Tagged Health Industry

Viewpoints: CBO’s Surprising Findings; Medicaid Enrollees Feel Powerless

A selection of opinions on health care from across the nation.

The Wall Street Journal: Blame-Sharing On ObamaCare
The oracles at the Congressional Budget Office this week descended from Delphi to predict 20% premium increases if the Trump Administration ends illegal Obama Care subsidies for insurers, and Democrats are happy to agree. Yet a careful reading of the report reveals some surprising results that are far less ominous and for consumers mostly benign. CBO and the Joint Committee on Taxation analyze what would happen if the Trump Administration cut off “cost-sharing” subsidies, which are government payments to insurers that defray deductibles and co-pays for certain people below 250% of the poverty line. (8/16)

San Antonio Press-Express: Free Market Not The Health Care Panacea
It is arguable that some business-type approaches are aspects of a health care system, and I suspect they are incorporated even in countries with universal or purported “socialist” health care system. Nonetheless, I would like [Sen. John] Cornyn and [Sen. Ted] Cruz or like-minded colleagues to name one developed country where a free market health care system is established that works for everyone or even the majority. (Juan H. Flores, 8/16)

The Washington Post: People Who Get Medicaid Are Made To Feel Powerless. That Pushes Them Out Of Politics And Toward Fatalism.
During the debate over the Republicans’ unsuccessful push to repeal and replace Obamacare this summer, thousands of activists across the country held rallies, attended town hall meetings and staged protests in an effort to stop the GOP. News coverage regularly featured protesters from the disability community, many of whom would have been affected by potential cuts to Medicaid. … But very few of the 70 million low-income and disabled Americans who receive Medicaid benefits actually participated in the debates, despite the fact that changes to the federal program could have had fundamental consequences for their lives. … people enrolled in Medicaid often feel stigmatized by the system. They can be frustrated by differences in the way the program is administered across states and even local communities. As a result, they disengage from politics. (Jamila Michener, 8/17)

Oregonian: Insurers Are Setting Patients Up For Failure
Thomas Edison once said, “I have not failed. I’ve just found 10,000 ways that won’t work.” While his words illustrated an insatiable passion to invent new technologies like the light bulb, a larger idea belies a fatal flaw we’re seeing insurance companies apply to modern medicine. Through a practice called step therapy or fail first, insurers demand failure upon the people whose lives they’ve been entrusted. (David Russo, 8/16)

NPR: How Doctors Deal With Hate, Racism And Their Own Biases
The events that unfolded in Charlottesville last weekend are a stark reminder of how far we haven’t come as a nation. Like so many Americans, I am horrified that white supremacist and neo-Nazi adherents have recently found sanction to put hateful ideologies more overtly on display. … For doctors, public emergencies bring to mind ethical duties and dilemmas that never go away. Current events compel us to examine our core beliefs and do a gut-check of our own ethical standards and sense of professionalism. (John Henning Schumann, 8/16)

Morning Consult: Missouri, The ‘Show Me (The Money)’ State
Up until recently, Missouri was the only state without a Prescription Drug Monitoring Program for opioids. The good news is that’s changing — sort of. Last month, Gov. Eric Greitens issued an executive order creating one. The governor’s order directs the state Department of Health and Senior Services to build a database, which will be designed to help identify suspicious patterns of prescriptions of controlled substances — including opioids. Good news? Seems to be, until you look into the details — where the devil resides. (Peter Pitts, 8/17)

Bloomberg: Take The Addiction Out Of Smoking
Imagine a world in which teenagers who experiment with cigarettes never make a habit of smoking them. This is a future the Food and Drug Administration envisions with its bold new plan to rid cigarettes of most of their nicotine, the substance that makes them so highly addictive. It’s an intriguing idea, potentially one of the best to come along in the decades-old fight against smoking — which still kills almost half a million Americans a year. (8/16)

The New England Journal of Medicine: A Nicotine-Focused Framework For Public Health
With the tools provided to the Food and Drug Administration (FDA) under the Family Smoking Prevention and Tobacco Control Act of 2009, the agency has taken consequential steps to prevent sales of tobacco products to children, expand the science base for understanding traditional and newer tobacco products, and conduct public education campaigns. But the agency needs to do more to protect Americans; in particular, we must shape a regulatory framework that reduces their use of combustible cigarettes. (Scott Gottlieb and Mitchell Zeller, 8/16)

The New England Journal of Medicine: Saying Goodbye To Lectures In Medical School — Paradigm Shift Or Passing Fad?
“Become a doctor, no lectures required.” This headline about the University of Vermont’s proposed new approach to medical education generated considerable controversy. Although this proposed change is more drastic than the curriculum reform taking place at other medical schools, the movement away from traditional lecture-based courses has been under way in U.S. medical schools for more than three decades. … But are the newest proposed changes evidence-based, or are they merely the latest fad in medical education? (Richard M. Schwartzstein and David H. Roberts, 8/17)

The New England Journal of Medicine: Medical Education In The Era Of Alternative Facts
Students currently entering U.S. medical schools arrive in an era of increasing distrust of large institutions, expanded use of social media for information, a political lexicon in which uncomfortable facts are derided as “fake news” while fabrications masquerade as reality, and the erosion of truth that such trends entail. The challenges for medical education are imminent and formidable. How do we, as teachers, merit the trust of future physicians? How do we pass on to them science’s preeminent legacy of propelling advances in understanding, preventing, and curing illnesses? How do we instill in them a lifelong appreciation for the importance of hypothesis testing, peer review, and critical analysis of research? (Richard P. Wenzel, 8/17)

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

Kansas’ Osawatomie State Hospital Passes Inspection

The psychiatric hospital lost its certification in 2015, which resulted in a loss of about $1 million a month in federal funding for the state, but it now appears to be back on track. Meanwhile, in Oregon, the Willamette Valley Behavioral Health plans to sue the state over the rejection of its plan to build a 100-bed psychiatric hospital. In addition, the cause of the illness at New Hampshire’s Exeter Hospital is still unclear and two Florida cancer centers face fraud allegations.

Wichita Eagle: Osawatomie State Hospital Passes Inspection
A Kansas psychiatric hospital that lost its federal certification in 2015 — causing the state to lose $1 million a month in federal funding — passed an initial inspection this week, a first step toward getting recertified. Osawatomie State Hospital completed a successful inspection on Tuesday, said the Kansas Department for Aging and Disability Services. (Shorman, 8/16)

KCUR: Osawatomie State Hospital Back On Track For Recertification, Officials Say
Kansas officials have cleared an initial hurdle in their effort to regain federal certification for Osawatomie State Hospital. Problems that federal inspectors cited in May have been fixed, making the state’s largest mental health hospital eligible for a full recertification inspection, according to the Kansas Department for Aging and Disability Services. That inspection must take place within the next 120 days, according to KDADS Secretary Tim Keck. (McLean, 8/16)

The Oregonian: Hospital Chain To Sue State Over Rejection Of Wilsonville Plan
The beleaguered Oregon Health Authority, under fire since the release of internal records revealed its plan to smear a health care provider it regulates, got more bad news Wednesday. Willamette Valley Behavioral Health has notified the state it will be filing a lawsuit in connection with the agency’s rejection of a proposed 100-bed psychiatric hospital in Wilsonville. Jason Conger, a former state legislator now practicing law in Bend and representing Willamette, accused the agency of acting on behalf of competing mental health treatment providers. (Manning, 8/16)

New Hampshire Union Leader: Cause Of Exeter Hospital ‘Illness’ Still Unknown
Nearly a week after 19 workers at Exeter Hospital suddenly felt dizzy and nauseous inside the operating department, officials say the cause of the illness remains a mystery. The hospital said it’s conducting an internal investigation in hopes of finding the source, but so far no one has been able to pinpoint the culprit. (Schreiber, 8/16)

The News-Press: 2 Florida Cancer Centers Accused Of Medicare Fraud, Unsafe Practices
Two of the nation’s largest cancer-care providers are accused of engaging in an illegal “gentleman’s agreement” to divide up treatment services in Florida. The allegation against Florida Cancer Specialists & Research Institute and 21st Century Oncology lists multiple claims — gender discrimination, fraudulent Medicare billing and unsafe medical practices — against the companies in a 50-page federal whistleblower lawsuit filed last year that had, until recently, been under seal and out of the public eye. (Gluck, 8/16)

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Hacks Targeting Health Care Data Spike 162% Over Last Year

Security experts account for the jump by saying that hacking has gotten easier and more organizations are now reporting incidents. Meanwhile, Bayada Home Health Care and St. Luke’s Health System also make industry news.

Modern Healthcare: Healthcare Data Breaches Caused By Hacks Are On The Rise 
Data breaches caused by hacking, so-called IT incidents and unauthorized access are on the rise, with 162% more incidents at healthcare organizations so far in 2017 as there were in all of 2016, according to data from HHS’ Office for Civil Rights. Security experts said that’s because hacking has gotten easier and organizations are now reporting incidents they previously might have kept quiet about. (Arndt, 8/16)

The Philadelphia Inquirer/Philly.com: Bayada Home Health Transfer To Nonprofit Will Start Next Spring
Giving away a health-care business with operations in 22 states and five foreign countries is not easy. That’s what J. Mark Baiada has found since June 2016, when he announced his intention to turn Bayada Home Health Care into a nonprofit to protect it from a sale and ensure that its mission endures. The process will start in April and is expected to take 18 months to two years because it is a complicated process, Baiada said Wednesday. (Brubaker, 8/17)

Houston Chronicle: Deposed St. Luke’s CEO Staying On Longer 
In an unusual change of plans, deposed St. Luke’s Health System CEO Michael Covert is staying on until his replacement is selected and assumes office. Catholic Health Initiatives, St. Luke’s owner, in late June announced that Covert had submitted his resignation and said they expected to name interim leadership in the next two weeks. A statement at the time said the interim leader would work with the board of directors to launch a national search. (Ackerman, 8/16)

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UnitedHealth CEO Stephen Hemsley Steps Down

The insurer’s current president David Wichmann will take over the position while Hemsley, who has been with the health plan since 1997, will move into a newly created role as executive chairman of the board of directors.

The Wall Street Journal: UnitedHealth Names David Wichmann As New CEO
UnitedHealth Group Inc. said David S. Wichmann, its current president, will next month succeed Stephen J. Hemsley as chief executive, a widely expected transition at the top of the nation’s largest health insurer. Mr. Wichmann, 54 years old, will take over the CEO job on Sept. 1, and Mr. Hemsley, 65, who has held the title since 2006, will become executive chairman. UnitedHealth Group’s current board chairman, Richard Burke, will then take the title of lead independent director. (Wilde Mathews, 8/16)

The Associated Press: UnitedHealth CEO To Step Down After Run Of More Than Decade
UnitedHealth Group has picked company President David Wichmann to replace CEO Stephen Hemsley in a long-planned transition that Wall Street greeted with polite applause.The nation’s largest health insurer says Wichmann, 54, will take over Sept. 1, and Hemsley will become executive chairman of the company’s board. Current Chairman Richard Burke will shift to lead independent director. (Murphy, 8/17)

Modern Healthcare: UnitedHealth CEO Hemsley Stepping Down
UnitedHealth CEO Stephen Hemsley is stepping down from the helm of the nation’s largest health insurer. David Wichmann, the Minnetonka, Minn.-based insurer’s president, will take over as CEO and become a director of the company on Sept. 1. Hemsley, who has been with the health plan since 1997, will remain with the insurer in a newly created role as executive chairman of the board of directors. (Livingston, 8/16)

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

Viewpoints: Trump Driving Premium Increases; Opioid Treatment For Prisoners

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

The New York Times: How Donald Trump Is Driving Up Health Insurance Premiums
Health insurance premiums for 2018 are on the rise for many, and for that, most of the blame falls squarely on the shoulders of President Trump. In recent days, a bevy of insurers have announced significant increases for Americans who purchase their coverage on the exchanges …. Reinforcing these developments is an analysis by Charles Gaba of acasignups.net, who projected that at the moment, average premium increases next year are likely to total around 29 percent. Of that, just 8 percentage points will result from medical inflation, and 2 percentage points will stem from the reinstatement of an Obamacare health insurance tax; the balance will be related to the uncertainty that Mr. Trump has created around key pieces of Obamacare. (Steven Rattner, 8/15)

Health Affairs: The ‘Tanning Tax’ Is A Public Health Success Story
When the [tanning] tax was enacted in 2010, the non-partisan Congressional Joint Committee on Taxation estimated that it would bring in $2.7 billion in revenue over 10 years, and would offset some of the costs of the ACA overall. After four years, however, the tax had only brought in about $367 million, far less than the approximate $1 billion originally projected by that time. Some detractors then declared the tax a “failure” and blamed it for the loss of tens of thousands of jobs. Yet these arguments discount the notion that the revenue was perhaps a secondary goal of the tax, behind its ability to deter people from engaging in the dangerous pursuit of indoor tanning. (Elisabeth Ryan, 8/15)

The Wall Street Journal: Medicaid’s Opioid Fix
President Trump last week declared the opioid epidemic a national emergency, which given the human toll may be an understatement. As states beg Washington for more money to treat drug abuse, one question worth asking is whether the gusher of Medicaid dollars has contributed to the crisis. (8/15)

