halls. During the event, protesters in a packed auditorium at Springdale High School frequently stood and chanted denunciations of the senator’s support of the Trump administration and the GOP’s ongoing efforts to repeal the Affordable Care Act. (Lima, 2/22)

Politico: Town Hall Anger Hits N.J. As Republican Lance Faces The Public
For the first few minutes of Republican U.S. Rep. Leonard Lance’s town hall meeting Wednesday evening, it almost looked like he had won over a passionate anti-Trump crowd of nearly 1,000. Lance, an eight-year incumbent, answered a question about repeal of the Affordable Care Act by saying he supports “repairing” the law and keeping some of its most popular provisions, including protections for pre-existing conditions, banning lifetime caps on coverage and allowing young people to stay on their parents’ coverage until age 26. The crowd applauded. Then things changed. (Friedman, 2/22)

The New York Times: Trump Vowed To Protect The Safety Net. What If His Appointees Disagree?
Two days before Election Day, Donald J. Trump traveled to Sioux City, Iowa, and proclaimed that he was the protector of federal programs aimed at helping elderly and low-income Americans. It was Hillary Clinton, he said, who was an untrustworthy steward of the working class and who would slash vital benefits. “I am going to protect and save your Social Security and your Medicare,” Mr. Trump said. “You made a deal a long time ago, a long time ago.” The pledge followed earlier promises to enact a new paid-maternity-leave benefit and not to make cuts to Medicaid, the health insurance program for the poor. (Alcindor, 2/23)

The Associated Press: Health Insurer Aetna To Spend $3.3B Buying Back Stock
Aetna will spend $3.3 billion to buy back more than 20 million shares of its stock after the health insurer’s board authorized more repurchases last week. The nation’s third largest insurer said Wednesday that it entered into accelerated buyback agreements with two dealers for about 10.4 million shares from each. Aetna will pay each dealer $1.65 billion and is using available cash to fund the deals. (2/22)

The Wall Street Journal: Second Theranos Lab Has Blood-Testing License Revoked
An Arizona lab run by blood-testing firm Theranos Inc. put patients at risk and failed to quickly fix its deficiencies, the main U.S. lab regulator found, triggering a new round of sanctions last month against the company. The Centers for Medicare and Medicaid Services imposed some of the harshest penalties in its arsenal on the Arizona lab. The agency revoked the lab’s U.S. testing license, barred it from billing Medicare and ordered it to alert customers of its problems, according to a Jan. 27 letter obtained by The Wall Street Journal in a public records request. (Weaver, 2/22)

The Associated Press: Oregon AG Girding To Protect Abortion Rights
On the heels of Washington state’s successful pushback of President Donald Trump’s immigration order, Oregon is readying for a court battle if the federal government tries to curtail abortion rights, the state’s attorney general said. The attorneys general of both Oregon and Washington said in interviews with The Associated Press that they are increasingly sharing information and consulting with each other and with other Democratic counterparts, as the White House and Congress try to roll back Obama policies and steer a conservative course for the nation. (Selsky, 2/22)

The New York Times: In The Face Of A.L.S., Simon Fitzmaurice Finds His Fire Inside
After his short film screened at the Sundance Film Festival in 2008, a euphoric Simon Fitzmaurice was walking the snowy streets of Park City, Utah, when his foot began to hurt. Back home in Ireland that summer, by then dealing with a pronounced limp, he received a shattering diagnosis: motor neuron disease, or M.N.D. (more commonly known in the United States as A.L.S., or Lou Gehrig’s Disease), a neurological disorder that causes increasing muscle weakness and eventual paralysis and is, in most cases, fatal. The doctor gave Mr. Fitzmaurice, then 33, three or four years to live. (Shattuck, 2/22)

The Washington Post: The Best Medicine For ADHD Might Not Be Medicine, At Least At First
Steve and Michelle were desperate. Their 6-year-old son, Sam, was diagnosed with ADHD soon after entering first grade. Sam’s behavior seemed outright defiant: He ignored adults when his name was called and was in constant motion. Sam let out bloodcurdling screams when forced to stop playing a game on the iPad. His teacher had struggled to manage similar behaviors in class, and his guidance counselor said Sam “needed to be on medicine.” Steve and Michelle weren’t so sure, but they wondered if they were being negligent by not putting him on Ritalin or something similar. But despite the relentless advertising for meds, and the occasional coercion by school personnel, your young ADHD child may not need Ritalin. At least not yet. (Griffin, 2/23)

The New York Times: Prolonged Sleep May Be Early Warning Sign Of Dementia
Older adults who started sleeping more than nine hours a night — but had not previously slept so much — were at more than double the risk of developing dementia a decade later than those who slept nine hours or less, researchers report. The increased risk was not seen in people who had always slept more than nine hours. (Rabin, 2/22)

The Washington Post: Do Pet Cats Cause Schizophrenia? A New Study Suggests No.
As if parents of young children didn’t have enough things to worry about, here’s another: Some scientists think pet cats might increase kids’ risk of developing schizophrenia. But there’s good news out of this growing field of research, which focuses on the links between a cat-borne parasite that causes toxoplasmosis and mental health disorders. A new study of about 5,000 children in the United Kingdom found no evidence that cat ownership during gestation or childhood was associated with psychotic experiences that can be early signs of mental illness — such as hallucinations or delusions of being spied on — when they were teenagers. (Brulliard, 2/22)

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

KHN On Call: What’s Next For The ACA?

“KHN On Call” is a new regular feature, a product of our ongoing partnership with NPR. Each week, Julie Rovner, KHN’s chief Washington correspondent, will answer a few audience questions about the new administration’s effort to revamp U.S. health care — to “repeal and replace” the Affordable Care Act. Which changes are real and imminent? What can the president do without congressional agreement? How will policy changes affect patient lives? Tell us what you’d like to know. The segment will air on Morning Edition and we’ll repost the audio and a story here. You can submit questions via Twitter @MorningEdition #ACAchat or @KHNews #KHNOnCall.

Health care under the Affordable Care Act is poised to change — again. The Republican-led Congress has vowed to “repeal and replace” the health law known as Obamacare.

That has left many people anxious and confused about what will happen and when. So NPR’s Morning Edition asked listeners to post questions on Twitter and Facebook, and we will be answering some of them here and on the radio in the weeks ahead.

Many of the questions or comments that have come in so far have to do with timing. For example, Steva Stowell-Hardcastle of Lewisburg, Pa., said, “I’m confused about what parts of the ACA have been repealed and when those changes take place.”

First, while some parts of the huge health law have been altered since it passed in 2010, nothing substantive has been repealed in 2017.

In January, Republicans in Congress passed a budget resolution that called for major changes to the law to be made in a subsequent bill, called budget reconciliation. That will allow the bill to pass the Senate with only a majority of votes, rather than the 60 votes needed to overcome a filibuster by Democrats. Congressional leaders have yet to unveil what they plan to put in that second bill.

Whatever they include, however, they cannot repeal the entire law in reconciliation. That’s because the budget process limits changes to those that directly affect the federal budget. Put simply, they can modify money but not rules. While there is some debate over how that will look, most people believe the rule that requires insurers to cover people with preexisting conditions could not be repealed through a budget bill.

The Trump administration has taken a few actions, but none making concrete changes — yet. In January, Trump signed an executive order calling for federal agencies to “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the act” that would “impose a fiscal burden” on states, individuals, healthcare providers, and others in the health industry.

But so far the only federal action in response to that order has come from the IRS, which decided not to more strictly enforce the “individual mandate” that requires most Americans to have health insurance. The IRS, however, noted that the requirement is still law.

A related question comes from Kathryn Henry of Iowa City, Iowa. She asks, “If it is repealed, what happens to people like me who currently have insurance through it and when?”

Both President Trump and GOP congressional leaders have insisted that they want a smooth transition from the current system to a new one, particularly for the 11 million or so people who purchased coverage on the federal or state health insurance exchanges.

“We don’t want to pull the rug out from under people while we’re replacing this law,” said House Speaker Paul Ryan (R-Wis.) in January. Trump has insisted that repealing the law and replacing it be done “essentially simultaneously,” so as not to leave people without insurance.

Unless something unexpected happens, people who purchased insurance for 2017 should be covered through the remainder of the year.

The bigger question is what happens in 2018. The uncertainty alone is prompting some insurers to get out of the individual insurance market, which is the most affected by the health law.

Insurance company Humana has already said it won’t participate in the health insurance exchanges next year, and the CEO of Aetna told reporters that his company might drop out, too. If Congress deadlocks over how to overhaul the health law, that exodus could accelerate.

Insurers were supposed to tell the federal government whether they planned to participate in the insurance exchanges by May 3, but the Trump administration has now given them until the end of June.

Categories: Repeal And Replace Watch, The Health Law

Geriatricians Can Help Aging Patients Navigate Multiple Ailments

For months, Teresa Christensen’s 87-year-old mother, Genevieve, complained of pain from a nasty sore on her right foot. She stopped going to church. She couldn’t sleep at night. Eventually, she stopped walking except when absolutely necessary.

Her primary care doctor prescribed three antibiotics, one after another. None worked.

“Doctor, can’t we do some further tests?” Teresa Christensen remembered asking. “I felt that he was looking through my mother instead of looking at her.”

Referred to a wound clinic, Genevieve was diagnosed with a venous ulcer, resulting from poor circulation in her legs. A few weeks ago, she had a successful procedure to correct the problem and returned home to the house where she’s lived for more than 50 years in Cottage Grove, Minn., a suburb of St. Paul.

Judith GrahamNAVIGATING AGING

Would her mother benefit from seeing a geriatrician going forward, wondered Christensen, her mother’s primary caregiver, in an email to me? And, if so, how would she go about finding one?

I reached out to several medical experts, and they agreed that a specialist in geriatrics could help a patient like Genevieve, with a history of breast cancer and heart failure, who’d had open heart surgery at age 84 and whose mobility was now compromised.

Geriatricians are “experts in complexity,” said Dr. Eric Widera, director of the geriatrics medicine fellowship at the University of California, San Francisco.

No one better understands how multiple medical problems interact in older people and affect their quality of life than these specialists on aging. But their role in the health care system remains poorly understood and their expertise underused.

Interviews with geriatricians offer insights useful to older adults and their families:

Basic knowledge. Geriatricians are typically internists or family physicians who have spent an extra year becoming trained in the unique health care needs of older adults.

They’re among the rarest of medical specialties. In 2016, there were 7,293 geriatricians in the U.S. — fewer than two years before, according to the American Geriatrics Society.

Geriatricians can serve as primary care doctors, mostly to people in their 70s, 80s and older who have multiple medical conditions. They also provide consultations and work in interdisciplinary medical teams caring for older patients.

Recognizing that training programs can’t meet expected demand as the population ages, the specialty has launched programs to educate other physicians in the principles of geriatric medicine.

“We’ve been trying to get all clinicians trained in what we call the ‘101 level’ of geriatrics,” said Dr. Rosanne Leipzig, a professor of geriatrics at the Icahn School of Medicine at Mount Sinai in New York City.

Essential competencies. Researchers have spent considerable time over the past several years examining what, exactly, geriatricians do.

A 2014 article by Leipzig and multiple co-authors defined 12 essential competencies, including optimizing older adults’ functioning and well-being; helping seniors and their families clarify their goals for care and shaping care plans accordingly; comprehensive medication management; extensive care coordination; and providing palliative and end-of-life care, among others skills.

Underlying these skills is an expert understanding how older adults’ bodies, minds and lives differ from middle-age adults.

“We take a much broader history that looks at what our patients can and can’t do, how they’re getting along in their environment, how they see their future, their support systems, and their integration in the community,” said Dr. Kathryn Eubank, medical director of the Acute Care for Elders unit at the San Francisco Veterans Affairs Medical Center. “And when a problem arises with a patient, we tend to ask ‘How do we put this in the context of other concerns that might be contributing?’ ”

Geriatric syndromes. Another essential competency is a focus on issues that other primary care doctors often neglect — notably falls, incontinence, muscle weakness, frailty, fatigue, cognitive impairment and delirium. In medicine, these are known as “geriatric syndromes.”

“If you’re losing weight, you’re falling, you can’t climb a flight of stairs, you’re tired all the time, you’re unhappy and you’re on 10 or more medications, go see a geriatrician,” said Dr. John Morley, professor of geriatrics at Saint Louis University.

“Much of what we do is get rid of treatments prescribed by other physicians that aren’t working,” Morley continued.

Recently, he wrote of an 88-year-old patient with metastasized prostate cancer who was on 26 medications. The older man was troubled by profound fatigue, which dissipated after Morley took him off all but one medication. (Most of the drugs had minimal expected benefit for someone at the end of life.) The patient died peacefully eight months later.

Eubank tells of an 80-year-old combative and confused patient whom her team saw in the hospital after one of his legs had been amputated. Although physicians recognized the patient was delirious, they had prescribed medications that worsened that condition, given him insufficient pain relief and overlooked his constipation.

“Medications contributing to the patient’s delirium were stopped. We made his room quieter so he was disturbed less and stopped staff from interrupting his sleep between 10 p.m. and 6 a.m.,” Eubank said. “We worked to get him up out of bed, normalized his life as much as possible and made sure he got a pocket talker [hearing device] so he could hear what was going on.”

Over the next four days, the patient improved every day and was successfully discharged to rehabilitation.

Finding help. A geriatric consultation typically involves two appointments: one to conduct a comprehensive assessment of your physical, psychological, cognitive and social functioning, and another to go over a proposed plan of care.

The American Geriatrics Society has a geriatrician-finder on its website — a useful resource. Also, you can check whether a nearby medical school or academic medical center has a department of geriatrics.

Many doctors claim competency in caring for older adults. Be concerned if they fail to go over your medications carefully, if they don’t ask about geriatric syndromes or if they don’t inquire about the goals you have for your care, advised Dr. Mindy Fain, chief of geriatrics and co-director of the Arizona Center on Aging at the University of Arizona.

Also, don’t hesitate to ask pointed questions: Has this doctor had any additional training in geriatric care? Does she approach the care of older adults differently — if so, how? Are there certain medications she doesn’t use?

“You’ll be able to see in the physician’s mannerisms and response if she takes you seriously,” Leipzig said.

If not, keep looking for one who does.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

Categories: Aging, Navigating Aging, Syndicate

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Sprint To Find Zika Vaccine Could Hinge On Summer Outbreaks

As warmer temperatures herald the arrival of pesky mosquitoes, researchers are feverishly working on several promising vaccines against Zika, a virus notorious for infecting humans through this insect’s bite.

The speed and debilitating effects of last year’s Zika outbreak in the Western Hemisphere prompted a sprint to develop a vaccine. Just a little more than a year after the pandemic was declared a global health emergency, a handful of candidates are undergoing preliminary testing in humans.

But researchers say the uncertainty over whether the Zika epidemic will continue affects their ability to finish testing. They need locations with an active viral outbreak to conduct large-scale human trials and make sure the vaccine actually protects against disease.

