From Health Care

In Snapshot Of How Bad Opioid Crisis Has Become, Counselors Overseeing Halfway House Die Of Overdoses

“The staff members in charge of supervising recovering addicts succumbed to their own addiction and died of opioid overdoses. Opioids are a monster that is slowly consuming our population,” Pennsylvania’s Chester County District Attorney Tom Hogan said.

The Washington Post: Residents Of Halfway House Found Two Men Dead From Overdoses — Their Drug Counselors
The man’s losing battle with heroin was laid out right there on the nightstand of the halfway house. There were three morning devotionals, including “God Calling,” geared toward keeping a person’s thoughts pointed heavenward. Then there was the nicotine: two packs of cigarettes, a vaporizer and a case of snus to quell cravings. And near the edge: empty packets of heroin, a spoon and a syringe half full of the last hit the man would ever inject. (Wootson, 5/24)

Meanwhile, in Tennessee —

Nashville Tennessean: State Data Confirms Overdose Deaths Are Primarily White Opioid Users
A new report from the Tennessee Department of Health on drug overdose deaths sheds new light on the opioid epidemic plaguing the state, darkening the lines of an emerging portrait of the typical abuser killed by the powerful painkillers. The drug overdose fatalities are overwhelmingly white, mostly male and increasingly less likely to have prescriptions for the drugs that kill them. And, across Tennessee, those killed are more likely to overdose on opioids — including heroin and fentanyl — than on any other kind of drug. (Fletcher, Nelson and Wadhwani, 5/24)

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

Johnson & Johnson To Pay $33M In Investigation Over Manufacturing Practices

“Johnson & Johnson’s disregard for proper manufacturing practices of children’s medications was unacceptable,” says Illinois Attorney General Lisa Madigan in a statement.

Stat: J&J To Pay $33 Million For Lapses That Led To ‘Phantom Recalls’
Johnson & Johnson agreed to pay $33 million to 42 states to settle allegations that its over-the-counter subsidiary falsely claimed have to followed federal manufacturing practices that led to the recall of millions of bottles of Tylenol, Motrin, Benadryl, and Sudafed. The settlement comes eight years after an embarrassing scandal for the health care giant, which endured congressional investigations, shareholder lawsuits, and a disturbing loss of market share in a key business over its handling of the manufacturing lapses. (Silverman, 5/24)

In other pharmaceutical news —

Stat: Drug Pricing Battle Hits Ohio With Dueling Ads Over Ballot Measure
The next battleground over prescription drug prices is now playing out in Ohio, where consumer groups and the pharmaceutical industry this week launched dueling ad campaigns over a controversial November ballot measure that is being promoted to lower costs. At issue is the Ohio Drug Price Relief Act, which would require state agencies to pay no more for medicines than the US Department of Veterans Affairs. The agency currently gets a 24 percent federally mandated discount off average manufacturer prices and the measure, if passed, would presumably benefit more than 3.4 million residents. (Silverman, 5/24)

Stat: No One Says ‘Cure,’ But Pipeline For ALS Treatments Looks Promising
Considering it took more than two decades for a second ALS drug to make it to the US market, you might think that few companies are willing to take the risk of developing such treatments. But in fact, it hasn’t been for lack of trying. After the Food and Drug Administration approved MT Pharma America’s Radicava this month, experts said there have always been a number of possible therapies being explored and tested in ALS — commonly known as Lou Gehrig’s disease — but without much success. Now, though, researchers say advances in the field over the past few years mean the treatments that are currently in clinical trials seem to hold greater potential than in the past. (Joseph, 5/25)

The New York Times: Rare Gene Mutations Inspire New Heart Drugs
What if you carried a genetic mutation that left you nearly impervious to heart disease? What if scientists could bottle that miracle and use it to treat everyone else? In a series of studies, the most recent published on Wednesday, scientists have described two rare genetic mutations that reduce levels of triglycerides, a type of blood fat, far below normal. People carrying these genes seem invulnerable to heart disease, even if they have other risk factors. (Kolata, 5/24)

The Cannabist: Report: Medical Marijuana Could Poach $4 Billion From Pharmaceutical Sales Annually
If the United States legalized medical marijuana for conditions such as chronic pain, anxiety and seizures, cannabis could siphon more than $4 billion annually from the nation’s pharmaceutical industry, a new study hypothesizes. The report expected to be released Wednesday by New Frontier Data, a provider of data and analytics to cannabis businesses, is intended to show how cannabis could disrupt pharmaceutical sales in nine key treatment areas. (Wallace, 5/24)

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

Citing CBO Report, Critics Decry GOP Bill’s Potential Fallout In California

Though the budget analysis released Wednesday on the GOP health care bill didn’t address California specifically, both the state’s Medicaid program and its individual market could be seriously harmed if the legislation passes, according to legislators, consumer advocates and other critics.

“I feel like I am in a bad dream,” said Sen. Ed Hernandez, the West Covina Democrat who chairs the state Senate Health Committee.

The Congressional Budget Office confirmed what Hernandez expected — that large numbers of people would lose coverage and poorer, older Californians would pay significantly more for coverage under the American Health Care Act.

The Republican bill passed the House of Representatives earlier this month with no Democratic support and is now in the hands of the Senate, which is working on its own version.

Use Our Content

Hernandez said he’s especially concerned about the changes to the Medicaid program, known as Medi-Cal in California. “The state budget is not going to be able to absorb this,” he said. “We are going to have a real problem.”

All 14 members of California’s Republican delegation in the House voted for the GOP bill. Like their counterparts nationally, several have said that President Obama’s signature health law was failing and that the new legislation would offer consumers more choice and better care at better prices.

But critics said the law would roll back much of what California had achieved when it heartily embraced the Affordable Care Act, which brought the state’s uninsured rate to record lows.

Nationally, the $119 billion in savings projected by the CBO over a 10-year period doesn’t seem worth the anticipated cost of adding 23 million to the rolls of the uninsured, said John Baackes, CEO of LA Care Health Plan.

In California, Baackes said, the cuts to Medi-Cal “will create a huge gap that the state would have to fill.” And he said it could end the Medicaid expansion ushered in by the Affordable Care Act. Since the law took effect, about 5 million more people enrolled in Medi-Cal, including 3.7 million who became newly eligible under the expansion.

An earlier analysis of the House bill by the California Department of Health Care Services, which oversees the state’s Medicaid program, estimated that the state would lose more than $24 billion annually by 2027 compared to what it would have received under the ACA.

Covered California officials declined to comment on the budget analysis Wednesday but have said in the past that the GOP legislation would make coverage unaffordable for many Californians, especially those who have lower incomes and live in pricier areas.

Even assuming California keeps the 10 essential benefits spelled out under the ACA and continues to prohibit higher premiums for those with preexisting conditions, the individual market in the state would be destabilized, said Laurel Lucia, a health care researcher at the University of California-Berkeley Labor Center.

For many people, the Republican proposal also would reduce premium subsidies for Covered California plans, which Lucia said would make coverage less affordable. And proposed caps on federal Medicaid spending would tightly squeeze the California program, she said.

“Overall there would be substantial loss of coverage for low- and middle-income Californians, especially older Californians,” Lucia said.

Jen Flory, a policy advocate at the Western Center on Law & Poverty in California, said the CBO report shows that “drastic cuts to Medicaid are largely offsetting tax cuts for wealthy Americans.”

Flory said she also feared that that optional Medi-Cal benefits under the law — such as prescription drugs and nursing home care — would be at risk. “The state would be faced with some really tough choices,” Flory said.

Carmela Castellano-Garcia, CEO of CaliforniaHealth+ Advocates, said the CBO score is “devastating.”

“It will impact millions in the state of California,” she said.

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.

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

Tags: ,

First Edition: May 25, 2017

May 25 2017

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

Kaiser Health News: Millions Of Ill People May Face ‘Extremely High Premiums’ Under House Bill, CBO Says
Julie Rovner reports: “The Republican overhaul of the federal health law passed by the House this month would result in slightly lower premiums and slightly fewer uninsured Americans than an earlier proposal. But it would leave as many as one-sixth of Americans living in states where older and sicker people might have to pay much more for their health care or be unable to purchase insurance at all, the Congressional Budget Office said Wednesday.” (Rovner, 5/24)

The Associated Press: GOP Health Bill: 23M More Uninsured; Sick Risk Higher Costs
The Congressional Budget Office report, issued Wednesday, also found that average premiums would fall compared with President Barack Obama’s health care overhaul, a chief goal of many Republicans. But that would be partly because policies would typically provide fewer benefits and sicker people would be priced out, it concluded. (5/25)

Los Angeles Times: GOP Health Bill Would Raise Deductibles, Lessen Coverage And Leave 23 Million More Uninsured, Analysis Finds
The House bill would be particularly harmful to older, sicker residents of states that waive key consumer protections in the current law, including the ban on insurers charging sick consumers more. The budget office estimates that about one-sixth of the U.S. population live in states that would seek such waivers, which would be allowed under the House bill. “Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance,” the report notes. (Levey, 5/24)

The Wall Street Journal: CBO Report On Health Bill: What It Is And Why It Matters
Under budget rules, the health bill must cut the federal deficit (the House’s first version did that to the tune of $337 billion), so that is an important number. It is also important to look at how much of the budget savings would come from reduced Medicaid spending, because steep cuts mean more people without insurance. That is another key figure: the increase in the uninsured compared with leaving the ACA in place. The more uninsured, the harder it may be for Republicans to sell their plan to the public. And effects on premiums matter, since Senate GOP lawmakers have said their main goal is to bring down premium costs. (Armour, 5/24)

USA Today: CBO: House Obamacare Repeal Will Increase Uninsured By 23 Million
Many House Republicans avoided specifics of the analysis and instead focused on the overall picture which was “that the American Health Care Act achieves our mission: lowering premiums and lowering the deficit,” House Speaker Paul Ryan, R-Wis., said. “We’re on a rescue mission, and today’s CBO report reinforces what we’ve said before — our American Health Care Act will lower premiums and reduce the deficit,” said House Republican Conference Chair Cathy McMorris Rodgers, R-Wash. “The CBO report doesn’t tell the whole story when it comes to the benefits of this bill, but we’re one step closer to keeping our promise to repeal and replace Obamacare.” (Collins, 5/24)

The Washington Post: How The CBO Thinks The Republican Health-Care Bill Will Affect Your Pocketbook
But what does that mean to most Americans? The CBO helpfully broke down how much insurance premiums would cost for people at two income levels — $26,500 and $68,200 annually — at three ages. The upshot is that people making $68,200 a year who are in the two younger ages (21 and 40) will pay less in premiums annually because they will get a tax credit not available to people at their income level under Obamacare. But for older and poorer Americans, the effect will mostly be worse. (Bump, 5/24)

The Wall Street Journal: House GOP Health Bill Would Add 23 Million Uninsured, Cut $119 Billion In Deficit Through 2026, CBO Says
The findings provide ammunition for the two competing factions that Senate Republican leaders need to pull together to pass a bill. Centrist Republicans, concerned about the number of uninsured, hope to make the House bill less far-reaching, while conservatives want to double down on measures the CBO suggests will lower premiums on average. (Armour and Peterson, 5/25)

The Washington Post: Senate Republicans Have All The Evidence They Need To Reject The House-Passed Health-Care Overhaul
For a week now, some congressional insiders had been whispering that the critical “score” from the Congressional Budget Office, on the legislation that narrowly passed the House earlier this month, might not provide any real deficit savings. Such a finding would have violated the Senate’s more arcane rules for considering budgetary items under fast-track rules — and it might have forced House Speaker Paul D. Ryan (R-Wis.) to redraw the legislation and hold another vote. So there were a few sighs of relief late Wednesday afternoon when the CBO declared the legislation would find $119 billion in savings over 10 years, more than enough to allow it to pass muster under the Senate’s so-called reconciliation rules, which allow a simple majority for passage rather than the usual 60-vote majority. That’s an important feat for Senate Republicans, who control just 52 seats. (Kane, 5/25)

Politico: Senate Dems Seize On CBO To Slam GOP
Senate Democrats on Wednesday seized on a new projection that 23 million more Americans would be uninsured under the House GOP’s Obamacare repeal to hammer the Republican senators now crafting their own plan. Led by Minority Leader Chuck Schumer, Senate Democrats staged a fiery press conference less than 45 minutes after the non-partisan Congressional Budget Office released its report on the House-passed Obamacare repeal. Schumer argued that Senate Republicans are making a mistake similar to their House counterparts’ hasty passage of a bill before its CBO score emerged. (Schor, 5/24)

Politico: Peril For Republicans If They Push Forward With Obamacare Repeal
Obamacare repeal is in trouble in the Senate, and a nonpartisan analysis of the House’s repeal legislation issued Wednesday only reinforced that reality. Within minutes of the release of the report showing 23 million fewer Americans would be insured over a decade, two Senate Republicans blasted the estimate and the House bill, underscoring just how much the legislation will have to change to get through the upper chamber. (Demko and Haberkorn, 5/24)

Reuters: McConnell Frets About Healthcare, Hopeful On Tax Overhaul
U.S. Senate Majority Leader Mitch McConnell said on Wednesday he does not yet know how Republicans will amass the votes needed to pass legislation now being crafted to dismantle Obamacare, but expressed some optimism on another top priority, overhauling the tax code. In an exclusive interview with Reuters, McConnell said healthcare and taxes still top the Republican legislative agenda, and he added that he will not reach out to the minority Democrats on either one because differences between the two parties are too stark. (5/24)

Politico: Health Care Or Russia? Democrats Divided On 2018 Focus
The Democratic Party is embroiled in a debate over where they should focus their efforts to win back political power: health care or Russia. The party’s campaign committees and many of Democrats’ leading super PACs have spent virtually all their energy this year on shaming Republicans for their push to repeal Obamacare, an issue that clearly touches voters’ daily lives. (Robillard and Schor, 5/24)

Reuters: Anthem Still Weighing 2018 Obamacare Individual Participation
Anthem Inc on Wednesday said its plans for selling 2018 Obamacare individual plans are still up in the air because of political and regulatory uncertainty, making it the latest health insurer to say questions about continued funding of government subsidies will affect consumers next year. Anthem, the biggest provider of individual health plans, is looking at all 14 states where it sells Obamacare coverage to determine to what extent it will participate next year, given the continued uncertainty around subsidies and regulations, its chief executive said on Wednesday. (Humer, 5/24)

