From Medicine and Health

‘The Field Is Confused, Disoriented, And Completely Devastated’: Alzheimer’s Researchers Forced Back To Drawing Board

Following a large conference last week, there was a sense that disappointing failure after disappointing failure has left the field desperate and in need of new ideas. But there’s reason to hope. Not only is there plenty of money out there to support research, there’s also a movement to include players who have been previously cast aside in the conversation. In other public health news: car crashes, vaccines, drowning, surgery, knee injuries, and more.

To Close Budget Gaps, Alaska Cut Dental Care For Low-Income Adults. But Advocates Say That Will Be More Costly In Long Run.

“We can’t continue to be all things for all people,” Gov. Mike Dunleavy said in June, “we don’t have the money to do that.” But advocates say preventive dental care saves money because it catches problems before they become more costly. Medicaid news comes out of Michigan, Ohio, North Carolina and Wisconsin.

Pharma Deploys Small Army Of Advocates To Fight Against The Budget Deal That Reportedly Contains Pricing Reforms

It isn’t clear yet what kind of policies Congress is considering that could hurt the pharmaceutical industry’s bottom line, but it has been reported that the reforms could cost the industry $115 billion. In other pharmaceutical news: the CVS-Aetna merger, hep C treatment and prisoners, biotech, and President Donald Trump’s drug pricing strategy.

Chicago Safety Net Hospitals Say They Won’t Survive Under ‘Fair Workweek’ Ordinance

The hospitals say that complying with the rule, which requires employees to compensate workers when there are last-minute schedule changes, would mean a collective $30 million loss. Meanwhile, Chicago-area chains have been reconfiguring themselves to become specialty hospitals. Other hospital news comes out of California, Massachusetts and Kansas, as well.

There’s Lots Of Talk About Surprise Medical Bills In Congress, But Ambulance Costs Have Been Left Out Of Conversation

Lawmakers across the country and federally have been trying to figure out the best way to address surprise medical bills. But one of the main causes of the problem –ambulance rides — isn’t in any of the proposed legislation. “If you call 911 for an ambulance, it’s basically a coin flip whether or not that ambulance will be in or out of network,” said Christopher Garmon, a health economist at the University of Missouri-Kansas City. Meanwhile, legislation in the House over the bills is unlikely to be addressed until after August recess.

As National Spotlight Shines Bright On Quality Of Detention Facilities, A Mental Health Crisis Flies Under Radar

One estimate puts the number of detainees with mental illnesses between 3,000 and 6,000. “This is a system that, for a long time, has failed to understand, neglected, and even ignored the mental health needs of folks caught up in it,” said Elizabeth Jordan, director of the Immigration Detention Accountability Project at the Civil Rights Education and Enforcement Center. “But under this administration … it has gotten so much worse.” In other news on the border crisis: sleep deprivation in young detainees, protesters at an Oklahoma Army base, and human-rights violations at a Florida detention center.

Biden’s ‘Incremental’ Health Plan Still Would Be A Heavy Lift

The headlines about presidential candidate Joe Biden’s new health care plan called it “a nod to the past” and “Affordable Care Act 2.0.” That mostly refers to the fact that the former vice president has specifically repudiated many of his Democratic rivals’ calls for a “Medicare for All” system and instead sought to build his plan on the ACA’s framework.

Sen. Bernie Sanders, one of Biden’s opponents in the primary race and the key proponent of the Medicare for All option, has criticized Biden’s proposal, complaining that it is just “tinkering around the edges” of a broken health care system.

Still, the proposal put forward by Biden last week is much more ambitious than Obamacare — and, despite its incremental label, would make some very controversial changes. “I would call it radically incremental,” said Chris Jennings, a political health strategist who worked for Presidents Bill Clinton and Barack Obama and who has consulted with several of the current Democratic candidates.

Republicans who object to other candidates’ Medicare for All plans find Biden’s alternative just as displeasing.

“No matter how much Biden wants to draw distinctions between his proposals and single payer, his plan looks suspiciously like “SandersCare Lite,” wrote former congressional aide and conservative commentator Chris Jacobs.