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“On one hand, you don’t want to see outbreaks of infection,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “But on the other hand, [without that testing] you might have to wait a long time to make sure that the vaccine works.”

All the vaccines currently being tested are in Phase I clinical trials, which means they are being tested for safety in a small number of people. According to a review paper published Tuesday in the journal Immunity, the vaccines represent a variety of scientific techniques to thwart the disease, ranging from inactivating the virus to manipulating its DNA.

The NIAID announced Tuesday it is launching yet another Phase I trial for a vaccine made out of proteins found in mosquito saliva. The product is intended to trigger a human immune system response to the mosquito’s saliva and any viruses mixed with it. If successful, the product could protect humans against a spectrum of mosquito-transmitted diseases, including Zika.

Col. Nelson Michael, director of the U.S. Military HIV Research Program at the Walter Reed Army Institute of Research and co-author of the paper, said he expects preliminary reports on the safety of some of the older vaccines in April. As of now, he said, it is impossible to guess which vaccine will prove most effective in providing immunity.

“Sometimes it’s difficult to predict which horse will win the race,” Michael said.

The NIAID announced Tuesday it is launching yet another phase I trial for a vaccine made out of proteins found in mosquito saliva. (Courtesy of NIAID)

The NIAID is launching a phase I trial for a vaccine made out of proteins found in mosquito saliva. (Courtesy of NIAID)

Zika ― which is spread from infected people to others by mosquito bites or sexual contact, often infects people without showing symptoms. In some cases, it causes flu-like symptoms, such as fever, muscle aches and joint pain in adults ― and, in rare cases, Guillain-Barré syndrome, which can cause temporary paralysis. But it is most notorious for causing some children to be born with microcephaly ― a birth defect in which a child’s head is smaller than the average size ― if their mothers were exposed to Zika.

The virus garnered international attention after hundreds of cases of disabled babies surfaced in Brazil. It quickly swept through South America and the Caribbean before stopping on the southern coast of the U.S.

The World Health Organization declared the outbreak a “public health emergency of international concern” on Feb. 1, 2016, then ended the alert on Nov. 18.

Vaccines that meet the safety standard in Phase I clinical trials undergo subsequent rounds of testing to gauge effectiveness. To measure this, researchers rely on the gold standard of administering the vaccine to large number of individuals already exposed to the virus. However, Zika’s recent arrival to the Western Hemisphere means researchers don’t know whether the virus will become a perennial threat, or a one-time explosion.

The uncertainty poses several implications for the surge in Zika vaccine development. A lull in the outbreak could cause significant delays in testing, pushing back the timetable for a commercially available product, Fauci said.

While researchers can use alternative methods to measure efficacy without large-scale testing, a decline in the circulation of the Zika virus could set progress back by years because the vaccine testing would be ineffective.

“If we don’t get a lot of infections this season in South America and Puerto Rico, it may take years to make sure the vaccine works,” he said.

Fauci expects to launch the next round of human trials for a DNA vaccine developed by the NIAID next month.

Michael also worries that a lag in the number of Zika cases could lead the private sector to pull funds from vaccine development. It takes millions of dollars to develop a drug or vaccine, and pharmaceutical companies play a critical role in making and manufacturing them, he said. But those companies have many competing interests, he noted, and if it is hard to test a vaccine this year, the public and private Zika prevention efforts may turn their attention elsewhere.

“This is a constant issue where you put your resources,” he said.

A transmission electron micrograph of Zika virus, which is a member of the family Flaviviridae, is shown. (Cynthia Goldsmith/CDC)

A transmission electron micrograph of Zika virus, which is a member of the family Flaviviridae, is shown. (Cynthia Goldsmith/CDC)

So far, signs suggest that the climate could be ripe for Zika again this year. Warmer-than-usual temperatures are affecting areas across the Western Hemisphere, CBS reported, including hotbeds of the Zika outbreaks in Brazil. The higher temperatures increase the voracity of Zika’s main transmitter, the Aedes aegypti mosquito.

In the United States, areas with populations of the Aedes aegypti are closely monitoring their numbers. Last year, Texas and Florida dealt with locally acquired cases of Zika infection.

In Texas, public health officials have monitored mosquito populations throughout the winter to track their numbers and any presence of the virus. Despite unseasonably warm weather, said Chris Van Deusen, spokesman for the Texas Department of State Health Services, they have seen lower numbers of the Aedes aegypti and no cases of Zika.

Van Deusen said the state is also monitoring the outbreak in Mexico, since heavy traffic across the border increases the possibility of transmission. Officials are expecting another outbreak of locally transmitted cases of disease, Van Deusen said.

“There’s so many factors that go into it, it’s really impossible to make an ironclad prediction,” he said.

Categories: Public Health, Syndicate

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Popular Charity Heart Screenings For Teens May Cause More Problems Than They Solve

Dozens of not-for-profit organizations have formed in the past decade to promote free or low-cost heart screenings for teens. These groups often claim such tests save lives by finding abnormalities that might pose a risk of sudden cardiac death.

But the efforts are raising concerns. There’s no evidence that screening adolescents with electrocardiograms (ECG) prevents deaths. Sudden cardiac death is rare in young people, and some physicians worry screening kids with no symptoms or family history of disease could do more harm than good. The tests can set off false alarms that can lead to follow-up tests and risky interventions or force some kids to quit sports unnecessarily.

“There are harms that I don’t think a lot of people realize,” said Dr. Kristin Burns, who oversees a two-year-old registry at the National Institutes of Health of sudden deaths in people under 20. It’s one of several efforts aimed at gathering better data about cardiac abnormalities in kids.

Studies using limited data have found between one and four sudden cardiac deaths occur annually per 100,000 kids between ages 1 and 18. By comparison, 22 out of 100,000 U.S. teens are killed in accidents, including those involving motor vehicles, and nine out of 100,000 commit suicide, according to the Centers for Disease Control and Prevention.

Some screening advocates believe sudden cardiac deaths are underreported and not enough is being done to spare families from the fate of losing a child. “We have to acknowledge that every kid who drops dead, they’ve been failed by the current system,” said Darren Sudman, who founded Simon’s Fund, a screening effort in greater Philadelphia in memory of his infant son, who died of an arrhythmia.

Screening programs say they’re educating parents about the risks. “What we want to emphasize is, make sure your kid is heart-safe,” said Dr. Jonathan Drezner, a sports and family medicine specialist in Seattle at UW Medicine and medical director of the local Nick of Time Foundation.

Enthusiasm for ECGs, which measure the electrical activity in the heart to detect abnormalities, grew after a 2006 study showed they lowered death rates among athletes in Italy. But research in other countries has not yielded similar results, and the Italian researchers recently were accused of refusing to share their data so it could be evaluated independently.

Some 60,000 to 70,000 U.S. teens were screened in 2016, most by foundations created by families who lost a child to sudden cardiac death, said Darren Sudman, who runs an online directory, Screen Across America. It’s unclear whether high school athletes face higher risk than non-athletes, so screening programs usually invite everybody.

Screenings typically are held in high schools and overseen by volunteer cardiologists, with funding from individuals and businesses including hospitals. A handful of hospitals and for-profit companies also run screenings.

It may be presumptuous to claim ECGs save lives, but parents often believe they do, said Sudman. “If I find a heart condition, I promise you there are parents who are thanking me for savings their kid’s life.”

That perception is stoked by tragic stories in the media of children who died suddenly after never reporting a symptom. Meanwhile, the drawbacks of ECGs are seldom depicted. As many as 1 in 10 ECGs detects a potential abnormality, and the emotional and financial toll of such a finding can be significant — especially when they turn out to be wrong.

Following a screening ECG and echocardiogram last fall, Daniel Garza, 16, a talented sophomore basketball player in San Antonio, was told he had hypertrophic cardiomyopathy, a thickening of the heart muscle and the most common cause of sudden cardiac death in young people. He was advised to quit all exercise, at least temporarily.

“We were shocked, just shocked,” said his mother, Denise. She said her son became depressed when he couldn’t play the sport he enjoyed and excelled at. “He came home and cried himself to sleep. He said, ‘Mom, why did God give me this gift to take it away?’”

The Garzas traveled to the Mayo Clinic in Rochester, Minn., where further tests indicated his enlarged heart was a benign condition known as athletic heart, a result of intense training. His mother estimates that correcting the misdiagnosis cost more than $20,000, including medical costs, travel and lost work.

Daniel has returned to the basketball court. Still, Denise Garza said the emotional toll was rough. “It was one of the hardest things my family has ever endured.”

Several cardiologists said they often see cases like this or worse. Even after follow-up testing, it can be unclear which cases are life-threatening, so kids with low risk could be restricted from exercise or given life-altering interventions such as implantable defibrillators, surgery or anti-arrhythmic medications.

Medical groups have wrestled with the issue. The American Heart Association and the American College of Cardiology recommended in 2014 against mass ECG screening, noting that sudden cardiac death is rare in teens and false positives generate “excessive and costly second-tier testing.” ECGs also miss at least 1 in 10 cases of hypertrophic cardiomyopathy and more than 9 in 10 cases of congenital anomalies, the second-most-common cause.

But their expert panel accepted voluntary screening “in relatively small cohorts” if there’s physician involvement, quality control and a recognition of unreliable results and ancillary costs.

By contrast, there’s broad support for automated external defibrillators, which have been shown to prevent deaths at schools and other public places. Some foundations focus their efforts on disseminating the defibrillators.

One problem with ECGs is a lack of good data.

“There’s no evidence we have that ECG screening saves lives,” said Dr. Jonathan Kaltman of the NIH’s National Heart, Lung, and Blood Institute. “There’s never been a controlled clinical trial, which is the only way to answer that question.”

Efforts are underway to improve the accuracy of the screening programs. Some are adding echocardiograms, which use ultrasound to produce images of the heart, to verify potential abnormalities. Advocates say false positives have dropped as a result of better interpretation guidelines, known as the Seattle Criteria, which are expected to soon be endorsed by cardiology societies in revised form.

But the criteria are not perfect, and there’s a “giant gap” in training cardiologists to use them, said Drezner, one of the developers. He’s also a medical adviser for Parent Heart Watch, a consortium of foundations. “If I was a parent, I’d want to know about the experience of the (cardiologists) and what they’re going to do to help my kid if they have a positive screen.”

At the urging of screening advocates, the NIH partnered with the Centers for Disease Control and Prevention to rigorously track cardiac deaths as part of a Sudden Death in the Young Case Registry. So far a handful of states and counties have joined the effort, which helps local health departments collect better data. The goal is to standardize death investigations and get a firm handle on how often kids die from heart abnormalities as well as the role of factors such as genetics. Initial findings are expected to be available in about two years. The NIH is also funding three university-based research groups to answer key questions about sudden cardiac death in the young.

Some screening organizations are getting behind a nascent initiative with the Cardiac Safety Research Consortium to harness their own screening data for research. It would require standardizing their practices and tracking outcomes, which organizations aren’t now equipped to do.

“Screening is happening. We can’t avoid that,” said Dr. Salim Idriss, director of pediatric electrophysiology at Duke University and co-chair of the initiative. “We have a really good opportunity to get the data we need to make it better.”

Separately, the UT Southwestern Medical Center in Dallas recently began a four-year pilot study involving athletes and band members at eight high schools to determine the feasibility of a full-scale randomized controlled trial.

A valid finding on the overarching question of whether ECG screening saves lives could require at least 800,000 participants and a cost of $15 million, said Dr. Benjamin Levine, a cardiologist and the lead researcher.

The pilot is partly a response to legislation that would mandate ECGs for student athletes in Texas. A similar bill was also introduced in South Carolina. Both bills failed, but it’s expected there will be more attempts to mandate ECGs, leaving state legislators looking for better guidance.

“We’re not going to solve this by having more debates, but by having more data,” Levine said.

Categories: Cost and Quality, Syndicate

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Viewpoints: Health Policy Moves Back To Town Halls; GOP Wrestles With Medicaid Debate

A selection of opinions on health care from around the country.

Chicago Tribune: To The GOP On Obamacare: This Spud’s For You
Health care policy as a political hot potato has become a popular metaphor. Writers at Vox, CNBC, the American Constitution Society and elsewhere have compared Obamacare to a fresh-from-the-oven tuber that’s too painful to hold and must be tossed back across the aisle as quickly as possible. Noting growing concerns about inherent flaws in the complex structure of Obamacare — formally known as the Patient Protection and Affordable Care Act — libertarian Bloomberg View columnist Megan McArdle argued in a Feb. 15 essay that Congress is no longer “arguing about whether (and how) the exchanges can be saved, but playing hot potato as both parties vie to avoid being stuck with the blame for the ensuing disaster.” Nice try. (Eric Zorn, 2/21)

Roll Call: Town Hall Winners And Losers So Far
We’re halfway through the Presidents Day recess, the first during President Donald Trump’s first term in office. … it’s no surprise that town halls would become a focal point for the anger swirling on the left. Some members have plainly refused to meet with groups they think will be hostile to them. Others have flung open the sashes and let the emotions fly. Others have worked assiduously to restrain something that is inherently not theirs to control — the reaction of voters to their government’s actions in Washington. With half of the recess still left to play out, here are the winners and losers so far. (Patricia Murphy, 2/22)

The Wall Street Journal: Repeal And Replace Panic
In the 2009 ObamaCare debate, White House aide David Plouffe told nervous Democrats “no bed-wetting,” meaning keep calm and all will be well. House Democrats went on lose 63 seats in 2010, but the double irony is that Mr. Plouffe’s advice now applies to those reporters and liberals who seem to be invested in the failure of the GOP’s version of health-care reform. Every day brings a new story about Republicans in disarray, the “mirage” of the GOP’s reform and the impossibility of change. … The reality is that Congress is on schedule, progress is underway, and the many potential problems are avoidable. (2/21)

Forbes: Cassidy-Collins Patient Freedom Act Looks Better As Other Reform Efforts Falter
In a different political climate, the “Patient Freedom Act” introduced last month by Republican Senators Bill Cassidy and Susan Collins would be getting close scrutiny and perhaps some significant support. It is — and I apologize for language that appears to have become profane in these polarized times — a compromise. The bill recognizes that an outright repeal and replacement of Obamacare is going to be politically challenging for at least the next two years. It likewise recognizes that the persistence of Obamacare nationwide is likely to be challenging and expensive. (Seth Chandler, 2/21)

Bloomberg: A GOP Tax Idea Would Upend Health Insurance 
Last week brought thwarted mergers, threats by insurers to leave the Affordable Care Act’s individual exchanges, and the release of a (very) rough sketch of a possible GOP repeal-and-replace plan for the ACA. What’s missing in that skeletal outline is how to pay for new initiatives, such as an expanded tax credit to help people buy insurance, while also repealing the new taxes established by the ACA. Some in the GOP are floating one possible solution: capping the federal tax breaks workers and companies get for employer-provided health insurance. (Max Nisen, 2/21)

