Tagged Health Industry

State Highlights: Calif. Nurses Launch Campaign Targeting Lawmaker Who Pulled Single-Payer Bill; Audit Of Ga. Health Plan Finds Thousands Of Ineligibles

Media outlets report on news from California, Georgia, Minnesota, Florida, Massachusetts, Texas and Virginia.

San Jose Mercury News: California Single Payer Health Care Backers Dog Democrat
The surprise decision by Assembly Speaker Anthony Rendon to block California’s single-payer health care bill, which the Democrat on Friday called “woefully incomplete,” has so infuriated the California Nurses Association — the bill’s sponsor — that the group has launched an aggressive campaign to pressure him to change his mind. The speaker says he’s even getting threats of violence online, directed at him and his family — a claim that a union spokesman on Wednesday dismissed as an attempt to distract the public from his actions. (Murphy, 6/28)

Sacramento Bee: CA Lawmaker Death Threats For Blocking Universal Health Care
Anger over Assembly Speaker Anthony Rendon’s decision to shelve universal health care legislation in California has boiled into aggressive protests and even violent rhetoric against the Democratic leader. Rendon said Wednesday that he and his family have experienced “distressing” death threats since announcing late last Friday that the “woefully incomplete” Senate Bill 562 would not move forward this year. (Koseff, 6/28)

Georgia Health News: Grady Gets Big Corporate Grant To Help Fight HIV
The Grady Health Foundation announced Wednesday that a giant biopharmaceutical company is donating $2 million to help renovate the Grady system’s HIV/AIDS center in Atlanta. The Grady Ponce de Leon Center, which opened in 1993, serves about 6,000 patients annually from a 20-county area that includes Fulton and DeKalb, which have the highest prevalence of HIV in the state. (Miller, 6/28)

Miami Herald: Miami Beach Wants To Regulate Pharmacies So It Can Regulate Medical Pot
After state lawmakers passed legislation governing Florida’s medical marijuana industry this month, local zoning regulations for dispensaries being considered in Miami Beach have stalled. The new state regulations pre-empt local governments from regulating medical cannabis dispensaries any more than they regulate pharmacies, blowing a hole in the zoning plans of Miami-Dade County and Miami Beach. (Flechas and Dixon, 6/28)

Boston Globe: Medford Hospital Sharply Cutting Inpatient Services
Hallmark Health System plans to significantly slash inpatient services at its struggling hospital in Medford beginning this fall, the company said Wednesday. Officials said they plan to close 50 of the 98 inpatient beds at Lawrence Memorial Hospital, including all 40 medical/surgical beds and all 10 intensive care beds. (Dayal McCluskey, 6/28)

Houston Chronicle: Memorial Hermann Cypress Hospital Seeks More Volunteers 
Officials at the recently opened Memorial Hermann Cypress Hospital are seeking volunteers who are interested in helping out at the $168 million facility. Currently, the hospital’s program includes 45 active volunteers. Positions are open to those who are retired, community members in the workforce, and college students. (Bradley, 6/28)

Richmond Times-Dispatch: Virginia Launches Statewide Collaborative To Enhance Care Of Mothers, Infants
Every year, more babies are born in withdrawal from drugs — and as the nationwide opioid epidemic rages on, the problem has only gotten worse. Several regional hospital collaboratives around the state have worked to share best practices for caring for infants and mothers, but new funding in the state budget has allowed for the creation of the statewide Virginia Neonatal Perinatal Collaborative. (O’Connor, 6/28)

San Francisco Chronicle: Homeless Camps Becoming Entrenched In Oakland
San Francisco has a mature infrastructure to help the homeless — from cutting-edge Navigation Centers that help people find shelter to a recent $100 million charitable donation to support the chronically destitute. Oakland is still experimenting with how to respond to the crisis. (Garfoli and Veklerov, 6/28)

Boston Globe: A Medical Marijuana Dispensary Might Be Coming To Newbury Street
A medical marijuana dispensary could move in among the retail shops on Newbury Street next summer, after the Boston City Council voted unanimously Wednesday to let the project proceed. The nonprofit that proposed the facility at 331 Newbury St., Compassionate Organics, will need additional approvals from the state Department of Public Health and Boston zoning and health officials before it can start selling cannabis to registered patients. (Adams, 6/28)

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

Rural Regions In Nevada May Be Left With No Options For 2018 As Anthem Pulls Back Offerings

The state insurance marketplace, the Silver State Health Insurance Exchange, said that insurers had filed to offer plans only in Clark, Washoe and Nye counties.

Bloomberg: Anthem’s Exit Creates Obamacare ‘Crisis’ For Rural Nevadans 
Anthem Inc.’s decision to quit offering Obamacare plans in much of Nevada will leave large parts of the state without options on the health law’s exchanges. The health insurer, a one-time Obamacare stalwart, has accelerated its retreat in recent weeks, blaming in part the uncertainty about the fate of the health law in Washington for making it difficult to come up with plans and calculate premiums. In Nevada, officials including Republican governor Brian Sandoval called the situation a crisis on Wednesday. (Tracer and Recht, 6/28)

In related news —

KCUR: Health Care Uncertainty Leaves Many Missouri Counties Without ACA Marketplace Coverage 
Insurance is all about predicting the future, so with the future of the Affordable Care Act in flux, uncertainty about what’s going to happen has made 2017 a tricky year for insurance companies. “Oh, it’s tough, because businesses don’t plan backwards. They plan forwards. They want to think about what the business is going to look like next year and two years out and three years out,” says Timothy McBride, a health economist at Washington University in Saint Louis. (Smith, 6/29)

Meanwhile, a report finds that the Senate bill wouldn’t offer much help to the individual marketplace —

Modern Healthcare: Senate Healthcare Bill Will Hurt Individual Market In The Long Run 
Senate Republicans’ healthcare bill to repeal and replace the Affordable Care Act would bolster the dwindling individual insurance market in the short term, but eventually cause enrollment to plummet, according to a report by ratings agency S&P Global. The Senate bill eliminates the financial penalty for individuals who don’t purchase health insurance. Instead, the Better Care Reconciliation Act replaces the fine with a six-month waiting period that’s unlikely to keep people enrolled, S&P analysts said. (Livingston, 6/28)

The Oregonian: Oregon Uninsured Rate Would Triple Under Senate Health Care Plan 
An estimated 420,000 Oregonians would lose their health care coverage by 2026 — mostly due to Medicaid cuts — if the Senate health care bill becomes law, according to a new state analysis. Republican boosters of the Senate plan say the bill is desperately needed to prop up an increasingly unstable insurance market. State officials argue the opposite — that the estimated 150,000 Oregonians predicted to drop out of the individual insurance market over the next two years could plunge the market into a “death spiral.” (Manning, 6/28)

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

The Intersection Of Health Policy And Politics: Seeking A Path To Single-Payer; Searching For Freedom From Obamacare’s Regulations

Editorial and opinion writers offer their views on health policy buzz words like single-payer, public option and even regulatory relief.

Bloomberg: California’s Health-Care Example For Washington
As Republicans in Washington contemplate the uncertain fate of their health-care bill over the July 4 recess, they might consider recent events in another legislature on the opposite coast of America. Earlier this month, Democrats in the California state senate passed their own big, bold, bad health-care bill. The legislation would have required the state government to supplant insurers, providing health insurance to all residents and negotiating medical costs with hospitals, doctors and other providers. (6/27)

Los Angeles Times: If There’s A Smart Path To Single Payer Healthcare In California, We Haven’t Found It Yet
California Assembly Speaker Anthony Rendon did the state a favor late Friday afternoon when he slammed the brakes on a fast-moving Senate bill to create a single-payer healthcare system in California. As should be obvious from the flailing Republican efforts in Washington, it’s easy to talk about drastic changes in the way healthcare is financed, but hard to make those changes work without hurting many of the people you’re trying to help. (6/27)

Los Angeles Times: Will The Republican Healthcare Bill Make Us More Free?
Thhe central theme of the Republican campaign to repeal the Affordable Care Act has been freedom: freedom from Obamacare’s onerous regulations, freedom from overpriced insurance and most of all, freedom from the tyrannical individual mandate. The Senate has now released its long-awaited alternative to Obama-era health reform. Although the Better Care Reconciliation Act is embattled, there’s still a decent chance that the Senate will pass it. If it does, the bill is likely to become law. (Nicholas Bagley, 6/28)

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

State Highlights: Ala.’s Psychiatric Care Of Inmates Cruel And Unusual, Judge Rules; Suit Filed Against La. Abortion Regulation

Media outlets report on news from Alabama, Louisiana, Missouri, Texas, California and Kansas.

Houston Chronicle: Memorial Hermann Lays Off 350 More Employees 
The Memorial Hermann Health System, Houston’s largest employer, is laying off another 350 employees, bringing its total to more than 460 this year. Memorial Hermann announced the layoffs Tuesday, the same day it notified most of the affected employees. The reduction, which represents less than 2 percent of Memorial Hermann’s 25,000 employees workforce, affected people at all levels. (Ackerman, 6/27)

KCUR: Osteopathic Medicine, Born In Missouri, Now Seeks To Fill Rural Health Care Gaps 
Osteopathic medical schools, whose numbers have doubled in the last 10 years, are in the middle of a huge push into smaller communities…These days, the care provided by D.O.s and M.D.s is typically so similar that most patients wouldn’t know the difference. But that hasn’t always been the case.At the root of osteopathic medicine is osteopathic manipulative treatment, a hands-on technique that looks like a cross between chiropractic manipulation and massage. There’s evidence this can help treat some kinds of pain. (Smith, 6/28)

San Francisco Chronicle: Old-School Shelters Need To Upgrade Services
Unlike old-school shelters, the Navigation Center offers 24-hour access, has storage for belongings, partners are allowed to sleep together, and pets may be brought inside. The big difference? The Navigation Center has case managers offering intensive help on a range of services, including treating addictions, obtaining identification cards and finding housing. (Knight, 6/27)

New Orleans Times-Picayune: Flight Lands At Armstrong Airport After Woman Gives Birth On Board Plane
Thousands of feet above the Gulf of Mexico, Cristina Penton realized her baby boy was coming sooner rather than later.Penton said she began feeling contractions less than 20 minutes after she took off aboard Spirit Airlines Flight 971 from Ft. Lauderdale, Fla. on Saturday night. Within the hour, the flight had landed at Louis Armstrong International Airport, with Penton holding her newborn son in her arms. Once she knew something was wrong, Penton alerted flight attendants who found a pediatrician and a nurse on board and prepared to give an all-natural birth in the front row of the plane. Pilots re-routed the plane to New Orleans, but Penton’s water broke in flight. Ten minutes later, Christoph Carsten Lezcano was born aboard the aircraft, 19 1/2 inches long and weighing seven pounds. (Rand, 6/27)

San Francisco Chronicle: Women Gain Force In Speaking Up On Sex Abuse, Discrimination
They had the numbers: six women who would describe in disturbing detail exactly how they were harassed, assaulted or made to feel uneasy by the unwanted advances of San Francisco venture capitalist Justin Caldbeck. Three of those women decided to identify themselves publicly — a risky move for victims of sexual violence or harassment, who are often dismissed, threatened or discredited in efforts to poke holes in their stories. (Lang, 6/27)

St. Louis Public Radio: Marijuana Isn’t A Medical Treatment Or Moneymaker For Missouri, But That Could Change After 2018
In Missouri, there are at least 22 ballot proposals aimed at persuading voters in 2018 to join that growing club of pro-pot states, an effort similar to a successful ballot drive last year in Arkansas. But all of this comes as U.S. Attorney General Jeff Sessions is calling for a crackdown on the growing number of states that appear to be ignoring the federal ban on pot. (Mannies, 6/27)

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

Hospitals Ramp Up Hyperbaric Therapy For Diabetics, Despite Concerns

The Villages Regional Hospital did not sweat its decision to add hyperbaric oxygen therapy in 2013.