Biden’s plan is built on expanding the ACA to reduce costs for patients and consumers, similar to what Hillary Clinton campaigned on in 2016. It would do things Democrats have called for repeatedly since the ACA was passed. Among them is a provision to that would “uncap” federal help to pay for health insurance premiums — assistance that is now available only to those with incomes below 400% of the poverty level, or about $50,000 for an individual. Under Biden’s plan, no one would be required to pay more than 8.5% of their income toward health insurance premiums. The plan also proposes to make coverage more affordable to use by effectively lowering deductibles and copayments.

But it includes several proposals that Congress has failed repeatedly to enact, including some that were part of the original debate over the ACA. It also has some initiatives that are so expansive, it is hard to imagine them passing Congress — even if Democrats sweep the presidency and both chambers of Congress in 2020.

Here are some of the more controversial pieces of the Biden health plan:

Public Option

Although many of the Democratic presidential candidates have expressed varying degrees of support for a Medicare for All plan, nearly all have also endorsed creating a government-sponsored health plan, known colloquially as a “public option,” that would be available to people why buy their own health insurance. In other words, it would apply to those who don’t get insurance through their job or qualify for other government programs, like Medicare or Medicaid.

A public option was included in the version of the ACA that passed the House in 2009. But it could not muster the 60 votes needed to pass the Senate over GOP objections — even though the Democrats had 60 votes at the time.

Biden’s public option, however, would be available to many more people than the 20 million or so in the current individual insurance market. According to the document put out by the campaign, it would be available to those who don’t like or can’t afford their employer insurance, and to small businesses.

Most controversial, though, is that the 2.5 million people ineligible for either Medicaid or private insurance subsidies because their states have chosen not to expand Medicaid would be automatically enrolled in the new public option, at no cost to them or the states where they live. Also included automatically in the public option would be another 2 million people with low incomes who currently are eligible for ACA coverage subsidies but would also be eligible for expanded Medicaid.

That part of Biden’s proposal has prompted charges that the 14 states that have so far chosen not to expand Medicaid would save money compared with those that have expanded, because expansion states have to pay 10% of the cost of that new population.

Jennings, the Democratic health strategist, argued that’s unavoidable because it’s the population that needs coverage most. “If you’re not going to have everyone get a plan right away, you need to make sure those who are most vulnerable do,” he said.


The Biden plan calls for eliminating the “Hyde Amendment,” an annual rider to the spending bill for the Department of Health and Human Services that forbids the use of federal funds to pay for abortions. Biden recently ran into some difficulty when his position on Hyde was unclear.

But the plan also calls for federal abortion funding. “[T]he public option will cover contraception and a woman’s constitutional right to choose,” said the document.

In 2010, the Affordable Care Act very nearly failed to become law after an intraparty fight between Democrats who supported and opposed abortion funding. Abortion opponents wanted firm guarantees in permanent law that no federal funds would ever be used for abortion; abortion-rights supporters called that a deal breaker. Eventually, a shaky compromise was reached.

And while it is true that there are now far fewer Democrats who oppose abortion in Congress than there were in 2010, the idea of even a Democratic-controlled Congress voting for federal abortion funding seems far-fetched. The current Democratic-led House has declined even to include a repeal of the Hyde Amendment in this year’s HHS spending bill, because it could not get through the GOP-controlled Senate or get signed by President Donald Trump.

Undocumented Immigrants

When Obama said in a speech to Congress in September 2009 that people not in the U.S. legally would be ineligible for federal help purchasing insurance, it prompted the infamous “You lie!” shout from Rep. Joe Wilson (R-S.C.).

Today, all the Democratic candidates say they would provide coverage to undocumented residents. There is no mention of them specifically in the plan posted on Biden’s website, although a campaign official told Politico that undocumented people would be able to purchase plans on the health insurance exchanges but would not qualify for subsidies.

Still, in his speech unveiling the plan at an AARP-sponsored candidate forum in Iowa, Biden did not address this issue of immigrants’ health care. He said only that his plan would expand funding for community health centers, which serve patients regardless of ability to pay or immigration status, and that people here without legal authority would be able to obtain coverage in emergencies, which is already law.