WBUR: Caring For Immigrant Patients When The Rules Can Shift Any Time
Knowing patients’ immigration status and the reasons they came to this country can affect the services they are eligible for, the relative costs of medications, the fears that may keep them from returning for needed services, and even the diagnosis of unexplained symptoms. Immigration policy, Marlin told us, “is no longer a spectator sport” for us or for our patients. But it is not simple to practice medicine under these new and uncertain circumstances. (Elisabeth Poorman, 2/21)

Bloomberg: ‘Right To Try’ Laws Don’t Help The Dying 
A national “right to try” law, supported by Vice President Mike Pence and scores of Republicans in the the House and Senate, is meant to circumvent the FDA’s regulatory authority by giving patients who are terminally ill the right to use drugs that the agency hasn’t yet approved. The idea sounds reasonable; in the past few years, bipartisan majorities in two-thirds of state legislatures have passed essentially the same law. In reality, however, these laws give patients no new rights at all. They do nothing to compel drug makers to provide experimental medicines to the dying, or insurers to pay for them. They merely eliminate a patient’s right to sue for any injuries that might arise — that is, if any patient ever gets an untested drug in this way. (2/21)

Boston Globe: Did Dana-Farber Pay Too High A Price For Its Mar-A-Lago Fund-Raiser?
When asked why he robbed banks, the legendary bank robber Willie Sutton said, “Because that’s where the money is.” That’s also why the Dana-Farber Cancer Institute holds fund-raisers at Mar-a-Lago, the posh Palm Beach resort that serves as President Trump’s Florida home. It’s where the money is. The most recent gala, held over the past weekend, raised $2.2 million. All for a good cause. But at what cost? (Joan Vennochi, 2/21)

St. Louis Post-Dispatch: Turn Off The Drug Spigot In The St. Louis Region
Heroin and opioid overdoses have increased to the point where they claim more lives regionally than homicides. State and local lawmakers need to focus greater efforts on combating a growing epidemic. Gov. Eric Greitens’ pledge to help create a statewide prescription drug database is a good start, but a more comprehensive law enforcement effort would go even further to push down the number of drug-related deaths. (2/21)

Pittsburgh Post-Gazette: Overprescribed: Curbing The Easy Fix Of Psychiatric Meds For Seniors
With many communities still struggling to manage the opioid epidemic, the last thing the nation needs is a new drug-related problem — the overprescribing of psychiatric and other medications to senior citizens. A new report in the journal JAMA Internal Medicine raises a red flag about the trend, saying it appears to be particularly common in rural areas where patients with symptoms of mental illnesses might have less access to talk therapy and other nondrug treatments. But even in these communities, there are alternatives to medications that can and should be explored. (2/20)

Stat: Patient Reviews Published Online Can Help Improve Health Care
It’s no secret that the US health care system needs to improve. Consumers — in this case patients and employers — have more collective power to influence change than they realize by choosing how, where, and from whom they get health care. Uber, Nordstrom, and many other companies seek their customers’ opinions and respond to them. Health care needs to follow suit to become the patient-centered service industry that it should be. The University of Utah, where I work, began collecting patient feedback early on and was the first health system in the US to publicly post patients’ reviews of their providers. It has paid off in many ways. (Vivian S. Lee, 2/21)

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Perspectives: Drug Prices Are Meaningless — And That’s The Problem

Read recent commentaries about drug-cost issues.

Los Angeles Times: Big Pharma Really, Really Doesn’t Want You To Know The True Value Of Its Drugs
The latest poster child for cruel and inhuman drug pricing is Kaleo Pharma, maker of an emergency injector for a med called naloxone, which is used as an antidote to save the lives of people who overdose on painkillers. As America’s opioid crisis reaches epidemic levels, Kaleo has jacked up the list price for its Evzio auto-injector by 600%, soaring from $690 several years ago to $4,500, according to lawmakers. (David Lazarus, 2/17)

The Wall Street Journal: How Other Countries Freeload On U.S. Drug Research
President Trump says American companies have been getting “systematically ripped off” by foreign governments and firms. He’s right. Yet he has backed a proposal that would make the problem even worse—permitting Americans to buy prescription drugs from overseas retailers, a practice known as importation. This policy wouldn’t help American consumers much, but it would gut American pharmaceutical companies. The negotiator-in-chief should instead use his skills to open foreign markets for American firms. (Peter Pitts, 2/21)

The Hill: Allowing Medicare To Directly Negotiate Drug Prices Will Hurt Seniors’ Access To New Drugs 
President Trump’s recent attack on pharmaceutical companies as “getting away with murder” is the stuff of headlines. He also commented that the federal Medicare program could save billions of dollars if the program negotiated prices directly with pharmaceutical companies. But lawmakers and the public should understand what direct Medicare drug price negotiations might mean for seniors’ access to needed treatments. (Rafael Fonseca, 2/17)

National Review: Donald Trump & Prescription Drug Costs: Harder To Lower Than They Seem
Keeping track of Donald Trump’s shifting policy positions could make even the most balanced of observers dizzy. Take, for example, the president’s position on prescription-drug prices. Candidate Trump garnered bipartisan plaudits by criticizing the pharmaceutical industry for the high cost of prescription drugs. Shortly after becoming president, he reached out to Democrats such as Representative Elijah Cummings with a promise to lower drug costs. But not long after that, he met with drug company CEOs and backed away from that promise. (Michael Tanner, 2/15)

Health Affairs: Can Employers Take A Bigger Role In Controlling Drug Costs?
An estimated 150 million Americans receive insurance through their employer — and employees and employers alike continue to suffer from “sticker shock” for prices for new drugs, despite several years of debate and threatened congressional action to control the high prices of pharmaceutical products. While considerable attention has been paid to potential actions by Medicare or the Food and Drug Administration (FDA), there has been less focus on the role of private payers to solve the issue. Employers sponsoring health benefits are not bound by the same statutory constraints that apply to Medicare and can decide with fewer restrictions what is covered and how much of the cost employees pay for each service. However, employers are sensitive to making changes to health benefits that could interfere with employee recruitment and this article will discuss employers’ options to address high drug prices more aggressively in that context. (Rober Galvin and Troyen Brennan, 2/17)

Albany Times Union: Why We Get Frustrated With Prescription Drug Prices!
This weekend as I was thumbing through some items in the pharmacy, I came  across the manufacturers information on the reintroduction of Auvi-Q to the market.  Auvi-Q is a autoinjector of epinephrine which is more publicly known as Epi-Pen. The drug is made by Kaleo who you might remember as they recently made news with their new product for narcan for drug overdose know as Evzio.  Evzio as was noted in this interview by Asa Stackel at WNYT 13, comes in at a price of $4,920 per unit which significantly more expensive than other naloxone products which are in the $100 range on average.  As a reminder the Evzio was about $690, came off the market and then back on at $4,920. Well history is repeating itself…..Auvi-Q, which last time we dispensed it was about $465 in early 2016 is back on the market at $4,200.  Yes, a ten fold increase! (New York Assemblyman John T. McDonald, 2/20)

Bloomberg: Alexion Needs New Bets
Alexion Pharmaceuticals Inc. is the latest in a long line of biopharma dealmakers to wish for a time machine. Its $8.4 billion acquisition of Synageva in 2015 was meant to help resolve its dependence on its leading rare-disease drug Soliris. It’s not working. (Max Nisen, 2/16)

The Motley Fool: Thanks, Martin Shkreli, For The Dumbest Advice Ever On Drug Pricing
Martin Shkreli is the epitome of everything the American consumer loves to hate. Shkreli, formerly the CEO of privately held Turing Pharmaceuticals, found himself in the spotlight in Sept. 2015 after his company acquired the rights to Daraprim, a life-saving, infection-fighting drug for AIDS and cancer patients. Despite not changing the formulation of Daraprim (which happened to be more than six decades old), or altering its manufacturing process one iota, Shkreli raised its per-pill price from $13.50 to $750 overnight, a nearly 5,500% increase. (Sean Williams, 2/17)

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When Giving ‘Hope To The Hopeless’ Comes At A Sky-High Price

News outlets report on stories related to pharmaceutical drug pricing.

Sacramento Bee: Orphan Drugs Offer Hope For Treating Rare Diseases, Despite High Price Tags 
At Sutter Children’s Center in Sacramento this week, the 7-year-old was given an injection of Spinraza, the first drug approved in the U.S. to treat spinal muscular atrophy, or SMA. … With Spinraza, each thumb-sized 5-milliliter vial – about a teaspoon’s worth – costs $125,000. The recommended dosage is four “loading” injections within about two months, followed by maintenance shots every four months for life. For families such as the Goepperts, that price tag is staggering: roughly half a million dollars just for the initial series of Spinraza shots and $375,000 a year thereafter. (Buck, 2/20)

USA Today: New Patient Group Focuses On Drug Prices Amid Bipartisan Concern
A new patient advocacy group launches Wednesday that distinguishes itself by focusing only on drug prices and eschewing money from the pharmaceutical industry at a time when drug makers are pouring millions into a campaign fighting efforts to regulate them. The formation of Patients for Affordable Drugs (PFAD) comes as local officials and members of Congress are decrying the latest huge drug price hikes, this time by drugmaker Kaléo for its version of the overdose antidote naloxone. (O’Donnell and Shesgreen, 2/22)

Stat: The Latest Voucher Deal Suggests Prices Are Finally Falling
In a noteworthy deal, Gilead Sciences agreed to pay $125 million to Sarepta Therapeutics for a priority review voucher. But one Wall Street analyst expressed disappointment over the price tag and suggested the deal raises questions about how much these controversial vouchers can fetch going forward. (Silverman, 2/21)

San Francisco Chronicle: Pharma CEO Insists $89,000 Drug Will Be Affordable For Patients 
When Marathon Pharmaceuticals’ $89,000 price for a year’s supply of its newly approved muscular dystrophy drug sparked outrage this month, the company’s CEO responded with another figure: $20. That’s how much he expects Duchenne muscular dystrophy patients to pay per prescription of the drug, he wrote in a letter posted on the company’s website. Insurers would cover the medication, and patients would pay only their typical co-pays. He touted the company’s patient assistance program to help patients defray out-of-pocket costs. (Schencker, 2/21)

Stat: Q&A: Pharmacy Middlemen Are ‘Monopolistic Terrorists’
Recent debates about drug pricing have tended to focus on manufacturers and patients, but Doug Collins is among the few legislators looking at the middlemen. Collins, a Republican congressman from Georgia, railed against the country’s three major pharmacy benefit managers in an interview with STAT, expressing his desire for a drug-pricing debate that centers on what he views as the true power centers instead of  “Pharma bro” and the push to allow drug-price negotiation under Medicare Part D. (Facher, 2/20)

Boston Globe: Harvard Pilgrim Expands Use Of Novel Drug Purchasing Deals 
Leveraging its buying power as one of the state’s largest health insurers, Harvard Pilgrim Health Care has struck two more deals to pay for expensive drugs based on how effectively they treat patients, an emerging strategy aimed at reining in medical spending. Harvard Pilgrim, which has 1.3 million members, said the agreements cover the rheumatoid arthritis medicine Enbrel, made by Amgen Inc., and Eli Lilly & Co.’s osteoporosis medicine Forteo. (McCluskey and Woodward, 2/22)

Stat: Here’s Why J&J Won The Bidding For Actelion – And Sanofi Didn’t
As big-game hunting goes, Sanofi chief executive Olivier Brandicourt is 0-for-2. Two months ago, Sanofi appeared to be on the verge of acquiring Actelion Pharmaceuticals, which would have been a notable accomplishment for a couple of reasons: Johnson & Johnson had just backed out of negotiations to acquire Actelion and Sanofi had recently lost out on bidding for Medivation, a stinging defeat in a growth strategy that relies on big deals. (Silverman, 2/16)

Stat: PhRMA CEO: ‘FDA Review Process Is The Gold Standard’
The CEO of the Pharmaceutical Research and Manufacturers of America on Tuesday came out strongly in favor of a rigorous Food and Drug Administration. His remarks come as the Trump administration weighs potential candidates to lead the agency who have suggested they would radically change how it vets new drugs. Asked by STAT about the notion that the FDA should no longer evaluate drugs for effectiveness, the industry trade group’s Stephen Ubl was unambiguous: “We believe that the FDA review process is the gold standard and should remain so.” (Robbins, 2/21)

LancasterOnline: Pennsylvania Proposal Would Make Prescription Drug Manufacturers Reveal Costs
Some state lawmakers are proposing to give the Insurance Department more teeth to tackle the problem of skyrocketing prescription drug prices. House Bill 161 would require pharmaceutical companies to disclose the cost of drugs — including materials, research, clinical trials, marketing and advertising.The bill is co-sponsored by Lancaster city Democrat Mike Sturla and Jim Cox, a Republican who represents part of northern Lancaster County. (Stauffer, 2/21)

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State Highlights: N.H. Health Budget Would Give Nurses A Raise; Texas Lawmaker Moves To Outlaw Guns At State Mental Hospitals

Outlets report on news from New Hampshire, Texas, Florida, Oregon, California, Missouri and Minnesota.

