From Medicine and Health

First Edition: March 29, 2017

Mar 29 2017

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

Kaiser Health News: Justice Department Joins Lawsuit Alleging Massive Medicare Fraud By UnitedHealth
Fred Schulte reports: “The Justice Department has joined a California whistleblower’s lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans. Justice officials filed legal papers to intervene in the suit, first brought by whistleblower James Swoben in 2009, on Friday in federal court in Los Angeles. On Monday, they sought a court order to combine Swoben’s case with that of another whistleblower.” (Schulte, 3/29)

Kaiser Health News: March Madness Vasectomies Encourage Guys To Take One For The Team
KQED’s April Dembosky reports: “Doctors say it all started eight years ago, when a urology clinic in Oregon ran an ad promoting the benefits of scheduling a vasectomy in March. “You go in for a little snip, snip and come out with doctor’s orders to sit back and watch nonstop basketball,” the voice-over promised. “If you miss out on this, you’ll end up recovering during a weekend marathon of ‘Desperate Housewives’!” (Dembosky, 3/28)

Kaiser Health News: Lead Poisoning’s Lifelong Toll Includes Lowering Social Mobility, Researchers Find
Shefali Luthra reports: “Findings published Tuesday in JAMA break new ground by suggesting the effects of childhood lead exposure continue to play out until adulthood, not only harming an individual’s lifelong cognitive development, but also potentially limiting socioeconomic advancement. Specifically, Duke University researchers tracked a generation of kids based on data collected through a nearly 30-year, New Zealand-based investigation known as the Dunedin Multidisciplinary Health and Development Study.” (Luthra, 3/28)

Kaiser Health News: On The Air With KHN: What’s Next For The Affordable Care Act?
On Friday, House Republican leaders failed to secure enough support to pass their plan to repeal and replace the Affordable Care Act. Reporters with Kaiser Health News and California Healthline (produced by KHN) have appeared on numerous radio and television shows in recent days to assess what’s next for the health law. Listen to what they had to say below. (3/28)

The New York Times: Repeal Of Affordable Care Act Is Back On Agenda, Republicans Say
Under extreme pressure from conservative activists, House Republican leaders and the White House have restarted negotiations on legislation to repeal the Affordable Care Act. But efforts to revive the legislation in the House could take weeks, lawmakers conceded, as Congress moves forward with a full plate of other time-consuming issues. And the renewed push did not meet with much enthusiasm from Senate Republicans, who said they had other priorities at the moment. (Pear and Peters, 3/28)

The Associated Press: Ryan Says House To Revisit Health Care, Offers No Details
Speaker Paul Ryan said Tuesday he’s going to give battered House Republicans another crack at a health care overhaul. But he offered no timeline, and leaders haven’t resolved how to overcome the deep GOP divisions that crumpled their legislation last week in a humiliating retreat for themselves and President Donald Trump. (3/28)

USA Today: House Republicans Say They Are Still Negotiating Obamacare Repeal
After the failure of the bill and some weekend reflection, Freedom Caucus Chairman Mark Meadows, R-N.C., and his caucus are trying to do things differently. The group is working with leadership and moderate Republicans to try to bring back the bill in a different form. Meadows had a meeting with Ryan on Tuesday, which was unusual because the Freedom Caucus had largely gone around leadership during the negotiation process and dealt directly with the White House. (Collins, 3/28)

The Associated Press: Senate, White House Pass On House Push To Revive Health Bill
Senate Majority Leader Mitch McConnell, R-Ky., made his views clear after a closed-door lunch with fellow Senate Republicans and Vice President Mike Pence. “It’s pretty obvious we were not able, in the House, to pass a replacement. Our Democratic friends ought to be pretty happy about that because we have the existing law in place, and I think we’re just going to have to see how that works out,” McConnell said. “We believe it will not work out well, but we’ll see.” (3/28)

Politico: GOP On Reviving Obamacare Repeal: Lots Of Talk, No Action
[L]awmakers and aides acknowledge the odds are not in their favor. The conference is still deeply divided, and members are seething over the demise of their replacement bill — with most fingers pointing at members of the arch-conservative Freedom Caucus. During a meeting with several dozen whips Monday night, Republican allies of leadership vented about how they want to punish members of the conservative group who “don’t play with the team.” (Bade, Cheney and Bresnahan, 3/28)

Politico: Roskam Rejects Bid To Revive Failed GOP Obamacare Repeal Bill
Rep. Peter Roskam (R-Ill.), a former member of House Republican leadership, is leading a charge to bury Speaker Paul Ryan’s Obamacare replacement once and for all and start over, multiple sources told POLITICO. The move by the senior House Republican who sits on the Ways and Means committee could complicate any GOP leadership attempt to resurrect the bill that Ryan pulled from the floor Friday. (Bade and Bresnahan, 3/28)

Politico: Trump Tells Senators: We Can Deal On Health Care ‘Very Quickly’
President Donald Trump still sees a deal on health care. In fact, he told senators he has “no doubt that that’s going to happen very quickly.” Speaking in brief remarks at a White House reception for senators and their spouses, Trump brushed off the recent collapse of a House-led bill to repeal and replace Obamacare. (Jackson, 3/28)

The Washington Post: Here’s When We’ll Know The Future Of Obamacare
President Trump and his fellow Republicans have failed, at least for now, in their bid to repeal Obamacare entirely, but they still have plenty of ways to cripple the law without pulling it off the books. By blocking funding for subsidies or refusing to enforce the individual mandate, the administration and congressional Republicans could undermine the law’s insurance exchanges — government-established marketplaces where individuals can buy health insurance from private companies, often with the help of federal subsidies. The exchanges and an expanded Medicaid program are the main programs in Obamacare, officially known as the Affordable Care Act, aimed at expanding coverage to the uninsured. (Johnson, 3/28)

Politico: Trump Could Blow Up Obamacare With One Move
President Trump says that Obamacare is going to explode. But if that happens, it is likely because his administration supplies the spark that detonates the marketplaces. The White House could decide at any time to eliminate subsidies relied upon by insurers to lower costs for Obamacare’s poorest customers, as a result of a court win by House Republicans last spring. (Demko, 3/29)

The Associated Press: Hillary Clinton Calls Defeat Of GOP Health Care Bill ‘A Victory For All Americans’
A spirited Hillary Clinton took on the Trump administration Tuesday in one of her first public speeches since she lost the presidential election, criticizing the country’s Republican leaders on everything from health care to the shortage of women appointees in top administration positions. Cracking jokes about her November defeat and her months out of the limelight since, Clinton spoke to thousands of businesswomen in San Francisco, joking there was no place she’d rather be, “other than the White House.” (Knickmeyer, 3/28)

The Washington Post: Kansas Moves To Expand Medicaid As GOP Legislatures Face Pressure After ‘Trumpcare’ Failure
State lawmakers in this deep-red state on Tuesday did what a year ago would have been unthinkable: They voted to expand Medicaid under the health-care law that Republicans here have railed against for years. … The abrupt reversal in Kansas could be the front edge of a larger shift nationally, as state lawmakers absorb the repercussions of congressional Republicans’ failed attempt to repeal and replace elements of the Affordable Care Act. (DelReal and Somashekhar, 3/28)

Reuters: Kansas Passes Medicaid Expansion Bill Despite Governor’s Objection
The Kansas Senate gave final approval on Tuesday to a bill expanding eligibility for Medicaid under the federal Affordable Care Act (ACA) even though the measure faces a likely veto by Republican Governor Sam Brownback. The 25-14 Senate vote followed the House’s 81-44 passage of the bill last month, with the vote totals falling short of veto-proof margins in both Republican-controlled chambers. (Pierog, 3/28)

The Wall Street Journal: Kansas GOP-Led Legislature Approves Medicaid Expansion
Legislators said it appears likely Mr. Brownback would veto the bill. “To expand Obamacare when the program is in a death spiral is not responsible policy,” Melika Willoughby, the communications director for Mr. Brownback, said in an emailed statement after the vote Tuesday. “Kansas must prioritize the care and service of vulnerable Kansans, addressing their health care needs in a sustainable way, not expanding a failing entitlement program to able-bodied adults.” (Levitz and Mahtani, 3/28)

The Associated Press: Felony Charges For 2 Who Secretly Filmed Planned Parenthood
California prosecutors on Tuesday charged two anti-abortion activists who made undercover videos of themselves trying to buy fetal tissue from Planned Parenthood with 15 felonies, saying they invaded the privacy of medical providers by filming without consent. The charges against David Daleiden and Sandra Merritt of the Center for Medical Progress come eight months after similar charges were dropped in Texas. (Dalton, 3/29)

The Washington Post: Two Activists Who Filmed Undercover Videos Of Planned Parenthood Charged With 15 Felonies
In announcing the charges against David Robert Daleiden and Sandra Merritt on Tuesday, California Attorney General Xavier Becerra said the duo used manufactured identities and a fictitious bioresearch company to meet medical officials and covertly record the private discussions they initiated. “The right to privacy is a cornerstone of California’s Constitution, and a right that is foundational in a free democratic society,” Becerra said. “We will not tolerate the criminal recording of confidential conversations.” (Schmidt, 3/29)

Los Angeles Times: Antiabortion Activists Face 15 Felony Charges Over Undercover Videos That Targeted Planned Parenthood
An affidavit filed in San Francisco Superior Court alleges that Daleiden and Merritt used phony California driver’s licenses and a fabricated medical research company, BioMax Procurement Services, to attend the National Abortion Federation’s 2014 conference in San Francisco. At the conference, the pair posed as BioMax representatives, offered fake names and surreptitiously recorded eight attendees and speakers, according to court papers. (Hamilton, 3/28)

Politico: California Charges Creators Of Planned Parenthood Undercover Videos
Daleiden’s sting videos, released two years ago through the Center for Medical Progress, accused Planned Parenthood clinics of profiting from the sale of fetal tissue. Planned Parenthood has strongly denied the accusations, and numerous investigations into the organization since the videos were released haven’t found any wrongdoing. The videos strengthened efforts in Congress to cut off federal funding to Planned Parenthood — efforts that are still underway. (3/28)

The Associated Press: Iowa Republicans Back ‘Fetal Heartbeat’ Abortion Legislation
Republicans in the Iowa Legislature are backing newly filed legislation that would ban abortions once a fetal heartbeat is detected, which would be the strictest ban in the country if enacted. A GOP-led House committee had been set to vote on the provision Tuesday night but lawmakers later adjourned without a decision. It’s expected to be taken up again Wednesday. (3/28)

The New York Times: Severe Eczema Drug Is Approved By F.D.A.; Price Tag Is $37,000 A Year
The Food and Drug Administration on Tuesday approved a drug to treat people with a serious form of eczema, a potential breakthrough for people who have suffered for years without relief. But it will not come cheap. The drug, to be called Dupixent, will carry a list price of $37,000 a year, a hefty price tag for patients who are increasingly being asked to pay a larger share of the drugs they take. (Thomas, 3/28)

The Associated Press: FDA Approves 1st Drug For Moderate & Severe Eczema Cases
The drug is an antibody that patients inject just under the skin every two weeks. It binds to a specific protein to inhibit the immune system’s inflammatory response. That’s why in many study participants, Dupixent also improved the asthma and hayfever common in eczema patients. It’s now in late-stage patient testing as an allergy treatment. (Johnson, 3/28)

The New York Times: F.D.A. Approves First Drug To Treat Severe Multiple Sclerosis
The Food and Drug Administration approved on Tuesday the first drug to treat a severe form of multiple sclerosis, offering hope to patients who previously had no other options to combat a relentless disease that leads to paralysis and cognitive decline. The federal agency also cleared the drug to treat people with the more common, relapsing form of the disease. (Thomas, 3/28)

The Wall Street Journal: FDA Approves Drug For Primary Progressive Multiple Sclerosis
“This is an historic day for the MS community with the approval of the first-ever treatment for people living with primary progressive MS. This is a real game-changer,” said Cyndi Zagieboylo, president and chief executive of the National MS Society. “The National MS Society hopes this is just the beginning of the development of the next generation of treatments for MS.” (Burton, 3/28)

The Wall Street Journal: FDA Nominee Plans Recusals From Decisions On Many Drug Firms
The Trump administration’s nominee to lead the Food and Drug Administration plans to recuse himself for a year from FDA decisions on more than 20 companies, including some drug giants. Scott Gottlieb in recent years has held positions and received millions of dollars in income as adviser, executive, paid speaker or consultant to the companies, according to financial-disclosure documents he has filed with government ethics officials. (Burton, 3/29)