How The Eastern Cherokee Took Control Of Their Health Care

CHEROKEE, N.C. — Light pours through large windows and glass ceilings of the Cherokee Indian Hospital onto a fireplace, a waterfall and murals. Rattlesnake Mountain, which the Cherokee elders say holds ancient healing powers, is visible from most angles. The hospital’s motto — “Ni hi tsa tse li” or “It belongs to you” — is written in Cherokee syllabary on the wall at the main entrance.

“It doesn’t look like a hospital, and it doesn’t feel like a hospital,” Kristy Nations said on a recent visit to pick up medications at the pharmacy. “It actually feels good to be here.”

Profits from the tribe’s casino have helped the 12,000 members of the Eastern Band of Cherokee Indians opt out of the troubled U.S. government-run Indian Health Service. They are part of an expanding experiment in decentralization, in which about 20% of federally recognized tribes in Oklahoma, California, Arizona and elsewhere have been granted permission to take full control of their health care.

For the North Carolina Cherokee, self-governance has meant adopting an integrated care model designed by Alaska Natives to deliver care that not only improves patients’ health, but also is tailor-made for the needs of the tribe. It has meant the opening of a 20-bed state-of-the-art facility in 2015 and the construction of an 18-bed mental health clinic scheduled to open in October 2020.

The hospital is a “medical home for our people,” said Casey Cooper, the hospital’s CEO who is a member of the tribe.

Half of the Indian Health Service budget is now managed by Indian tribes to various degrees. But while full control has worked out well for tribes with resources like the Eastern Cherokee, they are one of just a few bright spots in an otherwise dire medical landscape. It remains to be seen how widely this model can be applied.

“Not all tribal communities have access to the economic opportunities that we have,” Cooper said. “Some tribes are in these desolate, remote locations where there are no natural resources or economic development opportunities. I get that.”

Casey Cooper, CEO of the Cherokee Indian Hospital(Katja Ridderbusch for KHN)

Self-Governing To Change The Narrative

The U.S is legally obligated to offer health services to all members of the 573 federally recognized tribes. Yet the federal Indian Health Service, which currently provides direct care to about 2.2 million out of the nation’s estimated 3.7 million American Indians and Alaska Natives, is chronically underfunded. The current IHS budget is about $5.4 billion, yet the National Indian Health Board estimates the total level of need to be nearly $37 billion.

American Indians are more than twice as likely to get diabetes and six times as likely to get tuberculosis than the average U.S. population. Mental illness, and especially substance abuse, runs high in Indian Country. Native Americans are more likely to commit suicide than any other ethnic or racial group.

Health disparities are particularly harsh in the Northern Plains region. In the Dakotas, average life expectancy among American Indians is 20 years less than among white Americans.

“You do not have to cross an ocean to find Third World health conditions,” said Dr. Donald Warne, a professor of public health at the University of North Dakota and an Oglala Lakota tribesman. “You can find them right here, in the heartland of the United States.”

One particularly grim example is the Rosebud Indian Reservation in South Dakota. In 2015, the Centers for Medicare & Medicaid Services found safety violations at the local IHS hospital so severe that they shut down the emergency room for six months. During this time, at least five patients died en route to other hospitals located sometimes 100 or more miles away. Since then, the situation has only slightly improved.

“The Indian Health Service respects tribal sovereignty and is committed to tribal self-governance,” said IHS spokesman Joshua Barnett. “IHS recognizes that tribal leaders and members are in the best position to understand the health care needs and priorities of their communities.”

Self-governance also allows tribes to be eligible for Medicare, Medicaid, private-sector health insurance, partnerships with larger health systems and even federal grants that are designed for underserved communities — all which can be limited for the IHS.

“Generally speaking, tribally operated health care systems tend to run more efficiently, more effectively and with higher quality of care than IHS-managed systems,” said Warne.

The 155,000-square-foot, 20-bed Cherokee Indian Hospital rests on a small knoll in western North Carolina. (Katja Ridderbusch for KHN)

The hospital serves over 12,000 members of the Eastern Band of Cherokee Indians who live on the Qualla Boundary, at the foothills of the Great Smoky Mountains National Park. (Katja Ridderbusch for KHN)

Money Makes A Difference

The Cherokee Indian Hospital is lucky to be supported by a tribe that’s economically thriving due to gambling revenues, according to Cooper. The Qualla Boundary is home to Harrah’s Cherokee Casino Resort. It’s a unique situation, said Indian health expert Warne, as most reservation casinos don’t make huge profits.