Bloomberg: Prisoners Need Opioid-Addiction Treatment
President Donald Trump’s initial bombastic comments about North Korea last week overshadowed the event he was holding to highlight his administration’s efforts to fight opioid addiction. Unfortunately, there wasn’t much to overshadow. Trump failed to mention, much less embrace, any of the recommendations contained in a new report from his Commission on Combating Drug Addiction and the Opioid Crisis. … One of the most effective steps the federal government could take went unmentioned: treating addicts who end up behind bars. Each year, about one-third of heroin users spend time locked up, yet federal prisons do not offer medication-assisted addiction treatment. (8/15)

Stat: The FDA Made A ‘Grand Bargain’ On Fast Drug Approvals, But Pharma Isn’t Holding Up Its End
The FDA, in an effort to bring promising new therapies to patients as quickly as possible, has introduced a spate of shortcuts to speed up the approval process. Those programs are working as intended, new research finds, but drug companies are often loath to fulfill their obligations. The big idea behind the FDA’s accelerated drug approval program is that regulators will OK a promising drug based on clues that it will improve patient lives, so long as pharma companies later carry out larger trials to confirm those hints of efficacy. But looking at four years of data, a team of researchers found that only 50 percent of those trials actually took place within three years of approval. (Damian Garde, 8/15)

Stat: I Went To Medical School In Charlottesville. I Know White Anger Well
After watching the violence unfold in Charlottesville, Va., over the weekend, after watching white supremacists descend on the city where I went to medical school, and onto the University of Virginia campus where I became a doctor, this is what I said to myself. I’ve seen this anger before. For four years, my task was to learn to treat people who were sick. Even the ones who wore their Confederate pride openly, even the ones who threatened to shoot me on home health visits. My task was to learn from experienced physicians how to help people get well. Even when they witnessed racist behavior directed toward me. Even when they glossed over that bigotry. (Jennifer Adaeze Okwerekwu, 8/14)

Los Angeles Times: Vaccination Rates Are Up In California, But Pockets Of Resistance Still Threaten Everyone
As the new school year begins, parents have reason to worry about what their kids may be exposed to in the classroom. Despite an overall increase in kindergarten vaccination rates to 95.6% since 2015, when the Legislature stopped allowing public school students to skip their shots simply because of their “personal beliefs,” a Los Angeles Times analysis found that at nearly 750 California schools, most of them charter or private schools, 90% or fewer of the kindergartners had their full course of vaccinations against diseases such as measles, polio, and whooping cough. The optimal rate for preventing a measles outbreak is 95%. (8/15)

The New York Times: 10 Things My Chronic Illness Taught My Children
My children have a mother with a chronic illness. They live with my rheumatoid arthritis just as much as I do. I was given my diagnosis when all three of them were young, and since then I’ve spent a lot of time worrying about what the daily uncertainty of my condition would mean to them, and whether it would affect their development. They are all teenagers now, one getting ready for college, and I can attest that my illness has indeed affected them. Here’s how. (Paula M. Fitzgibbons, 8/16)

Sacramento Bee: Democrats Must Stand Up For Abortion Rights
As Democratic leaders search for ways to win in 2018, some have recently suggested that women’s rights and reproductive health care are dispensable. …Such a strategy would not only betray what it means to be a Democrat, it would also be destined to fail. (Amy Everitt, 8/15)

Arizona Republic: Arizona’s Abortion Crusade Just Cost Us Another $600,000
Cathi Herrod’s crusade to make life as miserable as possible for women who seek abortions just cost us another $600,000. A U.S. District Court judge on Monday ordered the state to reimburse Planned Parenthood and other abortion providers for their costs in fighting yet another unconstitutional law passed by our leaders. (Laurie Roberts, 8/15)

Des Moines Register: How You Can Prevent Medication Errors
[T]he risk of preventable drug errors does not end when you leave the hospital. Consumers are accidentally harming themselves at home with their own medications. The rate of serious medication mix-ups has doubled since 2000, according to a new study. … Too many Americans take the wrong medication, take drugs in the wrong dose or inadvertently take them twice. … Among the simple suggestions from the Centers for Disease Control and Prevention: don’t share prescriptions or take anyone else’s, read the label and warnings, dispose of drugs you’re no longer supposed to take, turn on a light to check bottles if you take medication at night and keep prescriptions away from children. (8/15)

Atlanta Journal-Constitution: Glen Campbell’s Death ‘Brings Alzheimer’s Out Of The Shadows.’ Now What?
Campbell was diagnosed in 2011. He died a week ago at age 81, having helped bring “Alzheimer’s out of the shadows and into the spotlight.” He became a public face of the disease in 2014 when he allowed a film crew to shoot his final tour for the award-winning documentary “I’ll Be Me.” Alzheimer’s, a progressive disease of the brain, is best known for causing memory loss, but it also has other debilitating effects on the body, and can affect people’s ability to move and eat by themselves. There is no cure for the illness. If you’re fortunate enough to have to imagine what that’s like, count it a blessing and hope it never happens to you. Anyone left holding the memories will tell you there’s never been a more lonely or trying place. (Gracie Bonds Staples, 8/15)

JAMA: Consideration Of Dental, Vision, And Hearing Services To Be Covered Under Medicare
[T]here is public and legislative support for the recognition of dental, vision, and hearing services as an integral part of overall health and health services. The evidence points to consideration of ways to include such services in available coverage options under the Medicare program. Low-income older adults are at a greater risk of forgoing necessary services not covered by Medicare that have consequences for the rising costs of the covered services such as avoidable hospitalizations and emergency department visits. (Amber Willink, Cathy Schoen and Karen Davis, 8/15)

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Perspectives: Drug Companies Getting Stingy With Subsidies; Supreme Court Deals Blow To Consumers

Read recent commentaries about drug-cost issues.

Los Angeles Times: Drug Companies Are Growing Less Generous In Helping Patients Pay For Meds
Industry watchers say soaring drug prices have prompted many pharmaceutical companies to rethink long-standing programs to help subsidize purchases or even give meds away for free. “More and more people have become aware of these programs, and demand has gone up,” said David P. Wilson, president of PRAM Insurance Services, a Brea firm that helps employers with prescription-drug benefits. (David Lazarus, 8/15)

Stat: A Supreme Court Pharma Case Deals Consumers A Big Loss
The U.S. Supreme Court case of Bristol-Myers Squibb Co. vs. Superior Court of California, which was decided in favor of BMS in June, may seem like an arcane question of legal jurisdiction. It’s anything but.The case centered on a drug called Plavix that BMS developed. Plavix, also known by its generic name, clopidogrel, is an anti-platelet used to prevent blood from clotting inside blood vessels. Ever since the drug was approved by the FDA in 1997, thousands of people have claimed that it caused them gastrointestinal bleeding, severe bleeding from relatively minor cuts, and even brain damage. (Michael Burg, 8/14)

Stat: Eli Lilly’s Odyssey To Use A Fake Rule And Fake News To Protect Bad Patents
The story begins in 1991, when Eli Lilly applied for a Canadian patent for its antipsychotic drug, Zyprexa. Five years later, it applied for a Canadian patent for its attention deficit hyperactivity disorder drug, Strattera. In both cases, the company copied its U.S. patent applications without making changes to address the specificities of Canadian patent law, presumably as a cost-saving measure. (E. Richard Gold, 8/16)

JAMA: Value-Based Pricing And State Reform Of Prescription Drug Costs
Faced with increasing prescription drug costs and congressional gridlock, some states have enacted meaningful reforms. In April 2017, New York State became the first public payer in the United States to authorize limits on prescription drug costs based on their therapeutic benefits. Under its new budget legislation, the state can identify high-cost drugs, determine a value-based price, and use enhanced powers to negotiate supplemental rebates to achieve this target price for its Medicaid program. (Thomas J. Hwang, Aaron S. Kesselheim and Ameet Sarpatwari, 8/15)

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

Drugmakers ‘Game The System And Game The Rules,’ FDA Head Gottlieb Says

News outlets report on stories related to pharmaceutical pricing.

USA Today: FDA Chief Says Drug Makers Are Gaming The System To Slow Generic Competition; Vows Action
A day after President Trump lashed out at the black CEO of drug maker Merck on Twitter, his new Food and Drug Administration commissioner said brand name drug companies are “gaming the system” to block generic competition and vowed to do something about it. Physician and FDA chief Scott Gottlieb declined to comment on Trump’s tweet urging Merck’s Kenneth Frazier to lower drug prices after Trump’s response to the violent Charlottesville, Va., protests prompted Frazier to resign from the White House manufacturing council. However, in a meeting Tuesday with USA TODAY’s Editorial Board, Gottlieb didn’t mince words when it came to his plans to stop what he said are anti-competitive actions by brand-name pharmaceutical companies that keep prices high. (O’Donnell, 8/15)

Politico: Trump Tweets Up A Storm On Drug Prices But Delivers Little Change
Back in January, Trump had signaled his intention to go after powerful drugmakers at his very first news conference, accusing the industry of “getting away with murder.” The issue is top of mind for voters — a bigger health priority than repealing Obamacare. But the White House has invested little political capital in the issue, appointing industry insiders to key posts while abandoning key campaign pledges to allow Medicare to negotiate drug prices and import cheaper medicines from overseas. (Karlin-Smith, 8/15)

Stat: Who Gets All That Biopharma Lobbying Money?
As the winds shift in Washington, here’s something to depend on: Big pharma and health products companies will be the top spenders on lobbying, and the competition isn’t close. Since 1998, they have doled out $3.7 billion to convince, cajole, entice, or strong-arm Congress and federal agencies — more than $1 billion more than any other industry. That doesn’t count campaign contributions, donations to independent pressure groups, and outlays for politicking at the state level. Since January 2016, the industry has spent about $144 million on federal lobbying, according to data compiled by the Center for Responsive Politics. It can claim a big victory from last year’s passage of the 21st Century Cures Act, which is expected to speed up Food and Drug Administration drug approvals. (Piller, 8/16)

ProPublica and The New York Times: Generic Drug Prices Are Declining, But Many Consumers Aren’t Benefiting
Not all drug prices are going up. Amid the public fury over the escalating costs of brand-name medications, the prices of generic drugs have been falling, raising fears about the profitability of major generic manufacturers. Last week, Teva Pharmaceuticals reported that it had missed analysts’ earnings estimates in the second quarter and planned to lay off 7,000 workers. Its share price plummeted 24 percent in one day as investors worried there was no end in sight. (Ornstein and Thomas, 8/8)

Bloomberg: What’s Harder Than Making Copycat Biotech Drugs? Selling Them 
Big-name drugmakers want to profit from selling lower-priced copies of rivals’ expensive biotechnology drugs. Patients and doctors want to pay less for medicine. Getting those two sides together is harder than it looks. Part of the problem: a web of relationships between drug companies and insurers that shields incumbent drugs and often sidelines upstarts until the market becomes crowded. (Hopkins, 8/15)

Stat: High Drug Prices Loom Large At Gathering Of State Legislators
A representative of the Trump administration on Tuesday made a familiar promise to a crowd of state legislators here: We know high drug prices are a problem. And we’re working to solve it. Lowering drug costs is a “priority,” and the Department of Health and Human Services is “committed to doing all we can to increase affordability and accessibility,” said Jane Norton, HHS’s point person in dealing with state governments. (Robbins, 8/8)

Kaiser Health News: Climbing Cost Of Decades-Old Drugs Threatens To Break Medicaid Bank
Skyrocketing price tags for new drugs to treat rare diseases have stoked outrage nationwide. But hundreds of old, commonly used drugs cost the Medicaid program billions of extra dollars in 2016 vs. 2015, a Kaiser Health News data analysis shows. … Rising costs for 313 brand-name drugs lifted Medicaid’s spending by as much as $3.2 billion in 2016, the analysis shows. Nine of these brand-name drugs have been on the market since before 1970. In addition, the data reveal that Medicaid outlays for 67 generics and other non-branded drugs cost taxpayers an extra $258 million last year. (Lupkin, 8/14)

Stat: The FDA Made A ‘Grand Bargain’ On Fast Drug Approvals, But Pharma Isn’t Holding Up Its End
The FDA, in an effort to bring promising new therapies to patients as quickly as possible, has introduced a spate of shortcuts to speed up the approval process. Those programs are working as intended, new research finds, but drug companies are often loath to fulfill their obligations. The big idea behind the FDA’s accelerated drug approval program is that regulators will OK a promising drug based on clues that it will improve patient lives, so long as pharma companies later carry out larger trials to confirm those hints of efficacy. But looking at four years of data, a team of researchers found that only 50 percent of those trials actually took place within three years of approval. (Damian Garde, 8/15)

Cleveland Plain Dealer: Poll: Most Ohioans Unclear About Prescription Drug Issue 2
The forces for and against Issue 2 are spending so much money that they could set new records in Ohio in election spending. But six out of 10 registered Ohio voters told Survey USA they don’t know much, if anything about Issue 2, according to WOIO Cleveland 19 News, which commissioned the poll with WXIX 19 Cincinnati and WTOL 11 Toledo. (Hancock, 8/8)

The Wall Street Journal: England’s NHS Turns To Clinical Trial To Make Cheaper HIV Drug Available
A branded HIV drug that has been shown to reduce the risk of infection with the virus by 86% is proving too expensive for some at-risk European patients. England’s National Health Service thinks it has a solution. The high price of Gilead Sciences Inc .’s HIV drug Truvada has deterred many countries from providing the pill as a preventive treatment for people at high risk of contracting the AIDS-causing virus, doctors, activists and patients say. (Mancini, 8/11)

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State Highlights: Ohio Co-Op Accused Of Fraud; California Heads Toward Serious Doctor Shortage

Media outlets report on news from Ohio, California, Maryland, Missouri, Pennsylvania, New Hampshire, Texas, Arizona and Colorado.