New Hampshire Union Leader: DHHS Budget Calls For $10M In Raises For Nurses 
A 15 percent raise for nurses working in the Department of Health and Human Services will cost the state $10 million over the next two years, but is necessary to attract and retain health care professionals in an increasingly competitive market, according to Health and Human Services Commissioner Jeffrey Meyers. The head of the state’s biggest agency presented a $1.4 billion two-year spending plan for fiscal years 2018-2019 to House budget-writers on Tuesday. He said increased pay for nurses and other providers is a top priority. (Solomon, 2/21)

Austin Statesman: Legislator Seeks To Keep Guns Out Of State Psychiatric Hospitals
One year after state psychiatric hospitals began letting people carry guns on campus, a Republican legislator is pushing a bill that reverses course. House Bill 14, filed by Rep. Andrew Murr, R-Junction, outlaws firearms at Texas’ 10 state-run mental health hospitals, which care for people with depression, schizophrenia, bipolar disorder and other illnesses. (Ball, 2/21)

Health News Florida: Flu Widespread In Florida, With Extra Bug 
Influenza season is at its peak nationwide, and Florida is no exception. That’s obvious on the map at the Centers for Disease Control website. Warren McDougle, epidemiology manager for the Hillsborough County Health Department, says the flu shot apparently did a good job of covering the predominant strain, A (H3). But unfortunately, there’s another mean virus going around, according to anecdotal reports. (Gentry, 2/21)

Register-Guard: Oregon Plan Would Provide Insurance To Unauthorized Kids 
Now, both women are advocating for a new state law — dubbed “Cover All Kids” by supporters — that would extend government-funded health insurance in Oregon to many unauthorized immigrants under the age of 19. The proposal would give government-funded health insurance to an estimated 17,600 unauthorized immigrants, at a cost of $55 million in the biennium that starts July 1. Critics blast the concept and the price tag, especially given state government’s cash crisis.But supporters say it’s a humane and sensible idea. (Hubbard, 2/21)

The Wall Street Journal: Bidder Says Los Angeles-Area Hospital Didn’t Need To Close
A health-care firm that offered to buy Gardens Regional Hospital and Medical Center Inc., a Los Angeles-area hospital that cared for low-income residents before shutting down, told a bankruptcy judge that its purchase efforts were unfairly ignored. In court papers, Le Summit Healthcare LLC officials told Bankruptcy Judge Ernest Robles that they are still willing to operate the nonprofit hospital while they obtain the new licensing and permits to restart its operations. They say Gardens Regional Hospital’s lawyers closed the 137-bed hospital unnecessarily. (Stech, 2/21)

St. Louis Public Radio: Homer G. Phillips Hospital: ‘They Were Not Going To Be Treated As Second-Class Citizens’ 
In the first half of the 20th century, segregation touched virtually every part of American life. Black residents of St. Louis weren’t just barred from schools, lunch counters and drinking fountains reserved for whites. Even hospitals could refuse to admit black patients. But the hospitals that were built to serve African-American patients hold a special place in medical history. The facilities employed and trained thousands of black doctors and nurses. In St. Louis, Homer G. Phillips Hospital quickly became a trusted household name. Today marks the 80th anniversary of its dedication ceremony on Feb. 22, 1937. (Bouscaren, 2/22)

The Star Tribune: Minnesota Medical Professionals Work To Close Health Gaps For LGBT Patients 
[Deb] Thorp, medical director of the Park Nicollet Gender Services Clinic in Minneapolis, is taking part in a rare national conference next week to address health disparities among lesbian, gay, bisexual and transgender people. She and other researchers say the LGBT community is more vulnerable to some diseases, and has poorer access to, and a lower quality of, health care compared with the general population — in part because of fear. (Shah, 2/21)

The Star Tribune: Minnesota Parents Lobby For Kids At ‘Dyslexia Day’ At State Capitol 
On Tuesday, the advocacy group’s annual rally spread across the Capitol rotunda, where several hundred parents and children called attention to a hidden disability that affects as many as one in 10 children. Dyslexia wasn’t even recognized as a specific learning disability by the Minnesota Department of Education until 2015. Children who spoke at Tuesday’s rally said they wished schools understood more. (Hopfensperger, 2/21)

St. Louis Public Radio: Chemical Companies To Pay $15 Million To Clean Up Sauget Superfund Site 
Four chemical companies could have to pay $14.8 million to clean up a federal Superfund site in Sauget. The settlement, which needs court approval, would address groundwater contamination, cap some of the waste and install a well monitoring system. Industrial waste has been dumped in six sites within the Sauget Area 1 Superfund from the 1930s until the 1980s. The Environmental Protection Agency has been investigating the site since the early 1980s. (Chen, 2/21)

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Maternal Mortality Rates, Obesity Cause U.S. To Lag Behind Developed Countries On Life Expectancy

It is also the only high-income country without universal health insurance coverage and has the largest share of unmet health-care needs due to financial costs. In other public health news: vaccines, heart disease, testosterone, art therapy and post-election stress.

The Washington Post: U.S. Life Expectancy Will Soon Be On Par With Mexico’s And The Czech Republic’s
Life expectancy at birth will continue to climb substantially for residents of industrialized nations — but not in the United States, where minimal gains will soon put life spans on par with those in Mexico and the Czech Republic, according to an extensive analysis released Tuesday. South Korean women and Hungarian men are projected to make the largest overall gains (with South Koreans second among males). There is a better-than-even chance that South Korean women will live to an average of 90 years old by 2030, which would be the first time a population will break the 90-year barrier, according to the research published in The Lancet. (Bernstein, 2/21)

Miami Herald: Russian, Swedish Scientists Discover Artificial Compound That Slows Aging 
Scientists from Lomonosov Moscow State University, working with those from Stockholm University in Sweden, have used a new compound to slow the aging process in mice. The compound is an artificial antioxidant, SkQ1, and it already is sold in Russia as part of an eye drops solution. It is still undergoing clinical trials in the U.S. (Veciana-Suarez, 2/21)

Roll Call: One Thing Congress Agrees On: Vaccines Work
A bipartisan group of lawmakers are stressing the need to highlight benefits of vaccines amid reports of local outbreaks of infectious diseases. “The science is clear: FDA-licensed vaccines are proven to be safe and effective, and save the lives both of those who receive them and vulnerable individuals around them,” the lawmakers wrote in a Tuesday letter sent to their colleagues. “As Members of Congress, we have a critical role to play in supporting the availability and use of vaccines to protect Americans from deadly diseases.” (Bowman, 2/21)

Miami Herald: Don’t Ignore Shortness Of Breath, Lightheadness 
The Centers for Disease Control and Prevention estimates that anywhere from 2.7 to 6.1 million Americans suffer from atrial fibrillation and reports that more than 750,000 related hospitalizations occur annually. With 130,000 estimated deaths each year — a rate that has been rising for more than two decades — atrial fibrillation costs the United States about $6 billion each year, according to the CDC. [David] Ancona, who says that patients with superventricular tachycardia appear in the ER daily, believes prevention is key. But the nature of the disease can make that difficult. (Ogle, 2/22)

Miami Herald: Carrie Fisher’s Death Sheds New Light On Women’s Heart Disease 
For years, the National Institutes of Health, which provides most of the money for medical research, has used male mice to study heart disease. Why? Men were the primary research subjects. Women have heart disease, too. In fact, heart disease is the No. 1 killer of American women (and men). Yet heart disease death rates in the United States have declined steadily for men over the last quarter century. Not so much for women. (Cohen, 2/21)

NPR: Testosterone Has Mixed Results On Older Men’s Health
Many men over 65 with low testosterone levels say their sense of well-being, not to mention sexual function, isn’t what it used to be. That’s why some doctors prescribe testosterone replacement. But the effectiveness of testosterone has been controversial. Studies of the risks and benefits have been mixed, and the Food and Drug Administration beefed up its warnings about cardiac side effects of testosterone supplementation in 2015. (Neighmond, 2/21)

NPR: Testosterone Patients Not Told About Anemia
There’s a lesson about one of the testosterone studies released this week that has nothing to do with testosterone: The study on how testosterone affects anemia was designed with an ethical lapse that nobody noticed until the study was complete. That’s surprising because it was designed and carried out by a couple of dozen of well-regarded scientists. Their protocols were reviewed by 12 university institutional review boards, whose job is to evaluate the ethics of an experiment. It was funded by the National Institutes of Health, and the trial was overseen by a watchdog data safety and monitoring board. But all of those safety features fell short this time. (Harris, 2/21)

The Wall Street Journal: Karen Pence’s Advocacy For Art Therapy Stirs Controversy
As Vice President Mike Pence visited Europe to reassure world leaders, his wife, Karen Pence, pursued her own issue: promoting art therapy. At first blush, it might seem Mrs. Pence’s support for art therapy would win public backing akin to the broad support Barbara and Laura Bush received for their promotion of literacy, instead of the divisive type of response Tipper Gore got for her campaign against offensive music lyrics. But the Donald Trump era is no ordinary time. (Barnes, 2/21)

Kaiser Health News: A New Diagnosis: ‘Post-Election Stress Disorder’
Wally Pfingsten has always been a news junkie. But since President Donald Trump was elected, he’s been so anxious about the political tumult that even just having the TV news on in the background at home is unbearable. “It’s been crippling,” said the 35-year-old San Mateo, Calif., resident and political moderate who has supported both Democratic and Republican candidates in the past. “I feel angry, really, really angry, far more angry than I expected to be. (Gold, 2/22)

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Personal Tragedies A Driving Force For State Lawmakers Aiming To Combat Opioid Crisis

Many lawmakers across the country are motivated by the way their loved ones have been touched by the epidemic. “We’re all here because we have this empty void in our lives,” said Minnesota state Rep. Dave Baker, whose son started out taking prescription drugs for back pain and died of a heroin overdose in 2011. Media outlets report on the crisis out of New Hampshire, Massachusetts, Minnesota and Georgia.

The Associated Press: State Lawmakers Channel Grief Into Fight Against Opioids
In statehouses across the country, lawmakers with loved ones who fell victim to drugs are leading the fight against the nation’s deadly opioid-abuse crisis, drawing on tragic personal experience to attack the problem. A Minnesota state senator whose daughter died of a heroin overdose in a Burger King parking lot — a friend hid the needles instead of calling for help — spearheaded a law that grants immunity to 911 callers. In Wisconsin, a state representative has introduced more than a dozen opioid-related bills in the years since his daughter went from painkillers to heroin to prison. A Pennsylvania lawmaker whose son is a recovering heroin addict championed a state law that expanded availability of an antidote that can reverse an overdose. (Potter, 2/21)

New Hampshire Union Leader: Ground Broken On Expanded Treatment Center In Manchester
City and state leaders marked a milestone in combating the opioid, heroin and fentanyl crisis with the ground-breaking Tuesday of an expanded treatment center and new recovery housing. The Families in Transition’s Family Willows Substance Use Treatment Center and Recovery Housing, located in the old Hoitt’s Furniture building on Wilson Street, is focused on one at-risk population: women, and mothers with children. It will provide treatment for an estimated 400 women annually, said Dick Anagnost, a businessman who is chairman of the Families in Transition board of directors. (Tuohy, 2/22)

Boston Globe: ‘Angel’ Opioid Initiative Thrives Despite Exit Of Gloucester Police Chief 
As Gloucester police chief, Leonard Campanello pledged in 2015 that drug users could walk into the police station, hand over heroin, and walk out into treatment within hours — without arrest or charges. The concept of help rather than handcuffs became a national sensation. But when Campanello left office in October, under fire for allegedly lying to city investigators probing complaints by two women against him, questions arose about the future of a program propelled in part by Campanello’s outsize personality. (MacQuarrie, 2/21)

Georgia Health News: House Health Panel Approves Needle Exchange Bill 
House Bill 161 is sponsored by state Rep. Betty Price, a physician. She is the wife of U.S. Health and Human Services Secretary Tom Price, who is also a physician and was until recently a U.S. congressman from Georgia. She backed a similar proposal last year. It was approved by the House but failed to get consideration in the state Senate. (Miller, 2/21)

Meanwhile, lawmakers want answers on drugs that are going missing at VA clinics —

The Associated Press: Lawmakers Urge VA To Explain Rising Cases Of Drug Theft
The heads of two congressional committees said Tuesday they want the Department of Veterans Affairs to better explain its efforts to stem drug theft and loss in light of rising cases of missing prescriptions and other unauthorized use at VA hospitals. Rep. Phil Roe, who chairs the House Veterans Affairs Committee, said his panel had scheduled a hearing for Monday. The Associated Press reported last Monday on government data showing a sharp increase since 2009 in opioid theft and drugs that had simply disappeared at the VA. (Yen , 2/21)

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Texas Temporarily Blocked From Cutting Off Medicaid Funds For Planned Parenthood

The federal judge said the state did not provide credible evidence that the organization violated medical or ethical standards related to abortion procedures.

Houston Chronicle: Federal Judge Stops Texas From Kicking Planned Parenthood Out Of Medicaid
A federal judge on Tuesday stopped Texas officials from kicking Planned Parenthood out of the state’s Medicaid program, providing a reprieve that will at least temporarily allow the organization to continue receiving reimbursements for providing non-abortion services to about 10,000 poor residents. U.S. District Judge Sam Sparks said in a 42-page ruling that he was not swayed by the state’s explanation for the eviction – an undercover video that purported to show that Planned Parenthood was illegally selling the organs of aborted fetuses – and would not allow the move until and unless the state provides a better rationale at a full trial. (Rosenthal, 2/21)

The New York Times: Judge Blocks Medicaid Cuts To Planned Parenthood In Texas
A federal judge on Tuesday temporarily blocked Texas from cutting off Medicaid funding to Planned Parenthood, ruling the state had presented no credible evidence to support claims the organization violated medical or ethical standards related to abortion procedures.The ruling, a preliminary injunction issued by Sam Sparks, a United States District Court judge in the Western District of Texas, means that, for now, 30 health centers that serve about 12,500 Medicaid patients can continue to receive funding from the medical program that serves the poor. The case is set to go to trial, where the judge can rule on its merits. (Mele, 2/21)

The Associated Press: Judge Blocks Texas Cutting Medicaid To Planned Parenthood
An injunction issued by U.S. District Sam Sparks of Austin comes after he delayed making decision in January and essentially bought Planned Parenthood an extra month in the state’s Medicaid program. … Sparks’ decision preserves what Planned Parenthood says are cancer screenings, birth control access and other health services for nearly 11,000 low-income women at 30 clinics. Texas originally intended to boot Planned Parenthood in January but Sparks told the state to wait pending his ruling. Arkansas, Alabama, Kansas, Mississippi and Louisiana have also had similar efforts blocked. (Weber, 2/21)

Dallas Morning News: Federal Judge Blocks Texas’ Move To Kick Planned Parenthood Out Of Medicaid
Texas Attorney General Ken Paxton said in a prepared statement that he will appeal the decision, which he said “is disappointing and flies in the face of basic human decency.” “Even the remains of the most vicious criminals are treated with respect,” Paxton said. “But the children who never had a chance at life become so-called medical waste or, alternatively, a commodity to be bartered for. No taxpayer in Texas should have to subsidize this repugnant and illegal conduct. We should never lose sight of the fact that, as long as abortion is legal in the United States, the potential for these types of horrors will continue.” (Mekelburg, 2/21)

The Hill: Judge Blocks Texas Plan To Cut Planned Parenthood Medicaid Funding 
Texas Gov. Greg Abbott (R) and state health officials first moved to cut Medicaid funding last year after controversial undercover videos of Planned Parenthood officials surfaced. Anti-abortion groups claimed the recordings prove the organization is “harvesting” fetal tissue, while Planned Parenthood has denied allegations surrounding the videos. (Hensch, 2/21)

Meanwhile, in Virginia —

The Associated Press: McAuliffe Vetoes Bill Cutting Abortion Clinics’ Funding
Virginia Gov. Terry McAuliffe has vetoed a bill that would have restricted funding for Planned Parenthood clinics. The Democrat vetoed the measure Tuesday during an event outside the executive mansion. He vetoed the same measure last year and said Tuesday it would harm tens of thousands of Virginians who rely on Planned Parenthood. (2/21)

Richmond Times Dispatch: McAuliffe Vetoes Bill That Would Defund Planned Parenthood 
Gov. Terry McAuliffe has vetoed a bill that would restrict Planned Parenthood from contracting with the state. The bill, sponsored by Del. Benjamin L. Cline, R-Rockbridge, passed the Senate last week on a 20-19 vote. It would prevent the Virginia Department of Health from providing funds to clinics that provide abortion services to women who are not covered by Medicaid. (Demeria, 2/21)

And a new regulation gains traction in the anti-abortion movement, but scientific evidence for the procedure is lacking —

The Associated Press: Experts: Science Behind ‘Abortion Reversal’ Is Flawed
Lawmakers in several states are considering requirements for doctors to inform women seeking medical abortions about an unproven procedure called “abortion reversal.” Doctors’ groups oppose the bills because of flawed science and ethical concerns. There is no evidence the procedure works and little information about its safety. The procedure involves shots of the hormone progesterone given if a woman changes her mind after the first step of a medical abortion. (Johnson, 2/22)

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Delays Still Plague Some Applications In Kansas For Medicaid’s Long-Term Care Coverage

The state has worked to clear up many other Medicaid backlogs, but applications for long-term care are often complicated and the decisions still lag, KCUR reports. Other outlets also report on Medicaid news in Minnesota and Colorado.