The hospital’s annual budget has grown from $20 million to over $80 million within the past 17 years. The largest sources are third-party reimbursements, mostly from Medicaid and Medicare, at $27.4 million, followed by IHS contributions and tribal funding.

In 2012, the hospital decided to implement a new, patient-centered approach called the Nuka System of Care, created by the Southcentral Foundation, a nonprofit health provider owned and led by Alaska Natives. A Cherokee delegation visited a Nuka program to see how it could be tailored to their culture and health needs.

“An integrated approach is more consistent with traditional healing,” Warne said. Since “we don’t separate our physical, mental, spiritual and emotional health the way we do in modern specialized health care.”

At Cherokee Indian Hospital, patients are assigned a team, which typically includes a primary care physician or a family nurse practitioner as well as a nutritionist, a pharmacist and a behavioral health specialist.

Rebuilding their health care prompted the need for the new hospital. Gambling revenue covered most of the costs for the $82 million facility. “The old building was outdated and inefficient,” said Cooper, “a constant reminder of the paternalistically provided Indian Health Service.”

Dr. Richard Bunio, Cherokee Indian Hospital’s clinical director(Katja Ridderbusch for KHN)

The new hospital’s main concourse — called Riverwalk — tells stories from Cherokee legend through graphics of a winding river, fish and turtles inlaid in the terrazzo floor. Signs are written in English and Cherokee. A literal translation of the emergency room sign is “Get better in a hurry,” and the dental suite is “the place that gives you a big smile.”

Patients can receive dialysis, acupuncture, massage therapy and chiropractic care. The ambulance bay, surgical suite and in-patient unit are located out of patients’ view to reduce anxiety and stress.

“The building really is one big strategic tool,” Cooper said.

Nations, the patient visiting recently, remembers the old days when she and her family, many of them dealing with diabetes and some on dialysis, used to wait for hours in the former hospital, a dark space dubbed “the bunker.”

The 46-year-old said that she’d typically see different providers every visit. “And every time I would have to tell my story over and over and over.” Now, she feels somewhat accountable to her care team — and more motivated to make and keep appointments.

“Back then, if my provider had wanted me to see a nutritionist, for example, I would have probably said, ‘Whatever,’ and forgotten about it,” she said.

“We’re trying to build a relationship with our patients,” said Richard Bunio, the Cherokee Indian Hospital’s clinical director who is Canadian and married to a tribe member. He noted that Native Americans generally have suffered a lot of historical trauma, leading to deeply rooted mistrust of mainstream medicine.

By quality measures, including the widely used Healthcare Effectiveness Data and Information Set, the hospital has recently performed in the top quartile for blood pressure control, blood sugar control and several cancer screenings. Also, Cooper added that in the past four years the diabetes rate in the community has leveled.

At Cherokee Indian Hospital, patients are assigned a core team, which typically includes a primary care physician or a family nurse practitioner as well as a case manager and a scheduler. Three core teams share a nutritionist, a pharmacist and a behavioral health specialist. Pictured (left to right) are certified nursing assistant Katelynn Sides, registered nurse Nicole Dyck, family nurse practitioner Tracy Birchfield and licensed practical nurse Crissy Smith.(Katja Ridderbusch for KHN)

Could It Work Everywhere?

It is uncertain if self-governance would work for tribes such as the Rosebud Sioux or the Oglala Lakota on the Pine Ridge Indian Reservation, where geographic isolation, poverty and a lack of resources make new health care investments difficult.

“It’s a huge challenge, but it’s possible,” said Warne, adding that philanthropy or partnerships with an academic health system might help finance such projects.

Not too long ago, tribal officials from South Dakota visited the Cherokee Indian Hospital. Despite their geographic and socioeconomic challenges, Cooper said, he believes self-determination is essential for their future. “Self-determination works. Self-determination is the right thing. And self-determination is the catalyst to restoring the health of our communities.”

