Tagged Health Industry

State Highlights: Ga. Provider Fee Renewal Legislation Gains Final OK; In N.J., Religious Exemptions For Childhood Vaccinations On The Rise

Outlets report on news from Georgia, New Jersey, District of Columbia, California, Minnesota, Kansas, Florida, Ohio, Iowa, Texas and Connecticut.

Atlanta Journal Constitution: Hospital ‘Provider Fee’ Gains Final Legislative Approval
Legislation needed to renew a fee on Georgia hospitals to help close a more than $900 million gap in Medicaid funding is on its way to Gov. Nathan Deal’s desk. The state House on Friday voted 152-14 to give final approval to Senate Bill 70, which authorizes the Department of Community Health board to levy the fee for another three years. The board is expected to do so quickly if Deal signs the bill into law, as expected. (Gould Sheinin, 2/10)

The Associated Press: House Moving To Block DC ‘Death With Dignity’ Law
A House committee is taking up an unusual resolution that would invalidate a local law in the nation’s capital. The House Oversight Committee will vote Monday on whether to send a resolution to the House floor blocking the District of Columbia’s “Death with Dignity” law. Oversight chairman Jason Chaffetz, a Utah Republican, has vowed to stop the law, calling it “misguided” and immoral. (2/13)

Stat: California’s Criminal Penalties For HIV Transmission Could Be Rolled Back
The state legislature decided in 1988 that somebody who donated blood while knowingly HIV-positive could be punished with up to six years in prison. Ten years later, it became a felony to have unprotected sex with the intent of transmitting HIV to a partner. Now, in 2017, a group of Democratic state lawmakers say times have changed — not that those behaviors shouldn’t be illegal, but that HIV/AIDS shouldn’t be singled out. Under California’s newly introduced Senate Bill 239, intentionally transmitting any infectious or communicable disease, including HIV, would be a misdemeanor, not a felony. (Facher, 2/13)

The Star Tribune: Advocates For Disabled Send A Distress Signal To Legislators 
A group of individuals with disabilities, many in wheelchairs, testified at a state Senate hearing last week that Minnesota needs urgent measures to expand the supply of workers who care for tens of thousands of vulnerable adults and children in their homes. The state-funded personal care assistance program, they argue, has not kept pace with burgeoning demand and a more competitive labor market, thrusting many people with complex health needs into life-or-death situations. (Serres, 2/11)

KCUR: More Funding For Mental Health, Disability, Senior Services In Kansas: None Of The Above? 
A Kansas House committee overseeing budgets for social services offered appreciation to programs serving the elderly and people with disabilities or mental illnesses. Legislators may not be able to offer much more than that. Rep. Barbara Ballard, ranking minority member on the House Social Services Budget Committee, suggested members approve $250,000 to fund services for seniors, such as bathing and assistance with housework. The funds wouldn’t begin to make up for $2.1 million in cuts to Senior Care Act services last year, she said, but would help Area Agencies on Aging chip away at their waiting lists. (Wingerter, 2/10)

Orlando Sentinel: UCF Helps First Responders Fight PTSD, Pulse Flashbacks 
For some, it’s the scent of tequila or the sound of an iPhone ringing. Hearts race, breathing sharpens, palms sweat and suddenly, they’re back at the scene of the most traumatic event most are lucky enough never to have to see. Some Pulse nightclub terror attack first responders say post-traumatic stress disorder triggers can show up in everyday settings, but the University of Central Florida’s Dr. Deborah Beidel says they don’t have to stop sufferers from living their lives. (Doornbos, 2/10)

Columbus Dispatch: State Aid To Vastly Expand Ohio State Program For Victims Of Traumatic Stress
Crawford was seeing a counselor, but it wasn’t helping. Then her husband told her about the Stress, Trauma and Resilience program, or STAR, at Ohio State University’s Wexner Medical Center, where Crawford learned ways to cope with her anxiety so she could function again. “It absolutely changed my life,” said Crawford, now 30.The program, started eight years ago, offers psychological treatment to people affected by crime and other traumas. It’s on the verge of expanding with an $839,335 grant from the Ohio attorney general’s office that will more than quadruple the budget. (Viviano, 2/12)