KCUR: For One Family, Move To Kansas Meant Medicaid Delays 
All that Michael Sykes has to show for his months-long quest to get his mother’s nursing home bed covered by Medicaid is a pile of paperwork. Kansans like Sykes have been facing long waits to find out if they qualify for health coverage under KanCare, the state’s privatized Medicaid program. The state has cleared up much of the backlog over the past year, but thousands of applications for long-term care coverage remain hung up. That has left applicants frustrated and forced nursing homes to absorb months of delayed payments. (Marso, 2/22)

KCUR: What’s The Matter With KanCare? Challenges On Four Fronts
KanCare is a $3 billion program that provides health insurance to more than 425,000 Kansans — complex and bureaucratic by its nature. And lately it seems the privatized Medicaid program has drawn more than its share of complaints from Kansas medical providers, beneficiaries and applicants. Some are the result of a switch in 2013 to management not by the state but instead by three private insurance companies, while others stem from court rulings or policymaker decisions. (Marso, 2/22)

The (Minneapolis) Star Tribune: Report Calls For Stronger Oversight Of Medicaid Spending For Disabled, Elderly 
Minnesota does not collect adequate information to monitor programs that spend more than $2 billion annually on care and services for the elderly and people with disabilities, according to a legislative auditor report released Tuesday. … However, the Minnesota Department of Human Services (DHS) does not provide adequate financial oversight of the organizations that provide the services, nor does it adequately regulate the workers who go into people’s homes, the report said. (Serres, 2/21)

Colorado Public Radio: Grand Junction Shows How To Lower Medicaid Costs While Improving Care
Medicaid provides health insurance for more than a million Coloradans, who comprise about a fifth of the state population. Medicaid is also one of the largest parts of the state budget, and costs rise each year. That spurred lawmakers to support an experiment by a health care collaborative in the Western Slope, Rocky Mountain Health Plans. … Patrick Gordon, associate vice president at Rocky Mountain Health Plans, spoke to Colorado Matters host Ryan Warner. (2/21)

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Changes To Medicare’s Primary-Care Payment Model Could Deter Physician Participation

Also, another look at what it means for a Medicare beneficiary to be “under observation.”

Modern Healthcare: Doctors, Payers May Dislike Changes To Primary-Care Model 
A tweak in the way some providers are reimbursed under a new primary-care payment model could deter providers from joining the Medicare initiative. The CMS is looking to expand its ambitious primary-care model known as Comprehensive Primary Care Plus. But there hasn’t been as much interest in the pilot as anticipated, and now the agency wants to pay incentives only to some participating providers and not others. (Dickson, 2/21)

Sun Sentinel: Being In A Hospital ‘Under Observation’ Vs. Admitted Can Limit Vital Benefits For Seniors
Going into the hospital is stressful enough. But if you’re a senior on Medicare, and you stay at a hospital under “observation status,” you may end up with serious financial pain, too. That’s because Medicare may not cover some benefits — including post-hospital rehabilitation care in a nursing home — if a hospitalized patient is classified as being under observation vs. being admitted as an inpatient. (Lade, 2/21)

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The Health Law’s Two Americas: Those Who Qualified For Help And Those Who Didn’t

For those who were able to get federal subsidies, the health law was a blessing. The ones who didn’t were left feeling angry and short-changed.

The Associated Press: Health Law Created Winners And Losers When Buying Insurance
Michael Schwarz is a self-employed business owner who buys his own health insurance. Subsidized coverage through “Obamacare” offers protection from life’s unpredictable changes and freedom to pursue his vocation, he says. Brett Dorsch is also self-employed and buys his own health insurance. But he gets no financial break from the Affordable Care Act. “To me, it’s just been a big lie,” Dorsch says, forcing him to pay more for less coverage. (Alonso-Zaldivar, 2/22)

Kaiser Health News: GOP Fix To Insurance Markets Could Spike Premiums For Older Customers
Dale Marsh has not been enamored with his health insurance since the Affordable Care Act took effect. Premiums for Marsh, 53, and his wife, Tammy, rose, their deductibles grew, and they gave up access to their regular doctors to keep costs down. This year, facing monthly premiums of $1,131 — a 47 percent increase from four years before — they decided to go without coverage. “It’s useless insurance,” said Marsh, who owns a software company with Tammy, 52, in Graford, Texas. “We’re praying for the best, that neither one of us need insurance, that we don’t have to go the hospital.” Yet, a new premium spike may be in store for those in their 50s and 60s. (Rau and Appleby, 2/22)

In other news, worries about repeal persist —

The Associated Press: ‘It Saved My Life’: Talk Of Obamacare Repeal Worries Addicts
While the Affordable Care Act has brought health coverage to millions of Americans, the effects have been profound, even lifesaving, for some of those caught up in the nation’s opioid-addiction crisis. In Kentucky, which has been ravaged worse than almost any other state by fentanyl, heroin and other drugs, Tyler Witten went into rehab at Medicaid’s expense after the state expanded the program under a provision of the act. Until then, he had been addicted to painkillers for more than a decade. “It saved my life,” he said. (Beam and Johnson, 2/22)

The Philadelphia Inquirer: Advocates: Repealing Obamacare Would Cost N.J. Jobs And Lives
The generally left-leaning groups detailed county-by-county effects in an effort to get residents to put pressure on representatives at town hall meetings during this week’s congressional recess. Some lawmakers who have not scheduled meetings are discovering that gatherings have been planned in their absence. With more than $4 billion a year in direct federal funding at stake, the ripple effect of rescinding the law would kill 86,000 jobs, according to an analysis by New Jersey Policy Perspective. About 800,000 residents would lose health insurance without the ACA’s Medicaid expansion and subsidies for coverage purchased on the federal exchange. Plus, 212,000 seniors who fall into Medicare’s “doughnut hole” would each lose an average $1,241 in prescription assistance. (Sapatkin, 2/21)

Asbury Park Press: Group: Obamacare Repeal Costs Jersey Shore Over $500M
The Jersey Shore would lose more than $500 million a year in federal funding and 11,000 jobs if Obamacare is repealed without a replacement, according to a study released by consumer advocates on Tuesday. While replacement proposals on the table would soften the blow, they would leave New Jersey and consumers with less financial help for health care and possibly insurance policies that don’t cover as much, they said. (Diamond, 2/21)

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Administration, House GOP Agree To Freeze ‘Insurer Bailout’ Lawsuit

House Republicans had filed the suit in response to a series of President Barack Obama’s unilateral executive actions on paying insurers that they said were unconstitutional.

The Wall Street Journal: Trump Administration Seeks Delay In Lawsuit Over Health-Law Subsidies
The Trump administration and House Republicans on Tuesday asked a court for a further delay in a lawsuit over certain Affordable Care Act subsidies, a move that may help assuage insurers debating whether to participate in the health law’s 2018 exchanges. In May, a federal district court judge ruled that the government was improperly reimbursing insurers to help them cover discounts they were required to give some low-income consumers, potentially a major blow to the insurers. (Hackman, 2/21)

CQ Roll Call: Trump, House GOP Seek Delay In Key Obamacare Lawsuit
An end to the lawsuit could mean an end to the subsidy payments, so lawmakers would be prompted to act if they want to keep the insurance market stable while they come up with legislation. Insurers have called the payments “critical,” and made the issue their chief lobbying priority. Top Republicans, including appropriators, now say they’re willing to make the payments as they implement a health policy overhaul, despite a previous unwillingness to do so under the Obama administration that sparked the lawsuit in the first place. (Ruger, 2/21)

Morning Consult: House, DOJ Seek To Continue Hold In Case Over Obamacare Payments
Now lawyers for the House of Representatives and the Department of Justice want the case to remain on hold, meaning insurers would still receive payments in the meantime. Both sides proposed keeping the case on hold and giving status reports every three months, beginning May 22, 2017, according to a joint motion. “The House and Department of Justice filed a motion seeking more time to continue efforts to resolve the lawsuit without the court’s assistance,” Doug Andres, a spokesman for House Speaker Paul Ryan, said in an email. (McIntire, 2/21)

In other news —

Modern Healthcare: Filing Extension May Not Be Enough To Keep Insurers In Individual Market 
Health insurers are pleased the Trump administration wants to give them seven extra weeks to file rates for individual-market plans in 2018. But that move does little to settle their uncertainty about whether to offer plans at all. Their anxiety has been heightened by the Republican drive to repeal and replace the Affordable Care Act and by a pending House Republican lawsuit to block certain payments to insurers. Carriers say they need to know the rules of any new system before they can design plans and set rates. (Dickson, 2/21)

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Tax Proposals In GOP Repeal Plan Could Be Hard To Swallow For Conservatives

In addition to a credit to help people buy insurance, Republicans have suggested opening up some employer-sponsored health insurance plans to taxation. Both ideas are drawing opposition from the right wing of the party. Meanwhile, the fight over Medicaid looms large in the Senate.

The Hill: Two Tax Issues Dividing Republicans On ObamaCare
Republican lawmakers are objecting to two key elements of their party’s plan to replace ObamaCare, creating obstacles in the road to repeal. Conservatives worry a tax credit to assist people with the cost of insurance, which would help people maintain or get coverage, will be too costly and that recipients might abuse the government help…Objections also are being raised against a proposal to open up some employer-sponsored health insurance plans to taxation. Some Republicans worry that proposal is essentially a new version of ObamaCare’s much-reviled “Cadillac tax.” (Sullivan, 2/21)

The Hill: ­ObamaCare Fix Hinges On Medicaid Clash In Senate 
The most divisive issue for Senate Republicans when it comes to repealing and replacing ­ObamaCare is what to do with Medicaid. The Affordable Care Act gave states the option of accepting federal funds to expand Medicaid, the healthcare program for the poor and disabled. Millions of people gained health insurance after 31 states — including many with Republican governors — decided to accept the deal. Repealing ­­ObamaCare would end the Medicaid expansion, cutting federal funds to all of those states. (Bolton, 2/22)

Iowa Public Radio: Loebsack: GOP Plan To Replace ACA “Wholly Inadequate” 
Iowa’s only Democrat in the U.S. House of Representatives says he still doesn’t know the details of what Republicans will propose as a replacement for the Affordable Care Act. Dave Loebsack is on the House Energy and Commerce Committee, which will vote on a replacement before sending it to the full House. (Kieffer, Perkins and Leland, 2/21)

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A Not-So-Fun Recess: Hostile Crowds Confront GOP Lawmakers Over Repeal Plans

“With all due respect, sir, you’re the man that talked about the death panels. We’re going to create one great big death panel in this country,” the vice chairman of the Iowa Democratic Party’s Rural Caucus said at Sen. Chuck Grassley’s town hall meeting. Across the country, lawmakers are facing agitated and concerned voters during their weeklong recess.

The New York Times: At Town Halls, Doses Of Fury And A Bottle Of Tums
Representative Marsha Blackburn may have expected to draw a friendly crowd by scheduling a town hall-style meeting in a Tennessee community that had voted overwhelmingly for President Trump, but she instead faced a hurricane-strength blast of disapproval on Tuesday. Ms. Blackburn, an eight-term Republican, was sharply questioned about a wide range of issues that have unsettled Mr. Trump’s first month in office, including health care, the environment, education and the president’s links to Russia. (Gabriel, Kaplan, Alvarez and Huetteman, 2/21)

The Associated Press: GOP Members Of Congress Meet With Protests At Town Halls
A month into Trump’s presidency, protests continue over his immigration policies, Cabinet selections and the GOP’s push to repeal the Affordable Care Act, without all the specifics on how to replace it. At the town halls, protesters are probing their lawmakers to see if they will veer from some of Trump’s more controversial decisions, and if they will promise coverage for those currently served by the Affordable Care Act. Trump took to Twitter on Tuesday to address the town halls. “The so-called angry crowds in home districts of some Republicans are actually, in numerous cases, planned out by liberal activists. Sad!” he tweeted. (Matisse, 2/21)

The Associated Press: US Senate Leader: Winners Make Policy, Losers Go Home
Nearly 1,000 people jeered Senate Majority Leader Mitch McConnell as he drove to a speech Tuesday where he told local business leaders that “winners make policy and the losers go home.” … Several people stood and booed as McConnell finished his remarks, including answering a few questions about the Affordable Care Act and regulations on the financial industry imposed by the legislation known as Dodd-Frank. McConnell was largely unfazed by those he called “the people outside,” saying he was “proud” of them for expressing their views. (Beam, 2/21)

Politico: This Time, Grassley Hears Pro-Obamacare Voices
What a difference eight years makes. More than 100 Iowans on Tuesday packed into a small farm town community center by 7:45 a.m. to urge Sen. Chuck Grassley not to repeal Obamacare, and to air their opposition to President Donald Trump’s agenda, his Cabinet nominees and his Supreme Court pick. (Haberkorn, 2/21)

Politico: GOP Lessons From The Latest Round Of Brutal Town Halls
An overflow crowd here was eager to take on Rep. Dave Brat, the conservative Republican who just weeks earlier needled liberal protesters in his district and groused about all the women “in my grill” over GOP plans to repeal and replace Obamacare. But with a plain-spoken approach — and a format that didn’t revolve around live-fire questions from the combative crowd — Brat offered his colleagues a potential blueprint for defusing tense constituent town halls that have bedeviled his Republican colleagues as they’ve been swarmed by protesters. (Cheney, 2/21)

CNN: Brat Faces Raucous Crowd At Town Hall
Rep. Dave Brat faced a raucous crowd Tuesday night at a town hall here in the outer edge of his district, where a majority of the room interrupted him with angry shouts and jeers. The Virginia Republican took at least 34 questions for over an hour and at times appeared to enjoy the back-and-forth. “I don’t mind boisterousness. I’m having fun,” Brat said toward the end, swinging his arm in the air as people continued to shout at him. “I like having debate, spirited conversation — if you can have a conversation.” (Killough, 2/21)

WAVY (Hampton Roads, Va.): Boisterous Crowd Voices Concerns At Rep. Taylor’s First Town Hall In Va. Beach
Representative Scott Taylor (R-VA) held a packed town hall meeting at Kempsville High School in Virginia Beach Monday night. 10 On Your Side’s Joe Fisher reports the crowd was at capacity with about 750 people inside. Hundreds more were turned away at the door because they couldn’t fit in the school’s auditorium. … Taylor also said he supports the repeal of the Affordable Care Act and the implementation of a new policy that doesn’t discriminate against people with pre-existing conditions. “The vast majority of people are getting crushed by Obamacare,” he said. “What’s responsible I believe, is dissecting, having a discussion, and finding the best thing.” (Satchell, 2/21)