The Wall Street Journal: Another Insurer To Leave Missouri’s ACA Marketplace
Blue Cross and Blue Shield of Kansas City plans to pull out of the Affordable Care Act health insurance exchanges next year, a move that leaves a region in northwestern Missouri at risk of having no available marketplace plans. The nonprofit said that after losing more than $100 million on ACA plans through 2016, it will stop offering exchange plans in 30 counties in northwestern Missouri and two counties in Kansas. (Wilde Mathews, 5/24)

The Wall Street Journal: Health-Tech Startups Pivot As Obamacare Uncertainty Mounts
As Congress grapples with possible repeal of the Affordable Care Act, political uncertainty is prompting some health-technology startups to revamp their sales pitches or products, while others are finding it tougher to attract fresh capital. The challenges are likely to be greatest for very young firms with limited resources, companies tied directly to the insurance market or that sell to hospitals facing potential cuts in Medicaid, say some investors and others that work with startups. (Simon, 5/24)

The Associated Press Fact Check: Medicaid A Target For Cuts Despite Assurance
Medicaid is clearly in line for cuts under President Donald Trump’s budget despite assurances to the contrary from his budget chief. Mick Mulvaney, director of the Office of Management and Budget, while introducing the budget Tuesday: “There are no Medicaid cuts in the terms of what ordinary human beings would refer to as a cut. We are not spending less money one year than we spent before.” (5/25)

The Associated Press: Trump Budget Faces Dem Opposition, GOP Doubts About Math
Mulvaney gave an unapologetic defense of Trump proposals to slash programs related to the environment, education, health care for the poor and foreign aid. The former tea party congressman told the Budget Committee that he went line by line through the federal budget and asked, “Can we justify this to the folks who are actually paying for it?” Democrats charged that Trump’s cuts would rip apart the social safety net. Rep. Pramila Jayapal, D-Wash., told Mulvaney that the proposed cuts to food stamps, payments to the disabled, and other programs are “astonishing and frankly immoral.” (Taylor, 5/24)

The New York Times: In One Chart: Trump Plans To Cut Medicaid After Promising Not To
President Trump has long promised not to cut Medicaid, Medicare and Social Security. But in his budget released on Tuesday, he proposes making massive cuts to Medicaid. Mr. Trump is proposing to cut $610 billion from Medicaid benefits. This could come on top of more than $800 billion in cuts to Medicaid sought in the health care overhaul bill passed by the House on May 4. (Park, 5/24)

The Associated Press: Wisconsin Seeks To Be First To Drug Test Medicaid Applicants
Gov. Scott Walker wants to make Wisconsin the first state in the country to require childless adults applying for Medicaid to undergo drug screening, a move that could serve as a national model. Walker’s plan, which needs federal approval, comes as he prepares to run for a third term next year. Wisconsin’s Republican-controlled Legislature approved Walker’s request for a waiver to do the drug tests two years ago, but is now digging into the details of how it would actually work. (5/25)

The New York Times: Trump’s Pick For Mental Health ‘Czar’ Highlights Rift
For decades, therapists, patient advocates and countless families have worked to elevate mental health care in the political conversation. Their cause recently received a big boost when a new law created a federal mental health “czar” to help overhaul the system and bridge more than 100 federal agencies concerned with mental health. But the White House’s choice for the first person to fill that position has already been divisive, exposing longstanding rifts within the field that may be difficult to mend. (Carey and Fink, 5/24)

The Associated Press: VA Plans Mental Care For Discharged Vets, But At What Cost?
Veterans Affairs Secretary David Shulkin touted new efforts Wednesday to expand urgent mental health care to thousands of former service members with less-than-honorable discharges, even while acknowledging his department isn’t seeking additional money to pay for it. Testifying at a House hearing, Shulkin offered new details on his initiative announced in March to stem stubbornly high rates of suicide. Stressing a need at that time for “bold action,” he noted the additional coverage would help former service members who are more likely to have mental health distress. Of the 20 veterans who take their lives each day, about 14 had not been connected to VA care. (Yen, 5/24)

The Associated Press: Consultant Charged In Scheme To Trade US Secrets For Profit
A Washington consultant, three hedge fund workers and a government employee were blamed Wednesday by federal prosecutors for an insider trading scheme that converted government secrets into hedge fund profits. … Acting U.S. Attorney Joon H. Kim said the defendants used “highly sensitive and confidential information” from the Centers for Medicare & Medicaid Services, part of the U.S. Department of Health and Human Services, to enable three hedge fund workers to make over $3.5 million illegally for their company from 2012 through 2014. The Securities and Exchange Commission said the profits reached $3.9 million. (5/24)

Reuters: Five Charged With Insider Trading Involving U.S. Health Agency
Prosecutors said that from 2012 to 2014, Olan, Huber and Fogel schemed to get confidential information about CMS’s internal decision-making from Blaszczak, who previously worked there. Blaszczak in turn got the information from his former colleague and “close friend” Worrall, prosecutors said. (Pierson, 5/24)

The New York Times: Nevada And Connecticut Are Latest To Ban Discredited ‘Conversion Therapy’
At least nine states now ban “conversion therapy” for minors, a discredited method meant to change a person’s sexual orientation or gender identity, after Nevada and Connecticut this month joined others in prohibiting the practice. Gov. Brian Sandoval of Nevada last week signed Senate Bill 201, making it illegal for any licensed medical or mental health care professional to provide sexual orientation or gender conversion therapy to anyone under 18 years of age, a statement from his office said. (Hauser, 5/24)

The New York Times: Rare Gene Mutations Inspire New Heart Drugs
What if you carried a genetic mutation that left you nearly impervious to heart disease? What if scientists could bottle that miracle and use it to treat everyone else? In a series of studies, the most recent published on Wednesday, scientists have described two rare genetic mutations that reduce levels of triglycerides, a type of blood fat, far below normal. People carrying these genes seem invulnerable to heart disease, even if they have other risk factors. (Kolata, 5/24)

Reuters: J&J Settles Drug Manufacturing Probe By U.S. States For $33 Million
Johnson & Johnson has agreed to pay $33 million to resolve charges by most U.S. states that it misrepresented the manufacturing practices behind Tylenol, Motrin, Benadryl and other over-the-counter drugs that were eventually recalled. The settlement, announced by attorneys general for 42 states and the District of Columbia, resolves claims related to several products, including children’s medicines, that were voluntarily recalled from 2009 to 2011. (Raymond, 5/24)

The Washington Post: Marijuana Extract Sharply Cuts Seizures In Severe Form Of Epilepsy
An oil derived from the marijuana plant sharply reduces violent seizures in young people suffering from a rare, severe form of epilepsy, according to a study published Wednesday that gives more hope to parents who have been clamoring for access to the medication. Cannabidiol cut the median number of monthly convulsive seizures from 12.4 to 5.9 in 52 children with Dravet syndrome who took the medication over a 14-week test period, according to research published in the New England Journal of Medicine. Fifty-six children using a placebo saw the number of seizures drop only from a median of 14.9 to 14.1 per month. (Bernstein, 5/24)

The Associated Press: Marijuana Extract Helps Some Kids With Epilepsy, Study Says
“This is the first solid, rigorously obtained scientific data” that a marijuana compound is safe and effective for this problem, said one study leader, Dr. Orrin Devinsky of NYU Langone Medical Center. He said research into promising medical uses has been hampered by requiring scientists to get special licenses, plus legal constraints and false notions of how risky marijuana is. “Opiates kill over 30,000 Americans a year, alcohol kills over 80,000 a year. And marijuana, as best we know, probably kills less than 50 people a year,” Devinsky said. (Marchione, 5/24)

The Washington Post: Residents Of Halfway House Found Two Men Dead From Overdoses — Their Drug Counselors
The man’s losing battle with heroin was laid out right there on the nightstand of the halfway house. There were three morning devotionals, including “God Calling,” geared toward keeping a person’s thoughts pointed heavenward. Then there was the nicotine: two packs of cigarettes, a vaporizer and a case of snus to quell cravings. And near the edge: empty packets of heroin, a spoon and a syringe half full of the last hit the man would ever inject. (Wootson, 5/24)

The Washington Post: It’s Not Pain But ‘Existential Distress’ That Leads People To Assisted Suicide, Study Suggests
A few decades ago, doctor-assisted suicide was considered a fringe idea despite surveys showing many physicians support the idea under certain circumstances. The face of euthanasia at that time was Jack Kevorkian, a Michigan pathologist nicknamed “Dr. Death.” By his own admission, he helped 130 people end their lives. He was convicted of homicide and served eight years in prison. While doctor-assisted suicide remains a polarizing issue, some countries and states have begun to accept it. Belgium, the Netherlands, Luxembourg and Switzerland have legalized voluntary euthanasia. In 2016, Canada legalized “medically assisted death.” Australia, France, South Africa and the United Kingdom are considering similar measures. (Cha, 5/24)

NPR: The Zika Virus Made Its Way To Miami Earlier Than Thought
Last year’s Zika outbreak in Miami likely started in the spring of 2016, with the virus introduced multiple times before it was detected, researchers say. And most of those cases originated in the Caribbean. The study, published Wednesday in Nature, examined more than 250 cases of local Zika transmission in three Miami neighborhoods. Researchers analyzed 39 Zika virus genomes isolated from 32 people who had been infected and seven Aedes aegypti mosquitoes, the species that carries Zika. (Allen, 5/24)

NPR: Some Fitness Trackers Give Inaccurate Measurements Of Calories Burned
Sleek, high-tech wristbands are extremely popular these days, promising to measure heart rate, steps taken during the day, sleep, calories burned and even stress. And, increasingly, patients are heading to the doctor armed with reams of data gathered from their devices. “They’re essentially asking us to digest the data and offer advice about how to avoid cardiovascular disease,” says cardiologist Euan Ashley, associate professor of medicine at the Stanford University Medical Center and Stanford Hospital and Clinics in northern California. (Neighmond, 5/24)

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

Millions Of Ill People May Face ‘Extremely High Premiums’ Under House Bill, CBO Says

The Republican overhaul of the federal health law passed by the House this month would result in slightly lower premiums and slightly fewer uninsured Americans than an earlier proposal. But it would leave as many as one-sixth of Americans living in states where older and sicker people might have to pay much more for their health care or be unable to purchase insurance at all, the Congressional Budget Office said Wednesday.

In some states, said the report, “less healthy people would face extremely high premiums, despite the additional funding that would be available” in the bill to help offset those increases.

The report incorporates the changes to the bill made just before it narrowly passed the House on May 4. Those changes included an amendment offered by Rep. Tom MacArthur (R-N.J.) that would let states waive some key provisions of the health law, including requirements to cover “essential health benefits” and to offer insurance to people with preexisting conditions at no extra cost.

CBO said the current version would result in savings of $119 billion over 10 years and 23 million more uninsured people than would be expected under the current law.

Use Our Content

According to the estimate, premiums would be slightly lower than under the Affordable Care Act, but mostly because “the insurance, on average, would pay for a smaller proportion of health care costs.”

Prior to the changes, the CBO estimated that the bill would result in savings of $150 billion over the next decade and grow the number of uninsured Americans by 24 million. That dollar figure was a considerable change from the original version of the bill that CBO said would have saved $337 billion, but lawmakers decided to spend back some of those savings on help for those likely to be cut off from insurance.

The two earliest versions of the bill could not muster enough support for the House leadership to bring them to a vote on the floor. Later, MacArthur and leaders of the conservative Freedom Caucus negotiated changes that they said should help bring down premium costs for consumers. That is the bill approved and now evaluated by CBO.

The CBO also estimated that in states deciding to take the option to waive requirements related to charging sicker people more, “the nongroup market would start to become unstable.” In particular, said the report, “people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.”

And in states that chose to waive the requirements for essential benefits, even people with insurance “would experience substantial increases in what they would spend on health care,” because their policies might no longer cover expensive treatments like those for maternity care or mental health and substance abuse.

Despite repeated claims from President Donald Trump and congressional Republicans that the Affordable Care Act is collapsing, the CBO specifically said that the market would continue “to be stable in most areas” under current law. It predicted the same for the original version of the House bill.

In fact, the only place the CBO specifically said the individual insurance market might become unstable is in states that decide to waive the ACA’s coverage requirements. It did not guess which states might do that, but the report says that one-sixth of the population could be subject to that instability.

“What is clear is that these waivers make life much, much worse for people with preexisting conditions, for older people, for sicker people,” said Aviva Aron-Dine, a senior fellow at the Center on Budget and Policy Priorities and former Obama administration health staffer.

The savings in the bill are mostly the result of capping federal funding to states for the Medicaid program for those with low incomes and scaling back the tax credits that help some people with low and modest incomes pay for private insurance. An estimated 14 million of the 23 million people who would no longer have insurance would otherwise have obtained it through Medicaid.

The bill would also repeal nearly all the taxes imposed in the ACA to pay for the new benefits, including taxes on wealthy individuals and much of the health industry.

Reaction to the new estimate fell mostly along predictable party lines.

“CBO continues to find that through our patient-focused bill, premiums will go down and that our reforms will help stabilize the market,” said a statement from House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) and its health subcommittee chairman, Michael Burgess (R-Texas).

By contrast, Rep. Steny Hoyer (D-Md.) said the new estimate shows “TrumpCare will kick millions of Americans off their insurance coverage and force consumers to pay more for less.”

But the reaction was not completely partisan. Sen. Bill Cassidy (R-La.), a key swing vote in the Senate, said that “Congress’s focus must be to lower premiums with coverage which passes the Jimmy Kimmel test,” referring to the late-night host’s tearful monologue about the health problems of his newborn son. The House-passed bill, he said, “does not. I am working with Senate colleagues to do so.”

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

CBO: House GOP Health Bill Would Leave 23 Million Without Coverage – San Francisco Chronicle

The agency said the bill would reduce premiums for younger, healthier people, and raise them for older and sicker people, including those with pre-existing medical conditions such as diabetes and cancer, “if they could purchase (insurance) at all,” the report said, despite the additional funding Republicans added to help sick people. House Speaker Paul Ryan, R-Wis., said the report “again confirms that the American Health Care Act achieves our mission: lowering premiums and lowering the deficit.” He called the report “another positive step toward keeping our promise to repeal and replace Obamacare.”

