From Health Care

Political Reverberations: How Graham-Cassidy Impacts The Health Care Debate

Editorial pages feature opinions praising this “last-chance” legislation or calling it “nonsense” and “cynical.” They also detail how, regardless of the outcome of the vote planned for next week, the GOP will own it.

The Wall Street Journal: Republicans Get One Last Chance On ObamaCare Reform
For seven years Republicans promised to repeal ObamaCare, and now they have one last chance to deliver. A bill recently introduced by Sens. Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson would eliminate some of ObamaCare’s most unpopular provisions and enact reforms that would lower costs, expand choices, promote federal fiscal responsibility, and give power back to states and consumers. … The Graham-Cassidy bill’s biggest strength is the idea that states are uniquely equipped to design and implement health care programs that suit their residents. The bill would consolidate much of the federal funding given to states under ObamaCare’s coverage provisions—including money for its Medicaid expansion and subsidies to help people buy private insurance—into a single block grant, which states could use for a wide variety of health reforms. (Lanhee J. Chen, 9/20)

JAMA Forum: Republicans Will Own Whatever Happens To The ACA And Health Care Reform
As has become clear, “Repeal and Replace” of the Affordable Car Act (ACA), a mantra that provided such a unifying theme for Republicans when Democrats controlled the White House, has been much harder than Republicans expected when they achieved “full control” of the government. Republicans were barely able to pass a health care bill in the House despite their substantial majority over Democrats (240-194) and the Senate fell short of passing the so-called “skinny” repeal bill, HR 1628, which repealed only a limited portion of the ACA. (Gail Wilensky, 9/19)

The Washington Post: Lots Of Vulnerable House Republicans Come From States That Will Lose Under Cassidy-Graham
If the Senate passes Cassidy-Graham, its latest attempt to repeal Obamacare, the legislation will then go to the House for a vote. If that happens, Speaker Paul D. Ryan (R-Wis.) has vowed to engineer its quick passage in the lower chamber, too …. certain states are going to be hit with major losses if this bill becomes law. And it turns out that those states that would lose out happen to be heavy with incumbent House Republicans whose seats are vulnerable in 2018. Will those vulnerable House Republicans vote for a bill that drains their states of huge sums of money that could have been used to cover their own constituents? (Sarah Posner and Greg Sargent, 9/20)

The Wall Street Journal: The Republicans Who May Save ObamaCare
Like Lazarus, the Republican effort to repeal ObamaCare has risen from the dead. Pundits dutifully filled out the toe tag in July, after a repeal-and-replace bill failed to pass the Senate. Now comes new legislation championed by Sens. Lindsey Graham and Bill Cassidy, which just might get the 50 GOP votes needed for Vice President Mike Pence to break the tie and pass the bill. … Senate passage would clear the way to ending the individual and employer mandates, repealing the medical-device tax, and phasing out the ObamaCare exchanges and their highly prescriptive regulations. … The danger is that there are at least four Republican senators at risk of voting “no.” (Karl Rove, 9/20)

Bloomberg: Republicans Peddle Nonsense To Sell Health-Care Plan
Graham and Cassidy have sold this hastily assembled measure as a bipartisan compromise that, rather than cutting coverage, merely gives the states the funds and flexibility to determine their own health-care policies. None of that holds up. The bill is purely partisan—it’s being rushed through for the simple reason that it lacks any Democratic support. Graham, in press conferences, has hailed the plan as a middle-ground compromise between Obamacare and the coverage-slashing Republican proposals that collapsed in July. That’s nonsense. (Albert R. Hunt, 9/20)

Boston Globe: Yet Another Cynical GOP Ploy On Health Care
The latest Republican vehicle for repealing and replacing Obamacare is Graham-Cassidy, a bill that would dramatically cut federal health care spending and block-grant remaining monies to the states while not requiring those states to spend the money on expanding care. (Micheal Cohen, 9/20)

Bloomberg: How The Health-Care Debate Would Change If Graham-Cassidy Passes
What a difference a week makes. Last week, many commentators (including me) saw the Graham-Cassidy bill as a bit of Hail Mary legislating, a last desperate stand against Obamacare. This week, it started to look as if it might actually have some chance of passage. The legislative math remains daunting; the parliamentary obstacles high. But the status of Republican health-care efforts has moved from “flatline” to “still breathing, barely.” (Megan McArdle, 9/20)

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

Longer Looks: Cassidy-Graham; A Man-Made Epidemic & A Single-Payer Failure

Each week, KHN’s Shefali Luthra finds interesting reads from around the Web.

FiveThirtyEight: Republicans Really Could Repeal Obamacare This Time
So why are we going through this exercise again? For two reasons. First, Cassidy and Graham have been persistent. Senate Majority Leader Mitch McConnell, who had essentially said the party was done with attempting to repeal Obamacare after the most recent failed effort in July, is reportedly at least open to spending this week seeing if the bill can pass. Second, this may be Republicans’ last opportunity to repeal Obamacare — at least for a while. (Perry Bacon Jr., 9/18)

Vox: GOP Senators Are Rushing To Pass Graham-Cassidy. We Asked 9 To Explain What It Does. 
The stakes of the Republican rush to repeal and replace Obamacare could hardly be higher. The GOP has less than two weeks to pass a repeal-and-replace plan before their budget reconciliation instructions expire, and the insurance of tens of millions of Americans hangs in the balance. Vox conducted the interviews with nine Republican senators throughout the Capitol and Russell Senate Office Building on Tuesday. (Jeff Stein, 9/20)

CQ Magazine: A Simple Fix For Obamacare: Make Boomers Pay More
The dramatic collapse of the Republicans’ Senate health care bill in July put an end, for now, to talk of repealing the Affordable Care Act. And it’s raised the possibility that lawmakers might take to heart the admonition of their colleague, Arizona Republican Sen. John McCain, to seek targeted fixes to the problems in the health care marketplace that both Republicans and Democrats acknowledge.  One of the biggest problems is that many people making too much money to qualify for government subsidies still cannot afford to buy insurance. Those middle class and upper middle class Americans who don’t get insurance from their employers are the 2010 law’s biggest losers. (Shawn Zeller, 9/18)

New York Magazine: A New Last Chance
Monica Halem calls it the “fertility train.” Every woman who embarks on a cycle of in vitro fertilization is familiar with the ride: the multiple cycles of hormonal stimulation, the pain of the injections, the discomfort and the bloating; then the delicate harvest of eggs to be fertilized outside the body, and the anxious wait for genetic testing on the embryos to make sure they have the right number of chromosomes before they are transferred back; and then, if all of the embryo tests come back abnormal, or the embryos don’t implant, or the pregnancy ends prematurely in miscarriage, the process starts all over again. (Stephen Hall, 9/17)

The Huffington Post: San Diego’s Hepatitis Outbreak Is A Man-Made Disaster
The outbreak has killed 16 people and infected 421 since November, ravaging San Diego’s large homeless and illicit drug-using population. It could eventually cost the county health department up to a million dollars, a local health official estimated. But San Diego could have avoided its hepatitis A crisis — or at least ensured it didn’t get this bad — if its homeless residents had better access to housing and the city provided the services they need to stay healthy, activists and public health experts say. (Dana Liebelson and Lauren Weber, 9/19)

Vox: Single-Payer Health Care Failed Miserably In Colorado Last Year. Here’s Why.
On the day the state of Colorado voted for Hillary Clinton over Donald Trump by about 5 points, voters there also rejected a ballot measure to enact a state-based single-payer system by an astounding margin of 79 percent to 21 percent. Amendment 69, the Colorado Creation of ColoradoCare System Initiative, would have created a system in which all Coloradans would gain insurance through a tax-funded government insurance program. Private health insurers would have been rendered obsolete. (Dylan Matthews, 9/14)

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: Texas Bill To Curb ‘Surprise Medical Bills’ Now In Effect; Blue Cross Will Continue To Run N.C.’s State Health Plan

Media outlets report on news from Texas, North Carolina, Maine, Florida, California, Nevada, Colorado, Michigan, Missouri, New Hampshire, Louisiana and Minnesota.

The Associated Press: Lawsuit Challenges Law That Only Doctors Perform Abortions
The American Civil Liberties Union and Planned Parenthood filed a federal lawsuit Wednesday that challenges a Maine restriction common across most of the U.S. that abortions be performed solely by physicians. The two groups were joined by four nurses and abortion provider Maine Family Planning in challenging the law that prevents advanced practice registered nurses, such as nurse practitioners and nurse midwives, from performing the procedure. (9/20)

Las Vegas Review-Journal: Southern Nevada Medicare Dilemma: Pay More Or Switch Doctors
The recent decision by Southwest Medical Associates to stop covering traditional Medicare patients in Southern Nevada makes 66-year-old Anne Zarate sick to her stomach. That queasy feeling is not just because, as the Las Vegas woman puts it, she’s being “thrown out with 7,000 others in a city where access to medical care is weak at best.” She also sees Southwest’s action as an example of the inability of government to deliver quality health care in the United States. (Harasim, 9/18)

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

Bouncing Back From Trauma Is Possible, But Some People Have To Work Harder Than Others

Dr. Dennis Charney has spent years studying trauma. And then he joined the ranks of the patients he worked with. In other public health news, ADHD, embryo editing, effects of gender stereotypes, the science of weight loss, the flu and more.

Stat: As A Scientist, He Studied Trauma Victims. Then He Became One
Dr. Dennis Charney stepped forward to address the court here, the man who tried to kill him standing no more than 20 feet away. He stated his full name for the record and then began detailing what happened. How one morning as he picked up his iced coffee and lightly buttered bagel, he heard a shotgun boom and saw blood pouring from his shoulder and chest. How he spent five days in the intensive care unit and then was scared to sleep with the lights off. How even now, a year later, he carried buckshot in his body. (Joseph, 9/21)

The Washington Post: Could ADHD Be A Type Of Sleep Disorder? That Would Fundamentally Change How We Treat It.
Over the past two decades, U.S. parents and teachers have reported epidemic levels of children with trouble focusing, impulsive behavior and so much energy that they are bouncing off walls. Educators, policymakers and scientists have referred to attention-deficit/hyperactivity disorder, or ADHD, as a national crisis and have spent billions of dollars looking into its cause. They’ve looked at genetics, brain development, exposure to lead, the push for early academics, and many other factors. But what if the answer to at least some cases of ADHD is more obvious? (Cha, 9/20)

NPR: Embryo Editing Yields DNA Clues To Early Human Development
For the first time, scientists have edited the DNA in human embryos to make a fundamental discovery about the earliest days of human development. By modifying a key gene in very early-stage embryos, the researchers demonstrated that a gene plays a crucial role in making sure embryos develop normally, the scientists say. (Stein, 9/20)

Minnesota Public Radio: The Science Of Weight Loss
We’ve all heard the conventional wisdom on how to lose weight: eat less and exercise more. But new research shows that shedding pounds and keeping them off may be more complicated than a “one-size-fits-all” approach. (Miller and Franz, 9/20)

Chicago Sun-Times: Mother Says Insurers Failed Her Suicidal Son
It was a year ago this week that Joseph “Joey” Dailidas took his own life with an intentional overdose of prescription medicine. … Despite laws intended to require insurers to provide parity between coverage for mental health treatment and other medical conditions, many believe mental health and addiction treatment are still getting short shrift. (Mark Brown, 9/20)

Baltimore Sun: Mosquito Emoji: A Pair Of Public Health Workers Have An Itch To Make It Happen
Why shouldn’t people who hate the little blood suckers in the backyard, as well as those who love them in the lab, be able to express their feelings about them in a single character via text or on social media, ask Marla Shaivitz, a digital communications manager at the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs, and Jeff Chertak, a senior program officer for malaria advocacy and communications at the Bill & Melinda Gates Foundation. (Cohn, 9/20)

Kaiser Health News: Caregivers Draw Support By Mapping Their Relationships
Every time Jacque Pearson tried to devise a plan to move her 81-year-old dad, who has Alzheimer’s, from his home in Boise, Idaho, to hers in Denver, she felt stuck. Then, two weeks ago, she had a breakthrough. It happened at an AARP-sponsored session in which Pearson created a “CareMap” — a hand-drawn picture showing all the people she cares for as well as the people surrounding those individuals and her own sources of support. (Graham, 9/21)

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

Florida Closes Nursing Home Tied To 9 Patient Deaths, Issues Rebuke For False Patient Records

Staff at the home entered normal vital signs into the medical records of several residents after they had already been evacuated, Florida officials said.

The Associated Press: Florida Suspends License Of Nursing Home Over Irma Deaths
Florida officials have suspended the license of a nursing home that had nine patients die after Hurricane Irma knocked out its air conditioning. The Agency for Health Care Administration said Wednesday that it suspended the license of the Rehabilitation Center at Hollywood Hills. The agency previously banned the facility from admitting new patients and from receiving Medicaid. The home filed a lawsuit trying to block those orders. (9/20)

Miami Herald: Irma Aftermath: Nursing Home Where 9 Died Shut Down By State
The Hollywood Hills nursing home that became a sweltering deathtrap for nine seniors after Hurricane Irma was shut down Wednesday. … A statement released by the Agency for Health Care Administration said the center’s license was suspended, and unveiled new details about the nursing home, which has a history of poor inspections by state regulators. (Madan, 9/20)

The New York Times: Florida Nursing Home Listed Dead Resident As ‘Resting In Bed,’ State Says
A state agency has found that the Florida nursing home where eight residents died after it lost air-conditioning following Hurricane Irma “presents a danger to every person on its premises” and must close after staff at the facility failed to call 911 for its overheated patients, even as their temperatures began spiking as high as 109.9 degrees Fahrenheit. The agency also rebuked the nursing home for entering normal vital signs, or mildly elevated temperatures, into the medical records of several residents after they had already been evacuated or, in one case, had already died. Those entries, it said, were made “under dubious circumstances.” (Yee and Fink, 9/20)

The Wall Street Journal: Florida Suspends License Of Nursing Home Tied To Eight Deaths
The latest order comes a day after the Rehabilitation Center at Hollywood Hills filed a lawsuit against the state to block two previous orders, both of which effectively shut down the home, claiming the orders weren’t justified. Under direction from Gov. Rick Scott, the state has taken several steps to stop operations at the Hollywood, Fla., facility following the deaths last week. The nursing home’s residents “did not receive timely medical care because the trained medical professionals at the facility overwhelmingly delayed calling 911,” Florida’s Agency for Health Care Administration said, citing initial findings from an ongoing investigation. (Evans and Kamp, 9/20)

And in a look at other medical services affected by natural disasters —

Stat: Mobile Dialysis Could Save Lives In A Disaster. But Is There A Cost To Safety?
The calls started coming in the days after Hurricane Sandy. Flooded dialysis centers had shuttered across New York and New Jersey. Some patients and practitioners didn’t know where to turn. So they dialed Anita Chambers. “It was difficult to hear stories of patients being driven four to eight hours to find a center that could take them,” Chambers, said recalling the 2012 superstorm. “There were centers open that had all the patients in the day — seeing these patients in the middle of the night.” (Blau, 9/21)

