From Medicine and Health

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Before we dive in to the harder news, please join me in enjoying this story about scientists dosing a shy breed of octopus with ecstasy to see if the animal became cuddly and friendly while high. (I swear, it relates to health care: More studies are evaluating psychedelic drugs as outside-the-box treatments, especially for post-traumatic stress disorder in veterans.)

Now, here’s what else you may have missed:

Senators were busy bees this week on the Hill. In a rare bipartisan feat, the upper chamber passed a sweeping opioids package … but there’s some fine print. Lawmakers still have to iron out the (harder, more controversial) differences between the Senate and House versions of the legislation, and they probably won’t do that work until November — conveniently, after midterms. Until then, they have a talking point!

And you know that “doughnut hole” change (which forces drugmakers to pay more for medication used by Medicare beneficiaries) that pharma hates and has been pestering lawmakers about for ages? Congress might tuck a measure rolling that back into the opioid package.

The Associated Press: GOP, Dems Unite Behind Senate Bill Fighting Addictive Drugs

Stat: GOP Lawmakers Seeking to Use Opioids Bill to Deliver Drug Industry Major Victory

It’s not all roses for drugmakers, though: A Senate-passed bill would ban “gag clauses,” which currently keep pharmacists from talking to consumers about lower-cost options.

Stat: Senate Passes Bill That Would Ban ‘Gag Clauses’ Limiting Disclosures on Drug Prices

In a sharp divergence from the budget spectacles of years past, the Senate quietly OK’d a measure to avert a government shutdown. The measure included a big, 5 percent boost to the National Institutes of Health, which was the fourth-straight significant increase for the agency.

The Associated Press: Senate Backs Bill to Avert Shutdown, Boost Military Spending

There’s a real fear out there that we’re all one bad accident away from financial ruin. A bipartisan group of senators wants to protect patients from that worry with its proposed measure on surprise bills, otherwise known as “balance billing.” (Bonus: Check out the KHN story that Republican Sen. Bill Cassidy cited in his announcement.)

The Hill: Bipartisan Senators Unveil Proposal to Crack Down on Surprise Medical Bills


As the news continues to evolve over the sexual assault allegations against Supreme Court nominee Brett Kavanaugh, here’s a health tidbit you might have missed if you didn’t scan all the way to the bottom of today’s stories. Gov. Bill Walker of Alaska, an independent, and his lieutenant governor, Byron Mallott, both came out against Kavanaugh’s nomination — not because of the accusations, but because they’re worried he’s going to jeopardize Medicaid coverage. It will be interesting to see if that’s enough to sway Alaska Sen. Lisa Murkowski, a Republican, who is being watched closely as a possible swing vote.

The New York Times: Christine Blasey Ford Opens Negotiations on Testimony Next Week


Attorney general races are rarely the belles of the ball when it comes to elections. But as more of them use their position to try to check President Donald Trump’s policies (especially ones chipping away at the health law), the campaigns are drawing more eyes.

Politico: Obamacare Lawsuit Boosts Democrats in State AG Races

Preexisting conditions have been a bomb Republicans have been trying to defuse for weeks on the campaign trail, but even GOP strategists call it a losing battle. “What you have to do at this point is duck and cover,” said one in Politico’s coverage.

Politico: Republicans ‘Duck and Cover’ on Pre-Existing Conditions


A new, more detailed report has emerged of the slow-moving medical catastrophe that was Hurricane Maria. It’s also a grim insight into why counting a death toll becomes so complicated.

The Associated Press: Maria’s Death Toll Climbed Long After Rain Stopped

Meanwhile, an investigation has been launched into why two mentally ill women who were seeking care were taken from a safe hospital and driven into Florence’s floodwaters, where they both drowned.

The New York Times: They Were Seeking Mental Health Care. Instead They Drowned in a Sheriff’s Van.


In the miscellaneous, must-read file for the week:

  • The U.S. is the most dangerous place to have a baby in the developed world, yet states are doing little to address the issue. And the ones that are, often blame the moms.

USA Today: Maternal Deaths: What States Aren’t Doing to Save New Mothers’ Lives

  • We’re on the precipice of some amazing breakthroughs for cancer treatments, yet Native Americans and black patients are missing out because they’re underrepresented in clinical trials.