(Lochlead 5/24)

Categories: Uncategorized

Analysis Of GOP Healthcare Bill: 23 Million More Uninsured, Skimpier Coverage, Higher Deductibles 

The much-anticipated report cast a new shadow over the controversial legislation and likely will complicate Republican efforts to get the bill through the Senate, where it already faces difficult prospects. According to the budget office, which both parties in Congress look to for estimates on the impact of complex legislation, the bill would cause 23 million fewer people to have health insurance by 2026. Many additional consumers would see skimpier health coverage and higher deductibles, the budget office projected.

(Levey 5/24)

Categories: Uncategorized

CBO Score Of Revised GOP Health Bill: Over Next Decade, 23M Would Be Left Uninsured, Deficit Reduced By $119B

May 24 2017

The nonpartisan Congressional Budget Office issues its latest report on the American Health Care Act.

The New York Times: C.B.O. Projects Dismantling Obamacare Increases Uninsured By 23 Million In A Decade
A bill to dismantle the Affordable Care Act that narrowly passed the House this month would increase the projected number of people without health insurance by 14 million next year and by 23 million in 2026, the Congressional Budget Office said Wednesday. That 10-year figure is slightly less than originally estimated. It would reduce the federal deficit by $119 billion over a decade, less than the $150 billion in savings projected in late March for an earlier version of the bill. And in states that seek waivers from rules mandating essential health coverage, the new law could make insurance economically out of reach for some sick consumers. (Pear, 5/24)

NPR: CBO: Republicans’ AHCA Would Leave 23 Million More Uninsured
The deficit reduction in the latest version of the bill represents a decline from previous versions. When the CBO first scored the AHCA, it said the plan would save $337 billion over 10 years. Later revisions reduced those savings to $150 billion. By far the biggest savings would come from Medicaid, which serves low-income Americans. That program would face $884 billion in cuts. Cutbacks in subsidies for individual health insurance would likewise help cut $276 billion. But those are offset in large part by bigger costs, including the repeal of many of Obamacare’s taxes. (Kurtzleben, 5/24)

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

Manchester bombing: Salman Abedi may have been part of ‘network’

[Po]lice made three more arrests and said they were investigating a “network” as the probe intensified into the suicide bombing at a pop concert that killed 22 people and wounded scores more. Home Secretary Amber Rudd said the sophistication of the attack Monday at Manchester Arena indicate Salman Abedi, 22, likely did not act alone. … “extensive searches” across the city. The latest arrests came one day after the suspected bomber’s brother was taken into custody. (Hjelmgaard, Onyanafajife;ajf and f;jfaisj, 5/24)

Categories: Uncategorized

Millones de personas enfermas enfrentarían primas altísimas, según nuevo informe

El informe de la Oficina de Presupuesto del Congreso (CBO) conocido el miércoles 24 de mayo indicó que, bajo el proyecto de salud republicano aprobado por la Cámara Baja a principios de mes, millones de personas tendrían que pagar mucho más por su atención médica, o incluso no podrían siquiera solventarla.

En algunos estados, dijo el informe, “las personas menos saludables se enfrentarían a primas muy altas, a pesar de la financiación adicional que estaría disponible” bajo el proyecto de ley para ayudar a compensar esos aumentos.

El informe incorporó los cambios al proyecto hechos justo antes de aprobarse el 4 de mayo. Esos cambios incluyeron una enmienda ofrecida por el representante Tom MacArthur (republicano de New Jersey) que permitiría a los estados renunciar a algunas disposiciones claves de la ley de salud, incluyendo los requisitos para cubrir los “beneficios esenciales de salud” y para ofrecer seguro a las personas con condiciones preexistentes sin costo adicional.

La CBO dijo que la nueva versión del proyecto de ley resultaría en un ahorro de $119 mil millones en 10 años y que habría 23 millones de personas más sin seguro, comparado con las estimaciones bajo la ley actual.

Según la estimación, las primas serían ligeramente más bajas que las de la Ley de Cuidado de Salud Asequible (ACA), en especial porque “el seguro, en promedio, pagaría una proporción menor de los costos de atención médica”.

Use Nuestro Contenido

Antes de los cambios, la CBO había estimado que el proyecto de ley daría lugar a ahorros de $150 mil millones en la próxima década y aumentaría el número de estadounidenses sin seguro médico en 24 millones. Esa cifra en dólares fue un cambio considerable respecto a la versión original del proyecto de ley que la CBO dijo que habría ahorrado $337 mil millones, pero los legisladores decidieron gastar parte de esos ahorros en ayuda para aquellos que podrían no poder afrontar el costo de un seguro de salud.

Las dos primeras versiones del proyecto de ley no pudieron reunir suficiente apoyo para que los representantes de la Cámara Baja los sometieran a votación. Más tarde, MacArthur y los líderes del Freedom Caucus negociaron los cambios que, dijeron, deberían ayudar a bajar los costos de las primas (lo que se paga por mes por tener cobertura de salud) para los consumidores. Ese es el proyecto aprobado y que ahora evaluó la CBO.

La CBO también estimó que en los estados que decidan tomar la opción de renunciar a los requisitos relacionados con pagar por las personas más enfermas, “el mercado de los asegurados individuales sería inestable”. En particular, dijo el informe, “las personas menos saludables (con condiciones médicas preexistentes o enfermedades recién diagnosticadas) no podrían, en última instancia, comprar un seguro de salud integral con primas comparables a las de la legislación vigente”.

Y en los estados que optaran por renunciar a los requisitos para los beneficios esenciales, incluso las personas con seguro “experimentarían aumentos sustanciales en lo que gastarían en la atención de la salud”, porque sus planes ya no podrían cubrir tratamientos costosos como cuidados de maternidad, salud mental o abuso de sustancias.

A pesar de las repetidas declaraciones del presidente Donald Trump y de los republicanos del Congreso de que ACA se está derrumbando, la CBO dijo específicamente que el mercado continuaría “siendo estable en la mayoría de las áreas” bajo la ley actual. Predijo lo mismo para la versión original del proyecto de ley de la Cámara Baja.

De hecho, la CBO dijo específicamente que el único lugar en el que el mercado de seguros individual puede llegar a ser inestable es en los estados que decidan renunciar a los requisitos de cobertura de ACA. No predijo qué estados podrían hacer eso, pero el informe dice que una sexta parte de la población podría verse afectada por esa inestabilidad.

“Lo que está claro es que estas exenciones hacen la vida mucho, mucho peor para las personas con condiciones preexistentes, para las personas mayores, para las personas más enfermas”, dijo Aviva Aron-Dine, experta senior del Center on Budget and Policy Priorities y ex miembro del equipo de salud de la administración de Barack Obama

Los ahorros en el proyecto de ley surgen principalmente de limitar la financiación federal a los estados para el Medicaid, el programa que ofrece atención de salud a los más pobres, y de reducir los créditos fiscales que ayudan a algunas personas con ingresos bajos y modestos a pagar por un seguro privado. Un estimado de 14 millones de los 23 millones que ya no tendrían seguro lo habrían podido obtener a través del Medicaid.

El proyecto de ley también derogaría casi todos los impuestos que dispuso ACA para pagar los nuevos beneficios, incluyendo los impuestos a los individuos ricos y a gran parte de la industria de la salud.

La reacción a la nueva estimación fue predecible.

“La CBO continúa encontrando que, a través de nuestro proyecto enfocado en el paciente, las primas bajarán y que nuestras reformas ayudarán a estabilizar el mercado”, dijo en un comunicado el presidente del Comité de Energía y Comercio de la Cámara de Representantes, Greg Walden (republicano de Oregon) y el presidente del subcomité de salud, Michael Burgess (republicano de Texas).

Por el contrario, el representante Steny Hoyer (demócrata de Maryland) dijo que la nueva estimación muestra que “el Trumpcare expulsará a millones de estadounidenses de su cobertura de seguros y obligará a los consumidores a pagar más por menos”.

Pero la reacción no fue completamente partidaria. El senador Bill Cassidy (republicano de Louisiana), un votante clave en el Senado, dijo que “el enfoque del Congreso debe ser primas bajas con cobertura que supere la prueba Jimmy Kimmel”, refiriéndose al emocional monólogo que el conductor de TV hizo sobre los problemas de salud de su hijo recién nacido. El proyecto de ley aprobado por la Cámara, dijo, “no pasa la prueba. Estoy trabajando en eso con los colegas del Senado”.

Categories: Cost and Quality, Noticias En Español, Repeal And Replace Watch, The Health Law

Tags:

Viewpoints: The Rule Of Law And Subsidies; Anticipating CBO’s Score On The GOP Health Plan

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

Bloomberg: Rule Of Law Actually Applies To Democrats, Too
Yes. Congress can mandate subsidies without also mandating a funding source. Medicaid is another example. This is crazy, but there it is. For once the Constitution is admirably clear on how the executive branch should handle this quandary: “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law; and a regular Statement and Account of the Receipts and Expenditures of all public Money shall be published from time to time.” The law appropriated no money for these cost-sharing reduction payments. But the Obama administration went ahead and paid them anyway. (Megan McArdle, 5/23)

The New York Times: How To Read The C.B.O. Score Of The Health Bill Like An Expert
Today, the Congressional Budget Office will issue important numbers about the House-passed version of the American Health Care Act, the Republican bill to repeal and replace portions of the Affordable Care Act. Although the budget office had analyzed an early version of the bill, the House on May 4 took the unusual step of voting before the budget office could gauge how several last-minute amendments might affect the deficit or the number of uninsured. (Margot Sanger-Katz, 5/24)

RealClear Health: Why Nutrition Standards And Policies Should Continue
The U.S. Department of Agriculture said recently it will delay the implementation of school lunch rules aimed at lowering the amount of sodium and raising the whole grain content of meals served to kids. At the same time, the Food and Drug Administration announced it will delay for one year the implementation of Obama administration rules to require calorie labels on menus and prepared food displays. (Deborah A.Cohen, 5/24)

WBUR: America’s Food Access Problem Starts On The Farm 
Given that we’re tangled in knots over how to pay for health care, it’s remarkable that food and farm policy isn’t more in the public’s mind. Heads of hunger programs and food banks have begun to grasp the obvious; as one told WBUR, “food is medicine, food is health,” with good health impossible in the absence of nutritious eating. (Rich Barlow, 5/23)

San Jose Mercury News: Single-Payer Detracting From Big Medi-Cal Fight
Sen. Ricardo Lara’s single-payer legislation was a non-starter in California from day one, even before it was given an eye-popping $400 billion price tag. … It’s merely an exercise in politics, which is all well and good except that it detracts from a far more important California health care issue: Can the state fight off President Trump’s inhumane effort to slash the nation’s Medicaid budget by more than $880 billion through 2026? (5/23)

Stat: Risk Scores For Preventing Heart Disease, Stroke Must Take The Long View
Back in 1998, researchers with the legendary Framingham Heart Study created the first heart risk calculator. Using answers to questions about age, cholesterol and blood pressure levels, tobacco use, and the presence of diabetes, it estimated an individual’s risk of having a heart attack or stroke over the next 10 years. Since then, this calculator has been revised and many others have been developed, including ones that extend the time horizon out to an individual’s lifetime. Yet much to our surprise, the use of these single-point-in-time risk calculators does little to reduce the risk of heart attack or stroke compared with not using such calculators. ( Kunal N. Karmali and Mark Huffman, 5/23)

On the Ground: Our Teeth Are Making Us Sick
The left side of Jacquelyn Garcia’s face throbbed fiercely. She had tried taking Tylenol and Excedrin for the pain, but threw them up. On a Monday morning straight after working the night shift as a custodian, she rushed to the N.Y.U. emergency dental clinic. Here a student delivered the verdict: decay so deep it had reached the nerve. The tooth needed to be pulled. (Zoe Greenberg, 5/23)

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

Perspectives On Doing The Math: Trying To Add Up ‘Trumponomics;’ The Trump Budget’s ‘Best New Idea’

Opinion writers take a hard look at how health and safety net programs fare in the Trump administration’s proposed budget plan.