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

First Edition: September 21, 2017

Sep 21 2017

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

Kaiser Health News: Last-Ditch Effort By Republicans To Replace ACA: What You Need To Know
Republican efforts in Congress to “repeal and replace” the federal Affordable Care Act are back from the dead. Again. While the chances for this last-ditch measure appear iffy, many GOP senators are rallying around a proposal by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), along with Sens. Dean Heller (R-Nev.) and Ron Johnson (R-Wis.). They are racing the clock to round up the needed 50 votes — and there are 52 Senate Republicans. (Rovner, 9/19)

Kaiser Health News: Caregivers Draw Support By Mapping Their Relationships
Every time Jacque Pearson tried to devise a plan to move her 81-year-old dad, who has Alzheimer’s, from his home in Boise, Idaho, to hers in Denver, she felt stuck. Then, two weeks ago, she had a breakthrough. It happened at an AARP-sponsored session in which Pearson created a “CareMap” — a hand-drawn picture showing all the people she cares for as well as the people surrounding those individuals and her own sources of support. (Graham, 9/21)

Kaiser Health News: Open Your Mouth And Say Goo-Goo: Dentists Treating Ever-Younger Patients
Allen Barron scrunches up his tiny face and wails as his mother gently tips him backward onto the lap of Jean Calvo, a pediatric dental resident at the University of California-San Francisco. Allen’s crying may be distressing, but his wide-open mouth allows Calvo to begin the exam. She counts his baby teeth and checks for dental decay. “Nothing I am going to do will hurt him,” Calvo tells Allen’s mother, Maritza Barron, who is holding her son’s hands. (Udesky, 9/21)

The Associated Press: Study: Most States Would Take A Hit From GOP Health Bill
Most states would take a stiff budgetary hit if the latest Senate GOP health care bill becomes law, according to an analysis released Wednesday. That would likely result in more uninsured Americans. The study by the consulting firm Avalere Health found that the Graham-Cassidy bill would lead to an overall $215 billion cut to states in federal funding for health insurance, through 2026. Reductions would grow over time. (9/20)

The Washington Post: Under Latest Health-Care Bill, Red States Would Benefit Disproportionately
The latest Republican proposal for curtailing the Affordable Care Act was assembled with such haste that it may get a vote before a full cost estimate is finished. But it is not a new idea. At its core, the bill introduced by Sen. Bill Cassidy (R-La.) and Sen. Lindsey O. Graham (R-S.C.) would implement a decades-old conservative concept, capping the amount that taxpayers spend on Medicaid and giving states full control over the program. As he’s sold the legislation to conservative governors and activists, Graham has described it as a possible triumph for federalism, and a way to end the progressive dream of universal health care managed from Washington. (Weigel, 9/20)

The Washington Post: Cassidy-Graham Bill Would Cut Funding To 34 States, New Report Shows
More than half of the overall cuts in the legislation — named for its primary sponsors, Republican Sens. Bill Cassidy (La.) and Lindsey O. Graham (S.C.) — would come from Medicaid, the analysis shows. States with relatively low medical costs, skimpy Medicaid benefits and no program expansion would win out. Texas would gain more than any state, about $35 billion from 2020 through 2026. On the other hand, states with higher-priced medicine and generous benefits for their low-income residents, such as California and New York, would lose billions of dollars. (Goldstein, Weigel and Eilperin, 9/20)

The Hill: 34 States Would See Funding Cut From New ObamaCare Repeal Bill: Study
Cassidy, Graham and the other co-sponsors of the bill said the legislation is about fairness. It aims to redistribute money from high-spending Medicaid expansion states — like California — to states that rejected the expansion — like Texas. But it isn’t just blue states that stand to lose under the Graham-Cassidy proposal. (Weixel, 9/20)

The New York Times: How The Latest Obamacare Repeal Plan Would Work
The latest Republican proposal to undo the Affordable Care Act would grant states much greater flexibility and all but guarantee much greater uncertainty for tens of millions of people. The legislation, proposed by two Senate Republicans, Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, would not only reduce the amount of federal funding for coverage over the next decade, but also give states wide latitude to determine whom to cover and how. The result is a law that would be as disruptive as many of the Republicans’ previous proposals, but whose precise impact is the hardest to predict. (Abelson and Sanger-Katz, 9/20)

NPR: Republicans Try One Last Effort To Repeal Obamacare
Graham-Cassidy essentially deconstructs all of the major programs created by the Affordable Care Act, gathers up the money and hands it over to states to run their own health care programs. It gets rid of both the subsidies that help people buy individual health insurance policies and the reimbursements to insurance companies for offering price breaks on copayments and deductibles to the lowest-income customers. It rolls back the Obamacare Medicaid expansion that was adopted by 31 states and Washington, D.C., and it eliminates the Basic Health Program that was created under the ACA and implemented in New York and Minnesota. (Kodjak, 9/19)

Stat: Abortion Coverage Would Be Restricted Under New GOP Health Care Plan
The GOP health care overhaul barreling toward a possible Senate vote this month would restrict abortion coverage for some people as early as next year. Most of the major changes included in the package, from Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, wouldn’t take effect until 2020. That’s when the legislation would end the subsidies currently available to consumers who don’t get their health insurance through their job or a government program. It’s also when the legislation would overhaul — and cut — government contributions to state Medicaid programs. (Mershon, 9/20)

The Hill: GOP Takes Heavy Fire Over Pre-Existing Conditions
The new ObamaCare repeal measure from Senate Republicans would give states a way to repeal protections for people with pre-existing conditions, a controversial move that opponents of the bill are denouncing. The provision attracted widespread attention on Wednesday after late-night host Jimmy Kimmel blasted Sen. Bill Cassidy (R-La.), a lead author of the legislation. Kimmel said the senator is violating the “Jimmy Kimmel test,” which Cassidy coined as a way of saying that no one should be denied care because they can’t afford it. “This guy Bill Cassidy just lied right to my face,” Kimmel said. (Sullivan, 9/20)

The Hill: Blue Cross Warns GOP Repeal Bill ‘Undermines’ Pre-Existing Condition Rules
The Blue Cross Blue Shield Association warned against a new GOP ObamaCare bill on Wednesday, saying it would “undermine” protections for pre-existing conditions. “The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions,” the association said in a statement. (Sullivan, 9/20)

The Hill: Trump: New ObamaCare Repeal Does Cover Pre-Existing Conditions
President Trump argued Wednesday that the latest Republican effort to repeal much of ObamaCare does include coverage of pre-existing conditions. “I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does! A great Bill. Repeal & Replace,” Trump wrote on Twitter, referring to the legislation being pushed by Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.). (Shelbourne, 9/20)

The Wall Street Journal: McConnell Plans Vote On GOP Health Bill Next Week
A spokesman for Mr. McConnell (R., Ky.) said it was “the leader’s intention to consider Graham-Cassidy on the floor next week,” referring to the bill sponsored by GOP Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. The spokesman’s statement didn’t commit the Senate to a vote, which would need to happen before the end of next week for Republicans to pass the measure by a simple majority. (Peterson and Radnofsky, 9/20)

Politico: Senate Girds For Final Obamacare Repeal Vote
McConnell has told colleagues he will only bring up the bill if it will succeed. The statement does leave some wiggle room to not proceed with a vote. It’s still anyone’s guess whether the bill’s backers can get to 50 votes. One Republican senator suggested that McConnell may ultimately decide to bring the bill up for another failed vote, in part to show GOP donors and President Donald Trump that the Senate GOP tried again. (Everett and Kim, 9/20)

Politico: The Unlikely Group Who Brought Obamacare Repeal Back To Life
Senate Republicans’ last-ditch attempt to repeal and replace Obamacare rests on the unlikely collaboration of a veteran senator who can’t stand health policy, a wonky freshman who has never passed major legislation and a former senator who lost his seat a decade ago. Together, Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.) and former Pennsylvania Sen. Rick Santorum crafted the latest GOP repeal bill in hopes of delivering on the party’s seven-year-old campaign promise to repeal Obamacare. (Haberkorn and Bade, 9/21)

The Associated Press: Republicans See Political Necessity In Health Care Effort
It’s divisive and difficult, but the Republican drive to erase the Obama health care overhaul has gotten a huge boost from one of Washington’s perennial incentives: Political necessity. In the two months since Senate Republicans lost their initial attempt to scuttle President Barack Obama’s statute, there’s fresh evidence GOP voters are adamant that the party achieve its long-promised goal of dismantling that law. This includes conservative firebrand Roy Moore forcing a GOP primary runoff against Sen. Luther Strange, R-Ala., who’s backed by President Donald Trump, and lots of money, plus credible primary challenges facing Republican Sens. Jeff Flake of Arizona and Nevada’s Dean Heller. (9/21)

The New York Times: ‘Chuck And Nancy,’ Washington’s New Power Couple, Set Sights On Health Care
When Representative Nancy Pelosi, the House Democratic leader, introduced Chuck Schumer to members of her caucus this month, she warmed up the room with a well-worn joke about her Senate counterpart: “You know they say the most dangerous place in Washington is between Chuck and a camera.” Mr. Schumer’s love of the spotlight aside, it has been behind the scenes where “Chuck and Nancy,” as President Trump calls them, have forged what may be the most surprisingly potent partnership in Mr. Trump’s Washington. (Stolberg, 9/20)

The Washington Post: Ready To Deal This Time? Alaska’s Murkowski Is In The Health-Care Spotlight. Again.
Lisa Murkowski walked briskly down a cavernous hallway on the first floor of the Capitol, awash in a small sea of reporters. Suddenly she paused, seemingly overcome by the pressure of the moment. “You guys — hold,” the Republican senator from Alaska said curtly. “Give me breathing room, please. It gets a little intense. I know you guys don’t feel it, but it’s like, whoa.” Another effort to replace the Affordable Care Act is underway, and in Washington that means one thing: Murkowski is at the center of it all — under the glare of the national spotlight and squarely on the minds of White House officials and Senate Republican leaders who are strenuously seeking her support. (Sullivan, 9/20)

The Hill: The Two Senators Who Will Likely Decide Fate Of ObamaCare Repeal
All eyes are on Sens. John McCain (Ariz.) and Lisa Murkowski (Alaska) as Republicans try to approve a new ObamaCare repeal bill in the next 11 days. The two were among the three Republicans who sank the last GOP effort to repeal ObamaCare, and President Trump and his allies probably can’t afford to lose either if they are to win a vote next week. (Hellman, 9/20)

Politico: Christie Says He Opposes Graham-Cassidy Bill
Gov. Chris Christie said on Wednesday that he opposes the latest Senate plan to repeal and replace Obamacare, deeming it “too injurious” to New Jersey. “I oppose Graham-Cassidy because it is too injurious to the people of New Jersey,” Christie told reporters standing outside an addiction treatment center in Somerset County. “I’m certainly not going to support a bill that takes nearly $4 billion from people in the state.” (Jennings, 9/20)

The Hill: Blumenthal: ObamaCare Repeal Bill One Of The ‘Most Cruel’ Acts In History
Sen. Richard Blumenthal (D-Conn.) said Democrats will use “all the tools and tactics” they can to stop the new Republican effort to repeal ObamaCare, legislation he called “the most cruel and outrageous.” “We are preparing and planning to use every tool and tactic available to us because we are on the precipice of one of the most cruel and outrageous legislative acts in recent history,” Blumenthal told CNN’s “The Situation Room.” (Shelbourne, 9/20)

The Hill: New Mexico Gov: GOP Healthcare Bill ‘Still Needs Some Work’
New Mexico’s Republican governor is not yet persuaded to support the latest GOP effort to repeal ObamaCare. “While it’s encouraging that Congress is working on a healthcare solution, the governor is concerned this bill could hurt New Mexico and still needs some work,” a spokesman for Gov. Susana Martinez told The Albuquerque Journal. (Shelbourne, 9/20)

The New York Times: Insurers Come Out Swinging Against New Republican Health Care Bill
The health insurance industry, after cautiously watching Republican health care efforts for months, came out forcefully on Wednesday against the Senate’s latest bill to repeal the Affordable Care Act, suggesting that its state-by-state block grants could create health care chaos in the short term and a Balkanized, uncertain insurance market. In the face of the industry opposition, Senate Republican leaders nevertheless said they would push for a showdown vote next week on the legislation, drafted by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. (Pear, 9/20)

The Hill: Insurer Trade Group Blasts Latest ObamaCare Repeal Bill
In a letter to Senate leadership, America’s Health Insurance Plans said a repeal bill sponsored by GOP Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.) would have “real consequences on consumers and patients.” The bill would further destabilize the individual market; cut Medicaid; pull back on protections for pre-existing conditions; not end taxes on health insurance premiums and benefits; and potentially allow government-controlled, single-payer health care to grow, wrote Marilyn Tavenner, the group’s President and CEO. (Hellmann, 9/20)

The Hill: Insurers Are Scrambling To Keep Up With ObamaCare Drama
Insurance companies blindsided by the Senate GOP’s decision to pull the plug on bipartisan talks and move forward again with ObamaCare repeal are scrambling to figure out how to move forward. The death of the bipartisan push leaves them with no clear way to shore up fragile marketplaces ahead of the 2018 enrollment season, which begins Nov. 1. (Roubein, 9/21)

The Wall Street Journal: With Timing Tight For GOP’s Health-Law Repeal Effort, Opponents Rush To Mobilize
Opponents of a Republican plan to dismantle most of the Affordable Care Act are scrambling to ramp up a resistance campaign before a possible Senate vote next week on a bill many never expected would gain traction. With such a narrow window, consumer and other groups are seeking to pressure specific GOP senators they see as most likely to waver. They also assert that Republicans are trying to ram through a bill outside the normal process while reneging on a promise to preserve the ACA’s consumer protections, claims the bill’s sponsors reject. (Armour, 9/21)

Politico: Left On ‘Full War Footing’ To Stop Obamacare Repeal
The liberal activists roused into the streets by President Donald Trump are revving up for one last campaign to save Obamacare.The sudden resurgence of Republicans’ repeal push appeared to catch Democrats and their base by surprise. But ahead of Senate Majority Leader Mitch McConnell’s plans to vote next week on a new bill to dismantle the health law, the Democratic grass roots is on what one leading activist called “full war footing.” (Schor, 9/20)

The Washington Post Fact Checker: Sen. Cassidy’s Rebuttal To Jimmy Kimmel: ‘More People Will Have Coverage’
Late-night host Jimmy Kimmel attacked Cassidy over the health-care repeal plan crafted by Cassidy and Sens. Lindsey O. Graham (R-S.C.),  Dean Heller (R-Nev.) and Ron Johnson (R-Wis.) as a last-ditch effort to replace the Affordable Care Act. Kimmel asserted, among other things, that the proposed law “will kick about 30 million Americans off insurance. ”Firing back, Cassidy flatly stated that “more people will have coverage … There are more people who will be covered through this bill than under the status quo.” (Kessler, 9/21)

