From Medicine and Health

Hospitals’ Best-Laid Plans Upended By Disaster

It was 3:35 a.m. and flames from a massive Northern California wildfire licked at the back of a Santa Rosa hospital.

Within three hours, staffers evacuated 122 patients to other facilities — something they’d never come close to doing before. Ambulances sped off with some of the sickest patients; city buses picked up many of the rest.

With phone lines charred and communication restricted, doctors and nurses struggled to figure out who was sent where — forced to keep their wits even as some of their own homes burned and their families fled.

This was not exactly covered in their meticulously executed drills and disaster-preparedness videos.

“You never know how you’ll react until it comes your way … until fate taps you on the shoulder,” said Dr. Josh Weil, an emergency medicine physician at Kaiser Permanente in Santa Rosa who led the hospital evacuation operation on Oct. 9.

America’s hospitals were beset by an unusual number of calamities in 2017: The fires that raged in Northern and Southern California; hurricanes that displaced thousands in Houston, Florida and Puerto Rico; the deadliest mass shooting in modern history that killed 58 people and wounded more than 500 others in Las Vegas; and the attack at a Bronx hospital in which a doctor turned a gun on his former colleagues, killing one and injuring six.

Across the country, natural disasters have become more frequent and more deadly; the carnage from mass shootings resembles that on a battlefield. In some cases, these crises are more severe and elaborate than most hospitals — particularly smaller ones — are prepared for, and experts say it is time to bring facilities up to speed.

“The probability that any individual hospital will be involved in an unusual event is increasing,” said Dr. Carl Schultz, professor emeritus of emergency medicine and public health at the University of California-Irvine. “All hospitals are potentially vulnerable,” he said, and “there is more pressure for hospitals to be prepared.”

That’s the case, he added, even though hospitals often lack the resources and funding to upgrade their disaster plans.

In the new year, hospitals that responded to outsized tragedies in 2017 are reassessing their plans in light of their painful experiences. Below are some instructive examples:

Keeping Track Of Patients

In Northern California, staffers from the Kaiser hospital in Santa Rosa rushed to clear out their wards as the ferocious Tubbs Fire approached. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

The original plan was to jot down details from each displaced patient’s identification bracelet so that the hospital could later confirm that patients arrived at other hospitals safely. But with the fire coming fast upon them, it became clear this would take too long, Weil said.

On the fly, one staffer suggested taking photos of patient wristbands with smartphones, he said.

“That was a brilliant idea that really saved us,” Weil said.

The hospital is now considering whether smartphones might be of greater use in future emergencies, or if there’s a more efficient way to track patients who must be rapidly whisked away.

Eight days earlier, another tracking issue surfaced at Sunrise Hospital & Medical Center in Las Vegas — this one concerning incoming patients. The facility was suddenly inundated by people shot or otherwise injured during the tragedy at the outdoor country music festival; 212 patients were admitted in a two-hour window, 124 of them with gunshot wounds.

Of those, 92 had no official photo identification on them.

Families dashed desperately from one hospital to another searching for their loved ones, said Alan Keesee, the hospital’s chief operations officer. Without IDs for patients, it was a challenge to confirm whether they were at the hospital, let alone whether they would be OK.

Enterprising staffers listed their unidentified patients’ physical traits and unique features, such as tattoos, to help match people with the descriptions family members provided. In turn, many relatives pulled up social media profile photos of their loved ones to give the hospital something to go by.

The chaotic process of patient identification exposed a desperate need for a centralized data hub where descriptions of unidentified patients in a massive emergency could be uploaded and accessed by all area hospitals, Keesee said.

And indeed, he said, his hospital is working with the Nevada Hospital Association and other local health agencies to determine whether the hub can be created.

Communication And Coordination

Last June, a former doctor stormed Bronx-Lebanon Hospital armed with a semiautomatic rifle.