Los Angeles Times: Surprise, Surprise: Trump’s Budget Punishes The Sick And The Poor While Rewarding The Wealthy
One factor holding back economic growth is that too many working-age Americans have fallen out of the labor force. The administration’s proposed budget for the fiscal year that begins Oct. 1 tries to tackle that problem, as well it should. But rather than grapple with some of the challenges underlying the disappearance of millions of Americans from the workforce — in particular, the technological changes and globalization that have caused so many blue-collar and middle-class jobs to evaporate, and the gap between the education and training Americans have received and the skills demanded by today’s employers — the Trump budget seeks to force people back into the workforce by making it harder to obtain or keep food stamps, Medicaid and Social Security disability benefits, while reducing federal support for welfare and children’s health. (5/23)

The Washington Post: Trumponomics: The Philosophy That It Doesn’t Suck Enough To Be Poor
For months, pundits and political advisers have tried to figure out what “Trumponomics” really stands for. Even President Trump himself struggled to characterize it, saying, “It really has to do with self-respect as a nation.” Now that we have the president’s budget in hand, we have a more definitive answer: Trumponomics — like Ryanonomics — is based on the principle that living in poverty doesn’t suck quite enough. That is, more people would be motivated to become rich if only being poor weren’t so much fun. (Catherine Rampell, 5/23)

The New York Times: Trump’s Budget Doesn’t Make Sense
Yes, Republicans have a blind spot when it comes to acknowledging that revenues must be a part of the fix. But to their credit, many Republicans — including, notably, Paul Ryan, the speaker of the House — have made the case for why we have to reform our largest entitlement programs, including Social Security and Medicare (though there has recently been a disquieting silence on the topic). And many Republicans are taking the responsible position that tax reform should at least be revenue neutral. Democrats, many of whom too often act as demagogues on entitlement reform, are clear that taxes must increase (though they also must stop pretending it is just millionaires who will be affected). They also have been admirable in their commitment to the pay-as-you-go principle in recent major legislation, which at least keeps us from digging the hole deeper. (Maya MacGuineas, 5/23)

The New York Times: Why Work Requirement Became A Theme Of The Trump Budget
The new White House budget proposal is built on a deep-rooted conservative belief: The government should help those who are willing to work, and cull from benefit rolls those who aren’t. That emphasis on work underlies deep cuts and proposed changes to food stamps, cash assistance and health benefits for the poor in a budget that boosts spending for the military and border security. Expect the poor to work in exchange for aid, the White House argues, and antipoverty programs will work better while costing the government less. (Emily Badger, 5/24)

USA Today: Trump Budget’s Best New Idea
Since the passage of the Family and Medical Leave Act in 1993, American parents working for companies with at least 50 employees have had a right to 12 weeks of unpaid leave after the birth or adoption of a child. But many don’t take advantage of that option for the simple reason that they can’t afford to go that long without a paycheck. The Trump administration, at the urging of first daughter Ivanka Trump, has included in its budget released Tuesday a plan for paid medical leave of up to six weeks. (5/23)

USA Today: Trump’s Parental Plan Will Hurt
President Trump’s budget includes a proposal for six weeks of mandated paid family leave for new parents. Despite its superficial appeal, this idea is likely to harm families more than it helps. The initial Trump proposal, floated in September, would have limited mandated leave to mothers, thereby likely engaging in unconstitutional sex discrimination. Key aspects of the new plan are still unclear. But it avoids legal problems by covering fathers, too. Yet it has serious flaws, nonetheless. (Ilya Somin, 5/23)

Bloomberg: Trump’s DOA Budget Has Two Silver Linings
It also breaks Trump’s campaign commitments to spare Social Security and Medicaid from budget cuts. Budget Director Mick Mulvaney explained this problem away (with Trump in Israel) by asserting in a Monday night briefing that proposals in the plan to cut Social Security disability benefits don’t count because they’re not retirement payments. (Albert R. Hunt, 5/23)

The Kansas City Star: Trump Budget Replicates Disastrous Kansas Approach. This Won’t End Well.
But tax cuts were only one half of the [Gov. Sam] Brownback experiment. Aided by conservatives in the Legislature, Kansas eviscerated the state’s social safety net: privatizing Medicaid, imposing new restrictions on welfare benefits, insisting on a tough food stamp work requirement. Humiliating the poor seemed to be a particular focus. For a time, the state told welfare recipients they could withdraw only $25 at a time from an automated teller machine, a decision that prompted anger and derision across the nation before it was repealed. (5/23)

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

Perspectives: FDA Wades Into Pricing Controversy, But Doesn’t Have Authority To Actually Fix It

Read recent commentaries about drug-cost issues.

Morning Consult: Is The FDA Digging Its Own Hole On Drug Pricing And Opioids?
The Food and Drug Administration may be digging a huge hole for itself by singling out drug pricing and opioid abuse for priority and focused attention. These two highly-visible and highly-charged issues have been pushed into the political arena. The FDA has, unwisely, agreed to take them on. Both issues are mission impossible for the FDA, which has neither the authority nor the resources to solve either problem. The agency is setting itself up to be perceived as having failed. (Wayne Pines, 5/22)

Bloomberg: A Bipartisan Way To Lower Drug Prices
White House budget director Mick Mulvaney has floated an idea to bring down drug prices that’s both promising and — if other Republicans can be persuaded to go along — bipartisan. At a recent health-care forum, Mulvaney proposed that drugmakers be required to pay rebates to the government on drugs sold to Medicare beneficiaries, as they do with drugs sold to Medicaid patients. … In an ideal world, the secretary of Health and Human Services would negotiate on behalf of the 41 million people enrolled in Medicare’s Part D prescription drug plan. That kind of purchasing power — accompanied by the right not to cover a drug it deems too expensive — would give the department great leverage. Unfortunately, Congress not only forbids such negotiation, it requires that Medicare pay for all medicines approved by the Food and Drug Administration. (5/22)

Stat: Clinical Trial Participants Should Have A Say In New Drug Pricing
People who volunteer to participate in clinical trials of new drugs provide a valuable service to pharmaceutical companies and to the rest of us. In return, I think that they should have a say in how much these drugs will cost when they hit the market. Not only would that honor their service, but it would also provide a patient-centered mechanism to lower the price of new drugs. (Spencer Phillips Hey, 5/18)

Bloomberg: Amgen Can Shrug Off Its Bone-Drug Risks
With promising trial results and an FDA approval seemingly near, Amgen Inc.’s osteoporosis drug Evenity was expected to contribute at least something to the company’s top line this year. But Amgen on Sunday evening reported the drug raised unexpected heart-safety concerns. Now the best hope is that its FDA approval will only be pushed to next year and that its commercial opportunity will merely be limited, not eliminated. Otherwise, it may not be worth the effort to keep seeking approval. (Max Nisen, 5/22)

Forbes: New Taxes Won’t Lower Drug Prices
Prescription drug prices continue to be a hot political issue, with the Trump administration preparing to release an action plan as soon as repeal and replace legislation clears Congress. Mick Mulvaney, who heads the White House budget office and is participating in the talks, floated an idea last week that should quickly be crossed off the list of policy ideas. (Grace-Marie Turner, 5/18)

Stat: Will PhRMA’s New Membership Criteria Help?
Earlier this month, PhRMA — the trade group representing innovator pharmaceutical companies — announced a set of new membership criteria. Going forward, PhRMA members will need to meet certain standards regarding their investment in R&D. PhRMA may have felt it needed to take action to restore public confidence in the industry and to constrain the bad press its members have been receiving on the drug pricing front. In my view, the new rules miss the mark. (Rachel Sachs, 5/22)

Bloomberg: Amazon’s Long Shadow Falls On Pharmacies
It’s hard to think of an industry Amazon.com Inc. isn’t currently trying to conquer, or at least thinking of conquering. Pharmacies might be next. According to a CNBC report, Amazon is considering a leap into the prescription-drug business. It wouldn’t be easy, but the industry and its investors shouldn’t dismiss the threat. (Max Nisen, 5/17)

JAMA: Pharmaceutical Marketing For Rare Diseases
The US Food and Drug Administration (FDA) draws a distinction between direct-to-consumer advertising of specific drug products, which it regulates, and advertisements intended to create disease awareness, which it does not. Other nations, including the United Kingdom and the Netherlands, that ban direct-to-consumer marketing permit disease awareness efforts. Challenges arise when disease awareness efforts are made for conditions for which only 1 approved drug product is available; in this case, awareness will boost the sales of a specific drug, and several nations, include the United States, selectively regulate this type of advertising. Recently, a novel form of disease awareness promotion, through a daytime soap opera, raised questions about the role and regulation of this form of marketing. (Sham Mailankody and Vinay Prasad, 5/18)

CityBeat Cincinnati: November Ballot Issue Leaves Lower Drug Prices Up To Ohioans
This November, Ohio voters will decide on a referendum that sounds like a sure thing for passage: lower drug prices. No, this isn’t a follow-up to last year’s marijuana measure, which failed anyway. The discount would only apply to drugs purchased by state employees and retirees and through state programs like Medicaid. An estimated 3.7 million Ohioans, close to a third of the state’s population, would directly benefit. (James McNair, 5/22)

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

Amazon Mulls Entering PBM Field, Even As These Middlemen Bear Brunt Of Blame Over High Drug Costs

News outlets report on stories related to pharmaceutical pricing.

Stat: Can Amazon Win As A Pharmacy Benefits Manager?
What kind of impact could Amazon have if the ubiquitous company enters the mysterious and complicated world of pharmacy benefit managers? The online retailer is reportedly exploring the pharmacy business and, as part of the plan, may build an internal PBM for its own employees, but later roll this out to the world at large. The possibility is intriguing because it comes at a time when these middlemen — which negotiate with drug makers for favorable insurance coverage — are under varying degrees of financial and political pressure. (Silverman, 5/18)

Stat: US Drug Prices Are So High That Canada Wants Other Countries As Reference Points
How high are drug prices in the US? So high that the Canadian government may remove the US from its long-standing list of countries that are used as a guide for determining whether prices are excessive. In a proposal issued last week, Health Canada said it wants to overhaul the framework used by the Patented Medicine Prices Review Board, which assesses therapeutic benefits and sets ceiling prices. Right now, this is accomplished, in part, by benchmarking prices against what drug makers currently charge in seven other countries — the US, France, Germany, Italy, Sweden, Switzerland, and the UK. (Silverman, 5/22)

The Wall Street Journal: How The FDA Approved A $300,000-A-Year Drug Its Own Experts Didn’t Believe Worked
Jennifer McNary, a stay-at-home mother, was desperate to find a medicine that might spare her two sons an early death from a rare form of muscular dystrophy. Chris Garabedian, the chief executive of a pharmaceutical firm, was desperate to find a profitable drug that would reverse his company’s slow fall. They met in June 2012 at a conference on Duchenne muscular dystrophy and joined forces, often behind the scenes and with little public disclosure, in a yearslong mission to push the government to approve a drug to treat DMD, as it is known. (Pulliam and Mullins, 5/19)

Stat: Generic Hepatitis C Meds Really Are Cost Effective: Study
For the past three years, various governments and patient advocacy groups have clamored for lower-cost hepatitis C medicines, given the high cure rate for these pricey new drugs. Now, a new study finds that upfront treatment with cheaper generic versions can offer a substantial payback. Using a mathematical model for patients in India, researchers found that copycat versions costing around $300 would increase life expectancy by more than eight years and reduce lifetime health care costs by more than $1,300 per person. (Silverman, 5/18)

The Wall Street Journal: FDA Approves Merck’s Keytruda To Treat Cancers With Genetic Defects
The U.S. Food and Drug Administration on Tuesday approved Merck & Co.’s Keytruda drug to treat tumors with a certain genetic defect—the first time the agency has cleared a cancer drug for a use not tied to the site of a tumor. The FDA approved Keytruda to treat tumors with genetic defects known as “microsatellite instability” or “mismatch repair” deficiencies, which are present in an estimated 4% of cancers. Studies showed the drug shrank tumors in a significant number of patients with colorectal and 14 other cancer types that had the genetic defect. (Loftus, 5/23)

CQ Roll Call: House GOP Tries Last-Minute Push For FDA Marketing Change
Republicans are attempting to address a major priority of the drug and medical device industries as part of a bill to fund the Food and Drug Administration, but in so doing risk injecting a controversial issue into what was supposed to be a smooth bipartisan negotiation. The makers of drugs and devices want the FDA to loosen the regulations governing how they can discuss and promote uses of their products that haven’t been explicitly approved. Approved uses are typically identified on a product’s label, but the practice of using drugs or devices in a so-called “off-label” way is common in some areas of medicine where treatment options may be limited, such as for cancer patients or pediatric populations. (Siddons, 5/24)

Stat: FDA Leaps Into Precision Medicine — With Caveats
The many proponents of precision medicine have long promised a world where terms like “lung cancer” and “melanoma” are rendered quaint by the awesome power of genomics. And the FDA, with its latest approval, just endorsed that vision of the future. The agency cleared Merck’s blockbuster cancer drug Keytruda to treat any solid tumor with one of two genetic abnormalities, marking the first time the FDA has granted such an agnostic approval. There are, of course, caveats — the mutations are rare, and Keytruda can be used only after a prior treatment has failed — but it’s a milestone approval nonetheless, and one that will be heartening to some forward-thinking biotech companies. (Garde, 5/23)

Stat: UK Regulator Says Merck Broke Competition Laws Over Biosimilars
The UK antitrust regulator accused Merck of illegally offering discounts for the Remicade biologic medicine in order to block lower-cost biosimilar versions. In a brief statement, the Competition and Markets Authority said it found that the drug maker “provisionally” broke the competition law and was “abusing its dominant position” in the market with its discount scheme. Remicade is used to treat chronic inflammatory diseases such as rheumatoid arthritis. (Silverman, 5/23)

Reuters: India’s Drug Pricing Regulator Clamps Down On Drug Cocktails
India’s drug pricing regulator has demanded explanations from 65 domestic and global drugmakers for selling new forms of essential diabetes and antibiotic drugs without its approval. The move could bring penalties for the drugmakers, among them Abbott Laboratories, Sanofi, Novartis and Indian firms such as Sun Pharmaceutical Industries and Lupin, the National Pharmaceutical Pricing Authority (NPPA) said on its website. (Siddiqui, 5/18)

Reuters: UK Competition Watchdog Accuses Merck Of Obstructing Biosimilars
Britain’s competition watchdog has accused Merck & Co of operating an unfair discount scheme for its medicine Remicade that it said was designed to restrict competition from so-called biosimilar copies. The Competition and Markets Authority (CMA) said on Tuesday it had provisionally found the U.S. company’s European unit, Merck Sharp & Dohme, had abused its dominant position through the scheme, opening it up to potential financial penalties. (Hirschler, 5/23)

Stat: Former Lilly Employee Wins An Ironic Lawsuit Over Disability Benefits
A federal appeals court ruled last week that Eli Lilly should not have ended disability benefits to a former human resources director who claimed she was unable to continue working because she suffered from fibromyalgia, a chronic neurologic condition. Yet at the same time the former employee was fighting in court to have those benefits restored, the drug maker was marketing a medicine in the US to treat the condition, which one of its own consultants had described as “very disabling,” according to court documents. (Silverman, 5/22)

Stat: How A Drug Ad Made Its Way Into ‘General Hospital’
[Anna] Devane is a soap opera character, as you might have guessed, appearing for the last 32 years on “General Hospital.” And her dramatic diagnosis is brought to you by Incyte Corp., a biotech company that happens to market a drug for her on-screen disease, the rare blood disorder polycythemia vera. The scene, which aired in February, is a novel twist on what’s called unbranded advertising, in which drug companies detail the symptoms of a disease but refrain from mentioning the names of any drugs. (Garde, 5/18)

FiercePharma: Drama And Diagnosis On Soap Opera Set Troubles Cancer Doctors, Puts Incyte In Hot Seat
Soap operas often include medical mysteries and miracles, but a couple of real-life doctors are concerned about Incyte’s connection to the latest drama on General Hospital. Writing in JAMA, oncologists Sham Mailankody and Vinay Prasad question the ABC soap opera’s rare-disease plot enabled by a partnership with the biopharma company Incyte. In the General Hospital storyline begun in February, leading character Anna Devane is diagnosed with a rare blood cancer called polycythemia vera (PV). The show doctors explain to the character, who is played by Incyte spokesperson Finola Hughes, that PV is part of a group of rare blood cancers called myeloproliferative neoplasms, and that there are treatments, but no cure. (Bulik, 5/22)

Stat: This Company Admitted Failure — And The Stock Market Rewarded It
Rather than shunning the company, investors embraced it. Only a small number of them cashed out their shares. (The coauthor of the paper who took responsibility for the error returned the stock, but made the shares a donation.) The IPO, delayed by a few weeks, went forward. And within a few years WntResearch stock went on a surge that to date has left it up nearly 500 percent over 6 1/2 years. In other words: Openness was a risk in the short run but a long-term boon for the company. (Oransky and Marcus, 5/23)

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

With Little Federal Progress Being Made, States Step Up Own Efforts To Curb High Drug Prices

Bills in California and Nevada reflect a growing trend across the country. Outlets report on news out of Ohio, Texas and New York, as well.