The Washington Post: Republicans Tweak Sanders Over Health Care, But Cassidy-Graham Could Open A Path For His Bill
One short week ago, 16 Senate Democrats and dozens of progressive groups rallied with Sen. Bernie Sanders (I-Vt.) to celebrate the release of his Universal Medicare for All bill — a moonshot that they hoped would reset the national conversation on health care. Sen. Lindsey O. Graham (R-S.C.) sounded downright giddy. His own legislation to curtail the Affordable Care Act, and block grant Medicaid, was released just a few hours before Sanders’s, to a smaller but just as skeptical group of reporters. (Weigel, 9/20)

The Associated Press: Obama: GOP’s Efforts To Repeal Health Care ‘Aggravating’
Former President Barack Obama on Wednesday called repeated Republican efforts to repeal his signature health care law “aggravating” as he urged people not to be discouraged by unsteady progress as they work on pressing global issues. Speaking at a summit hosted by billionaires Bill and Melinda Gates to coincide with the United Nations General Assembly, the Democrat said the real problems facing the world “can’t discourage any of us from the belief that individually and collectively, we can make a difference.” (Hajela, 9/20)

The Washington Post: Obama Says Repealing The ACA Would Inflict ‘Real Human Suffering’ On Americans
“It wasn’t perfect, but it was better,” the former president said of the ACA. “And so when I see people trying to undo that hard-won progress, for the 50th or 60th time, with bills that would raise costs or reduce coverage, or roll back protections for older Americans, people with preexisting conditions, the cancer survivor, the expectant mom, or the child with autism, or asthma, for whom coverage will once again will be unattainable, it is aggravating.” (Eilperin, 9/20)

Politico: Obama Calls Constant GOP Efforts To Repeal Obamacare ‘Aggravating’
Sen. Lindsey Graham of South Carolina, one of the Republicans pushing the latest effort to undo Obamacare, said after Obama’s speech that it would be “unrealistic” to expect the former president to acknowledge problems with his namesake law. “It’s no surprise President Obama opposes sending money and power back to the states and closer to where the patients live,” Graham said in a statement. “Obamacare was designed with the exact opposite goal in mind — which is to consolidate health care power and decision-making in Washington.” (Dovere, 9/20)

The Wall Street Journal: States Back Big Insurance Increases Amid Health Law’s Uncertainty
Many state regulators are approving sharp rate increases for Affordable Care Act insurance plans that will be sold next year, as they are forced to make decisions despite the latest uncertainty about the law’s future. The 2018 premiums for ACA plans are supposed to be locked in Wednesday, under a federal deadline, at the same time that Republicans in the Senate are moving toward a potential vote next week on legislation that would scrap most of the health law. (Wilde Mathews, 9/20)

The Wall Street Journal: Health-Law Repeal Push Could Jeopardize Children’s Program Funding
The 11th-hour push to dismantle major portions of the Affordable Care Act by the end of the month is imperiling funding for several popular bipartisan health programs that are set to expire Sept. 30. The top Republican and Democrat on the Senate Finance Committee brokered a deal last week to reauthorize funding for the Children’s Health Insurance Program, or CHIP, for five years, just as the program’s funding is set to phase out. (Hackman, 9/20)

The New York Times: Spokeswoman Cites ‘Demanding Schedule’ For Health Secretary’s Use Of Private Jets
Tom Price, the health and human services secretary, spent tens of thousands of taxpayer dollars to fly on private jets to attend routine public events instead of taking cheaper commercial airliners because he has an “incredibly demanding schedule,” his spokeswoman said Wednesday. Mr. Price, a physician and former Republican congressman from Georgia, chartered five work-related flights last week alone. In all, the private flights cost the federal government as much as $60,000, according to a report by Politico, citing internal department documents. (Thrush, 9/20)

The Wall Street Journal: HHS Defends Tom Price’s Use Of Private Jets
Politico reported late Tuesday on five recent trips taken by Dr. Price on charter flights estimated in the report to have cost tens of thousands of dollars apiece. These trips occurred in situations where driving, passenger rail or commercial flights were all viable options, according to the report. “The Trump administration treats taxpayer dollars like they are frequent-flier miles, while they try to take health care away from millions,” the Democratic National Committee said Wednesday. “These funds could be used to make health care more affordable and accessible, to help fund Medicaid, combat the opioid epidemic or increase ACA enrollment.” (Radnofsky, 9/20)

The Hill: Top Dem Asks Watchdog To Look Into Price Private Jet Travel
A top House Democrat is asking the inspector general of Health and Human Services (HHS) to look into a report that the head of the department took private jets to travel for official business. Rep. Frank Pallone Jr. (N.J.), the top Democrat on the House Energy and Commerce Committee, released a statement Wednesday saying he would ask the HHS inspector general for a “full accounting” of Secretary Tom Price’s travel. (Sullivan, 9/20)

The Associated Press: Florida Suspends License Of Nursing Home Over Irma Deaths
Florida officials have suspended the license of a nursing home that had nine patients die after Hurricane Irma knocked out its air conditioning. The Agency for Health Care Administration said Wednesday that it suspended the license of the Rehabilitation Center at Hollywood Hills. The agency previously banned the facility from admitting new patients and from receiving Medicaid. The home filed a lawsuit trying to block those orders. (9/20)

The Wall Street Journal: Florida Suspends License Of Nursing Home Tied To Eight Deaths
The latest order comes a day after the Rehabilitation Center at Hollywood Hills filed a lawsuit against the state to block two previous orders, both of which effectively shut down the home, claiming the orders weren’t justified. Under direction from Gov. Rick Scott, the state has taken several steps to stop operations at the Hollywood, Fla., facility following the deaths last week. The nursing home’s residents “did not receive timely medical care because the trained medical professionals at the facility overwhelmingly delayed calling 911,” Florida’s Agency for Health Care Administration said, citing initial findings from an ongoing investigation. (Evans and Kamp, 9/20)

Stat: Mobile Dialysis Could Save Lives In A Disaster. But Is There A Cost To Safety?
The calls started coming in the days after Hurricane Sandy. Flooded dialysis centers had shuttered across New York and New Jersey. Some patients and practitioners didn’t know where to turn. So they dialed Anita Chambers. “It was difficult to hear stories of patients being driven four to eight hours to find a center that could take them,” Chambers, said recalling the 2012 superstorm. “There were centers open that had all the patients in the day — seeing these patients in the middle of the night.” (Blau, 9/21)

The Washington Post: Pfizer Sues Johnson & Johnson, Alleging Anticompetitive Practices To Maintain A Drug Monopoly
A legal brawl between two of the world’s largest drug companies could shape the future of a nascent market of copycat drugs that are intended to bring down the cost of the most advanced and expensive medicines. Pfizer filed a lawsuit Wednesday against fellow pharmaceutical giant Johnson & Johnson for using “anticompetitive” tactics to quash its cheaper version of a powerful rheumatoid arthritis drug. Johnson & Johnson issued a statement saying the lawsuit had no merit. (Johnson, 9/20)

The Wall Street Journal: Pfizer Alleges J&J Thwarted Competition To Remicade, In Legal Test Of Biotech-Drug Copies
The complaint, filed Wednesday in U.S. District Court in Philadelphia, says J&J’s “exclusionary contracts” for Remicade with health insurers, hospitals and clinics effectively prevented them from offering Pfizer’s lower-priced copy so they could retain rebates and other J&J perks. The lawsuit is the first antitrust action to surface amid the emergence of biosimilars, which are copies of popular biotech drugs, after years of litigation over patents and timing of launches. Pfizer’s Inflectra is the biosimilar of Remicade. (Rockoff, 9/20)

Stat: Advocacy Groups Get Some, But Not All, Trial Data On Gilead Hepatitis C Drugs
File this under, “Half a loaf.” After a two-year battle, a pair of public health advocacy groups obtained sought-after clinical trial data from regulators for two hepatitis C treatments sold by Gilead Sciences (GILD). But they failed to gain access to the most coveted information that would allow researchers to independently verify test results which were originally generated by the company. (Silverman, 9/20)

Stat: Pfizer Accuses J&J Of Illegally Stifling Coverage For Its Biosimilar
The move comes nearly a year after Pfizer launched its drug amid speculation that a price war with J&J would ensue, since prevailing wisdom says a lower price is needed to gain market share. But despite initially pricing Inflectra at a 15 percent discount to the $31,500 list price for Remicade, the drug generated just $172 million in sales during the first six months of this year. By contrast, Remicade notched $3.2 billion in global sales – and $1 billion in U.S. sales – during that time. (Silverman, 9/20)

The Associated Press: Lawsuit Challenges Law That Only Doctors Perform Abortions
The American Civil Liberties Union and Planned Parenthood filed a federal lawsuit Wednesday that challenges a Maine restriction common across most of the U.S. that abortions be performed solely by physicians. The two groups were joined by four nurses and abortion provider Maine Family Planning in challenging the law that prevents advanced practice registered nurses, such as nurse practitioners and nurse midwives, from performing the procedure. (9/20)

Stat: As A Scientist, He Studied Trauma Victims. Then He Became One
Dr. Dennis Charney stepped forward to address the court here, the man who tried to kill him standing no more than 20 feet away. He stated his full name for the record and then began detailing what happened. How one morning as he picked up his iced coffee and lightly buttered bagel, he heard a shotgun boom and saw blood pouring from his shoulder and chest. How he spent five days in the intensive care unit and then was scared to sleep with the lights off. How even now, a year later, he carried buckshot in his body. (Joseph, 9/21)

The Washington Post: Could ADHD Be A Type Of Sleep Disorder? That Would Fundamentally Change How We Treat It.
Over the past two decades, U.S. parents and teachers have reported epidemic levels of children with trouble focusing, impulsive behavior and so much energy that they are bouncing off walls. Educators, policymakers and scientists have referred to attention-deficit/hyperactivity disorder, or ADHD, as a national crisis and have spent billions of dollars looking into its cause. They’ve looked at genetics, brain development, exposure to lead, the push for early academics, and many other factors. But what if the answer to at least some cases of ADHD is more obvious? (Cha, 9/20)

NPR: Embryo Editing Yields DNA Clues To Early Human Development
For the first time, scientists have edited the DNA in human embryos to make a fundamental discovery about the earliest days of human development. By modifying a key gene in very early-stage embryos, the researchers demonstrated that a gene plays a crucial role in making sure embryos develop normally, the scientists say. (Stein, 9/20)

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

Caregivers Draw Support By Mapping Their Relationships

DENVER — Every time Jacque Pearson tried to devise a plan to move her 81-year-old dad, who has Alzheimer’s, from his home in Boise, Idaho, to hers in Denver, she felt stuck. Then, two weeks ago, she had a breakthrough.

It happened at an AARP-sponsored session in which Pearson created a “CareMap” — a hand-drawn picture showing all the people she cares for as well as the people surrounding those individuals and her own sources of support.

On one side of the paper, Pearson sketched out her father’s situation. There were three friends from Alcoholics Anonymous and his longtime doctor — the people he relies on most. There were three sisters and two sons in Arizona, not very involved. And there she was, the primary caregiver, far, far away.

As she peered at the drawing later that evening, Pearson saw what she had to do. “I’m going to contact each of his Alcoholics Anonymous friends and his doctor and ask them to convince my father to come to Colorado,” she told me when I called a week later.

How could a quick sketch of stick figures (representing the people in her father’s life), triangles (representing his medical providers), arrows (representing relationships between people) and box-like houses (where she and her father live) have this kind of impact?

Judith GrahamNAVIGATING AGING

CareMaps are an intriguing new tool created by the Atlas of Caregiving, an ambitious project that hopes to gather comprehensive data about family caregivers. The project’s pilot study examined 14 families in the San Francisco Bay Area who wore miniature cameras and sensors, kept a log of their activities and participated in extensive in-person interviews.

One of the goals was to understand what Rajiv Mehta, the project’s founder, calls the “ecosystem of family caregiving, the relationships that surround caregivers and that shape their experiences.”

One family caregiver might be at odds with her siblings but have a close group of friends she can turn to for emotional support as she cares for a disabled husband, for example. Another might be divorced but have a son living at home who can help with practical responsibilities as he cares for his mother with Parkinson’s disease, who moved in a year ago. Yet another couple in their 60s, both struggling with serious illness, may rely primarily on their three children, all living nearby, but have few friends.

How could these webs of relationships — people who are caring for each other and who are cared for, in turn, by others — be portrayed? Interviewers started drawing them quickly as family members were speaking. Symbols were assigned to people, pets, health care professionals, facilities and households.

Over time, refinements were added. Bidirectional arrows, for example, could show support flowing between people in both directions and the amount of assistance being provided (multiple times a day, daily, weekly or occasionally). Instructions for drawing CareMaps — anyone can give it a try — are available on the Atlas of Caregiving website.

At conferences, Mehta displayed some CareMaps and was surprised by the interest they generated. Somehow, seeing these pictures helped social workers, psychologists and other professionals understand what caregivers were experiencing in a different way.

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In California, the Santa Barbara Foundation launched a series of caregiving workshops last year, using the CareMaps tool. Carol Levine, who directs the United Hospital Fund’s Families and Health Care Project and advises the Atlas of Caregiving, attended some of those sessions and was struck by how many participants seemed to have “aha moments.”

“There’s something visceral about making these pictures — it seems to open people’s vision to a broader view of what they were doing as caregivers,” she said.

Phylene Wiggins, director of the community caregiving initiative at the Santa Barbara Foundation, recalled leading a group at one of the workshops. “After people drew their CareMaps, we started going around the table and talking about their maps, and it was so heartbreaking,” she remembered. “One by one, each caregiver said ‘I am so alone.’ ‘I am so alone.’ ‘I am so alone.’” Encouraging those kinds of conversations and discovering ways to address that social isolation are among the foundation’s priorities, she said.

Cynthia McNulty, a social worker at Family Service Agency in Santa Barbara County, said her agency is using CareMaps in individual and group counseling sessions as a conversation opener. “Many of the people we work with, especially Latinos, don’t even acknowledge themselves as caregivers,” she said. “This is a useful way to shed light on the responsibilities they’ve taken on and needs that might not be met.”

“There’s no stigma attached: You’re just drawing a picture, not complaining,” she said.

AARP is testing CareMaps in six cities this year — Charleston, S.C.; Denver; Houston; Los Angeles; Phoenix; and Tulsa, Okla. It may roll out workshops more widely next year, depending on feedback. And the Atlas of Caregiving is preparing a web-based version, set to debut by year‘s end or early next year, Mehta confirmed.

In Denver, Alice Jordan, 69, is the primary caregiver for her partner, Vickie, 64, who has multiple sclerosis. When she drew her CareMap recently, Jordan saw that almost nobody was supporting Vickie other than her brother Bob, the only one of four siblings who checks in to see how she’s doing.

“MS isn’t a warm-and-fuzzy type of illness,” Jordan said, when I contacted her after attending one of the AARP sessions. “I’m going to call Bob and tell him how much we both appreciate him.”