Staff members had trained for just this kind of incident. But they had not anticipated how restricted their movements would be once police took over, said Dr. Sridhar Chilimuri, the physician-in-chief that day.

“Shooting victims need blood transfusions, so you need to get from the blood bank to the operating rooms quickly,” Chilimuri said.

But the hospital lockdown blocked access to elevators. Doctors and nurses also had to fetch surgical instruments and move patients, he added, but they couldn’t do so without approval from police.

Because it was an internal shooting, police had to clear staffers of suspicion before they could return to work — even the doctors needed for lifesaving operations.

The hospital has since updated its drills to include an accelerated process of police screening — targeting the medical staff most urgently needed — and its training videos now show an attacker armed with an assault weapon rather than a small handgun.

“Hopefully that will help us cut down on the time we are crippled,” Chilimuri said.

Running Low On Supplies

When Hurricane Irma barreled into South Florida in September, the 10 Tenet Health hospitals in the region felt ready.

They had beefed up their disaster plans after Hurricane Matthew landed a year earlier, said Cathy Philpott, a director of nursing practice and clinical operation for the hospital system. They also brought in staff from other states and rolled in backup generators, she said.

Even so, they faced an unexpected challenge: a shortage of platelets, cells that help the body form clots to stop bleeding.

Until sister hospitals in Boston could airlift platelets in, the hospitals had to work with local blood banks to conserve the supply and prioritize their use for trauma patients. When hurricanes are forecast in the future, the hospitals will reach out to local blood banks and host platelet drives as the storms approach, Philpott said.

“That’s the lesson learned,” she said.

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

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University Under Fire For Off-The-Grid Herpes Vaccine Experiments

WASHINGTON — Southern Illinois University’s medical school has halted all herpes research, one of its most high-profile projects, amid growing controversy over a researcher’s unauthorized methods offshore and in the U.S.

SIU’s ethics panel launched a “full” investigation Dec. 5 of the herpes vaccine experiments by university professor William Halford, according to a memo obtained by Kaiser Health News.

Halford, who died in June, had injected Americans with his experimental herpes vaccine in St. Kitts and Nevis in 2016 and in Illinois hotel rooms in 2013 without routine safety oversight from the Food and Drug Administration or an institutional review board, according to ongoing reporting by KHN. Some of the participants say they are experiencing side effects.

The panel, known as the Misconduct in Science Committee, told SIU’s medical school dean that the inquiry should not only investigate the extent of Halford’s alleged wrongdoing, but also scrutinize “members of his research team,” according to the Dec. 5 memo obtained through a Freedom of Information Act request.

“The Misconduct in Science Committee is now in its investigative stage and the School anticipates this investigation will take approximately 120 days,” SIU spokeswoman Karen Carlson told KHN in an emailed response. “However, the investigation could take longer.”

The panel’s inquiry marks the second one to be launched by SIU since Halford’s methods were detailed in a KHN report in 2017.

The Department of Health and Human Services asked the university to determine whether Halford’s activities violated the institution’s pledge to HHS. SIU, a state university, had pledged to follow human-subject safety protocols for all research, even if privately funded.

In October, SIU medical school’s institutional review board determined Halford’s activities were in “serious noncompliance” with university rules and U.S. regulations and recommended that the misconduct committee investigate, according to records obtained by KHN under open-records laws.

Now, the committee has taken up the case, putting more pressure on SIU’s medical school, which initially said it bore no responsibility for the experiments.

The committee, which is made up of five faculty members, holds hearings about such misconduct and can call witnesses before reaching a conclusion.

The university is required to have such a committee to assure the federal government that it will examine allegations of research misconduct, said Bethany Spielman, a professor of health law at SIU’s medical school in Springfield,Ill. The medical school receives about $ 9 million a year in federal research dollars.

“Part of the reason this committee exists is to keep the federal funding clean and flowing,” said Spielman, who specializes in bioethics. “Any university that does research, especially with human subjects, wants to be trusted by the federal government and the public.”