Columbus Dispatch: Did Healthcare Co-Op Rip Off Small Ohio Communities?
A 4-year-old group of governments created to lower health-care costs for thousands of public employees has been ravaged by accusations of mismanagement and millions of dollars in deficits. The Ohio auditor’s office and some county prosecutors are investigating the Ohio Public Entity Consortium Healthcare Cooperative, a self-insurance program with headquarters near Plain City. (Narciso, 8/15)

San Jose Mercury News: UCSF Study: State Faces Shortage Of Primary Care Clinicians
California is heading for a serious shortfall of primary care doctors, physicians’ assistants and nurse practitioners over the next few decades — a crisis that could force patients to seek medical help for routine illnesses at hospital emergency rooms instead, a new study released Tuesday warns. That alternative is among the most troubling scenarios if a predicted shortage of 4,700 primary care clinicians occurs in California by 2025, according to authors of the UC San Francisco Healthforce Center report. (Seipel, 8/15)

Sacramento Bee: Diabetes Monitor Bill Will Save Lives
Assembly Bill 447, which is making its way through the Legislature, would require Medi-Cal to cover continuous glucose monitors. AB 447 would not only help improve the lives of Medi-Cal patients, but also would help lower health care spending and save taxpayer money. (Berit Bagley, 8/15)

The Baltimore Sun: As Judge Considers Holding State In Contempt, Md. Health Secretary Defends Psychiatric Care
Maryland’s top health official spent more than 90 minutes in court Tuesday morning defending the pace at which the state is moving mentally ill criminal defendants out of jail and into treatment. A Baltimore judge is weighing whether to hold the state in contempt for failing to follow court orders to immediately move those individuals into treatment. At times, they have languished in jail for months waiting for space to open in one of the state-run psychiatric hospitals. (Wood, 8/15)

The Philadelphia Inquirer/Philly.com: Public Health Management Unit Wants To Reclaim Its Independence
The National Nurse-Led Care Consortium, which has been part of Public Health Management Corp. since 2001, wants to leave the Philadelphia organization, alleging that PHMC’s escalating management fee and other problems have jeopardized the consortium’s ability to fulfill its mission of supporting community care led by nurses. The management fee PHMC charges the National Nurse-Led Care Consortium (NNCC) has soared to $403,800 for the year ended June 30 from $196,800 four years earlier, while the consortium’s overall revenue climbed just 27 percent, according to a lawsuit filed Monday in Philadelphia Common Pleas Court seeking to break that deal. (Brubaker, 8/15)

New Hampshire Union Leader: Board Of Medicine Allows Conditional Return Of Doctor Suspended Over Drug Use 
The state Board of Medicine has agreed to allow an anesthesiologist accused of diverting a powerful painkiller for his own use to resume practicing medicine on a limited basis. The board approved a conditional return for Dr. Christopher Manfred, who agreed Jan. 30 to voluntarily stop practicing medicine after the state issued an order temporarily suspending his license over allegations involving the painkiller hydromorphone, an opioid that goes by the brand name Dilaudid. (8/15)

Sacramento Bee: Sacramento Country Ordered To Close Illegal Shelter For Foster Children
More than a year after telling Sacramento County Child Protective Services to stop using a clerical office as a makeshift youth shelter, state officials have ordered the agency to end the illegal practice by a September deadline. The California Department of Social Services wrote in a July letter to Sacramento County Child Protective Services that it must stop letting kids sleep at the county office on Auburn Boulevard near Watt Avenue. (Garrison and Chabria, 8/15)

Houston Chronicle: Houston-Area Organizations Meeting Needs Of Hearing Impaired 
A big misconception among adults with a hearing impairment is that they don’t think anything can be done to improve their hearing and are unaware of new hearing technology that can improve hearing in daily activities. Some adults delay getting help because they think they can’t afford to purchase hearing aids. Local organizations such as Hear-Say Partners in Hearing – a nonprofit organization for adults with hearing loss that offers hearing loss counseling, recycled hearing aids and affordable new hearing aids, as well as university speech and hearing clinics – can offer hearing testing and speech therapy services that can assist adults who need low-cost services. (Benton, 8/15)

The Washington Post: There’s Plague In Arizona. Authorities Warn Of Fleas That Can Infect People And Pets.
Public health officials in two Arizona counties are warning residents about the discovery of plague bacteria, an endemic concern among those who live in the American Southwest but unsettling, nonetheless, given the disease’s devastating impact on human history. Navajo and Coconino counties are adjacent to one another, and in each community the findings are identical: Fleas carrying Yersinia pestis, the bacterium that causes plague, were discovered this month and pose a potentially grave threat to people and their pets, especially cats. (deGrandpre, 8/15)

Denver Post: Lawsuit: Botched Liposuction Highlights Need For Colorado Oversight Of Drugs, Procedures At Plastic Surgery Centers
Allegations that a botched liposuction sent a patient into heart failure has raised questions about why Colorado allows plastic-surgery centers to operate without state oversight, and whether health officials are putting patients in peril by failing to root out sloppy handling of powerful painkillers and anesthetics. The lawsuit names as a defendant Elizabeth Lammot Campbell, who provided anesthetic services for several area plastic surgeons. (Osher, 8/15)

The Associated Press: Prison Doctor Sues State Alleging LGBTQ Discrimination
A psychologist at a California prison facility has alleged she was twice locked in a room with a dangerous inmate in retaliation for reporting mistreatment of LGBTQ inmates. Lori Jespersen sued the California Department of Corrections and Rehabilitation on Monday for violations of civil rights and whistleblower protection laws, as well as the Prison Rape Elimination Act and the Health Insurance Portability and Accountability Act, known as HIPAA. (Ronayne, 8/16)

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Hospital Roundup: Highest-Paid Nonprofit Hospital Exec In Mass. Made $4.3M; Rural Colo. Health Centers Get Grant

Hospitals in Massachusetts, Colorado, Missouri, Pennsylvania and Illinois make news today.

Boston Globe: Partners CEO Tops Hospital Pay List
Partners HealthCare’s chief executive, Dr. David Torchiana, topped the list of executives at the state’s largest nonprofit hospitals who received sizable pay raises in 2015, according to their most recent public filings. Torchiana, who oversees the state’s largest health system and largest private employer, earned nearly $4.3 million in total compensation. (Dayal McCluskey, 8/15)

Denver Post: Colorado Health Centers Receive Nearly $2 Million In Federal Grant Money
Colorado health centers in rural or impoverished areas will receive nearly $2 million in federal grant money this year to help better serve their patients. Twenty centers are in line to receive the grants, ranging from the Metro Community Provider Network, which has been awarded about $280,000 in total grant funds, to the Colorado Coalition for the Homeless, which will receive just over $13,000. Centers in southern Colorado, on the Eastern Plains and on the Western Slope were also awarded grants. (Ingold, 8/15)

St. Louis Public Radio: MU Study Finds Successful Ways To Reduce Hospital Admissions Of St. Louis Nursing Home Residents
In 2011, one in four nursing home residents on Medicare was hospitalized. It’s an issue that impacts many facets of health care, from quality of life for nursing home residents to spending of taxpayer dollars, and on Tuesday’s St. Louis on the Air, host Don Marsh spoke with a University of Missouri Nursing School professor about ways to reduce avoidable hospital admissions. (Moffitt, 8/15)

The Philadelphia Inquirer/Philly.com: Bankruptcy Judge Tentatively Approves Girard Medical Center Sale
Pending final review, U.S. Bankruptcy Judge Magdeline D. Coleman on Tuesday said she would approve the sales of North Philadelphia Health System’s properties at Eighth Street and Girard Avenue for a combined $10.25 million. The bulk of the property, including Girard Medical Center and the associated Goldman Clinic, a methadone clinic, will go to Ironstone Real Estate Partners for $8.5 million. Ironstone intends to maintain the property as a behavioral-health and drug-treatment center as long as it has an agreement with a care provider to operate the facilities. (Brubaker, 8/15)

Chicago Tribune: Edward-Elmhurst Hospital System Plans $50 Million In Cuts, Including Layoffs
West suburban hospital system Edward-Elmhurst Health plans to slash $50 million in costs, including through layoffs, in response to many of the same financial pressures afflicting hospitals across Illinois and the country. Edward-Elmhurst CEO Mary Lou Mastro said during a call with reporters Tuesday that the system has not yet determined how many layoffs will be necessary or which positions might be affected. She said the system has already started holding vacant positions open and now has 300 positions that aren’t being filled. (Schencker, 8/15)

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Physicians Increasingly Support Single-Payer Health Care, Survey Finds

Fifty-six percent of doctors either expressed strong support or were somewhat supportive of a single-payer system, according to a survey by the physician recruitment firm Merritt Hawkins.

Kaiser Health News: Doctors Warm To Single-Payer Health Care
Single-payer health care is still a controversial idea in the U.S., but a majority of physicians are moving to support it, a new survey finds. Fifty-six percent of doctors registered either strong support or were somewhat supportive of a single-payer health system, according to the survey by Merritt Hawkins, a physician recruitment firm. In its 2008 survey, opinions ran the opposite way — 58 percent opposed single-payer. What’s changed? (Bluth, 8/16)

Houston Chronicle: Doctors Have A Change Of Heart On Single Payer
A majority of doctors questioned nationwide now support a single-payer health care system – an almost exact reversal of their stance nine years ago. Fifty-six percent of the 1,033 physicians who responded to the Aug. 3 Merritt Hawkins survey said they either strongly supported or somewhat supported a single-payer system. (Deam, 8/14)

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First Edition: August 16, 2017

Aug 16 2017

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

Kaiser Health News: CBO: Killing Cost-Sharing Subsidies Would Hike Silver Plan Premiums And Deficit
KHN reporter Phil Galewitz writes: “If President Donald Trump were to follow through on his threats to cut federal cost-sharing subsidies, health insurance premiums for silver plans would soar by an average of 20 percent next year and the federal deficit would rise by $194 billion over the next decade, the nonpartisan Congressional Budget Office said Tuesday. The change would not be expected to have much long-term effect on the number of uninsured people, according to the analysis. But it could cause a shift in which plans are popular with marketplace customers as insurers realign some of their prices to defray the loss of the federal payments, the CBO said. Surprisingly, some customers might find better deals by looking at higher-end products.” (8/15)

Kaiser Health News: Doctors Warm To Single-Payer Health Care | Kaiser Health News
KHN reporter Rachel Bluth writes: “Single-payer health care is still a controversial idea in the U.S., but a majority of physicians are moving to support it, a new survey finds. Fifty-six percent of doctors registered either strong support or were somewhat supportive of a single-payer health system, according to the survey by Merritt Hawkins, a physician recruitment firm. In its 2008 survey, opinions ran the opposite way — 58 percent opposed single-payer. What’s changed?” (8/16)

The Associated Press: Report: Higher Premiums If Trump Halts ‘Obamacare’ Subsidies
Premiums for a popular type of individual health care plan would rise sharply, and more people would be left with no insurance options if President Donald Trump makes good on his threat to stop “Obamacare” payments to insurers, the Congressional Budget Office says. The nonpartisan number crunchers also estimated that cutting off payments that now reduce copays and deductibles for people of modest incomes would add $194 billion to federal deficits over a decade. That head-scratching outcome is because a different Affordable Care Act subsidy would automatically increase as premiums jump, more than wiping out any savings. (Alonso-Zaldivar, 8/15)

NPR: CBO Analysis Finds That Ending Reimbursements To Insurers Will Raise The Deficit
If President Trump decides to cut off payments to insurance companies called for under the Affordable Care Act, it’s going to cost him. Or, more accurately, it’s going to cost taxpayers — about $194 billion over 10 years. The cost is “eye-poppingly large,” says Nicholas Bagley, a professor of health law at the University of Michigan. “This single policy could effectively end up costing 20 percent of the entire bill of the ACA.” (Kodjak, 8/15)

The New York Times: Trump Threat To Obamacare Would Send Premiums And Deficits Higher
Even before efforts to repeal the Affordable Care Act collapsed in the Senate last month, Mr. Trump began threatening to stop paying the subsidies, known as cost-sharing reductions. He said the health care law would “implode” and Democrats would have no choice but to negotiate a replacement plan. Mr. Trump described his strategy as, “Let Obamacare implode, then deal.” Those threats continue, though the Trump administration has paid the subsidies each month. (Pear and Kaplan, 8/15)

The Wall Street Journal: What Are Insurance Subsidies And What Would Happen If They Were Cut?
As health insurers weigh their commitments to the Affordable Care Act’s exchanges for 2018, they point to a key issue that will affect the rates they would charge and indeed whether they will participate: Federal subsidies known as cost-sharing reductions. Those payments are likely to be a major story going forward, and on Tuesday, the Congressional Budget Office estimated that if President Donald Trump carried out his threat to halt the subsidies, it would boost premiums for middle-priced plans by 20% next year. (Wilde Mathews, 8/15)

The Wall Street Journal: Trump Targets McCain Over Health Vote
President Donald Trump continued his attacks against individual Senate Republicans, criticizing Sen. John McCain (R., Ariz.) and his pivotal health-care vote at a news conference Tuesday at Trump Tower in New York City. A week after Mr. Trump knocked Senate Majority Leader Mitch McConnell (R., Ky.) over the Senate’s failure to pass any legislation dismantling and replacing the Affordable Care Act, the president took aim at Mr. McCain, now in his sixth Senate term. (Peterson, 8/15)