For her part, Jordan initially felt that the circle of people who care for her would be empty. “When we started doing the diagram, it was like, ‘Bloody hell, I don’t have anybody,’” she said. But she found herself drawing Steve, a neighbor, who helps out when she goes out of town; Mary, a former colleague whom she walks with once a week; Onna, one of her sons whom she has lunch with regularly; Irene, a friend with Parkinson’s disease who’s always ready to talk; and her church, a source of comfort and connection.

“It made me realize I had more support than I thought,” Jordan said. And for that, she added, she’s very grateful.

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

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation and coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.

Categories: Aging, Navigating Aging

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Open Your Mouth And Say Goo-Goo: Dentists Treating Ever-Younger Patients

Allen Barron scrunches up his tiny face and wails as his mother gently tips him backward onto the lap of Jean Calvo, a pediatric dental resident at the University of California-San Francisco.

Allen’s crying may be distressing, but his wide-open mouth allows Calvo to begin the exam. She counts his baby teeth and checks for dental decay.

“Nothing I am going to do will hurt him,” Calvo tells Allen’s mother, Maritza Barron, who is holding her son’s hands.

To some, the 20-month-old toddler may seem far too young for a dental exam. In fact, he’s on the late side, according to leading dental and pediatric professional associations.

To stave off a lifetime of dental problems and make sure parents learn how to prevent children’s tooth decay, babies should have their first exam when they get their first tooth, or no later than their 1st birthday, according to guidelines from the American Academy of Pediatric Dentistry.

However, many dentists are uncomfortable treating babies, and that has created a significant gap in dental care for infants and toddlers of all backgrounds, experts say. The shortfall is hard to quantify because professional organizations, such as the American Dental Association, do not survey their members on whether they care for infants.

“People think that children are afraid of dentists, but really it’s that dentists are afraid of children,” said Pamela Alston, who is a dentist and dental director of the Oakland-based Eastmont Wellness Center, a publicly funded clinic that is part of the county-run Alameda Health System.

Hoping to narrow the gap in care, the public health agencies of San Francisco and Alameda counties are launching pilot programs to train dentists to treat babies. About 70 dentists will learn over the next three years how to coax infants into cooperating and help parents guard against tooth decay. The first training session in Alameda County is scheduled for early November; San Francisco will begin its training in January. The American Dental Association was not aware of any similar programs in other states.

The guidelines calling for earlier dental visits stemmed from a growing awareness that cavity-causing bacteria can be passed from parents to babies, through shared utensils, for example. Giving babies bottles of fruit juice or sugar water also can cause cavities. Decay in baby teeth has been linked to adult tooth decay.

“By the time children are age 3, they are often so far down the road that prevention is no longer an option,” said Ray Stewart, a pediatric dental professor at UCSF, who has treated infants for more than 15 years and is among the professionals enlisted by Alameda and San Francisco to train the dentists.

Communicating directly with children during dental exams can help reduce their stress, Stewart says. (Robert Durell for Kaiser Health News)

Dentists don’t regard exams of very young children as a means of boosting their income, said Alicia Malaby, spokeswoman for the California Dental Association. “Denti-Cal reimbursements are below actual costs for many procedures,” she said. Rather, they want to help “improve community health outcomes.”

Low-income children, who are more at risk of dental decay and have less access to care than their affluent peers, present the greatest need for early oral exams, dental professionals say.

A portion of the revenue from California’s new tobacco tax will be earmarked to help very young children from low-income families get the dental care they need. The money will be used to give dentists a 40 percent increase on top of the standard reimbursement for services to Denti-Cal patients, including oral exams of children age 3 and under. Denti-Cal provides dental care to beneficiaries of Medi-Cal, California’s version of Medicaid.

Alameda County will offer dentists an extra $20, on top of that statewide increase for appointments with Denti-Cal-covered children that include a thorough exam of the baby’s mouth, a fluoride varnish if needed, a talk with parents about prevention and a demonstration of how to brush their baby’s teeth.

The Alameda and San Francisco training programs, funded by grants from Medi-Cal, could be replicated throughout California if they are successful, according to the Department of Health Care Services.

Maritza Barron came to UCSF after her own dentist — despite the best of intentions — was unable to examine her baby’s mouth. “He tried to say ‘open up’ to him but he wouldn’t do it,” Barron said of the failed attempt, which left her son in tears.

Alston, the Oakland dentist, once faced similar challenges treating very young children, but she has since undergone a transformation. She blames dentists’ wariness of young patients on a lack of experience. When she graduated from dental school in 1982, she said, she had no training that prepared her to work with children younger than 6.

“I didn’t feel like I could manage their behavior,” Alston said.

Over time, however, it became increasingly clear to her that she wasn’t seeing children early enough.

Almost all of the kids who came to her for their first dental visit at age 6 had mouths riddled with tooth decay, Alston said. She had to refer them to specialists for treatment that required sedation. She kept lowering the minimum age for a first visit in her practice, then left it at age 3 for a long time.

But even 3-year-olds were coming in with cavities. Ultimately, she learned how to treat infants and toddlers through a program run by Alameda County’s public health department — not unlike the training to be offered by the new pilot programs.

Today, Alston is passionate about treating very young children and has lined up pediatricians to refer infants to her. And she has revised her guidance on when kids should get their first oral exam, advising parents to bring their children in when their first tooth starts to erupt.

People think that children are afraid of dentists, but really it’s that dentists are afraid of children.

Pamela Alston, Eastmont Wellness Center

She also trains dental students to examine infants. An important trick she teaches them is how to avoid being bitten: “Put your finger behind the last tooth!”

Communicating directly with children during dental exams can help reduce their stress, saod both Alston and Stewart, the UCSF dental professor.

At a recent visit to UCSF’s Pediatric Dentistry Faculty Clinic, 18-month-old Sebastian King scrutinized the dental mirror Stewart handed to him.

“That’s what I’m going to put in your mouth to look at your teeth!” Stewart told him exuberantly.

He asked the young boy to show him where his mouth was. Sebastian smiled with delight as Stewart handed him a blue exam glove he’d blown up into a balloon, and the young boy remained calm throughout the exam.

Helping parents understand their role is also critical, dentists say.

In addition to advising parents not to share eating utensils with their children, Stewart urges them not to let their kids fall asleep with a bottle of milk and to limit their consumption of fruit juice. He also says they should wipe their infants’ gums and teeth with a cloth after feeding them to remove residue that can cause cavities.

That’s the message Calvo, the dental resident, gave to Barron, whose baby sat happily on his mother’s lap after his exam. The boy had cavities because he had been falling asleep with his bottle.

Barron said she recognized that weaning Allen from the bottle at night would be a challenge.

But “it’s really logical,” she told Calvo, adding that she was determined to give it a try.

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

KHN’s coverage of children’s health care issues is supported in part by a grant from The Heising-Simons Foundation.

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Podcast: ‘What The Health?’ Zombie Repeal-And-Replace Bill Rises Again

Republican efforts to “repeal and replace” the Affordable Care Act are back, in a big way. And the “What the Health” podcast is focused on Capitol Hill’s debate on the bill by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.):

  • The impact of shifting billions in federal funding to states.
  • Sizing up the implications for the four wavering Republican senators.
  • The demise of bipartisan attempts to fix Obamacare.
  • And does the measure pass the Jimmy Kimmel test?

The White House and Congressional Republican leaders are lining up behind the Graham-Cassidy bill that in many ways would even more broadly remake the nation’s health system than the proposals that failed to pass in July.

It is still far from certain the Senate can muster the 50 votes necessary before a Sept. 30 budget deadline, which ends their ability to pass such sweeping legislation with a simple majority. But the push is on.

Meanwhile, the unexpected effort to repeal Obamacare has pushed to the backburner two other key health issues with late September deadlines.

Republicans and Democrats at the Health, Education, Labor, and Pensions Committee have – for now – abandoned plans for a bipartisan bill to stabilize the individual health insurance market. Health insurers must make final decisions about whether to participate in Affordable Care Act by Sept. 27. And Congress seems likely to let the Children’s Health Insurance Program expire on Sept. 30, at least temporarily.

In this week’s episode of “What the Health?” Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, and Margot Sanger-Katz of the New York Times discuss all these issues. Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner: Politico’s “Prices’s private-jet travel breaks precedent,” by Dan Diamond and Rachana Pradhan.

Joanne Kenen: HuffPost’s “The Week My Husband Left And My House Was Burgled I Secured A Grant To Begin The Project That Became BRCA1,” by Mary-Claire King.

Margot Sanger-Katz: Stat News’ “Every time it’s a battle: In excruciating pain, sickle cell patients are shunted aside,” by Sharon Begley.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

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

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Viewpoints: Returning To Work After A Psychotic Break; The Fiscal Responsibility Of Legalizing Weed

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

The New York Times: The ‘Madman’ Is Back In The Building
For my first day back to work I dressed in a sober navy sweater and a pair of dark slacks. Normal haircut, neatly trimmed beard. I got there early to avoid the morning rush and the inevitable stares and whispers. I had been “away with some issues” — that was the official company line, but offices are gossip hotbeds, and I wondered how much of the real story had filtered through. Did they know that I’d marched through the city for 12 hours — manic, psychotic and convinced I was being videotaped by secret TV producers, the star of my own reality show? That the police had found me later that evening shirtless, barefoot and crying on a subway platform? That I’d been involuntarily committed to Bellevue, the notorious psych ward to which we at Legal Aid routinely sent our most mentally ill clients? (Zack McDermott, 9/20)

Bloomberg: Marijuana Sales Can Make U.S. Tribes Richer And Poorer
“This is going to be bigger than bingo,” James Billie told CNN over the summer. A former chief of the Seminole, whose company MCW gives financing and legal counsel to American Indian tribes to help them grow and sell marijuana on their land, Billie could barely contain his excitement about this new venture. (Naomi Schaefer Riley, 9/19)

Louisville Courier-Journal: Repeat After Me: Yes. We. Cannabis.
Let me be blunt: I used to smoke weed. I have notebooks filled with very profound and original observations about the interconnectedness of all beings to prove it. But, I haven’t burned one down for more than a decade. So, when I suggest that Kentucky legalize recreational marijuana, it’s not because I have a toke in this fight. Instead, Kentucky lawmakers should stop puffing and start passing legislation to legalize weed for two reasons: It’s the right thing to do, and it’s the fiscally responsible thing to do. (Ben Carter, 9/19)

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

Policy Points: Looking For Innovation In Medicare And Medicaid; Health Care In Japan

Editorial pages feature an announcement by the head of the Centers for Medicare & Medicaid Services on Trump administration plans, one suggestion for covering more Americans and a look at how Japan handles health care.

The Wall Street Journal: Medicare And Medicaid Need Innovation
More than 130 million Americans are enrolled in Medicare and Medicaid. America’s elderly and most vulnerable citizens depend on these programs. But both face fiscal crises. … The Centers for Medicare and Medicaid Services has a powerful tool for improving quality and reducing costs: the Center for Medicare and Medicaid Innovation. … This administration plans to lead the Innovation Center in a new direction. On Wednesday we are issuing a “request for information” to collect ideas on the path forward. (Seema Verma, 9/19)

New Haven (Conn.) Register: ‘Medicare For All’ Could Be Cheaper Than You Think
Sanders’s plan would come at a steep price: likely more than US$14 trillion over the first decade, based on an estimate I did of a previous version. There is, however, a simpler and less costly path toward single-payer, and it may have a better chance of success: Simply strike the words “who are age 65 or over” from the 1965 amendments to the Social Security Act that created Medicare and, voila, everyone (who wants) would be covered by the existing Medicare program. While this wouldn’t be single-payer – in which the government covers all health care costs – and private insurers would continue to operate alongside Medicare, it would be a substantial improvement over the current system. (Gerald Friedman, 9/20)

Bloomberg: Want A Better Health Care System? Check Out Japan
Senator Bernie Sanders’s new health care plan, called “Medicare for All,” would eliminate private health insurance and have the government pay for 100 percent of all health services. It’s not going to happen, but it does point the way toward a system that could work better: A public-private hybrid akin to what Japan has. (Noah Smith, 9/19)

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

Thoughts On Graham-Cassidy: ‘Bad Idea’; ‘Shoddiest’ Repeal Idea Yet; ‘Ideological Crusade’

Opinion writers offer dim views of the current measure being advanced by Senate Republicans to undo the Affordable Care Act.

The Washington Post: Another Execrable Health-Care Bill Proves Bad Ideas Never Die
Over the next week and a half, Republican senators may try one last time to repeal and replace Obamacare. The latest bill, from Sens. Bill Cassidy (La.), Lindsey O. Graham (S.C.), Dean Heller (Nev.) and Ron Johnson (Wis.), is about as execrable as the others that GOP lawmakers previously failed to approve. The process by which Republicans would pass it would be as sloppy and partisan as the one to which senators such as John McCain (R-Ariz.) objected earlier in the summer. The outcome would be no less destructive. The big difference now is the clock; the procedural window for passing a health-care bill along straight party lines will disappear at the end of the month, spurring Republicans to try one last time. That is a sad excuse to rush through — without even an attempt at bipartisanship and without a complete Congressional Budget Office assessment — a half-baked bill that would harm millions. (9/19)

Bloomberg: The Latest Obamacare Repeal Is The Shoddiest Yet
The new version, sponsored by Senators Lindsey Graham of South Carolina and Bill Cassidy from Louisiana, would do a number of things to a health care system that millions rely upon. A main selling point is giving states additional ability to act on their own — which means that virtually all of the popular protections of the Affordable Care Act, including on pre-existing protections, would be at risk — and also slashing health care funding. What exactly would it do? It’s not much clearer than that now and won’t get much clearer until next month. The Congressional Budget Office has announced they “will not be able to provide point estimates of the effects on the deficit, health insurance coverage, or premiums for at least several weeks.” (Jonathan Bernstein, 9/19)

USA Today: Obamacare Repeal Is An Ideological Crusade Past Its Sell-By Date. Give It Up, GOP
Just when Democrats thought it was safe to either stop paying attention or go full Don Quixote on Medicare For All, Obamacare repeal is back. When an entire political party has campaigned and won for seven years on getting rid of a law that was about as popular as President Trump (as in not very), it’s hard to move on. We get that. And who would have thought the country would change its collective mind, just when Republicans won control of the whole government? (Jill Lawrence, 9/19)

Bloomberg: Graham-Cassidy Is Already Hurting Health Care 
This last-gasp bill — called Graham-Cassidy after the senators leading it — would be extremely disruptive to hospitals and government-focused insurers. The proposal ends individual and employer insurance mandates, gives states a big chunk of money and then largely leaves them to run their own health-care markets. It would likely lead to large cuts to Medicaid, destabilize the individual insurance market, and significantly reduce insurance coverage. (Max Nisen, 9/19)