Hyperbaric treatment, increasingly given to diabetics — many of them elderly with persistent wounds — involves breathing pure oxygen inside a pressurized air chamber typically for two hours each weekday, often for more than a month. Twenty outpatient sessions can bring a hospital $9,000 in revenue.

Villages serves a central Florida retirement community that supplied nearly half of the hyperbaric patients at another hospital 30 minutes away. Hospital officials knew their clientele preferred their medical appointments only a golf-cart’s ride from home.

“Wound care was a service line we saw as low-hanging fruit,” said Todd Powell, who oversees hyperbaric therapy at Villages hospital.

Many hospitals seem to agree. Enticed by healthy Medicare payments — about $450 for a two-hour session — and for-profit management companies that do much of the work, nearly 1,300 U.S. hospitals have installed hyperbaric facilities. That’s triple the number that an industry group says offered the service in 2002, when Medicare first decided to pay for the therapy for certain diabetic wounds.

Medicare — the largest payer of hyperbaric services — has flagged evidence of overuse in at least some parts of the country. Medicare officials declined to comment for this story, but they have retained coverage for more than 15 years, even as studies have questioned the therapy’s effectiveness.

The American Diabetes Association does not recommend the treatment. After an ADA committee of experts in diabetes care reviewed the available research last year, it concluded there was “not enough supporting data on the efficacy of this treatment to recommend its use,” said William Cefalu, the association’s chief medical officer.

Some experts say hyperbaric therapy’s increased use for diabetic wounds owes more to hospitals’ pursuit of Medicare revenue than to the treatment’s proven value.

“The science remains poor to support its use, but it is being widely used [in the United States], and one possible explanation to this may be related to reimbursement,” explained Dr. Andrew Boulton, an internationally recognized expert on hyperbaric therapy, and a professor of medicine at University of Manchester medical school in Great Britain.

“Some folks are chasing the money. It’s seen as a money grab because reimbursement has been favorable,” acknowledged John Peters, executive director of the Undersea & Hyperbaric Medical Society, which accredits 200 hyperbaric oxygen facilities nationally and has inspected 500 for accreditation in the past 15 years.

Offered at a handful of hospitals in the last decades of the 20th century, hyperbaric chambers were a niche treatment for deep-sea divers suffering with the bends — a painful and potentially fatal condition where gas bubbles accumulate in the bloodstream during too-rapid ascents from depth. In 2002 — after industry lobbying and some suggestive research — Medicare approved hyperbaric therapy for certain diabetic wounds that did not respond to conventional treatments.

That decision drove a building boom in outpatient wound care centers over the next half-decade, featuring hyperbaric therapy. Medicare covers the treatment for more than a dozen conditions in which skin fails to heal, such as failing grafts and tissue damage from anti-cancer from radiation, but the USA’s rising diabetic population supplies much of the demand.

It costs about $500,000 to install a hyperbaric unit with two chambers. With Medicare’s lucrative reimbursement policies, “hospitals can generate cash almost immediately,” Peters said. During hyperbaric sessions, patients merely lie on a bed in a glass-enclosed tube containing high-pressure oxygen under a physician’s supervision.

The business model is so compelling that management companies typically pay for the equipment and staff. Hospitals provide space for the chamber, make patient referrals and handle billing. The companies and the hospitals split revenue from insurers.

Because of poor blood circulation, diabetics are susceptible to developing ulcers in their lower legs and feet that heal poorly and can sometimes lead to amputations. Hyperbaric oxygen therapy, in theory, works by stimulating the body’s creation of new blood vessels and aiding the formation of new skin around a wound. Side effects are uncommon but include ear and sinus pressure, paralysis and air embolisms.

In 2015, Medicare imposed stricter billing procedures in three states where its expenses for hyperbaric services were 21 percent above the national average — possible evidence of overuse or overbilling. Providers in Illinois, Michigan and New Jersey must get regulators’ preauthorization of expenses before treating Medicare patients for the most commonly approved conditions in non-emergency cases. Elsewhere, Medicare requires documentation supporting hyperbaric therapy’s need only after services begin.

Signs of abusive industry practices predate the 2015 action. A critical report by the Health and Human Services Department’s inspector general in 2000 disclosed that Medicare was billed millions of dollars for non-diabetic wound care treatments that were inappropriate or excessive. The office has promised a follow-up report before Oct. 1 — its first since 2000.

The Justice Department alleged fraud or other wrongdoing involving hyperbaric therapy in at least five cases from 2008 to 2014. It has won more than $11 million in penalties and restitution — along with some jail sentences — in court rulings and settlements.

(The FDA warned in 2013 about some treatment centers’ falsely promoting the therapy for unapproved uses, including as a cure for cancer, autism and diabetes.)

Medicare’s crackdown on billing in three states saved $5.3 million in its first 13 months, the government said in November. Medicare’s total spending on hyperbaric therapy — including all approved conditions — in 2015 fell about 10 percent to $230 million. That was the first annual decline in a decade.

Debates about the utility of the treatment continue despite decades of use.

In fact, few large, controlled studies have explored hyperbaric oxygen therapy for diabetic wounds — and nearly all were done outside the United States.

Some studies have found the treatment benefits certain patients while others have concluded it neither increases a wound’s chances of healing nor prevents amputations. The problem is knowing which wounds would have healed over time on their own.

Businesses and individuals invested in the facilities remain unalloyed boosters. The treatment “used to be considered voodoo medicine. But today more doctors have been swayed, and it’s now seen as mainstream therapy,” said Marc Kaiser, owner of Precision Health Care, which manages hyperbaric centers at five hospitals in New York and Connecticut.

Based on studies and anecdotal experience, Dr. Geoffrey Gurtner, a plastic surgeon who helped establish the Stanford University Wound Care Center in 2014, believes the therapy has some merit. But he said that research is needed to understand how the treatment works, which patients need it and the right number of sessions for each wound.

And, critics say, companies are profiting from and abusing the current state of uncertainty. Medicare pays for hyperbaric therapy for diabetic wounds that have not healed after 30 days of standard treatments. If hospitals provide more than 30 treatments, they must document that patients’ wounds are improving.

Twenty to 30 sessions of hyperbaric therapy should heal diabetic wounds, but radiation-damaged skin might require 40 treatments, said Dr. Phi-Nga Jeannie Le, a Houston physician.

“The problem is, we see these financially motivated centers keep doing the treatment into the hundreds of visits,” she said.

Also, Medicare pays nearly double the standard rate when the treatment is performed at hospital-affiliated facilities, which can add on a “facility fee.” Because of this quirk in the rules, hyperbaric management companies tend to court hospitals to install their devices.

April Hall underwent 50 sessions of hyperbaric oxygen therapy at MedStar Good Samaritan Hospital in Baltimore last summer.

April Hall receives hyperbaric oxygen therapy at MedStar Good Samaritan Hospital in Baltimore in 2016. (Phil Galewitz/Kaiser Health News)

Stretched out in one of the hospital’s four hyperbaric chambers, wrapped in blankets with her head propped up to watch television, Hall breathed pure oxygen for two hours at a time.

One wound on the bottom of her left foot healed. The other did not.

“I did what I had to do to save my foot,” said Hall, 50, who is on Medicare disability.

Sometimes even dozens of treatments do not avert amputations, as diabetic William Padgett Jr., 65, of Culpeper, Va., can attest. He lost his right leg in 2013 after nearly 90 hyperbaric sessions failed to heal a wound.

Last year, he tried hyperbaric oxygen again to close a wound on his left leg, taking about 80 sessions over four months at a hospital in Arlington, Va. The wound healed. “It’s been a slow process … but well worth the time,” he said.

William Padgett Jr. of Culpeper, Va., received dozens of hyperbaric oxygen therapy sessions in 2013 and again in 2016 for diabetic wounds on his lower legs. Part of his right leg still had to be amputated, but the left one was saved. (Phil Galewitz/Kaiser Health News)

In any one case, it is hard to say whether the treatment was key to success.

A 2014 federal whistleblower lawsuit against Healogics, which manages about half — 750 — of the nation’s hospital-owned wound-care and hyperbaric centers, raised other concerns. Two doctors and a third employee who worked for Healogics alleged a company conspiracy to defraud the federal government by billing it for unnecessary wound care and hyperbaric services.

Healogics denied the claims in its court-filed responses, and a judge dismissed the case for lack of detail. It is under appeal.

The lawsuit alleged Healogics “actively targeted each and every [wound care] patient for conversion” to hyperbaric therapy and set benchmarks for each center on the amount of hyperbaric care that would be provided.

According to Healogics, 5 percent of its 326,000 patients last year had hyperbaric treatment. Only 2 percent of those received more than 50 sessions.

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

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State Highlights: Boston Children’s Hospital Snags Top Ranking In Report; Ariz. Governor Targets Planned Parenthood Funding

Media outlets report on news out of Arizona, California and Ohio.