In SIU’s response to KHN’s open-records request, the university excised the names of the committee members.

Carlson said that after the committee’s investigation is complete “in conjunction with recommendations from the appropriate federal agencies, we will address our policies and procedures and anything else that arises from the investigation.”

“Currently, no herpes research is being conducted at SIU,” she said.

SIU had said Halford conducted his research on human subjects independently in the Caribbean in 2016 with a company he co-founded with a Hollywood filmmaker. Yet, SIU’s medical school shared in a patent on a prospective vaccine with Halford’s company, Rational Vaccines, and promoted Halford’s vaccine research on its website.

The university has not responded to questions about its role in earlier experiments on human experiments by Halford. According to emails obtained by KHN and an account by one of the participants in the herpes vaccine experiment, Halford injected patients with the vaccine in 2013 in Illinois hotel rooms.

Many of the email exchanges with the participants in 2013 — asking them to send photographs of rashes, blisters and other reactions — were sent from Halford’s university email account. He used the university phone for communication and he referred to a graduate student as assisting in the experiment and to using the lab, which ethics experts said could constitute an improper use of state funds.

It is unclear whether the committee will have access to Halford’s or his former colleagues’ emails for its inquiry. An SIU colleague who had worked with him on his research took a job with Rational Vaccines, according to his online profile. Edward Gershburg, a former SIU professor, describes himself as the company’s chief technology officer, according to his LinkedIn account. Gershburg, who is no longer with the university, could not be reached for comment, and the company did not respond to questions about him.

In the Dec. 5 memo obtained by KHN, the misconduct committee pointed out that Halford received federal funding for his research on animals from the National Institutes of Health. In such cases, universities are supposed to ensure that researchers don’t use federal funding for unauthorized research, ethics experts told KHN. SIU’s Carlson said Halford’s NIH funds stopped in 2012.

“It is unclear at this time whether that grant is affected by the alleged misconduct,” stated the memo, which was sent to the medical school dean, Jerry Kruse, who assumed that role on Jan. 1, 2016.

In a reference to Halford’s nasal cancer, which was diagnosed before the human-subject experiments, the committee added: “We can only speculate as to [Halford’s] motivation, which may have been related to his terminal illness.”

NIH declined comment and HHS did not respond to questions.

The pressure on the university has intensified with attention from Capitol Hill and a high-profile lawyer.

In letters sent out earlier this month, Iowa Sen. Chuck Grassley, the Republican chair of the Judiciary Committee, told the Trump administration and Southern Illinois University that he wanted to be reassured that “corrective action” was being taken to prevent similar research abuses.

In a separate development, three participants injected with an unauthorized herpes vaccine by Halford are demanding compensation from SIU for alleged side effects from the vaccine.

The participants recently hired Alan Milstein, a New Jersey lawyer who specializes in litigating research abuses. In late December, Milstein notified SIU that the participants hired him to pursue litigation. Milstein asked for a meeting to discuss the participants’ fears about the vaccine and possible side effects.

“They realize now they were used as guinea pigs in outrageously unethical experiments that defied and flouted the most basic requirements of human-subject research in this country,” Milstein said in an interview.

The participants, who have herpes, have requested anonymity to protect the privacy of their health.

Milstein sent a similar letter to Halford’s company, Rational Vaccines.

Rational Vaccines was co-founded with Hollywood filmmaker Agustín Fernández III and has since received millions of dollars in private investment from billionaire Peter Thiel, who contributed to President Donald Trump’s campaign.

SIU declined to comment, and the company did not respond to questions about Milstein’s letter.

While critics have accused Milstein of relying on overly aggressive tactics that obstruct legitimate research, he is widely known to pursue research misconduct cases, even those involving some of the nation’s most prominent research institutions.

Over the past decade, Milstein has represented plaintiffs alleging research abuses committed by drug companies and prestigious universities, including Stanford University and the University of Pennsylvania. The complaints often have led to confidential settlements.