The Washington Post: The Graham-Cassidy Health-Care Bill Puts Millions Of Americans At Risk
The Senate is on the verge of launching a dangerous experiment. Having failed for months to repeal and replace the Affordable Care Act, Republicans hope to dump onto the states the problem of providing low- and moderate-income Americans with access to health care. So long as they are determined to push forward without meaningful Democratic input, they have until Sept. 30 to act under Senate rules. The Graham-Cassidy bill — their last chance to meet this deadline — would simply hand the states block grants and abandon to them millions of Americans whom the ACA now helps. (Timothy Jost, 9/19)

Los Angeles Times: Repeal And Replace Is Back, And Scarier Than Ever
Like the villain in a slasher movie, Senate Republicans keep coming for the health insurance of tens of millions of Americans. After Sen. John McCain’s dramatic “no” vote seemed to finish off this year’s attempts to repeal the Affordable Care Act, a proposal by two senators with mostly unearned reputations for moderation — Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) — represents the latest threat to the many people who gained access to healthcare under President Obama. The scariest part is that it might just pass. (Scott Lemieux, 9/19)

St. Louis Post-Dispatch: Last-Ditch Graham-Cassidy Health Care Bill Is The Worst One Yet
Under cover of a fog of news, Senate Republicans have been trying to round up enough votes for yet another bid to repeal and replace the Affordable Care Act. The bill they have in mind is in many ways worse than any of the three bills that failed this summer. After a dramatic thumbs-down “no” vote by Sen. John McCain, R-Ariz., killed the GOP’s third ACA replacement bill, Senate Majority Leader Mitch McConnell, R-Ky., said it was time to move on. Congress went into recess until after Labor Day, and the nation’s attention turned to hurricanes, immigration, budget matters and rapprochement between President Donald Trump and Democrats. (9/19)

The New York Times: John McCain Faces A New Test Of His Principles
It looks as if John McCain’s Senate colleagues are going to test him once again. And the health insurance of millions of Americans depends on the outcome. This summer, when his party was trying to force a health bill with unprecedented haste — no hearings, no support from medical experts — McCain stood up for the idea of the Senate. By now, you’ve probably heard a line or two from his July 25 speech, shortly after learning he had aggressive brain cancer. But the full speech is worth reading. It’s McCain at his best, a defense of the imperfect but noble pursuit of democratic politics. (David Leonhardt, 9/19)

Roll Call: The Fatal Flaw For Republicans In Graham-Cassidy
The Republicans’ latest drive to repeal Obamacare is reminiscent of a poetry fragment from Tennyson’s “The Charge of the Light Brigade”: “Theirs not to make reply, theirs not to reason why.” Whatever happens with the bill likely slated to reach the Senate floor next week, it is hard to escape the feeling that this wild charge will end badly for the Republicans. (Walter Shapiro, 9/20)

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Perspectives: Drugmakers Love To Hide Behind R&D Costs. Are They Justified?

Read recent commentaries about drug-cost issues.

Bloomberg: Pharma Keeps Ignoring Its Price Problem
Want to get pharma companies up in arms? Tell them it doesn’t cost that much to get a cancer drug to market.A widely reported paper published Monday in the Journal of the American Medical Association did exactly that, claiming that the median cost of developing a cancer drug was $648 million for a set of 10 companies. A recent industry-sponsored study puts the number closer to $3 billion. (Max Nisen, 9/14)

Stat: This Pharma CEO Promised Fair Pricing, But His Latest Move Is Raising Ire
One year ago, Brent Saunders tried to single-handedly reset the national debate over drug pricing. The Allergan chief executive issued a “social contract” and vowed to keep price hikes below 10 percent a year. He argued that drug makers could — and should — act responsibly amid smoldering criticism over prices. Few companies followed suit, but Saunders won a high profile for his efforts. Now, though, an ingenious deal he struck to protect Allergan’s patents on a lucrative drug calls into question his campaign to do right by the American public. In short, the social contract may be headed for the trash bin. (Ed Silverman, 9/19)

Bloomberg: So Much PARP Inhibitor Deal Hype, So Little Payoff
We’re more than a year into a frenzy of M&A speculation about a new group of cancer drugs called PARP inhibitors, and there’s been no big buyout payoff. But investors aren’t jaded yet. An unverified rumor that Eli Lilly & Co. is considering buying PARP competitor Clovis Oncology Inc. was enough to send the purported target’s shares up 10 percent on Monday. (Max Nisen, 9/18)

The Columbus Dispatch: Drug-Price Issue Risky, Speculative
Many elections, voters are left with the choice of having to cross their fingers or hold their nose. If Issue 2 passes in November, Ohioans would be doing both. The highly confusing Ohio Drug Price Relief Act boils down to this: Ohioans would be stuck with an unworkable ballot-initiated law that, given its faulty premise, won’t produce the fantastical savings promised. Likely, the legislature would struggle with repairing the law to stanch damage to critical social programs; politicians generally are reluctant to tamper with a vote of the people. (9/18)

Bloomberg: Biotech Gets More Forgiving, But Riskier
More than just about any other sector, biotech demands faith from its investors. Right now, belief appears to be strong. Faced with a string of worrying news from prominent biotechs in the past two weeks, investors have largely been willing to give the benefit of the doubt. That’s a big shift from 2016, when any weakness was immediate cause for a huge selloff. (Max Nisen, 9/13)

Bloomberg: Allergan Patent Deal Isn’t Just Unusual. It’s Ugly.
Late last year, at a Forbes magazine health-care conference, I heard Brent Saunders, the chief executive of Allergan PLC, talk about drug prices. He said the drug industry’s reliance on big price increases to generate profits had gotten out of hand. He vowed that Allergan wouldn’t raise prices more than 10 percent a year, and described a patient assistance program that would ensure no one would lack an Allergan medicine because of cost. … you know the old saying: Watch what they do, not what they say. Late Friday afternoon, Saunders and Allergan showed their true colors: The company announced that it would transfer the patent rights to one of its most important drugs, the eye medication Restasis, to the Saint Regis Mohawk Tribe. (Joe Nocera, 9/11)

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This Caustic Crusader With A Knack For Making Enemies Has Especially Harsh Words For Pharma

News outlets report on stories related to pharmaceutical pricing.

Stat: Armed With Data, And Twitter, This Doc Takes On The Medical Establishment
Dr. Vinay Prasad is a professional scold: He takes to Twitter each day to critique this cancer drug as ineffective, or blast that one as overpriced, or dismiss the clinical trial of another as completely irrelevant. So it’s a bit of a surprise to catch him at the bedside of an elderly man with lymphoma, laughing gently with his patient as he inquires about his day — and painstakingly explains a potent drug’s unpleasant side effects. (Keshavan, 9/15)

Chicago Tribune: Insurers Cutting Back On Drug Coupons Amid Concerns Over Consumer Costs 
With many drug prices rising, consumers often pull out coupons or discount cards from drugmakers to save money when they buy medications at pharmacies. But some insurers, including in Illinois, are limiting how those discounts may be applied amid concerns they’re driving up health care costs for everyone. Curbing the coupons could mean more money out of consumers’ pockets in the short term, but in the long run could also help hold down drug prices and health care costs, say critics of the cards and coupons. (Schencker, 9/14)

Stat: Brand-Name Drug Prices Are Still Rising, Just Not As Fast As Before
Prescription drug prices may be rising, but a new analysis suggests just not as fast as before. Price hikes for brand-name drugs in this year’s second quarter were 7.1 percent. This obviously exceeds inflation and may have crimped some wallets, but this is below the 9.7 percent hikes that occurred in the same period a year earlier, according to SSR Research, which tracks the pharmaceutical industry. (Silverman, 9/19)

Stat: Streamlined FDA Reviews Fail To Catch Harmful Glitches In Health Software
The Food and Drug Administration carefully polices many categories of drugs and devices. But when it comes to software, the agency’s oversight is scanty at best — something that a new study finds is resulting in failure to detect dangerous glitches in software-enabled medical equipment. The study comes amid ongoing debate over the FDA’s role in reviewing the booming number of software-enabled products in health care. (Ross, 9/12)

Reuters: Drug Industry On Tenterhooks As Maryland Price-Gouging Law Nears
As U.S. consumer outrage grows over prescription drug prices, state authorities and patient advocates in Maryland are preparing to enforce the nation’s first law designed to punish drugmaker price-gouging. The state Attorney General’s office said it will field complaints and investigate “unconscionable increases” in essential generic medicines when the closely watched law takes effect Oct. 1. (Beasley, 9/15)

Stat: What It’s Like To Be A Hollywood Director Making An Ad For Pfizer
If Pfizer’s latest ad looks to you like a visual effects-heavy Hollywood film, it’s by design. The beaming couples and natural landscapes typical of pharma ads have been replaced by dreamlike scenes of a giant sailing ship, a launching rocket, and twin-sized beds flapping their wings through the clouds. And no, Pfizer (PFE) wouldn’t disclose the ad’s budget. It’s the handiwork of Hollywood veteran Robert Stromberg, who won Academy Awards for art direction in “Avatar” and “Alice in Wonderland,” and more recently directed the fantasy film “Maleficent.” (Robbins, 9/15)

Bloomberg: FDA Clears Biotech Drug Copycats, But Buying Them Isn’t So Easy 
In 2016, Roche Holding AG sold $3 billion worth of its blockbuster biotechnology drug Avastin. Last week, the U.S. Food and Drug Administration approved what’s expected to be a less-expensive version. Patients and insurers won’t be able to start counting the savings any time soon. Of seven so-called biosimilar drugs the FDA has cleared since the first approval of one of the drugs in 2015, only three are available for sale. The rest are tied up in legal disputes that can block the cheaper versions for years. (Koons, Edney and Decker, 9/18)

Stat: Pricing Wars Flare In Ireland As Government Battles With Two Drug Makers
The latest flare-up over prescription drug pricing is taking place in Ireland, where two drug makers are at war with the government for refusing to provide coverage for a pair of medicines. In one instance, CSL Behring (CSL) announced plans to end a compassionate use program later this month for its Respeeza treatment for people with an inherited form of emphysema. The move had previously been signaled if government coverage was not provided, but was formalized after Ireland’s Health Service Executive last month decided the drug is not cost effective. (Silverman, 9/18)

Cleveland Plain Dealer: Issue 2 Fact Check: Are All Of The VA’s Prices Public Record?
Despite claims from supporters of Issue 2, drug prices from the Department of Veterans Administration are not entirely a matter of public record, according to the department. One of the main arguments over Issue 2, an Ohio initiative on the November ballot seeking to lower the price the state pays for pharmaceuticals to no more than the VA pays, is whether the VA’s pricing is publicly available. (Richardson, 9/18)

Reuters: Doctors Who Take Pharmaceutical Money Use Twitter To Hype Drugs
Some cancer doctors use Twitter to promote drugs manufactured by companies that pay them, but they almost never disclose their conflicts of interest on the social media platform, a new study shows. “This is a big problem,” said senior author Dr. Vinay Prasad, a professor at Oregon Health and Science University in Portland. “Doctors are directly telling patients about their views on drugs, and financial conflict plays a role. But they’re not telling patients they have a conflict.” (Cohen, 9/11)

The New York Times: Why Are Drug Prices So High? We’re Curious, Too
This much is clear: The public is angry about the skyrocketing cost of prescription drugs. Surveys have shown that high drug prices rank near the top of consumers’ health care concerns, and politicians in both parties — including President Trump — have vowed to do something about it. What’s not as clear is exactly why prices have been rising, and who is to blame. (Thomas and Ornstein, 9/17)

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State Highlights: States, Localities Face High Costs For Retiree Health Benefits; Hepatitis A Outbreak Declared In Los Angeles

Media outlets report on news from Illinois, California, the District of Columbia, Delaware, Maryland, Connecticut, Arizona, Ohio, Kansas, Florida, Minnesota, Colorado and Texas.

The Wall Street Journal: States Need $645 Billion To Pay For These Promises, And That’s Not Counting What They Owe In Pensions
When Aurora, Ill., closed its books in December, about $150 million disappeared from the city’s bottom line. The Chicago suburb of 200,000 people hadn’t become poorer. Instead, for the first time it recorded on its balance sheet the full cost of health care promised to public employees once they retire. States and cities around the country will soon book similar losses because of new, widely followed accounting guidelines that apply to most governments starting in fiscal 2018. (Gillers, 9/20)

Los Angeles Times: Health Officials Declare Hepatitis A Outbreak In L.A. County
Los Angeles County health officials declared a hepatitis A outbreak Tuesday, days after a public health emergency was announced in San Diego County, where at least 16 people have died of the highly contagious virus. Case numbers are still small in L.A. County, with only 10 people infected as part of the outbreak, said Dr. Barbara Ferrer, director of the L.A. County Department of Public Health. By comparison, almost 450 people have contracted the virus in San Diego. (Karlamangla, 9/19)

The Washington Post: Poor, Sick And Still Traveling Long Distances For Health Care In D.C.
The District’s poorest residents are still forced to travel far outside their neighborhoods for their health care, according to a report released Tuesday by Mayor Muriel E. Bowser. Less than 25 percent of Medicaid patients living east of the Anacostia River see a primary-care doctor in their Zip code. Despite efforts to expand services in Wards 7 and 8, many still call 911 emergency services for their basic health needs. And residents needing specialty care must commute downtown where most of the medical specialists are clustered. (Itkowitz, 9/19)

The Associated Press: New Delaware Law Will Expand Cancer Treatment Options
Cancer patients in Delaware will soon have more treatment option under legislation being signed by Gov. John Carney. A bill to be signed Wednesday requires health insurers to cover any medically appropriate drug that has been approved by the Food and Drug Administration for the treatment of stage 4 metastatic cancer and other cancers without requiring proof that the patient failed to respond to a different drug or drugs. (9/20)

The Baltimore Sun: Baltimore Health Department Seeks To Double Buprenorphine Treatment 
Baltimore health officials want to double the number of people in the city who can get access to the addiction treatment drug buprenorphine, help they say heroin addicts desperately need. Officials estimate that 25,000 people in the city are addicted to heroin or other opioids. Numbers on how many people are currently getting buprenorphine in Baltimore were not available, but officials said that even doubling the number of patients with access would not close the gap entirely. (Duncan, 9/19)

The Wall Street Journal: Doctor’s Defamation Suit Highlights Online Patient Reviews
A defamation lawsuit filed by an Ohio plastic surgeon that is slated to go to trial early next year could have far-reaching consequences for disputes between doctors and their patients over online reviews about the quality of medical care, according to legal experts. Dr. Bahman Guyuron, former chairman of the department of plastic surgery at Case Western Reserve University School of Medicine, sued Marisa User in 2015 over anonymous reviews she had posted on the cosmetic-surgery website RealSelf and other sites where patients swap information about doctors. (Palazzolo, 9/19)

KCUR: Southeast Kansas County Among Eight U.S. Communities Awarded Culture Of Health Prize 
Residents of Allen County in Kansas are getting some national recognition for their health-improvement efforts. The county is one of eight 2017 winners of the Culture of Health Prize awarded by the Robert Wood Johnson Foundation, the nation’s largest public health philanthropy.  Richard Besser, the foundation’s president and CEO, traveled to Iola, the county seat, to make the announcement in person Tuesday. (Mclean, 9/19)