Des Moines Register: Health Care Stripped From Collective Bargaining As Statewide Insurance Plan Takes Shape
Sweeping changes proposed to Iowa’s collective bargaining laws would block most public-sector unions from negotiating over health insurance, though they stop short of instituting a mandatory statewide health insurance system Gov. Terry Branstad has floated. Republican leaders say they considered including such a plan in the legislation, but felt it could be too restrictive. Instead, the bill leaves open the possibility for a voluntary statewide health insurance program that employers could opt into. (Pfannenstiel, 2/10)

California Healthline: California Regulator Slams Health Insurers Over Faulty Doctor Lists
California’s biggest health insurers reported inaccurate information to the state on which doctors are in their networks, offering conflicting lists that differed by several thousand physicians, according to a new state report. Shelley Rouillard, director of the California Department of Managed Health Care, said 36 of 40 health insurers she reviewed — including industry giants like Aetna and UnitedHealthcare — could face fines for failing to submit accurate data or comply with state rules. (Terhune, 2/10)

Cleveland Plain Dealer: Painesville’s Latino Community Rallies Around Neighbor After Brain Surgery
Juan [Horta] was diagnosed with xanthoastrocytoma, an uncommon and aggressive brain tumor. Stage three. A surgeon at University Hospitals removed the tumor, and Juan was sent to a nursing home to recover. Caesar, and his mother, Maria Guillen, visited daily. They noticed what Caesar called “a ball” on the back of Juan’s neck, and it was getting bigger by the day. On the fifth day, Juan was unresponsive. The “ball” was filled with cerebrospinal fluid, and Juan needed another surgery to insert a shunt… As an undocumented immigrant, he is not qualified for public benefits, including Medicaid. Government programs require proof of legal immigration. Once that proof is supplied, it is still five years before immigrants can apply for assistance. (Ischay, 2/11)

Texas Tribune: How Texas Pimps Recruit And Sell Underage Girls For Sex 
Texas Tribune reporters talked to three convicted traffickers to try to understand the power they wield over victims and the attraction of what they call “the lifestyle.” They explained how vulnerable kids end up in the sex trade and how the business works. The interviews also revealed a common thread between pimps and their victims: the poverty and violence in their backgrounds. (Walters, Satija and Smith, 2/13)

New Haven Independent: Cigarette Tax Hike: Promoting Health Or Penalizing The Poor?
The two New Haven state representatives offered those takes Wednesday after Gov. Dannel P. Malloy proposed proposed a $40.6 billion two-year budget that included raising the taxes on a pack of cigarettes by 45 cents, to bring the total cost to $4.35… The problem, argued Rep. Porter, whose district includes New Haven’s Newhallville neighborhood, is that it can also end up punishing poor people for their patterns of addiction without offering alternative treatment programs or therapies, like smoking cessation counseling. Lower-income people smoke at disproportionately higher rates. (Gellman, 2/13)

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

Hospital Roundup: Preventing Avoidable Patient Errors; Executive Incentives To Improve Quality

Other industry news relates to a Chinese eye hospital chain planning to enter the U.S. market, Ohio facilities joining to create a new trauma care network and a Florida hospital partnering with a Brazilian company to help patients with disabilities.

Stat: A Millionaire’s Mission: Get Hospitals To Stop Killing Their Patients
Joe Kiani likes to point out that the most worn spot on most medical monitoring devices is the mute button. … His tech fix — if widely implemented — could bring order to the cacophony of beeps, buzzes, and blaring alarms that can so overwhelm nurses and doctors that they push “mute” and miss true emergencies. It could make it easier for staff to monitor patients with complex needs. And it could flag, in advance, potentially fatal errors like incorrect dosing and drug allergies. (McFarling, 2/13)

Modern Healthcare: Paying For Population Health
Trinity Health system executives take home heftier paychecks when they keep patients healthy and out of the hospital. The annual incentive pay for each executive, including the 93-hospital system’s CEO, is docked if Trinity’s total patient population doesn’t show reduced rates of obesity, smoking, readmissions and hospital-acquired conditions. Hitting financial targets, on the other hand, receives little weight in the incentive plan. Trinity’s strategy is a sharp departure from the status quo of CEO pay packages where financial incentives have long dominated. But it is a surefire way to focus top leaders’ attention on the health system’s mission to deliver better outcomes and lower costs to patients in the 22 states where it operates. (Livingston, 2/11)