Regardless of whether SIU can be found negligent in court, Spielman of SIU said she believed the university owed the participants an “institutional apology” for how the research was conducted.

“The university should acknowledge that there must have been some kind of breakdown in the system,” she said.

KHN’s coverage of prescription drug development, costs and pricing is supported by the Laura and John Arnold Foundation.

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First Edition: January 23, 2018

States Face Costly Conundrum: How To Treat Inmates With Hepatitis C

In a corner of Jymie Jimerson’s house in the town of Sparta, in southwestern Missouri, she has set up a kind of shrine. It has Native American art representing her Cherokee heritage alongside Willie Nelson albums, books and photos in remembrance of her late husband.

There’s a copy of Nelson’s mid-’70s LP “Red Headed Stranger.”

“When Steve was young, he had red hair and a red beard, so he always really identified with Willie’s ‘Red Headed Stranger,’” Jimerson said. “I try to keep it up there as a reminder of better days.”

Her husband, Steve Jimerson, was sentenced to life in prison in 1996 for his role in the shooting deaths of two men. Jimerson said her husband’s life had been ravaged by drug abuse. But after he entered prison, he got off drugs and become a mentor for other inmates.

“Once he got inside, recovery became his life,” Jimerson said. “And that was his passion until the day he died.”

Steve Jimerson died on Jan. 6, 2017, of complications from hepatitis C, a liver infection that’s especially widespread among prison inmates. He was 59.

While the disease is common among the incarcerated, treatment with the latest hepatitis drugs isn’t.

Civil liberties groups in Missouri and at least seven other states are now suing to get more inmates treated with new-generation hepatitis C drugs that are highly effective but also costly.

After Steve Jimerson was diagnosed with hepatitis C in prison, his widow said, he was on the lookout for news of treatment advances.

In 2013, Gilead Sciences introduced Sovaldi, the first of a new generation of drugs called direct-acting antivirals that can cure hepatitis C and with fewer side effects than the previous treatments. But the excitement was dampened by the drug’s price. A full course of treatment carried an $84,000 price tag.

In 2016, around 5,000 inmates in Missouri’s prisons had hepatitis C, and no more than 14 of them received the drugs, according to internal state data obtained by the Roderick & Solange MacArthur Justice Center in St. Louis. That’s about 15 percent of the 32,000 people incarcerated in Missouri’s prisons.

Jimerson said that her husband wasn’t given direct-acting antivirals. By the fall of 2016, his health was deteriorating rapidly, and he grew pessimistic about the prospects for a cure.

“He told me that if someone had to die to get the DOC [Department of Corrections] to change their policy, he was OK with it being him,” she said.

As recently as 2012, scores of Missouri inmates were being treated with older hepatitis C drugs, including one called interferon that is notorious for its debilitating side effects. But in 2013, the Federal Bureau of Prisons started changing treatment guidelines to replace the old hepatitis C drugs with new ones.

Many states follow those guidelines, including Missouri, according to a spokesperson from Corizon Health, the private company that provides health care for Missouri’s inmates.

But the updated guidelines gave prisons more leeway to decide when it’s appropriate to provide treatment. And as Missouri phased out the old drugs, it hasn’t used the new drugs nearly as often. That has left only a handful of inmates getting any hepatitis C drug treatment at all.

In December 2016, the American Civil Liberties Union and MacArthur Justice Center sued to get the Missouri Department of Corrections to provide direct-acting antiviral drugs to inmates with hepatitis C who qualify for treatment.

ACLU lawyer Tony Rothert said the state’s current treatment practices violate the U.S. Constitution’s Cruel and Unusual Punishments Clause, part of the Eighth Amendment.

“The Supreme Court has said that in the context of medical care, that means that prisons cannot be deliberately indifferent to serious medical needs,” Rothert said. “Hepatitis C fairly easily satisfies this test, because if left untreated, there’s a fair chance that you will die.”