FiercePharma: Nevada Bill Could Force Sanofi, Novo And Lilly To Reveal Their Insulin Pricing Secrets
As a variety of states weigh measures targeting pharmaceutical pricing, Nevada’s Senate has passed a tough new bill that would publicly spotlight insulin makers’ price hikes and profits. Approved by the Nevada Senate on Friday, the bill would force diabetes drugmakers to disclose information on their insulin pricing, profits, costs and more, and would require the state government to publish the information publicly on the internet. (Sagonowsky, 5/22)

Columbus Dispatch: Broad Coalition Anchored By Drug Makers Opposes Ohio Ballot Issue
Opponents of a ballot issue aimed at lowering prescription drug prices today announced a broad coalition to fight the proposal Ohioans will see in the Nov. 7 election. The group Ohioans Against the Deceptive Rx Ballot Issue formed to oppose the Ohio Drug Price Relief Act, an initiated statute that, if passed, would require the state government to pay no more for prescription drugs than the lowest price paid by the U.S. Department of Veterans Affairs. (Johnson, 5/23)

Columbus Dispatch: High-Powered, Bipartisan Team Lined Up To Push Drug Price Vote
The Ohio Drug Price Relief Act will have a high-profile bipartisan campaign team working to pass the ballot issue in the Nov. 7 election. Financed in part by the AIDS Healthcare Foundation, the act would require state agencies to pay no more for prescription drugs than the lowest price paid by the U.S. Department of Veterans Affairs. Supporters say that could lower prices by 40 percent or more and cause a ripple effect for Ohio consumers. (Candisky, 5/16)

Cleveland.com: Former Ohio Medicaid Directors Oppose Drug Price Ballot Issue
Three former Ohio Medicaid directors say a November ballot measure intended to lower prescription drug prices would have the opposite effect for most Ohioans. “The money’s going to come from some place and this is not the way to do it,” John McCarthy, former Medicaid director under Gov. John Kasich, said in a Tuesday phone call with reporters. The call was organized by opponents to the measure, Ohioans Against the Deceptive Rx Ballot Issue, which launched their campaign earlier in the day. (Borchardt, 5/23)

Texas Tribune: Scientists Wary As Texas Mulls Allowing Sale Of Unproven Drugs 
A group of scientists and medical professionals is sounding the alarm in the final days of the Texas legislative session about a little-noticed bill that would allow manufacturers of unproven drugs to sell their products to dying patients. Supporters of House Bill 3236 by state Rep. Kyle Kacal, R-College Station, say it could help incentivize drugmakers to get promising, experimental drugs onto the market and into needy patients’ hands. (Walters, 5/23)

Kaiser Health News: New York State Wants Its Prescription Drug Money Back — Or Else
New York Medicaid regulators aim to use the threat of imposing increased scrutiny of prescription drugs — such as eyeing their relative effectiveness and their profit margins — to coax additional discounts from drugmakers. The rules, signed into law in mid-April as part of the state’s budget, don’t go as far as the surcharge that Democratic Gov. Andrew Cuomo originally sought to control the “skyrocketing costs of prescription drugs,” but they retain elements guaranteed to get under a pharmaceutical executive’s skin. (Appleby, 5/22)

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

State Highlights: Contract Dispute In Ariz. Leaves Many Out Of Network At Dignity Health Hospitals; Texas Lawmakers OK Maternal Health Bills

Media outlets report on news from Arizona, Texas, California, Minnesota, Georgia, Colorado and Florida.

Sacramento Bee: Health Care For Illegal Immigrants Proposed By California Senator
State Sen. Ricardo Lara doesn’t only want to reconstruct the way health care is delivered and paid for in California. As the debate around publicly funded universal health care heats up in the Capitol, Lara is also seeking to expand the state’s low-income health program to undocumented adults up to age 26. (Hart and Miller, 5/23)

Georgia Health News: State AG Backs Wider View Of Records In Hospital Court Fight 
The state’s attorney general has urged the Georgia Supreme Court to reverse a lower court opinion that barred access to Northside Hospital’s financial records. Chris Carr, in office since late last year, said in a Monday court filing that the Georgia Open Records Act is broader in its applications than what Northside Hospital has argued. (Miller, 5/23)

Atlanta Journal Constitution: GA Attorney General Weighs In On Northside Hospital Open Records Case 
Georgia law requires open government even when a private party is carrying out the public’s work, Attorney General Christopher Carr argued in a brief filed Monday in the Northside Hospital open records case before the Georgia Supreme Court… The Georgia Supreme Court asked the Attorney General’s office to file an opinion in the hotly-contested case that started when attorney E. Kendrick Smith requested documents from Northside under the state’s sunshine law. (Teegardin, 5/23)

Texas Tribune: Grieving Mom “Humbled” And “Relieved” After Senate Passes Autopsy Bill 
As the Texas Senate passed a bill on Tuesday that would ensure parents can view their deceased child’s body before an autopsy is conducted, a grieving mother shed tears from the gallery… Currently, parents need permission from a justice of the peace or medical examiner to see their deceased child if his or her death occurs outside a hospital or health care institution. (Mansoor, 5/23)

Austin American Statesman: Texas Senate Approves Bill Aimed At Identifying Postpartum Depression
The Texas Senate on Tuesday approved a bill aimed at increasing identification of postpartum depression among mothers participating in federally backed health care programs for low-income families. Under House Bill 2466 by Rep. Sarah Davis, R-West University Place, mothers who bring their kids in for checkups can get screened for postpartum depression by their children’s pediatricians. (Collins Walsh, 5/23)

Denver Post: New Leadville Hospital Dealt Major Setback After Feds Withhold Loan 
Lake County’s only hospital, St. Vincent in Leadville, has put plans to build a new facility on hold after financial projections came up shorter than expected, indicating the small hospital has recovered from the financial brink but still needs to improve its balance sheet before a much-needed building upgrade. In 2014, the hospital announced it would be shutting down because of critical building repairs and declining revenues, but service cuts and a partnership struck several months later with Centura Health — which also runs St. Anthony Summit Medical Center in Frisco — kept the 138-year-old hospital open. (5/23)

Sacramento Bee: Abortion Reversal Therapy Grows More Popular Despite Doubts
Several California clinics advertise the therapy, claiming to be able to undo the effects of the first dose containing mifepristone, which blocks progesterone production and causes the uterine lining to shed. The second set of pills contains misoprostol, which makes the uterus contract and initiates bleeding and cramping. More than 350 providers nationwide perform abortion reversal therapy, according to proponents of the treatment. (Caiola, 5/23)

Kansas City Star: Kansas Records: Several Hotline Calls Still Didn’t Save Adrian Jones 
The head of Kansas’ child welfare agency said earlier this month that social workers’ last contact with the family of Adrian Jones was in February 2012. But records obtained by The Kansas City Star on Tuesday show that social workers with the Kansas Department for Children and Families investigated a hotline call 10 months later, in December 2012. (Baurer and Woodall, 5/23)

Kansas City Star: Missouri Hospital And Clinic Settle Medicare Fraud Suit 
A Missouri hospital, clinic and infusion center have agreed to pay $34 million to settle a federal lawsuit that alleged they defrauded Medicare. The suit alleged that Mercy Hospital Springfield and its affiliate, Mercy Clinic Springfield Communities, had an improper financial agreement that provided kickbacks to oncologists based on the value of their chemotherapy referrals to the infusion center. (Marso, 5/23)

KQED: Valero Outage Prompts Benicia To Consider Industrial Safety Ordinance 
City officials would have greater oversight over the Valero refinery under a proposal set to be unveiled at the Benicia City Council meeting on Tuesday—a potential reform prompted by the major outage at the facility earlier this month. Mayor Elizabeth Patterson is proposing the city develop regulations similar to those in Contra Costa County, home to several refineries. That county’s industrial safety ordinance, considered to be one of the strongest in the country, requires oil refining facilities to undergo safety audits and have risk management plans. (Goldberg, 5/23)

Miami Herald: John Morgan ‘Prepared To Invest $100M’ In Medical Marijuana 
John Morgan spent nearly $7 million pushing two statewide ballot initiatives to expand medical marijuana throughout the state of Florida. But that’s a drop in the bucket compared to what the wealthy Orlando attorney and possible gubernatorial candidate says he’s prepared to invest in the industry now that it’s about to explode. (Smiley, 5/23)

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

WHO’s Next Director-General Will Be First To Come From Africa

Former Ethiopian health minister Tedros Adhanom Ghebreyesus has been elected to head the World Health Organization, the United Nations agency responsible for coordinating international responses to infectious disease epidemics like Ebola and Zika.

The New York Times: W.H.O. Elects Ethiopia’s Tedros As First Director General From Africa
Tedros Adhanom Ghebreyesus of Ethiopia was voted director general of the World Health Organization on Tuesday, the first African ever to head the agency. The election was the first conducted by the W.H.O. under more open and democratic rules. After nearly two years of public campaigning, originally by six candidates, the voting took place in a closed-door session in which the health ministers of 186 countries cast their ballots in secret. (McNeil and Cumming-Bruce, 5/23)

The Washington Post: WHO Picks Tedros Adhanom Ghebreyesu Of Ethiopia To Lead The Global Health Agency
During the third and final round of balloting in Geneva, members of the World Health Assembly voted 133 to 50 to pick Tedros, as he is known, to be the next director-general, according to unofficial tallies. Cheers broke out, observers said, as he beat out David Nabarro, a 67-year-old physician and longtime United Nations official from Britain, and Sania Nishtar, a 54-year-old cardiologist from Pakistan. It was the first time member states took part in a secret ballot that gave each member state an equal vote. In the past, leaders were chosen by an executive board and voting took place behind closed doors. Nishtar was eliminated during the first round of voting. (Sun, 5/23)

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

Teaching Hospitals Have Lower Death Rates For Older Patients Than Less Costly Community Hospitals

Researchers found that the 30-day mortality rate at major teaching facilities was 8.3 percent, compared with 9.5 percent at non-teaching ones. Today’s other public health stories cover child fatalities from car crashes, near-death experiences, botulism in California, and the heart benefits of chocolate.

Stat: Pricey Teaching Hospitals Have Lowest Death Rates For Older Patients
At a time when insurers are steering patients away from expensive academic medical centers, a new study counters the idea that the quality of care is consistent across hospitals, concluding that major teaching hospitals have lower mortality rates for older patients than community hospitals. Using millions of Medicare records, researchers found that the 30-day mortality rate — the percentage of patients who died within 30 days of hospitalization and one common way to gauge quality — was 8.3 percent at major teaching hospitals, compared with 9.2 percent at minor teaching hospitals and 9.5 percent at non-teaching hospitals. The figures accounted for differences in patient populations and hospital characteristics. (Joseph, 5/23)

NPR: One Fifth Of Children In Fatal Car Crashes Were Improperly Restrained
A new study found that 20 percent of children who were in a fatal car crashes were not buckled in properly, or were not wearing a seat belt at all, and that child fatality rates in deadly car crashes vary widely by state. The results add evidence to the argument that state regulations and public information tactics can affect motor vehicle safety for kids. The Centers for Disease Control and Prevention has noted that, for example, seat belt use across all age groups is higher in states with more stringent seat belt enforcement laws. (Hersher, 5/23)

Cronkite News: ‘Everybody Wants That Miracle’: Survivors Of Near-Drownings Face Tough Road To Recovery
The state’s constant warm climate keeps pools open year-round, the most common environment for drownings involving toddlers; in fact, toddlers in the Grand Canyon state are far more likely to drown compared with rates of childhood drownings from around the nation  —  and authorities say they’re nearly all preventable. For those who survive, recovery could last a lifetime. (Souse, 5/23)

The New York Times: Why Chocolate May Be Good For The Heart
Eating chocolate has been tied to a reduced risk of heart disease. Now scientists have uncovered one possible reason. Using data from a large Danish health study, researchers have found an association between chocolate consumption and a lowered risk for atrial fibrillation, the irregular heartbeat that can lead to stroke, heart failure and other serious problems. The study is in Heart. (Bakalar, 5/23)

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

Who Should Be Punished When A Child Dies From An Accidental Gunshot? The Answer Varies State To State

A series by USA Today and The Associated Press offers a look at gun safety and children in different states.

USA Today/The Associated Press: States Rejecting Bills Intended To Keep Guns Away From Kids
In state after state, proposals that would create or toughen laws intended to keep kids from getting ahold of unsecured guns have stalled — caught up in a debate over whether they are effective prevention measures or just government overreach. Child access prevention laws allow prosecutors to bring charges against adults who fail to safely store their loaded guns, especially when they are obtained by minors and used to harm. (Foley and Penzenstadler, 5/24)

In related news —

KCUR: Kansas Committee Advances Bill To Keep Gun Ban At Some Health Facilities 
The Kansas Senate Ways and Means Committee on Tuesday advanced a bill that would allow public health care facilities to continue to ban concealed guns. A state law taking effect July 1 will allow people to carry concealed guns into any public building that is not secured by armed guards and metal detectors. The bill that advanced Tuesday would allow guns to be banned at state-run psychiatric hospitals, publicly owned medical facilities and the University of Kansas Health System. (Koranda, 5/23)

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

Some States, Facing Tight Budgets, Working To Recertify Medicaid Enrollees’ Eligibility

Missouri, Wyoming and Mississippi have enacted laws to scrutinize whether Medicaid or food stamp recipients are eligible, and several other states are considering such measures. News outlets also report on Medicaid news from Oregon, Iowa, Indiana and Kansas.