Yet many of the South Dakota tribal leaders remain skeptical. They are concerned that self-determination would let the federal government off the hook from its responsibility to provide health services.

Therefore, the Rosebud Sioux took a different route. Instead of just parting ways with the IHS, they sued the federal government for violating treaties. The case is pending in court.

A Conservative Group Paints Trump’s Drug-Pricing Experiment As ‘Socialist.’ Is It?

As part of its effort to curb high prescription drug costs, the Trump administration is considering an experiment that has triggered strong opposition from Americans for Tax Reform, Grover Norquist’s powerful conservative organization, which the president typically counts among his supporters.

One of the most visible elements of the group’s battle plan is a nationwide commercial, on which it has spent almost half a million dollars, according to estimates by ad tracker It has been on the air since May.

The Americans for Tax Reform’s ad begins with President Donald Trump saying, “America will never be a socialist country.”

It then quickly pivots to take aim at the administration.

“You’re right, Mr. President,” the ad continues. “But the Department of Health and Human Services is considering a plan to adopt socialist price controls from foreign countries.”

That led us to wonder if the organization’s take is an accurate description.

The ad is referring to an initiative being considered by the administration that would be part of the president’s promise to curb high drug prices. Though not expected to launch until 2020 at the earliest, it would test-drive the effectiveness of setting price limits on what the federal government pays for prescription drugs. It would tie some payments in Medicare Part B — which covers hospital and physician-administered drugs — to prices charged in other countries, mostly in Europe. The trial would be limited to brand-name medicines that are responsible for a high percentage of Part B spending.

We contacted Americans for Tax Reform to find out the basis for this claim. John Kartch, a spokesman, said “price controls themselves are socialist” and argued that they constitute a “fundamental building block of state control of the economy.”

But independent experts we spoke to said this characterization, while politically powerful, is misleading.

“Socialism,” as defined by Merriam-Webster, involves “collective or governmental ownership and administration of the means of production and distribution of goods.” In this case, the label doesn’t accurately reflect distinctions in how different countries handle drug pricing and neglects to consider important context about the American pharmaceutical market.

The International Pricing Index

HHS is still deciding which countries it might include in its “international pricing index,” or IPI. Under consideration are Austria, Belgium, Canada, the Czech Republic, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, the Netherlands and the United Kingdom.

Some of those nations may use strategies that could be termed “socialist.” Also on the list, though, are countries that use market-based approaches, experts said.

“Each of these countries has a complex set of decision points, and they’re not the same,” said Stacie Dusetzina, associate professor of health policy at Vanderbilt University.

In Germany, for instance, the first year a drug is on the market, the manufacturer can set its own price. After that, an independent board assesses the drug’s added clinical value, which is used to determine what the country’s nonprofit insurance plans — known as sickness funds — will pay. That, drug pricing experts said, is hardly “socialism.”

Even the “price control” phrasing is suspect, some argued.

That’s because, while the IPI countries vary in strategy, many do not dictate what a pharmaceutical company charges for a drug, said Rachel Sachs, an associate professor of law at Washington University in St. Louis who studies drug pricing. Rather, she said, they are simply saying what the national insurance plan will pay.

Some of the countries in question also maintain private insurance systems beyond the government plan. For instance, in Canada, people have options, depending on the province where they live, of various forms of public and private prescription drug coverage, which differ in generosity. Therefore, what the government pays for a drug doesn’t necessarily dictate arrangements negotiated between drug companies and other insurers.

Plus, experts said, the advertisement’s framing ignores the role the U.S. government already plays in shaping the pharmaceutical market.

Currently, Medicare Part B cannot negotiate lower prices, and it is required to cover drugs that come to market. Drug patents, meanwhile, give manufacturers monopolies over their products for a set period — and the power to charge higher prices. Together, that means the government has no bargaining power, while drugmakers can set the prices where they want.

“We really need to take a look at our own system, and it’s quite far removed from a free market,” said Ameet Sarpatwari, an epidemiologist and lawyer at Harvard Medical School, who studies drug-pricing regulations.

Some argued that incorporating the IPI into Medicare Part B payments might inject more, not less, competition into the current payment system. The administration has made this argument, too. For instance, when we contacted HHS for comment, a spokeswoman directed us to this speech by Secretary Alex Azar as well as this  December blog post, both of which outline how this approach would strengthen the U.S. bargaining position by setting Medicare’s rates more in line with those of other nations.