Advocates making this argument got a big boost for their case in November 2017, when a federal judge in Florida ordered that state’s prisons start providing direct-acting drugs to its inmates at least until that state’s case goes to trial in August.

“It was a great victory for people who are incarcerated and have hepatitis C because now we have a federal judge who said, ‘Look, this is just unconscionable,’ and the state is going to have to do something about it,” said Elizabeth Paukstis, public policy director of the National Viral Hepatitis Roundtable.

In July 2017, the Missouri lawsuit took a leap forward when the judge overseeing the case certified it as a class action on behalf of state inmates with hepatitis C. The Missouri Department of Corrections and Corizon, which are defendants in the lawsuit, have appealed that ruling.

Both the Missouri Department of Corrections and Corizon declined to comment on the suit or answer questions about their hepatitis C treatment protocols beyond saying they are following federal guidelines.

But if Missouri and other states are required to offer the new drugs, they would face a huge problem, said Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Public Health. “Even if they wanted to treat patients, they would break the bank. They would run out of money to treat every other medical condition,” he said.

For example, if Missouri gave the 2,500 inmates that the ACLU says are candidates for Harvoni, the direct-acting antiviral drug it now uses, the cost would exceed $236 million, based on its list price. That far exceeds the Department of Corrections’ entire budget for inmate health.

Gonsalves said the emergence of newer, cheaper drugs could help, and some state prison systems have managed to negotiate discounts.

Even at a lower cost, though, providing these drugs on a large scale could still cost states a fortune. But advocates insist it’s worth it to stop the disease from spreading. And a 2015 study showed that as many as 12,000 lives would be saved if inmates across the country were screened and treated; preventing liver transplants and liver disease would save money in the long run.

“The impetus for treating infectious disease in the prison system is that it’s a population you can reach, it’s a population you can cure, and it’s a population you can help prevent onward infections from,” Gonsalves said.

Jymie Jimerson understands that many people might be skeptical about providing expensive health care for prison inmates. But she hopes they can see them as more than people convicted of crimes, she said.

“I’m not condoning what they did. I’m not condoning criminals,” Jimerson said. “What I’m saying is, they’re human beings. And there are hundreds, hundreds of first-time offenders that this medication would cure them. So that when they went home, they could actually spend time and enjoy a little bit of life with their families.”

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

KHN’s coverage of prescription drug development, costs and pricing is supported by the Laura and John Arnold Foundation.

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Tax Bill Provision Designed To Spur Paid Family Leave To Lower-Wage Workers

Tucked into the new tax law is a provision that offers companies a tax credit if they provide paid family and medical leave for lower-wage workers.

Many people support a national strategy for paid parental and family leave, especially for workers who are not in management and are less likely to get that benefit on the job. But consultants, scholars and consumer advocates alike say the new tax credit will encourage few companies to take the plunge.

The tax credit, proposed by Sen. Deb Fischer (R-Neb.), is available to companies that offer at least two weeks of paid family or medical leave annually to workers, but two key criteria must be met. The workers must earn less than $72,000 a year and the leave must cover at least 50 percent of their wages.

If contributing at the half-wage level, a company receives a tax credit equal to 12.5 percent of the amount it pays to the worker. The tax credit will increase on a sliding scale if the company pays more than 50 percent of wages. It could go up to a maximum credit of 25 percent of the amount the employer paid for up to 12 weeks of leave.

Payments to full- and part-time workers taking family leave who’ve been employed for at least a year would be eligible for the employer’s tax break. But the program, which is designed to test whether this approach works well, is set to last just two years, ending after 2019.

Aparna Mathur, a resident scholar in economic policy studies at the American Enterprise Institute, says the new tax credit sidesteps a pitfall for Republicans. They are wary of any legislation mandating that employers provide paid leave. The tax credit also is appropriately aimed at lower-wage workers who are most likely to lack access to paid leave, said Mathur, who co-authored a recent report on paid family leave.