KTVH (Helena, Mont.): Hundreds Gather In Helena To Ask Daines To Hold Town Hall
U.S. Sen. Steve Daines was scheduled to speak before the Montana House Tuesday, but several hours before the address, his office announced it had been rescheduled to Wednesday. Despite that change, hundreds of protesters still gathered on the State Capitol steps in Helena in hopes of getting the senator’s attention. … Celeste Thompson, a home care worker, said she has health care because of the federal Affordable Care Act. She asked for more information on how Republicans in Congress plan to replace the ACA if it is repealed. “Our lives and so many others depend on access to health care,” Thompson said. “If the Affordable Care Act is repealed, that access will be stripped away from us.” (Ambarian, 2/21)

Montana Public Radio: Protesters Give Sen Daines An Earful At The State Capitol
Just before U.S. Senator Steve Daines was scheduled to give a speech in front of Montana lawmakers Tuesday afternoon, a crowd of protesters gathered on the Capitol steps. The event was organized by a Facebook group called “Bring The Town Hall to Steve Daines”. … About an hour and a half before Senator Daines was scheduled to arrive at the Capitol Tuesday to address Montana’s House of Representatives, he postponed his speech, pushing it to Wednesday. Staff with Senator Daines’ office say he pushed his speech back a day to work with his schedule, saying Daines had several other reasons to be in Helena on Wednesday. (Cates-Carney, 2/21)

Arkansas Online: Cotton Hears Medicare Concerns
A group of Arkansas senior citizens told U.S. Sen. Tom Cotton on Tuesday that they like their Medicare Advantage plans, but a few expressed concerns about higher spending caps and rising medication costs. Cotton, a Republican from Dardanelle, told the group that he supports the federally-funded program and will defend it on Capitol Hill. Nonetheless, the overall health care system needs changes, he said, promising to work to improve it. (Lockwood, 2/22)

CQ Roll Call: Health Coverage Questions Persist For Republicans
As Republican lawmakers face questions from constituents and colleagues about their plans to repeal and replace the 2010 health care law, they’re finding few answers, including what kind of legislation could pass the Senate. Republicans do not need Democratic support to undo parts of the law, since they will move the legislation through the budget reconciliation process that requires a simple majority in the Senate. But with only 52 Republican senators, the GOP plan will need support from the party’s conservatives and moderates, and it’s not clear what could get everyone on board. (Bowman, 2/22)

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First Edition: February 22, 2017

Feb 22 2017

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

Kaiser Health News: A New Diagnosis: ‘Post-Election Stress Disorder’
Jenny Gold reports: “Wally Pfingsten has always been a news junkie. But since President Donald Trump was elected, he’s been so anxious about the political tumult that even just having the TV news on in the background at home is unbearable. “It’s been crippling,” said the 35-year-old San Mateo, Calif., resident and political moderate who has supported both Democratic and Republican candidates in the past. “I feel angry, really, really angry, far more angry than I expected to be.” (Gold, 2/22)

Kaiser Health News: GOP Fix To Insurance Markets Could Spike Premiums For Older Customers
Jordan Rau and Julie Appleby report: “Dale Marsh has not been enamored with his health insurance since the Affordable Care Act took effect. Premiums for Marsh, 53, and his wife, Tammy, rose, their deductibles grew, and they gave up access to their regular doctors to keep costs down. This year, facing monthly premiums of $1,131 — a 47 percent increase from four years before — they decided to go without coverage. “It’s useless insurance,” said Marsh, who owns a software company with Tammy, 52, in Graford, Texas. “We’re praying for the best, that neither one of us need insurance, that we don’t have to go the hospital.” Yet, a new premium spike may be in store for those in their 50s and 60s.” (Rau and Appleby, 2/22)

California Healthline: A Safety-Net Medical Center Wrestles With What ‘Repeal’ Might Mean
Anna Gorman reports: “Little surprises Lynda Sutherland, who has been a licensed vocational nurse for 35 years at San Mateo Medical Center. But in the past few years, Sutherland said, she’s been surprised by what’s missing: the patients who used to return again and again to the public hospital for the same ailments. “They’re just not coming back,” she said.” (Gorman, 2/22)

The Associated Press: Health Law Created Winners And Losers When Buying Insurance
Michael Schwarz is a self-employed business owner who buys his own health insurance. Subsidized coverage through “Obamacare” offers protection from life’s unpredictable changes and freedom to pursue his vocation, he says. Brett Dorsch is also self-employed and buys his own health insurance. But he gets no financial break from the Affordable Care Act. “To me, it’s just been a big lie,” Dorsch says, forcing him to pay more for less coverage. (2/22)

The New York Times: At Town Halls, Doses Of Fury And A Bottle Of Tums
Representative Marsha Blackburn may have expected to draw a friendly crowd by scheduling a town hall-style meeting in a Tennessee community that had voted overwhelmingly for President Trump, but she instead faced a hurricane-strength blast of disapproval on Tuesday. Ms. Blackburn, an eight-term Republican, was sharply questioned about a wide range of issues that have unsettled Mr. Trump’s first month in office, including health care, the environment, education and the president’s links to Russia. (Gabriel, Kaplan, Alvarez and Huetteman, 2/21)

The Associated Press: GOP Members Of Congress Meet With Protests At Town Halls
A month into Trump’s presidency, protests continue over his immigration policies, Cabinet selections and the GOP’s push to repeal the Affordable Care Act, without all the specifics on how to replace it. At the town halls, protesters are probing their lawmakers to see if they will veer from some of Trump’s more controversial decisions, and if they will promise coverage for those currently served by the Affordable Care Act. Trump took to Twitter on Tuesday to address the town halls. “The so-called angry crowds in home districts of some Republicans are actually, in numerous cases, planned out by liberal activists. Sad!” he tweeted. (2/21)

The Associated Press: US Senate Leader: Winners Make Policy, Losers Go Home
Nearly 1,000 people jeered Senate Majority Leader Mitch McConnell as he drove to a speech Tuesday where he told local business leaders that “winners make policy and the losers go home.” … Several people stood and booed as McConnell finished his remarks, including answering a few questions about the Affordable Care Act and regulations on the financial industry imposed by the legislation known as Dodd-Frank. McConnell was largely unfazed by those he called “the people outside,” saying he was “proud” of them for expressing their views. (2/21)

Politico: This Time, Grassley Hears Pro-Obamacare Voices
What a difference eight years makes. More than 100 Iowans on Tuesday packed into a small farm town community center by 7:45 a.m. to urge Sen. Chuck Grassley not to repeal Obamacare, and to air their opposition to President Donald Trump’s agenda, his Cabinet nominees and his Supreme Court pick. (Haberkorn, 2/21)

Politico: GOP Lessons From The Latest Round Of Brutal Town Halls
An overflow crowd here was eager to take on Rep. Dave Brat, the conservative Republican who just weeks earlier needled liberal protesters in his district and groused about all the women “in my grill” over GOP plans to repeal and replace Obamacare. But with a plain-spoken approach — and a format that didn’t revolve around live-fire questions from the combative crowd — Brat offered his colleagues a potential blueprint for defusing tense constituent town halls that have bedeviled his Republican colleagues as they’ve been swarmed by protesters. (Cheney, 2/21)

The Wall Street Journal: Trump Administration Seeks Delay In Lawsuit Over Health-Law Subsidies
The Trump administration and House Republicans on Tuesday asked a court for a further delay in a lawsuit over certain Affordable Care Act subsidies, a move that may help assuage insurers debating whether to participate in the health law’s 2018 exchanges. In May, a federal district court judge ruled that the government was improperly reimbursing insurers to help them cover discounts they were required to give some low-income consumers, potentially a major blow to the insurers. (Hackman, 2/21)

The Associated Press: ‘It Saved My Life’: Talk Of Obamacare Repeal Worries Addicts
While the Affordable Care Act has brought health coverage to millions of Americans, the effects have been profound, even lifesaving, for some of those caught up in the nation’s opioid-addiction crisis. In Kentucky, which has been ravaged worse than almost any other state by fentanyl, heroin and other drugs, Tyler Witten went into rehab at Medicaid’s expense after the state expanded the program under a provision of the act. Until then, he had been addicted to painkillers for more than a decade. “It saved my life,” he said. (2/22)

The Associated Press: State Lawmakers Channel Grief Into Fight Against Opioids
In statehouses across the country, lawmakers with loved ones who fell victim to drugs are leading the fight against the nation’s deadly opioid-abuse crisis, drawing on tragic personal experience to attack the problem. A Minnesota state senator whose daughter died of a heroin overdose in a Burger King parking lot — a friend hid the needles instead of calling for help — spearheaded a law that grants immunity to 911 callers. In Wisconsin, a state representative has introduced more than a dozen opioid-related bills in the years since his daughter went from painkillers to heroin to prison. A Pennsylvania lawmaker whose son is a recovering heroin addict championed a state law that expanded availability of an antidote that can reverse an overdose. (2/21)

USA Today: New Patient Group Focuses On Drug Prices Amid Bipartisan Concern
A new patient advocacy group launches Wednesday that distinguishes itself by focusing only on drug prices and eschewing money from the pharmaceutical industry at a time when drug makers are pouring millions into a campaign fighting efforts to regulate them. The formation of Patients for Affordable Drugs (PFAD) comes as local officials and members of Congress are decrying the latest huge drug price hikes, this time by drugmaker Kaléo for its version of the overdose antidote naloxone. (O’Donnell and Shesgreen, 2/22)

The Associated Press: Lawmakers Urge VA To Explain Rising Cases Of Drug Theft
The heads of two congressional committees said Tuesday they want the Department of Veterans Affairs to better explain its efforts to stem drug theft and loss in light of rising cases of missing prescriptions and other unauthorized use at VA hospitals. Rep. Phil Roe, who chairs the House Veterans Affairs Committee, said his panel had scheduled a hearing for Monday. The Associated Press reported last Monday on government data showing a sharp increase since 2009 in opioid theft and drugs that had simply disappeared at the VA. (Yen , 2/21)

The New York Times: Judge Blocks Medicaid Cuts To Planned Parenthood In Texas
A federal judge on Tuesday temporarily blocked Texas from cutting off Medicaid funding to Planned Parenthood, ruling the state had presented no credible evidence to support claims the organization violated medical or ethical standards related to abortion procedures.The ruling, a preliminary injunction issued by Sam Sparks, a United States District Court judge in the Western District of Texas, means that, for now, 30 health centers that serve about 12,500 Medicaid patients can continue to receive funding from the medical program that serves the poor. The case is set to go to trial, where the judge can rule on its merits. (Mele, 2/21)

The Associated Press: Judge Blocks Texas Cutting Medicaid To Planned Parenthood
An injunction issued by U.S. District Sam Sparks of Austin comes after he delayed making decision in January and essentially bought Planned Parenthood an extra month in the state’s Medicaid program. … Sparks’ decision preserves what Planned Parenthood says are cancer screenings, birth control access and other health services for nearly 11,000 low-income women at 30 clinics. Texas originally intended to boot Planned Parenthood in January but Sparks told the state to wait pending his ruling. Arkansas, Alabama, Kansas, Mississippi and Louisiana have also had similar efforts blocked. (Weber, 2/21)

The Associated Press: McAuliffe Vetoes Bill Cutting Abortion Clinics’ Funding
Virginia Gov. Terry McAuliffe has vetoed a bill that would have restricted funding for Planned Parenthood clinics. The Democrat vetoed the measure Tuesday during an event outside the executive mansion. He vetoed the same measure last year and said Tuesday it would harm tens of thousands of Virginians who rely on Planned Parenthood. (2/21)

The Associated Press: Experts: Science Behind ‘Abortion Reversal’ Is Flawed
Lawmakers in several states are considering requirements for doctors to inform women seeking medical abortions about an unproven procedure called “abortion reversal.” Doctors’ groups oppose the bills because of flawed science and ethical concerns. There is no evidence the procedure works and little information about its safety. The procedure involves shots of the hormone progesterone given if a woman changes her mind after the first step of a medical abortion. (2/22)

The Washington Post: U.S. Life Expectancy Will Soon Be On Par With Mexico’s And The Czech Republic’s
Life expectancy at birth will continue to climb substantially for residents of industrialized nations — but not in the United States, where minimal gains will soon put life spans on par with those in Mexico and the Czech Republic, according to an extensive analysis released Tuesday. South Korean women and Hungarian men are projected to make the largest overall gains (with South Koreans second among males). There is a better-than-even chance that South Korean women will live to an average of 90 years old by 2030, which would be the first time a population will break the 90-year barrier, according to the research published in The Lancet. (Bernstein, 2/21)

The Wall Street Journal: Karen Pence’s Advocacy For Art Therapy Stirs Controversy
As Vice President Mike Pence visited Europe to reassure world leaders, his wife, Karen Pence, pursued her own issue: promoting art therapy. At first blush, it might seem Mrs. Pence’s support for art therapy would win public backing akin to the broad support Barbara and Laura Bush received for their promotion of literacy, instead of the divisive type of response Tipper Gore got for her campaign against offensive music lyrics. But the Donald Trump era is no ordinary time. (Barnes, 2/21)

NPR: Testosterone Has Mixed Results On Older Men’s Health
Many men over 65 with low testosterone levels say their sense of well-being, not to mention sexual function, isn’t what it used to be. That’s why some doctors prescribe testosterone replacement. But the effectiveness of testosterone has been controversial. Studies of the risks and benefits have been mixed, and the Food and Drug Administration beefed up its warnings about cardiac side effects of testosterone supplementation in 2015. (Neighmond, 2/21)

NPR: Testosterone Patients Not Told About Anemia
There’s a lesson about one of the testosterone studies released this week that has nothing to do with testosterone: The study on how testosterone affects anemia was designed with an ethical lapse that nobody noticed until the study was complete. That’s surprising because it was designed and carried out by a couple of dozen of well-regarded scientists. Their protocols were reviewed by 12 university institutional review boards, whose job is to evaluate the ethics of an experiment. It was funded by the National Institutes of Health, and the trial was overseen by a watchdog data safety and monitoring board. But all of those safety features fell short this time. (Harris, 2/21)

The Wall Street Journal: Bidder Says Los Angeles-Area Hospital Didn’t Need To Close
A health-care firm that offered to buy Gardens Regional Hospital and Medical Center Inc., a Los Angeles-area hospital that cared for low-income residents before shutting down, told a bankruptcy judge that its purchase efforts were unfairly ignored. In court papers, Le Summit Healthcare LLC officials told Bankruptcy Judge Ernest Robles that they are still willing to operate the nonprofit hospital while they obtain the new licensing and permits to restart its operations. They say Gardens Regional Hospital’s lawyers closed the 137-bed hospital unnecessarily. (Stech, 2/21)

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

A New Diagnosis: ‘Post-Election Stress Disorder’

Wally Pfingsten has always been a news junkie. But since President Donald Trump was elected, he’s been so anxious about the political tumult that even just having the TV news on in the background at home is unbearable.