The Wall Street Journal: Senator McCaskill Begins Probe Of Prescription Opioid Marketing
An influential Democratic lawmaker has begun a probe into the marketing of opioid drugs, sending letters to Purdue Pharma LP, Johnson & Johnson and other big sellers of the pain medicines for materials detailing sales practices. Sen. Claire McCaskill (D.-Mo.), the top-ranking Democrat on the Senate Homeland Security and Governmental Affairs Committee, said she aims to clarify “the challenges industry practices pose to efforts to curb opioid addiction.” (Rockoff, 3/28)

The Washington Post: Opioid Crisis: McCaskill Demands Documents From Manufacturers
Sen. Claire McCaskill of Missouri demanded information Tuesday from five top opioid manufacturers, saying she would investigate their alleged role in the drug epidemic responsible for more than 200,000 overdose deaths since 2000. “This epidemic is the direct result of a calculated sales and marketing strategy major opioid manufacturers have allegedly pursued over the past 20 years to expand their market share and increase dependency on powerful — and often deadly — painkillers,” McCaskill, who is the ranking Democrat of the Homeland Security and Governmental Affairs Committee, wrote to company executives. (Bernstein and Higham, 3/28)

USA Today: Suburban Drug Overdoses Fuel Spike In Premature Death Rate
Premature deaths among those aged 25-44 were way up in 2015, due in large part to a surge of drug overdoses in suburban areas, a report out Wednesday shows. Drug deaths are also accelerating among 15- to 24-year-olds, but almost three times as many people in this age group died by homicide, suicide or in motor vehicle crashes, according to the new report from the Robert Wood Johnson Foundation (RWJF). A rural and urban divide, along with racial differences, were also evident in the data. Young white adults in rural areas were more likely to die by suicide or overdose, while homicides by firearms were much more common for young black victims. (O’Donnell, Gluck and Carter, 3/29)

The New York Times: In School Nurse’s Room: Tylenol, Band-Aids And An Antidote To Heroin
At every school in New Rochelle, just north of the Bronx, in Westchester, there is a locked medicine cabinet in the nurse’s office, stocked with things like EpiPens for allergic reactions, inhalers for asthma, Tylenol for aches and pains. Now, those cabinets also include naloxone, an antidote for people who are overdosing on opioids like heroin. Given as an injection or a nasal spray, naloxone can quickly revive someone who is not breathing. The city keeps it in every nurse’s office, including in its elementary schools. (Harris, 3/29)

NPR: Lead Exposure In Childhood May Blunt Thinking Skills For Decades
“It’s toxic to many parts of the body, but in particular in can accumulate in the bloodstream and pass through the blood brain barrier to reach the brain,” says the study’s first author, Aaron Reuben, a graduate student in clinical psychology at Duke University. (Bichell, 3/28)

The New York Times: Costly Doctors Don’t Provide Better Care
Doctors who tend to spend more in treating hospitalized patients do not get better results than those who spend less, a new study has found. Researchers examined spending records of 72,042 physicians at more than 3,000 acute care hospitals. The patients were fee-for-service Medicare beneficiaries 65 and older treated between January 2011 and the end of 2014. (Bakalar, 3/28)

The Washington Post: This Woman Is Growing A Second Skeleton — And It’s Locking Her Inside Her Own Body
Jasmin Floyd was on her way to kindergarten in northeastern Connecticut, buckled into the back seat of her mother’s car. On the way, she called out, “Mommy, my neck hurts,” her mother, RoJeanne Doege, recently recalled. Doege said she peered through the rearview mirror and tried to reassure her, “Honey, it’s probably just how you slept. ”But it wasn’t — and, not long after that, Floyd’s father noticed that their 5-year-old’s neck was tilted ever so slightly to the side. (Bever, 3/28)

The Washington Post: Should ‘Morning-After’ Pills Be Available On College Campuses Around The Clock?
Sarah Riback doesn’t have personal experience with getting the pills on campus. But the 19-year-old at the University of Maryland knows peers who have needed them. “This is a common thing that a lot of other female students have had to do,” she said. She’s talking about emergency contraception. Riback and other advocates say morning-after pills should be available on college campuses at all hours. At U-Md., they’re available at a student health center pharmacy that is open 36 hours a week, Monday through Friday. (Larimer, 3/28)

Los Angeles Times: Hepatitis B And C Can Be Wiped Out In The U.S. By 2030. Here’s How
Health experts have devised an aggressive plan to stamp out a viral disease that is fueling a sharp rise in liver cancer in the United States and killing 20,000 Americans per year. Their national strategy for eliminating two types of hepatitis by 2030 hinges on persuading the federal government to purchase the rights to one or more of the costly new medications that can essentially cure hepatitis C. (Healy, 3/28)

Los Angeles Times: California GOP Lawmakers Introduce Bills To Boost Healthcare And Jobs For Veterans
Republican state lawmakers unveiled a package of six bills Tuesday aimed at improving job training and healthcare services for California veterans. “Our veterans have served this country bravely and it is only right for us to recognize their contribution and see that when they do come home they receive the care and assistance they deserve,” said state Sen. Janet Nguyen of Garden Grove, who authored three of the measures. (Dillon, 3/28)

NPR: Scientists Replicate Female Reproductive System In A Dish To Aid Research
Scientists say they’ve made a device in the lab that can mimic the human female reproductive cycle. The researchers hope the device, assembled from living tissue, will lead to new treatments for many medical problems that plague some women, ranging from fibroids and endometriosis to infertility, miscarriages and gynecologic cancers. (Stein, 3/28)

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

March Madness Vasectomies Encourage Guys To Take One For The Team

Doctors say it all started eight years ago, when a urology clinic in Oregon ran an ad promoting the benefits of scheduling a vasectomy in March.

“You go in for a little snip, snip and come out with doctor’s orders to sit back and watch nonstop basketball,” the voice-over promised. “If you miss out on this, you’ll end up recovering during a weekend marathon of ‘Desperate Housewives’!”

Copycat ads followed. Now a sports radio show in Washington, D.C., has an annual Vasectomy Madness contest, where the prize is a free vasectomy.

Here’s how it works: Three guys come on the air to make their cases for getting snipped. The announcers ruthlessly roast them, and then listeners vote on their favorite.

“All right, let’s bring in our next contestant,” a host said. “I believe it’s Abe from Warrenton, Va. So tell us your story. Why are you here?”

Abe has three kids, ages 9, 6 and 3.

“Another one — surprise! Due in July,” Abe said. “I was shopping after the third for a vasectomy and, like a dope, dragged my feet.”

There’s Mike, also expecting his fourth child — also a surprise.

“My wife and I have had enough,” he pleaded. “We need help to stop the flow.”

And then there’s Charles.

“Four kids. Three different women,” Charles said, inspiring a roar of jeers from the hosts.

Procrastination can be so common with the “Big V” that it takes a panel of sports jocks offering a free procedure for some guys to finally let a doctor take a scalpel to their nether regions.

That may be one reason vasectomy rates are low: About 5 percent of women rely on their partner’s vasectomy for contraception, unchanged from a decade ago. The Centers for Disease Control and Prevention’s National Survey of Family Growth compares that to 20 percent of women who have had a sterilization procedure, even though women’s surgery is more invasive and more expensive.

“Men are culturally the providers. It’s hard for them to seek care,” said Dr. Paul Turek, a California urologist. “They don’t know how to be a patient.”

Turek has clinics in San Francisco and Beverly Hills. He sees an uptick in vasectomy visits during March Madness, and he’s also noticed more guys coming in together.

“One group came in from a tech company in a limousine,” he said.

Last year, five college buddies scheduled a group vasectomy in March. They live all over the U.S. now, and one of them had an idea to reunite in San Francisco and undergo the outpatient procedure together.

“I gave ’em a deal,” Turek said. “I closed the doors. We had sports TV on. They were having fun.”

As each guy returned to the waiting room, he was greeted with fist bumps and high-fives. Then the men hobbled back to their hotel to bet on the games and yell at the television together.

Turek made an interesting observation during that bro basketball weekend: The friends seemed to recover faster than his typical patients.

“They had no complaints,” he said. “They were back at work sooner. They took fewer pain pills. It was the best anesthesia, having their buddies with them.”

Turek gives all his vasectomy patients a certificate of honor for “uncommon bravery and meritorious performance.”

There is another theory about why vasectomies aren’t more popular: the cost. The Affordable Care Act requires insurers to cover contraceptives without charging out-of-pocket costs. But vasectomies weren’t included in the rule. The procedure costs about $500, but some doctors charge up to $1,000.

That’s why Charles subjected himself to the free vasectomy contest at the D.C. radio station. His insurance covers a portion of the procedure, “but I’d still have to pay my deductible, which is, like, a thousand bucks.”

Vasectomy was overlooked in Obamacare because, under the law, birth control was considered a women’s health service.

“Right now the policy says to a couple: Your insurance will cover birth control without any out-of-pocket costs on your end, as long as it’s the woman who’s using it,” says Adam Sonfield, senior policy manager at the Guttmacher Institute.

Last year, 12,000 people signed a petition asking regulators to cover vasectomy without cost sharing. Doctors’ groups even drafted language to this effect to add to the regulations.

But when the Trump administration took over, it told the groups to stop trying, according to Aaron Hamlin, executive director of the Male Contraception Initiative.

“The birth control benefit has been under pretty much continual political attack since the ACA was enacted,” said Sonfield.

So for now that leaves guys like Charles, Mike and Abe vying for a free March Madness vasectomy. The winner in the end?

Abe — one of the guys expecting his fourth child.

His prize came with a catch, though. He will have to let one of the sportscasters come to his appointment, to broadcast a “play-by-play.”

This story is part of a partnership that includes KQED, NPR and Kaiser Health News.

Categories: Cost and Quality, Health Industry, Public Health, The Health Law

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On The Air With KHN: What’s Next For The Affordable Care Act?

On Friday, House Republican leaders failed to secure enough support to pass their plan to repeal and replace the Affordable Care Act. Reporters with Kaiser Health News and California Healthline (produced by KHN) have appeared on numerous radio and television shows in recent days to assess what’s next for the health law. Listen to what they had to say below.

National Media

NPR’s All Things Considered with Mary Agnes Carey (March 25):


CNN’s Smerconish with Mary Agnes Carey (March 25):


WBUR’s On Point with Mary Agnes Carey (March 27):

https://kaiserhealthnews.files.wordpress.com/2017/03/032717-on-point_carey.mp3


WAMU’s 1A with Julie Rovner (March 27):

Click here to listen to the segment.


WBUR’s Here & Now with Julie Rovner (March 27):

https://kaiserhealthnews.files.wordpress.com/2017/03/032717-here-now_rovner.mp3


PBS NewsHour with Mary Agnes Carey (March 27):

[embedded content]


California Media

KCRW’s The Mixer with Anna Gorman (March 24):

https://kaiserhealthnews.files.wordpress.com/2017/03/032417-kcrw_gorman.mp3


KQED’s The California Report with Pauline Bartolone (March 27):

https://kaiserhealthnews.files.wordpress.com/2017/03/032717-kqed_bartolone.mp3


KPCC’s Air Talk with Chad Terhune (March 27):

https://kaiserhealthnews.files.wordpress.com/2017/03/032717-kpcc_terhune.mp3

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

Justice Department Joins Lawsuit Alleging Massive Medicare Fraud By UnitedHealth

The Justice Department has joined a California whistleblower’s lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans.

Justice officials filed legal papers to intervene in the suit, first brought by whistleblower James Swoben in 2009, on Friday in federal court in Los Angeles. On Monday, they sought a court order to combine Swoben’s case with that of another whistleblower.

Swoben has accused the insurer of “gaming” the Medicare Advantage payment system by “making patients look sicker than they are,” said his attorney, William K. Hanagami. Hanagami said the combined cases could prove to be among the “larger frauds” ever against Medicare, with damages that he speculates could top $1 billion.

UnitedHealth spokesman Matt Burns denied any wrongdoing by the company. “We are honored to serve millions of seniors through Medicare Advantage, proud of the access to quality health care we provided, and confident we complied with program rules,” he wrote in an email.

Burns also said that “litigating against Medicare Advantage plans to create new rules through the courts will not fix widely acknowledged government policy shortcomings or help Medicare Advantage members and is wrong.”

Medicare Advantage is a popular alternative to traditional Medicare. The privately run health plans have enrolled more than 18 million elderly and people with disabilities — about a third of those eligible for Medicare — at a cost to taxpayers of more than $150 billion a year.