But it’s not a big enticement.

“Providing this benefit is a huge cost for employers,” Mathur said. “It’s unlikely that any new companies will jump on board just because they have a 12.5 to 25 percent offset.”

That view is shared by Vicki Shabo, vice president for workplace policies and strategies at the National Partnership for Women & Families, an advocacy group, who said it will primarily benefit workers at companies already offering paid family leave. The new tax credit “just perpetuates the boss lottery,” she added.

Heather Whaling said her 22-person public relations company probably qualifies for the new tax credit, but she doesn’t think it’s the right approach. Whaling, the president of Geben Communication in Columbus, Ohio, already offers paid leave. The company provides up to 10 weeks of paid leave at full pay for new parents. Four employees have taken leave, and by divvying up their work to other team members and hiring freelancers they’ve been able to get by.

“It is an expense, but if you plan and budget carefully it’s not cost-prohibitive,” she said.

The tax credit isn’t big enough to provide a strong incentive to provide paid leave, said Whaling, 37. Besides, “having access to paid family leave shouldn’t be luck of the draw, it should be available to every employee in the country.”

Still, the tax credit may be appealing to companies that have been considering adding a paid family and medical leave benefit, said Rich Fuerstenberg, a senior partner at benefits consultant Mercer.

By defraying some of the cost, the tax credit could help “tip them over” into offering paid leave, he said. But  “I’m not even sure I’d call it the icing on the cake,” Fuerstenberg said. “It’s like the cherry on the icing.”

Only 15 percent of private-sector and state and local government workers had access to paid family and medical leave in 2017, according to the Bureau of Labor Statistics’ National Compensation Survey. Eighty-eight percent had access to unpaid leave, however.

Under the federal Family and Medical Leave Act, employers with 50 or more workers generally must allow eligible employees to take unpaid leave for up to 12 weeks annually for specified reasons. These include the birth or adoption of a child, caring for your own or a family member’s serious health condition, or leave for military caregiving or deployment. An individual’s job is protected during such leaves.

A tax credit that can be claimed at the end of the year is unlikely to encourage small businesses to offer paid family and medical leave, said Erik Rettig, an expert on family leave policies at the Small Business Majority, which advocates for those firms on national policy.

“It isn’t going to help the family business that has to absorb the costs of this employee while they’re gone,” Rettig said.

A better solution, according to Shabo and others, is to provide a paid family leave benefit that’s funded by employer and/or employee payroll contributions. Sen. Kirsten Gillibrand (D-N.Y.) and Rep. Rosa DeLauro (D-Conn.) last year reintroduced such legislation. Their bill would guarantee workers, including those who are self-employed, up to 12 weeks of family and medical leave with as much as two-thirds of their pay.

A handful of mostly Democratic states — including California, New Jersey, Rhode Island and New York — have similar laws in place, and a program in the District of Columbia and Washington state will begin in 2020.

“We know from states that this approach works for both employees and their bosses,” Shabo said.

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CHIP Renewed For Six Years As Congress Votes To Reopen Federal Government

A brief, partial shutdown of the federal government was resolved Monday, as the Senate and House approved legislation that would keep federal dollars flowing until Feb. 8, as well as fund the Children’s Health Insurance Program for the next six years.

The legislation is awaiting President Donald Trump’s signature, expected later Monday evening.

The CHIP program, which provides coverage to children in families who earn too much to qualify for Medicaid but not enough to afford private insurance, has been bipartisan since its inception in 1997. But its renewal became a partisan bargaining chip over the past several months.

Funding for CHIP technically expired Oct. 1, although a temporary spending bill in December gave the program $2.85 billion. That was supposed to carry states through March to maintain coverage for an estimated 9 million children, but some states began to run short almost as soon as that bill passed.