“It’s been crippling,” said the 35-year-old San Mateo, Calif., resident and political moderate who has supported both Democratic and Republican candidates in the past. “I feel angry, really, really angry, far more angry than I expected to be.”

He’s tried hard to quell his anxiety. First, he shut down his Facebook page to limit his exposure to the daily soaking of news from Washington. But not knowing the goings-on made him anxious, too. He found himself sneaking onto the Facebook account he made for his dog. “I felt like I was cheating,” he said.

Pfingsten is not alone in his politics-induced anxiety — it’s so common it’s been given an unofficial name: Post-Election Stress Disorder. Mental health professionals around the country, especially those working in Democratic strongholds, report a stream of patients coming in with anxiety and depression related to — or worsened by — the blast of daily news on the new administration.

In the past, therapists say it’s been fairly uncommon for patients to bring up politics on the couch. “It is big money to talk about politics with me ― that is not what we do!” said Maria Lymberis, a psychiatrist in Santa Monica, Calif.

But that was before “fake news,” “alternative facts,” “repeal and replace,” contested confirmations, travel bans, protests and suits over travel bans, suspicions about Russian influence and the departures of the acting attorney general and the new national security adviser. Among other things.

Requests for therapy appointments to Talkspace, an online therapy portal based in New York City, tripled immediately following the election and have remained high through January, according to the company. In particular, Talkspace has seen a steady increase in requests from minorities, including Muslim-Americans, African-Americans, Jews, gays and lesbians.

“In my 28 years in practice, I’ve never seen anything like this level of stress,” said Nancy Molitor, a psychologist in the Chicago suburbs. She says the vast majority of her patients — from millennials to those in their 80s — are bringing up politics in their therapy sessions. “What we’re seeing now after the inauguration is a huge uptick in anxiety.”

Many of her patients say they are having trouble sleeping and focusing at work or are fighting more with family members, she said.

Mental health professionals around the country, especially in Democratic strongholds, report a stream of patients coming in with anxiety and depression. (Andrew Harrer/Bloomberg via Getty Images)

Mental health professionals around the country, especially in Democratic strongholds, report a stream of patients coming in with anxiety and depression. (Andrew Harrer/Bloomberg via Getty Images)

I have people who’ve told me they’re in mourning, that they’ve lost their libido,” Molitor said. “I have people saying the anxiety is causing them to be so distracted that they’re blowing through stop signs or getting into fender benders.”

The anxiety appears to be widespread. Fifty-seven percent of Americans report that the current political climate is a very or somewhat significant source of stress, and 40 percent say the same about the outcome of the election, according to an online survey of 1,019 adults conducted by the American Psychological Association after the inauguration. Between August 2016 and January 2017, the overall average stress level increased significantly for the first time since the Stress in America survey began 10 years ago.

And it’s not Democrats: a quarter of Republicans report that the outcome of election is a significant source of stress for them.

“I’m seeing lot of anxiety and anger on both sides,” says Elaine DuCharme, a psychologist in Glastonbury, Conn. “People who are Republicans are afraid to tell anyone. They’re afraid that everybody thinks that every Republican thinks exactly as Trump does, and support every single thing he does.”

She says some of her patients are particularly concerned about maintaining civil relationships with friends and loved ones who have different political opinions. “People are walking on eggshells,” DuCharme said.

Karri King, 56, who lives in Buckeye, Ariz., and voted for Trump, says her experiences on social media have left her feeling sad and hopeless. “There’s so much negative from all these stupid Facebook posts acting like the world is going to end. And it’s false. And I can’t do a thing about it.”

King said she’s tried to engage civilly with people online who disagree with her, but “every time [Republicans] turn around, we’re bashed.”

When you say “a bunch of idiots” voted Trump in, “you’re talking about half of all Americans! We were hopeful at first, and now we’re angry and tired of being blamed,” said King. “Nobody wants to listen anymore, and that’s where my sadness comes from.”

Of course, in some parts of the country, especially those that are overwhelmingly Republican and outside big cities, people seem relieved if not uplifted by the new president’s flurry of executive orders and appointments.

Kristin Addison-Brown, a psychologist in rural Jonesboro, Ark., says before the election, some of her patients were voicing concerns about a possible Clinton victory. But since then, “it’s pretty much been crickets for my patients. They got their guy, so they’re not stressed anymore.”

Nancy Cottle, a Trump supporter in Mesa, Ariz., has been riding high since the election. “We got to go to the inauguration, and, oh, it was a wonderful experience! We got to go to the Trump hotel and have breakfast and then lunch there, and it was just great. The inauguration itself was very inspiring.”

Cottle, 64, has been struggling to understand the public outcry about Trump. “It’s like the sky is falling ― but a lot of that is just drama,” she said. “I feel encouraged, I feel hopeful. I can’t wait to wake up and see what the day’s going to bring and what else is going to happen.”

That same daily dose of news ― and the uncertainty of what will happen next ― rattles many Trump opponents.  But, like Pfingsten, they can’t seem to quit their news consumption cold turkey.

“Part of the brain wants to know what’s going on, and you’re drawn to watching CNN or reading the news. And then the other part of you is saying no, no, this isn’t good for me!” says Molitor, the Chicago psychologist. “It’s unfortunately like driving by a car accident ― they know it’s not good for them [to gawk], but it’s hard to stop.”

Molitor recommends patients stay engaged but limit the time they spend on Facebook or watching the news. Focus instead on other things you enjoy, she advises ― calling a friend, taking a walk or reading a book.

“I never read the Harry Potter books, so I’m reading Harry Potter,” says Matthew Leal, a 34-year-old San Francisco resident who found himself sinking into a depression after the election. “Someone could see this and say I’m being totally escapist right now, but I feel like it’s kind of what I need.”

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GOP Fix To Insurance Markets Could Spike Premiums For Older Customers

Dale Marsh has not been enamored with his health insurance since the Affordable Care Act took effect. Premiums for Marsh, 53, and his wife, Tammy, rose, their deductibles grew, and they gave up access to their regular doctors to keep costs down. This year, facing monthly premiums of $1,131 — a 47 percent increase from four years before — they decided to go without coverage.

“It’s useless insurance,” said Marsh, who owns a software company with Tammy, 52, in Graford, Texas. “We’re praying for the best, that neither one of us need insurance, that we don’t have to go the hospital.”

Yet, a new premium spike may be in store for those in their 50s and 60s. As Republicans consider how to bring down costs for younger people, lawmakers are considering relaxing or eliminating the restrictions on how much more insurers can charge older consumers.

Middle-aged Americans already face the highest premiums in the health care markets for individuals who don’t get coverage from their workplace or the government. Plans are permitted to charge three times as much for a 64-year-old as for a 21-year-old. Last year 3.3 million consumers ages 55 through 64 bought insurance on the marketplaces. That was a quarter of all those covered, more than any other age group tracked by the federal government, data show.

The GOP has not unified behind a single plan, but one proposal last year by House Speaker Paul Ryan (R-Wis.) would let insurers make older people pay five times more than young adults. Another plan offered by Department of Health and Human Services Secretary Tom Price when he was a Georgia congressman would do away entirely with age restrictions and instead give tax credits that increase by age. House Republican leaders embraced a similar concept of tax credits this month.

The politics for Republicans are precarious as older voters are such an important part of their support. More than half of consumers who bought insurance on the federal exchanges last year in Iowa, Ohio, Pennsylvania and Wisconsin — all important states in the presidential election — were 45 or older, according to a Kaiser Health News analysis. Insurance purchasers in Florida and Michigan also trend older than in most states.

Many older customers think current prices are not fair. “I’m in excellent health, I don’t live at the pharmacy,” said Susan Finney, a 59-year-old commercial real estate broker in Chesterfield, Mo. “I’m a walker, four miles a day.”

Finney said her monthly premiums have risen from $490 to $793 since 2015. “The health insurance companies are out of control,” she said.

Before the health law, insurers selling policies to individuals could base their premiums on several factors, including age, gender and health history. That meant many states allowed ratios of 5 to 1 or even higher.

The insurance industry favors relaxing the age rules, arguing it will allow them to reduce rates for younger consumers, who are coveted because they tend to be healthier and thus use fewer medical services. Last year 2.2 million people ages 26 to 34 obtained coverage on the markets — a third fewer than purchasers ages 55 and over. The imbalance between young and older consumers is one reason premiums jumped in many markets this year.

Two studies predict changing the age rules to 5 to 1 would lead to double-digit spikes in premiums for older people and significant but smaller reductions for the young. A major reason for the dramatic swings is that age is one of the few elements that insurers are allowed to consider when setting rates. The 2010 health law barred insurers from considering most other factors, including the health and medical histories of people when setting rates and their genders.

The actuarial firm Milliman estimated that if insurers were allowed to charge older people five times more than young ones, adults in their 20s would see their annual premiums drop by $696 — 15 percent — to $4,008 next year.

But those savings would pale next to the added burdens on older people, Milliman said. Those in their 60s would see average annual premiums rise by 22 percent, growing by $3,192 to $17,916, according to Milliman’s projections, which were commissioned by AARP. That lobbying group for older Americans opposes loosening the age rules. A study last year by the Rand Corp. for the Commonwealth Fund, a New York foundation, projected up to 29 percent premium increases.

“We do need to make it more affordable for young people,” said Susan Murray, the Marshes’ health insurance broker in Dallas. But, she said, plans are already too expensive for many older people who earn too much to qualify for financial assistance from the government. “There are the lost people like Dale who just can’t afford it,” she said.

James Capretta, a former budget adviser to President George W. Bush now at the American Enterprise Institute, a Washington think tank, said older people can afford to pay higher premiums than young people, especially if Republicans add other provisions to cushion them from the highest costs.

“People 50 to 65 are probably in their higher earning years, they’ve had the capacity to work and save more,” Capretta said. “People at 25 are just starting out, and we’re adding this additional burden on them.”

Others worry the changes might backfire by discouraging healthy older people from signing up. “Those are the very people you want to keep,” said Sabrina Corlette, a researcher at Georgetown University’s Health Policy Institute. “They’re healthy, and because they’re older, they pay a higher premium.”

It’s not clear how many people would be swayed to buy — or drop — insurance if age changes were made. Milliman estimates that if the age ratio was increased to 5 to 1, enrollment for people ages 50 and older would drop by 18,000, while enrollment for those under 50 would increase by 386,000. That would mean a net increase in enrollment of 2 percent. Rand had more seismic estimates, predicting 3 million people under 35 would gain coverage but 700,000 people over 47 would drop coverage.

“Reduced coverage among older adults, who are at greater risk for health problems, under the 5:1 approach could likewise raise costs for hospitals, doctors, and other health care providers, who will see more uncompensated care,” the Rand economists wrote.

As Republicans mull various ideas to lower premiums, health economists say each has drawbacks. Some want to give the most expensive patients separate insurance underwritten by the government, which would add billions to the budget deficit.

Others want to trim all the types of services insurers must cover, but savings would be limited by the fact that the costliest kinds of care, including hospitals, doctors and prescription drugs, are the ones that most people can’t do without. Lawmakers are considering several methods to make sure healthy people buy insurance, including automatically enrolling them and letting insurers charge higher rates to those who let their coverage lapse.

Price suggested replacing income-based tax credits with age-based tax credits up to $3,000, but those wouldn’t even cover the premium increases anticipated by Rand and Milliman. It would be unlikely to be enough for someone like Robert Baker, a 59-year-old hairdresser in St. Louis, who says insurance costs are too high even though he qualifies for an income-related subsidy.

Baker said he did not buy insurance this year. The 2008 financial crisis wiped him out, he said, and he needs to sock away earnings for retirement. “If I spend most of that on insurance, I won’t have any money when I’m old,” he said.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

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Some Immigrants, Fearful Of Political Climate, Shy Away From Medi-Cal

Some foreign-born Californians are canceling their Medi-Cal coverage or declining to enroll in the first place, citing fears of a Trump administration crackdown on immigrants.

Among those dropping coverage are people in the country legally but concerned about jeopardizing family members who lack permanent legal status, according to government officials, immigration attorneys and health care advocates.

Others worry they will be penalized in the future for using public benefits such as Medi-Cal, the state’s version of the federal Medicaid program that provides health coverage to low-income residents.

“We’re hearing from a lot of counties that they’re getting calls from immigrant families who are receiving benefits, or whose children are citizens and may be receiving benefits, asking to be disenrolled,” said Cathy Senderling-McDonald, deputy executive director of the County Welfare Directors Association of California in Sacramento, which represents human services directors from the state’s 58 counties.

Senderling-McDonald stressed that the reports are anecdotal but are coming from across the state. “It’s not just one or two counties,” she said.

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Many immigrants are dropping out even though they are legally entitled to and eligible for the benefits they’re receiving, she said.

In reality, experts say, terminating benefits might not help since the immigrants’ names are already in the system.

The Community Health Initiative of Orange County, a nonprofit group that helps local residents apply for health coverage, has worked in the past month with two immigrant families that have withdrawn applications for Medi-Cal coverage.

In one case, a Santa Ana mother had applied in January for full Medi-Cal benefits for her daughter, an unauthorized immigrant, said Aaron Reyes, the group’s director of programs and policy.

But the mother called back about a week later and told them to scrap the application, even though California provides full Medi-Cal coverage to all low-income children, regardless of immigration status.

“She said she heard that Trump was going to deport people, and that they’re going to use the names of people who are getting services,” he said. “We told her there was currently nothing like that going on, but she didn’t want to take any chances.”

In the other case, a Buena Park mom submitted an application last month for Medi-Cal and food stamps for her daughter, a green-card holder. A few weeks later, she called back to cancel the application.

“The parent said she was afraid of Donald Trump and didn’t want any problems,” Reyes said.

President Trump has made cracking down on unlawful immigration a focal point of his presidency. In addition to fraying relations with Mexico over his plans to build a wall along the southern border, he has vowed to get tough on unauthorized immigrants already here. Two weeks ago, immigration authorities rounded up hundreds of people in deportation raids across the country, including in California.

Trump’s administration also has drafted an executive order that would, if implemented, exclude potential immigrants likely to need certain types of aid and deport those already in the United States who have used social services, according to a Washington Post analysis of the order. It also would require social service agencies to report immigrants receiving benefits to federal authorities.

“The overall climate has been terrifying for immigrant families,” said Tanya Broder, senior attorney at the Los Angeles-based National Immigration Law Center. “We have literally heard from people who don’t know whether to continue cancer treatment. I encourage them to continue getting the care they need while they can get it.”

Broder wants immigrants to know that “at this point, the rules have not changed. The executive order has not been filed.”