Although the plans generally enjoy strong support in Congress, they have been the target of at least a half-dozen whistleblower lawsuits alleging patterns of overbilling and fraud. In most of the prior cases, Justice Department officials have decided not to intervene, which often limits the financial recovery by the government and also by whistleblowers, who can be awarded a portion of recovered funds. A decision to intervene means that the Justice Department is taking over investigating the case, greatly raising the stakes.

“This is a very big development and sends a strong signal that the Trump administration is very serious when it comes to fighting fraud in the health care arena,” said Patrick Burns, associate director of Taxpayers Against Fraud in Washington, a nonprofit supported by whistleblowers and their lawyers. Burns said the “winners here are going to be American taxpayers.”

Burns also contends that the cases against UnitedHealth could potentially exceed $1 billion in damages, which would place them among the top two or three whistleblower-prompted cases on record.

“This is not one company engaged in episodic bad behavior, but a lucrative business plan that appears to be national in scope,” Burns said.

On Monday, the government said it wants to consolidate the Swoben case with another whistleblower action filed in 2011 by former UnitedHealth executive Benjamin Poehling and unsealed in March by a federal judge. Poehling also has alleged that the insurer generated hundreds of millions of dollars or more in overpayments.

When Congress created the current Medicare Advantage program in 2003, it expected to pay higher rates for sicker patients than for people in good health using a formula called a risk score.

But overspending tied to inflated risk scores has repeatedly been cited by government auditors, including the Government Accountability Office. A series of articles published in 2014 by the Center for Public Integrity found that these improper payments have cost taxpayers tens of billions of dollars.

“If the goal of fraud is to artificially increase risk scores and you do that wholesale, that results in some rather significant dollars,” Hanagami said.

David Lipschutz, senior policy attorney for the Center for Medicare Advocacy, a nonprofit offering legal assistance and other resources for those eligible for Medicare, said his group is “deeply concerned by ongoing improper payments” to Medicare Advantage health plans.

These overpayments “undermine the finances of the overall Medicare program,” he said in an emailed statement. He said his group supports “more rigorous oversight” of payments made to the health plans.

The two whistleblower complaints allege that UnitedHealth has had a practice of asking the government to reimburse it for underpayments, but did not report claims for which it had received too much money, despite knowing some these claims had inflated risk scores.

The federal Centers for Medicare & Medicaid Services said in draft regulations issued in January 2014 that it would begin requiring that Medicare Advantage plans report any improper payment — either too much or too little.

These reviews “cannot be designed only to identify diagnoses that would trigger additional payments,” the proposal stated.

But CMS backed off the regulation’s reporting requirements in the face of opposition from the insurance industry. The agency didn’t say why it did so.

The Justice Department said in an April 2016 amicus brief in the Swoben case that the CMS decision not to move ahead with the reporting regulation “does not relieve defendants of the broad obligation to exercise due diligence in ensuring the accuracy” of claims submitted for payment.

The Justice Department concluded in the brief that the insurers “chose not to connect the dots,” even though they knew of both overpayments and underpayments. Instead, the insurers “acted in a deliberately ignorant or reckless manner in falsely certifying the accuracy, completeness and truthfulness of submitted data,” the 2016 brief states.

The Justice Department has said it also is investigating risk-score payments to other Medicare Advantage insurers, but has not said whether it plans to take action against any of them.

Categories: Cost and Quality, Courts, Health Industry, Medicare

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Lead Poisoning’s Lifelong Toll Includes Lowering Social Mobility, Researchers Find

Cynthia Brownfield was lucky. When her daughter, then 2 years old, tested for high levels of lead in her blood, she could do something.

Brownfield, a pediatrician in St. Joseph, Miss., got her home inspected and found lead in the windows. She got them replaced and had her pipes fixed, too. Her daughter, now 12, was probably affected, says Brownfield. But quick action minimized the exposure. Her daughter is now a healthy, fully-functioning preteen.

“We were in the financial position where we could hire a plumber and change the windows,” she said. But others — even her own patients — may not be so fortunate. This reality may have implications even more far-reaching than generally accepted.

Findings published Tuesday in JAMA break new ground by suggesting the effects of childhood lead exposure continue to play out until adulthood, not only harming an individual’s lifelong cognitive development, but also potentially limiting socioeconomic advancement. Specifically, Duke University researchers tracked a generation of kids based on data collected through a nearly 30-year, New Zealand-based investigation known as the Dunedin Multidisciplinary Health and Development Study.

They studied the development of more than 1,000 New Zealanders born between April 1972 and March 1973. Because at that time gasoline still contained lead, exposure was common, creating a sizeable sample that included people across class and gender. More than half in that data set had been tested for lead-exposure at age 11, and the study tracked brain development and socio-economic status over the years — making for “a natural time” to use them to study lead’s health effects, said Aaron Reuben, a PhD candidate in neuropsychology at Duke University, and the study’s first author.

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By the time study participants reached age 38, a pattern emerged: Children who were exposed to lead early in life had worse cognitive abilities, based on how their exposure level. The difference was statistically significant. They were also more likely to be worse off, socioeconomically, than those who had not been exposed to lead. The study found that no matter what the child’s IQ, the mother’s IQ, or the family’s social status, lead poisoning resulted in downward social mobility. That was largely thanks to cognitive decline, according to the research.

“Regardless of where you start out in life, exposure to lead in childhood exerts a downward pull to your trajectory,” Reuben said.

Though this research was set in New Zealand, it offers insight into a problem experts said is fairly ubiquitous in the United States and across the globe. The CDC estimates that as many as half a million children between ages 1 and 5 had blood lead levels high enough to cause concern: 5 micrograms per deciliter and up. At least 4 million households across the country have children experiencing significant lead exposure.

Last year’s water crisis in Flint, Mich., brought lead exposure front and center as a public health concern. Meanwhile, a Reuters investigation published this winter found elevated lead levels in almost 3,000 communities around the country. The Centers of Disease Control and Prevention recently changed its guidelines to suggest that any childhood exposure to the chemical is harmful, and is pushing to get rid of lead poisoning in kids by 2020.

In the U.S., children at risk are typically poorer and racial minorities — in part because they more often live in older houses with lead paint. This is a stark difference from the research population, which tended to be white. However, because the study spanned a period of time in which lead was still used in gasoline, the lead exposure measured in the study spanned a wider class spectrum.

That adds greater consequence to these findings, many said.

“Kids who are poor, or who have some of these other social determinants of health that are negative — they end up with a double whammy. Whatever health consequences they have from being poor, those are added to the additional consequences of being exposed to lead,” said Jerome Paulson, an emeritus professor and pediatrician at George Washington University. Paulson has researched lead’s effects on children, although he wasn’t involved with this study.

“If you want to talk about ‘breaking out of poverty,’ kids who have lead exposure are probably going to have more difficulties,” he added.

That said, these conclusions aren’t perfect. For instance, the research doesn’t account any variation in how the children who were tested may have been previously exposed to lead, or how their continued lead exposure through adulthood may have differed. Those who worked in jobs like construction, for instance, may have had greater lead exposure than those in white-collar jobs, Paulson noted. But on the whole, he said, it makes a strong case for the long-term impact of childhood lead exposure.

Pennsylvania, Maryland and Massachusetts, which all have cities with concentrated areas of older housing, have identified lead poisoning as a major child health hazard. The CDC has also embraced “primary prevention” — testing homes for lead and removing it before people move in and risk exposure. But securing resources for lead testing, screening and abatement poses its own set of challenges.

The JAMA study illustrates, in part, one such difficulty. Lead poisoning happens over years, not overnight. So illustrating the impact, even if it’s ultimately significant, is hard to do.

“Prevention doesn’t have a lot of pizzazz. If you prevent something from happening, it’s a wonderful thing, but it’s hard to measure and take credit for,” said David Bellinger, a neurology professor at Harvard Medical School and a professor in the environmental health department of the university’s public health school, who wrote a commentary that ran alongside the JAMA paper.

And funding for such programs is often unreliable, said Donna Cooper, the executive director of Public Citizens for Children and Youth, a Pennsylvania-based nonprofit that advocates on behalf of young people. For instance, the White House’s initial budget plans would boost some lead abatement funds but slash other grants used for similar purposes. And for many states, she said, even what’s long been available isn’t enough to meet the scope of the concern.

“We have very clear CDC guidance on what should be done, and no money to back it up,” Cooper said. “It ebbs and flows with the headlines.”

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Viewpoints: Short Shrift For Mental Health Coverage; Medicare’s Firewall From ‘Harmful’ Changes

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

Boston Globe: Changing Attitudes Is Harder Than Changing The Law 
Someone trying to access mental health care is twice as likely to be denied coverage by a private insurer than someone seeking surgical or other medical care, according to a survey of 84 insurance plans in 15 states by the National Alliance on Mental Illness. Matt Selig, executive director of Health Law Advocates, a Boston-based nonprofit group that represents low-income residents, said that last year alone his agency opened cases for 158 people who were denied coverage for mental health or substance use treatment, nearly half of them children. (Kevin Cullen, 3/27)

Arizona Republic: McCain Can Stop Cuts To Seniors’ Health Care
The future of Medicare and Medicaid may depend on John McCain. He is one of a handful of Senate Republicans who could serve as a firewall against harmful changes to this crucial program that Arizona seniors rely upon. … Looking down the road, the majority in Congress has also proposed to privatize Medicare and raise the eligibility age from 65 to 67. These actions could reduce health care coverage and increase out-of-pocket costs for Arizona’s 1,134,000 seniors and people with disabilities. (Max Richtman, 3/27)

Los Angeles Times: Note To Republicans: Drop The Crusade Against Planned Parenthood
Millions of Americans who rely on the Affordable Care Act for their insurance coverage dodged a bullet last week when Republican infighting killed a bill by the House GOP leadership to repeal and replace the healthcare law. So, thankfully, did Planned Parenthood. Embedded in the bill was a provision to bar federal funding temporarily for this well-regarded and crucial healthcare provider, which the GOP has tried, obsessively, to dismantle for years. (3/28)

St. Louis Post-Dispatch: Saluting Our Doctors: The Calm Within The Storm
For many, the role of physicians in hospice is especially important — as they attend to patients and families at this most vulnerable time, guiding and comforting them through the toughest decisions they will ever make. What kind of quality of life does the patient want? What side effects can be expected from chemo or certain medications? What’s the best way to deal with pain? It’s a role hospice doctors readily accept. (Dr. Hashim Raza, 3/28)

The New York Times: Training Your Brain So That You Don’t Need Reading Glasses
By middle age, the lenses in your eyes harden, becoming less flexible. Your eye muscles increasingly struggle to bend them to focus on this print. But a new form of training — brain retraining, really — may delay the inevitable age-related loss of close-range visual focus so that you won’t need reading glasses. Various studies say it works, though no treatment of any kind works for everybody. (Austin Frakt, 3/27)

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Perspectives On What Happens Now: Can Obamacare Be Fixed Or Will It Be Left To ‘Explode’?

Opinion writers offer their thoughts on this question, outline ways the health law can be spared and examine the direction in which the political winds could send the ongoing debate.