USA Today: Best Children’s Hospitals Ranked By U.S. News & World Report
An annual report by U.S. News & World Report ranks the nation’s top 50 children’s medical centers by 10 pediatric categories including cancer, neurology, diabetes and endocrinology. U.S. News has ranked children’s hospitals since 2006, and awards rankings based on measures such as clinical outcomes, patient volume, staffing adequacy and compliance with best practices, to name a few. (Bowerman, 6/27)

Arizona Republic: To Defund Planned Parenthood, Arizona Wants Say In Family Planning
Ducey and the Legislature this year, with a push from the conservative Center for Arizona Policy, placed into the budget the requirement that the state try to take control of Arizona’s $4.5 million share of federal family-planning funds. For more than 30 years, the non-profit Arizona Family Health Partnership has overseen the federal Title X program in Arizona, working with Planned Parenthood and other community clinics. (Beard Rau, 6/26)

Cleveland Plain Dealer: Summa Health To Eliminate 300 Positions, Discontinue Certain Services On Projected $60 Million Operating Losses
Summa Health plans to eliminate 300 positions and change its service offerings as the health system faces $60 million in operating losses. In an internal memo to employees Monday, Interim President and CEO Dr. Cliff Deveny said the Akron-based system in the next month would need to eliminate positions and discontinue and consolidate services to shore up financial losses from low inpatient and outpatient numbers. (Christ, 6/26)

Cleveland Plain Dealer: 1 In 4 Children In Ohio Will Experience Domestic Violence, Study Says
One in four Ohio children will experience domestic violence before reaching adulthood, according to a new study. The study by Case Western Reserve University researchers, conducted on behalf of the HealthPath Foundation of Ohio, sought to determine the extent and expense of domestic violence, as well as gaps in addressing its roots and aftermath, CWRU said. (Farkas, 6/26)

San Jose Mercury News: Lawsuit: HR Exec Worried Cancer Survivor Had ‘Chemo Brain’
An associate vice president in the human resources department at San Francisco State University told faculty she worried that an employee of the college recovering from cancer had “chemo brain,” according to a lawsuit filed last month… A statement from the university’s lawyer said the school is fighting the claims. (Deruy ,6/26)

Columbus Dispatch: Getting Food To Hungry Kids In Southeast Ohio
Britany Kuhn recently led her six children on a 20-minute walk to get lunch from a local meal program. Such programs are made possible by the Children’s Hunger Alliance, a nonprofit organization working to keep children from going hungry through a project focused on Jackson, Lawrence, Pike, Ross, Scioto and Vinton counties in southeastern Ohio. (Henry 6/27)

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

Why California’s Single-Payer Proposal Was Doomed To Fail

The bill was more a reflection of ideological wishes than reality, and thus never stood a strong chance of passing.

Sacramento Bee: Why Universal Health Care Died In California
The authors of Senate Bill 562, Democrats Ricardo Lara and Toni Atkins, didn’t include a way to pay for the far-reaching legislation, which was estimated to cost $400 billion to start… So when Assembly Speaker Anthony Rendon, a policy wonk who says he supports universal health care, announced late Friday he was holding the bill in committee, he merely expedited the inevitable. (Cadelago and Luna, 6/27)

KQED: California Dems Continue Single-Payer Blame Game
The California Nurses Association lashed out at Assembly Speaker Anthony Rendon, who announced on Friday that the single-payer legislation would not advance in the Assembly in 2017. Rendon hit back on Monday, criticizing the legislation that passed the Senate earlier this month. (Marzorati, 6/26)

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

Take Our Quiz To Test Your Wits On Aging

As we get older, it helps to tickle the noggin’ with trivia. Here’s a pop quiz to see what you have learned as a regular reader of Kaiser Health News.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Aging, Health Industry, Insurance, Medicaid, Medicare, Multimedia, Pharmaceuticals

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House Seeks To Cap Malpractice Awards As Part Of Health Care Update

Last week, a jury awarded a Pennsylvania man $620,000 for pain and suffering in a medical malpractice lawsuit he filed against a surgeon who mistakenly removed his healthy testicle, leaving the painful, atrophied one intact.

However, if a bill before the House of Representatives passes, the maximum he would be able to receive for such “non-economic” damages would be $250,000.

Non-economic damages cover losses that are hard to put a dollar amount on such as suffering, loss of a limb, pain, and loss of companionship. In addition, medical malpractice awards may include monetary damages to cover medical costs and loss of future wages. Sometimes punitive damages may be awarded as well as punishment for reckless or other harmful behavior.

The bill is part of a package of proposed reforms that supplement the American Health Care Act, the House measure to replace the Affordable Care Act that was narrowly approved in May. The Trump administration pledged to support the tort reform legislation.

Passage is far from certain. Groups across the political spectrum oppose the measure. Patients advocates say it would be unfair to seriously injured people whose lives are changed forever because of medical negligence. Many conservatives don’t embrace it either because it would impose federal standards on tort law, an area where states have traditionally determined the rules.

Michelle AndrewsInsuring Your Health

The Congressional Budget Office estimated that the bill would lower health care costs by reducing medical liability insurance premiums and the use of health care services by providers worried about being sued. This would lead to lower spending on federal health care programs and lower medical insurance liability premiums. The effect would be to reduce deficits by nearly $50 billion over 10 years.

Supporters say caps on medical malpractice awards discourage frivolous lawsuits and reduce the cost of health care because providers no longer need to practice defensive medicine.

Yet research shows that costs from medical liability make up just 2 to 2.5 percent of total health care spending.

About half of states have a cap of some sort on non-economic damages in medical malpractice cases, according to Joanne Doroshow, executive director of the Center for Justice and Democracy, a consumer advocacy organization for civil justice issues.

Under the House bill, states that have caps on non-economic damage awards could keep those in place. In states without such caps, even if the state constitution prohibits them or state courts have struck them down, the federal $250,000 cap would apply.

The case of the Pennsylvania man’s surgery is a “never event,” one that experts on patient safety say should never occur. Since that state doesn’t have a cap on non-economic damages, if the House bill had been in effect, it would limit the amount that the jury could award the patient to $250,000. The patient, Steven Hanes, 54, also was awarded $250,000 in punitive damages.

Hanes declined to be interviewed, but his attorney, Braden Lepisto, said his client was shocked to learn of the proposed cap. “He felt that the $250,000 cap was ridiculous because that amount would not compensate him for what he has gone through and will go through moving forward,” Lepisto said in an email. He added, “The reality is that there are many individuals who are injured from medical negligence who do not have ‘economic loss’ as defined by the law. Nonetheless, their lives are altered from the pain and suffering, loss of life’s pleasures, and the emotional effects of the injuries.”

The House bill would also come into play in Florida, where earlier this month the state Supreme Court struck down caps on non-economic damages in medical negligence cases because the court ruled they violate the equal protection clause of the state constitution. The House bill would supersede the state court decision and impose the cap in Florida cases.

Although the damages cap is noteworthy, other elements of the House bill also trouble consumer advocates. For example, it would establish a three-year statute of limitations following an injury for consumers to bring a lawsuit, or a one-year limit from the date that the consumer discovers or should have discovered an injury.

“Because it’s [worded as] whichever comes first, for all intents and purposes it’s one year,” said Doroshow. “That is a drastic change. Almost no state has a statute of limitations that severe.”

The bill would also set limits on the amounts that lawyers can recover in contingency fees from consumer judgments. This seemingly consumer-friendly provision could actually harm patients, said Doroshow.

Medical malpractice cases are complex and expensive to bring, she noted. “If you have a law that caps the ability of the attorney to recover from the judgment, they’ll think twice before taking a case,” Doroshow said. “It hurts the patient’s ability to have a competent attorney or any attorney at all.”

Meanwhile, some supporters of tort reform say the House bill goes about it the wrong way.

“The federal government doesn’t really have a legitimate role to play here,” said Dr. Jeffrey Singer, a general surgeon in Phoenix who is an adjunct scholar at the libertarian Cato Institute, located in Washington, D.C.

Conservatives might be relying too much on the idea of tort reform to bring down health care costs, he said.

“It’s become almost a part of the canon of people who align themselves with the market-oriented conservative reforms school,” he said. “But it should be done at the state level and we’re fooling ourselves if we think that it’ll be the magic bullet.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Health Care Costs, Health Industry, Insuring Your Health, Public Health

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Senate And House Take Different Plans To Scrap Individual Mandate

Update: This story was originally published March 21, 2017. It was updated on June 26, 2017 with details of the Senate health care bill.

The Affordable Care Act’s tax penalty for people who opt out of health insurance is one of the most loathed parts of the law, so it is no surprise that Republicans are keen to abolish it. But the penalty, called the individual mandate, plays a vital function: nudging healthy people into the insurance markets where their premiums help pay for the cost of care for the sick. That has required Republican lawmakers to come up with alternatives, which were included in the House bill that passed in May and updates to the Senate draft bill released Monday.

The GOP approach is called a “continuous coverage”  or “creditable coverage” penalty. It would apply to people who buy insurance if they have gone 63 consecutive days without a policy during the past 12 months. In the Senate bill, they would have to wait six months before they could buy insurance. The bill that passed the House took a different tack: it did not include a waiting period but required insurers to increase  premiums by 30 percent, and that surcharge would last for a year. While the ACA assesses a fine for each year people don’t buy insurance, the GOP plan would punish those who decide to purchase it after not being in the market.

Much is at stake. If the GOP’s approach fails to prod enough healthy people into buying insurance, rates for everyone else in the insurance pool will rise, destabilizing promises by President Donald Trump and GOP leaders to make their Obamacare replacement more affordable. The nonpartisan Congressional Budget Office projects that millions fewer people will buy insurance if the individual mandate is repealed and replaced with a continuous coverage surcharge as the House proposed.

The budget office expects that the Senate’s six-month waiting period would “slightly increase the number of people with insurance. ” Nonetheless, CBO projects that at least 22 million people will lose insurance under either the House or Senate bill because both proposals scale back government assistance to people buying insurance and limit Medicaid coverage.

Why do people allow their insurance to lapse?

Some simply can’t afford the premiums, like Sheila Swartz. She and her husband, Don, who has a heart condition, dropped their policy in December after learning monthly premiums were going to increase by about $140 to $530. “You can’t get blood out of a turnip,” said Swartz, who lives outside Nashville, Tenn., and works as a house cleaner. “If you can’t afford that premium, you can’t afford that premium.”

Others stop paying premiums when they lose a job or are hit with unexpected costs in other areas, such as major home or car repairs. “If you have to pay rent or health insurance, you are probably not going to choose health insurance,” said Bruce Jugan, a health insurance broker in Montebello, Calif.

Some people try to game the system, taking the calculated risk of going without insurance until they get sick or know they need expensive medical care, such as for maternity or an elective surgery.

Both the Affordable Care Act and the GOP proposal include a deterrent by limiting people from enrolling anytime they want. People must wait for annual enrollment periods, usually in the final weeks of the year, meaning that some people might have to wait months before getting coverage. (People still can get insurance during special enrollment periods if they lose a job, get divorced or have another specified major life change.)

How tough is the GOP penalty compared with the individual mandate?

Under the ACA, the average individual mandate penalty in 2015 was $442, according to the Internal Revenue Service.  The House penalty would vary based on cost of premiums but generally would be more expensive than paying the mandate’s penalty. A 40-year-old with annual premiums of $4,328 would pay an extra $1,298 because of the House surcharge.

“It’s got teeth,” said Cheryl Damberg, a Rand Corp. economist. “In some ways, it’s a more punishing penalty, and it’s going to hit people who are least capable of financially affording it.”

Seth Chandler, a law professor at the University of Houston Law Center who has been critical of the Affordable Care Act’s insurance markets, said he is skeptical the House surcharge is high enough to make people enroll. “I am concerned that the Republicans are succumbing to the same softness of heart as the Democrats succumbed too when they set the individual mandate [fine],” he said. “If you start to see insurance companies object or drop out of the markets, that’s a sign this thing is miscalculated.”

Two conservative economists at the American Enterprise Institute, Joseph Antos and James Capretta, argue the penalty is “far too small” to be effective. “Healthy consumers are likely to take their chances,” they wrote. “With the repeal of the individual mandate, and the retention of the ACA’s insurance rules, the overall effect would be significant market turbulence, starting immediately in 2017.”