The Hill: GOP Senator Meeting With White House On New ObamaCare Plan 
Sen. Bill Cassidy (R-La.) said he’s meeting with the White House and the Trump administration “two or three times per week” on a plan to repeal and replace ObamaCare. Cassidy has teamed up with Sens. Lindsey Graham (R-S.C.) and Dean Heller (R-Nev.) on a new proposal that would essentially block-grant ObamaCare funding to the states while repealing the law’s individual and employer mandates. (Hellmann, 8/15)

The Hill: White House To Pressure McConnell On ObamaCare
White House officials are exploring ways to pressure Senate Majority Leader Mitch McConnell (R-Ky.) to return to the controversial issue of ObamaCare repeal when the Senate returns to work in September. President Trump, who has repeatedly criticized McConnell in public, wants to hold the leader’s feet to the fire on the issue, say White House sources. (Bolton, 8/16)

The Wall Street Journal: Nevada And Centene Reach Agreement On Insurance Markets
Roughly 8,000 consumers in Nevada were at risk of losing access to health plans on the exchange after Anthem Inc. and Prominence Health Plan said in June they would exit markets in 14 counties. Insurers can hold off on final decisions to participate in exchanges until late September, but many have exited markets, citing volatility and prolonged uncertainty about the White House’s support for the markets. (Evans, 8/15)

The New York Times: Obamacare’s Bare County Problem Looks Mostly Solved, For Now
A few months ago, it looked as if large swaths of the country might end up without any insurers willing to sell Obamacare insurance in 2018. But in the last few weeks the “bare county” problem, which President Trump had cited as a sign the markets were failing, has nearly solved itself. On Tuesday, Gov. Brian Sandoval of Nevada announced that Centene would offer insurance in 14 rural counties of Nevada that had been bare. That leaves only two counties in the country without insurers saying they will sell coverage; fewer than 400 Obamacare customers live in those counties. (Sanger-Katz, 8/15)

Stat: CMS Moves To Cancel Medicare Programs Overhauling Some Hospital Payments
The Centers for Medicare and Medicaid Services moved to cancel pilot programs that would have paid certain hospitals a lump sum for all of the care associated with heart attacks, bypass surgeries, and some hip and femur fractures, including the initial visit, the surgery, and follow-up care. It’s canceling a similar program that targeted cardiac rehabilitation, and the agency is also proposing to drastically reduce the number of hospitals that have to participate in a separate program already underway that offers similar lump payments for hip and knee replacements. (Mershon, 8/15)

USA Today: FDA Chief Says Drug Makers Are Gaming The System To Slow Generic Competition; Vows Action
A day after President Trump lashed out at the black CEO of drug maker Merck on Twitter, his new Food and Drug Administration commissioner said brand name drug companies are “gaming the system” to block generic competition and vowed to do something about it. Physician and FDA chief Scott Gottlieb declined to comment on Trump’s tweet urging Merck’s Kenneth Frazier to lower drug prices after Trump’s response to the violent Charlottesville, Va., protests prompted Frazier to resign from the White House manufacturing council. However, in a meeting Tuesday with USA TODAY’s Editorial Board, Gottlieb didn’t mince words when it came to his plans to stop what he said are anti-competitive actions by brand-name pharmaceutical companies that keep prices high. (O’Donnell, 8/15)

Politico: Trump Tweets Up A Storm On Drug Prices But Delivers Little Change
Back in January, Trump had signaled his intention to go after powerful drugmakers at his very first news conference, accusing the industry of “getting away with murder.” The issue is top of mind for voters — a bigger health priority than repealing Obamacare. But the White House has invested little political capital in the issue, appointing industry insiders to key posts while abandoning key campaign pledges to allow Medicare to negotiate drug prices and import cheaper medicines from overseas. (Karlin-Smith, 8/15)

Stat: Congressional Democrats May Form Expert Panel On Trump’s Mental Health
Three congressional Democrats have asked a psychiatrist at Yale School of Medicine to consult with them about forming an expert panel to offer the legislators advice on assessing President Trump’s mental health. Yale’s Dr. Bandy Lee told STAT that over the last few weeks members of Congress or their staff have asked her to discuss how members might convene psychiatrists, psychologists, and other mental health professionals “to review the president’s mental health, and review it on a periodic basis.” The closed meeting is expected to take place in September, she said. (Begley, 8/16)

Houston Chronicle: Doctors Have A Change Of Heart On Single Payer
A majority of doctors questioned nationwide now support a single-payer health care system – an almost exact reversal of their stance nine years ago. Fifty-six percent of the 1,033 physicians who responded to the Aug. 3 Merritt Hawkins survey said they either strongly supported or somewhat supported a single-payer system. (Deam, 8/14)

Politico: Colorado’s Gardner Faces Blowback At Home Over Obamacare Repeal
Sen. Cory Gardner was hammered for supporting Obamacare repeal during a series of raucous town halls on Tuesday, where constituents repeatedly criticized his role in a closed-door partisan process to draft the failed GOP health bill. Gardner, who’s responsible for protecting the GOP majority in the Senate in 2018, faced heated criticism over the repeal effort that collapsed just a few weeks ago, even as congressional leaders try to pivot to tax reform when they return from the lengthy recess next month. (Pradhan, 8/15)

NPR and ProPublica: They Got Hurt At Work — Then They Got Deported
To assess the impact of Florida’s law on undocumented workers, ProPublica and NPR analyzed 14 years of state insurance fraud data and thousands of pages of court records. We found nearly 800 cases statewide in which employees were arrested under the law, including at least 130 injured workers. An additional 125 workers were arrested after a workplace injury prompted the state to check the personnel records of other employees. Insurers have used the law to deny workers benefits after a litany of serious workplace injuries, from falls off roofs to severe electric shocks. A house painter was rejected after she was impaled on a wooden stake. (Grabell and Berkes, 8/16)

The New York Times: A Start-Up Suggests A Fix To The Health Care Morass
If you watched the drama in Washington last month, you may have come away with the impression that the American health care system is a hopeless mess. … So it is surprising that across the continent from Washington, investors and technology entrepreneurs in Silicon Valley see the American health care system as the next great market for reform. (Manjoo, 8/16)

The Washington Post: Oregon Approves Sweeping Bill Expanding Abortion Access
Called the Reproductive Health Equity Act, the measure requires health insurers to provide birth control and abortion without charging a co-pay. It also dedicates state funds to provide reproductive health care to noncitizens excluded from Medicaid. Antiabortion groups swiftly condemned the new law, saying it will force taxpayers to foot the bill for a procedure many consider to be a form of murder, and that it cements Oregon’s status as the most liberal state when it comes to abortion. (Somashekhar, 8/15)

Reuters: Texas Governor Signs Bill To Limit Insurance Coverage For Abortions
The Republican governor of Texas signed into law on Tuesday a measure that will restrict insurance coverage for abortions, compelling women to buy a supplemental plan if they want coverage for the procedure. Governor Greg Abbott said the measure known as House Bill 214 would protect abortion opponents from subsidizing the procedure. Democratic critics decried it as forcing people to buy “rape insurance.” (Herskovitz, 8/15)

The New York Times: A Changed Landscape For Abortion Rights In Texas
The drive between Del Rio and San Antonio consists of vast expanses of Texas farmland dotted with tiny towns. Along the route, a huge wooden sign in Hondo greets passers-by: “Welcome: This is God’s Country. Please don’t drive through it like hell.” By the time Kristen passed the sign on her way to get an abortion, she had been riding a Greyhound bus for four hours. The 150-mile trip was the shortest distance she could travel to visit an open clinic — Whole Woman’s Health in San Antonio. Her journey is not unique in Texas. (Van Houten, 8/16)

The Associated Press: Lawsuit Accuses Drug Manufacturer Of Worsening Opioid Crisis
South Carolina on Monday became the latest state to accuse a drug manufacturer of exacerbating its opioid drug crisis by using deceptive marketing. Attorney General Alan Wilson sued Purdue Pharma on Monday, accusing the maker of OxyContin and other opioid drugs of violating South Carolina’s Unfair Trade Practices Act. (Kinnard, 8/15)

The Wall Street Journal: South Carolina Sues Purdue Pharma, Alleging Deceptive Opioid Marketing
South Carolina’s suit follows efforts by several other jurisdictions to hold pharmaceutical companies accountable for what they call deceptive marketing of opioid painkillers. The states and others say that such marketing has led to an epidemic among residents, leading to addiction, overdose and deaths. The lawsuit, filed in South Carolina state court, focuses solely on Purdue Pharma, which manufactures OxyContin and other opioid drugs. New Hampshire last week filed a similar suit against Purdue. (Randazzo, 8/15)

The Associated Press: US Teen Drug Overdose Deaths Inch Up After Years Of Decline
After years of decline, teen deaths from drug overdoses have inched up, a new U.S. government report shows. The drop in teen deaths had been a rare bright spot in the opioid epidemic that has seen adult overdose deaths surge year after year — fueled by abuse of prescription painkillers, heroin and newer drugs like fentanyl. (Stobbe, 8/15)

NPR: People With Addictions Lured To Bogus Rehab Treatment Via ‘Body Brokers’
Some sober homes are good places. But others see a person who has an addiction as a payday. Amid the nation’s growing opioid crisis, South Florida has become a mecca for drug treatment. And as more people arrive looking for help, there’s more opportunity for corruption and insurance fraud. There are millions to be made in billing patients for unnecessary treatment and tests, according to officials investigating the problem. (Haden, 8/15)

The Associated Press: Colorful Portraits Show Faces Of New Hampshire Drug Crisis
At the New Hampshire State Library’s latest art exhibit, the bright smiles and bold colors of the canvases belied the broken hearts of those who attended its opening reception. More than 80 paintings are on display this month featuring the faces of the state’s opioid epidemic. What started as one mother’s private outlet for grief has grown into a larger effort to comfort others and reduce the stigma of addiction. (Ramer, 8/16)

The Wall Street Journal: How To Handle A Large, Unexpected Medical Bill
These days, not only are health-care costs climbing but individuals also often are bearing a greater portion of their medical bills than before, as many insurers cut back on payments and more companies expect employees to pay higher deductibles and copays.Meanwhile, many people don’t have sufficient emergency funds to pay for an unanticipated medical expense. … Against this backdrop, advisers such as Mr. Van Zutphen (who successfully negotiated a 25% reduction on his long-ago bill) are encouraging clients to negotiate medical costs, question charges and move quickly to resolve disputes or arrange payment plans. (Dagher, 8/15)

The Associated Press: Government Joins Food Fight Over Menu Labeling Requirements
The U.S. government has joined a food fight between New York City and a national group opposing new food labeling regulations for chain grocery and convenience stores. The Department of Justice filed legal papers this week on behalf of the Food and Drug Administration, asking a judge to block the city from enforcing a law requiring some stores serving prepared foods to post calorie information where the foods are sold. (Eltman, 8/16)

The Washington Post: There’s Plague In Arizona. Authorities Warn Of Fleas That Can Infect People And Pets.
Public health officials in two Arizona counties are warning residents about the discovery of plague bacteria, an endemic concern among those who live in the American Southwest but unsettling, nonetheless, given the disease’s devastating impact on human history. Navajo and Coconino counties are adjacent to one another, and in each community the findings are identical: Fleas carrying Yersinia pestis, the bacterium that causes plague, were discovered this month and pose a potentially grave threat to people and their pets, especially cats. (deGrandpre, 8/15)

The Washington Post: This Morbid Microbe’s Infection Strategy Is Gross But Genius
Pathogens are real jerks. As if infecting and killing plants and animals isn’t bad enough, they can also turn their hosts into zombies that spread the pathogens to their next victim. Now scientists report that bacteria make some victims summon other victims as their dying act. The bacteria hijack the chemical signaling pathway of insects, making them release a burst of hormones that serve as a beacon to attract friends and potential mates right before the bacteria kill off the host. Like malware marauding as an enticing link, the bacteria attract and then infect. (Gallegos, 8/16)

NPR: Homeland Security’s Nuclear Fallout Guidelines Include Warning About Conditioner
If, for some reason, you find yourself in a situation where you need to wash radioactive material from your body, don’t reach for the bottle of hair conditioner. Conditioner can bind radioactive particles to your hair. That warning was part of guidelines issued last Friday by Guam’s Office of Civil Defense, following threats from North Korea that it was preparing to test a missile that would create an “enveloping fire” around the U.S. territory. On Tuesday, North Korean state media reported it would not carry out the test after all. (Chen, 8/15)

News21: 63 Million Americans Exposed To Unsafe Drinking Water
As many as 63 million people — nearly a fifth of the United States — from rural central California to the boroughs of New York City, were exposed to potentially unsafe water more than once during the past decade, according to a News21 investigation of 680,000 water quality and monitoring violations from the Environmental Protection Agency. The findings highlight how six decades of industrial dumping, farming pollution, and water plant and distribution pipe deterioration have taken a toll on local water systems. (Philip, Sims, Houston and Konieczny, 8/15)

The Associated Press: Researchers To Study Chemical Contamination Of US Waters
University of Rhode Island and Harvard University professors are collaborating through a new research center to study chemicals that have contaminated water at sites nationwide. The chemicals, called perfluorinated chemicals, have been linked to cancer and other illnesses but aren’t federally regulated in drinking water. Water has been contaminated near sites of industrial facilities and U.S. military bases. (McDermott, 8/15)

The Wall Street Journal: Some Companies Want You To Take A Mental-Health Day
Bosses want their workers to start taking mental-health days for the right reasons. Workers often say they are taking a mental-health day with a wink and a nudge, as it is commonly understood that they will be catching up on housework or going to the beach. Meanwhile, many people who genuinely need time off to see a therapist or recover from an anxiety attack say they are less than forthcoming with their managers about why they need a break. (Fontana, 8/15)

NPR: Osteoarthritis Is Much More Common Now Than In Ancient Knees, Study Suggests
American doctors have been noticing an increase in osteoarthritis of the knee. They have suspected two driving forces: more old people and more people who are overweight. A study published in this week’s Proceedings of the National Academy of Sciences argues that’s far from the whole story. Even correcting for body mass index and age, osteoarthritis of the knee is twice as common now as it was before the 1950s. (Harris, 8/15)

USA Today: Vitamin B3 May Play An Important Role In Preventing Miscarriages And Birth Defects
For some moms, taking vitamin B3 may help prevent miscarriages and certain birth defects, according to a study published last week in the New England Journal of Medicine. Researchers in Sydney, Australia, analyzed the DNA of four families where mothers had experienced multiple miscarriages or had babies with serious birth defects, usually involving the heart, kidney and spine. (Toy, 8/15)

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Doctors Warm To Single-Payer Health Care

Single-payer health care is still a controversial idea in the U.S., but a majority of physicians are moving to support it, a new survey finds.