Stateline: What Happens When States Go Hunting For Welfare Fraud
Now, faced with growing Medicaid enrollment and tight budgets, Republican lawmakers in several … states are taking … steps to ensure that people receiving welfare benefits are eligible for them. Under their proposals, which are modeled on legislation drafted by a national conservative group, recipients would face tougher and more frequent eligibility checks. And the checks could be conducted by private contractors who are motivated to justify their hiring by knocking as many people as possible off the rolls. (Fifield, 5/23)

The Oregonian: Health Authority Estimates 32,000 Medicaid Recipients Could Be Ineligible 
Oregon Health Authority officials told a legislative committee Tuesday that the agency might have provided Medicaid benefits to some 32,000 people who no longer qualified for them. If historical trends hold true, as the state processes a backlog of 115,000 Medicaid renewals, 28 percent of them could be deemed ineligible because they make too much money. But Lynne Saxton, director of the health authority, flatly rejected the idea that the lingering questions about the state’s Medicaid rolls poses a financial risk for the state. The questions come just as state lawmakers consider a new tax on health care providers. At the federal level, the Trump administration continues to push for the repeal of the Affordable Care Act and the sweeping Medicaid changes that came with it. (Manning, 5/23)

Des Moines Register: Privatized Medicaid Appears To Be Saving Iowa Money. But Is It Real?
Iowa will spend $600 less on each Medicaid recipient this year compared with before private companies were hired to manage the program, according to a projection from the nonpartisan Legislative Services Agency. … The data does not account for millions of dollars in losses the private companies hired to manage the program have accrued in the current fiscal year, losses Iowa has agreed to at least partially repay in 2018. Those losses won’t show up in the current year’s budget. (Clayworth, 5/23)

Modern Healthcare: Indiana Medicaid Director Moser Steps Down
Joe Moser, a key architect of Indiana’s alternative Medicaid expansion program has stepped down from his role as the state’s Medicaid director. Moser was appointed by then-Gov. Mike Pence in 2013 and oversaw the care of more than 1.5 million Medicaid and Children’s Health Insurance Program enrollees. Moser told Modern Healthcare he has no plans to work with the Trump administration, but would be open to that possibility. He decided to leave Indiana’s Medicaid agency in order to pursue new opportunities. (Dickson, 5/23)

Kansas City Star: Federal Officials Accept Plan To Fix Kansas Medicaid Program 
Federal officials have accepted a corrective action plan for Kansas’ privatized Medicaid program, an important hurdle in ensuring the program can continue to operate next year. The federal Centers for Medicare & Medicaid Services had rejected the state’s request to extend its KanCare program through 2018 in January after finding that the program was “substantively out of compliance” with federal regulations. (Lowry, 5/23)

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

First Edition: May 24, 2017

May 24 2017

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

Kaiser Health News: Putting A Lid On Waste: Needless Medical Tests Not Only Cost $200B — They Can Do Harm
Chad Terhune reports: “It’s common knowledge in medicine: Doctors routinely order tests on hospital patients that are unnecessary and wasteful. Sutter Health, a giant hospital chain in Northern California, thought it had found a simple solution. The Sacramento-based health system deleted the button physicians used to order daily blood tests. “We took it out and couldn’t wait to see the data,” said Ann Marie Giusto, a Sutter Health executive.” (Terhune, 5/24)

Politico: Trump Undermines Senate GOP’s Medicaid Backers
A group of Republican senators is fighting desperately to preserve health coverage for millions of low-income constituents who have benefited from Obamacare. And the president of their own party seriously undercut their negotiating position with his budget Tuesday. By proposing hundreds of billions of dollars in Medicaid cuts in combination with the House-passed health care bill’s more than $800 billion in Medicaid spending reductions, President Donald Trump is effectively throwing in with fiscal conservatives looking to constrain the program’s growth and wind down its coverage as quickly as possible. And that could be perilous for more than a dozen GOP senators who have been meeting for months over how to preserve the law’s benefits. (Everett and Cancryn, 5/23)

The Washington Post: Trump Budget Would Cut Health Benefits For Many Lower-Income Kids, Experts Fear
Lower-income children would have their federal health benefits cut sharply under President Trump’s proposed budget, which analysts say could reverse gains that have pushed uninsured rates for this vulnerable population below 5 percent. The shift stems from a combination of factors, including a plan to reduce Medicaid by $1.4 trillion over the next decade and a roughly 20 percent decrease in funding for the Children’s Health Insurance Program (CHIP), along with proposed changes to eligibility requirements and the way federal matching funds are calculated. (Eilperin, 5/23)

The Associated Press: Poor And Disabled Big Losers In Trump Budget; Military Wins
The poor and the disabled are big losers in President Donald Trump’s $4.1 trillion budget proposal while the Pentagon is a big winner. Trump’s plan for the budget year beginning Oct. 1 makes deep cuts in safety net programs, including Medicaid and the Children’s Health Insurance Program. The proposal also includes big cuts in Social Security’s disability program. (5/24)

USA Today: Health Care Advocates Say The Trump Budget Plan Would Gut Medicaid
Advocates for low income people struggled to find the words to describe the likely effect of the proposed $800 billion in cuts proposed to Medicaid in the Trump administration’s budget released Tuesday. Depending who you ask, it will be devastating or “just awful” to the lowest income Americans, especially children and those with chronic health conditions, mental illness or substance use disorder. (O’Donnell, Saker and Robinson, 5/23)

The Associated Press: Agency-By-Agency Look At Trump’s Budget
The budget initiates deep cuts to health insurance programs for people with modest incomes, including coverage for children. Those cuts would go beyond the House GOP bill that repeals much of the Affordable Care Act, also known as “Obamacare,” and limits future federal financing for Medicaid. (5/24)

NPR: Trump Administration Seeks Deep Cuts In Health Care, Medical Research
The NIH, which funds research into medical treatments and basic science, would see cuts of almost $6 billion, to about $26 billion. That would include a $575 million cut to the National Heart, Lung and Blood Institute and $838 million cut to the National Institute of Allergy and Infectious Diseases, which is involved in a wide range of diseases including AIDS and Zika. The National Institute of Diabetes and Digestive and Kidney Diseases would be cut by $355 million. (Kodjak and Stein, 5/23)

Los Angeles Times: Cancer Research, Public Health And Worker Safety Would All See Steep Cuts Under Trump Budget
Under the heading “Putting America’s Health First,” the Trump administration’s 2018 budget blueprint includes a $5.8-billion cut for the National Institutes of Health, a move that would slash the medical research agency’s funding by just over 18%. It would reduce public health spending by the U.S. Centers for Disease Control and Prevention by $1.32 billion, a 17% decline from 2017 spending levels. And it would cut the Food and Drug Administration’s spending by $854 million, a 31% decrease cut from current funding levels. (Healy, 5/23)

The Washington Post: Trump’s Budget Proposal Aims To Cut All Federal Funds From Planned Parenthood
President Trump’s 2018 budget proposal would bar Planned Parenthood and other abortion providers from receiving federal funds that help pay for health-care services for millions of Americans. The budget, the “New Foundation for American Greatness,” was released Tuesday, proposing to cut trillions of dollars in spending during the next decade. The budget is part of the Trump administration’s effort to follow through on a campaign promise to exclude “certain entities that provide abortions, including Planned Parenthood” from participating in any Department of Health and Human Services programs, according to a fact sheet from the White House. (Bever, 5/23)

The New York Times: Cuts To AIDS Treatment Programs Could Cost A Million Lives
At least one million people will die in sub-Saharan Africa and elsewhere, researchers and advocates said on Tuesday, if funding cuts proposed by the Trump administration to global public health programs are enacted. The United States currently spends more than $6 billion annually on programs that buy antiretroviral drugs for about 11.5 million people worldwide who are infected with H.I.V., the virus that causes AIDS. The Trump administration has proposed slashing those programs by at least $1.1 billion — nearly a fifth of their current funding, said Jen Kates, a vice president at the Kaiser Family Foundation. (Harris, 5/23)

Reuters: Trump Budget Cuts May Stir Backlash In Rural America
President Donald Trump’s proposals to slash federal aid to the poor, the sick and people living in rural areas reflect conservatives’ demands for a smaller federal government but target many of the very people who voted for him last November. In his first detailed budget submission to Congress on Tuesday, Trump requested major reductions to programs that help poor families afford groceries and poor and disabled people get healthcare. (Cowan, 5/23)

The Washington Post: Even Some Republicans Balk At Trump’s Plan For Steep Budget Cuts
While some fiscally conservative lawmakers, particularly in the House, found a lot to praise in Trump’s plan to balance the budget within 10 years, most Republicans flatly rejected the White House proposal. The divide sets up a clash between House conservatives and a growing number of Senate Republicans who would rather work with Democrats on a spending deal than entertain Trump’s deep cuts. “This is kind of the game,” said Senate Majority Whip John Cornyn (R-Tex.). “We know that the president’s budget won’t pass as proposed.” (Snell, Paletta and DeBonis, 5/23)

The Wall Street Journal: Bipartisan Pushback Greets Trump’s Proposed Budget
“I hate to say it, but I would say the budget was dead before the ink was dry,” Rep. Don Young (R., Alaska), who opposes the budget’s elimination of two programs in his state. Payments to Medicaid, the federal-state health program for the poor, would be cut by more than $600 billion over a decade from levels projected under current law in addition to proposed Medicaid cuts under the House bill repealing and replacing much of the Affordable Care Act. (Davidson, Peterson and Andrews, 5/23)

The Associated Press: Icy Reception To Trump Budget From Fellow Republicans
Longtime GOP Rep. Hal Rogers of Kentucky declared proposed cuts to safety net and environmental proposals “draconian.” “I don’t think the president’s budget is going anywhere,” said Republican Sen. Bill Cassidy of Louisiana, asked if he’s concerned about the message sent by slashing the Medicaid program for the poor and disabled. (5/23)

The New York Times: Republicans Will Reject Trump’s Budget, But Still Try To Impose Austerity
Finally some good news for President Trump: His new budget stands absolutely no chance of being enacted by Congress. Moving forward with the cuts outlined in the $4.1 trillion spending plan created by the budget director, Mick Mulvaney, formerly one of the most determined fiscal hawks in Congress, would no doubt have major repercussions and compound the peril of Republicans already facing upheaval over their health care proposals. It would most likely hurt some of the very voters in rural and economically distressed corners of the nation who catapulted Mr. Trump to the White House and Republicans to control of the House and Senate. The effect on those constituents would be quickly felt. (Hulse, 5/23)

The Associated Press: Cabinet Members Head To Capitol Hill To Defend Trump Budget
Top officials in President Donald Trump’s Cabinet are heading to Capitol Hill to defend his plans to cut domestic programs and parry Democratic criticism of his tax proposals. Budget Director Mick Mulvaney appears Wednesday before the House Budget panel while Treasury Secretary Steven Mnuchin will testify at the tax-writing House Ways and Means Committee. The budget contains virtually no further detail on taxes beyond the cuts the administration proposed in a one-page outline last month. (Taylor, 5/24)

The Associated Press: Clinton: Trump Budget Shows ‘Unimaginable’ Cruelty
Hillary Clinton proclaimed Tuesday that President Donald Trump’s budget shows an “unimaginable level of cruelty” for millions of Americans and children. The former Democratic presidential nominee, who recently declared herself part of the Trump resistance, lashed out at the Republican president’s spending plan in aggressive terms after being honored in New York City by the Children’s Health Fund, a nonprofit organization that helps provide health care to poor and homeless children. (5/23)

The Associated Press: Budget Office To Gauge Health Bill Effect On Coverage, Cost
Congressional Republicans are about to learn more about whether their drive to dismantle President Barack Obama’s health care law has been worth the political pain they’ve been experiencing. The Congressional Budget Office planned to release its estimate Wednesday of what impact the GOP’s House-passed health care overhaul would have on coverage and premiums. (5/24)

Politico: Republicans Gird For CBO Verdict On Obamacare Repeal
Republicans are bracing for a report Wednesday expected to say their Obamacare repeal plan would leave millions of Americans without health insurance, further complicating their efforts to pass legislation quickly. The CBO’s analysis of the bill comes three weeks after House Republicans rushed to vote on the legislation without an update on its cost, or its impact on the nation’s uninsured. The agency’s score will serve as the unofficial framework for Senate lawmakers negotiating their own version of repeal and will likely help those eager to make big changes. It’s also expected to become a rallying point for Democrats critical of an effort that could strip health care from millions. (Cancryn and Ferris, 5/23)

Los Angeles Times: With Healthcare In Turmoil, Senate Republicans Are Under Pressure To Buck Trump
Senate Republicans face increasing pressure to rescue health insurance markets and protect coverage for millions of Americans amid growing fears the Trump administration is going let the markets collapse. In recent days, leading hospitals, physician groups, health insurers and the U.S. Chamber of Commerce have pleaded with the Senate to step in, effectively going around the White House. (Levey and Mascaro, 5/23)

The Washington Post: Fact-Checking A Rosy Portrait Of The American Health Care Act
In a $2 million ad campaign to support the House GOP health plan, the right-leaning American Action Network (AAN) features a California woman named Elizabeth Jacinto who says she suffered under Obamacare and expresses enthusiasm for the American Health Care Act. The ACHA only narrowly passed the House and was greeted lukewarmly by the Senate, so a key part of the effort appears to assist 21 GOP lawmakers who cast a tough vote to support proposal. (Kessler, 5/24)

The Associated Press: Health Care Is Key Issue As Montana Fills US House Seat
Meagher County, Montana, may not be much different than the rest of the rural enclaves across America that voted overwhelmingly for Donald Trump last fall. The median annual household income is $38,000 — about 25 percent below the national average. Nearly 20 percent of its 1,800 residents live in poverty. And more than one in four people don’t have health insurance. (5/23)

The Associated Press: Congressman Quits Post In GOP Group Over Health Care Bill
A New Jersey Republican congressman who helped push the House health care bill to passage quit his post Tuesday as a chairman of the chamber’s moderate Tuesday Group, criticizing colleagues for having “different objectives and a different sense of governing than I do.” Rep. Tom MacArthur, a second-term congressman, announced his decision at a closed-door meeting of the group, which has roughly 50 members. (5/23)