The Washington Post: Obamacare Is The Law Of The Land. But It’s Still Vulnerable.
House Speaker Paul D. Ryan’s (R-Wis.) decision to pull legislation to reconfigure the nation’s health-care system is a major setback to President Trump and the GOP. For seven years, Republicans promised to repeal and replace Obamacare. Their failure to deliver on this promise exposes intraparty divisions that will not be easily healed. (Eric Patashnik and Jonathan Oberlander, 3/27)

Los Angeles Times: Can Trump Be Stopped From Making Obamacare ‘Explode’?
Supporters of the Affordable Care Act may have celebrated prematurely at the demise last week of the House Republicans’ proposal for its repeal. Yes, the most immediate threat to the future of Obamacare is dead, for now. And in the wake of the House fiasco, President Trump as well as some Senate Republicans have made noises about reaching out to Democrats to shore up the health insurance program. But the Trump White House and congressional Republicans still have it within their power to damage the prospects of health coverage for millions of Americans, whether by actively undermining the Affordable Care Act by administrative fiat or by letting it wither by neglect. (Michael Hiltzik, 3/27)

The Atlantic: Obamacare Won’t Explode Unless Trump Wants It To
The scope of Obamacare’s problems is small, but significant. While health-care costs have been going up less than normal in recent years and premiums for people insured by their employers have also been fairly stable, people who buy their own insurance through the Obamacare marketplaces saw premiums spike by an average of about 25 percent this year. Also, several insurers pulled out of the Obamacare exchanges in the past year, leaving 21 percent of exchange enrollees with just one insurance option and people in Knoxville, Tennessee with potentially no insurers at all. (Olga Khazan, 3/28)

The New York Times: Pushing Obamacare Over The Cliff 
After Republicans pulled their legislation to repeal and replace the Affordable Care Act last Friday, President Trump told The Washington Post, “The best thing politically is to let Obamacare explode.” Or he could light a match. Republicans may have conceded defeat in their legislative effort to get rid of Obamacare, but their guerrilla war to achieve its demise remains underway. (Steven Rattner, 3/28)

The Washington Post: Why Trump Won’t ‘Let Obamacare Explode’
As President Trump licked his wounded ego Friday, he told The Post in an interview, “The best thing politically is to let Obamacare explode.” His Office of Management and Budget director, Mick Mulvaney, echoed that sentiment on “Meet the Press.” (Jennifer Rubin, 3/27)

The Des Moines Register: It’s Time To Embrace And Fix Affordable Care Act
“I have to tell you, it’s an unbelievably complex subject,” President Donald Trump told governors during a meeting last month. “Nobody knew that health care could be so complicated.” Nobody except everyone else. That is why the 2009 Democratic-controlled Congress spent a year debating and ironing out the details of what eventually became the Affordable Care Act. The two-part law and regulations total thousands of pages. Before passage, lawmakers met with insurers, hospitals, physicians and patient advocacy groups to build a consensus for what they all understood was a labyrinthine endeavor. (3/27)

The New York Times: Republicans For Single-Payer Health Care
Without a viable health care agenda of their own, Republicans now face a choice between two options: Obamacare and a gradual shift toward a single-payer system. The early signs suggest they will choose single payer. That would be the height of political irony, of course. Donald Trump, Paul Ryan and Tom Price may succeed where left-wing dreamers have long failed and move the country toward socialized medicine. And they would do it unwittingly, by undermining the most conservative health care system that Americans are willing to accept. (David Leonhardt, 3/28)

Atlanta Journal-Constitution: Post-AHCA, How Health Reform Can Move Forward In Georgia
When Roswell’s Tom Price moved from Congress to the executive branch as secretary of health and human services, he instantly gained the power to reshape much of the way health care works in this country, regardless of what becomes of Obamacare. Ironically, it’s Obamacare that gives him that ability… It also gives Price’s department the authority to grant the states waivers to the law’s requirements for health plans offered on their insurance exchanges, and that’s where this gets interesting. (Kyle Wingfield, 3/27)

WBUR: Can Gov. Charlie Baker Fix Health Care In America?
Republicans have long hyped the need for a replacement bill by sowing the fear that Obamacare is imploding. Yet they hypocritically ignore their own complicity in creating the conditions for failure. Now that their bill has collapsed, the new mantra is to practice saying “I told you so,” in the event their self-fulfilling prophecy comes to fruition. (Lauren Stiller Rikleen, 3/28)

The Washington Post: Why Trump And The GOP Could Fail On Tax Reform, Too
There are many lessons to be learned from the failure of the GOP health-care effort. An important one is that being a businessman, even a successful one, does not prepare you for the complexities of governing, any more than being a successful software engineer means you could easily become a great carpenter. (Paul Waldman, 3/27)

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Different Takes On Who’s To Blame For The Demise Of The House GOP Health Plan

Editorial pages across the country offer their thoughts on the blame game as well as the policies and politics that led to last week’s dramatic outcome.

Los Angeles Times: Healthcare Debacle Results From Republicans Believing Their Own Myths
Donald Trump and congressional Republicans created a political debacle for themselves by believing a set of scare stories about Obamacare that came back to haunt them. It is an object lesson in how false realities ultimately pop like soap bubbles when pricked by plain old truth. There are five fatal fibs the GOP sold to supporters and to themselves. (David Horsey, 3/27)

Boston Globe: In Donald Trump’s Oval Office, The Buck Stops Elsewhere
Since US House Speaker Paul Ryan scrapped last week’s vote on the Republican proposal to replace Obamacare, Trump has blamed different people for its demise, depending on the day. From the Oval Office on Friday, Trump blamed Democrats. On Saturday, Trump asked people to watch a Fox News Channel show on which the host proclaimed, “Paul Ryan needs to step down as speaker of the House.” (Pindell, 3/27)

The Wichita Eagle: Trump’s Ego Costs Him Opportunity On Health Care
When President Trump’s first major governing challenge unexpectedly crystallized last week, his failure to meet it was preordained by his personality. Because he considers himself the center of every universe, an opportunity to step toward greatness was invisible to him. His primary failure wasn’t his inability to persuade the hard-liners in his party to go along with a cobbled-together, cynical and desperate attempt to repeal and replace the Affordable Care Act. Solomon could not have salvaged that wreck. (Davis Merritt, 3/28)

Los Angeles Times: Who’s To Blame For Trump’s Failures? Must Be Paul Ryan
Paul Ryan did it. That’s the argument many of the louder voices on the right are shouting. In the story they tell, the speaker of the House is fully responsible for the GOP’s failure to pass an Obamacare repeal-and-replace bill last week. President Trump should walk across a Havana ballroom like Michael Corleone in “The Godfather Part II,” kiss Ryan on the mouth and say, “I know it was you, Paul. You broke my heart.” (Jonah Goldberg, 3/27)

The Washington Post: This Is Why The Freedom Caucus Called The Shots On Trump’s Health-Care Bill
The Republicans’ failed strategy to repeal and replace the Affordable Care Act is puzzling. Knowing that a more conservative health-care bill would be dead on arrival in the Senate, why did President Trump and House Speaker Paul D. Ryan (R-Wis.) seek the votes of the House Freedom Caucus (HFC), a group of about 30 of the chamber’s most conservative members? Desperate to secure a majority, the White House offered significant last-minute policy concessions to the group — turning off the more centrist members of the Tuesday Group, failing to secure Freedom Caucus votes and dooming the bill. (Ruth Bloch Rubin, 3/27)

The Wall Street Journal: The GOP Entitlement Caucus
The full dimensions of the GOP’s self-defeat on health care will emerge over time, but one immediate consequence is giving up block grants for Medicaid. This transformation would have put the program on a budget for the first time since it was created in 1965, and the bill’s opponents ought to be held accountable for the rising spending that they could have prevented. (3/27)

The Washington Post: The Freedom Caucus Blows Its Chance To Govern
A few days before the House Freedom Caucus brought down the American Health Care Act, Rep. Mark Meadows laid out the stakes for his group: “This is a defining moment for our nation, but it’s also a defining moment for the Freedom Caucus.” The North Carolina Republican was right. The vote was indeed a defining moment — a test in which the Freedom Caucus had to decide: Would it remain a minoritarian opposition bloc whose only role was to defend truth without compromise? Or could it become something bigger, transforming itself into a majoritarian governing force that could lead Congress toward achievable conservative victories and have a lasting impact on the direction of our country? (Marc A. Thiessen, 3/27)

Huffington Post: The Death Of Trumpcare Is The Ultimate Proof Of Obamacare’s Historic Accomplishment
Somehow, despite the intense political forces arrayed against it, and the mind-boggling policy problems it tries to solve, the 2010 health care law keeps defying efforts to wipe it out. That says something about the people who wrote it ― and what they have achieved. Obamacare has never been hugely popular, and it has never worked as well as its architects hoped. Millions of Americans don’t like it and, even now, there are parts of the country where the markets are struggling to survive. But the program has provided security and access to care for millions of others. More importantly, it has shifted the expectations of what government should do ― and of what a decent society looks like. (Jonathan Cohn, 3/26)

Los Angeles Times: The Original Mistake That Distorted The Health Insurance System In America
A World War II-era mistake distorted the U.S. health insurance system. Reformers tried to fix the problem with patchwork solutions until Obamacare dumped yet another layer of misguided policy onto what was already a mess. Now the tangle is so perplexing that a Republican Congress, under a Republican president, could not even bring a health-insurance reform bill to a vote last week. But legislators will no doubt try to tackle the issue again, and when they do, they should consider erasing the original error instead of merely papering it over. (Myron Magnet, 3/28)

RealClear Health: Five Lessons From The AHCA’s Demise
While the keyhole of history has had insufficient time to bring the failed launch of the American Health Care Act (AHCA) into focus, it’s not too soon to begin learning some of the lessons it can teach us. Legislative efforts have a lifespan but our health care system does not. So whether we are still rejoicing or recriminating, let’s take a look at some timeless principles we can apply to the ongoing effort to improve health care in the United States. (Billy Wynne, 3/27)

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State Highlights: Once-Grand D.C. Hospital Serving African-American Patients Beset By Troubles; Colo. City Bucks Free-Standing ER Trend

Media outlets report on news from D.C., California, Missouri, Colorado, New Jersey and Pennsylvania.

The Washington Post: Howard University Hospital Shows Symptoms Of A Severe Crisis
But over the past decade, the once-grand hospital that was the go-to place for the city’s middle-class black patients has been beset by financial troubles, empty beds and an exodus of respected physicians and administrators, many of whom said they are fed up with the way it is run. The facility has faced layoffs, accreditation issues, and sexual harassment and discrimination lawsuits, and it has paid out at least $27 million in malpractice or wrongful-death settlements since 2007, a Washington Post examination has found. (Thompson, 3/25)

Denver Post: Wheat Ridge Stands Firm On Its Prohibition Of Free-Standing ERs
Free-standing emergency rooms may be on a growth streak in Colorado — there are around three dozen facilities today from just a handful a few years ago — but not everyone is rolling out the welcome mat. On Monday night, the Wheat Ridge City Council voted to extend a year-long moratorium it had placed on free-standing ERs in 2016 for another year as it comes up with regulations for the medically advanced, emergency care centers before the first sets up shop in the city. (Aguilar, 3/27)

Des Moines Register: Branstad Defends Pledge To Help Medicaid Firms Cover Losses
Gov. Terry Branstad on Monday defended his administration’s decision to help private Medicaid managed care organizations shoulder huge financial losses, and he said it doesn’t mean the project is in trouble. … The three companies have complained they’ve lost hundreds of millions of dollars in Iowa in the year since they began running the state’s $4 billion Medicaid program. The Des Moines Register reported Friday that the Department of Human Services has signed contract amendments under which the state agreed to help the companies cover some of those losses. (Leys,3/27)

St. Louis Post Dispatch: St. Louis County Home Health Worker Admits Defrauding Elderly Of $30,000 
A home health care worker from St. Louis County pleaded guilty to federal charges Monday and admitted defrauding elderly people in the area, the U.S. Attorney’s office said. De’Janay Noldon, 27, worked as a certified nurse’s assistant caregiver at a Webster Groves company that provides home health care for the elderly, prosecutors said. She used a nursing home resident’s personal information to open lines of credit that she used to pay her own bills, make purchases in stores and online and pay bills for relatives and friends, prosecutors said. (Patrick, 3/27)

NJ Spotlight: NJ Spotlight Helps Plan For Healthcare Future As GOP Bill Melts Down 
Hours before the Republican plan to replace Obamacare died in Congress Friday without a vote, healthcare experts in New Jersey gathered to discuss how the state’s healthcare system can withstand the major changes under consideration in Washington, D.C., and ensure gains made in recent years aren’t entirely lost. Several speakers said that regardless of the fate of the Republican bill, the state needed to prepare for potential changes. Some suggested creating a state-run insurance plan that would essentially extend the existing Medicaid proposal, which now covers one-in-five New Jersey residents, or finding other ways to reduce the cost of care so more can afford to purchase commercial plans. (Stainton, 3/27)

The Philadelphia Inquirer/Philly.com: In Fight Over EMS, Virtua Hospital Blasts Camden County’s ‘Political Machine’
Virtua Hospital executives on Monday accused Camden County freeholders of fear-mongering, saying the board is attacking Virtua’s emergency response times to clear the way for rival Cooper University Hospital to take over as the county’s emergency response provider. The remarks came after Virtua executives learned that freeholders were to host a forum Tuesday morning with mayors from around the county whose agenda would include improvements to advanced life support services. Virtua, which provides such services to municipalities throughout Camden County, was not invited to the meeting, which was described in a letter to mayors as an opportunity to address concerns about response times that are “woefully inadequate” in some areas. (Steele, 3/27)

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Clinic Seeks To Turn Marijuana From ‘Gateway Drug’ To Gateway To Treatment

A small but growing number of pain doctors and addiction specialists are overseeing the use of marijuana as a substitute for more potent and dangerous drugs. In other public health news: the opioid epidemic, lead standards, childhood trauma, multiple sclerosis, Zika, HPV vaccines and concussions.