ProPublica/Stat: Black Patients Are Being Left Out of Clinical Trials for New Cancer Therapies

  • Personal health aides can be a lifeline for elderly patients. Inviting a stranger into your home, though, is inherently risky and there’s few regulations that exist to weed out predators.

Boston Globe: Stranger in the House

  • And a fascinating Alzheimer’s treatment called “reminiscence therapy” has seen success overseas and is gaining traction here. Check out this one facility that recreated a 1950s town square, complete with Buddy Holly on the jukebox and an old-fashioned diner.

The Wall Street Journal: To Help Alzheimer’s Patients, A Care Center Re-Creates The 1950s


As a newsroom that has a dedicated chocolate drawer and sweet treats brought in by colleagues a few times a week, this article on employers cutting down on sugary snacks sparked a bit of a debate here. To ban or not to ban, that is the question of the week.

Have a great weekend!

State Highlights: Safety Allegations Against Manchester VA Unfounded, Internal Draft Report Shows; Colorado’s Mental Health System Riddled With Failures, Advocates Say

Media outlets report on news from New Hampshire, Colorado, Florida, Illinois, Massachusetts, Maryland, Tennessee, Louisiana, Texas, Washington, Ohio, Connecticut, California, Minnesota and Kansas.

CHIP Coffers Are Habitually Raided To Finance Other Parts Of The Budget. Take A Look At How It Survives.

Funds for the Children’s Health Insurance Program are technically outside the jurisdiction of the Appropriations Committees and don’t count against annual discretionary caps, and the pool of “contingency money” dedicated to the program has been tapped sparingly. Medicaid news comes out of Alabama and Maine, as well.

‘A Lot Of Opportunities’ Exist For Cutting Drug Costs, Trump Health Official Tells Congress

Joe Grogan, OMB’s associate director for health programs, didn’t specify what lawmakers can do before year’s end to stem rising costs, but one bill with bipartisan support helps generic companies obtain samples of brand drugs as part of the development process. News on the industry also spotlights a new lobbying heavyweight for PBM and Medicaid pharmaceutical spending.

America’s Drug Death Trends Are More Complex Than The Current Narrative About Opioid Overdoses

Overdose deaths are on a sharp upward trajectory, but the roles different drugs play in that overarching epidemic has been simplified to focus on opioids. A new study reveals the depth of the crisis in America over the past four decades, and offers a grim picture of the country’s future. In other drug-related news: hospitals and addiction treatment; the Trump administration’s efforts to curb the epidemic; information exchanges; and more.

Sloan Kettering Hit With Another Controversy Over Exclusive Deal With For-Profit Startup It Has Financial Stake In

Memorial Sloan Kettering Cancer Center and its officials hold an equity stake in the artificial intelligence startup to which the center has granted exclusive rights to use its vast archives. The connections raised some eyebrows so soon after the resignation of the center’s chief medical officer over his failure to disclose financial conflicts.

Massive Opioid Package Gives Congress Opportunity To Roll Back ‘Doughnut Hole’ Change That Pharma Hates

In February, Congress passed a provision forcing drug manufacturers to pay more for drugs used by Medicare beneficiaries. The industry has been railing about the change ever since, and the bipartisan opioid package might be lawmakers’ chance to hand pharma a big win.

Alex Azar Came To HHS Ready To Execute A Four-Point Health Plan. Then The Zero-Tolerance Crisis Happened.

HHS Secretary Alex Azar became the public face of the crisis because his agency is responsible for housing the migrant children that were separated from their parents. The Washington Post looks at how he handled the pressure. Meanwhile, Azar plans to shift millions from public health programs to help pay to house detained migrant children.

If Congress Can Assure Her Safety, Kavanaugh Accuser Says She’s Open To Testifying

Christine Blasey Ford originally said she wouldn’t testify about her allegations against Supreme Court nominee Brett Kavanaugh without an FBI investigation. While that’s still her preference, she said that she’s willing to come in next week “on terms that are fair.” Meanwhile, psychological experts dig into the complexities of memory.

Bad Air And Inadequate Data Prove An Unhealthy Mix

WASCO, Calif. — Kira Hinslea wanted to play outside, but she knew she couldn’t until her mom checked an air-quality app on her phone.