USA Today: Rep. Tom MacArthur Quits As Leader Of Moderate Tuesday Group
“I realized through the health care debates that people in my group wanted different things. They had a very different view of governing,” MacArthur told reporters during a House vote Tuesday. MacArthur became co-chairman of the Tuesday Group at the beginning of this year. A former insurance executive now in his second term in the House, he was the first New Jersey Republican to support House leaders’ bill to repeal and replace the Affordable Care Act, or Obamacare. (Jackson, 5/23)

The Washington Post: Q&A: Rep. Tom MacArthur And The Agony Of GOP Moderates In Trump’s Washington
MacArthur’s brief and uneasy turn under the national spotlight has been telling. Exchanges from his packed forum this month in deep-blue Willingboro — mostly of supporters of the Affordable Care Act fuming about his attempts to repeal and replace the law — have been replayed endlessly on cable news. And the centrists MacArthur once led are increasingly nervous about their reelection chances — and have groused that his eagerness to cut a deal with Freedom Caucus hard-liners is partly responsible for their vulnerability. (Costa, 5/23)

The New York Times: W.H.O. Elects Ethiopia’s Tedros As First Director General From Africa
Tedros Adhanom Ghebreyesus of Ethiopia was voted director general of the World Health Organization on Tuesday, the first African ever to head the agency. The election was the first conducted by the W.H.O. under more open and democratic rules. After nearly two years of public campaigning, originally by six candidates, the voting took place in a closed-door session in which the health ministers of 186 countries cast their ballots in secret. (McNeil and Cumming-Bruce, 5/23)

The Washington Post: WHO Picks Tedros Adhanom Ghebreyesu Of Ethiopia To Lead The Global Health Agency
During the third and final round of balloting in Geneva, members of the World Health Assembly voted 133 to 50 to pick Tedros, as he is known, to be the next director-general, according to unofficial tallies. Cheers broke out, observers said, as he beat out David Nabarro, a 67-year-old physician and longtime United Nations official from Britain, and Sania Nishtar, a 54-year-old cardiologist from Pakistan. It was the first time member states took part in a secret ballot that gave each member state an equal vote. In the past, leaders were chosen by an executive board and voting took place behind closed doors. Nishtar was eliminated during the first round of voting. (Sun, 5/23)

The Wall Street Journal: FDA Approves Merck’s Keytruda To Treat Cancers With Genetic Defects
The U.S. Food and Drug Administration on Tuesday approved Merck & Co.’s Keytruda drug to treat tumors with a certain genetic defect—the first time the agency has cleared a cancer drug for a use not tied to the site of a tumor. The FDA approved Keytruda to treat tumors with genetic defects known as “microsatellite instability” or “mismatch repair” deficiencies, which are present in an estimated 4% of cancers. Studies showed the drug shrank tumors in a significant number of patients with colorectal and 14 other cancer types that had the genetic defect. (Loftus, 5/23)

The Washington Post: FDA Commissioner Gottlieb Calls For ‘More Forceful Steps’ To Curb Opioid Epidemic
Food and Drug Commissioner Scott Gottlieb called on his staff Tuesday to explore “more forceful” efforts to curb the epidemic, including requiring training for doctors and ensuring patients aren’t prescribed the medications for unnecessarily long periods that increase the risk of addiction. “Opioid prescriptions should be written only for appropriate patients and for appropriate durations,” Gottlieb said in his first interview since becoming commissioner. “No more 30-day supplies for tooth extractions” or uncomplicated hernia repairs. (McGinley, 5/23)

USA Today/The Associated Press: States Rejecting Bills Intended To Keep Guns Away From Kids
In state after state, proposals that would create or toughen laws intended to keep kids from getting ahold of unsecured guns have stalled — caught up in a debate over whether they are effective prevention measures or just government overreach. Child access prevention laws allow prosecutors to bring charges against adults who fail to safely store their loaded guns, especially when they are obtained by minors and used to harm. (Foley and Penzenstadler, 5/24)

NPR: One Fifth Of Children In Fatal Car Crashes Were Improperly Restrained
A new study found that 20 percent of children who were in a fatal car crashes were not buckled in properly, or were not wearing a seat belt at all, and that child fatality rates in deadly car crashes vary widely by state. The results add evidence to the argument that state regulations and public information tactics can affect motor vehicle safety for kids. The Centers for Disease Control and Prevention has noted that, for example, seat belt use across all age groups is higher in states with more stringent seat belt enforcement laws. (Hersher, 5/23)

The New York Times: Why Chocolate May Be Good For The Heart
Eating chocolate has been tied to a reduced risk of heart disease. Now scientists have uncovered one possible reason. Using data from a large Danish health study, researchers have found an association between chocolate consumption and a lowered risk for atrial fibrillation, the irregular heartbeat that can lead to stroke, heart failure and other serious problems. The study is in Heart. (Bakalar, 5/23)

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

Putting A Lid On Waste: Needless Medical Tests Not Only Cost $200B — They Can Do Harm

It’s common knowledge in medicine: Doctors routinely order tests on hospital patients that are unnecessary and wasteful. Sutter Health, a giant hospital chain in Northern California, thought it had found a simple solution.

The Sacramento-based health system deleted the button physicians used to order daily blood tests. “We took it out and couldn’t wait to see the data,” said Ann Marie Giusto, a Sutter Health executive.

Alas, the number of orders hardly changed. That’s because the hospital’s medical-records software “has this cool ability to let you save your favorites,” Giusto said at a recent presentation to other hospital executives and physicians. “It had become a habit.”

There are plenty of opportunities to trim waste in America’s $3.4 trillion health care system — but, as the Sutter example illustrates, it’s often not as simple as it seems.

Some experts estimate that at least $200 billion is wasted annually on excessive testing and treatment. This overly aggressive care also can harm patients, generating mistakes and injuries believed to cause 30,000 deaths each year.

“The changes that need to be made don’t appear unrealistic, yet they seem to take an awful lot of time,” said Dr. Jeff Rideout, chief executive of the Integrated Healthcare Association, an Oakland, Calif., nonprofit group that promotes quality improvement. “We’ve been patient for too long.”

In California, that sense of frustration has led three of the state’s biggest health care purchasers to band together to promote care that’s safer and more cost-effective. The California Public Employees’ Retirement System (CalPERS), the Covered California insurance exchange and the state’s Medicaid program, known as Medi-Cal — which collectively serve more than 15 million patients — are leading the initiative.

Progress may be slow, but there have been some encouraging signs. In San Diego, for instance, the Sharp Rees-Stealy Medical Group said it cut unnecessary lab tests by more than 10 percent by educating both doctors and patients about overuse.

A large public hospital, Los Angeles County-University of Southern California Medical Center, eliminated preoperative testing deemed superfluous before routine cataract surgery. As a result, patients on average received the surgery six months sooner.

These efforts were sparked by the Choosing Wisely campaign, a national effort launched in 2012 by the American Board of Internal Medicine (ABIM) Foundation. The group asked medical societies to identify at least five common tests or procedures that often provide little benefit.

The campaign, also backed by Consumer Reports, encourages medical providers to hand out wallet-sized cards to patients with questions they should ask to determine whether they truly need a procedure.

Critics have knocked Choosing Wisely for playing it too safe and not going after some of the more lucrative procedures, such as certain spine operations and arthroscopic knee surgeries.

Daniel Wolfson, chief operating officer at the ABIM Foundation, said the Choosing Wisely campaign has been successful at starting a national conversation about unwarranted care. “I think we need massive change and that takes 15 years,” Wolfson said.

The state effort, dubbed Smart Care California, is in the early stages as well.

Initially, the group has focused on cutting the number of elective cesarean sections, reducing opioid use and avoiding overtreatment for patients suffering low-back pain. In its contract with health insurers, the Covered California exchange requires that their in-network providers meet a range of quality standards, including low C-section rates.

Dr. Richard Sun, co-chairman of the Smart Care group and a medical consultant at CalPERS, said he’s pursuing safer, more affordable treatments for low-back pain, a condition that cost the state agency $107 million in 2015. “One challenge is developing metrics that everyone can agree upon to measure improvement,” he said.

For patients, overtreatment can be more than a minor annoyance. Galen Gunther, a 59-year-old from Oakland, said that during treatment for colorectal cancer a decade ago he was subjected needlessly to repeated blood draws, often because the doctors couldn’t get their hands on earlier results. Later, he said, he was overexposed to radiation, leaving him permanently scarred.

“Every doctor I saw wanted to run the same tests, over and over again,” Gunther said. “Nobody wanted to take responsibility for that.”

At Cedars-Sinai Medical Center in Los Angeles, officials said that economic incentives still drive hospitals to think that more is better.

“We have excellent patient outcomes, but it’s at a very high cost,” said Dr. Harry Sax, executive vice chairman for surgery at Cedars-Sinai. “There is still a continued financial incentive to do that test, do that procedure and do something more.”

In addition to financial motives, Sax said, many physicians still practice defensive medicine out of fear of malpractice litigation. Also, some patients and their families expect antibiotics to be prescribed for a sore throat or a CT scan for a bump on the head.

To cut down on needless care, Cedars-Sinai arranged for doctors to be alerted electronically when they ordered tests or drugs that run contrary to 18 Choosing Wisely recommendations.

The hospital analyzed alerts from 26,424 patient encounters from 2013 to 2016. All of the guidelines were followed in 6 percent of those cases, or 1,591 encounters.

Sax said Cedars-Sinai studied the rate of complications, readmissions, length of stay and direct cost of care among the patients in whose cases the guidelines were followed and compared those outcomes with cases where adherence was less than 50 percent.

In the group that didn’t follow the guidelines, patients had a 14 percent higher incidence of readmission and 29 percent higher risk of complications. Those complications and longer stays increased the cost of care by 7 percent, according to the hospital.

In 2013, the first year of implementation of Choosing Wisely guidelines, Cedars-Sinai said it avoided $6 million in medical spending.

For perspective, Cedars-Sinai is one the largest hospitals in the nation with $3.3 billion in revenue for the fiscal year ending June 30. It reported net income of $301 million.

In Northern California, Sutter has incorporated more than 130 Choosing Wisely recommendations as part of a broader effort to reduce variation in care. In all, Sutter said, it has saved about $66 million since 2011.

That’s a significant sum. However, during the same period, Sutter reported $2.7 billion in profits. Last year alone, it posted an operating profit of $554 million on revenue of nearly $12 billion.

Giusto said her team of employees tasked with changing physician behavior and eliminating these variations is separate from administrators who are focused on maximizing reimbursement. She said there can be conflicting forces within a hospital.

“We get real excited about a project with [emergency department] doctors on reducing CT scans for abdominal pain,” said Giusto, director of Sutter’s office of patient experience. “Then I can hear the administration say that was a fee-for-service patient. I just lost money, right?”

Giusto meets with doctors to present data on how many tests or prescriptions they order and how that compares to others. At one clinic, she shared slides showing that some doctors were ordering more than 70 opioid pills at a time while others prescribed fewer than 20. In response, Sutter set a goal of 28 tablets in hopes of reducing opioid abuse.

“Most of the physicians changed,” Giusto said. “But there were still two who said, ‘Screw it. I’m going to keep doing it.’”

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

Categories: Cost and Quality, Health Industry

Tags: ,

Viewpoints: ‘Taxpayer-First Budget’ Inflicting Pain; Slow Rollout Of Menu Calorie Counts

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

The New York Times: A Budget That Promises Little But Pain
If President Trump’s 2018 budget, to be unveiled on Tuesday, was worthy of praise, you can bet Mr. Trump would be in Washington to bask in it. But his overseas trip keeps him at a distance physically, if not politically. As detailed in a preview on Monday by Mick Mulvaney, the White House budget director, the budget is a naked appeal to far-right Republicans aiming for a partisan rallying cry, even as a legislative victory most likely remains out of reach. Of 13 major initiatives in the budget, nine are drastic spending cuts, mostly aimed at low-income Americans. The biggest of those, by far, is an $866 billion reduction over 10 years in health care spending, mostly from Medicaid. (5/23)

The Washington Post: Another Bad Budget From Trump Targets The Poor
President Trump released a proposal for fiscal year 2018 discretionary spending — the “skinny budget” — two months ago, and the $1.1 trillion plan garnered deservedly poor reviews. In a nutshell, Mr. Trump would have gutted the Environmental Protection Agency, the National Institutes of Health and similarly crucial domestic agencies to fund a big boost in defense spending and border security. On Tuesday the White House releases its ideas for the remaining $3 trillion or so in federal spending, including large-scale entitlements such as Medicaid, and the early indications are that the priorities embodied in this sequel will be no more humane or rational. (5/22)

Miami Herald: The Federal Budget Released Today Puts Taxpayers First
This Tuesday, the president will release his Fiscal Year 2018 budget request. The title on the cover reads “A New Foundation for American Greatness.” But it’s what’s inside that’s more important. What people will see there is something that has been missing from Washington for a long time: “A Taxpayer First Budget.” … For years, we’ve focused on how we can help Americans receive taxpayer-funded assistance. Under President Trump’s leadership, we’re now looking at how we can respect both those who require assistance and the taxpayers who fund that support. For the first time in a long time, we’re putting taxpayers first. (Budget director Mick Mulvaney, 5/22)

The Washington Post: Trump’s First Budget: Why Attention Must Be Paid To It
So, with two partial exceptions, the President’s budget cannot be viewed as anything other than the standard issue, highly partisan, thoroughly uncompromising budgets we’ve seen from Republicans since the rise of Paul D. Ryan. The purpose of these budgets, which even Ryan himself has characterized as more “visionary” than realistic, is to shrink government outside of defense and give the savings to their wealthy donors in the form of regressive tax cuts. Their ultimate targets are Social Security, Medicare, and Medicaid, and with this budget, we can see that strategy evolving. (Jared Bernstein, 5/22)