Finally, there’s the issue of whether the United States would actually be “adopting” strategies used by other countries. Using their prices as a reference point isn’t the same thing as importing their regulatory system.

A Broader Conversation

The “socialist price control” label is one of a few commonly deployed arguments against efforts to curb drug prices — one that’s “effective but misleading,” Sarpatwari argued.

Other claims in the advertisement — that HHS’ proposal would reduce pharmaceutical innovation and limit access to lifesaving medical treatments — are also popular attack lines.

There isn’t a good body of research to suggest this would happen. Sachs suggested that, if prices come down, there would likely be some impact on either drug access or innovation. Assessing the magnitude of those changes is difficult at best, though. And, she said, it would be balanced against people who are, under the changed system, newly able to afford treatment.

Among other challenges, experts noted, would be obtaining accurate data about what other countries pay for drugs. Another: finding a strategy to force manufacturers to accept the lower price.

But those aren’t concerns Americans for Tax Reform chose to emphasize. Given the experimental nature of what the administration is considering, they’re also issues HHS could learn from and address based on how things go, Dusetzina said.

Our Ruling

The advertisement in question claims that HHS “is considering a plan to adopt socialist price controls from foreign countries.”

HHS is weighing a strategy that would take into account prices paid in other countries to set amounts paid by the Medicare program. But the advertisement’s language — in particular, the phrase “adopt socialist price controls” — is reductive, inaccurate and misleading, experts said. These strategies do not necessarily constitute “price controls.” And while some could conceivably be viewed as “socialist,” it is inaccurate to suggest all of them are.

Furthermore, the claim ignores important context about the American drug-pricing market.

This claim contains an element of truth but ignores critical facts — and is in some cases actively misleading. We rate it Mostly False.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! As you all know, when I come across an outrageous medical mystery story I like to drag you all down with me because horrified misery loves company. This week’s offering: A man in Kentucky went into his doctor complaining of eye irritation. And what did his doctor pull out of his eyeball? That’s right! A tick. (You’re welcome.)

Quickly moving on! Here’s what you might have missed during this very hot week.

The tensions in the Democratic presidential field that have been brewing for a while erupted into verbal sparring between Sen. Bernie Sanders (I-Vt.) and former Vice President Joe Biden. The mini-war seems to be more than just your typical political posturing — both men have deep personal stakes in the issue (which, if you haven’t noticed, voters care a lot about right now). Sanders’ “Medicare for All” plan is nearly synonymous with the man himself, while Biden experienced firsthand the blood, sweat and tears it took to actually get the health law passed.

Earlier in the week, Biden dropped his own health plan, which could be summed up as the Affordable Care Act on steroids. And his promise that went along with the reveal — “If you like your plan … you can keep it” — was a blast-from-the-past that highlights all the advantages (the health law is quite popular at the moment) and pitfalls (that promise when President Barack Obama made it was ranked PolitiFact’s “Lie of the Year”) of taking this particular path.

It also nudged Biden and Sanders into a collision over their philosophical differences that played out in public at various events this week. Neither candidate pulled punches, but Sanders, in particular, had some tough words for his rival. “Unfortunately, he is sounding like Donald Trump,” he said. “He is sounding like the health care industry, in that regard.”

On that note, Sanders called on the Democratic candidates to join his pledge not to take donations from the health industry or pharma. Though he didn’t name names, it seemed to many like another jab at Biden.

Biden also took shots of his own, calling Medicare for All costly and complicated, and insinuating that those looking to get rid of the health law are no better than Republicans.

Whatever the outcome of this particular scuffle, it highlights that, in a crowded field, candidates are looking for things to set them apart. And in this particular election cycle, looks like it’s health care.