The New York Times: Addiction Specialists Ponder A Potential Aid: Pot
Nine days after Nikolas Michaud’s latest heroin relapse, the skinny 27-year-old sat on a roof deck at a new drug rehabilitation clinic here. He picked up a bong, filled it with a pinch of marijuana, lit the leaves and inhaled. All this took place in plain view of the clinic’s director. … The new clinic is experimenting with a concept made possible by the growing legalization of marijuana: that pot, rather than being a gateway into drugs, could be a gateway out. (Richtel, 3/27)

Stat: EPA Sidestepped Decision To Tighten Standards For Lead Levels
The 750,000-ton stack is a mix of lead, arsenic, and other toxic metals, blended with sand and abandoned by the businesses that once employed most of the town, about 100 miles southwest of Chicago, in the Illinois River Valley. When the wind blows, specks of toxic metals sail off the slag heap and land on the town’s modest houses and gardens, in school playgrounds, on church steps and, sometimes, in the water…It is the lead — a toxin that can damage children’s brains at even low levels of exposure — that worries most people here. (Kaplan, 3/28)

Milwaukee Journal Sentinel: An Intractable Problem
Public health experts in Milwaukee and around the nation now see a direct link between childhood trauma and an incapacitated workforce. Improving the latter is impossible without addressing the former. Children exposed to abuse, violence and neglect may not be able to concentrate in school, much less job training programs. (Schmid and Crowe, 3/27)

Columbus Dispatch: Multiple Sclerosis Drug Offers Hope Of Halting Disease
In multiple sclerosis, an abnormal immune-system response leads to an attack of nerve fibers and the fatty myelin that surrounds them in the central nervous system… Ocrelizumab works by depleting B cells, which are immune cells that participate in the attack on myelin, Racke said. The drug represents a transformation in MS care, said Dr. Aaron Boster, director of the MS center at OhioHealth, where he also serves as systems medical chief of neuroimmunology. (Viviano, 3/28)

Miami Herald: Zika Virus: Rick Scott Visits Miami Prepare Mosquito Season 
South Florida’s battle plan for Zika, expected to rebound with the rainy season, includes more boots on the ground to inspect and fumigate for mosquitoes, more lab resources to speed up test turnaround times and the promise of a more collegial collaboration between the federal and state governments. (Chang, 3/27)

Kaiser Health News: New Vaccine Recommendation Cuts Number Of HPV Shots Children Need
You’d think that a vaccine that protects people against more than a half-dozen types of cancer would have people lining up to get it. But the human papillomavirus (HPV) vaccine, which can prevent roughly 90 percent of all cervical cancers as well as other cancers and sexually transmitted infections caused by the virus, has faced an uphill climb since its introduction more than a decade ago. Now, with a new dosing schedule that requires fewer shots and a more effective vaccine, clinicians and public health advocates hope they may move the needle on preventing these virus-related cancers. (Andrews, 3/28)

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White House Shies Away From Planned Parenthood Defunding Talk

Press secretary Sean Spicer says the Trump administration won’t commit to including the hot-button issue in the upcoming spending bill. In other women’s health news, some states are still moving to protect access to contraception and Democrats try to reconcile their platform with a need to include anti-abortion voters.

The Hill: WH Won’t Commit To Defunding Planned Parenthood In Spending Bill
The White House refused to commit Monday to defunding Planned Parenthood in an upcoming must-pass spending bill, a sign it’s looking to avoid a government shutdown over the hot-button issue. President Trump viewed the now-dead Republican healthcare bill as “an opportunity to defund” Planned Parenthood, according to press secretary Sean Spicer, who wouldn’t say whether the president would demand defunding in future legislation. (Fabian, 3/27)

Roll Call: Abortion Opponents Look For A Home In Democratic Party
For supporters of abortion rights, the Democratic Party has become the only real option. But as the party struggles to make inroads in red states, where its economic message may resonate more than its social values, some Democrats think there needs to be more flexibility on that issue. … But there’s no easy answer for the Democratic Party. The platform’s narrow focus on abortion rights is borne of a commitment to protect the rights of women to control their own bodies — a self-determination issue from which few Democratic lawmakers in Congress want to back away. (Pathé, 3/28)

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McAuliffe Says Health Bill’s Collapse In Congress Signals Need For Virginia To Expand Medicaid

But the state’s Republican lawmakers, who have consistently opposed such a move, appear unlikely to accept the governor’s suggestion. News outlets also examine a proposal in Georgia to revamp Medicaid, a look at how the program for low-income Americans has evolved since the 1960s and a request from Wisconsin to add drug tests for eligibility.

The Washington Post: McAuliffe: If Obamacare Is Here To Stay, Then It’s Time To Expand Medicaid
The failure of Congress to repeal and replace Obamacare has emboldened Gov. Terry McAuliffe (D) to renew his stalled crusade to expand Medi­caid in Virginia. On Monday, he proposed an amendment to state budget language to give him power to set an expansion in motion, and called on the Republican-controlled General Assembly to immediately begin making plans. But Republican legislators were unmoved by the plea, saying they would reject the amendment and that they stood firm against expanding Medicaid. (Schneider, 3/27)

CNN: McAuliffe Pushes Virginia Medicaid Expansion After GOP’s Failure To Repeal Obamacare
Virginia’s Democratic governor is using President Donald Trump’s failure to repeal Obamacare to heap pressure on Republican state lawmakers to expand Medicaid. Gov. Terry McAuliffe — who has long supported the Affordable Care Act’s Medicaid expansion, but has been stymied by GOP legislators in extending the coverage to more than 400,000 Virginians — announced the push Monday. (Bradner, 3/27)

Atlanta Journal-Constitution: Georgia Eyes New Medicaid Options After Trump Health Bill Fails 
Gov. Nathan Deal said Monday his administration is exploring changes to Georgia’s Medicaid program after a sweeping Republican overhaul of the Affordable Care Act was scuttled in a stunning rebuke to Donald Trump and Congressional leaders. The Republican governor said there are limits to what the state can request “as long as mandates under the basic Obamacare legislation stand in place.” But he said the state would review healthcare options that could include changes to “mandated minimum coverage” provisions that require the state Medicaid program to cover a range of health services to recipients. (Bluestein, 3/27)

The Associated Press: Georgia Governor Says State Will Explore Health Care Changes
Trump’s administration has signaled a willingness to let states experiment with Medicaid funds using waivers. Former Georgia congressman Tom Price now leads the Department of Health and Human Services under Trump. Deal said Monday that he wants the state to look into the options but didn’t discuss details. He also added that his administration hasn’t developed a proposal so far. (Foody, 3/27)

The New York Times: In Health Bill’s Defeat, Medicaid Comes Of Age
When it was created more than a half century ago, Medicaid almost escaped notice. Front-page stories hailed the bigger, more controversial part of the law that President Lyndon B. Johnson signed that July day in 1965 — health insurance for elderly people, or Medicare, which the American Medical Association had bitterly denounced as socialized medicine. The New York Times did not even mention Medicaid, conceived as a small program to cover poor people’s medical bills. (Zernike, Goodnough and Belluck, 3/27)

Milwaukee Journal Sentinel: With Congress Gridlocked, Scott Walker Wants Trump To OK Drug Tests For State Health Coverage
With the GOP’s repeal of Obamacare stymied in Congress, Gov. Scott Walker is still rejecting the federal law and instead asking the Trump administration to let Wisconsin drug test applicants for state coverage. Even though federal money remains available for providing health care to more Wisconsin residents, the GOP governor says he’s not reconsidering his decision to skip that and forgo hundreds of millions of dollars from federal taxpayers. (Stein, 3/27)

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Kansas Senate Gives Preliminary Approval To Medicaid Expansion Bill

Moderate Republicans join with Democrats to easily push through the legislation. But Gov. Sam Brownback has criticized the measure and may veto it.

KCUR: KanCare Expansion Bill Now Just One Step Away 
Buoyed by the failure of Republicans in Congress to repeal the Affordable Care Act, the Kansas Senate on Monday gave tentative approval to a Medicaid expansion bill after debating it for nearly three hours. A bipartisan group of 25 senators voted for the bill. All 13 “no” votes were cast by Republicans concerned about the cost of expansion and opposed to covering low-income, non-disabled adults. If it survives a final-action vote Tuesday, the bill would go to Republican Gov. Sam Brownback, whose spokeswoman reaffirmed his opposition to expansion in tweets during the debate but did not say whether he would veto it. (McLean, 3/27)

Wichita (Kan.) Eagle: Kansas Senate Votes To Expand Medicaid
The legislation in the Senate would expand eligibility for the program for people with incomes of up to 133 percent of the federal poverty line, which is $24,600 for a family of four. The federal government covers 90 percent of the cost of expansion, while the states pay the remaining 10 percent. (Shorman, 3/27)

Kansas City Star: Kansas Senate Votes To Expand Medicaid As Gov. Sam Brownback Doubles Down On Opposition
Opponents of the bill have spent much of the 2017 session downplaying the legislation’s chances because of uncertainty over how health care would change under President Donald Trump’s administration. … But the opponents’ argument faded slightly after U.S. House Speaker Paul Ryan, a Wisconsin Republican, canceled a vote on a bill that would have repealed the Affordable Care Act and effectively barred states from expanding Medicaid beyond March 1, due to a lack of GOP support. (Woodall and Lowry, 3/27)

The Associated Press: GOP Failure In Congress Boosts Medicaid Effort In Kansas
Legislators and advocates in Kansas pushing to expand the state’s health coverage for the poor to thousands of adults are buoyed by the failure of Republicans in Washington to repeal former President Barack Obama’s signature health care law. … The effort in Kansas could prove largely symbolic because Republican legislators remain deeply divided and Brownback is a longstanding critic of health care policies championed by Obama, a Democrat. Yet supporters have scored a significant gain by getting a bill so close to passage. (Hanna, 3/27)

Topeka Capital Journal: Senators Back Medicaid Expansion To Aid Vulnerable Hospitals
Financially fragile hospitals in Kansas — especially facilities in rural areas of the state — have a lot to lose in the Kansas Legislature’s debate about expanding Medicaid services. The Alliance for a Healthy Kansas reported 31 of the state’s 107 hospitals are financially vulnerable because each must grapple with costs of providing care to people who are uninsured. The Senate voted 25-13 on Monday to send the Medicaid expansion bill, House Bill 2044, to final action on Tuesday. Expansion would deliver Medicaid services to about 150,000 more Kansans. (Harford, 3/27)

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Federal Government Takes In $22 Billion In Fines Paid By Health Companies Since 2010

Stat looked at data from 39 agencies to analyze which segments of the health care industry have settled with the government. It found that pharmaceutical companies paid the most, accounting for almost 80 percent of penalties.

Stat: Who Paid The Biggest Fines In Health Care?
When you think of business expenses in the health care industry, you probably don’t think about this mostly hidden cost: settlements made with government agencies. From 2010 to 2017, pharmaceutical companies, health care service providers, and producers of medical equipment and supplies paid the federal government more than $22 billion to settle legal cases. STAT analyzed data from 39 federal regulatory agencies that initiated legal actions against health care companies. In some instances, the companies settled cases without acknowledging any wrongdoing. (Bronshtein, 3/27)

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Price, A Fierce Opponent Of ACA, Now Stuck Holding The Reins On Administering It

Many expect new HHS Secretary Tom Price to shift the regulations onto a more conservative path, but don’t expect him to try to sabotage it completely.