Los Angeles Times: Trump’s Budget Plan Continues His Deceitful Attack On The Disabled — And Violates A Campaign Pledge
We pointed out back in March that Trump budget direct Mick Mulvaney displayed an alarming ignorance about Social Security disability benefits during an appearance on the CBS program “Face the Nation.” Now it turns out that there was method to his muttering. In effect, Mulvaney was telegraphing that the Trump White House was planning to cut disability benefits sharply. Axios reported Sunday that the Trump budget due out Tuesday will include $1.7 trillion in cuts to major social insurance and assistance programs, including food stamps, the Children’s Health Insurance Program, and Social Security disability. (Michael Hiltzik, 5/22)

Forbes: This Week’s Rollout Of Trump 2018 Budget Could Be His Biggest Failure Yet
On top of everything else, the Trump 2018 budget and OMB Director Mulvaney’s first testimony about it, which is currently scheduled for Wednesday before the House Budget Committee, is virtually certain to get much less attention because the Congressional Budget Office is now expected to release its estimates of the impact of the House-passed American Health Care Act that same day … and those numbers are very likely to be devastating. … CBO’s new AHCA numbers took on dramatically increased importance last week when the Republican leadership let it be known that the House might have to vote on the bill a second time because, as reported, it might not satisfy all of the Senate’s Byrd rule requirements. (Stan Collender, 5/21)

Philly.com: Slash Medicaid And You Jeopardize Care For Everyone
Just before launching his presidential campaign, Donald Trump promised that if elected, he would not cut funding for Medicaid. Chalk that up to yet another campaign promise reneged on. Trump’s budget proposal calls for more than $800 billion in cuts. … But even more is at stake than the lives of poor and disabled Americans, something the architects of these plans don’t seem to care much about. The cuts would jeopardize the entire health care system. (Robert I. Field, 5/23)

The Washington Post: Trump’s Budget Is So Cruel A Russian Propaganda Outfit Set The White House Straight
Trump, who once vowed “no cuts” to Medicaid, would now cut Medicaid by more than $800 billion, denying support to 10 million people. He lops a total of $1.7 trillion off that and similar programs, including food stamps, school lunches and Habitat for Humanity. Mulvaney, defending the budget Monday, made a frank admission: “This is, I think, the first time in a long time an administration has written a budget through the eyes of people who actually are paying the taxes. Too often in Washington I think we often think only on the recipient side.” (Dana Milbank, 5/22)

USA Today: Calorie Labeling Isn’t Rocket Science
Watching your weight while grabbing a bite at your favorite chain restaurant, supermarket food bar or convenience store was supposed to get easier under a 2010 federal law requiring that certain businesses post calorie counts. This isn’t rocket science. But after seven years, the final posting rules are still on hold, and this month the Trump administration delayed compliance again. If the newest date — May 7, 2018 — holds, it will have taken nearly as long to post calorie counts as it did to put a man on the moon after President Kennedy announced this ambitious goal in 1961. (5/22)

USA Today: Pizza Makers Weigh In On Calories
America’s pizza delivery companies want a reasonable 21st century solution to the nutrition labeling challenge: We simply want approval to put the information where our customers look for it. At Domino’s, we’ve been posting nutritional information on our website for nearly 14 years because it’s the easiest way to provide the information to our customers where they will most likely see it. Unfortunately, the menu labeling rule as written does not make accommodations for brands whose majority of orders come from people who order online. The rule seems better suited to sit-down chains and fast-food joints. (Tim McIntyre, 5/22)

Forbes: North Carolina Poised To Reform Welfare Programs To Protect Truly Needy
A provision in the [North Carolina] Senate’s budget proposal, spearheaded by Sen. Ralph Hise, would rein in frequently-exploited loopholes in the state’s food stamps and Medicaid systems, bringing overdue protection to valuable resources for families who need them most and protecting the system from abuse. North Carolina’s current broad-based eligibility expansion in food stamps has been ripe for reform since 2010 when former Gov. Bev Perdue took advantage of a loophole that expanded welfare eligibility beyond the federal limits. (Josh Archambault, 5/22)

The New York Times: Hey Parents, Surprise, Fruit Juice Is Not Fruit
Many American children consume more than half of their fruit as juice, and the American Academy of Pediatrics has issued new guidelines clarifying its stance on that substitution: For most kids, it’s a bad thing. The new guidelines aren’t just intended to persuade pediatricians to talk to parents about the disadvantages of the ubiquitous juice box. They also take aim at the federal government’s Dietary Guidelines for Americans, which are the basis for the nutritional guidelines in the Department of Agriculture’s School Lunch Program — guidelines that allow for the replacement of half of the recommended daily servings of fruits with 100 percent fruit juice. (KJ Dell’Antonia, 5/22)

Louisville Courier-Journal: Fighting The Opioid Epidemic
As many as two million Americans are struggling with prescription drug addiction across the nation. Tragically, heroin and opioid overdoses claim an average of 91 lives every day. This startling trend continues to get worse, especially here in Kentucky. … I made securing crucial new resources to help combat heroin and prescription opioid abuse a top priority in the government funding bill that was recently signed into law. These new resources, which dedicates substantial funding through the appropriations process to address this crisis, will allow us to take another step towards ending it. (Senate Majority Leader Mitch McConnell (R-Ky.), 5/23)

Stat: Training Medical Students How To Teach Helps Them Embrace Ambiguity
In volunteering to help teach the course, neither of us anticipated that questions asked by first-year medical students would heighten our curiosity and passion for medicine. But they did. We looked for answers and followed up with the students who asked them. In the process, we also reflected on how to be better self-directed learners and more effective teachers. (Jasmine Rana and Taylor Freret, 5/22)

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

Different Takes: Pay Attention To Senate’s Reform Plan; GOP Should Focus On Tax Credits

Opinion writers take a look at the latest moves to overhaul the federal health law.

The New York Times: It’s Time To Worry About Health Care In The Senate
While the rest of the country has been transfixed by Trumpian chaos, members of the Senate have spent the last two weeks talking about taking health insurance from millions of Americans. There is an alarmingly large chance that they’ll decide to do so. But if they do, they will almost certainly rely on a political sleight of hand to disguise their bill’s damage. Understanding that sleight of hand — and calling attention to it — offers the best hope for defeating the bill. (David Leonhardt, 5/23)

Forbes: The Right Way For GOP Senators To Replace Obamacare’s Tax Credits
If you’ve been a regular reader of The Apothecary, you know that the key flaw in the American Health Care Act—the House Republican bill to replace Obamacare—is that the tax credits it offers to the uninsured will price low-income near-elderly workers out of the market. The problem is that Ryancare’s tax credits are, for the most part, unadjusted for income; a couple making $150,000 gets the same level of assistance as someone making $13,000. This flat credit ends up being especially problematic for older individuals, because their underlying premiums are much higher than those for younger people. (Avik Roy, 5/23)

The Washington Post: Want To Know What Trumpcare Would Do To The Country? Look At The Implosion In Iowa.
Wondering what the country’s health-care system would look like under Trumpcare? Take a gander at Iowa, where the individual market is on the verge of collapse. Just one insurer remains in most of the state, and that insurer, Medica, is threatening to exit. Republicans love to point to Iowa’s struggles as evidence of Obamacare’s failures. But in reality, the Hawkeye State has functioned as a petri dish for the GOP’s health plan. The state’s problems provide useful lessons for what could go wrong if Trumpcare becomes law nationwide. (Catherine Rampell, 5/22)

The New York Times: Health Policy Is Vital To Tax Reform Policy
There is strong bipartisan support in Congress for cutting the corporate tax rate to improve competitiveness. … But what is really holding back the international competitiveness of American businesses isn’t so much the tax code as our health system. The United States is unique among major countries in that health insurance for the working population is provided almost entirely by employers. (Bruce Bartlett, 5/23)

Boston Globe: White House Needs Data, Not Word Clouds, On Health Care
If ever there was a time for careful, sober, data-driven policy analysis, that time is now. The nation has a president whose claims are a word cloud of superlatives, assertions that frequently bear little resemblance to reality. Add a Republican House so eager to advance a right-wing agenda that inconvenient truths and deficit worries are easily brushed aside, and the potential for long-term health care and fiscal harm is very real. (5/23)

Health Affairs: Preserving The Bipartisan Commitment To Health Care Delivery System Reform
Improving and reforming our health care delivery system is not a partisan issue. The need to improve health care delivery models, as a means for ensuring better patient outcomes and a more efficient health care system, enjoys broader consensus than elements surrounding health insurance coverage and financing. It is important for Congress, the Trump administration, and the health care industry to continue bipartisan efforts to shift our health care delivery system and provider payment models toward value-based care. (Alice M. Rivlin and Sheila Burke, 5/18)

San Antonio Press-Express: Christianity And The Health Care Bill 
Many political leaders who support the U.S. House of Representatives’ or whatever U.S. Senate version emerges of a new health care bill will proudly identify themselves as Christian, pro-life and pro-family. What puzzles me is how these leaders reconcile their personal values and commitments with embracing a plan that limits or excludes poor people, as well as persons with pre-existing conditions. (Allan Hugh Cole Jr., 5/22)

Health Affairs: Health Insurance Benefits Should Be Equitable, Not Necessarily Equal
As policy makers grapple with potentially undoing or modifying the largest expansion of health insurance in a generation, the cost and generosity of benefits hold center stage. Traditional underpinnings of insurance plans—premiums, deductibles, copayments, and coinsurance—frequently create barriers to the optimal use of these plans by consumers. They also can exacerbate inequities in health care, by inhibiting the use of services known to benefit health. Novel approaches to insurance plan design to produce a more equitable and efficient distribution of health care expenditures are warranted. (Betsy Q. Cliff, Michael Rozier and A. Mark Fendrick, 5/22)

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

State Highlights: Aid-In-Dying Case To Be Heard In N.Y.; Mass. Hospital Revises Plan To Close Psychiatric Beds After Criticism

Media outlets report on news from New York, Massachusetts, Virginia, Texas, Connecticut, Florida, California, Colorado and Missouri.

The Wall Street Journal: New York Appeals Court To Hear Case On Doctor Aid In Dying
Eric Seiff says his mother begged his father to end her life throughout the two years she suffered from breast cancer before dying in 1955. Mr. Seiff told himself at the time he would never prolong his death. Mr. Seiff, an 84-year-old lawyer, is among those plaintiffs arguing that doctors should have the right to prescribe a fatal dosage of medication, in most cases barbiturates, to mentally competent terminally ill people. Their case against the state is scheduled to be heard May 30 in the New York Court of Appeals in Albany, the state’s highest court. (Kanno-Youngs, 5/22)

Boston Globe: UMass Memorial Seeks To Quell Criticism Of Psychiatric Bed Cuts 
UMass Memorial Medical Center, responding to sharp criticism from mental health advocates and the state, has revised its plan to close 13 psychiatric beds in Worcester and transfer patients to other Central Massachusetts hospitals. Worcester’s largest hospital submitted the updated plan late last week in response to officials at the state Department of Public Health, who said they were deeply concerned that the hospital’s original proposal would curtail patients’ access to services. (Dayal McCluskey, 5/22)

Richmond Times-Dispatch: New Mental Health Care Program Launched In Virginia
The Virginia Health Care Foundation has announced a new $1.5 million behavioral health program that is designed to increase access to mental health care for uninsured Virginians and those with little to no access to medical care… The foundation is a public-private partnership that helps uninsured Virginians and those who live in areas without robust medical, dental and mental health services. (Kleiner, 5/22)

The CT Mirror: Healthcare Union Ad Protests Ongoing State Layoffs 
The state’s largest healthcare workers’ union launched a new online ad Monday to protest the latest layoffs ordered by Gov. Dannel P. Malloy. The governor, who warned unions recently that he might have to order as many as 4,200 layoffs if concessions are not granted, has issued 113 pink slips in recent weeks. (Phaneuf, 5/22)

Health News Florida: Mosquito Control Ramps Up As South Florida Prepares For Zika 
Last summer’s wave of local transmission of the Zika virus hasn’t yet bled into 2017 , but officials from Key West to West Palm Beach are gearing up for another round of mosquito control by creating new staff positions, adding more equipment and increasing outreach efforts. In 2016, Florida saw more than 250 cases of locally transmitted Zika, the mosquito-borne virus spread by the Aedes aegypti mosquito that can cause fevers, rashes and joint pain. (Stein, 5/22)

Sacramento Bee: Nacho Cheese From Gas Station Blamed For Botulism Death 
One person has died of botulism after eating nacho cheese sauce from a Walnut Grove gas station, California health officials confirmed Monday. The man was one of 10 people who fell ill with the rare form of food poisoning in recent weeks after eating food purchased at Valley Oak Food and Fuel. (Caiola and Chang, 5/22)

Denver Post: Centura Health’s Longtime CEO To Step Down, Assume Special Advisor Role 
Centura Health’s chief executive will step down Sept. 1 after leading the Centennial-based healthcare network for nine years. Gary Campbell, the longest tenured CEO in Centura’s history, will be succeeded by chief operating officer Peter Banko, officials announced Monday. “Centura Health has been truly blessed with Gary’s visionary leadership,” Centura Health board chairwoman Patricia Webb said in a statement. “His faithful commitment to our ministry and efforts to transform the delivery of health care have allowed us to optimize health value across our region and meet the needs of consumers.” (Rusch, 5/23)

Texas Tribune: Bill On Certification Pits Doctors Against Hospitals 
A bill moving through the Legislature in the last week of the session is pitting doctors against hospitals over how much testing doctors should have to undergo to maintain their certification… Senate Bill 1148 would ban the Texas Medical Board from using the MOC as a requirement for physicians to obtain or renew their medical license. (Mansoor, 5/23)

San Francisco Chronicle: Evictions From Residential Care Home Disrupt Lives
The owner and operator of the Fulton Rest Home, an independent living facility for men with disabilities in Berkeley, told residents last month they had 60 days to clear out… A private operator of a residential care facility can close the business and evict the tenants with only a 30-day notice, according to Disability Rights California, an advocacy group that runs a website listing tenant rights for people in care homes. (Taylor Jr., 5/22)

Sacramento Bee: Norovirus Stomach Illness Spreads In Yolo County Schools 
That vomit- and diarrhea-inducing illness spreading through schools has reached more than 2,800 people in Yolo County as of Monday and could linger on campuses through the end of the academic year, health officials say… Kristin Weivoda, emergency medical services administrator for the county, said the spread of norovirus will be difficult to overcome before school is out because of the ease of transmission among children. (Kalb, 5/22)

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