Fifty-six percent of doctors registered either strong support or were somewhat supportive of a single-payer health system, according to the survey by Merritt Hawkins, a physician recruitment firm. In its 2008 survey, opinions ran the opposite way — 58 percent opposed single-payer. What’s changed?

Red tape, doctors tell Merritt Hawkins. Phillip Miller, the firm’s vice president of communications, said that in the thousands of conversations its employees have with doctors each year, physicians often say they are tired of dealing with billing and paperwork, which takes time away from patients.

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“Physicians long for the relative clarity and simplicity of single-payer. In their minds, it would create less distractions, taking care of patients — not reimbursement,” Miller said.

In a single-payer system, a public entity, such as the government, would pay all the medical bills for a certain population, rather than insurance companies doing that work.

A long-term trend away from physicians owning their practices may be another reason that single-payer is winning some over. Last year was the first in which fewer than half of practicing physicians owned their practice — 47.1 percent — according to the American Medical Association’s surveys in 2012, 2014 and 2016. Many doctors are today employed by hospitals or health care institutions, rather than working for themselves in traditional solo or small-group private practices. Those doctors might be less invested in who pays the invoices, Miller said.

There’s also a growing sense of inevitability, Miller said, as more doctors assume single-payer is on the horizon.

“I would say there is a sense of frustration, a sense of maybe resignation that we’re moving in that direction, let’s go there and get it over with,” he said.

Merritt Hawkins emailed its survey Aug. 3 and received responses from 1,003 doctors. The margin of sampling error is plus or minus 3.1 percentage points.

The Affordable Care Act established the principle that everyone deserves health coverage, said Shawn Martin, senior vice president for advocacy at the American Academy of Family Physicians. Inside the medical profession, the conversation has changed to how best to provide universal coverage, he said.

“That’s the debate we’re moving into, that’s why you’re seeing a renewed interest in single-payer,” Martin said.

Dr. Steven Schroeder, who chaired a national commission in 2013 that studied how physicians are paid, said the attitude of medical students is also shifting.

Schroeder has taught medicine at the University of California-San Francisco Medical Center since 1971 and has noticed students’ increasing support for a single-payer system, an attitude they likely carry into their professional careers.

“Most of the medical students here don’t understand why the rest of the country doesn’t support it,” said Schroeder.

The Merritt Hawkins’ findings follow two similar surveys this year.

In February, a LinkedIn survey of 500 doctors found that 48 percent supported a “Medicare for all” type of system, and 32 percent opposed the idea.

The second, released by the Chicago Medical Society in June, reported that 56 percent of doctors in that area picked single-payer as the “best care to the greatest number of people.” More than 1,000 doctors were surveyed.

Since June 2016, more than 2,500 doctors have endorsed a proposal published in the American Journal of Public Health calling for a single-payer to replace the Affordable Care Act. The plan was drafted by the Physicians for a National Health Program (PNHP), which says it represents 21,600 doctors, medical students and health professionals who support single-payer.

Clare Fauke, a communications specialist for the organization, said the group added 1,065 members in the past year and membership is now the highest since PNHP began in 1987.

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CBO: Killing Cost-Sharing Subsidies Would Hike Silver Plan Premiums And Deficit

If President Donald Trump were to follow through on his threats to cut federal cost-sharing subsidies, health insurance premiums for silver plans would soar by an average of 20 percent next year and the federal deficit would rise by $194 billion over the next decade, the nonpartisan Congressional Budget Office said Tuesday.

The change would not be expected to have much long-term effect on the number of uninsured people, according to the analysis. But it could cause a shift in which plans are popular with marketplace customers as insurers realign some of their prices to defray the loss of the federal payments, the CBO said. Surprisingly, some customers might find better deals by looking at higher-end products.

The cost-sharing subsidies are paid directly to insurers to help cover out-of-pocket costs, such as deductibles and copayments, for people who earn between 100 and 250 percent of the federal poverty level and who choose a marketplace silver plan. About 7 million consumers receive the benefit.

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These payments are separate from the subsidies offered as tax credits to help consumers pay their marketplace plan premiums, which are available to people earning up to 400 percent of the poverty level.

The CBO estimated that the federal government would spend $8 billion on the cost-sharing subsidies in 2018, if they are continued.

The loss of the payments would be expected to have minimal effect on the number of uninsured people over the next decade, CBO said. That is because the CBO predicts that insurers would raise their premiums on silver plans to make up for the loss of the federal payments, which insurers would still need to give to those customers. That price increase would spur a rise in the premium tax credits, too. The higher tax credits would, in turn, make the marketplace plans more attractive for some lower-income Americans who have not been customers.

Most states would let insurers compensate for the termination of payments by raising premiums substantially for silver plans offered through the marketplaces, the CBO said.

CBO officials based their estimates on a model in which the administration continues the payments through this year but tells insurers by the end of this month that the subsidies would be discontinued in 2018. Different timing would produce different outcomes, but CBO staff said the results would be less destabilizing for the marketplaces if a decision is announced before insurers set their rates by Sept. 5.

The CBO estimate of the effect of ending the cost-sharing payments on premium hikes nearly matches what independent nonpartisan experts previously predicted. The Kaiser Family Foundation earlier this year predicted that premiums would rise an average of 19 percent. (Kaiser Health News is an editorial independent program of the foundation.)

The payments have faced a legal challenge from House Republicans for several years, and Trump has threatened to drop the funding as part of his effort to let the “health care law implode.”

But the administration has continued paying the subsidies month to month as it waited for Congress to overhaul the Affordable Care Act. The Senate failed to pass a bill in July, and it’s unclear if congressional Republicans will renew that effort this fall.

“If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!” Trump tweeted at end of July.

“The CBO’s report once again exposes the vast cynicism of President Trump’s threats to purposefully raise Americans’ health costs by cutting off cost sharing reduction payments,” House Minority Leader Nancy Pelosi said in a statement. She called on Republicans to drop the threats to the cost-sharing subsidies to “stabilize the markets, and lower costs for all Americans.”

Cost-sharing payments were included in the health law as a way to make insurance more affordable.

Amid all the uncertainty about these payments and the administration’s efforts on marketplace enrollment, insurers are running out of time to plan for next year. Some have dropped out of the market, citing financial losses as claims for medical care exceeded their expectations.

The increase in the federal deficit cited by the CBO would be a result of the expected higher premiums. For people getting subsidized coverage, that added expense would be borne by the federal government and their costs would be little changed, the CBO said.

“When the premiums for the benchmark plan go up, the amount of the tax credits goes up, and the amount of the premiums paid by an enrollee who is eligible for the credits is generally unchanged,” the CBO pointed out in its report.

Gross premiums for marketplace silver plans, which cover 70 percent of the value of the insurance, would be 20 percent higher in 2018 and 25 percent higher by 2020 — boosting the amount of premium tax credits, according to the statutory formula.

But the CBO predicted that insurers would not raise the premiums for their bronze plans or gold plans. Therefore, some customers getting the higher tax credits could find a better deal with higher-value gold plans, which cover 80 percent of the value, according to the analysis.

For example, according to the CBO estimates, the premium for a silver plan for a 40-year-old earning $34,100 (225 percent of the poverty level) in 2026 would run from $6,500 to $8,200 because of the loss of cost-sharing subsidies. Her premium tax credit would also increase from $3,450 to $4,850, so her net premium cost would go up from $3,050 to $3,350. But a gold plan would cost $7,900, so after she applied her tax credit to that, she would be able to buy the gold plan for $3,050, or $300 cheaper than the silver plan.

“Gross premiums for gold plans would eventually be lower than those for silver plans,” CBO said.

The CBO analysis was requested by House Democratic leaders.

Categories: Health Industry, Insurance, The Health Law

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Viewpoints: Short-Term Health Fix; Sabotage To Marketplaces; VA Hospital Director Should Go

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

The Wall Street Journal: A Short-Term ObamaCare Fix
Republicans in Congress haven’t repealed or replaced Obama Care, but the Trump Administration still has an obligation to help Americans facing higher premiums and fewer choices. One incremental improvement would be rescinding regulations on temporary health-insurance plans. (8/14)

Huffington Post: Trump’s Obamacare Tantrum Shows He’s Learned Nothing From Repeal’s Collapse
Ever since the Affordable Care Act became law in 2010, Republicans have been saying they would repeal “Obamacare.” All they needed, they insisted, was a president willing to sign their legislation. Now here they are, six months into the Trump presidency, and they’ve given him no legislation to sign. But Republicans also made another set of promises ― to provide everybody with better, cheaper health care. And they don’t have a way to do that either. What they have, instead, is a set of plans that would take health insurance away from millions of people, while forcing those with serious or ongoing medical problems to pay a lot more for their care. (Jonathan Cohn, 8/14)

The New York Times: Doctor Shortage Under Obamacare? It Didn’t Happen
As the health law sought to solve one problem, access to affordable health insurance, it risked creating another: too few primary care doctors to meet the surge in appointment requests from the newly insured. Studies published just before the 2014 coverage expansion predicted a demand for millions more annual primary care appointments, requiring thousands of new primary care providers just to keep up. But a more recent study suggests primary care appointment availability may not have suffered as much as expected. (Austin Frakt, 8/14)

The Wall Street Journal: Trump Can Save Lives By Stopping Illegal Opioids At Their Source
Donald Trump last week announced he would declare the opioid crisis a national emergency …. , as his Commission on Combating Drug Addiction and the Opioid Crisis recommended late last month. … but the commission won’t succeed in reducing opioid deaths if it doesn’t make suppressing the supply of drugs its leading priority. The report contains no recommendations for reducing the largest supplies of opioids at their sources in Mexico and Asia. Cracking down on doctors who prescribe excessive amounts of legal pain medications is already having an effect, but the surging supply of illegal drugs like heroin and fentanyl has negated a lot of the gains. (John P. Walters and David W. Murray, 8/14)

Sacramento Bee: Why Are Opioids A National Crisis, But Smoking A Personal Choice?
About 33,000 Americans died of opioid overdoses in 2015, nearly triple the number who died in 2002, according to the National Institute on Drug Abuse. But opioids are far from the most lethal addiction in America. Smoking results in the deaths of 480,000 Americans a year, making it the top cause of premature death, according to the U.S. Centers for Disease Control and Prevention. (Karin Klein, 8/14)

The Wall Street Journal: Can the VA Fire Anyone?
Congress’s big reform agenda may be a flop, but in June it did manage to pass a modest success known as the VA Accountability and Whistleblower Protection Act that allows for easier dismissal of bad employees. The case of Brian Hawkins shows why the law is needed. Mr. Hawkins was until April director of the Veterans Affairs Medical Center in Washington, D.C. that serves some 100,000 vets. That was when Inspector General Michael Missal took the extraordinary step of issuing an emergency report on the D.C. facility. Mr. Missal said the hospital was so dysfunctional that he couldn’t endanger patients by waiting to complete his investigation. (8/14)

Modern Healthcare: The Switcheroo That Could Give McConnell Enough Votes To Repeal Obamacare
Just when you thought the Republican drive to repeal the Affordable Care Act was finally dead, there is a plausible new scenario being discussed on how Senate Majority Leader Mitch McConnell could resuscitate it. Some congressional Democrats think it’s possible, even likely, that President Donald Trump will offer Democratic Sen. Joe Manchin of West Virginia the post of Department of Energy secretary. That would allow Trump to move current Energy Secretary Rick Perry to the Department of Homeland Security …. In this musical-chairs scenario, West Virginia Gov. Jim Justice—who just switched from Democrat to Republican—would then appoint a Republican to fill Manchin’s Senate seat. (Harris Meyer, 8/14)

Des Moines Register: Iowa’s Secret Medicaid Negotiations Unacceptable
Iowa has a new governor and new human services director. Gov. Kim Reynolds and Department of Human Services Director Jerry Foxhoven should seize the opportunity to ditch their predecessors’ Medicaid privatization experiment that funnels billions of public dollars to three private, for-profit managed care companies. The continuation of privatization cannot be justified. Neither can the ongoing government secrecy surrounding it. The intentional, irresponsible lack of transparency raises even more suspicions this entire ordeal is a taxpayer-fleecing fiasco. (8/14)

Arizona Republic: The Judge, Not The Corrections Director, Was Out Of Line
U.S. Magistrate Judge David Duncan keelhauled the director of the Arizona Department of Corrections, Charles Ryan, into court the other day to flog him for a memo he had written that offended the judge. …Duncan is overseeing the implementation of a settlement over the health care the department provides inmates. (Robert Robb, 8/14)

JAMA Pediatrics: Communicating About Vaccines In A Fact-Resistant World
The continued success of vaccines, one of the most effective public health interventions, depends on high rates of acceptance. Vaccine refusal in the United States has increased since the late 1990s. This trend has coincided with an increase in vaccine safety concerns. Such concerns result from easy recall of adverse events, misinformation, and human tendency to poorly judge probabilities. When a significant proportion of the US population is impervious to scientific facts, such as belief in human-induced climate change, it is difficult to communicate vaccine-related information to patients. (Saad B. Omer, Avnika B. Amin and Rupali J. Limaye, 8/14)

The Conversation: Bullying And Suicide: What’s The Connection?
All 50 states have some kind of anti-bullying law, and schools are increasingly being called upon to implement bullying prevention programs. Bullying and suicide are both significant public health concerns for children and adolescents. (Melissa Holt, 8/12)

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: Ohio Tensions Rise Over Drug-Pricing Transparency Ballot Measure; Number Of Calif. Dialysis Patients Spikes

Media outlets report on news from Ohio, California, Texas, Maryland, Pennsylvania, Minnesota and Iowa.