The Hill: Price Faces Unwanted Task Of Administering ObamaCare 
Secretary of Health and Human Services Tom Price came into office last month ready to lead the charge on repealing ObamaCare. Now, that effort has run into a brick wall, leaving him to oversee a law he fiercely opposes. President Trump last week predicted that ObamaCare “soon will explode,” stirring speculation that the administration could seek to undermine the law. Yet there are also signs that Price and the Department of Health and Human Services (HHS) will take a more pragmatic approach. (Sullivan, 3/28)

WBUR: The Origins Of A Complex American Health Care System
The problems with the health care system in the United States may seem like they’re new, but they’re not. Historian Nancy Tomes explains to Here & Now’s Jeremy Hobson how our uneven, expensive and complicated system came to be. (Hobson, 3/27)

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First Edition: March 28, 2017

Mar 28 2017

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

Kaiser Health News: New Vaccine Recommendation Cuts Number Of HPV Shots Children Need
You’d think that a vaccine that protects people against more than a half-dozen types of cancer would have people lining up to get it. But the human papillomavirus (HPV) vaccine, which can prevent roughly 90 percent of all cervical cancers as well as other cancers and sexually transmitted infections caused by the virus, has faced an uphill climb since its introduction more than a decade ago. Now, with a new dosing schedule that requires fewer shots and a more effective vaccine, clinicians and public health advocates hope they may move the needle on preventing these virus-related cancers. (Andrews, 3/28)

California Healthline: Repeal And Replace Hits A Roadblock. What’s Next For California?
California embraced the Affordable Care Act and in many ways became a national model for how it could work — driving uninsured rates down from about 17 percent to 7 percent since the law rolled out. The state added 3.7 million people to the rolls under its Medicaid expansion, and 1.5 million joined its state-run marketplace, Covered California. Compared to other states, the exchange’s premium increases have remained low, though they have risen substantially this year. (3/28)

The Wall Street Journal: After GOP Bill’s Failure, Health-Law Lawsuit Takes Center Stage
President Donald Trump and GOP lawmakers, seeking to regroup following the collapse of the effort to repeal the Affordable Care Act, have an option for gutting the health law relatively quickly: They could halt billions in payments insurers get under the law. House Republicans were already challenging those payments in court as invalid. Their lawsuit to stop the payments, which they call illegal, was suspended as Republicans pushed to replace the ACA, but it could now resume—or the Trump administration could decline to contest it and simply drop the payments. Mr. Trump could unilaterally end the payments regardless of the lawsuit. (Armour, 3/27)

The Washington Post: Paul Ryan: House Republicans Will Continue Their Push For Health-Care Reform This Year
House Speaker Paul D. Ryan told Republican donors Monday that he intends to continue pushing for an overhaul of the nation’s health-care system by working “on two tracks” as he also pursues other elements of President Trump’s agenda. “We are going to keep getting at this thing,” Ryan said three days after intraparty opposition forced him to pull the American Health Care Act after it became clear it did not have enough Republican votes to pass. (DeBonis, 3/27)

The New York Times: 2018 Dilemma For Republicans: Which Way Now On Obamacare? 
As they come to terms with their humiliating failure to undo the Affordable Care Act, Republicans eyeing next year’s congressional campaign are grappling with a new dilemma: Do they risk depressing their conservative base by abandoning the repeal effort or anger a broader set of voters by reviving a deeply unpopular bill even closer to the midterm elections? (Martin, 3/28)

The New York Times: The Republicans In Power: From ‘We Got This’ To ‘What Now?’
The new Republican government is in deep trouble.President Trump and his majorities in the House and Senate had hoped to head out for their spring break celebrating the chest-thumping accomplishments of finally gutting President Barack Obama’s health care law and installing a conservative Supreme Court justice. They were determined to show the American public: We got this. (Hulse, 3/27)

The Wall Street Journal: Hospital Stocks Rise Amid Broader Slump
Monday’s climb in hospital stocks continues a rally that began last week, as the Trump administration and House Republicans failed to win support for a bill to dismantle the ACA. House Speaker Paul Ryan on Friday canceled a vote on the legislation, conceding it lacked enough Republican backing. Hospitals benefited from more paying patients under the Affordable Care Act, most notably in states that expanded Medicaid. (Evans, 3/27)

NPR Fact Check: Trump Says Obamacare Is ‘Exploding.’ That’s Not Quite True
President Trump is doing his best to put a good face on defeat in his party’s attempt to replace the Affordable Care Act, also known as Obamacare. His strategy is simple: declare that the law is failing. And he is selling that message in his own distinctly Trumpian way: concocting it out of simple, bold words and then hammering that message home, over and over: Obamacare, in his words, will “explode.” (Kurtzleben and Kodjak, 3/27)

Politico: Gallup: Trump Hits New Low After Health Care Flop
President Donald Trump’s approval rating slipped to a new low Monday in the Gallup daily tracking poll, the first measure of Trump’s job performance following his administration’s failure to move a new health care law through Congress. Only 36 percent of Americans approve of the way Trump is handling his job as president in interviews conducted last Friday through Sunday, a time period entirely after Republicans abandoned their bill to replace the 2010 Affordable Care Act. (Shepard, 3/27)

The Washington Post: McAuliffe: If Obamacare Is Here To Stay, Then It’s Time To Expand Medicaid
The failure of Congress to repeal and replace Obamacare has emboldened Gov. Terry McAuliffe (D) to renew his stalled crusade to expand Medi­caid in Virginia. On Monday, he proposed an amendment to state budget language to give him power to set an expansion in motion, and called on the Republican-controlled General Assembly to immediately begin making plans. But Republican legislators were unmoved by the plea, saying they would reject the amendment and that they stood firm against expanding Medicaid. (Schneider, 3/27)

USA Today/Milwaukee Journal Sentinel: With Congress Gridlocked, Scott Walker Wants Trump To OK Drug Tests For State Health Coverage
With the GOP’s repeal of Obamacare stymied in Congress, Gov. Scott Walker is still rejecting the federal law and instead asking the Trump administration to let Wisconsin drug test applicants for state coverage. Even though federal money remains available for providing health care to more Wisconsin residents, the GOP governor says he’s not reconsidering his decision to skip that and forgo hundreds of millions of dollars from federal taxpayers. (Stein, 3/27)

The New York Times: In Health Bill’s Defeat, Medicaid Comes Of Age
When it was created more than a half century ago, Medicaid almost escaped notice. Front-page stories hailed the bigger, more controversial part of the law that President Lyndon B. Johnson signed that July day in 1965 — health insurance for elderly people, or Medicare, which the American Medical Association had bitterly denounced as socialized medicine. The New York Times did not even mention Medicaid, conceived as a small program to cover poor people’s medical bills. (Zernike, Goodnough and Belluck, 3/27)

The Associated Press: GOP Divided Over New Course After House Health Care Debacle
Still reeling from last week’s House health care debacle, Republicans are pivoting to tax cuts and other issues but remain riven into factions and all over the map about how and when to return to their marquee pledge to eviscerate former President Barack Obama’s 2010 overhaul. House Republicans are gathering Tuesday to discuss their agenda, their first meeting since House Speaker Paul Ryan, R-Wis., suddenly abandoned plans last Friday for a vote on the GOP legislation. The retreat on the party’s top legislative priority so far this year was a jarring defeat for President Donald Trump and Republican leaders and raised questions about whether the GOP could muster the unity it will need on other issues. (Fram, 3/28)

The Associated Press: Bitter GOP Finger-Pointing Clouds Path For Trump Agenda
President Donald Trump is hoping to drive his priorities forward following the crumbling of the Republican health care bill but GOP finger-pointing is rampant, underscoring how tough it will be to produce the unity the party will need. Rep. Ted Poe, R-Texas, criticized the contrarian House Freedom Caucus on Monday, a day after resigning from the hard-right group because it helped sink the Republican health care effort. “You can have your principles and then when it comes to voting, you have to compromise to get something passed,” Poe said of the caucus, which has roughly three dozen members. (Yen, 3/27)

The Associated Press: High Court Struggles Over Hospital Pension Dispute
The Supreme Court seemed to struggle on Monday over whether some of the nation’s largest hospitals should be allowed to sidestep federal laws protecting pension benefits for workers. Justices considered the cases of three church-affiliated nonprofit hospital systems being sued for underfunding pension plans covering about 100,000 employees. But the outcome ultimately could affect the retirement benefits of roughly a million employees around the country. (3/27)

The New York Times: Addiction Specialists Ponder A Potential Aid: Pot
Nine days after Nikolas Michaud’s latest heroin relapse, the skinny 27-year-old sat on a roof deck at a new drug rehabilitation clinic here. He picked up a bong, filled it with a pinch of marijuana, lit the leaves and inhaled. All this took place in plain view of the clinic’s director. … The new clinic is experimenting with a concept made possible by the growing legalization of marijuana: that pot, rather than being a gateway into drugs, could be a gateway out. (Richtel, 3/27)

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New Vaccine Recommendation Cuts Number Of HPV Shots Children Need

You’d think that a vaccine that protects people against more than a half-dozen types of cancer would have people lining up to get it. But the human papillomavirus (HPV) vaccine, which can prevent roughly 90 percent of all cervical cancers as well as other cancers and sexually transmitted infections caused by the virus, has faced an uphill climb since its introduction more than a decade ago.

Now, with a new dosing schedule that requires fewer shots and a more effective vaccine, clinicians and public health advocates hope they may move the needle on preventing these virus-related cancers.

In December, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommended reducing the number of shots in the HPV vaccine from three to two for girls and boys between the ages of 9 and 14. The recommendation was based on clinical trial data that showed two doses was just as effective as a three-dose regimen for this age group. (Children older than 14 still require three shots.)

Michelle AndrewsInsuring Your Health

The study was conducted using Gardasil 9, a version of the vaccine approved by the Food and Drug Administration in late 2014. It protects against nine types of HPV: seven that are responsible for 90 percent of cervical cancers and two that account for 90 percent of genital warts.

In addition, the new version of Gardasil improved protection against HPV-related cancers in the vagina, vulva, penis, anus, rectum and oropharynx — the tongue and tonsil area at the back of the throat.

An earlier version protected against four types of HPV.

From the start, clinicians have run into some parental and political roadblocks because the vaccine, which is recommended for preteens, protects against genital human papillomavirus — a virus transmitted through sexual contact. Many physicians are also reluctant about discussing the need for the vaccine, and for many parents, the vaccine’s cancer-prevention benefits were overshadowed by concerns about discussing sexual matters with such young kids. Yet for maximum protection, the immunizations should be given before girls and boys become sexually active.

The focus should not have been on sexually transmitted infections, some say. “You only get one chance to make a first impression,” said Dr. H. Cody Meissner, a professor of pediatrics at Tufts University School of Medicine and a member of the American Academy of Pediatrics’ committee on infectious diseases. “This vaccine should have been introduced as a vaccine that will prevent cancer, not sexually transmitted infections.”

The HPV virus is incredibly common. At any given time, nearly 80 million Americans are infected, and most people can expect to contract HPV at some point in their lives. Most never know they’ve been infected and have no symptoms. Some develop genital warts, but the infection generally goes away on its own and many people never have health problems.

However, others may develop problems years later. There are approximately 39,000 HPV-related cancers every year, nearly two-thirds of them in women. In addition to cervical cancer, more than 90 percent of anal cancers and 70 percent of vaginal and vulvar cancers are thought to be caused by the HPV virus. Recent studies show that about 70 percent of cancers in the oropharynx may also be linked to HPV.

A 2015 study published in the Journal of the National Cancer Institute estimated that earlier versions of the HPV vaccine could reduce the number of HPV-related cancers by nearly 25,000 annually, and the new version of the vaccine could further reduce the number of such cancers by about 4,000.

The vaccine is estimated to prevent 5,000 cancer deaths annually, said Dr. Paul Offit, professor of pediatrics and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

But compliance is an ongoing problem. “They’re not getting the one vaccine that protects against diseases from which they’re most likely to suffer and die,” Offit said, noting that deaths from pertussis and meningococcal disease, for which adolescents are also vaccinated at that age, are minuscule compared with HPV-related cancers.

In 2015, 87 percent of 13-year-olds were up-to-date with the Tdap vaccine that protects against tetanus, diphtheria and pertussis, and 80 percent had received the meningococcal vaccine, according to the Centers for Disease Control and Prevention. But just 30 percent of girls and 25 percent of boys at that age had received all three doses of the HPV vaccine. In contrast to other vaccines, however, the HPV vaccine is required only in a few states for secondary school.

Public health advocates say they think the shift to a two-dose regimen could make a big difference in the number of adolescents who get all the necessary doses of the HPV vaccine. For one thing, the fewer shots the better, in general, they say.

In addition, because the second HPV shot is supposed to be given anywhere from six months to a year after the first one, “parents can fit it into a routine regimen when people go in for their 12-year-old’s regularly scheduled visit,” said Dr. Joseph Bocchini Jr., chairman of pediatrics at Louisiana State University Health in Shreveport who is president-elect at the National Foundation for Infectious Diseases.