Nashville Tennessean: Dr. Ming Wang To Lead Chinese Eye Hospital Chain’s U.S. Expansion
Fast-growing Chinese eye hospital chain Aier Eye Hospital plans to enter the U.S. market this year, with headquarters in Nashville and a long-term goal to open eye clinics across the country. Leading eye surgeon Dr. Ming Wang of Wang Vision Institute has been tapped as CEO of Aier-USA. The company established a holding company in the U.S., with a starting fund of $50 million. Wang’s association with Aier dates back 15 years, when the company was a small private eye hospital trying to gain a foothold in China’s health care market, where the vast majority of hospitals are controlled by the government. (Alfs, 2/10)

Cleveland Plain Dealer: Major Hospitals Join Together For A Trauma Care Network: Strong Points 
Cleveland Clinic, MetroHealth and University Hospitals have joined together to create a new Northern Ohio Trauma System (NOTS), which will provide coordinated trauma care to patients throughout Cuyahoga County and the seven-county Northeast Ohio region. As part of this enhanced trauma network, University Hospitals is adding its trauma expertise to NOTS. The NOTS network was originally formed in 2010 between MetroHealth and Cleveland Clinic, and NOTS assisted the City of Cleveland public safety forces to get the right patient to the right place at the right time for their care. (MacFarland, 2/10)

Orlando Sentinel: Florida Hospital Partners With Brazilian Company Livox 
In the speech and language impairment world, Livox falls under the umbrella of augmentative and alternative communication, or AAC. The systems help people with disabilities and impaired communication express themselves despite conditions such as autism, stroke, cerebral palsy or even cancer. The devices can be sophisticated and expensive, such as the one Stephen Hawking uses. Or they can be much simpler apps with images, which produce sentences and phrases when pressed by the user. Livox is more user-friendly and easier to customize than other apps available on the market, according to families and speech therapists who use it. (Miller, 2/13)

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

States Begin To Assess Effects Of Judge’s Decision To Block Anthem-Cigna Merger

Officials and news outlets in Colorado and New Hampshire, two states that opposed the merger, review the situation.

Denver Post: A Judge Blocked The Anthem-Cigna Health Insurance Merger. What Does That Mean For Colorado?
Individual insurance plans account for only about 8 percent of the market in Colorado. But Anthem, and to a lesser extent Cigna, are also players in the employer-sponsored insurance world — which is 50 percent of the state’s insurance market. In 2014, Anthem — listed under its previous name, Wellpoint — was the largest insurer in the state’s small group market and the second-largest in the large group market, according to a report by the Kaiser Family Foundation, a nonprofit group that is not affiliated with the insurer and health care provider Kaiser Permanente. (Ingold, 2/11)

New Hampshire Union Leader: Anthem Pushes Appeal, NH AG Celebrates Cigna Merger Defeat 
New Hampshire Attorney General Joseph Foster said it marks a big victory for consumers, since his office, along with the AGs from 10 other states and the District of Columbia, brought the civil lawsuit, aimed at torpedoing the merger. “The court’s decision is a tremendous win for consumers, employers, health-care providers, and other health insurers who compete in this state,” Foster said in a statement. “New Hampshire already has too few competitors in the health insurance market. Anthem and Cigna directly compete in important segments of the New Hampshire market, offering different approaches for fostering improved health care at lower costs.” (Landrigan, 2/11)

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

Grassley Launches Inquiry Into Orphan Drugs After KHN Investigation

Republican Sen. Chuck Grassley, chairman of the Senate Judiciary Committee, has opened an inquiry into potential abuses of the Orphan Drug Act that may have contributed to high prices on commonly used drugs.

In a statement, Grassley said the inquiry is “based on reporting from Kaiser Health News” and strong consumer concern about high drug prices.

“My staff is meeting with interested groups and other Senate staff to get their views on the extent of the problem and how we might fix it,” Grassley wrote on Feb. 3, adding that he will continue to work on bringing prices down in other ways as well.