Melissa Rodgers, director of programs for the San Francisco-based Immigrant Legal Resource Center, emphasized that immigrants who are currently receiving health care and nutrition benefits for which they’re eligible “are not breaking the law in any way.”

The most recent statistically credible statewide enrollment data from California’s Department of Health Care Services (DHCS) are about four months old, so they don’t yet show any possible Trump effect on enrollment.

Department spokesman Adam Weintraub said the federal government hasn’t imposed any significant changes on Medi-Cal since Trump’s inauguration.

But, he said, “DHCS cannot speculate as to any potential changes to the Medicaid program that may occur under a new administration.”

Weintraub added that the department “takes its responsibility to safeguard personal health information seriously” and shares only details about an applicant’s immigration status with the federal Centers for Medicare & Medicaid Services, and only “for the purposes of administering the Medicaid program.”

Two weeks ago, Ale Ricardez, program manager for San Diegans for Healthcare Coverage, spoke with a woman who had taken the first steps to rescind her family’s Medi-Cal application.

Everyone in the family is a citizen except the woman’s husband, who has work authorization and is in the process of getting his green card, Ricardez said.

“She was concerned that they would risk the immigration process for her husband if they continued with the application,” she said.

Ricardez told the woman that her family is legally entitled to the benefits as long as they qualify, but that didn’t change her mind, Ricardez said.

While some immigrants are canceling their coverage, others aren’t even signing up.

Alice Ting, an enrollment worker at Asian Pacific Health Care Venture, a group of clinics in Los Angeles and El Monte, received two calls in the past two weeks from nervous immigrants asking if they should cancel their Medi-Cal. Ultimately, they decided to remain enrolled after she explained they qualified, she said.

Another trend has grabbed her attention even more: She used to get daily phone calls from Chinese immigrants inquiring about how to apply for Medi-Cal. “I’ve noticed recently it’s decreased,” she said.

Jan Spencley, executive director of San Diegans for Healthcare Coverage, has witnessed a similar trend.

“We are seeing people who are not enrolling who are eligible, and people ending coverage who have it,” Spencley said. “People are not enrolling unless they have to.”

Advocates and immigration experts warn that dropping health coverage — or not signing up — might compromise public health, let alone an individual or family’s health.

“Letting fear lead to actual serious bodily harm, that’s really not the way to go,” Rodgers said. “If people need health care, they should get it.”

At the same time, Rodgers and others aren’t making promises about the future, because they don’t know what it holds.

“We don’t want to say, ‘This isn’t going to happen, don’t worry,’ and then have something bad happen,” Reyes said. “For us, it’s important to be as accurate as possible, which is really challenging right now.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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Single-Payer Health Care Bill Introduced In California Senate

Legislation introduced in the California Senate last week would set the state on a path toward the possible creation of a single-payer health care system ― a proposal that has failed to gain traction here in the past.

The bill, which is a preliminary step, says that it is the “intent of the Legislature” to enact a law that would establish a comprehensive, single-payer health care program for the benefit of everyone in the state. The legislation, introduced by state Sen. Ricardo Lara (D-Bell Gardens), does not offer specifics of what the plan would look like, nor does it mention a timetable.

A single-payer system would replace private insurance with a government plan that pays for coverage for everyone. Proponents argue that single-payer systems make health care more affordable and efficient, but opponents say they raise taxpayer costs and give government too much power.

Medicare, the federally-funded health coverage for the elderly, is often held up as a model of what a single-payer system might look like.

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Lara said in an interview late last week that the state needs to be prepared in case the Affordable Care Act is repealed, as President Donald Trump and Congressional Republicans have promised.

“The health of Californians is really at stake here and is at risk with what is being threatened in Congress,” Lara said, as the debate continued in Washington about the future of President Barack Obama’s signature health law. “We don’t have the luxury to wait and see what they are going to do and what the plan is,”

Lara noted that while the Affordable Care Act expanded health coverage for many Californians, it left others uninsured or underinsured. He said the single-payer bill builds upon his “health for all kids” legislation, which resulted in coverage beginning last May for 170,000 immigrant children here illegally.

“I’ve met many children who have asked me point blank, ‘What about my mom? What about my dad?’” Lara said.

He recently withdrew a request to the federal government, based on a bill he had introduced, that would have allowed adult immigrants here illegally to purchase unsubsidized health plans through Covered California, the state’s insurance exchange.

Sen. Ricardo Lara, D-Bell Gardens (Courtesy Sen. Lara's office)

Sen. Ricardo Lara, D-Bell Gardens (Courtesy Sen. Lara’s office)

According to the text of the Lara’s bill, a single-payer system would help address rising out-of-pocket costs and shrinking networks of doctors.

No state has a single-payer health system. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after the state couldn’t figure out how to finance it. Last year, Colorado residents rejected a ballot measure that would have used payroll taxes to fund a near universal coverage system.

In California, voters rejected a ballot initiative in 1994 that would have established a government-run universal health program. Gov. Arnold Schwarzenegger later vetoed two bills that would have accomplished the same goal.

It’s difficult to create consensus on single-payer plans because they dramatically shift how health care is delivered and paid for, said Larry Levitt, a senior vice president at the Kaiser Family Foundation (California Healthline is produced by Kaiser Health News, an editorially-independent program of the foundation.)

“Single-payer plans have lots of appeal in their simplicity and ability to control costs,” Levitt said. “But what I think has always held back a move to single-payer is the disruption they create in financing and delivery of care.”

The problem, Levitt said, is that even if they end up costing less overall, single-payer plans look to the public like a “very big tax increase.”

The California Nurses Association, the primary sponsor of the new bill, is planning a rally in Sacramento this week in support of a single-payer system. Bonnie Castillo, the group’s associate executive director, said the goal is to create a system that doesn’t exclude anyone and helps relieve patients’ financial burdens.

“Patients and their families are suffering as a result of having very high co-pay and premium costs,” she said. “They are having to make gut-wrenching decisions whether they go to the doctor or they stick it out and see if they get better on their own.”

Castillo said that with so much uncertainty at the national level, California has the ability to create a better system. “We think we can get this right,” she said.

Charles Bacchi, president and CEO of the California Association of Health Plans, said he hadn’t yet seen the bill, but the trade group has opposed single-payer proposals in the past.

“It’s hard to tell until you know the details,” Bacchi said. “But past studies have shown [single-payer systems] are incredibly expensive and would be disruptive.”

He said health plans, doctors, hospitals and others are “laser-focused on protecting and enhancing the gains we have made in coverage” under the Affordable Care Act and ensuring that California continues to receive critical funding. “We think that’s where the focus should be,” he said.

One possible concept of a single-payer system in California would be to bring together funding from several sources under one state umbrella: Medi-Cal, which covers the poor; Medicare, the federal program that covers older adults, and private insurance.

Lara said he has not yet figured out the financing, saying that it is still early in the legislative process. But he said that even as California continues to defend the Affordable Care Act, it is time to put forward an alternative.

“I think we’ve reached a tipping point now that we haven’t had before,” he said.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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Viewpoints: How Technology Is Advancing Wellness; Moral Questions About Gene Editing

A selection of opinions on health care from around the country.

The Wall Street Journal: Health-Care Innovations Are Coming To Your Digital Device
Mobile phones and tablets have pushed themselves to the center of modern life. Instead of going to the bookstore, readers download the latest novel direct to their devices. Online shopping has left malls quieter than ever. Video chatting helps far-flung families stay in touch. Health care needs this same kind of disruption. … Personal technology can make routine medical care and healthy living easier. (Regina Benjamin and Andrew Thompson, 2/20)

The Washington Post: If We’re Going To Play God With Gene Editing, We’ve Got To Ask Some Moral Questions
The past 30 days have seen several unheralded but consequential strides in the scientific quest for god-like control of our destiny. Last week, the National Academy of Sciences and the National Academy of Medicine published a report on human genome editing that allows the manipulation of sperm and egg cells to create changes that could be passed down to offspring. In January, scientists for the first time grew a part-pig, part-human “chimera,” a step toward developing animal embryos with functioning human organs for interspecies transplantation. With Tesla chief executive Elon Musk hinting last month at having made progress on a brain-computer interface, injectable electronics and other forms of human augmentation have clearly entered mainstream discussion as a way for humans to keep up with quickly advancing artificial intelligence. (Christine Emba, 2/20)

Indianapolis Star: Invest In Health, Raise Cigarette Tax
Once again the General Assembly considers raising the cigarette tax. This time the proposal is to increase the tax by a $1.50 per pack. … Unquestionably, Indiana is one of the unhealthiest states in the country.  We rank near the bottom in public health funding; we have one of the highest smoking rates; we have an infant mortality rate that rivals some third world countries; and, Indiana ranks as one of the worst in rates of obesity, cancer, and most measures of the chronic diseases that plague our nation. Despite the great advances in tobacco control that have occurred over the past half-century, tobacco still remains our number one public health issue; tobacco use remains the leading cause of preventable disease and premature death. (Richard Feldman, 2/20)

Sacramento Bee: Living And Thriving With A Dementia Diagnosis 
About 80 percent of people with dementia develop Alzheimer’s disease, a particularly insidious form of dementia that leads to death. I am in the early stages of dementia, and they tell me my tests currently clear me of Alzheimer’s, so my experiences have been far less scary by comparison to many others’. My prognosis is for continued regression with no reversal. Otherwise, I am a healthy and physically active guy rapidly approaching 70 and generally enjoying retirement along with my wife of 49 years. (Kent Pollock, 2/20)

San Jose Mercury News: Bring Sanity To Gun Policy For The Mentally Ill
Part of the stigma associated with mental illness is the notion that the mentally ill are uniformly dangerous. It doesn’t help that any time there is a mass shooting, the immediate response is the perpetrator must be crazy. This sad lack of knowledge about the mentally ill is perhaps only eclipsed by our lack of understanding of the underlying causes of gun violence. When the two issues collide, the result is legislative mayhem. (2/20)

Boston Globe: Listening To A Doctor About His Pain 
The opioid epidemic has led to what [Paul] Konowitz believes is a well-intentioned but misguided change in the way doctors prescribe pain medication. Or, more specifically, the way they avoid prescribing pain medication. He thinks there has been an overreaction, an overcorrection, so that many people who really need medication for pain are not getting it. There is evidence backing his theory. (Kevin Cullen, 2/20)

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

Different Takes On Inside-The-Beltway Health Policy Developments

Opinion writers offer a variety of views on how the plans being advanced by the Trump administration and GOP Congress will shape a range of health concerns — from the effort to repeal, replace or repair the health law effort to federal health programs and Planned Parenthood’s future.

The Washington Post: Obamacare’s Enduring Victory
What’s the holdup, House Republicans? During the Obama administration, you passed literally dozens of bills to repeal all or part of the Affordable Care Act — knowing that none had any chance of being signed into law. Now that Donald Trump is in the White House, why can’t you seem to pull the trigger? (Eugene Robinson, 2/20)

The New York Times: Ryancare: You Can Pay More For Less!
President Trump promised to replace the Affordable Care Act with something that is better, is cheaper and covers more people. Scratch that. Republican leaders in the House and Mr. Trump’s secretary of health and human services released a plan last week that would provide insurance that is far inferior, shift more medical costs onto families and cover far fewer people. (2/19)

Los Angeles Times: ‘Death Spirals,’ Deceit And Pampering The Rich: The Republicans Face High Noon On Repealing Obamacare
Congressional Republicans who have visited their home districts over the last few weeks have gotten a faceful of constituent rage about their plans to eviscerate the Affordable Care Act, which brings health coverage to more than 20 million Americans. If past is prologue, those heading home now for the Presidents Day recess are likely to feel a lot more heat. That may be why House Republicans this week rushed out a “policy brief” on “Obamacare Repeal and Replace.” Unfortunately for the poor souls who will be meeting with constituents, the brief answers none of the key questions about the GOP’s plans for the ACA. (Michael Hiltzik, 2/17)

The Washington Post: Republicans Are Selling Health-Care Reform That People Don’t Want 
House Speaker Paul Ryan (R-Wis.) says Obamacare is failing. Club for Growth president David McIntosh warns that voters “gave Republicans the charge to repeal and replace Obamacare,” so the “delays and discussions about repairing Obamacare need to stop.” The problem is that voters fear disruption, don’t want to lose what they have and won’t find what Republicans are selling very attractive. (Jennifer Rubin, 2/20)

The Washington Post: Ryan’s Health-Care Plan Will Be Hard To Defend
House Speaker Paul Ryan (R-Wis.) outlined a health-care plan to his members yesterday. Surprisingly, it did not include much detail, either because the speaker has not gotten that far or because he’s afraid of the reaction when the numbers are revealed. (Jennifer Rubin, 2/17)

Modern Healthcare: Give Seema Verma A Chance
Seema Verma, the Indiana consultant who injected personal responsibility requirements and health savings accounts into that state’s Medicaid program, deserves a shot at working with other states that want to redesign their programs. She repeatedly testified last week that her main goal for the program, if confirmed as CMS administrator, will be to achieve better outcomes for the vulnerable populations served by the program. “This shouldn’t be about kicking people off,” she said. (Merrill Goozner, 2/18)

Fox News: Seema Verma For Medicaid/Medicare Czar Is The Final Piece In The Health Care Puzzle
Seema Verma is a bold pick by President Trump to head the Centers for Medicare and Medicaid Services. She should be approved without further delay. During a hearing by the Senate Finance Committee this week she appeared confident and informed, refusing to take positions on raising Medicare’s eligibility age, price negotiation with drug companies, or caps on Medicaid allotments to the states. She stated that these decisions are up to Congress, showing an understanding of her role’s limits. (Marc Siegel, 2/20)

The Washington Post: Staffing, Budget Shortages Put Indian Health Service At ‘High Risk’
There’s a sliver of good news for a stricken federal agency during the first alarming month of President Trump’s administration: relief from Trump’s hiring freeze for the Indian Health Service (IHS). “This exemption is a step in the right direction,” seven Democratic senators said in a statement Friday. “Indian Health Services facilities face staff vacancy rates of 20 percent or higher, and a hiring freeze would make these challenges even more severe, further impacting access to health care and even patient health.” (Joe Davidson, 2/20)

Stat: Vaccine Programs Threatened By Exemptions, ACA Repeal
Our highly successful vaccination programs will be in danger if they are not factored into the current discussion of the repeal of the Affordable Care Act (ACA). There’s a clear connection between having health insurance and getting vaccinated, so reducing the number of people with health insurance, which could likely happen if the ACA is repealed, will translate into fewer children and adults who get their recommended vaccines. (John Auerbach, 2/17)

Los Angeles Times: An Attack On Abortion Rights And A Handout To The Rich: The Republicans’ New Plan For Repealing Obamacare
Congressional Republicans who have visited their home districts over the last few weeks have gotten a faceful of constituent rage about their plans to eviscerate the Affordable Care Act, which brings health coverage to more than 20 million Americans. If past is prologue, those heading home now for the Presidents Day recess are likely to feel a lot more heat. (Michael Hiltzik, 2/17)

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