The Georgetown University Center for Children and Families estimated that 24 states could face CHIP funding shortfalls by the end of January, putting an estimated 1.7 million children’s coverage at risk in 21 of those states.

Meanwhile, both houses of Congress had been at loggerheads over how to put the program on more firmer financial footing.

In October, just days after the program’s funding expired, the Senate Finance Committee approved a bipartisan five-year extension of funding by voice vote. But that bill did not include a way to pay the cost, then estimated at $8.2 billion.

In November, the House passed its own five-year funding bill for the program, but it was largely opposed by Democrats because it would have offset the CHIP funding by making cuts to Medicare and the Affordable Care Act (ACA).

Prospects for a CHIP deal brightened earlier this month when the Congressional Budget Office re-estimated how much the extension of funding for the program would cost. In a letter to Senate Finance Committee Chairman Orrin Hatch (R-Utah) on Jan. 5, CBO said changes to health care made in the tax bill would result in lowering the five-year cost of the program from $8.2 billion to $800 million — effectively a reduction of 90 percent.

The reason, explained CBO, is that the landmark tax bill passed in December eliminated the ACA’s individual mandate, which would likely drive up premiums in the individual market. Those higher premiums, in turn, would increase the federal premium subsidies for those with qualifying incomes. As a result, if kids were to lose their CHIP coverage and go onto the individual exchanges instead, the federal premium subsidies would cost more than their CHIP coverage.

Driving that point home, on Jan. 11, CBO Director Keith Hall wrote to Rep. Frank Pallone (D-N.J.) that renewing CHIP funding for 10 years rather than five would save the federal government money. “The agencies estimate that enacting such legislation would decrease the deficit by $6.0 billion over the 2018-2027 period,” the letter said.

That made it easier for Republicans to include the CHIP funding in the latest spending bill. But it infuriated Democrats, who had vowed not to vote for another short-term spending bill until Congress dealt with the issue of immigrant children brought to the country illegally by their parents.

Republicans, said Senate Minority Leader Chuck Schumer (D-N.Y.) on Sunday, “were using the 10 million kids on CHIP, holding them as hostage for the 800,000 kids who were Dreamers. Kids against kids. Innocent kids against innocent kids. That’s no way to operate in this country.”

Republicans, however, said it was the opposite — that Democrats were holding CHIP hostage by not voting for the spending bill. “There is no reason for my colleagues to pit their righteous crusade on immigration against their righteous crusade for CHIP,” said Hatch. “This is simply a matter of priorities.”

The CHIP renewal was not the only health-related change in the temporary spending bill. The measure also delays the collection of several unpopular taxes that raise revenues to pay for the ACA’s benefits. The taxes being delayed include ones on medical device makers, health insurers and high-benefit “Cadillac” health plans.

The bill does not, however, extend funding for Community Health Centers, another bipartisan program whose funding is running out. That will have to wait for another bill.

KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation.

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In Trump’s First Year, Anti-Abortion Forces Make Strides Despite Setbacks

As a candidate, President Donald Trump promised abortion opponents four specific actions to “advance the rights of unborn children and their mothers.”

One year into his presidency, three of those items remain undone. Nevertheless, abortion opponents have made significant progress changing the direction of federal and state policies on the issue.

Indeed, on Friday, as anti-abortion protesters gathered in Washington for the 45th annual March for Life, the Trump administration announced two new policies. One is a letter to states aimed at making it easier for them to exclude Planned Parenthood facilities from their Medicaid programs; the other is a proposed regulation to allow health care providers to refuse to perform services that conflict with their “religious or moral beliefs.”

“In my administration, we will always defend the very first right in the Declaration of Independence, and that is the right to life,” Trump said in a video address from the Rose Garden to the marchers.