CNN: Biden Proposes Massive New Obamacare Subsidies, Public Option in Health Care Plan

The New York Times: Sanders and Biden Fight Over Health Care, and It’s Personal

Politico: Sanders Calls on Democratic Rivals to Reject Drug, Insurance Industry Donations

The New York Times: Anxious Democratic Governors Urge 2020 Field Not to Veer Too Far Left

Meanwhile, the health law faced off against an unlikely foe this week: Democrats. Lawmakers in the House delivered what is in all intents and purposes a death blow to the “Cadillac tax,” a cost-containing provision that at one point in time was looked at as crucial to the law’s success. (The Senate hasn’t voted on it yet, but Republicans are not exactly fans of the tax, so its fate seems decided.)

But as hell has not frozen over, it’s not as if the Democrats are suddenly jumping on the GOP bandwagon to dismantle the law. The tax was disliked by unions (a key constituency) and some liberal-leaning economists. Rep. Joe Courtney (D-Conn.), the author of the repeal bill, even (subtly) called it, the “Middle Class Health Benefits Tax Repeal Act.”

The New York Times: House Votes to Repeal Obamacare Tax Once Seen As Key to Health Law

As a side note, you should be following Noam Levey’s great series on the ways Americans are hurting in the wake of the high-deductible revolution.

Los Angeles Times: Rising Health Insurance Deductibles Fuel Middle-Class Anger and Resentment

The Democratic field’s fireworks over candidates’ philosophical differences weren’t the only ones on display this week. Dr. Leana Wen was ousted from her position as head of Planned Parenthood after only eight months in the role. Although there have been reports about managerial styles, Wen has hinted that the friction comes from her desire to view the organization through a public health prism. During a time when the abortion wars grow only more intense, Wen’s strategy to emphasize abortion as part of a larger part of improving women’s health felt out of step to some.

The New York Times: A Messy Exit Leaves Planned Parenthood at a Philosophical Crossroads

As if underscoring that very tension, the ousting came as the Trump administration announced that the changes to family planing funding, often called a “gag rule” by critics, would be enforced immediately, now that it has the court’s go-ahead.

The Associated Press: Trump Abortion Restrictions Effective Immediately

After a yearlong legal battle, The Washington Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, obtained information from a Drug Enforcement Administration database that shows how 76 billion oxycodone and hydrocodone pain pills saturated the country as the opioid epidemic was gaining steam. Just six companies distributed 75% of the pills from 2006 to 2012, sending millions of pills into tiny rural towns with only a few thousand residents. The numbers reveal a trail of bright, screaming red flags that were overlooked as the country barreled toward a crisis point.

The Washington Post: Largest U.S. Drug Companies Flooded Country With 76 Billion Opioid Pills, DEA Data Shows

PBS NewsHour: The Opioid Industry Fought Hard to Keep This Database Hidden. Here’s What It Shows

There was some rare good news on the opioid front this week: For the first time since 1990, fatal drug overdoses actually fell. There are (of course!) caveats, though: Experts still see worrying trends when it comes to synthetic drugs such as fentanyl.

The Washington Post: Drug Overdoses Fell Significantly in 2018 for First Time in Decades, Provisional CDC Data Show

Everyone in Congress and the administration is really, very, extremely angry about high drug prices … and yet pharma is still racking up the wins on Capitol Hill. Stat has a great read on exactly what’s going on with the industry’s influence, and looks at a new strategy from drugmakers, who seem to be targeting a pair of vulnerable Republicans to get their way.

Stat: How Pharma, Under Attack From All Sides, Keeps Winning in Washington

In a landscape where everyone is jonesing to cut costs, why is it so breathtakingly easy to scam insurers? Some investigators estimate that fraud eats up 10% of all health care spending. Consumers’ gut reaction is that insurers would, of course, be stepping in to police these bad actors. But they don’t seem to have any desire — or, at least, not enough — to actually act. Maybe that’s because consumers are the ones getting stuck with the losses.

ProPublica: Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You.

Speaking of, a former VA employee who was supposed to help veterans navigate insurance for their kids who had spina bifida used the position to collect millions in kickbacks, prosecutors allege.