Health News Florida: Preventing Mosquito Infestations After Irma
With restoration continuing this week after Hurricane Irma, Florida Department of Health officials are warning residents about standing water left by the storm as a thriving environment for mosquitoes. Containers like garden pots, birdbaths, tires and cans, when filled with standing water, can host mosquitoes laying up to 200 eggs. (Riggins, 9/19)

The Star Tribune: St. Paul Considers Restricting Sale Of Menthol Tobacco
The City Council is considering adding menthol, mint and wintergreen-flavored tobacco to the list of products that can only be sold at tobacco shops. The council will hold a public hearing Wednesday night on the proposed change, which is similar to one the Minneapolis City Council approved last month. (Van Berkel, 9/19)

Columbus Dispatch: Legionnaires’ Cases Involving Ohio State Under Investigation
Columbus Public Health is investigating two separate Legionnaires’ disease cases with ties to Ohio State: one a student at the Drackett Tower dormitory and a Columbus resident who is employed at the university’s Newark campus. A statement released by Ohio State University said Columbus Public Health informed them late Tuesday afternoon that they believe there is no connection between the two cases. (Woods, 9/20)

Denver Post: These Services For Developmentally Disabled Residents Have Grown Because Douglas And Araphoe Voters Approved A Tax In 2001 
In the last 15 years, nonprofits and programs serving people with developmental disabilities have multiplied across Douglas and Arapahoe counties. Much of that growth can be traced to 2001, when voters in both counties approved a tax to fund those operations. …Wellspring Community opened in 2009 with a mission to provide work, education and enrichment opportunities to adults with special needs. Today, the growing organization has an art studio in downtown Castle Rock, a fully operational bakery in the Emporium and cooperative work/education programs at four locations around town. (Mitchell, 9/19)

Texas Tribune: For Some Transgender Texans, Bathroom Bill Fight Spurs Bids For Office
Four people in two years are hardly a speck in a state of nearly 28 million, but that number means Texas currently has more transgender candidates than any other state, according to Logan Casey, a Harvard researcher who studies LGBTQ representation in politics. And it’s a disproportionately large group — Texas carries just under 9 percent of the country’s population, but about 14 percent of its current transgender candidates. (Platoff, 9/20)

Chicago Tribune: Centegra Health To Eliminate, Outsource Hundreds Of Jobs
Financially troubled Centegra Health System plans to eliminate 131 jobs and outsource another 230 positions, the northwest suburban hospital system announced Tuesday. The layoffs and outsourcing come amid a time of financial stress for many hospitals nationwide and follow a year of steep losses for Centegra, which has hospitals in McHenry, Woodstock and Huntley. (Schencker, 9/19)

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Health Warnings On Soda Ads Suppresses Free Speech, Judges Rules

A San Francisco ordinance would have required a warning on sodas and sugary beverages, but Ninth U.S. Circuit Court of Appeals Judge Sandra Ikuta writes in the ruling that the label is “not purely factual” and “unduly burdens and chills protected commercial speech.”

The Associated Press: Appeals Court Blocks San Francisco Warning Law For Soda Ads
A federal appeals court on Tuesday blocked a San Francisco law requiring a health warning on soda ads, saying the measure was misleading and would suppress free speech. A unanimous, three-judge panel of the 9th U.S. Circuit Court of Appeals stopped the 2015 ordinance from going into effect until a lawsuit filed by the American Beverage Association and other groups is resolved. (Thanawala, 9/19)

The Wall Street Journal: Appeals Court Blocks San Francisco Law Requiring Soda Health Warnings
The three-judge panel of the Ninth U.S. Circuit Court of Appeals found the ordinance stifles commercial speech and unfairly targets soda over other potentially unhealthy food and drinks. The panel blocked the rule from going into effect. The San Francisco ordinance, passed in 2015, requires advertisements for certain sugar-sweetened drinks to include a disclaimer that says “WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay. This is a message from the City and County of San Francisco.” (Randazzo, 9/19)

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Critics Worried $200M Donation To Calif. University Lends Credence To Trend Of Unproven Therapies

Philanthropists Susan and Henry Samueli just donated a huge sum to UC Irvine, and some are concerned it will lead the institution to focus on alternative therapies that have no basis in science at a time when they’re gaining in popularity. In other public health news: domestic violence, lupus, smoking, and strange health events in Cuba.

Stat: A Huge Gift Boosts Alternative Therapies At A Med School, Sparking Outrage
When billionaires Susan and Henry Samueli this week announced a $200 million donation to the University of California, Irvine to launch a new health program dedicated to integrative medicine, they drew a standing ovation and glowing coverage. But for those who have been watching the steady creep of unproven therapies into mainstream medicine, the announcement didn’t go over quite as well. (McFarling, 9/20)

Los Angeles Times: Domestic Violence Homicide Rate Drops With Stricter Gun Law, Study Finds
When domestic violence offenders are required to relinquish their guns, instead of simply being barred from owning firearms, the risk that those offenders may kill their partners goes down, a new study finds. The paper, described in the Annals of Internal Medicine, highlights a simple method for lowering the risk women face of being killed by an intimate partner: Enforce the laws already in place. (Khan, 9/19)

The New York Times: A Stress Link To Lupus
Psychological trauma is associated with an increased risk for lupus, a new study reports. Lupus is a potentially fatal autoimmune disease that causes inflammation of the skin, joints and internal organs. Its cause is unknown. (Bakalar, 9/20)

The New York Times: The Fatal Toll Of Cheap Cigarettes
A new study suggests that the availability of cheaper, off-brand cigarettes is associated with an increase in infant mortality. Researchers writing in JAMA Pediatrics studied the link between cigarette prices and infant mortality in 23 European countries from 2004 through 2014. During this time, there were more than 53 million live births. (9/19)

The Associated Press: Cuba Again Denies Role In ‘Health Attacks’ On US Diplomats
The Cuban government on Tuesday again denied any involvement in or any knowledge of a mysterious series of health incidents that have affected American diplomats in Havana. … At least 21 members of the American diplomatic community in Havana have suffered from symptoms, including brain damage, believed to have come from some sort of sonic attack since late last year. The most recent incident was in August. (9/19)

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Following 9 Deaths At Florida Nursing Home, Task Force Formed To Push For Reforms

“We now have a chance to fix what went wrong and ensure something like this never happens again,” said one state lawmaker.

Miami Herald: Haunted By Nursing Home Deaths, Task Force Joins Rush To Make Reforms
In a crowded North Miami Beach City Hall chamber, elected officials, first responders and healthcare workers gathered to establish a task force to better regulate senior facilities, in the wake of eight deaths in Hollywood. The task force, started Tuesday, aims to combine efforts to enact national, state and local policies to ensure the safety of those in assisted living facilities in the wake of a disaster. (Ostroff, 9/19)

The Washington Post: Hurricane Aftermath: Death Toll Rises To 9 In South Florida Nursing Home That Overheated
A ninth patient from a South Florida nursing home that overheated during power outages following Hurricane Irma died on Tuesday, according to police. The death of Carlos Canal, the ninth patient, occurred nearly a week after the nursing home in Hollywood, Fla., became the focus of a criminal investigation when the air conditioning failed and eight other patients ultimately died. (Berman, 9/19)

Kaiser Health News: Nursing Home Disaster Plans Often Faulted As ‘Paper Tigers’
It does not take a hurricane to put nursing home residents at risk when disaster strikes. Around the country, facilities have been caught unprepared for far more mundane emergencies than the hurricanes that recently struck Florida and Houston, according to an examination of federal inspection records. Those homes rarely face severe reprimands, records show, even when inspectors identify repeated lapses. (Rau, 9/19)

Miami Herald: Gov. Scott Places Blame For 9 Deaths Directly On Hollywood Nursing Home
Four days after the owners of a Hollywood nursing home released a detailed time line casting blame for the deaths of eight elders on Florida health administrators and a local utility, Gov. Rick Scott’s administration issued a time line of its own — declaring that the Rehabilitation Center at Hollywood Hills “failed to do their basic duty to protect life.” (Marbin Miller and Klas, 9/19)

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N.M. Officials To Brief Lawmakers Today On Plans To Curb Medicaid Spending

Proposals to cut state spending have included requiring enrollees to pay monthly premiums and copayments. In other Medicaid news, a look at Louisiana’s program, a managed care contract controversy in Mississippi and record backlogs in Oregon.

The Associated Press: New Mexico Presses Forward With Medicaid Premiums, Copays
New Mexico is pressing forward with plans to limit increases in state spending on Medicaid health care for low-income and disabled residents by adding monthly premiums and copays from patients, as Senate Republicans in Washington contemplate fundamental changes to Medicaid. State officials will brief lawmakers Wednesday on an array of proposed changes to the state’s Medicaid health care program designed to keep costs down while improving the delivery of health care for New Mexico’s poorest residents. (9/20)

New Orleans Times-Picayune: Medicaid In Louisiana: Who Gets It? How Does It Work?
Medicaid has been at the center of much of the health care and budget debate this year in Washington and Baton Rouge. Here is a primer on the program. … About 74 million people — 1 in 5 five Americans — are enrolled in Medicaid. Louisiana is more dependent, with 1.6 million — about 1 in 3 residents — using the program. (O’Donoghue, 9/19)

Jackson (Miss.) Clarion-Ledger: $2B Medicaid Contract Moving Forward After Contract Review Board Refuses To Vote
Public Service Contract Review Board members took a passive role on the Medicaid managed care debate Tuesday, refusing to take up the matter after their staff recommended they approve the $2 billion contract. The non-vote means the MississippiCAN contract, the subject of much controversy since the Mississippi Division of Medicaid signed it in June, is effective and will move forward, according to the board and Medicaid’s attorney. (Wolfe, 9/19)

East Oregonian: Eliminating Medicaid Backlog Will Cost Oregon At Least $4.3 Million
An intensive effort to shore up Oregon’s Medicaid enrollment records is expected to cost the state at least $4.3 million. Participants in the Oregon Health Plan, Oregon’s Medicaid program, must have their eligibility for the plan verified annually in a process called redetermination. Oregon had fallen behind on those annual redeterminations, and by late May had an estimated backlog of about 115,000 people whose eligibility for the Oregon Health Plan was in question. (Withycombe, 9/19)

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First Edition: September 20, 2017

Sep 20 2017

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

Kaiser Health News: Last-Ditch Effort By Republicans To Replace ACA: 5 Things You Need To Know
Republican efforts in Congress to “repeal and replace” the federal Affordable Care Act are back from the dead. Again. While the chances for this last-ditch measure appear iffy, many GOP senators are rallying around a proposal by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), along with Sens. Dean Heller (R-Nev.) and Ron Johnson (R-Wis.). They are racing the clock to round up the needed 50 votes — and there are 52 Senate Republicans. (Rovner, 9/19)

Kaiser Health News: Nursing Home Disaster Plans Often Faulted As ‘Paper Tigers’
It does not take a hurricane to put nursing home residents at risk when disaster strikes. Around the country, facilities have been caught unprepared for far more mundane emergencies than the hurricanes that recently struck Florida and Houston, according to an examination of federal inspection records. Those homes rarely face severe reprimands, records show, even when inspectors identify repeated lapses. (Rau, 9/19)

Kaiser Health News: In Stark Contrast To ACA Plans, Premiums For Job-Based Coverage Show Modest Rise
Family health insurance premiums rose an average 3 percent this year for people getting coverage through the workplace, the sixth consecutive year of small increases, according to a study released Tuesday. The average total cost of family premiums was $18,764 for 2017, according to a survey of employers by the Kaiser Family Foundation and the Health Research & Educational Trust. That cost is generally divided between the employer and workers. (Galewitz, 9/19)

California Healthline: High On Drugs? Anthem Cites Soaring Drug Costs To Justify 35% Rate Hike In California
Health insurance giant Anthem predicts Californians will pop a lot more pills next year. To make the case for a hefty premium hike in the state’s individual insurance market, Anthem Blue Cross has forecast a 30 percent jump in prescription drug costs for 2018. Such a sharp increase is nearly double the estimates of two other big insurers, and it runs counter to industry trends nationally. (Terhune, 9/20)

The New York Times: Republican Leaders Defy Bipartisan Opposition To Health Law Repeal
Eleven governors, including five Republicans and a pivotal Alaskan independent, urged the Senate on Tuesday to reject a last-ditch push to dismantle the Affordable Care Act. But Republican leaders pressed toward a showdown vote. And they choked off separate bipartisan efforts to shore up health insurance markets under the Affordable Care Act, hoping to give Republican senators no alternative but to vote for repeal. (Pear and Kaplan, 9/19)

Politico: Backlash Throws Last-Ditch Obamacare Repeal Effort Into Doubt
Opponents of the proposal co-authored by Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina seized on its plan to overhaul Obamacare’s subsidized insurance and Medicaid expansion and replace those with block grants to the states — a mass restructuring they warned would sow chaos in insurance markets. They panned its new regulatory flexibilities as a backdoor route to undermining key patient protections — including safeguards for those with pre-existing conditions. And in the biggest blow, several Republican governors urged the GOP to abandon a plan that would force states to swallow potentially billions in funding cuts — and instead to focus on stabilizing Obamacare. (Cancryn, 9/19)

The Washington Post: New Health-Care Plan Stumbles Under Opposition From Governors
Among the signers were Alaska Gov. Bill Walker (I), who holds some sway over Murkowski, a potentially decisive vote who opposed a previous Republican effort to repeal and replace the Affordable Care Act. Nevertheless, Murkowski said Tuesday afternoon that she was still weighing her options and explained how her position on the bill might ultimately differ from her opposition to the repeal effort that failed dramatically in July. “If it can be shown that Alaska is not going to be disadvantaged, you gain additional flexibility. Then I can go back to Alaskans, and I can say, ‘Okay, let’s walk through this together.’ That’s where it could be different,” she said. (Sullivan, Eilperin and Snell, 9/19)

The Associated Press: A Last, Last Chance: Republicans Strain For Obamacare Repeal
Republicans must act by Sept. 30 in the Senate or face the prospect of a Democratic filibuster. That blocking action is currently staved off by budget rules that will expire at the end of the month. The new legislation, by Graham and Sen. Bill Cassidy of Louisiana, would undo the central pillars of former President Barack Obama’s health care law, and replace them with block grants to the states so they could make their own health care coverage rules. (Werner, 9/20)

The Hill: Graham Predicts ObamaCare Repeal Bill Will Get 50 Votes 
Sen. Lindsey Graham (R-S.C.) is predicting he will get enough votes on his bill to repeal ObamaCare and says House leadership has pledged they would also pass it. “I really believe we’re going to get 50 Republican votes,” Graham told reporters after a closed-door GOP caucus lunch on Tuesday. “I’ve never felt better about where we’re at.” (Carney, 9/19)