“Is it OK?” the 6-year-old eagerly asked her mother, Shirley Hinslea, one day late last month.

Hinslea gave Kira the green light, and the child beamed with excitement. “Yes! Yes! Yes!” she yelled, sprinting from the kitchen, across the living room and out to the porch of their mobile home in this small Kern County town.

Kira’s freedom didn’t last long. Within 20 minutes, her throat started to itch and her chest felt heavy, she told her mom. She wearily returned inside and sifted through her backpack for her inhaler.

Kira has had severe asthma since she was 2, and the polluted air in the San Joaquin Valley exacerbates her symptoms.

Valley residents inhale some of the dirtiest air in the nation, and families know to keep masks in their cars and inhalers within reach and to check the air quality on a daily — sometimes hourly — basis.

But Hinslea questions the air-quality readings. The mobile phone apps she uses to search for conditions in her ZIP code often lag hours behind the real-time data. Occasionally, apps and websites show conflicting readings, she said.

Now, local health and environmental groups in the San Joaquin Valley are helping residents like Hinslea get up-to-the-minute air-quality readings by distributing 20 monitors that measure particulate matter.

“We just don’t have all the information we need — not at the neighborhood level,” said Kevin Hamilton, a respiratory therapist and CEO of the Central California Asthma Collaborative, a nonprofit organization based in Fresno. “The regulatory agencies think regionally … not at the neighborhood level.”

Hinslea is enrolled in the collaborative’s asthma management program, and it offered her one of the palm-sized devices. She jumped at the opportunity. The monitors cost about $230 and require a Wi-Fi connection. A map showing all active monitors around the world — along with their data — can be viewed online.

“For [Kira’s] health, I want to have the best, real-time information,” said Hinslea, 47, as a staff member from the collaborative mounted the monitor on the side of the house near her front door.

The information collected from Shirley Hinslea’s new air monitor can be accessed online. (Ana B. Ibarra/California Healthline)

Health and environmental groups in the San Joaquin Valley are using off-the-shelf air monitors to begin collecting air-quality information at the neighborhood level while they wait for more sophisticated monitoring systems from the state. (Ana B. Ibarra/California Healthline)

Efforts by such nonprofits will supplement a new state law that aims to improve air quality — and air-quality monitoring — in communities such as Wasco that are heavily affected by air pollution.

As part of the law, the California Air Resources Board later this month is expected to name 10 polluted communities chosen to get help from the state to clean up their air. They will each have an air-monitoring system composed of several monitors strategically placed in different neighborhoods.

The monitors will track all types of air pollution, including the two most common: ozone, the main ingredient in smog, and particulate matter, which is pollution made up of ash, soot, diesel exhaust and other small particles.

The data from these monitoring systems will help communities identify specific pollution sources, such as sprayed pesticides, emissions from local oil refineries and from port operations. Then the California Air Resources Board and regional air districts will devise a plan to reduce those emissions, said Lindsay Buckley, a spokeswoman for the board. More communities will receive monitoring systems in later years.

Wasco, Calif., in northwestern Kern County, has a population of about 26,000. It is surrounded by farm fields and agricultural operations — and isn’t far from oil fields. Pollution from these and other sources worries some residents.

Communities slated to receive monitors in the first round include Shafter (near Wasco), south-central Fresno, Boyle Heights, south Sacramento, San Bernardino, El Centro in Imperial County and portside neighborhoods in San Diego County.

The state plans to begin monitoring those communities by next July.

Although Wasco is not among the first communities to receive a tracking system from the state, its residents will likely benefit from the data collected and lessons learned in nearby Shafter, Buckley said.

Wasco, home to about 26,000 people, takes pride in having the ideal climate for growing roses. It is also a big almond producer.

But as more farmers grow almonds, there’s more spraying of pesticides, said Gustavo Aguirre Jr., an organizer with the Central California Environmental Justice Network, which is helping distribute the 20 off-the-shelf air monitors.

Wasco is “surrounded 360 degrees by agricultural production,” he said, and the San Joaquin Valley is also a key player in oil and gas production for California.

“On top of that, we’re also in the middle of Highways 5 and 99,” Aguirre said. “So you have this cumulative effect from all these sources of pollution.”