A six-month Kaiser Health News investigation published in January found that the orphan drug program intended to help desperate patients is being manipulated by drugmakers. While the companies are not breaking the law, they are using the 1983 Orphan Drug Act to secure lucrative incentives and gain monopoly control of rare disease markets where drugs often command astronomical price tags.

KHN’s investigation, which was published and aired by NPR, found that many drugs that now have orphan status aren’t entirely new. More than 70 were drugs first approved by the Food and Drug Administration for mass market use. Those include cholesterol blockbuster Crestor, Abilify for psychiatric disorders, and rheumatoid arthritis drug Humira, the best-selling drug in the world.

Others are drugs that have received multiple exclusivity periods for two or more rare conditions. About 80 drugs fall into this latter category, including cancer drug Gleevec and wrinkle-fighting drug Botox.

Before the Orphan Drug Act passed, drugs for rare diseases were often abandoned during development — hence the name orphan. The patient populations were simply too small to be financially viable.

Senate Judiciary Committee Chairman Chuck Grassley (Chip Somodevilla/Getty Images)

Grassley, the senior senator from Iowa, is well positioned to call for changes in the law’s incentives. His Judiciary Committee oversees anticompetitive and patent-related issues. Grassley made headlines late last year calling for hearings to demand that drugmaker Mylan justify its price hikes for the lifesaving EpiPen.

Grassley’s office has reached out to staff members of the Senate Health, Education, Labor and Pensions Committee, which has jurisdiction over the FDA. When asked this week about a possible update to the law, the committee lauded the Orphan Drug Act for helping millions of families and said it “will continue oversight of the law to ensure it is working as intended.”

But there are questions over whether the law is working as intended. Dr. Robert Califf, who left his post last month as commissioner of the FDA, said he believes it’s time to review the orphan drug program and the incentives offered to corporations.

The decades-old law, Califf said, has been very successful in bringing effective treatments to rare disease patients. But like any program, he said, “once it reaches a mature phase, it’s important to reassess it.”

In talking about what could be changed, Califf said reexamining the FDA’s orphan drug policy “does need to occur at this point in time.”

Califf noted that before he arrived at the FDA in 2015 he was involved in consultant meetings where there “clearly is an effort for gaming” the orphan drug approval process.

“It’s understandable that whenever you put a financial incentive in place in the United States, people will try to figure out how to take advantage of it — almost all of them within the law,” Califf said. “So, I’m not talking about illegal activity but … there is a game of cat and mouse that goes on.”

In an interview late last year, PhRMA’s Anne Pritchett, vice president of policy and research at the drug industry’s lobbying group, said government incentives for orphan drug development are needed because the research involved is costly, risky and uncertain, and it can take years to develop a successful drug. This week, a PhRMA spokeswoman said they had not heard of any movement on changing or updating the Orphan Drug Act.

Dr. Martin Makary, a professor at Johns Hopkins University School of Medicine and a vocal critic of the high prices of orphan drugs, has offered up possible solutions. He suggested that drugmakers should pay back some of the federal incentive money once a drug reaches a blockbuster sales level for treating a rare disease.

“That money, at a certain point, could go back to the FDA through a back tax that starts after $1 billion in annual sales,” Makary said.

Former U.S. Rep. Henry Waxman (D-Calif.), who pioneered the Orphan Drug Act in the 1980s, thinks Congress should tackle prescription drug pricing on a variety of fronts, and that an update to the Orphan Drug Act is part of the solution.

Waxman noted that President Donald Trump has expressed concern about prescription drug prices and that could bring energy to the effort.

“Hopefully, he’ll come in with some good proposals and do something about the problem,” Waxman said. “I hope that when Congress does something, it will be something that has an impact.”

But Peter Saltonstall, president of the National Organization for Rare Disorders, said his group has heard “no energy” for changing the law now. He said his organization, which is the largest group representing rare disease patients, is constantly evaluating how well the Orphan Drug Act works.

“I think the Orphan Drug Act at least from our perspective has been successful,” Saltonstall said, adding that there are other prescription drug pricing concerns that could be addressed by Congress such as the high prices of a variety of drugs — orphans, he said, are a small portion of the nation’s total drug costs.