Politico: Republicans Rip Rand For Rejecting Obamacare Repeal
Rand Paul might soon go down as the Republican who saved Obamacare — and he couldn’t care less. “I’m actually happy to be out there as the leading advocate for repealing Obamacare, not keeping it,” the Kentucky Republican said in an interview. Of his GOP colleagues, Paul added: “These people, they so totally do not get it.” (Kim and Everett, 9/20)

Los Angeles Times: White House, Republican Leaders Join New Push For Obamacare Repeal As Bipartisan Effort Falters
House Speaker Paul D. Ryan (R-Wis.) made clear earlier Tuesday that House Republicans would not support the bipartisan Senate effort, further narrowing the options for those hoping for an alternative to the Graham-Cassidy bill. Ryan said the House instead was ready to approve the Cassidy-Graham bill. “He told me, ‘You pass it there, we’ll pass it here,’” said Graham, recounting a phone call with the speaker. (Levey and Mascaro, 9/19)

Politico: House GOP Under Pressure If Senate Passes Repeal
Though House GOP leaders are bullish that they can pull off a repeat performance on Obamacare repeal if given the chance, they’ll have to twist a lot of arms within the ranks to get there. Some conservatives want more flexibility for governors. At the same time, vulnerable centrists from states that would be hit hardest by the Senate bill, including California and New York, could face a severe backlash from constituents. (Bade and Cheney, 9/20)

Los Angeles Times: Obamacare 101: What Would The Graham-Cassidy Repeal Bill Do?
The Graham-Cassidy proposal shares some features of earlier repeal legislation approved in the House and debated in the Senate, including scrapping the requirement that Americans have health coverage and placing new restrictions on federal funding for Planned Parenthood. … But the new repeal bill is substantially more sweeping and goes far beyond just repealing the 2010 healthcare law, often called Obamacare. The Graham-Cassidy proposal would completely restructure how the federal government provides healthcare assistance to some 80 million Americans and create a new system for distributing hundreds of billions of dollars of government aid. (Levey, 9/19)

The Wall Street Journal: Q&A: Explaining The Graham-Cassidy Repeal Bill
The Graham-Cassidy bill would lump together the money spent on two ACA programs to expand health coverage: subsidies for private insurance and an expansion of the Medicaid program. That funding would be redistributed as block grants to states, who could use it to fashion their own health systems. All of the bill’s health spending would end in 2027 and need to be reauthorized by Congress. The bill also makes structural changes to Medicaid by capping how much federal money states can get. (Hackman, 9/19)

The New York Times: Blue States Face Biggest Cuts Under New Republican Health Care Plan
A new Republican plan to repeal the Affordable Care Act would give each state a federal block grant for health care using a complex formula that cuts funding for some states — including many that were won by Hillary Clinton in 2016 — according to a New York Times analysis of estimates from the Center on Budget and Policy Priorities, a left-leaning think tank. (Park, 9/19)

Reuters: Factbox: Latest Obamacare Repeal Bill Would Block Grant Money To States, Gut Medicaid
U.S. Senate Republicans are making one last attempt to overhaul Obamacare before a special parliamentary procedure allowing the bill to pass with a simple majority expires at the end of this month. The latest proposal, called the Graham-Cassidy bill and sponsored by Republican Senators Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson, would give states money in the form of block grants, allowing them to design their own healthcare systems while maintaining some regulations of the Affordable Care Act, former Democratic President Barack Obama’s signature domestic policy achievement. (Abutaleb, 9/19)

The Associated Press: Winners And Losers In GOP’s Last-Ditch Health Overhaul
The GOP’s last-ditch effort to repeal “Obamacare” would redistribute hundreds of billions of dollars in federal financing for insurance coverage, creating winners and losers among individual Americans and states in ways not yet fully clear. Independent analysts say the latest Senate Republican bill is likely to leave more people uninsured than the Affordable Care Act, and allow states to make changes that raise costs for people with health problems or pre-existing medical conditions. (9/19)

Politico: Graham-Cassidy Health Care Bill: What You Need To Know
The liberal-leaning think tank Center on Budget and Policy Priorities released estimates of how federal funding would change if the bill became law. In its analysis, California would be hardest hit, losing $27.8-billion in funding. … Cassidy’s office released its own estimates. Massachusetts takes the hardest hit with a more than $5 billion loss in funding. Overall, Southern states that did not expand Medicaid are poised to receive more in federal funding. (Frostenson, 9/19)

The Hill: GOP Faces Risks, Rewards In Rushing To Repeal Vote Without CBO Score 
Senate Republicans are rushing toward a vote on an ObamaCare repeal bill without getting a full analysis from the Congressional Budget Office on how their legislation would affect coverage and premiums. It’s a risky move, as Sens. Susan Collins (R-Maine) and John McCain (R-Ariz.) have both said they’d prefer to have a full score before casting their votes. (Sullivan, 9/19)

The Washington Post: Democrats Ask Base For One More ACA Rescue Mission
Senate Democrats, who spent weeks thinking they would won the fight to keep the Affordable Care Act in place, are mobilizing alongside progressive activists for 11 more days on the defensive. “They’re going to hear from us one more time!” Senate Minority Leader Charles E. Schumer said at a Tuesday afternoon rally outside the Capitol. “Protesting, picketing, emailing — you name it!” The multilevel campaign to block the Republican bill consists of everything progressives did to stop previous iterations — from “melting the phones” of Republican senators to waging sit-ins at their offices. (Weigel, 9/19)

The Hill: Cruel September Shifts To Democrats 
Democrats feeling whiplash over the GOP’s new effort to repeal ObamaCare have sought to step up their opposition to the new bill, which could be headed for a vote next week. After a Monday night floor protest, Democrats pointed to a bipartisan letter from 10 governors on Tuesday as a reason to kill the GOP bill. (Carney, 9/19)

Politico: Did Democrats Jump The Gun With Single-Payer Splash?
Last week, a group of Senate Democrats rallied behind single-payer health care at a splashy news conference. This week, the same group is scrambling to beat back the GOP’s latest Obamacare repeal blitz. The contrast shows the chasm between the two parties’ approach to health care: Republicans claim that Bernie Sanders’ “Medicare for All” pitch fueled their revived repeal effort, an argument that even Democratic single-payer foes dismiss as untrue. Yet some Democrats wish more attention had been paid to protecting the Affordable Care Act before some of the party’s biggest names turned to single payer. (Schor, 9/19)

The Washington Post: Jimmy Kimmel Gets Heated About Health-Care Bill, Says Sen. Bill Cassidy ‘Lied Right To My Face’
In May, late-night host Jimmy Kimmel delivered an emotional monologue as he revealed that his newborn son, Billy, was born with a heart defect that required immediate surgery. The operation was successful, but Kimmel was deeply shaken by the experience, which happened amid the debate over replacing the Affordable Care Act. Kimmel delivered a passionate plea about the astronomical costs of health care: “No parent should ever have to decide if they can afford to save their child’s life.” (Yahr, 9/20)

The Hill: AARP Calls On Senators To Reject Latest ObamaCare Repeal Bill
The AARP on Tuesday slammed the latest ObamaCare repeal bill and called on senators to reject it. The bill from Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) would increase health-care costs for older Americans with an age tax, decrease coverage and undermine protections for people with pre-existing conditions, the group said. (Weixel, 9/19)

The Hill: Hospitals Come Out Against New ObamaCare Repeal Bill 
The American Hospital Association is opposing the GOP’s last-ditch ObamaCare repeal bill, saying the legislation puts the health coverage of 10 million people at risk. “This proposal would erode key protections for patients and consumers and does nothing to stabilize the insurance market now or in the long term,” Rick Pollack, the group’s president and CEO, said in a statement Tuesday. (Roubein, 9/19)

NPR: Republicans Try One Last Effort To Repeal Obamacare
“The Graham-Cassidy plan would take health insurance coverage away from millions of people, eliminate critical public health funding, devastate the Medicaid program, increase out-of-pocket costs and weaken or eliminate protections for people living with pre-existing conditions,” says Georges Benjamin, executive director of the American Public Health Association, in a statement. (Kodjak, 9/19)

The Hill: GOP Chairman Declares Bipartisan ObamaCare Fix Dead 
The Senate Health Committee chairman on Tuesday released a statement ending a bipartisan effort to find an ObamaCare fix amid a new GOP push to repeal the law. “During the last month, we have worked hard and in good faith, but have not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted,” Senate Health Committee Chairman Lamar Alexander (R-Tenn.) said in the statement. (Sullivan, 9/19)

Politico: Ryan, White House Reject Bipartisan Health Fix
House Speaker Paul Ryan and the White House have informed Senate Republican leaders that they oppose a bipartisan plan to stabilize Obamacare being written in the Senate, according to Trump administration and congressional sources, in a clear bid to boost the Senate’s prospects of repealing the health law. (Everett, Dawsey and Bade, 9/19)

The New York Times: While Premiums Soar Under Obamacare, Costs Of Employer-Based Plans Are Stable
In sharp contrast to the soaring health insurance premiums in many Affordable Care Act marketplaces, the cost of coverage for the vast numbers of people who get insurance through their jobs rose relatively little this year, continuing a period of remarkable stability in the employer market, according to a national survey released Tuesday. The annual premium for family coverage rose an average of 3 percent to $18,764 this year, according the Kaiser Family Foundation, a nonprofit group, which conducted the annual survey of employers. (Abelson, 9/19)

The Associated Press: Health Benefit Offers From Small Businesses Keep Vanishing
Only half of America’s smallest businesses now offer health coverage to their workers because many say steady cost hikes have made it too expensive to afford a benefit that nearly all large employers still provide. The Kaiser Family Foundation said Tuesday that 50 percent of companies with three to 49 employees offered coverage this year. That’s down from 59 percent in 2012 and 66 percent more than a decade ago. (9/19)

The Wall Street Journal: The Hidden Obamacare Detail That Could Cost Hospitals Billions
Investors should get ready for more belt-tightening in the hospital industry. Maybe a lot more. Some aspects of  the Affordable Care Act, commonly known as Obamacare, were a blessing for hospitals. Expanded access to insurance has meant more customers who can pay for services they consume. That limits bad debt generated from bills that uninsured patients can’t afford to pay. (Grant, 9/19)

Politico: Price’s Private-Jet Travel Breaks Precedent
In a sharp departure from his predecessors, Health and Human Services Secretary Tom Price last week took private jets on five separate flights for official business, at a cost of tens of thousands of dollars more than commercial travel. The secretary’s five flights, which were scheduled between Sept. 13 and Sept. 15, took him to a resort in Maine where he participated in a Q&A discussion with a health care industry CEO, and to community health centers in New Hampshire and Pennsylvania, according to internal HHS documents. (Diamond and Pradhan, 9/19)

The Wall Street Journal: Senator Pushes For Hospital Inspections To Be Made Public
The chairman of the Senate Judiciary Committee is pressing for the public disclosure of hospital inspection reports, amid complaints that the nation’s largest hospital accreditation group doesn’t rigorously enforce health and safety standards. Sen. Chuck Grassley (R., Iowa) asked federal regulators in a letter Monday to outline specific statutory changes that would be needed to end the confidentiality of inspection reports done by accreditors, including the Joint Commission, a nonprofit organization based in Oakbrook Terrace, Ill. (Armour, 9/19)

The Wall Street Journal: States Need $645 Billion To Pay For These Promises, And That’s Not Counting What They Owe In Pensions
When Aurora, Ill., closed its books in December, about $150 million disappeared from the city’s bottom line. The Chicago suburb of 200,000 people hadn’t become poorer. Instead, for the first time it recorded on its balance sheet the full cost of health care promised to public employees once they retire. States and cities around the country will soon book similar losses because of new, widely followed accounting guidelines that apply to most governments starting in fiscal 2018. (Gillers, 9/20)

The Washington Post: Hurricane Aftermath: Death Toll Rises To 9 In South Florida Nursing Home That Overheated
A ninth patient from a South Florida nursing home that overheated during power outages following Hurricane Irma died on Tuesday, according to police. The death of Carlos Canal, the ninth patient, occurred nearly a week after the nursing home in Hollywood, Fla., became the focus of a criminal investigation when the air conditioning failed and eight other patients ultimately died. (Berman, 9/19)

The Wall Street Journal: Doctor’s Defamation Suit Highlights Online Patient Reviews
A defamation lawsuit filed by an Ohio plastic surgeon that is slated to go to trial early next year could have far-reaching consequences for disputes between doctors and their patients over online reviews about the quality of medical care, according to legal experts. Dr. Bahman Guyuron, former chairman of the department of plastic surgery at Case Western Reserve University School of Medicine, sued Marisa User in 2015 over anonymous reviews she had posted on the cosmetic-surgery website RealSelf and other sites where patients swap information about doctors. (Palazzolo, 9/19)

The New York Times: The Fatal Toll Of Cheap Cigarettes
A new study suggests that the availability of cheaper, off-brand cigarettes is associated with an increase in infant mortality. Researchers writing in JAMA Pediatrics studied the link between cigarette prices and infant mortality in 23 European countries from 2004 through 2014. During this time, there were more than 53 million live births. (9/19)

The New York Times: A Stress Link To Lupus
Psychological trauma is associated with an increased risk for lupus, a new study reports. Lupus is a potentially fatal autoimmune disease that causes inflammation of the skin, joints and internal organs. Its cause is unknown. (Bakalar, 9/20)

Los Angeles Times: Domestic Violence Homicide Rate Drops With Stricter Gun Law, Study Finds
When domestic violence offenders are required to relinquish their guns, instead of simply being barred from owning firearms, the risk that those offenders may kill their partners goes down, a new study finds. The paper, described in the Annals of Internal Medicine, highlights a simple method for lowering the risk women face of being killed by an intimate partner: Enforce the laws already in place. (Khan, 9/19)

The Washington Post: Poor, Sick And Still Traveling Long Distances For Health Care In D.C.
The District’s poorest residents are still forced to travel far outside their neighborhoods for their health care, according to a report released Tuesday by Mayor Muriel E. Bowser. Less than 25 percent of Medicaid patients living east of the Anacostia River see a primary-care doctor in their Zip code. Despite efforts to expand services in Wards 7 and 8, many still call 911 emergency services for their basic health needs. And residents needing specialty care must commute downtown where most of the medical specialists are clustered. (Itkowitz, 9/19)

The Associated Press: New Delaware Law Will Expand Cancer Treatment Options
Cancer patients in Delaware will soon have more treatment option under legislation being signed by Gov. John Carney. A bill to be signed Wednesday requires health insurers to cover any medically appropriate drug that has been approved by the Food and Drug Administration for the treatment of stage 4 metastatic cancer and other cancers without requiring proof that the patient failed to respond to a different drug or drugs. (9/20)

The Associated Press: Appeals Court Blocks San Francisco Warning Law For Soda Ads
A federal appeals court on Tuesday blocked a San Francisco law requiring a health warning on soda ads, saying the measure was misleading and would suppress free speech. A unanimous, three-judge panel of the 9th U.S. Circuit Court of Appeals stopped the 2015 ordinance from going into effect until a lawsuit filed by the American Beverage Association and other groups is resolved. (9/19)

The Wall Street Journal: Appeals Court Blocks San Francisco Law Requiring Soda Health Warnings
The three-judge panel of the Ninth U.S. Circuit Court of Appeals found the ordinance stifles commercial speech and unfairly targets soda over other potentially unhealthy food and drinks. The panel blocked the rule from going into effect. The San Francisco ordinance, passed in 2015, requires advertisements for certain sugar-sweetened drinks to include a disclaimer that says “WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay. This is a message from the City and County of San Francisco.” (Randazzo, 9/19)

Los Angeles Times: Health Officials Declare Hepatitis A Outbreak In L.A. County
Los Angeles County health officials declared a hepatitis A outbreak Tuesday, days after a public health emergency was announced in San Diego County, where at least 16 people have died of the highly contagious virus. Case numbers are still small in L.A. County, with only 10 people infected as part of the outbreak, said Dr. Barbara Ferrer, director of the L.A. County Department of Public Health. By comparison, almost 450 people have contracted the virus in San Diego. (Karlamangla, 9/19)

The Associated Press: Cuba Again Denies Role In ‘Health Attacks’ On US Diplomats
The Cuban government on Tuesday again denied any involvement in or any knowledge of a mysterious series of health incidents that have affected American diplomats in Havana. … At least 21 members of the American diplomatic community in Havana have suffered from symptoms, including brain damage, believed to have come from some sort of sonic attack since late last year. The most recent incident was in August. (9/19)

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

Last-Ditch GOP Effort To Replace ACA: 5 Things You Need To Know

Republican efforts in Congress to “repeal and replace” the federal Affordable Care Act are back from the dead. Again.