The Daily Beast: Feds Say Former VA Employee Used Vets’ Ailing Kids to Scam Millions

A lot of very cool (or at least interesting) news came out of the Alzheimer’s Association International Conference this week. A look at highlights:

Los Angeles Times: Blood Test for Alzheimer’s Disease Moves Closer to Becoming a Reality

CNN: Lifestyle Can Still Lower Dementia Risk Even If You Have High Genetic Risk, Study Suggests

The Washington Post: Women Who Work for a Salary See Slower Memory Decline in Old Age, Reducing Their Risk of Dementia, a New Study Suggests

And in the miscellaneous file:

• What’s it like to be a Border Patrol agent? Because access to them can be tightly controlled, it’s rare to hear about their experiences. This story contains a chilling, yet fitting musing: “Somewhere down the line people just accepted what’s going on as normal.”

ProPublica: A Border Patrol Agent Reveals What It’s Really Like to Guard Migrant Children

• It’s one of health care’s biggest challenges: weaning people off the habit of going to the ER instead of a primary care doctor. Well, New York City is going to invest $100 million a year to try to do just that.

The Wall Street Journal: New York City Hopes to Ease Strain on Its Emergency Rooms

• More than 200,000 kids in Tennessee were either cut or slated to be cut from insurance because the state’s unwieldy system heavily relied on hard-copy forms.

The Tennessean: At Least 220,000 Tennessee Kids Faced Loss of Health Insurance Due to Lacking Paperwork

• Do service dogs actually help veterans with PTSD? Although there are plenty of heart-warming anecdotal stories about the benefits, doctors in the VA are hesitant to recommend them over treatment that has been shown to work because there’s little hard science on their benefits. The thing is, the VA is supposed to be doing research on it. Yet, for some reason, it’s been lagging, despite the burgeoning mental health crisis among veterans.

The New York Times: Do Service Dogs Help Treat PTSD? After Years of Research, the V.A. Still Doesn’t Know

• A look at law enforcement in Alaska, where violence against women is gaining national attention, shows that dozens of convicted criminals have been hired as cops for these communities. In one small village, every single policeman on the force, including the chief, has a criminal record of domestic violence.

ProPublica/Anchorage Daily News: The Village Where Every Cop Has Been Convicted of Domestic Violence

That’s it from me! Try to stay cool and make sure to hydrate this weekend!

Prominent Vaping Researcher Asks For Study Linking E-Cigarettes To Heart Attacks To Be Retracted

The spat is over a study that claimed adult vaping was “associated with” a doubled risk of heart attack. Brad Rodu, a University of Louisville professor, says that when he obtained the federal data, he found the majority of the 38 patients in the study who had heart attacks had them before they started vaping. In other news, Juul has hired a prominent researcher known for his work on nicotine and the adolescent brain.

What Role Do Seizures Play In Alzheimer’s? Perhaps They Were Once Overlooked, But Now Researchers Say They Might Cause Dementia

Several unpublished studies getting attention at the Alzheimer’s Association International Conference this week point to new research on people who have gone on to develop Alzheimer’s after having seizures. News on the disease also looks at how exercise might help and potential links to infections.

A ‘Smart Pill’ To Help Patients Remember To Take Meds Was Touted As New Era In Care. Now Researchers Are Pushing Back.

The researchers argue that the evidence used to approve the product — called Abilify MyCite — was not only weak, but failed to demonstrate the technology improves adherence, a key point if the goal is to improve health outcomes. In other public health news: neuron research, seasickness, surgery, scooter safety, broken heart syndrome, and more.

Dangerous Heat Wave In Midwest, Along East Coast Prompts Officials To Find Ways To Protect Vulnerable Homeless, Seniors

Around the country, cities are mobilizing outreach teams, armed with supplies of water, to check on residents living on the streets or in housing without air conditioning. “We are treating this as the emergency it is,” said Josh Kruger, communications director for the Philadelphia Office of Homeless Services. In the District of Columbia, where the heat index is supposed to reach 115 this weekend, the mayor has declared a state of emergency and is keeping shelters open round the clock so people can try to cool off.

UnitedHealth Reverses Course, Approves Coverage For $2.1 Million Gene Therapy For Family Racing Against Clock

Lauren Sullivan, whose 21-month-old daughter, Daryn, had been trying to appeal UnitedHealth’s initial refusal and was running out of time to receive the drug before her second birthday in October, when the drug has to be administered. The company also approved claims for three other patients. In other news, UnitedHealth beats expectations for the quarter, prompting company to boost earnings guidance.