Today, more than 450 orphan drugs have been approved and gaining orphan designation is a popular business strategy for manufacturers. Drugs approved to treat rare diseases made up 40 percent of new drugs approved by the FDA in 2016 and nearly 50 percent of new drugs approved in 2015. The drugs are also very expensive with $111,820 as the average annual price of an orphan drug in 2014 versus $23,331 for a mass market drug.

As part of the 1983 law, Congress approved a basket of financial incentives to spur development. It includes seven years of market exclusivity to a drug for use on a specific rare disease. It also provided companies with tax credits on research and development and waived regulatory fees. And, notably, the drugs are often approved with smaller and fewer clinical trials because of the smaller patient populations.

In the 1990s, lawmakers introduced a number of amendments to the Orphan Drug Act in Congress, including proposals to impose taxes on profits and revoking exclusivity if the patient population exceeded the 200,000 bright line used to define a rare disease. The proposals all failed.

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

Categories: Cost and Quality, Health Industry, Pharmaceuticals, Syndicate

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Viewpoints: Medicare And Social Risk Factors; When The Goal Is Fewer Abortions

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

The New England Journal Of Medicine: Social Risk Factors And Equity In Medicare Payment
Medicare is steadily shifting from volume-based fee-for-service payments to value-based payment models, including accountable care organizations, episode-based bundled payments, and penalties for hospitals with relatively high Medicare readmission rates.1 These models typically provide financial bonuses or penalties related to the efficiency and quality of care, thereby shifting more financial risk to hospitals, medical groups, and other providers. Through a star rating system, bonuses are also provided to high-quality health plans in the Medicare Advantage program. (Melinda B. Buntin and John Z. Ayanian. 2/9)

Forbes: Medicare Is Reducing The Cost Of Knee Replacements (Here’s How That Could Backfire)
Early evidence suggests that bundled payments reduce the cost of knee replacements by an average of almost $1200 per procedure. With a million such procedures performed in a year, that reduction could save over $1 billion. Moreover, these savings don’t seem to come at the expense of quality, at least as far as we can tell. … Same quality at a lower price – who could be against that?! Well, caution is in order. Healthcare systems that enrolled in the bundled payment system increased the number of knee replacements they performed – about three procedures more per hospital. (Peter Ubel, 2/10)

Lexington Herald Leader: Pro-Life Forces, Planned Parenthood Want The Same Thing: Fewer Abortions
Sorry (not sorry) if this comes across as condescending, but I’m running out of ways to describe what should be self-evident: Nobody is “pro-abortion.” Aside from a few psychotics, nobody wants there to be more abortions. In that sense, the recent Women’s March and The March for Life were both anti-abortion demonstrations. That’s what I think many are not getting or, rather, choosing not to get. (Coleman Larkin, 2/9)

RealClear Health: Pharmaceutical Policy: Will Washington Upset Elegant Balance?
“Policymakers should be loath to tamper, even at the edges, with [the] elegantly balanced system of free-market drug development in the United States – one that encourages innovation and investment while generally working to stabilize prices at their lowest level possible.” Those words, written by the National Taxpayers Union (NTU) in a letter to Congress just two weeks ago, were meant to express opposition to a prescription drug importation scheme proposed as an amendment to the Senate’s FY 2017 Budget Resolution. Yet, they also apply to a number of other developments about federal policy toward pharmaceuticals. (Peter Sepp, 2/10)

Stat: Future Doctors Should Be Trained To Promote Social Change
Physicians have a special vantage point from which they can see the way that poverty, housing insecurity, a lack of health insurance, and other factors affect health. But most don’t know what to do with this information, or envision how they can make a difference. To create a truly healthy America, we need a new kind of medical training, one that prepares physicians for roles as health advocates. (Gaurab Basu and Danny McCormick, 2/9)

Stat: Alzheimer’s-Preventing Drugs May Already Exist — We Just Can’t Test Them
Some trials testing whether statins could reverse Alzheimer’s failed to produce conclusive evidence. But they did not address whether taking statins decades before Alzheimer’s symptoms arise might prevent the disease. Pharmaceutical companies lack the incentive to pay for expensive clinical trials to get older drugs approved for new uses. Why? Because many of them, like statins, are already off-patent, meaning they are sold at a low price. (Julie Zissimopolous, 2/9)