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Viewpoints: When Insurers Reject ‘Unproven Therapies’; Can Trump Help Americans Who Are Dying ‘Deaths Of Despair’

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

Arizona Republic: Sarah Wants Her Life Back (UnitedHealthcare Refuses To Give It To Her)
Isn’t it nice that the insurance company is looking out for Sarah, preventing her from having to endure “unproven therapies,” regardless of what her doctor has witnessed with other patients over and over and, well, over again? I’m quite sure UnitedHealthcare’s denial is for Sarah’s own good. Quite sure it has nothing to do with the cost of IVIG: about $32,000 a month. Or the fact that she’d need it for up to a year. (Laurie Roberts, 3/26)

The Washington Post: Americans Are Dying ‘Deaths Of Despair.’ Will Trump Help? 
It is a political cliche that President Trump owes his electoral victory to the extraordinary support he received from white voters without a college degree, two-thirds of whom voted for the Republican. Much less settled is the question of why these largely low-income voters, once reliable Democrats, cast their lot with a brash billionaire from New York. (3/25)

The Washington Post: More Lies On Planned Parenthood
Not “even a scintilla of evidence.” That was the judgment of a federal judge last month in Texas about allegations of wrongdoing by Planned Parenthood. He was not alone in finding that the health-care organization did not illegally profit from fetal-tissue donation: Three Republican-led congressional investigations, 13 states and a Texas grand jury all could find no substance to claims about the alleged sale of “baby body parts,” which gained currency through videos released by anti-abortion activists. (3/26)

The Wall Street Journal: High-Tech Help For The Freelance Physician
From Amazon to eBay and Uber to Airbnb, digital technology has revolutionized everyday life. But when you get sick, you might as well take a time machine back a few decades. You phone your doctor’s office to make an appointment. You sit in a waiting room stocked with old magazines. The physician writes down notes about your symptoms and stores them in paper files. When you’re done, a receptionist hands you a little card with the date and time of your next visit. (Allysia Finley, 3/24)

Louisville Courier-Journal: ‘Tired Of Burying My Friends’
I am a full-time student with a part-time job. I went to decent schools and stayed away from the neighborhoods my parents warned me about. I am not an anomaly, and neither is gun violence. I apologize if I seem insensitive towards the individual’s right to own a gun, but it is time we take a critical look at our society’s priorities. What good is a world full of guns if we must fill our days with this pain? How many of our children are we willing to lose to maintain our sense of entitlement? (Tara Ann Steiden, 3/23)

The New York Times: To Win Again, Democrats Must Stop Being The Abortion Party
But once-solid Catholic support for Democrats has steadily eroded. This was due at least in part to the shift by many American Catholic bishops from emphasizing social issues (peace, the economy) to engaging in the culture wars (abortion, gay marriage). Along the way, many Catholics came to view the Democrats as unconditionally supporting abortion. Last year’s election was a watershed in this evolution. Hillary Clinton lost the overall Catholic vote by seven points — after President Obama had won it in the previous two elections. She lost the white Catholic vote by 23 points. In heavily Catholic states like Pennsylvania, Wisconsin and Michigan, she lost by a hair — the last by less than 1 percent. A handful more of Catholic votes per parish in those states would have won her the election. (Thomas Groome, 3/27)

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Taking Stock: After The Smoke Clears, The Health Insurance Issues Remain

Premium costs, essential benefits, Medicaid expansion and the fact that the health industry has a huge impact on the financial markets are among the thoughts on which opinion writers continue to focus.

Bloomberg: Market Impact Of Republicans’ Insurance Debacle Far From Clear
Having stiff-armed political risk for quite a while, market participants now have to think a lot more about the issue in general — and specifically, about how much the Trump administration’s legislative agenda will suffer on account of Republicans’ last-minute decision on Friday to pull their health-care bill from an imminent vote on the floor of the House of Representatives. Some may be inclined to predict other failures that would impact forthcoming economic bills, given the erosion of Republicans’ political capital and the Washington blame game that’s sure to play out. But the situation on the ground is a lot more complicated than that. (Mohamed A. El-Erian, 3/24)

RealClear Health: The Root Cause Of Health Care Dysfunction
Before the Affordable Care Act (ACA) passed in March 2010, President Obama repeatedly promised that the typical family’s health premiums would go down by (sometimes “up to” but frequently “on average”) $2,500. That decline did not occur because the ACA strengthened the control that insurance companies—as opposed to patients—have over health care spending. In fact, Americans’ increasing dependence on health insurance over the last seven decades has been a major contributor to exploding health costs. (John R. Graham, 3/27)

Modern Healthcare: Some Insurance Benefits Are Essential
The House of Representatives last week postponed voting to gut Obamacare after new provisions weakening the essential benefits guarantee failed to win the support from right-wing Republicans, who are opposed to any form of subsidized health insurance. Suffice it to say that the last-minute maneuvering clarified how far the modern Republican Party is willing to go in undermining health insurance, and the healthcare system along with it. (Merrill Goozner, 3/25)

Forbes: More States To Expand Medicaid Now That Obamacare Remains Law
More states will pursue expansion of Medicaid health benefits for poor Americans under the Affordable Care Act after Republicans failed to repeal and replace the law. … At least two states – Kansas and North Carolina – are already working toward becoming the 32nd and 33rd states to expand Medicaid under the ACA. (Bruce Japsen, 3/26)

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What Happens Next?: How To Move Forward On Fixing The Nation’s Health Care

Opinion writers speculate on what will happen now for the future of Obamacare.

The New York Times: How To Build On Obamacare
“Nobody knew that health care could be so complicated.” So declared Donald Trump three weeks before wimping out on his promise to repeal Obamacare. Up next: “Nobody knew that tax reform could be so complicated.” Then, perhaps: “Nobody knew that international trade policy could be so complicated.” And so on. (Paul Krugman, 3/27)

USA Today: Here’s The Bipartisan Path Forward On Health Care: Andy Slavitt
The failure of Trumpcare last week can be seen as a rejection of policies that Americans judged would move the country backwards. But it also presents the opportunity to end the divisiveness that hampered the Obamacare era and move forward in a bipartisan direction that focuses not on destructive rhetoric, but squarely on reducing premiums and expanding access for all Americans. (Andy Slavitt, 3/26)

USA Today: Trump’s New Health Care Opportunity: Our View
President Trump says he has a new strategy to address problems with the Affordable Care Act. He is going to wait “to let Obamacare explode” and then wait some more to let the Democrats “come to us” so we can “make one beautiful deal for the people.” (3/26)

Chicago Tribune: Moving On: Who’ll Fix Obamacare Now?
This week in Washington, a staggered president and his party dig out from the rubble of their failed Obamacare replacement effort. As House Speaker Paul Ryan says, there’s no sugarcoating this. The politics of the Republicans’ failure to pass, or even vote on, the American Health Care Act was ugly. House conservatives in the Freedom Caucus sought a full repeal without an effective replacement, guaranteeing the smoldering political debris in Washington. Why be greedy? Millions of Americans gained coverage via Obamacare. You can’t replace something, no matter how gravely flawed, with nothing. (3/26)

USA Today: The Health Care War Is Far From Over
After eight years of fear-mongering and spreading outright lies about the Affordable Care Act, Republicans finally got the chance to step to the plate and give it their best swing. And they whiffed. Hard. (Neera Tanden, 3/27)

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State Reviews Of The GOP’s Health Plan Implosion

Editorial pages examine who dodged the bullets in their states and detail what went wrong with the American Health Care Act.

Kansas City Star: Americans Want Health Care That Works For All 
I continue to believe that most Americans think everyone should have health care. And while the current law is far from perfect and would benefit from some bipartisan improvements, it is by any measure — coverage, cost, continuity of care — vastly superior to the law Republicans proposed and then couldn’t pass last week. (Kathleen Sebelius, 3/25)

Cleveland Plain Dealer: Collapse Of Trumpcare A Victory For Republicans Who Pushed Back To Protect States Like Ohio
The dramatic collapse today of efforts by House Speaker Paul Ryan and President Donald Trump to force House Republicans to pass Ryan’s jury-rigged repeal of Obamacare was a victory not just for common sense but also for those Republicans who stood up to Trump. Among them: Sen. Rob Portman of Ohio, who, along with several other Republican senators, sent a letter to Majority Leader Mitch McConnell earlier this month outlining the plan’s likely harm to the millions of Americans covered by Medicaid expansion, in Ohio and other states — and to the states themselves. (3/24)

Miami Herald: Healthcare Bill, And GOP, Fail Miserably
But, and pardon the tortured mix of metaphor, Republicans had the ball in their court, for seven years now, and fumbled it — most spectacularly on Friday. That’s when their controversial bill to replace the Affordable Care Act, failed to win the necessary 216 votes to pass. House Speaker Paul Ryan recommended pulling it. President Trump, the biggest loser, agreed. The bill, a cornerstone of Trump’s campaign and that of scores of new Republican lawmakers, went down. Obamacare rules — until Republicans get serious. That’s great news for millions of Americans, and Floridians especially. The bill would have left almost 2 million state residents without health insurance and forced many others to pay thousands more for coverage. Republican Rep. Ileana Ros-Lehtinen told her local constituents she would vote No, while her more cowed Miami colleagues kept mumbling about having to study the situation. (3/25)

The Kansas City Star: Congratulations, Republicans. This Health Care Defeat Is Really A Win.
Cheer up, Republicans. Sometimes, what looks and feels like a loss is really a win. Usually it takes a while for the all-for-the-best benefits of a short-term defeat to sink in. But the health care bill that the Republicans pulled at the last minute on Friday would have quickly made the GOP nostalgic for the days when they could take bows for show votes repealing the Affordable Care Act for the umpteenth time. Had the bill passed, Republicans would have lost both politically and in human terms as the bill devastated many of the very voters who believed President Donald Trump’s campaign promise that “everybody’s going to be taken care of much better than they’re taken care of now.” (3/24)

Chicago Tribune: Why Health Care Can’t Be Fixed
Bill Clinton tried to fix America’s health care problems and was shot down by Congress. Barack Obama got his solution enacted only to find most people didn’t like it. Republicans who voted repeatedly to repeal Obamacare and replace it with something far better have found it fiendishly hard to agree on how. (Steve Chapman, 3/24)

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Perspectives From Monday Morning Quarterbacks: How The Health Bill Unraveled

Opinion writers analyze what happened last week in Congress when the House GOP’s health law replacement plan came undone.

The Wall Street Journal: The ObamaCare Republicans
House Republicans pulled their health-care bill shortly before a vote on Friday, and for once the media dirge is right about a GOP defeat. This is a major blow to the Trump Presidency, the GOP majority in Congress, and especially to the cause of reforming and limiting government. (3/24)

The Wall Street Journal: High Anxiety Over Health-Care Reform
What politicians, those hardy folk, don’t understand about health care is how anxious it makes their constituents. Not suspicious, not obstinate, but anxious. Because unlike such policy questions as tax reform, health care can be an immediate life-or-death issue for you. It has to do with whether, when, and where you can get the chemo if you’re sick, and how long they’ll let you stay in the hospital when you have nobody, or nobody reliable and nearby, to care for you. To make it worse, the issue is all hopelessly complicated and complex and pits you as an individual against huge institutions—the insurance company that doesn’t answer the phone, the hospital that says “I’m afraid that’s not covered”—and you have to make the right decisions. (Peggy Noonan, 3/24)

The Washington Post: The Lessons Trump And Ryan Failed To Learn From History
If President Trump and House Speaker Paul D. Ryan (R-Wis.) had paid attention to Mitt Romney, they could have avoided the fiasco of their now dead and unmourned health-care bill. They would not now face a situation in which both of them are being blamed because they both deserve to be. And the Republican Party would not be engulfed in a festival of recriminations. (E.J. Dionne Jr., 3/26)

The New York Times: The G.O.P.’s Existential Crisis
Give Donald Trump this: His travel ban enraged only half the country. The House Republicans’ attempt to replace the Affordable Care Act, meanwhile, has alienated everyone, including members of the Republican Party itself. The bill was supposed to go to a vote on Friday, but the leadership, facing a likely defeat, was forced to pull it when it became clear it didn’t have the necessary support. It was perhaps better off dead: Already a rushed, Rube Goldberg solution in search of a problem, by the time it neared the House floor it had so many compromises woven into it to win votes that, even if it passed, it would have probably gone down in defeat in the Senate. (Corey Robin, 3/24)

The Washington Post: Republicans’ Dangerous Health-Care Delusions
The jaw-dropping spectacle in which their party holds the White House and majorities in both houses of Congress and yet failed on its first, and arguably most significant, agenda item should disabuse Republicans of a number their deeply held, inaccurate beliefs. (Jennifer Rubin, 3/26)