The CBO predicted that there would be a brief increase in the number of people holding insurance in 2018, as roughly 1 million people buy coverage to avoid the surcharge. In most years afterward, however, about 2 million fewer people would buy policies, either because of the surcharge or because of the requirement they provide documentation proving they had been insured. The CBO said healthy people in particular would be more likely to avoid buying policies.

The House plan has some parallels to Medicare’s late enrollment penalty, which is applied to premiums for people who did not sign up upon turning 65. But Christopher Koller, a former Rhode Island health insurance commissioner, doubts the GOP penalty would be as effective. “Medicare is an entitlement with the force of government behind it,” said Koller, now president of the Milbank Memorial Fund, a foundation in New York that focuses on healthy populations. “You get lots of notices about what your obligations are as you approach that age.”

What about people who can’t afford premiums?

The House surcharge contains no hardship exemptions, unlike the individual mandate, which allowed people to escape paying a penalty if premiums would have eaten up too much of their income (8.16 percent in 2017).

In 2015, 5.6 million people paid the individual mandate penalty, but another 11 million claimed a hardship exemption, according to the IRS.

Lower-income people are going to have even more trouble buying — and keeping — coverage under either of the GOP plans, experts said. The ACA’s premium subsidies are based on income, and millions of people on the poorer end of the spectrum do not have to pay anything for premiums if they choose the cheapest plan. The House plan would offer a flat tax credit that adjusts only for age. The penalties would make some even more reluctant to buy insurance — especially if they are relatively healthy. The Senate plan retained income-based subsidies, but they are smaller than those under the ACA and are tied to plans with higher co-payments and deductibles.

“I think we would just end up with a lot more uninsured people, and they would clearly be the type of people who are less able to navigate and less able to afford insurance,” said Geoffrey Joyce, director of health policy for the University of Southern California Schaeffer Center for Health Policy & Economics.

Republican lawmakers say their plan rightly places the responsibility on individuals. It is a view shared by some health insurance brokers like Helena Ruffin, a broker in Playa Vista, Calif. She said that a continuous coverage requirement like the one proposed by the House would “limit those people who are not playing by the rules.”

“I am favor of the penalties,” she said. “Whether or not people are going to pay attention is another story.”

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.

Categories: Health Industry, Insurance, Repeal And Replace Watch, The Health Law, Uninsured

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CBO Report: 22 Million Would Lose Insurance By 2026 Under Senate bill

Jun 26 2017

This estimate is slightly lower than the nonpartisan Congressional Budget Office projected for the House-passed American Health Care Act,

The New York Times: Budget Office: Senate Health Care Bill Would Leave 22 Million More Uninsured
The Senate bill to repeal the Affordable Care Act would increase the number of people without health insurance by 22 million by 2026, a figure that is only slightly lower than the 23 million more uninsured that the House version would create, the nonpartisan Congressional Budget Office said Monday. Next year, 15 million more people would be uninsured compared with current law, the budget office said. The legislation would decrease federal deficits by a total of $321 billion over a decade, the budget office said. (Kaplan and Pear, 6/26)

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

State Highlights: Bill Would Make Volunteer Medical Work Across State Lines Easier; Texans’ Health Data Exposed For Months

Media outlets report on news from Tennessee, California, Massachusetts, Texas, Connecticut, Virginia, Ohio, Florida, Wisconsin and Colorado.

Nashville Tennessean: Bill Would Ease Rules On Charity Health-Care Providers
In 1985, [Stan] Brock founded a charitable organization that hosts free medical clinics for people who live in underserved, isolated or impoverished communities. Then he discovered another problem: Many states have laws that prohibit medical personnel from crossing state lines and working at his clinics…Rep. John J. Duncan Jr., R-Knoxville, has filed legislation that would provide $1 million to any state that allows licensed medical professionals to travel from other states and offer their services to those in need. The money would be a one-time allocation and, while the bill does not say how it would be used, the intent is to help states pay any costs associated with allowing outside doctors to volunteer within their borders. (Collins, 6/23)

California Healthline: You Are Now Protected From Nasty Surprise Bills
Before Kevin Powers underwent lung cancer surgery last October, his girlfriend, Agi Orsi, meticulously checked and double-checked to be sure his Santa Monica, Calif., hospital and surgeon were in his health plan’s network. They were. Even in the hospital, Orsi dutifully wrote “No out-of-network doctors” across the top of Powers’ admission paperwork. Her diligence was for naught. (Bazar, 6/26)

Boston Globe: Minuteman Health Shifting To For-Profit Status
Minuteman Health Inc., an insurer launched with millions of taxpayer dollars, said Friday it is seeking to ditch its nonprofit structure next year and sell plans under a new for-profit entity. Executives of the Boston-based company said the change is necessary because the company faces regulations that are too burdensome. (Dayal McCluskey, 6/23)

The CT Mirror: Prolonged CT Budget Standoff Will Hurt Towns, Disabled, Needy
Connecticut spends another $1.3 billion each year hiring community-based nonprofit agencies to provide the majority of social services offered to the disabled, the mentally ill, abused children, the poor and others… And while the administration won’t order layoffs while the concessions deal is pending, it will freeze vacant state jobs of all types and reduce consulting, legal and service contracts. (Phaneuf, 6/26)

California Healthline: Kaiser Permanente Fined — Again — For Mental Health Access Problems
Despite three warnings and a multimillion-dollar fine, Kaiser Permanente still fails to provide members with appropriate access to mental health care, according to a recent survey of the HMO by the state of California. The routine survey, released by the state Department of Managed Health Care, found that Kaiser Foundation Health Plan did not provide enrollees with “timely access” to behavioral health treatment, in violation of state law. (Gold, 6/26)

Richmond Times-Dispatch: “I’ve Seen Way Too Many Fatalities”: Providers Urge Parents To Talk About Gun Safety
Last week, the children’s hospital educated parents at its Children’s Pavilion downtown about not only gun safety but also how to ask other parents if they have a gun in the home in recognition of ASK — or Asking Saves Kids — Day, which is a collaboration of the Brady Center to Prevent Gun Violence and the American Academy of Pediatrics… Children in the U.S. die by gun 11 times as often as children in other high-income countries, according to the Brady Campaign. (O’Connor, 6/25)

Columbus Dispatch: ERs Adding Palliative Care To Treat Seniors’ Chronic Conditions
Historically, emergency departments have treated victims of gunshots, crashes and other traumatic injuries, plus people who have heart attacks, strokes and other medical emergencies. But as the nation’s elderly population has swelled, emergency departments have been flooded by seniors and others with chronic and, sometimes, fatal illnesses who often need more or different things than just the traditional “life-extending” care provided there. (Pyle, 6/26)

Miami Herald: Gables Cop Shot Him With A Taser. Six Months Later, There’s No Cause Of Death.
But the revelation of Gutierrez’s death comes amid increased scrutiny of fatal confrontations with police officers, in South Florida and across the United States. Some of those cases include people who die after being zapped by police Taser stun guns, a weapon hailed by authorities as a less-than-lethal way to stop violent offenders, but criticized by others as a weapon that too often proves deadly. (Ovalle, 6/26)

Sacramento Bee: Mt. Shasta Issues Boil Water Warning Due To E. Coli Bacteria
The city of Mt. Shasta put out a notice warning residents to bring all water to a boil for a minute before drinking it, cooking with it, making ice, brushing teeth or washing dishes. City officials said in the notice they expect to resolve the problem in seven to 10 days, meaning the issue could continue through the Fourth of July, when the city hosts some of its most popular events. (Garrison, 6/25)

Tampa Bay Times: Legalized Medical Marijuana Signed Into Law By Rick Scott
Gov. Rick Scott on Friday signed into law a broader medical marijuana system for the state, following through on a promise he made earlier this month. Lawmakers passed the measure, SB 8A, in a special session after failing in their regular session that ended in May to implement a constitutional amendment legalizing the drug, which was supported by 71 percent of voters last year. (Auslen, 6/23)

Milwaukee Journal Sentinel: Mobile Market Rolls Groceries Into Milwaukee’s Food Deserts
First started in 2015 as an initiative between Pick ‘n Save and the Milwaukee-based Hunger Task Force, the store makes fresh and healthy foods available to people who would otherwise have limited access to those options. The store supplements other efforts to expand food access in the city by addressing the question of “how do we give people dignity,” Hunger Task Force executive director Sherrie Tussler said. (Liu, 6/25)

Denver Post: Fort Collins Podiatrist Guilty Of Fraud.
A Fort Collins podiatrist has been sentenced to prison for billing Medicare for trimming clients’ toenails, which is not covered by the national social insurance program. Dr. Michael Thomas, 55, pleaded guilty to eight counts of health care fraud, according to a news release from the Acting U.S. Attorney, District of Wyoming. Thomas, who was sentenced to six months in prison and a $20,000 fine, fraudulently billed Medicare from December 2011 through November 2016. (Nicholson, 6/23)

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

In The End, Even The Middle Class Would Feel GOP Cuts To Nursing Home Care

ORANGE, Va. — Alice Jacobs, 90, once owned a factory and horses. She raised four children and buried two husbands.

But years in an assisted living facility drained her savings, and now she relies on Medicaid to pay for her care at Dogwood Village, a nonprofit, county-owned nursing home here.

“You think you’ve got enough money to last all your life, and here I am,” Jacobs said.

Medicaid pays for about two-thirds of the 1.4 million elderly people in nursing homes, like Jacobs. It covers 20 percent of all Americans, and 40 percent of poor adults.

On Thursday, Senate Republicans joined their House colleagues in proposing steep cuts to Medicaid, part of the effort to repeal the Affordable Care Act. Conservatives hope to roll back what they see as an expanding and costly health care entitlement. But little has been said about what would happen to older Americans in nursing homes if these cuts took effect.

Under federal law, state Medicaid programs are required to cover nursing home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage.

“The states are going to make it harder to qualify medically for needing nursing home care,” predicted Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. “They’d have to be more disabled before they qualify for Medicaid assistance.”

States might allow nursing homes to require residents’ families to pay for a portion of their care, she added. Officials could also limit the types of services and days of nursing home care they pay for, as Medicare already does.

The 150 residents of Dogwood Village include former teachers, farmers, doctors, lawyers, homemakers and health aides — a cross section of this rural county a half-hour northeast of Charlottesville. Many entered old age solidly middle-class but turned to Medicaid, once thought of as a government program exclusively for the poor, after exhausting their insurance and assets.

A combination of longer life spans and spiraling health care costs has left an estimated 64 percent of the Americans in nursing homes dependent on Medicaid. In Alaska, Mississippi and West Virginia, Medicaid was the primary payer for three-quarters or more of nursing home residents in 2015, according to the Kaiser Family Foundation. (KHN is an editorially independent project of the foundation.)

“People are simply outliving their relatives and their resources, and fortunately, Medicaid has been there,” said Mark Parkinson, president of the American Health Care Association, a national nursing home industry group.