San Jose Mercury News: No, Santa Cruz Is NOT Giving Away Free Meth To Keep Homeless Awake
No, the city of Santa Cruz is NOT considering whether to hand out free methamphetamine to homeless people. A flier is circulating around town, complete with city logo, announcing the City Council will consider the proposal at its upcoming meeting. It’s a hoax, surf city officials insist, spread by a group opposed to Santa Cruz’s controversial outdoor sleeping ban. (Prodis Sulek, 2/9)

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

Research Roundup: Wages And Health Spending; Workplace Injuries; Mexico City Policy

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Health Care Use And Spending Patterns Vary By Wage Level In Employer-Sponsored Plans
[W]e examined patterns of health care use and spending by wage category during 2014 among 42,936 employees of four self-insured employers enrolled in a private health insurance exchange. When demographics and other characteristics were controlled for, employees in the lowest-wage group had half the usage of preventive care (19 percent versus 38 percent), nearly twice the hospital admission rate (31 individuals per 1,000 versus 17 per 1,000), more than four times the rate of avoidable admissions (4.3 individuals per 1,000 versus 0.9 per 1,000), and more than three times the rate of emergency department visits (370 individuals per 1,000 versus 120 per 1,000) relative to top-wage-group earners. (Sherman et al., 2/6)

Health Affairs: Racial And Ethnic Differences In The Frequency Of Workplace Injuries And Prevalence Of Work-Related Disability
This study used national survey data to test for differences between members of minority groups and non-Hispanic white workers in the risk of workplace injuries and the prevalence of work-related disabilities. Non-Hispanic black workers and foreign-born Hispanic workers worked in jobs with the highest injury risk, on average, even after adjustment for education and sex. These elevated levels of workplace injury risk led to a significant increase in the prevalence of work-related disabilities for non-Hispanic black and foreign-born Hispanic workers. These findings suggest that disparities in economic opportunities expose members of minority groups to increased risk of workplace injury and disability. (Seabury, Terp and Boden, 2/6)

Health Affairs: Work, Health, And Insurance: A Shifting Landscape For Employers And Workers Alike
We examined the complex relationship among work, health, and health insurance …. Stagnation or deterioration in employment conditions and wages … has been accompanied by the erosion of health outcomes and employer-sponsored insurance coverage. … we present data and discuss the research that has established these links, and we assess the potential impact of policy responses to the evolving landscape of work and health. The expansion of insurance availability under the Affordable Care Act may have helped reduce the burden on employers to provide health insurance. However, the act’s encouragement of wellness programs has uncertain potential to help contain the rising costs of employer-sponsored health benefits. (Buchmueller and Valletta, 2/6)

Kaiser Family Foundation: Community Health Centers: Recent Growth And The Role Of The ACA
This brief draws on 2015 federal data on health centers and our 2016 Survey of Health Centers’ Experiences and Activities under the Affordable Care Act to provide a snapshot of health centers and their patients, analyze recent changes, and compare the experience of health centers in Medicaid expansion and non-expansion states. … Key findings include: Health centers are a core source of primary care in the U.S., particularly for Medicaid beneficiaries and uninsured people. … The Medicaid expansion strengthened health center finances and capacity. … Health centers report increased numbers of insured patients who are unable to pay their deductibles and cost-sharing. (Paradise et al., 1/18)

The Urban Institute: Access To Contraception In 2016 And What It Means To Women
This brief provides estimates of self-reported access to contraception among women at risk of unintended pregnancy and perceptions of the role of birth control in women’s lives. Most women are using contraception, the full cost of which is usually covered by health insurance or another program. Yet, some women report barriers to contraception access, many of which are related to cost. The majority of women agree that birth control has a positive effect on women’s lives. (Johnston, Courtot and Kenney, 1/23)

The Kaiser Family Foundation: The Mexico City Policy: An Explainer
On January 23, President Donald Trump reinstated the Mexico City Policy via presidential memorandum. This explainer provides an overview of the policy’s history and how it has been applied in the past. … The policy requires foreign non-governmental organizations (NGOs) to certify that they will not “perform or actively promote abortion as a method of family planning,” using funds from any source (including non-U.S. funds), as a condition for receiving U.S. government global family planning assistance and, as of Jan. 23, 2017, any other U.S. global health assistance. (1/23)