A vendor sells buttons during the “March for Life” on Jan. 19, 2018 in Washington, D.C. (Julie Rovner/KHN)

Marjorie Dannenfelser, president of the anti-abortion group the Susan B. Anthony List, led the Trump campaign’s Pro-Life Coalition. The then-candidate said he was committed to “nominating pro-life justices to the U.S. Supreme Court,” which happened with the nomination and confirmation of Justice Neil Gorsuch in April.

But despite many attempts, Congress did not pass a federal ban on abortions occurring after 20 weeks, did not cut off Planned Parenthood’s federal funding and did not write into permanent law the “Hyde Amendment,” which bans most federal abortion funding but needs annual renewal.

Still, there was progress on scaling back abortion and, in some cases, access to contraception at the federal level.

The administration made myriad changes. It reinstituted and expanded the “Mexico City Policy,” which forbids funding of international aid programs that “perform or promote” abortion. It issued rules aimed at allowing religious-affiliated and other employers to not offer contraceptive services if they have a “religious belief” or “moral conviction” against them, although federal courts have blocked the new rules from being implemented. And just last week it created a new “conscience and religious freedom” division in the Department of Health and Human Services’ Office of Civil Rights. That new division is designed to enforce both existing laws protecting the rights of conscience for medical personnel as well as the new regulations.

Most important, according to many in the anti-abortion movement, the president nominated and the Senate confirmed a dozen and a half federal district court and appeals court judges who are considered likely to rule in their favor.

Abortion rights supporters concede that while the priorities on their opponents’ wish list were not accomplished, plenty still happened.

“This administration is the worst we’ve ever seen for women and families,” said Kaylie Hanson Long of NARAL Pro-Choice America in a statement. “Its attacks on reproductive freedom are relentless, under the radar, and aren’t supported by the majority of Americans who believe abortion should remain legal.”

Dannenfelser said one of the biggest changes is the number of anti-abortion advocates now working in the Department of Health and Human Services in key roles. “I can say there is more unity in this administration than there has been in any presidency on this,” she said.

Abortion opponents know their biggest obstacle is the U.S. Senate, where they don’t have the 60 votes required for most legislation. “Without making advances in the Senate, it’s going to be really tough,” said Dannenfelser.

Meanwhile, outside Washington, states continued their efforts to restrict access to abortion and family planning. States have passed 401 separate measures since Republicans took over most state legislatures in 2011, according to the Guttmacher Institute, a reproductive rights research and advocacy group.

During 2017, 19 states enacted 63 separate restrictions, said Elizabeth Nash, who tracks state legislation for Guttmacher. Among the notable laws was one in Ohio to outlaw abortions of fetuses diagnosed with Down syndrome. Arkansas and Texas passed laws to ban “dilation and evacuation” abortions, a procedure that uses suction and medical instruments to remove the fetus and is the most common procedure for abortion after the first trimester of pregnancy. Both bans have been blocked by federal courts.

Some of the new restrictions came from states that have not been active on the issue in recent years. A Wyoming law requiring ultrasounds to be offered to pregnant women seeking an abortion was that state’s first in 30 years, Nash said.

But 2017 was also notable for states seeking to widen or ensure access to abortion and other reproductive services. For example, Delaware passed a law enshrining abortion rights, while Oregon and New York require private health plans to cover abortion without patients’ cost sharing. Legislators in California, which has a long history of protecting abortion rights, have been pushing a bill that would require public universities to provide abortion pills to female students who are less than 10 weeks pregnant. The bill stalled last year, but it is being picked up again this year.

As a result, said Nash, “we are really living in a bifurcated country. The states that are progressive are looking to protect access” to abortion and contraception. “The states that are conservative are looking to restrict it.”

In other words, a nation that looks a lot like it did 45 years ago, when the Supreme Court legalized abortion nationwide in Roe v Wade.

California Healthline Reporter Ana B. Ibarra in Sacramento, Calif., contributed to this article.

KHN’s coverage of women’s health care issues is supported in part by The David and Lucile Packard Foundation.

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