With more than 70 million people enrolled in Medicaid at an annual cost of more than $500 billion, the program certainly faces long-term financial challenges. Federal Medicaid spending is projected to grow by 6 percent a year on average, rising to $650 billion in 2027 from $389 billion this year, according to the Congressional Budget Office.

Even if Congress does not repeal the Affordable Care Act, Medicaid will remain a target for cuts, experts say.

“The Medicaid pieces of the House bill could be incorporated into other pieces of legislation that are moving this year,” said Edwin Park, a vice president at the Center on Budget and Policy Priorities, a Washington nonprofit that focuses on how government budgets affect low-income people. “Certainly, nursing homes would be part of those cuts, not only in reimbursement rates but in reductions in eligibility for nursing home care.”

While most Medicaid enrollees are children, pregnant women and non-elderly adults, long-term services such as nursing homes account for 42 percent of all Medicaid spending — even though only 6 percent of Medicaid enrollees use them.

Alice Jacobs in her room at Dogwood Village. Her fellow residents include former teachers, farmers, doctors, lawyers and health aides. (Khue Bui for The New York Times)

“Moms and kids aren’t where the money is,” said Damon Terzaghi, a senior director at the National Association of States United for Aging and Disabilities, a group that represents state agencies that manage programs for these populations or advocate for them. “If you’re going to cut that much money out, it’s going to be coming from older people and people with disabilities.”

The House health care bill targets nursing home coverage directly by requiring every state to count home equity above $560,000 in determining Medicaid eligibility. That would make eligibility rules tougher in 10 states — mostly ones with expensive real estate markets, including California, Massachusetts and New York — as well as in the District of Columbia, according to an analysis by the Center for Budget and Policy Priorities.

Dogwood Village receives about half of its $13 million annual operating costs from Medicaid, with rates from $168 to $170 a day. Some residents who come to the facility after a hospital stay are initially covered by Medicare, but if they stay longer than 100 days, that benefit ends, and those without savings move to Medicaid.

“You have patients who have spent their life savings, and they come here,” said Kristen Smith, the admissions coordinator. Smith said patients now were older and sicker than they used to be, frequently arriving directly from a hospital.

“It used to be hips and knee” surgeries, she said. “And now a lot of those patients are going home. What we’re seeing is more complex, sicker patients.”

With cinder-block walls brightened by pictures of horses that evoke this equestrian county, the nursing home offers crafts, bingo and other activities.

Mary Ann Mohrmann is 85, the average age of Dogwood Village residents. An elementary school teacher for 25 years, she has Charcot-Marie-Tooth disease, a neurological disorder that has weakened her legs, feet and thumbs and compromised her fine motor skills.

Two of her children have it, too, she said. None of them can take care of her at home. “I’ve been here years,” she said. “I don’t know how many.”

Mary Ann Mohrmann, 85, was an elementary school teacher for 25 years. She now suffers from a neurological disorder and lives at Dogwood Village of Orange County Health and Rehabilitation. (Jeff Poole/Orange County Review)

Medicaid helps pay for care for people with disabilities, like Nancy Huffstickler, 64, who has been here four years and regards herself as “a medical disaster.”

She listed her ailments: spinal cancer in remission, restless legs syndrome, high blood pressure and multiple ulcers. She has had spinal reconstructive surgery and a hip replacement. She is undergoing physical therapy with the hope that, one day, she will be able to leave her wheelchair and use a walker.

Huffstickler is fearful of Republicans’ health care changes. “It may save the federal government money, but what about us?” she asked.

Major Medicaid cuts would compel the facility to cut staff, supplies and amenities — changes that would affect the quality of care for all residents, not just those on Medicaid.

If that does not save enough money, the facility might have to reduce the number of Medicaid residents, said Vernon Baker, who resigned as administrator in April. “It’s not like our toilet paper or paper towels are like the Ritz-Carlton’s,” he said.

Some residents do not even know they are on government insurance; administrators often complete the paperwork to start Medicaid once other insurance expires. Others are embarrassed that they are dependent on a program that still carries stigma.

They should not be, said Jennifer Harper, the assistant director of nursing. Relying on Medicaid for nursing home care has become the new normal.

“These folks have worked their whole lives, some with pretty strenuous jobs, and paid into the system,” she said. But with changes looming, she said, “it may be a system that fails them.”

KHN’s coverage of aging and long-term care issues is supported by The SCAN Foundation.

Categories: Aging, Health Industry, Medicaid, The Health Law

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Viewpoints: The High Cost Of Insulin; Drug Companies’ Role In The Opioid Epidemic

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

The Washington Post: Insulin Is Too Expensive For Many Of My Patients. It Doesn’t Have To Be.
At age 15, I developed an unquenchable thirst and frequent urination, and lost 20 pounds. I had developed Type 1 diabetes, an autoimmune disease that destroyed my body’s ability to produce insulin. Without insulin, I would have eventually developed a condition called diabetic ketoacidosis, which is lethal without (and even sometimes with) treatment. Years later, I’m a practicing endocrinologist. I could never have imagined back when I first started taking insulin that one day I would have so many patients who could not afford the medication because of skyrocketing prices. When the drug was discovered in 1921, the original patent was sold to the University of Toronto for $1 so that no one else could patent it and “secure a profitable monopoly.” (David M. Tridgell, 6/22)

Chicago Tribune: If Sweet Drinks Are So Bad, Stop Subsidizing Them
Grrocery stores can’t tax SNAP purchases. That makes total sense. SNAP — the Supplemental Nutrition Assistance Program, informally known as food stamps — is funded with public money, so the government would simply be taxing itself. This simple rule has greatly complicated the rollout of Cook County’s new sweetened beverage tax and prompted a flurry of rule changes in the a penny-an-ounce levy set to take effect July 1. (Eric Zorn, 6/22)

Reuters: Big Social Security COLA Will Be Offset By Medicare Premiums
Retirees can look forward to the largest Social Security cost-of-living adjustment next year since 2012 — but don’t break out the champagne just yet. For many, higher Medicare premiums will take a big bite out of their raise. The 2018 Social Security cost-of-living adjustment (COLA) will not be announced until October, but inflation trends point toward an increase of about 2 percent, according to a recent forecast by the Senior Citizens League. That would be a welcome change compared with the 0.3 percent bump in 2017, and 2016 when no COLA was made. (Mark Miller, 6/22)

The Des Moines Register: Iowa’s CON Job: How The State Prevents Competition In Health Care
What if you wanted to start a business, but first you had to convince a government board that there was a need for your services? And to top it off, your potential competitors could show up to a hearing and argue that nobody needs your business? It sounds unfair and absurd, but that is exactly what Iowa and 27 other states do to doctors. Iowa makes it a crime for doctors like me to open up a new surgery center without obtaining special permission known as a “certificate of need” or CON from the state’s Health Facilities Council. (Lee Birchansky, 6/22)

RealClear Health: The Digital Health Hope: Transforming Outcomes In Health
There are more than 50 petabytes of data in the health care realm today. Analysis and the creative use of big data may likely hold the answers to solving many public health problems and curing chronic disease. Today, new technologies are rapidly being developed for the collection of biometric data directly from patients. Digital health has become the new frontier in medicine and billions of dollars are being invested every year by both government agencies as well as the private sector. Emerging digital health tools collect and archive big data and provide opportunities for researchers to ask important questions that will likely lead to the development of new and improved treatments. (Kevin Campbell, 6/23)

Kansas City Star: New System Will Modernize VA Record Keeping
Recently, Secretary of Veterans Affairs David J. Shulkin announced that the VA will overhaul its decades-old electronic patient record system. Rather than simply revamping the old system, and in an effort to provide better, more streamlined care for veterans, the VA will upgrade to a commercial system. (Todd Graves, 6/22)

Lincoln Journal-Star: Spike In Cardiac Arrest Saves Stunning
For someone suffering cardiac arrest, saying “every second counts” may seem trite – but it’s true. Every minute without CPR and defibrillation decreases the person’s chance of survival between 7 percent and 10 percent, according to the American Heart Association. Accordingly, quick action is imperative to save as many lives as possible. (6/22)

The New England Journal Of Medicine: Effective Legislative Advocacy — Lessons From Successful Medical Trainee Campaigns
“What is the best way for me to get involved politically?” Since last November’s election, I have fielded this question frequently from fellow residents as well as medical students. Many of them have never been politically active, having assumed that the arc of progress would continue uninterrupted, and so, understandably, have focused instead on a demanding training process that largely treats advocacy as extracurricular rather than as a core competency. Now, recognizing the myriad ways in which politics and policy influence the health care we deliver, many trainees feel a new sense of urgency to get involved. (Elizabeth P. Griffiths, 6/22)

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

Parsing The Key Issues: Who Wins And Loses; Impact On The Opioid Crisis

Opinion writers focus on certain hot-button issues that are brought to the fore by the Senate Republicans’ health proposal, especially those related to cost and coverage. In the background, there’s also discussion of the current insurance marketplace and how it needs to be fixed.

Los Angeles Times: Who Wins And Who Loses In The Senate Health Bill (As If You Can’t Guess)
The Senate GOP leadership calls its proposal to overhaul Obamacare the “Better Care” act. But better care for whom? Not for the working poor. The bill’s new premium subsidies for those not covered by large employer health plans would be less generous than they are now, pushing recipients into policies with higher deductibles and co-pays. And when the new subsidies begin in 2020, the bill would end the second set of subsidies that the Affordable Care Act provided those near the poverty line to offset their out-of-pocket costs. (6/23)

Huffington Post: If You Love High Deductibles, Then You’ll Love The Senate Health Bill
If the GOP proposal becomes law, then it’s likely out-of-pocket costs for people buying coverage through healthcare.gov or one of the state exchanges would tend to be higher, not lower ― unless these people were able and willing to pay even more in premiums. … The essential reality of the repeal effort ― one worth keeping in mind over the next few days, amid all the legislative negotiation over policy details ― is that Republicans want to reduce government spending on the poor and middle class. And less government spending for these people means, almost inevitably, that they will pay for a greater portion of their medical care. Either fewer will have insurance, the insurance they have will offer less protection, or both. It’s just a question of who suffers and how. (Jonathan Cohn, 6/22)

The New York Times: Shifting Dollars From Poor To Rich Is A Key Part Of The Senate Health Bill
The Affordable Care Act gave health insurance to millions of Americans by shifting resources from the wealthy to the poor and by moving oversight from states to the federal government. The Senate bill introduced Thursday pushes back forcefully on both dimensions. The bill is aligned with long-held Republican values, advancing states’ rights and paring back growing entitlement programs, while freeing individuals from requirements that they have insurance and emphasizing personal responsibility. (Margot Sanger-Katz, 6/22)