Here is a selection of news coverage of other recent research:

NBC/San Diego: Study Finds Medicare May Overpay Medicare Advantage Plans By $200B
A study at UCSD’s School of Medicine found that an incentive to increase patient risk scores could lead Medicare to overpay Medicare Advantage (MA) plans by roughly $200 billion over the next ten years. … The problem is they provide more benefits when they enroll a patient expected to use a large volume of medical services and less when plans enroll low risk patients. For example, spending is expected to be greater for an 85-year-old than for a 65-year-old, and greater for a patient with heart disease or diabetes, said university officials. (Pollack, 2/6)

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: Ga. House Approves Bill Mandating Insurance Broker Commissions; Colo. AG OKs Sale Of Nonprofit Insurer

Outlets report on news from Georgia, Colorado, Texas, California, Michigan, Kansas, Virginia, Massachusetts, Louisiana and Florida.

Denver Post: Coffman OKs Rocky Mountain Health Plans Sale
Colorado’s attorney general has given her blessing to the proposed sale of Rocky Mountain Health Plans, a Western Slope insurer, to UnitedHealthcare. In an opinion issued Thursday, Attorney General Cynthia Coffman wrote that she had concluded the sale can proceed legally. Rocky Mountain Health Plans is a nonprofit, and the sale will require it to convert to a for-profit company and leave the proceeds of the sale — some $36 million, according to Coffman’s opinion — to the Rocky Mountain Health Plans Foundation, which will use that money for charitable projects on the Western Slope. (Ingold, 2/9)

Texas Tribune: Texas Nurse Practitioners Push For Independence From Doctors
Texas nurse practitioners are once again seeking independence from costly agreements that require them to sign contracts with doctors in order to treat and write prescriptions for their patients. State Rep. Stephanie Klick, R-Fort Worth, introduced House Bill 1415 Thursday, saying the bill would get rid of so-called prescriptive authority agreements that require nurse practitioners — who have advanced degrees in a nursing speciality — to pay up to six-figure fees to “delegating” doctors. (Alfaro, 2/9)

San Francisco Chronicle: Kim Wants City To Ensure Access To Birth Control
Supervisor Jane Kim is working on legislation to require that San Francisco pick up the tab for birth control for any woman living in the city whose free prescription stands to be cut off under President Trump. While Trump has so far focused mostly on immigration policy and working himself into a lather over “Saturday Night Live” skits, Kim said she is bracing for an anticipated crackdown on birth control access from the new administration. (Knight, 2/9)

Detroit Free Press: Michigan Ending Discounts For Flint Water Bills
State officials have decided to end the state-funded subsidies that since 2014 had helped Flint residents pay their water bills after the city’s water system became contaminated with lead. Word of the subsidies’ impending cutoff surfaced Thursday after a senior adviser to Gov. Rick Snyder sent a letter to Flint’s interim chief financial officer, saying the subsidies will stop after Feb. 28, according to a news release from the City of Flint. The reaction of Flint’s mayor and other city officials was mild, characterizing the governor’s decision as a sign that the city’s water quality had improved although they stopped short of saying it was entirely safe. (Laitner and Zaniewski, 2/9)

KCUR: Dozens Of New Cases Expected Over Alleged Sexual Abuse At Leavenworth VA Hospital
A torrent of civil lawsuits over alleged sexual abuse by a former employee of the Department of Veterans Affairs hospital in Leavenworth is expected now that a federal judge has refused to dismiss one of the cases. Three more lawsuits were filed this week in federal court, bringing the total to 15 so far, and dozens more are expected to be filed in coming months. The suits by military veterans accuse Mark E. Wisner, a one-time physician’s assistant at the hospital who held himself out as a doctor, of sexually molesting them during physical exams. (Margolies, 2/9)

Richmond Times Dispatch: Bill To Redirect Reproductive Health Funds Passes State Senate Committee 
A bill that would restrict the funds available to Planned Parenthood clinics operating in Virginia has passed a state Senate committee. House Bill 2264, sponsored by Del. Benjamin L. Cline, R-Rockbridge, does not mention Planned Parenthood by name but proposes to restrict the state’s Department of Health from providing any funds to a Virginia clinic that provides abortions that are not covered by the state’s Medicaid program. (Demeria, 2/9)