Kira Hinslea, 6, takes a puff from her inhaler after having some trouble breathing and feeling chest pressure. The dirty and dusty air in Wasco, Calif., exacerbates her asthma symptoms.

Wildfire smoke this summer compounded worries over air quality for residents in the region, including Hinslea. “Now you’ve got smoke, and dust and just everyday pollution. … It can get really bad,” she said. “You look outside and think, ‘Is it overcast or is it smog?’”

When her daughter Kira’s asthma flares up, the little girl often coughs and wheezes through the night and misses school the next day, Hinslea said.

Having more timely and reliable information from the small air monitor near her front door will help her decide if her daughter can go to school — and if she does, whether she should stay indoors during recess, she said.

“It wasn’t always like this,” said Hinslea, who was born and raised in Wasco. “When I was little, it seemed crisper and brighter, fresh. It was just different.”


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

As States Try To Rein In Drug Spending, Feds Slap Down One Bold Medicaid Move

States serve as “laboratories of democracy,” as U.S. Supreme Court Justice Louis Brandeis famously said. And states are also labs for health policy, launching all kinds of experiments lately to temper spending on pharmaceuticals.

No wonder. Drugs are among the fastest-rising health care costs for many consumers and are a key reason health care spending dominates many state budgets — crowding out roads, schools and other priorities.

Consider Vermont, California and Oregon, states that are beginning to implement drug price transparency laws. In Nevada, the push for transparency includes the markup charged by pharmacy benefit managers (PBMs). In May, Louisiana joined a growing list of states banning “gag rules” that prevent pharmacists from discussing drug prices with patients.

State-based experiments may carry even greater weight for Medicaid, the federal-state partnership that covers roughly 75 million low-income or disabled Americans.

Ohio is targeting the fees charged to its Medicaid program by PBMs. New York has established a Medicaid spending drug cap. In late June, Oklahoma’s Medicaid program was approved by the federal Centers for Medicare & Medicaid Services to begin “value-based purchasing” for some newer, more expensive drugs: When drugs don’t work, the state would pay less for them.

But around the same time, CMS denied a proposal from Massachusetts that was seen as the boldest attempt yet to control Medicaid drug spending.

Massachusetts planned to exclude expensive drugs that weren’t proven to work better than existing alternatives. The state said Medicaid drug spending had doubled in five years. Massachusetts wanted to negotiate prices for about 1 percent of the highest-priced drugs and stop covering some of them. CMS rejected the proposal without much explanation, beyond saying Massachusetts couldn’t do what it wanted and continue to receive the deep discounts drugmakers are required by law to give state Medicaid programs.

The Medicaid discounts were established in 1990 law based on a grand bargain that drugmakers say guaranteed coverage of all medicines approved by the Food and Drug Administration in exchange for favorable prices.

The New England Journal of Medicine dives into the CMS decision regarding Massachusetts and its implications for other state Medicaid programs in a commentary by Rachel Sachs, an associate professor of law at Washington University in St. Louis, and co-author Nicholas Bagley. They dispute the Trump administration’s claim that Massachusetts’ plan would violate the grand bargain.

We talked with Sachs about Massachusetts’ proposal and the implications for the rest of the country. Her answers have been edited for length and clarity.

Q: Why do you think states, such as Massachusetts, should be allowed to exclude some drugs, a move the pharmaceutical industry has said would break the deal reached back in 1990?

In our view, there’s a way to frame it where the bargain has been broken and Massachusetts is simply trying to restore the balance. The problem is that the meaning of FDA approval has changed significantly over the last almost 30 years. Now we have a lot more drugs that are being approved more quickly, on the basis of less evidence — smaller trials, using surrogate endpoints — where the state has real questions about whether these drugs work at all, not only whether they are good value for the money.

Q: You suggest that Massachusetts could make a reasonable case if it chose to challenge the CMS denial. How?

CMS did not explain why it didn’t grant Massachusetts’ waiver. It needs to give reasons for denying something that Massachusetts, in our view, has the legal ability to do. CMS’ failure to give reasons in this case resembles their failure to give reasons in a number of other cases that have recently led courts to strike down actions by the Trump administration for failure to explain the actions that they were taking.

(Note: A spokeswoman for Health and Human Services in Massachusetts says the state is not going to challenge the CMS decision.)