Stat: In Ohio, Tension Brews Over Who’s Funding A Drug Price-Control Ballot Measure
It was supposed to be a battle over high drug prices, but right now, it’s become a battle over transparency — specifically, which drug makers are funding an effort to block a measure on the ballot in Ohio this November that seeks to rein in drug prices in the state. The proposal in Ohio is similar to the one that California voters shot down last November following a huge oppositional push from drug companies; it’s even backed by the same group, the AIDS Healthcare Foundation, which runs a nonprofit network of clinics. (Robbins, 8/14)

California Healthline: Number Of Dialysis Patients In California Surges
The number of Californians who are getting care at dialysis centers has spiked in recent years — but not because kidney disease is more prevalent. The reason is that people are living longer with end-stage renal disease, said Anjay Rastogi, a professor of nephrology at UCLA’s David Geffen School of Medicine. The number of new cases has generally leveled off in recent years, Rastogi said. “The same number of patients are being put on dialysis, but they stay on dialysis,” he said. (Bartolone, 8/15)

Austin American-Statesman: Senate Tentatively OKs $563 Million For Schools, Retired Teachers
With two days left in the special legislative session, the Texas Senate early Tuesday morning approved 25-6 a bill to pump an extra $351 million into the public education system over the next two years — a $1.5 billion cut from what the House had proposed. Tuesday morning’s vote sends the watered-down version of House Bill 21 into conference committee where Senate and House members will continue negotiations that began over the weekend. (Chang, 8/14)

Politico Pro: Latest Texas Abortion Curbs Designed To Avoid Legal Fireworks
Two new abortion curbs the Republican-controlled Legislature fast-tracked for Gov. Greg Abbott’s signature over the weekend represent an alternative approach that could avoid the kind of legal fireworks surrounding recent state efforts to limit access to the procedure. …If the two bills are signed into law, as expected, Texas lawmakers will have passed half a dozen new abortion measures this year. (Rayasam, 8/14)

Austin American-Statesman: Texas Is 18th Most Expensive State To Have A Baby, Online List Says
In WalletHub’s new ranking of the best and worst states to have a baby, the Lone Star State arrived at No. 34 overall, No. 32 in terms of birth costs, No. 35 in terms of health care rank, No. 38 in terms of “baby-friendliness” and No. 29 in terms of “family-friendliness.” Its ranking of No. 34 out of all 50 states and Washington, D.C. means that Texas is the 18th most expensive place to have a baby in America. (Harris, 8/14)

The Baltimore Sun: Maryland School Of Alternative Medicine To Offer New Naturopathic Program 
The Maryland University of Integrative Health is establishing a school of naturopathic medicine and plans to admit the first students to the program next year. The school of naturopathic medicine will be the first in the mid-Atlantic region and one of only a handful of schools nationwide that operate within a regionally accredited university, officials with the university of integrative health said. (McDaniels, 8/14)

The Baltimore Sun: Maryland Regulators Approve Eight New Medical Marijuana Growers 
Maryland’s medical marijuana regulators approved final licenses for eight growing companies on Monday, allowing them to start cultivating the drug. Several companies said they are ready to begin growing immediately, while others say they will take weeks to get started. …Until Monday, just one of the 15 selected firms had received final permission to start cultivating medical marijuana, which was first legalized in the state in 2013. Even at full capacity, one firm could not produce nearly enough to support 102 planned dispensaries. (Cox, 8/14)

The Philadelphia Inquirer/Philly.com: Conshy’s Symphony Health Drug-Data Firm Sold For $520M
PRA Health Sciences Inc., a North Carolina-based clinical research organization that tests drugs, has agreed to pay $520 million for Symphony Health Solutions Corp., a Conshohocken-based medical data company assembled by Silicon Valley investors from mostly suburban Philadelphia-based firms that collected patients’ drug prescriptions from doctors and sold the information to drug makers. …With sales of around $200 million a year, Symphony employs around 250, according to PRA. That’s down from 500 in 2012. The company’s profit margin, before financial expenses, was 20 percent last year, PRA chief financial officer Linda Baddour told investors in the conference call. (DiStefano, 8/14)

The San Diego Union-Tribune: Aztecs Cancel Monday Night’s Practice As Chickenpox Count Grows To Five Players 
San Diego State postponed Monday night’s football practice amid a rash of chickenpox cases that has increased from three to five Aztecs players. SDSU head coach Rocky Long said the move was made as a precaution in an effort to prevent the disease from spreading even further. …The SDSU weight room is shared by all the school’s sports teams, including in recent weeks the other fall sports of men’s and women’s soccer, women’s volleyball and women’s cross country. School officials said no chickenpox cases outside of the football team have been reported. (Kenney, 8/14)

San Jose Mercury News: Check Your Kids’ Vaccine Record As School Year Starts
August — ouch — is National Immunization Awareness Month and the start of school for many, timely reminders why local and state public health​ officials are urging parents to make sure their children are up to speed with their vaccines, preventing diseases like measles and whooping cough that can easily spread in childcare and school settings. Actually, it’s not just a reminder, it’s the law — and one that got even tougher in California starting last summer when parents no longer were allowed to opt out of immunizations for their children, save for legitimate medical exemptions. (Seipel, 8/15)

San Jose Mercury News: Healthcare Workers Rally To Halt Oakland Nurse’s Deportation
Health care workers and other community members are rallying at noon Monday in front of Highland Hospital to demand that U.S. immigration officials halt the imminent deportation of registered nurse Maria Sanchez and her husband on Tuesday. The couple, who moved to the Bay Area in the early 1990s from a small town in Mexico, are undocumented immigrants. (Seipel, 8/14)

San Jose Mercury News: Santa Clara County Hiring Transgender Services Manager
Santa Clara County is bolstering its services aimed at the South Bay’s diverse and often marginalized transgender community through a new program manager dedicated to that population — the second such post in the nation. The program manager will serve as a “trainer, mediator and facilitator” for the transgender community, who face unique challenges at school, the workplace, in hospitals, correctional facilities and elsewhere. (Kurhi, 8/14)

Iowa Public Radio: Data On Gunshot Wounds Lacking
Nationally, more people between the ages of 15-24 are shot than any other age group. Dr. Denville Myrie, a trauma surgeon at Mercy Medical Center, says that’s true for the ER he works for in Des Moines. (Moon and Kieffer, 8/14)

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Ga. Rural Hospitals Seek Partnerships To Survive Financial Challenges; Serious Mistakes Made At D.C.’s United Medical Center Led To OB Ward Shutdown

In other hospital news, hospital and health system executives’ compensation continues to soar; a Kansas official details the privatization plan for Osawatomie State Hospital; and more.

The Washington Post: Dangerous Mistakes Led To Shutdown Of United Medical Center Obstetrics Ward
D.C. regulators ordered the only full-service hospital in Southeast Washington to stop delivering babies last week because of dangerous mistakes the hospital’s staff made with multiple pregnant women and newborns, a letter obtained by The Washington Post shows. In one case, the hospital’s staff members did not take critical steps to prevent the transmission of HIV from an infected mother to her newborn …. In another, a morbidly obese woman who was about 35 weeks pregnant and had come to the hospital with trouble breathing was not properly monitored or treated, despite a history of potentially fatal blood-pressure problems. (Jamison and Nirappil, 8/14)

Modern Healthcare: C-Suite Pay Raises Target Transformational Healthcare Leaders 
Hospital and health system executives’ compensation continues to soar and will likely maintain that pace as organizations search for a narrowing set of qualified executives to lead more complex operations across a consolidating healthcare landscape. The most significant annual pay hikes are being doled out to executives who are believed to be best qualified to navigate the path to a system that increasingly favors value over volume. Incentive packages tend to focus on systemwide metrics, including reducing variation in care and unnecessary procedures, patient satisfaction and other measures that follow new reimbursement models. (Kacik, 8/14)

KCUR: Kansas Official To Outline Privatization Plan For Osawatomie State Hospital 
One way or another, Tim Keck wants to replace the state’s aging Osawatomie State Hospital with a new mental health treatment facility. Though he is meeting with some resistance, the secretary of the Kansas Department for Aging and Disability Services is pushing lawmakers to consider privatizing the state-run psychiatric hospital, which in recent years has been beset by operational problems. On Tuesday Keck will outline a privatization plan submitted by a Tennessee-based company to stakeholders and legislators during a 1 p.m. meeting at hospital’s administration building. (Mclean, 8/14)

Wyoming Public Radio: Wyoming Hospitals Surveyed For Safety, Quality
Twelve hospitals across the state participated in a survey by the Leapfrog Group, which works with the Wyoming Business Coalition on Health to evaluate providers in the state. …According to Wyoming’s Leapfrog Program Manager Linda Witko, encouraging providers to evaluate the safety and quality of their facilities will lower the cost of health care by reducing accidents and misdiagnoses. (Elder, 8/14)

KCUR: Work By Kansas City Artists Enhances KU Medical Center’S New Education Building 
Amid its ultramodern lecture halls, the University of Kansas Medical Center’s new health education building is also a showcase for several Kansas City artists. University leaders say the $82 million facility at the corner of 39th Street and Rainbow Boulevard, designed by Helix Architecture + Design, was shaped with student engagement in mind. But the years-long project also included formation of the University of Kansas Medical Center Art Commission. Saralyn Reece Hardy, director of KU’s Spencer Museum of Art, and Leesa Fanning, contemporary art curator at The Nelson-Atkins Museum of Art, were among the architects and university administrators charged with locating artists for the project. (Onianwa, 8/14)

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Funding For N.H.’s Medicaid Expansion Now In Jeopardy

The federal Centers for Medicare & Medicaid Services informed New Hampshire Gov. Chris Sununu that a fund helping to pay expansion costs, which is partially supported by voluntary donations from hospitals, violates federal law. Meanwhile, federal officials approved changes that will allow Nebraska to continue its Health Insurance Premium Program, through which the state’s Medicaid program helps people pay the costs of private health insurance. Also, Mississippi’s Medicaid director is in the hot seat.

Modern Healthcare: Hospital Donations Put N.H. Medicaid Expansion In Jeopardy 
New Hampshire’s Medicaid expansion may end next year, because of the state’s use of voluntary donations from hospitals to fund the program. State lawmakers approved creating a fund in 2015 to pay for Medicaid expansion after federal funding started to drop in 2016. The fund is partially furnished by voluntary donations from hospitals. (Dickson, 8/14)

Jackson (Miss.) Clarion-Ledger: Job Offer Or Misinterpretation? Medicaid Director Accused Of Conflict With Company Awarded Billion-Dollar Contract
Two years before winning a billion-dollar Medicaid contract, Molina Healthcare offered the agency’s director a job. At least that’s what attorneys said they could prove in court Monday before never getting the chance. The Mississippi Division of Medicaid awarded Molina Healthcare of Mississippi a contract to run MississippiCAN, the state’s managed care program, in June alongside incumbent companies UnitedHealthcare and Magnolia Health. … “That statement is false,” said Carl Gardner, a Molina legal representative. “We did not offer Dr. Dzielak a job or anyone else at the division.” As far as the emails, which the judge sealed, “(The attorney) is reading them out of context,” Gardner said. (Wolfe, 8/14)

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Apple, Aetna Discuss Deal To Distribute Free Or Discounted Watches To Insurance Beneficiaries

The move could cover 23 million insured by Aetna. In health care industry consolidation news, Google will buy Senosis health and Allscripts will acquire a part of billionaire Patrick Soon-Shiong’s NantHealth.

The Hill: Report: Aetna In Talks To Get Apple Watches To Its Customers 
Apple and Aetna held previously undisclosed meetings last week to discuss distributing Apple Watches to the millions of people who use the health insurance giant, CNBC reported Monday. The two companies allegedly discussed offering free or discounted watches to the 23 million individuals covered by Aetna. (Breland, 8/14)

The Hill: Google Buys Health Monitoring Startup 
Google on Monday bought Senosis Health, a startup that creates products used to monitor diseases. The startup makes tools focused on tracking lung function, taking hemoglobin counts and helping treat newborn jaundice, according to Geekwire. The acquisition is only the latest move involving a tech company expanding into healthcare. (Breland, 8/14)

Chicago Tribune: Allscripts Acquires Parts Of Patrick Soon-Shiong’s Business 
Chicago-based Allscripts has signed an agreement to acquire parts of Los Angeles billionaire Patrick Soon-Shiong’s NantHealth business. Health care technology firm Allscripts will exchange 15 million of its shares in NantHealth for certain “technology assets” and client relationships now owned by NantHealth. NantHealth said in a news release late last week that the sale will allow it to better focus on using artificial intelligence to help fight cancer. The deal is expected to close in the third quarter of this year. (Schencker, 8/14)

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Drug Manufacturers Face Looming Deadline To Track Medicines As U.S. Cracks Down On Counterfeits

In other pharma industry news, early clinical trial data prove to be a mixed blessing for investors, while the Food and Drug Administration issues new prescription advisories and recalls.