The New York Times: Get Cancer Now, Before Congress Cuts Your Insurance
I’m 35 years old. I didn’t go to college after high school. Instead I got a job in insurance, and I’ve spent half my life on the business side of keeping people healthy. Only once have I felt that the industry took positive steps toward insuring America, and that was when Obamacare mandated it. I assumed Donald Trump’s presidency would doom the law. A Republican replacement, which could cut off insurance for millions of people, may pass the Senate as soon as next week. And I fear that most Americans, who don’t really worry about their health until they get sick, won’t be willing to fight against it. (Justin Ordonez, 6/23)

Miami Herald: GOP Health Bill Will Worsen Opioid Crisis
It’s true. This feels like the center of the opioid crisis in America. But so do West Virginia and Maryland and Massachusetts and hamlets with such names as Pleasantville, Welch and Delray Beach. It is foolish to deny this is a catastrophe; ridiculous to think it is not affecting every American family. Believing that overdosing and addiction only happen to the poor and disadvantaged or celebrities such as Prince and Carrie Fisher is even worse than arguing that extreme droughts, floods, blizzards and other anomalies — such as the air being too hot for planes to get enough lift to take off — are not related to climate change. (Ann McFeatters, 6/23)

The Des Moines Register: GOP Health Bill Is A Disaster For Opioid Crisis
America’s addiction crisis is the defining public health challenge of our time. In 2015, more than 52,000 Americans died of drug overdoses, the majority related to opioids — far more than died from car accidents. More than 20 million Americans live with substance use disorders, leading to immeasurable suffering for individuals and families and costing our nation a staggering $442 billion in health care costs, lost productivity and criminal justice expenses. (Vivek Murthy, 6/22)

The New England Journal Of Medicine: Turmoil In The Individual Insurance Market — Where It Came From And How To Fix It
In recent weeks, some health insurers have announced that they will not offer individual market coverage in 2018, while others have requested sizable premium increases. In response to this news, President Donald Trump has pronounced the individual market structure created by the Affordable Care Act (ACA) “dead.” Similarly, House Speaker Paul Ryan (R-WI) has claimed that the market is experiencing a “death spiral” reflecting fundamental flaws in the ACA’s design. These claims misdiagnose the situation. The ACA’s individual market structure — though not perfect — is sound and has succeeded in greatly expanding coverage. As 2017 began, the market was poised to leave behind the growing pains of the past few years. Then the President and Congress acted to create needless turmoil. (Henry J. Aaron, Matthew Fiedler, Paul B. Ginsburg, Loren Adler and Alice M. Rivlin, 6/21)

Milwaukee Journal Sentinel: Anthem’s Withdrawal Is The Latest Obamacare Failure In Wisconsin
On Wednesday, Anthem Blue Cross Blue Shield announced it would pull out of Wisconsin’s health insurance market, making it the fifth health insurer to leave the state’s marketplace since the implementation of President Barack Obama’s disastrous health care law, ironically coined the Affordable Care Act. This devastating development will leave thousands of Wisconsinites without their preferred health insurance at the end of this year — another blow to a state that’s been hit repeatedly with a string of knocks dealt by the repercussions of Obamacare. (Jim Sensenbrenner, 6/22)

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

A Look At The Political Landscape: Who’s Really For Trumpcare?

There are lots of thoughts on how the politics surrounding the current GOP repeal-and-replace plans might play out.

Los Angeles Times: Recipe For Disaster: How Not To Cook Up Healthcare Reform
In case anyone was wondering what would happen if a handful of fairly wealthy, well-insured men gathered in a room and quietly tried to reinvent the $3-trillion U.S. healthcare system without any input from medical experts, patient advocates or others who know what they’re talking about, the U.S. Senate stepped up Thursday with the answer. (David Lazarus, 6/22)

Bloomberg: Why Republicans Will Pass Trumpcare
No one seems to like the Senate health-care bill. Liberal wonks detest it. At least four Republican Senators claim they aren’t prepared to support it, while other colleagues grumble about it. The White House, whose chief executive promised he wouldn’t cut Medicaid, as this bill does, is balking. But the Senate bill is very similar to the bill passed last month by the House. And the reason for that similarity is pretty basic: Both bills accomplish what Republicans want. (Francis Wilkinson, 6/22)

Los Angeles Times: I Can Help You Understand Trumpcare, But I Can’t Defeat It Alone
Next week, Republicans want the United States Senate to vote on a bill that would restructure our nation’s entire healthcare system — a system that makes up one-sixth of the American economy. This bill would affect the lives of nearly every American, from our parents or grandparents in need of caregiving, to our children struggling with asthma or opioid addiction, to our spouses battling cancer. And we only just received the full text on Thursday, a week before the vote on the bill. (Sen. Kamala D. Harris, 6/23)

The Washington Post: Is There Anybody Actually In Favor Of The Senate Health-Care Bill?
President Trump says the Senate health-care bill needs more negotiation. (So what foolish lawmaker would sign onto it now?) Planned Parenthood, hospitals, every Democratic lawmaker and a number of conservatives have panned the bill. Conservatives and libertarians oppose the bill because, to a greater extent than the House bill, it temporarily props up Obamacare. Already four Republicans — Sens. Rand Paul (Ky.), Ron Johnson (Wis.), Ted Cruz (Tex.) and Mike Lee (Utah) — have said they cannot support it because it does not fully repeal Obamacare or do enough to lower costs. (Jennifer Rubin, 6/22)

The New England Journal Of Medicine: The First Hundred Days for Health Care
Like my predictions about what a Republican win in the 2016 election would mean for U.S. health policy, my expectations about the ease and speed of passing an Affordable Care Act (ACA) replacement bill during President Donald Trump’s first 100 days in office have not exactly come to fruition. But given the Republican focus over the past 7 years on “repealing and replacing” the ACA and Trump’s promise to make health care reform an early focus of his administration (at one point, he suggested having Congress meet even before his inauguration), Congress’s attention to the issue has not been surprising — even if it’s not directly in line with Trump’s dominant campaign theme of “making America great again.” Indeed, it’s been argued that the economy and jobs would have been a politically easier first target than health care — an argument that was made retrospectively for the Obama administration as well. (Gail R. Wilensky, 6/22)

The Washington Post: Here’s How Ronald Reagan Would Fix The GOP’s Health-Care Mess
The internal GOP debate on how to replace Obamacare is essentially one of priorities. What is more important, saving money or saving lives? Senate and House Republicans may be surprised to learn that for their idol, Ronald Reagan, this was never a question at all. Throughout his life, Reagan always cared more about saving lives than saving money. (Henry Olsen, 6/22)

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Trump Executive Order Draft On Drug Prices Would Decrease Regulations, Take Steps To Increase Competition

CQ Roll Call reports that a draft document indicates that the Trump administration leaning toward a roll back of regulations to foster faster drug approvals and promoting competition and new payment models for federal insurance programs. In other pharmaceutical industry news, Mylan shareholders reject the Epi-Pen maker’s executive pay policy but re-elect its board.

Roll Call: Draft Drug Price Order Focuses On Regulations, Trade
The Trump administration might seek to roll back regulations in pursuit of faster drug approvals, promoting drug competition and new payment models for federal health insurance programs, according to a draft executive order obtained by CQ Roll Call. Some of the items listed would benefit pharmaceutical companies, despite President Donald Trump’s pledge earlier this year to take steps to rein in the industry because he said it was “getting away with murder.” But the administration is also hinting that it could address some anti-competitive behavior in that sector. There are also a number of recommended proposals that could give incentives for the development of generic drugs. (Siddons and Williams, 6/23)

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All Kids Should Be Screened for Obesity

Earlier this week, an influential group of experts in preventive care affirmed that children age 6 and older should be screened for obesity and referred to intensive treatment when necessary.

While the Affordable Care Act requires that nearly all plans cover such treatment, most kids don’t have access to programs featuring exercise, nutrition and counseling, according to an editorial published in JAMA Internal Medicine.

After rising for three decades, obesity rates for children and adolescents have leveled off in recent years. Still, nearly a third of kids are overweight, and 17 percent meet the standard for obesity, meaning that for their age and sex they have a body mass index (weight measured in kilograms divided by height measured in meters squared) that is in the 95th percentile or higher.

The U.S. Preventive Services Task Force, a nonpartisan group of medical experts that issues recommendations on preventive care, evaluated the evidence related to screening and treating children and adolescents for obesity. Based on that analysis, this week the group affirmed its 2010 recommendation.

Michelle AndrewsInsuring Your Health

Under the ACA, preventive care recommended by the task force must be covered by nearly all health plans without making consumers pay for it out-of-pocket. But despite the task force’s recommendation, insurance coverage is spotty, said Dr. Jason Block, associate director of the Division of Chronic Disease Research Across the Lifecourse at Harvard Medical School, who co-authored an editorial about the new guidelines.

Even when plans cover obesity treatment, they may not pay for a range of services.

“It’s a problem for obesity treatment programs across the board,” Block said. “They may cover the physician role in treatment but they may not cover the role of the exercise physiologist or the nutritionist.”

In addition, many obesity treatment centers are located in urban areas, far from where many children who need their services live. And many obesity programs don’t offer the minimum 26 hours of personal contact that the task force determined is necessary for effective treatment, Block said. (Programs that incorporated 52 contact hours were even more effective, the task force found.)

“We need to be more creative about accommodating strategies like telehealth and other technologies that can facilitate [access],” he said. “A health coach could engage by phone or email and help to facilitate some of that contact.”

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Viewpoints: Opioids And America’s Backward Slide; Remaining Vigilant Against Zika

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

The New York Times: Opioids, A Mass Killer We’re Meeting With A Shrug
About as many Americans are expected to die this year of drug overdoses as died in the Vietnam, Iraq and Afghanistan wars combined. For more than 100 years, death rates have been dropping for Americans — but now, because of opioids, death rates are rising again. We as a nation are going backward, and drug overdoses are now the leading cause of death for Americans under 50. (Nicholas Kristof, 6/22)

USA Today: Addiction Crisis Will Worsen With Advent Of ACHA
America’s addiction crisis is the defining public health challenge of our time. In 2015, more than 52,000 Americans died of drug overdoses, the majority related to opioids — far more than died from car accidents. More than 20 million Americans live with substance use disorders, leading to immeasurable suffering for individuals and families and costing our nation a staggering $442 billion in health care costs, lost productivity, and criminal justice expenses. (Vivek Murthy, 6/22)

Miami Herald: Pregnant Women Must Remain Vigilant Against Zika
Summer officially is here and, in Florida, we are already feeling record-breaking temperatures. The heat and humidity common to our region is bringing back the threat of Zika. Cases of the disease continue to be reported regularly, and because of that we urge pregnant women to stay vigilant and get tested for this life-altering virus. There is currently no vaccine to prevent Zika virus infection. (Manuel Fermin, 6/21)

St. Louis Post-Dispatch: Fighting Hunger Requires A Community Commitment
Statistics from the 2016 Hunger Atlas, published by the University of Missouri’s Interdisciplinary Center for Food Security, paint a bleak landscape. They show Missouri ranks among the top 10 states with the highest percentage of households classified as food insecure or having very low food security. Almost half a million Missourians experience hunger at some point over the calendar year, the report found. We have to do better. (Todd Schnuck, 6/22)