Q: While CMS blocked the Massachusetts experiment, it has approved the value-based purchasing plan in Oklahoma, and New York has capped its Medicaid drug spending. Aren’t those signs of flexibility for states?

In some ways, yes, and in other ways, no. New York passed a cap on state Medicaid pharmaceutical spending. But once the state hits that cap, it doesn’t mean the state will stop paying for prescription drugs. It just means the state is empowered to negotiate with some of these companies and seek additional discounts. They didn’t need CMS approval for this. New York doesn’t have the ability to say “If you don’t take this deal, we’re not going to cover this product.”

Oklahoma is pursuing outcomes-based pricing, which is of interest. It’s the first state to express interest in doing so. However, there are a lot of observers who are skeptical that outcomes agreements of this kind will materially lower prices or if they just provide companies cover to charge higher prices in the first instance.

Q: So what options do you see ahead for states given what happened in Massachusetts with the Medicaid waiver?

Unfortunately, states are quite limited in what they’re able to do on their own, in terms of controlling prescription drug costs — both costs that are borne by the state in its capacity as a public employer and its capacity as an insurer for the Medicaid population. and then more generally for the many citizens who are on private insurance plans throughout the state.

This is a real problem, this concern of federal pre-emption where states’ ability to go beyond federal law is often limited. So what we’re seeing now is more states like Massachusetts and Vermont taking action that forces the federal government to do something or say something. States are increasingly putting pressure on the federal government because they know that their ability to act on this problem of drug pricing is limited.

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

Podcast: KHN’s ‘What The Health?’ Health On The Hill

As the start of the fiscal year draws near — along with pivotal midterm elections — Congress is picking up its pace on legislation. This week alone the Senate passed a comprehensive bill aimed at curbing the opioid epidemic and a nearly final bill to fund the Department of Health and Human Services.

Meanwhile, a bipartisan group of senators unveiled draft legislation aimed at helping patients who receive “surprise” medical bills after inadvertently receiving medical care outside their insurance carrier’s network.

This week’s panelists are Julie Rovner of Kaiser Health News, Rebecca Adams of CQ Roll Call, Margot Sanger-Katz of The New York Times and Joanne Kenen of Politico.

On Sept. 27, the podcast will tape in front of a live audience at the Texas Tribune Festival in Austin, Texas. Details are here. Also on Sept. 27, KHN is hosting a live event to discuss medical overtreatment and its health consequences. More information on that event is here.

Among the takeaways from this week’s podcast:

  • Legislation to combat the opioid epidemic is expected to move through Congress quickly because both Republicans and Democrats are eager to show voters they are addressing what is a nationwide public health crisis.
  • That opioid package won’t provide a solution to one of the most vexing problems of the epidemic: The majority of deaths come from the use of an extremely powerful drug, fentanyl, that is often mixed with illegal opioids.
  • For the first time in years, Congress is likely to pass a bill to fund HHS before the start of the fiscal year on Oct. 1. The bill is known for triggering “culture war” debates, especially on issues dealing with abortion, but lawmakers have largely avoided that this year.
  • Opponents of abortion sought to use the HHS appropriations bill to defund Planned Parenthood. But both Republicans and Democrats worked to stop any poison pills that might have held up the bill. Also, the bill needs 60 votes to pass the Senate, so Democrats had to be accommodated in order to get it through.
  • Sen. Bill Cassidy (R-La.) headed a bipartisan group of senators who unveiled a bill this week that would squelch surprise medical bills that patients get from out-of-network hospitals or doctors, a process known as “balance billing.” The initiative isn’t expected to pass this year, but it is an issue that Cassidy will likely bring up again next year when the new Congress meets.

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

Julie Rovner: Politico’s “Obamacare Lawsuit Boosts Democrats in State AG Races,” by Alice Ollstein

Rebecca Adams: The Wall Street Journal’s “Behind Your Rising Health-Care Bills: Secret Hospital Deals That Squelch Competition,” by Anna Wilde Mathews

Joanne Kenen: The New York Times’ “23andMe Said He Would Lose His Mind. Ancestry Said The Opposite. Which Was Right?” by Laura Hercher

Margot Sanger-Katz: The New York Times’ “Manchin Counts on Health Care to Stave Off Republican Tide in West Virginia,” by Trip Gabriel

To hear all our podcasts, click here.

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