Stat: With Deadlines Looming, Pharma Companies Look To Tighten Drug Security
Most people trust that their medicine matches the description on the bottle. But what if it doesn’t? Counterfeit drugs look a lot like the real deal, but can contain too little or none of the active ingredients that make a drug work. Or worse, a counterfeit drug can have toxic compounds. (Wosen, 8/14)

The Wall Street Journal: Why Early Peeks At Drug Trials Are Giving Investors Whiplash
Roche Holding AG shares jumped 6.5% on a single day in early March when the drugmaker said its new breast-cancer treatment, Perjeta, helped prolong average patient survival in a clinical study. But the stock gave up nearly all those gains three months later, when the Swiss company disclosed full details of the trial at a medical conference. The study, dubbed Aphinity, showed what some doctors said was only a marginal benefit for Perjeta …. The episode throws light on the peculiar drip-feed way drug companies often disclose the results of clinical trials. (Loftus and Roland, 8/14)

Miami Herald: FDA Calls Out PharmaTech, 22 Liquid Drug Products Recalled
For the second time in 10 months, the FDA has issued an advisory to avoid liquid drug products made at Davie company PharmaTech after finding Burkholderia cepacia contamination in the products. And three drug companies issued a sweeping all-lots, all-expiration-dates wholesale and retail recall of 22 over the counter liquid medications made by PharmaTech. (Neal, 8/14)

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Insurers Can Bend Out-Of-Network Rules For Patients Who Need Specific Doctors

The Affordable Care Act has so far survived Republican attempts to replace it, but many people still face insurance concerns. Below, I answer three questions from readers.

Q: I have a rare disease, and there is literally only one specialist in my area with the expertise needed to treat me. I am self-employed and have to buy my own insurance. What do I do next year if there are zero insurance plans available that allow me to see my specialist? I cannot “break up” with my sub-specialty oncologist. I must be able to see the doctor that is literally saving my life and keeping me alive.

Michelle AndrewsInsuring Your Health

If the plan you pick covers out-of-network providers, you can continue to see your cancer specialist, although you’ll have to pay a higher percentage of the cost than if you were seeing someone in your plan’s network.

But many plans these days don’t provide any out-of-network coverage. This is certainly true of plans sold on the health insurance exchanges.

The situation you’re concerned about — that a specialist you consider crucial to your care isn’t in a plan’s provider network — isn’t uncommon, said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms.

If this happens, you can contact your plan and make the case that this particular provider is the only one who has the expertise to meet your needs. (Unfortunately, you probably can’t get this coverage assurance before you sign up.) Then ask your plan to make an exception and treat the out-of-network specialist as if she were in network for cost-sharing purposes. So, if in your plan an in-network specialist visit requires a $250 copayment, for example, the plan would agree that’s what you’d be charged to see your out-of-network specialist.

Or not. It’s up to the plan officials, and they may argue that someone in network has the expertise you need. If you disagree, you can appeal that decision.

But it may not come to that, said Corlette.

“Plans are prepared for this — the good ones are, anyway,” she said. “My understanding is that it’s pretty routine to grant exceptions for narrow subspecialties.”

Q: My company has asked employees to pay the Cadillac tax rather than putting the burden  on the company. They are also telling us not to worry because it will never happen, but want us to agree that if it does we will take on the cost. Can they do that?

Let’s step back for a minute. The so-called Cadillac tax is a 40 percent surcharge on the value of health plans above the thresholds of $10,200 for single coverage and $27,500 for family plans.

A few months ago when it looked as if the ACA was going to be replaced, many employers believed, as yours apparently still does, that the Cadillac tax would never become effective. Both the House and Senate bills delayed the tax until 2026, and a lot can happen between now and then. With the collapse of efforts to repeal the ACA, however, the tax is on the front burner once again, said J.D. Piro, who leads the health and law group at benefits consultant Aon Hewitt. It’s set to take effect in 2020.

Under the law, insurers or employers would be responsible for paying the tax, but experts say the costs would likely be passed through to enrollees (whether or not you explicitly agree to absorb them). So it may not matter how you respond to your employer.

Also, employers who don’t want to pay the surcharge might sidestep the issue by reducing the value of the plans they offer, said Piro. For example, they could increase employee deductibles and other cost-sharing, make coverage less generous or shrink the provider network.

“That’s simplest way to avoid the tax,” he said.

Q: I need to purchase affordable health insurance for my two daughters who are 19 and 17. Is Trump insurance available yet? I need something I can afford and everything is so expensive.

President Donald Trump never put forward a proposal to replace the ACA. Instead, he backed the House and Senate replacement versions, which ultimately failed. But those versions might not have addressed your concerns, and you could have several options through the ACA.

“Coverage wouldn’t necessarily have been cheaper,” said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

Under the Senate bill, for example, the nonpartisan Congressional Budget Office predicted that average 2018 premiums for single coverage would be 20 percent higher than this year’s. In 2020, however, premiums would be 30 percent lower than under current law, on average. But deductibles and other out-of-pocket costs would be higher for most people under the Senate bill, according to the CBO.

Premiums for young people would generally have declined. The bill would have allowed insurers to vary rates to a greater degree based on age, resulting in lower premiums for young people. In addition, premium tax credits generally would have increased for young people with incomes above 150 percent of the poverty level.

Your current coverage options under the ACA depend on your family situation. If you have coverage available to you through your employer, you can keep your daughters on your plan until they turn 26. For many parents, this is the most affordable, comprehensive option.

If that’s not a possibility, assuming the three of you live together and you claim them as dependents on your taxes, you may qualify for subsidized coverage on the health insurance marketplace next year. Your household income would need to be no more than 400 percent of the federal poverty level (about $82,000 for a family of three). You can apply for that coverage in the fall.

If you live in one of the 31 states plus the District of Columbia that have expanded Medicaid coverage to adults with incomes below 138 percent of the poverty level (about $28,000 for a family of three), you could qualify for that program. You don’t have to wait for open enrollment to sign up for Medicaid.

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

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State Highlights: State Attorneys General Step Up Litigation On A Range of Health Issues; Fla. Lawsuit Targets Medicare ‘Observation Status’

Media outlets report on news from Wisconsin, Florida, California, Georgia, Illinois, Texas, Pennsylvania, New Hampshire and Arizona.

The Associated Press: Democratic Attorneys Escalate Legal Fight Against Trump
[A]n emboldened coalition of Democratic state attorneys general has unleashed a torrent of lower-profile litigation they argue is necessary to protect public health, the environment and consumers from a Republican White House. State attorneys from Massachusetts to New York to California, often working together, have brought more than 40 legal actions against the Trump administration over the last seven months. The pace, which both parties describe as unprecedented, has produced an average of one lawsuit or legal motion every five days since Trump’s inauguration, not including many more letters, legal threats and formal comments to federal agencies. (Peoples, 8/13)

Naples (Fla.) Daily News: Lawsuit Aims To Give Medicare Seniors Rights On Hospital Stay
Connie Ragonesi spent seven days in a hospital bed in Florida with a fractured ankle, and it set in motion years of heartache. The 88-year-old was cared for under “observation status,” a Medicare policy that became a nightmare and contributed to her having to sell her home in Wellington, on the state’s east coast, according to her daughter, Carol Taylor. … The Washington, D.C.-based Center for Medicare Advocacy, which focuses on seniors’ rights, was recently granted class action status in a lawsuit against the federal government regarding the policy. The issue is whether patients should have the right to appeal to Medicare when they are placed by a hospital on the outpatient-based observation designation, as opposed to admitted. (Freeman, 8/12)

Milwaukee Journal Sentinel: New State Law On Dental Hygienists Could Be A ‘Game Changer’ In Improving Access To Basic Care
The new law enables clinics — particularly those such as community health centers that provide care primarily to people with low incomes — to hire dental hygienists to provide basic preventive care, such as cleanings, fluoride varnishes, sealants and education on oral health. …Access to dental care for adults and children covered by Medicaid programs, such as BadgerCare Plus, is a longstanding problem throughout Wisconsin. (Boulton, 8/12)

San Francisco Chronicle: California’s Assisted-Dying Loophole: Some Doctors Won’t Help Patients Die
Judy Dale died of cancer in her San Francisco home in September, in agony, after being denied the pain-relieving medication she might have received under the state’s aid-in-dying law that had taken effect three months earlier. A lawsuit by her children will determine whether UCSF Medical Center, where Dale first went for treatment, was responsible for her suffering by allegedly concealing its oncologists’ decision not to provide life-ending drugs to patients who ask for them. (Egelko, 8/12)

Atlanta Journal-Constitution: Some Georgia Retirees Will See Big Boost In Health Insurance Premiums
While Georgia’s state employees and teachers will see an average 3.7 percent hike in their health insurance premiums in 2018, the news is much worse for some retirees. About 46,000 retired teachers and state employees, and their dependents, currently get coverage from “premium” health insurance plans offered by Blue Cross Blue Shield and UnitedHealthcare through the State Health Benefit Plan. (Salzer, 8/11)

Los Angeles Times: Despite California’s Strict New Law, Hundreds Of Schools Still Don’t Have Enough Vaccinated Kids
Even with a new law that has boosted kindergarten vaccination rates to record highs, hundreds of schools across California still have so many children lacking full immunization that they pose an increased risk of disease outbreaks, according to a Times analysis of state data. At nearly 750 schools, 90% or fewer kindergartners had been fully vaccinated last year, the analysis found. Experts say the rate should be at least 95% to prevent the spread of highly contagious diseases such as measles. (Karlamangla and Poindexter, 8/13)

Austin American-Statesman: Texas Ranks 11th Worst State For Health Care
The state of Texas ranks as the 11th worst state for health care, according to the personal-finance website WalletHub’s study of the year’s best and worst states for health care. …The study compared each state and the District of Columbia 35 different measures of cost, accessibility and outcome to determine which state offered the best health care to citizens. (Hubby, 8/11)

The Philadelphia Inquirer: Ironstone Wins North Philadelphia Health System Bankruptcy Auction
Ironstone Real Estate Partners won Friday’s North Philadelphia Health System (NPHS) bankruptcy auction, agreeing to pay $8.5 million in cash with no contingencies, but with some twists to make the deal for the behavioral health operation work. Philadelphia-based Ironstone’s price is less than the baseline, or stalking-horse, bid of $10 million set by Meridian Behavioral Health Systems LLC, a Tennessee chain with facilities in four states, but Meridian’s offer was laden with conditions on the city and on unions that would have made it hard to complete the purchase. (Brubaker, 8/11)

Santa Rosa Press Democrat: New Sonoma County Jail Wing Seeks To Improve Care For Mentally Ill Inmates
When Sonoma County sheriff’s officials publicly revealed their plans last spring to build a $48 million jail wing for the mentally ill, a common question quickly emerged. Why not build a psychiatric hospital instead in Sonoma County? After all, the only local hospital beds for mental health patients are operated by a for-profit company, while many low-income residents suffering a psychiatric crisis often wait for hours in an emergency room, waiting for a bed to free up in a psychiatric hospital in another county. (Espinoza, 8/12)

Santa Rosa Press Democrat: Jail Is Largest Psychiatric Facility In Sonoma County
The largest psychiatric facility in Sonoma County is not a hospital.It’s the jail.If not by design then by default, jail cells have essentially replaced psychiatric hospital beds for many of Sonoma County’s most severely mentally ill residents. It is a trend that began before the closure of Santa Rosa’s two secured mental health hospitals a decade ago, and has continued since. Now, nearly 40 percent of the 1,100 inmates held at the county’s main jail and its lower-security North County Detention Facility near the Charles M. Schulz-Sonoma County Airport have some form of mental health issue, from mild depression to bipolar schizoaffective disorder. (Espinoza, 8/12)

Milwaukee Journal Sentinel: Seven People Sickened By Salmonella From Shelled Peas Purchased At Farmers Markets
Seven people have been sickened by salmonella bacteria after eating fresh shelled (loose) peas purchased at three farmers markets in Wisconsin, state health officials said Friday. The announcement came as federal health officials reported that the number of cases from a fatal nationwide salmonella outbreak linked to imported papayas — which includes one case in Wisconsin — has risen to 141. (Garza, 8/11)

Boston Globe: Parts Of N.H. Hospital Evacuated After Staff Sickened
Two sections of Exeter Hospital were evacuated Friday after 19 staff members reported flu-like symptoms in the inpatient operating room, a hospital official said. The cause of the staff members’ sickness at the New Hampshire hospital remained a mystery Friday, officials said. (Ellement and McDonald, 8/11)

San Antonio Express-News: Will Medical Air Transport Be There For You?
Much like many rural hospitals that are faced with impossible financial circumstances, air medical transport bases are being forced to close around the nation, leaving Americans without access to life-saving care. Already, 85 million of our fellow citizens (1 in 4) can only reach a Level 1 or 2 Trauma Care facility within an hour if they are brought there by a helicopter air ambulance. (LaRue, 8/13)

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 Hospitals Still Face Continuing Difficulties

Even though the Capitol Hill repeal-and-replace debate — and its proposed funding cuts — has quieted, worries persist about the future capacity of these facilities to provide services. The Wall Street Journal, for instance, examines the dangers of childbirth in rural America.