JAMA: Speak Up
Recently I attended … a weekly symposium that affords members of the faculty, house staff, nursing, pharmacy, and technical staff the opportunity to empathize and support one another in discussions of the “social and emotional” and ethical issues encountered in providing care to patients, their families, and each other. The topic was a complaint by a patient who stated she “could not understand” her physician “because of her accent” and that the doctor was late because “she is from Iran” and “doesn’t know the rules of this society.” … These stories stimulated several attendees to describe many similar experiences and the emotions they have elicited. It became apparent that rude and racist behaviors by our patients and their family members are increasing in frequency and ruthlessness. Our staff have been subjected to slurs by patients and families, targeting their gender, ethnicity, place of birth, apparel, speech characteristics, or skin color. (Douglas G. Merrill, 6/20)

JAMA: Losing Weight During The Postpartum Period
The postpartum period is one of the critical time points in a woman’s life that often places her at risk for obesity and obesity-related health conditions. Postpartum weight retention (defined as a retained weight of 4.5 kg at 6-12 months after delivery) affects an estimated 25% of the 4 million women in the United States who give birth each year. … Effective interventions are needed for these at-risk patient populations to stop the cycle of weight gain and adverse maternal and child outcomes. (Adam Gilden Tsai and Wanda K. Nicholson, 6/20)

JAMA: Putting The US Preventive Services Task Force Recommendation For Childhood Obesity Screening In Context
In this issue of JAMA, the US Preventive Services Task Force (USPSTF) recommends that clinicians screen for obesity in children and adolescents aged 6 to 18 years and refer those with an age- and sex-specific body mass index at the 95th percentile or greater to comprehensive, intensive behavioral interventions (B grade). This recommendation confirms what pediatric primary care clinicians and others do in the everyday care of children: monitor growth, counsel on healthy lifestyles, and refer when appropriate. Well-child care began with maternal education and use of child weighing stations in the late 1800s to address malnutrition. Today, many overweight and obese children and adolescents have a different type of malnutrition, and assessing growth and development has become increasingly important. (Rachel L. J. Thornton, Raquel G. Hernandez, Tina L. Cheng, 6/20)

The Columbus Dispatch: Doctor Tended To City’s Health
The city’s doctor is retiring at the end of the year. Dr. Teresa Long was on the front lines fighting to protect the health of Columbus residents against threats such as bioterrorism, flu, measles or mumps outbreaks, poor food sanitation, HIV, tobacco use, obesity or crib death. And that’s just a sampling of the critical efforts that the good doctor has tackled in her 30 years at Columbus Public Health. (6/22)

Miami Herald: The U.N. Owes Haiti Relief From Cholera Epidemic It Introduced
Seven years after its soldiers sparked the world’s worst cholera epidemic in Haiti, the United Nations is finally preparing to close its MINUSTAH peacekeeping mission there. As Nobel Peace laureates committed to the U.N.’s ideal of universal human rights, we are deeply concerned that the victims of MINUSTAH’s catastrophic actions remain without justice and reparations, despite U.N. promises to repair the harm it has caused. (Adolfo Perez Esquivel, Jody Williams, Shirin Ebadi, Rigoberta Menchu Tum and Betty Williams, 6/21)

The Health Care Blog: Overdiagnosing Trump
When I first read about neurosyphilis in medical school, I became convinced that Mrs. Thatcher, who I detested intensely because it was fashionable detesting her, had General Paralysis of the Insane. The condition, marked by episodic bouts of temporary insanity, which indicated that the spirochetes were feasting on expensive real estate in the brain, seemed a plausible explanation why she had introduced the retarded Poll Tax. (Saurabh Jha, 6/19)

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State Highlights: In Pushing For Legislation, N.J. Gov. Turns Up Heat On State’s Largest Insurer; Ohio Senate Approves Budget With Trims to Medicaid, Other Human Services Programs

Media outlets report on news from New Jersey, Ohio, Kansas, Utah, Georgia, Arizona and Massachusetts.

The Wall Street Journal: N.J. Gov. Chris Christie Increases Pressure On Insurer
New Jersey Gov. Chris Christie amped up pressure on the state’s largest health insurer on Wednesday, blasting what he said are systemic failures by the company while pushing for legislation he has proposed to give the state more control over its finances. At a news conference, the governor said Horizon Blue Cross Blue Shield of New Jersey has been the subject of repeated state-enforcement actions for more than a year, including a $15.5 million fine levied on Monday. (King, 6/21)

Cleveland Plain Dealer: $65.4 Billion Ohio Budget Bill Clears Senate: See Where The Money Goes
The Ohio Senate on Wednesday passed a $65.4 billion two-year state budget after making more than 150 changes to the bill passed by the House, setting the stage for a week of behind-the-scenes maneuvers and compromises between the two chambers… Senate Republicans closed the anticipated $1 billion gap through cutting state agency spending across the board, eliminating with unspent funds and trimming Medicaid administration costs. (Borchardt, 6/22)

KCUR: Kansas Foster Care Contractor Sees Benefits Of Trauma-Informed Training 
The foster care system in Kansas has problems, but a national child welfare group sees one area where it could lead the way for other states. Tracey Feild, director of the child welfare strategy group at the Annie E. Casey Foundation, said work on childhood trauma by KVC Kansas, one of the state’s two foster care contractors, could be a model for others. The Casey Foundation sponsors the annual Kids Count report and other child-focused research. (Wingerter, 6/21)

Arizona Republic: A Phoenix Health Clinic For Those With No Insurance, No Access To Care
A decade of health-care reform had filtered more people than ever into hospitals and doctor’s offices, but preventive care stayed out of reach for most of the 11 million people in the country without legal status… The health of 11 million people was left to a patchwork of charity and community clinics. It was a safety net full of holes:The UCLA Center for Health Policy Research found that undocumented immigrants are significantly less likely than legal immigrants to see a doctor, visit the emergency room or report themselves in good health. (Woods, 6/21)

Boston Globe: Mass. House Votes For Sweeping Changes To Pot Law 
The Massachusetts House of Representatives passed an expansive rewrite of the voter-approved marijuana legalization law Wednesday night — a bill that would alter major aspects of the referendum backed by 1.8 million voters just seven months ago… The House bill would sharply raise total pot taxes to a mandatory 28 percent, from a maximum of 12 percent in the ballot question. (Miller, 6/21)

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EpiPen Maker Reportedly Offered States Discounts If They Cut Down Competition

Stat reports that Mylan made the rebates conditional on states requiring that competitors’ products get special requests by clinicians to be covered by Medicaid. In other news, the Food and Drug Administration says it will hold a hearing on efforts by drugmakers to impede competition, and an Australian drug company that is linked to a U.S. congressman gets approval for U.S. trials.

Stat: Mylan Offered EpiPen Discounts To States In Exchange For Exclusive Status
The pharmaceutical company Mylan offered rebates to at least six state Medicaid programs on the condition that the states would make it harder for Medicaid patients to obtain products that compete with its EpiPen auto-injector, according to email correspondence obtained by STAT. The rebates Mylan offered to state Medicaid programs were conditional upon them making EpiPen easily available while competitor products would require special requests by clinicians in order for them to be covered. (Swetlitz, 6/22)

Morning Consult: FDA To Hold Public Hearing On ‘Gaming’ In Drug Industry
The Food and Drug Administration will hold a public meeting next month to investigate ways that federal regulations can be manipulated by brand-name drugmakers to impede generic competition from entering the market. The hearing, scheduled for July 18, is the latest step taken by newly installed FDA Commissioner Scott Gottlieb to have the agency take a more active role in policing drug prices. (Reid, 6/21)

Kaiser Health News: FDA Ruling On Aussie Biotech Could Boost Congressman’s Investment
An Australian biotech company whose largest shareholder is a U.S. congressman has the greenlight to begin human trials in the U.S. for a drug to treat advanced multiple sclerosis. The Food and Drug Administration’s decision is the first step in a long approval process demonstrating a new drug’s safety and effectiveness before regulators allow it to go on the market. In Innate Immunotherapeutics’ case, it could help the company achieve its stated goal of striking a merger or partnership deal with a larger drugmaker. (Bluth, 6/21)

Meanwhile, legislators in Pennsylvania consider giving patients more access to experimental drugs —

The Philadelphia Inquirer: Pa. ‘Right-To-Try’ Bill Moves Forward, But Would It Help Terminal Patients?
Pennsylvania is a step closer to joining 37 other states that have passed laws purporting to entitle terminally ill patients to try unapproved drugs. The Senate Health and Human Services Committee unanimously approved the “right to try” bill on Wednesday. In March, the proposal unanimously passed in a House committee, then went on to unanimous passage in the House of Representatives in April — unusually rapid legislative progress.  (Whether the full Senate and Gov. Wolf will follow suit is unclear.) (McCullough, 6/21)

And drugmakers report progress against a difficult eye disease —

San Francisco Chronicle: Drug Shows Promise Against Vision-Robbing Disease In Seniors
An experimental drug from Genentech is showing promise against an untreatable eye disease that blinds older adults — and, intriguingly, it seems to work in patients who carry a particular gene flaw that fuels the damage to their vision. Age-related macular degeneration is the leading cause of vision loss among seniors, gradually eroding crucial central vision. (Neergaard, 6/21)

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Anthem, An ACA Stalwart, Will Pull Out Of Two More States Citing Volatile Marketplace

Although Anthem is withdrawing from some marketplaces, other companies are diving in. Media outlets look at the results of Wednesday’s deadline for insurers to submit initial federal applications to offer 2018 marketplace plans.