While the chances for this last-ditch measure appear iffy, many GOP senators are rallying around a proposal by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), along with Sens. Dean Heller (R-Nev.) and Ron Johnson (R-Wis.)

They are racing the clock to round up the needed 50 votes — and there are 52 Senate Republicans.

An earlier attempt to replace the ACA this summer fell just one vote short when Sens. Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and John McCain (R-Ariz.) voted against it. The latest push is setting off a massive guessing game on Capitol Hill about where the GOP can pick up the needed vote.

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After Sept. 30, the end of the current fiscal year, Republicans would need 60 votes ­— which means eight Democrats — to pass any such legislation because special budget rules allowing approval with a simple majority will expire.

Unlike previous GOP repeal-and-replace packages that passed the House and nearly passed the Senate, the Graham-Cassidy proposal would leave in place most of the ACA taxes that generated funding to expand coverage for millions of Americans. The plan would simply give those funds as lump sums to each state. States could do almost whatever they please with them. And the Congressional Budget Office has yet to weigh in on the potential impact of the bill, although earlier estimates of similar provisions suggest premiums would go up and coverage down.

“If you believe repealing and replacing Obamacare is a good idea, this is your best and only chance to make it happen, because everything else has failed,” said Graham in unveiling the bill last week.

Here are five things to know about the latest GOP bill: 

1. It would repeal most of the structure of the ACA.

The Graham-Cassidy proposal would eliminate the federal insurance exchange, healthcare.gov, along with the subsidies and tax credits that help people with low and moderate incomes — and small businesses — pay for health insurance and associated health costs. It would eliminate penalties for individuals who fail to obtain health insurance and employers who fail to provide it.

It would eliminate the tax on medical devices. 

2. It would eliminate many of the popular insurance protections, including those for people with preexisting conditions, in the health law.

Under the proposal, states could “waive” rules in the law requiring insurers to provide a list of specific “essential health benefits” and mandating that premiums be the same for people regardless of their health status. That would once again expose people with preexisting health conditions to unaffordable or unavailable coverage. Republicans have consistently said they wanted to maintain these protections, which polls have shown to be popular among voters.

3. It would fundamentally restructure the Medicaid program.

Medicaid, the joint-federal health program for low-income people, currently covers more than 70 million Americans. The Graham-Cassidy proposal would end the program’s expansion under the ACA and cap funding overall, and it would redistribute the funds that had provided coverage for millions of new Medicaid enrollees. It seeks to equalize payments among states. States that did not expand Medicaid and were getting fewer federal dollars for the program would receive more money and states that did expand would see large cuts, according to the bill’s own sponsors. For example, Oklahoma would see an 88 percent increase from 2020 to 2026, while Massachusetts would see a 10 percent cut.

The proposal would also bar Planned Parenthood from getting any Medicaid funding for family planning and other reproductive health services for one year, the maximum allowed under budget rules governing this bill. 

4. It’s getting mixed reviews from the states.

Sponsors of the proposal hoped for significant support from the nation’s governors as a way to help push the bill through. But, so far, the governors who are publicly supporting the measure, including Scott Walker (R-Wis.) and Doug Ducey (R-Ariz.), are being offset by opponents including Chris Sununu (R-N.H.), John Kasich (R-Ohio) and Bill Walker (I-Alaska).

On Tuesday 10 governors — five Democrats, four Republicans and Walker — sent a letter to Senate leaders urging them to pursue a more bipartisan approach. “Only open, bipartisan approaches can achieve true, lasting reforms,” said the letter.

Bill sponsor Cassidy was even taken to task publicly by his own state’s health secretary. Dr. Rebekah Gee, who was appointed by Louisiana’s Democratic governor, wrote that the bill “uniquely and disproportionately hurts Louisiana due to our recent [Medicaid] expansion and high burden of extreme poverty.”

5. The measure would come to the Senate floor with the most truncated process imaginable.

The Senate is working on its Republican-only plans under a process called “budget reconciliation,” which limits floor debate to 20 hours and prohibits a filibuster. In fact, all the time for floor debate was used up in July, when Republicans failed to advance any of several proposed overhaul plans. Senate Majority Leader Mitch McConnell (R-Ky.) could bring the bill back up anytime, but senators would immediately proceed to votes. Specifically, the next order of business would be a process called “vote-a-rama,” where votes on the bill and amendments can continue, in theory, as long as senators can stay awake to call for them.

Several senators, most notably John McCain, who cast the deciding vote to stop the process in July, have called for “regular order,” in which the bill would first be considered in the relevant committee before coming to the floor. The Senate Finance Committee, which Democrats used to write most of the ACA, has scheduled a hearing for next week. But there is not enough time for full committee consideration and a vote before the end of next week.

Meanwhile, the Congressional Budget Office said in a statement Tuesday that it could come up with an analysis by next week that would determine whether the proposal meets the requirements to be considered under the reconciliation process. But it said that more complicated questions like how many people would lose insurance under the proposal or what would happen to insurance premiums could not be answered “for at least several weeks.”

That has outraged Democrats, who are united in opposition to the measure.

“I don’t know how any senator could go home to their constituents and explain why they voted for a major bill with major consequences to so many of their people without having specific answers about how it would impact their state,” said Senate Minority Leader Chuck Schumer (D-N.Y.) on the Senate floor Tuesday.

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

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In Stark Contrast To ACA Plans, Premiums For Job-Based Coverage Show Modest Rise

Family health insurance premiums rose an average 3 percent this year for people getting coverage through the workplace, the sixth consecutive year of small increases, according to a study released Tuesday.

The average total cost of family premiums was $18,764 for 2017, according to a survey of employers by the Kaiser Family Foundation and the Health Research & Educational Trust. That cost is generally divided between the employer and workers. (Kaiser Health News is an editorially independent program of the foundation.)

While overall premium increases remain modest, workers are picking up a greater portion of the tab — this year $5,714 for family coverage, about a third of total cost.

Employer-provided coverage for a single person rose on average 4 percent, to $6,690. Those individuals pay $1,213 on average.

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Still, the employer market looks remarkably stable compared to the price increases seen in the Affordable Care Act’s insurance marketplaces for people who buy their own coverage. Premiums on those plans spiked on average about 20 percent this year, and many insurers dropped out because of financial concerns.

For all the media attention and political wrangling over the  Obamacare exchanges, their share of the market is relatively small. They provide coverage to 10 million Americans while 151 million Americans get health insurance through their employer.

The continued slow rise of employer health premiums identified in the Kaiser survey surprised some analysts who have expected the trend to end as the economy picked up steam, leading to a jump in use of health services and health costs.

Drew Altman, CEO of the Kaiser Family Foundation, said it’s “health care’s greatest mystery” why health insurance costs have continued their slow pace even as the economy has picked up the past few years. “We can’t explain it.”

Another unexpected result was that workers’ deductibles — the health bills that workers must pay before their insurance coverage kicks in — remained stable this year at $1,221. Since 2010, as companies sought to keep premiums in check, deductibles have nearly doubled. Higher deductibles can limit premium increases because costs are shifted to workers and it gives them greater incentive to cut spending.

“Increasing deductibles has been a main strategy of employers to keep premiums down and we will have to watch if this plateauing is a one time thing … or if this portends a sharper increase in premiums in future years,” said Altman. “It could be deductibles are reaching their natural limit or could be the tighter labor market” that’s causing employers to back off, he added.

Meanwhile, a second employer survey released Monday by Mercer, a benefits consulting firm, suggests a modest increase in health costs coming next year, too. Employers said they expect their health costs to increase by an average 4.3 percent in 2018, according to the survey.

To deal with higher medical costs — notably big increases in the prices of prescription drugs — employers are using multiple strategies, including continuing to shift more costs to workers and paying doctors and hospitals based on the value of the services rather than just quantity of services.

Jeff Levin-Scherz, a health policy expert with benefits consultant Willis Towers Watson, said there is a limit on how much employers can shift costs to their workers, particularly in a tight labor market. “Single-digit increases doesn’t mean health care costs are no longer a concern for employers,” he said.

The 19th annual Kaiser survey also found that the proportion of employers offering health coverage remained stable last year at 53 percent. But the numbers have fallen over the past two decades.

The survey highlights that the amount workers pay can vary dramatically by employer size. Workers in small firms — those with fewer than 200 employees — pay on average $1,550 more annually for family premiums than those at large firms. The gap occurs because small firms are much more likely than large ones to contribute the same dollar amount toward a worker’s health benefits whether they’re enrolled in individual or family coverage.

More than one-third of workers at small employers pay at least half the total premium, compared with 8 percent at large employers.

That’s the case at Gale Nurseries in Gwynedd Valley, Pa., where health insurance costs rose 7.5 percent this year. Its 25 workers are paying nearly half the cost of the premium — at least $45 a week for those who choose the base coverage plan offered through Aetna. Employees also have deductibles ranging from $1,000 to $2,500.

A decade ago, the nursery paid the full cost of the premium.

“It’s crazy — we keep paying more and getting less,” said comptroller Candy Koons.

At the Westport (Conn.) Weston Family YMCA, health insurance premiums rose about 7 percent this year, leaving its 50 full-time employees to pay a $156 premium for individual coverage.

“It’s not problematic, but it’s one of our bigger costs associated with payroll,” said Joe Query, the human resources director.

Categories: Health Care Costs, Insurance, The Health Law

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Nursing Home Disaster Plans Often Faulted As ‘Paper Tigers’

It does not take a hurricane to put nursing home residents at risk when disaster strikes.

Around the country, facilities have been caught unprepared for far more mundane emergencies than the hurricanes that recently struck Florida and Houston, according to an examination of federal inspection records. Those homes rarely face severe reprimands, records show, even when inspectors identify repeated lapses.

In some cases, nursing homes failed to prepare for basic contingencies.

In one visit last May, inspectors found that an El Paso, Texas, nursing home had no plan for how to bring wheelchair-dependent people down the stairs in case of an evacuation. Inspectors in Colorado found a nursing home’s courtyard gate was locked and employees did not know the combination, inspection records show. During a fire at a Chicago facility, residents were evacuated in the wrong order, starting with the people farthest from the blaze.

Nursing home inspectors issued 2,300 violations of emergency-planning rules during the past four years. But they labeled only 20 so serious as to place residents in danger, the records show.

In addition, a third of U.S. nursing homes have been cited for another type of violation: failing to inspect their generators each week or to test them monthly. None of those violations was categorized as a major deficiency, even at 1,373 nursing facilities that were cited more than once for neglecting generator upkeep, the records show.

“That’s the essential problem with the regulatory system: It misses many issues, and even when it identifies them, it doesn’t treat them seriously enough,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. “It’s always the same story: We have some pretty good standards and we don’t enforce them.”

In the wake of eight deaths at Rehabilitation Center at Hollywood Hills, Fla., following Hurricane Irma, heightened attention has focused on new federal disaster-planning rules, with which nursing homes must comply by mid-November. Those were prompted by nursing home and hospital deaths during Hurricane Katrina in Louisiana in 2005.

Dr. David Gifford, senior vice president for quality and regulatory affairs at the American Health Care Association, a nursing home industry group, said facilities have gotten better at handling disasters after each one. Most evacuations go smoothly, he said.

“After each one of these emergencies we’ve learned and gotten better,” Gifford said.

But advocates for the elderly say enforcement of rules is as great a concern, if not greater.

Dr. David Marcozzi, a former director of the federal emergency preparedness program for health care, said that inspectors — also known as surveyors —  should observe nursing home staff demonstrating their emergency plans, rather than just checking that they have been written down.

“If you have not implemented and exercised plans, they are paper tigers,” said Marcozzi, now an associate professor at the University of Maryland School of Medicine. “The emphasis from the surveyor has to be ‘Show me how you do this.’ ”

Gifford said pre-planning and drills, which are important, only go so far in chaotic events such as hurricanes.

“No matter what planning you might have, what we have learned from these emergencies is these plans don’t always work,” he said. Nursing homes take surveys seriously and face closure if they do not fix flaws inspectors identify, he added.

Inspection results vary widely by state, influenced sometimes by lax nursing homes or more assertive surveyors, or a combination, according to an analysis of two types of emergency-planning deficiencies. In California, 53 percent of nursing facilities have been cited for two types of emergency-planning deficiencies, and a quarter have been cited in Texas. No nursing home in Indiana, Mississippi or Oregon was issued violations for those two emergency-planning violations during the past four years.

Asked to explain the rarity of severe citations in emergency preparation, the federal Centers for Medicare & Medicaid Services, which oversees inspections, referred a reporter to its emergency-preparedness mission statement on its website.

The danger of high temperatures for elderly residents, which the Hollywood Hills case shows can be disastrous, has been well known. In a heat wave in 2000, two nursing home residents in a Burlingame, Calif., facility died and six others suffered severe dehydration, heat stroke or exhaustion.

During the past four years, inspectors have cited 536 nursing homes for failing to maintain comfortable and safe temperature levels for residents. Inspectors deemed 15 as serious, including two where patients were harmed, records show.

“There is undoubtedly little, if any, enforcement of the laws since we see the same tragedies repeated time and again,” said Patricia McGinnis, executive director of California Advocates for Nursing Home Reform.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation. Coverage of aging and long-term care issues is supported by The SCAN Foundation.

Categories: Aging, Medicare, Public Health

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