The Wall Street Journal: Rural America’s Childbirth Crisis: The Fight to Save Whitney Brown
Since the start of the century, it has become more dangerous to have a baby in rural America. Pregnancy-related complications are rising across the U.S., and many require specialized care. For some women, the time and distance from hospitals with the resources and specialists to handle an obstetric emergency can be fatal. The rate at which women died of pregnancy-related complications was 64% higher in rural areas than in large U.S. cities in 2015. That is a switch from 2000, when the rate in the cities was higher, according to Centers for Disease Control and Prevention data analyzed by The Wall Street Journal. (McKay and Overberg, 8/11)

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

Hospital Officials Question Whether Medicare Readmissions Penalties Have Run Their Course

The program, mandated by the health law, has been credited with helping bring down costly readmissions. But hospital and industry leaders say that has hit a standstill. Also in the news, a new report spotlights a slowing of health care price increases, and WebMD’s CFO talks about plans for the company.

Modern Healthcare: Private Payers Tamp Down Hospital Prices In June
Consumers are getting some relief on healthcare prices this summer. The increase in June was just 1.5% compared with the prior-year period at 1.9%, according to a new report by the Altarum Institute’s Center for Sustainable Health Spending. Hospitals, whose privately insured patients paid just 1.8% more for services in June compared with the year before led the moderation. That’s the smallest monthly increase in that category since Altarum started tracking the private-payer pricing data in June 2014. (Barkholz, 8/11)

The Wall Street Journal: WebMD Wants To Go Beyond Medical Information
According to [WebMD’s] chief financial officer, Blake DeSimone, who was appointed to the position in September, WebMD is in the process of transforming its flagship site for consumers, WebMD.com, from a one-stop shop for information to a platform people can engage with and take action to improve their health. WebMD last month agreed to be acquired by private-equity firm KKR & Co. for $2.8 billion, after publicly putting itself in play early this year. (Stratton, 8/13)

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House Expected To Hold Hearings On ‘Right-To-Try’ Bill That Senator Tied To FDA Funding

The Senate quickly passed the bill that would allow dying patients access to experimental drugs after Sen. Ron Johnson (R-Wis.) had threatened to slow down consideration of a separate bill to renew the FDA’s fee-collection authority. In other drug industry news, the FDA is implementing new rules about hiring foreign scientists, industry tightens controls to keep out counterfeit drugs, cancer trials are low on patients and costs of old drugs rising quickly for Medicaid.

Roll Call: ‘Right To Try’ Bill Could Face Slower Action In House
A Senate-passed bill intended to help dying patients access experimental drugs will likely face lengthier deliberations in the House. While the Senate fast-tracked the bill on Aug. 3, the House will likely subject it to a hearing and markup before bringing it up to a vote, according to congressional aides and a lobbyist. (Siddons, 8/14)

Stat: FDA Puts New Restrictions On Hiring Of Foreign Scientists, Documents Show
The Food and Drug Administration is implementing a new hiring protocol that could make it significantly harder for foreign scientists to find jobs and research opportunities at the agency, according to interviews and newly obtained documents. The FDA recently began directing hiring managers not to extend any employment offers — including for fellowship and contractor positions — to any individual who has not lived in the U.S. for at least three of the five previous years, according to briefing materials shared with STAT that have been presented to some agency employees. (Mershon, 8/11)

Stat: With Deadlines Looming, Pharma Companies Look To Tighten Drug Security
Most people trust that their medicine matches the description on the bottle. But what if it doesn’t? Counterfeit drugs look a lot like the real deal, but can contain too little or none of the active ingredients that make a drug work. Or worse, a counterfeit drug can have toxic compounds. (Wosen, 8/14)

The New York Times: A Cancer Conundrum: Too Many Drug Trials, Too Few Patients
With the arrival of two revolutionary treatment strategies, immunotherapy and personalized medicine, cancer researchers have found new hope — and a problem that is perhaps unprecedented in medical research. There are too many experimental cancer drugs in too many clinical trials, and not enough patients to test them on. The logjam is caused partly by companies hoping to rush profitable new cancer drugs to market, and partly by the nature of these therapies, which can be spectacularly effective but only in select patients. (Kolata, 8/12)

Kaiser Health News: Climbing Cost Of Decades-Old Drugs Threatens To Break Medicaid Bank
Skyrocketing price tags for new drugs to treat rare diseases have stoked outrage nationwide. But hundreds of old, commonly used drugs cost the Medicaid program billions of extra dollars in 2016 vs. 2015, a Kaiser Health News data analysis shows. … Rising costs for 313 brand-name drugs lifted Medicaid’s spending by as much as $3.2 billion in 2016, the analysis shows. Nine of these brand-name drugs have been on the market since before 1970. In addition, the data reveal that Medicaid outlays for 67 generics and other non-branded drugs cost taxpayers an extra $258 million last year. (Lupkin, 8/14)

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Readers Have Their Say … On Pain And Who Stands To Gain In Drug Market

Letters to the Editor is a periodic KHN feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.


Surgeons AWOL In The ER

While performing surgeries simultaneously is supposedly justified on the grounds of teaching residents and fellows, it wasn’t always this way (“Double-Booked: When Surgeons Operate On Two Patients At Once,” July 12). The surgeon was expected to stay and oversee and advise the resident as they worked. The real reason surgeons double- and triple-book in teaching hospitals — and the hospitals let them — is that it jacks their income into the stratosphere. That is one way teaching hospitals attract and keep some of the more talented (if somewhat avaricious) surgeons. I have been a hospital and medical group executive for over 40 years.  I know this is true.

— Richard V. Stenson, Forest Grove, Ore.
MHA, MBA, FACHE, FACMGA


The Other Side Of The Opioid Crisis

Chronic migraines forced me to go on disability after 15 years of working as an RN in the NICU. I tried every medication suggested by my neurologist. The only medication that had any effect was gabapentin. Every day I read a new article about the abuse of an alternative to opioids, like gabapentin (“New On The Streets: Drug For Nerve Pain Boosts High For Opioid Abusers,” July 6). A new medication to vilify, restrict and cross off the list of alternatives to opioids. While I understand there is the potential of abuse for gabapentin, there is for all medications. In the efforts to fight the “opioid epidemic,” those of us who live with chronic pain have been ignored. Don’t be surprised if next time you break your leg, they give you an aspirin.

— Kristine Bell, Calgary, Alberta, Canada


Hammering Home The Message

There’s no better proof your recent video carries the drug lobby’s message than the PhRMA CEO’s two-word compliment: “Nailed It.” We take exception to the video (“Middlemen Who Save $$ On Medicines — But Maybe Not For You”), which we think confuses the roles of drug companies, wholesalers, drugstores, payors and pharmacy benefit managers (PBMs).

First, payors (employers, unions, government, health plans), not PBMs, decide what to do with the rebates that PBMs negotiate on their behalf. While PBMs are typically directed to pass through 90% of rebates, an increasing number of payors choose to have all rebates passed through. This is a transparent negotiation between PBMs and their clients. Likewise, it’s incorrect to say “consumers don’t see the savings” from rebates. Payors use rebates to reduce premiums, deductibles and copays for consumers.

Second, the video confuses the roles of PBMs, wholesalers and drugstores. Wholesalers and drugstores are the ones that buy and resell drugs. Whether those industries “pocket the difference” or include a “mark-up” is a question for them, not PBMs.

Third, the video confuses the role of drug companies (which set prices) and PBMs (which negotiate discounts off those prices). PBMs have no control over whether “prices for some drugs keep going up.”

It’s also a non sequitur to say PBMs favor competing drugs with higher rebates and discounts “instead of the cheaper drug.” By definition, the drug with the lowest net cost is the cheaper drug. In any case, 90% of the claims PBMs administer are generics, which involve no rebates at all.

Rising drug prices make coverage harder to afford for payors. Benefit design is not the cause but the effect. Payors try to cope by raising deductibles to continue offering coverage. It’s surprising that an established news organization would peddle such a misinformed video that so closely mirrors drugmaker talking points.

— Mark Merritt, Washington, D.C.
President and CEO of Pharmaceutical Care Management Association

Shaky Logic?

A recent KHN article (“5 Ways White House Can Use Its Muscle To Undercut Obamacare,” July 24) reports that various reputable entities suggest that Obamacare’s subsidized exchanges are “stabilizing.” But, a subsidy is money that bolsters that which is “unstable” by virtue of its being incapable of standing on its own. Are “Obamacare” exchanges requiring smaller and smaller subsidies, as time goes on, while delivering more and better coverage and care? Only then would “stabilizing” be an accurate description of their health and prospects.

— Larry Powers, Philadelphia


You Get What You Pay For

I am grateful for the attention Kaiser Health News brought to the extremely high sticker price of Spinraza. When assessing the cost of rare-disease drugs, one must look closely at the benefits the drug provides, and unfortunately the article (“Drug Puts A $750,000 Price Tag On Life,” Aug. 2) vastly undersold Spinraza’s benefits.

By any metric, Spinraza is a major breakthrough for spinal muscular atrophy (SMA) patients. In addition to the data you cited, over 70 percent of the infants saw a four-point or greater increase in The Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders score, another motor-skills gauge. And it cut the risk of death or permanent ventilation by 50%. Infants dosed before symptom onset show even more profound benefits, with many hitting motor milestones when expected and some even walking. The data also show Spinraza benefits patients on ventilators.

You state, “It was tested only on children, most under age 2, though it was approved for pediatric and adult use.” However, over half the patients in the pivotal trials were ages 2 to 12. The drug showed incredible benefit in these patients as well — a four-point difference in the Hammersmith motor function score compared to placebo. This a meaningful change in these kids’ lives. And because the drug worked in two different patient populations, it would be unethical to withhold it from older patients.

With respect to the cost to develop the drug, Ionis Pharmaceuticals, the developer of Spinraza, has spent over a billion dollars over 30 years developing the novel class of drugs Spinraza is a part of (antisense oligonucleotides). This is Ionis’ first commercial success. Implying development started in the early 2000s with public money does not tell the whole story. Without Ionis’ decades-long efforts, Spinraza would not exist.

— Nate Uhl, Greenwood, Ind.

[Editor’s note: The FDA provides this “drug trial snapshot” and summary review to detail who participated in the clinical trials that led to the approval of Spinraza and provide information about whether there were differences among sex, race and age groups.]


Benefits Vs. Risks

We would like to clarify a few points in “Denial, Appeal, Approval … An Adult’s Thorny Path to Spinraza Coverage” (Aug. 2). Kaiser Permanente is strongly committed to providing safe and effective care for our patients based on the patient’s clinical condition, physician expertise and evidence-based research. At this time, there is no published clinical evidence that nusinersen benefits adults with spinal muscular atrophy (SMA). While the Food and Drug Administration did approve nusinersen (Spinraza) for adults, the clinical trials tested nusinersen only in children up to age 15. This puts the responsibility of doing the research on the efficacy of nusinersen on health plans and delivery systems, while potentially exposing patients to side effects and harm.

Kaiser Permanente physicians have prescribed the drug for patients whose age and clinical condition indicate they are most likely to benefit from the treatment based on medical evidence. We encourage the FDA to re-examine its drug approval process to ensure that pharmaceutical companies have actually conducted research on the appropriate populations to prove their drugs are safe and effective.

— Dr. Sameer Awsare, Campbell, Calif.
Associate Executive Director, The Permanente Medical Group

[Editor’s note: Kaiser Health News is unaffiliated with Kaiser Permanente.]


Cutting To Heart Of The Data

Of course — if you demonize the cardiac surgeons with high death rates, then those surgeons will improve their rate by turning away patients who are likely to die (“Calif. Hits Nerve By Singling Out Cardiac Surgeons With Higher Patient Death Rates,” July 17). Those patients will die without surgery, but at least the reported numbers will improve! It happened in New York and will happen in California in proportion to how much demonization goes on.

— Dr. Bruce Bodner, Taunton, Mass.


What Readers Want: More Digging

When telling a story and someone says, “ObamaCare was too expensive,” don’t stop there. You need to dig into why the person is saying that. We need to know whether:

  1. The person has income too low to be eligible for a tax credit to help pay for the plan and thus would have had to pay the full price.
  2. The person has income too high to be eligible for a tax credit to help pay for the plan and thus would have had to pay the full price.
  3. The person is eligible for a tax credit to help pay for the plan but they looked at bronze plans and decided the deductible was too high to be worth it. They weren’t aware they were eligible for a cost-sharing reduction with a silver plan.
  4. The person is eligible for a tax credit to help pay for the plan, looked at both bronze and silver plans, considered cost-sharing reduction if eligible and it still was more than they could afford.

These are different problems and we need to know which it was.

— Mary Schneckenburger, Litchfield, Maine


Poster Child For The New 90s

Your story “How To Put The ‘Non-Age’ in Nonagenarian” (June 26) is a big deal! When I was 97, I was writing plays and producing them. Since my 90s, I’ve been writing books and have published five books. I dance, but I have to hold onto my walker. I travel every year to somewhere warm … and my memory is excellent. I take each day as it comes and find enjoyment in simple pleasures. I enjoy a good laugh and good conversations — my daughter says I’m very funny and should do sit-down comedy! I find life very interesting — even at my age. (I am going to be 103 on my next birthday.)

— Estelle Craig, Toronto

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

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