Bloomberg: Anthem, Obamacare Stalwart, Pulls Out Of Two More States 
Anthem Inc., the stalwart that has stuck with Obamacare longer than most other large health insurers, is shrinking its participation in the program and pulling out of two more states’ marketplaces. Anthem announced its exit from Wisconsin and Indiana on Wednesday, the deadline in many states for U.S. insurers to file their premium rates if they wish to participate in the Affordable Care Act next year. The insurer said it will leave the two individual insurance markets because uncertainty has become too great to continue offering plans. (Tracer and Edney, 6/21)

The Wall Street Journal: Anthem Says It Will Stop Offering ACA Plans In Two More States As Others Raise Their Bets
Anthem cited a volatile insurance market in its latest pullback announcement, and it said that planning and pricing for ACA plans “has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance,” including around the cost-sharing payments. The company previously said it would stop selling marketplace plans in Ohio next year. (Wilde Mathews, 6/21)

USA Today/Milwaukee Journal Sentinel: Anthem To Stop Selling Obamacare Plans In Wisconsin
Anthem said its decision does not affect its health plans for employers, its Medicare Advantage plans or Medicaid plans. It also will continue to renew its so-called transitional plans that were sold before March 2010 and December 2013. Those plans, which are not available to new customers, cover about 4,500 people in Wisconsin. (Boulton and Romell, 6/21)

The Hill: Anthem To End ObamaCare Plans In Indiana, Wisconsin 
Anthem will pull out of the ObamaCare exchanges in Indiana and Wisconsin next year, the insurance giant announced Wednesday. Anthem cited uncertainty surrounding how the Trump administration will handle the Affordable Care Act (ACA) as one reason for leaving. (Hellmann, 6/21)

The Hill: Insurer Startup To Enter Five ObamaCare Exchanges 
An insurance startup is expanding its reach in five state ObamaCare exchanges amid uncertainty over the Affordable Care Act’s future. In a blog post, the insurance startup Oscar said it was working in the states because it sees a business opportunity despite turmoil surrounding former President Obama’s signature law, which Republicans are seeking to repeal. (Roubein, 6/21)

Bloomberg: Oscar To Enter Tennessee’s Obamacare Market In 2018 
Oscar Insurance Corp. plans to begin selling health plans on the Obamacare marketplace in Tennessee in 2018 and expand its offerings in other states where it’s already operating. The closely held insurer will expand into new areas of Texas and California, according to a blog post Wednesday by Mario Schlosser, the chief executive officer. The company will also return to the New Jersey market that it earlier dropped. (Lauerman and Tracer, 6/21)

San Antonio Express-News: Kushner Family’s Oscar Health Expands Coverage Beyond Bexar
Insurance company Oscar Health announced Wednesday that it will expand coverage to surrounding and nearby counties, bucking a national trend of insurers scaling back coverage amid uncertainty surrounding federal health care policy changes. Oscar Health was founded in 2012 by Joshua Kushner, brother to President Donald Trump’s son-in-law Jared, and has a market value of around $2.7 billion. (Pound, 6/21)

KCUR: 18,000 Could Lose Health Coverage In Missouri’s ‘Bare Counties,’ As State Faces Tough Choices 
Next year, Blue Cross Blue Shield of Kansas City will leave the individual health care marketplace in Missouri that was set up under the Affordable Care Act. And when it does, about 18,000 patients in 25 western Missouri counties will lose their health insurance. If those enrollees sign on to Healthcare.gov this fall to buy a replacement plan, they may have no options to choose from. That’s because those 25 counties could become “bare.” If that happens, Missouri will be the first state to have bare counties since the health care exchanges were established in 2013. Insurance companies leaving the marketplace, coupled with uncertainty over the health law’s future, have left thousands of Missourians who buy insurance on their own in a “wait and see” mode. Although other states have coaxed insurance companies to stay, Missouri’s regulators have not publicly shared their plans to rectify the situation. (Bouscaren, 6/21)

Denver Post: No Insurers Leaving Colorado Health Exchange In 2018, Commissioner Says 
After months of worry, Colorado Insurance Commissioner Marguerite Salazar said Wednesday that no insurers are backing out of the state’s health care exchange for 2018, but consumers in the individual insurance market should expect to pay more. Salazar said nine companies filed plans with the state this week to offer individual insurance plans in 2018. That includes all seven insurers currently offering plans on Connect for Health Colorado, the state’s health insurance marketplace where all the plans sold meet Affordable Care Act requirements and are eligible for federal tax credits to help pay the premiums. (Ingold, 6/21)

The Baltimore Sun: State Considers Rate Increases On The Health Exchange As Another Insurer Drops Out
As s U.S. Senate leaders prepare to unveil their plan to remake the Affordable Care Act over time, Maryland officials must press ahead with the system as it stands for hundreds of thousands of residents. The Maryland Insurance Administration held its first hearing Wednesday on the large rate increases being sought by three insurance carriers selling health plans to individuals on the state exchange. The hearing came as another carrier decided to pull out of the market. Cigna Health and Life Insurance Co. follows UnitedHealthcare, which stopped selling plans last year. (Cohn, 6/21)

Nashville Tennessean: Farm Bureau Health Plans To Drop ACA Options In 2018, Cites Unsustainable Financials
Farm Bureau Health Plans will not sell individual Affordable Care Act insurance next year as a surge in 2017 membership threatens the company with heavy losses. The company covered 25,046 Tennesseans with its ACA-compliant plans as of the end of May. The company projects it could lose more than $15 million on those members by the end of 2017, according to a letter it sent to the state’s insurance commissioner dated June 21. But the losses are only one factor in its decision. (Fletcher, 6/21)

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Obamacare Exchanges Are Deteriorating But Not Imploding

Health insurers had until Wednesday to declare whether they planned to sell coverage next year on exchanges in most states.

The Associated Press: Government Health Insurance Markets Holding Up–Barely
Enough insurers are planning to sell coverage on the Affordable Care Act’s insurance exchanges next year to keep them working — if only barely — in most parts of the country. Competition in many markets has dwindled to one insurer — or none in some cases — and another round of steep price hikes is expected to squeeze consumers who don’t receive big income-based tax credits to help pay their bill. (Murphy, 6/21)

The Washington Post: Obamacare’s Exchanges Face Their Moment Of Truth
Insurers hit a major deadline Wednesday: They must inform regulators in 39 states whether they will sell insurance on many Affordable Care Act marketplaces and, if so, how much they would like to charge. It’s something of a moment of truth for the Affordable Care Act’s marketplaces, whose health depends in large part on the participation of private insurers. And so far, states are seeing mixed results: One major insurer has made a big pullout, while a different one announced it would expand into new states. (Johnson, 6/21)

The New York Times: With Health Law In Flux, Insurers Scramble To Meet Filing Deadline
While the Wednesday deadline does not represent a final commitment by any insurer, “it will be a good indicator of the health of these markets,” said Sabrina Corlette, a research professor at Georgetown University. House Speaker Paul D. Ryan, whose home state of Wisconsin was among those Anthem plans to exit, pointed to the decision as reason the Republicans needed to pass their overhaul of the health care legislation. “This law has failed our state,” he said. “Obamacare is clearly collapsing, and we have to step in before more families get hurt.” (Abelson, 6/21)

NPR: Health Insurers Struggle To Plan Coverage For Next Year
The Senate vote on a bill to repeal and replace the Affordable Care Act is, according to conventional wisdom, one week away. And we still don’t know what’s in the bill. Not having concrete information is deeply uncomfortable for a journalist like me. But for lots of people, like those who work in the insurance industry, not knowing what’s in that bill is a bigger deal. (Kodjak, 6/21)

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Survivors Of Childhood Diseases Struggle To Find Care As Adults

Rachael Goldring was born with congenital heart disease. Had she been born a few decades earlier, she probably would have died as a baby. Now 24, Goldring is part of a population of patients who present new challenges to a health care system unaccustomed to dealing with survivors of once-fatal conditions.

There are now more adults than kids living with some of these diseases, and medical training lags behind. Young adults who can’t find suitable doctors may drop out of care, and their conditions may worsen.

Goldring’s condition was pulmonary atresia with tetralogy of Fallot. She was born without a pulmonary valve directing blood from her heart to her lungs. It’s the condition that talk show host Jimmy Kimmel’s baby was born with this spring.

“I had my first surgery when I was 9 months,” Goldring said. “Now, they do it from birth.”

Her condition has also meant three more surgeries, a heart valve replacement, complicated secondary diseases and a lifetime in and out of doctors’ offices. “I just celebrated my one-year anniversary of staying out the hospital for the first time since birth,” she said. “So, this year, knock on wood, it’s been amazing.”

But she fears it might not last. Right now, she’s in limbo between pediatric and adult medical care. For Goldring, finding a good doctor could be a matter of life and death.

Today, congenital heart disease survivors can live well past childhood. Dr. Patrick Burke, a pediatrician at Valley Children’s Healthcare in Madera, Calif., said other once-fatal ailments like sickle cell disease and spina bifida have undergone similar advances.

“This is the so-called medical miracle promised to our parents and grandparents,” Burke said, adding that miracle kids like Goldring grow up to be complicated adults. “The job’s not done after the surgery or the initial treatment. Many if not most of these conditions require ongoing medical care — lifelong medical care.”

Burke is in charge of a new program at his hospital in the new field of “transitional care.” He said many conditions worsen around age 18, just as children age out of pediatric care. For instance, he said, that’s when patients with congenital heart disease suffer complications with their blood and organs. The trend is particularly stark for cystic fibrosis.

“We’re seeing this spike of deaths that are happening in the early 20s. And it’s bizarre,” he said.

Pediatrician Megumi Okumura at the University of California-San Francisco became interested in this transition during her residency in the early 2000s. She would see 40- and 50-year-olds in pediatric wards. The reason, she said, partly lies with our fragmented health care system.

“They are transferring from differing systems of care,” she said. “We have siloed pediatric-based care to adult-based care. We have different funding streams and programs.”

Now, Okumura and other researchers are looking for ways to remove what she considers artificial barriers. Clinics around the world are trying out new strategies like giving non-pediatric doctors more training or bringing in transitional specialists to connect chronically ill young adults with new providers.

Goldring is fortunate in that she can remain with her pediatrician until she finds the right adult provider. She’s working on the transition, but at the moment, she’s much more focused on another transition: She’ll get married in October.

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

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FDA Ruling On Aussie Biotech Could Boost Congressman’s Investment

An Australian biotech company whose largest shareholder is a U.S. congressman has the greenlight to begin human trials in the U.S. for a drug to treat advanced multiple sclerosis.

The Food and Drug Administration’s decision is the first step in a long approval process demonstrating a new drug’s safety and effectiveness before regulators allow it to go on the market. In Innate Immunotherapeutics’ case, it could help the company achieve its stated goal of striking a merger or partnership deal with a larger drugmaker.

Drugs to treat multiple sclerosis, which are taken for life, are some of the most expensive offerings in the U.S., costing about $5,000 a month, or $60,000 a year.

Regulators’ action “means you can do clinical studies. It doesn’t increase the likelihood of approval and it doesn’t mean the FDA is inclined to approve the drug,” said Ken Kaitin, director of the Tufts Center for the Study of Drug Development in Massachusetts.

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Rep. Chris Collins (R-N.Y.), who owns a 16.8 percent stake of the company, is also a member of Innate’s board. The Buffalo-area representative has helped draw other U.S. investors into Innate, including political donors and others with whom he has personal or professional connections.

The Office of Congressional Ethics is investigating Collins’ role, The Buffalo News reported last month.

Innate drew intense public scrutiny earlier this year after Health and Human Services Secretary Tom Price — previously a Republican member of Congress from Georgia — was identified as a shareholder after President Donald Trump nominated him to head up the department that includes the FDA. Price said he learned about the company from Collins.

The secretary sold his shares after he joined HHS.

CEO Simon Wilkinson said the company hopes the FDA will recognize the preliminary trials that Innate has done in other countries so that it can begin late-stage trials in the U.S.

Since the agency did not have any jurisdiction over those trials, it might require Innate to conduct early-stage research in this country, Kaitin said.

“The FDA can basically do whatever they want in this case,” he said.

Innate’s most recent trial, which included 93 participants in Australia and New Zealand, finished in April, and the company expects to announce the results by September.

Innate’s shares rose about 2 percent in Australian trading Wednesday after the company announced the FDA decision.

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