USA Today: Colossal GOP Failure And Not Just On Health
The plan to replace Obamacare with a new bill crafted by House Speaker Paul Ryan has failed, and embarrassingly so. And that failure is part and parcel of a larger failure of the Republican-led Congress to push an agenda in the new administration. (Glenn Harlan Reynolds, 3/26)

Bloomberg: A Republican Fiasco Years In The Making
We should pause and realize what a big deal this is. The number one agenda item for years, the one that most House Republicans campaigned on when first elected, and they couldn’t manage to even get an initial bill out of the House. Not only that, but it was clear this week that even though most of them were willing to vote for it, practically no one was enthusiastic about what they had produced. It also polled terribly, and conservative health care wonks hated the bill. (Jonathan Bernstein, 3/24)

Los Angeles Times: Trump Discovers That Legislating Is Complicated As The GOP Healthcare Bill Goes Down In Flames
Having recently learned that healthcare is complicated, President Trump has now discovered that legislating is complicated too. Trump’s attempt to force a half-baked bill to “repeal and replace” Obamacare down the throats of reluctant House Republicans failed, as House leaders were simply unable to satisfy the conflicting demands from the two wings of their party. In the end, it wasn’t a case of savvy dealmakers coming up with an offer that buyers couldn’t refuse; it was a case of buyers looking at the offer and saying, “No thanks.” (3/24)

Los Angeles Times: Boy, These Washington Big Shots Ate Well While Their Healthcare Bill Was Blowing Up
One can always count on this feature in the aftermath of any great event that has taken place behind closed doors: the journalistic “inside story.” It’s known in the trade as a “tick-tock.” And the implosion of the House Republicans’ Obamacare repeal bill has thrown off its fair share of examples, notably in the New York Times, Politico, the Washington Post and at CNN. They’re full of scenes of heightened drama from the last week, all described in cinematic detail, replete with the interior monologues of participants at the White House, the Capitol and other locations around town. (Michael Hiltzik, 3/26)

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State Highlights: Incidents Call Into Question Mass. Mental Health Care System; Texas ‘Granny Tax’ Sparks Nursing Homes Debate

Media outlets report on news from Massachusetts, Texas, Kansas, Connecticut, Washington, Tennessee, California and Wisconsin.

Boston Globe: In Massachusetts’ Failing Mental Health Care System, Even The Lucky Ones Aren’t So Lucky
James Boyd Jr.’s death is one of seven recent incidents involving Department of Mental Health clients that illuminate a growing concern inside the state agency: that the department is releasing a steady stream of people with serious mental illness to live in the community without proper supervision. While thousands with serious mental illness struggle to get any help, the roughly 21,000 Department of Mental Health clients are promised treatment at state-run facilities and state-funded programs in the community that are operated by private vendors… But the string of incidents raises questions about whether the department is doing enough to ensure the safety of its clients and the public. (Helman and Russell, 3/25)

San Antonio Press-Express: Nursing Homes Joust Over Fee Proposal: ‘Granny Tax’ Or Funding Lifeline? 
Nursing homes that are stretched thin as they care for Medicaid residents are asking lawmakers to approve a fee on their facilities that would allow Texas to get hundreds of millions of matching federal dollars to boost their low reimbursements. But the idea has generated a backlash from nursing homes that serve private-pay patients and object to paying the proposed assessment, which they call a “granny tax.” Their private-pay patients are outside of Medicaid, and the homes aren’t confident of promises that they’ll be otherwise repaid for their share of the fees that would trigger more Medicaid dollars. (Fikac, 3/25)

KCUR: Kansas Mental Health Centers Seek Exemption From Gun Law 
Unless the Legislature makes a change, community mental health centers across Kansas will have to allow patients and staff to bring their guns starting in July. A 2013 state law requires most publicly owned buildings to allow concealed weapons or to install metal detectors and post armed guards. The law included a four-year exemption for community mental health centers, universities, publicly owned medical facilities, nursing homes and low-income health clinics that ends July 1. (Wingerter, 3/24)

The CT Mirror: Anthem’s Cost Savings At Center Of Merger Suit Appeal Argument
Anthem and the Justice Department faced off in court Friday over the insurer’s proposed merger with Cigna, with the legal wrangling centered on whether any savings from the deal would justify shrinking the market for large employer insurance policies from four to three carriers. A federal district court in February sided with the Justice Department – and 11 states including Connecticut – in blocking the $54 billion merger. (Radelat, 3/24)

Seattle Times: Nurses Gain Traction In Legislature On Bills To Address ‘Dangerous’ Staffing 
For years, nurses have gone to Olympia, imploring lawmakers to understand that staffing problems were placing patient care at risk. There are constant staff shortages that force nurses to forgo meals and bathroom breaks in order to properly care for patients. There are the 12-hour nursing shifts that grow longer due to scheduling issues. There are nurse-to-patient ratios that seem to grow more dangerous. Nurses returned to Olympia this week to reiterate those messages to the Legislature yet again. But this time they have more optimism that lawmakers are listening. (Baker, 3/26)

Boston Globe: New State Rules For Long-Term Care Insurance Forgo Limits On Rate Hikes 
After five years of fits and starts, Massachusetts regulators are close to adopting rules that would increase oversight of long-term care insurance, a market that has been roiled by skyrocketing premiums for consumers and declining profits for insurance companies. But some consumers and advocates argue that the proposals would not do enough to protect policyholders from the escalating costs of long-term care insurance, which helps pay for nursing homes, home health services, and assisted living. (Fernandes, 3/26)

Nashville Tennessean: Can Nashville Find Cure For Price Blindness In Health Care?
“Price blindness,” or a lack of price transparency, affects healthcare consumers across the U.S. Pricing is so opaque that even many doctors and hospitals can’t estimate what a service might cost, leaving patients no options to compare or price-shop. This problem is unique to healthcare — can you imagine driving a car off the dealer’s lot and getting a bill in the mail later? Would you buy a television at Best Buy without a quick Amazon search? Most of us would not, but until recently, there just wasn’t a way for consumers to easily compare costs in healthcare. But Nashville companies like Healthcare Bluebook and MD Save are trying to change that, especially as consumers pick up more of the costs of their care. (Tolbert, 3/26)

Los Angeles Times: L.A. Officials Push For New Steps To Address Health Risks From Homebuilding Near Freeways
In a new push to address health risks from a surge in residential construction near freeways, Los Angeles officials have requested a study of development restrictions, design standards and other steps to protect residents from traffic pollution. Planning, transportation and other officials should prepare “strategies to address the hazard of freeway pollution affecting residents of new and existing structures,” according to a motion filed this week by councilmen Jose Huizar and Paul Koretz. These could include buffer zones and barriers, air filtration requirements and regulations on building design. (Barboza and Zahniser, 3/24)

Milwaukee Journal Sentinel: State Nearly Returned Suspended Psychologist To Wisconsin’s Youth Prison
State officials last year were on the verge of returning a suspended psychologist to his job at Wisconsin’s troubled juvenile prison, but backed off after a prosecutor said he could be charged with falsifying records, state records show. After learning of possible charges, the Department of Corrections kept psychologist Wilson Fowle on paid leave and began its own investigation. Six weeks later, Fowle retired and by the end of 2016 agreed to surrender his psychology license. (Marley, 3/24)

Boston Globe: Dozens Of Industries Could See A Boost From Legalized Marijuana 
A Swiss company that for years has provided Massachusetts with cigarette tax stamp services — helping the state thwart the black market — has its eyes set on what could be a much bigger public contract: tracking legal marijuana from seed to sale to keep it from being diverted to criminal enterprises… Such product tracing is one of dozens of industries that could see a big boom in business when recreational marijuana shops, growhouses, testing facilities, and infused-product manufacturers (think candy and brownies) open in Massachusetts, probably next year. (Miller, 3/27)

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Iowa Officials Secretly Agree To Help Medicaid Managed Care Companies Cover Some Losses

The three companies that won contracts to manage the state’s Medicaid program have been seeking government help on their $450 million in losses. State officials agreed to contract changes that will cost about $10 million in February but the information was only released Friday in response to a Des Moines Register open-records request. In other Medicaid news, South Carolina nursing homes accept a state offer to settle a dispute, and New Hampshire officials ponder how to improve their funding formula.

Des Moines Register: State Agrees To Help Medicaid Companies Shoulder Huge Losses
State leaders have agreed to help private Medicaid management companies shoulder huge losses they’ve suffered in covering more than 500,000 poor or disabled Iowans, documents released Friday show. The three national companies have complained about “catastrophic” losses on the Iowa project, which started last April. They have pleaded for the government to help them make up for about $450 million in red ink. … The documents were released Friday afternoon in response to a Des Moines Register open-records request made Jan. 12. (Leys, 3/24)

The (Columbia, S.C.) State/Independent Mail: State To Pay $12 Million To Nursing Homes For Medicaid Delays
Two dozen Upstate nursing homes have agreed to accept a total of $1.8 million to settle a dispute with state officials over delays in processing Medicaid applications. The payments are part of the $12 million that the South Carolina Department of Health and Human Services offered to pay 148 nursing homes throughout the state last month to avoid litigation. As of Friday, 138 nursing homes had agreed to the proposed settlement, said Colleen Mullis, the department’s deputy communications director. (Brown, 3/26)

Concord (N.H.) Monitor: New Hampshire Medicaid Match Among Nation’s Lowest
Now that the Republican effort to repeal the Affordable Care Act is off the table, New Hampshire and other states will get to keep their expanded Medicaid programs – at least for now. Even though that outcome is being welcomed by health care providers, the fact remains that New Hampshire’s current Medicaid reimbursement rates are some of the worst in the nation. The Granite State is among the states who receive a 50 percent Medicaid match from the federal Centers for Medicare and Medicaid – the lowest rate available for hospitals and other health care organizations. (Nilsen, 3/25)

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New ‘War On Drugs’ Needed To Battle Opioid Crisis, Sen. Manchin Argues

Stat interviews the West Virginia senator about his focus on a national epidemic that has hit his state particularly hard. In related news about the crisis: a New Jersey family files suit against a fentanyl manufacturer, doctor and pharmacy; Maryland lawmakers rush to pass an opioid bill; a New Hampshire physician assistant faces criminal charges over his Subsys prescriptions; and more.

Stat: Sen. Manchin: Time For A New ‘War On Drugs’ To Tackle Opioids
Senator Joe Manchin stepped onto the Senate floor last week to read a letter sent to him by Leigh Ann Wilson, a home caregiver whose 21-year-old daughter, Taylor, died from an opioid overdose last fall. “Please work quickly to prevent thousands of other Taylors from the same fate,” Manchin read. That was just the latest of many such letters that Manchin, a Democrat, has read on the Senate floor over the past year. He represents West Virginia, which has the highest rate of drug overdose deaths in the nation. And he seeks to amplify the voices of those most affected. (Blau, 3/27)

Stat: Lawsuit Blames Improper Marketing Of Potent Opioid For Woman’s Death
The family of a New Jersey woman who died after using a prescription version of the potent opioid fentanyl filed a wrongful death lawsuit Thursday against the drug’s maker, her doctor, and a specialty pharmacy that provided the drug. The lawsuit, filed in a New Jersey state court, alleges 32-year-old Sarah Fuller was the victim of a nationwide push by Insys Therapeutics to entice doctors to prescribe its Subsys fentanyl spray for patients for which the drug was not suitable. (Armstrong, 3/24)

Columbus Dispatch: More Ohio Newborns Suffer From Mother’s Addiction
The number of Ohio babies who come into the world sick and craving drugs continues to soar. New state reports show that the rate of neonatal abstinence syndrome — the medical term for withdrawal symptoms suffered by newborns — jumped to 159 per 10,000 live births in 2015. That’s more than eight times the rate a decade earlier, in 2005, when there were just 19 such hospitalizations for every 10,000 live births. (Price, 3/27)

The Hill: ‘Deaths Of Despair’ On The Rise Among Blue-Collar Whites 
A decades-long trend of economic stagnation and social immobility may be to blame for a shocking increase in death rates among middle-aged white Americans, a new study finds, as the number of deaths caused by drugs, alcohol abuse and suicide reaches levels not seen in generations. For nearly a century, advances in medical technology and healthy living have sent mortality rates of all Americans plummeting. But in recent years, a stark divide has emerged along educational and racial lines: as death rates plunge for minorities and well-educated whites, the number of whites without a college education dying in middle age is skyrocketing. (Wilson, 3/25)

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