Boston Globe: Mass. Is A Magnet For Foreign Students, But They’re Anxious About Trump 
Trump’s order was designed to stop terrorists and others who would commit violence in the United States. But it has also ensnared a highly educated community of Iranian scholars, researchers, and professionals who, over the last century of immigration, have risen to the top echelons of Boston’s academic, health care, and high-tech institutions. (Levenson, 2/10)

New Orleans Times-Picayune: Fairway Medical Center Near Mandeville Sold To LCMC Health
LCMC Health, the not-for-profit, academic health care system that includes Children’s Hospital and University Medical Center in New Orleans, has purchased Fairway Medical Center in western St. Tammany Parish. LCMC Health bought the surgical hospital near Mandeville in partnership with several local, specialty surgeons, the system announced Thursday (Feb. 9). The joint ownership is effective immediately. In addition to Children’s Hospital and the University Medical Center, LCMC is also comprised of New Orleans East Hospital, Touro Infirmary and West Jefferson Medical Center. The purchase price was not disclosed. (Chatelain, 2/9)

Health News Florida: Humana To Lay Off Hundreds In Florida 
Humana, Florida’s largest Medicare managed-care company, says it will lay off hundreds of employees in April, including 328 in Florida. Of those, 260 are in the Tampa Bay area, according to Humana spokeswoman Nancy Hanewickel. (Gentry, 2/9)

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

New Cancer Drugs Come Under Fire For Prices And Failing To Show Effectiveness

Researchers and patients are critical of drugs being brought onto the market that are expensive but offer little advantage in the fight against cancer. Meanwhile, Politico Pro looks at a new instance of an old drug getting approval for treating a rare disease, and pharmacy managers are looking for a way to explain their business.

Stat: Cancer Drug Reports: No Link Between Benefit And Price
Cancer drugs have been under a critical lens for many years now — and for good reason, according to a duo of new papers. Two thirds of recently approved cancer drugs just don’t work all that well, particularly when compared to their cost, according to a report in the Annals of Oncology. Another notable conclusion: The paper found no improved benefit from personalized medicine drugs, and first-in-class drugs. (Keshavan, 2/9)

Kaiser Health News: Dozens Of New Cancer Drugs Do Little To Improve Survival, Frustrating Patients
Marlene McCarthy’s breast cancer has grown relentlessly over the past seven years, spreading painfully through her bones and making it impossible to walk without a cane. Although the 73-year-old knows there’s no cure for her disease, she wants researchers to do better. It’s been years, she said, since she has found a drug that has actually helped. McCarthy said she’s frustrated that the Food and Drug Administration is approving cancer drugs without proof that they cure patients or help them live longer. (Szabo, 2/9)

Chicago Tribune: Northbrook Company’s Muscular Dystrophy Drug Wins FDA Approval
The U.S. Food and Drug Administration on Thursday approved a Northbrook pharmaceutical company’s drug to treat a deadly form of childhood-onset muscular dystrophy — only the second FDA-approved drug for the disease and the first for everyone with the disorder. … The approval of the drug, which will carry a list price of $89,000 for a year’s supply, comes as pharmaceutical companies face growing pressure to hold down medication prices. … Prices for medications such as deflazacort, which are used to treat rare diseases and called orphan drugs, are often much higher than drugs for more common ailments. The top 100 orphan drugs in the U.S. cost an average of $111,820 a year per patient in 2014, according to a report by Evaluate, a market research firm. (Schencker, 2/9)

Politico Pro: Double Whammy? New Drug Approval Raises Concerns About Pricing, Abuse Of Rare Disease Incentives
The FDA Thursday approved an old drug to treat a rare disease, a move that sparked fears that the manufacturer will dramatically increase the drug’s price. The approval is also raising red flags among health policy experts who say this looks like another case of a drug company abusing incentives designed to encourage new innovations for patients. … some health policy experts say the company may be overpricing the drug because it was approved for a rare condition. Drugs used to treat rare disease are typically able to command large price tags with less push back from payers. (Karlin-Smith, 2/9)

Stat: Stung By Criticism, Pharmacy Benefits Managers Try To Push Back
Five months after drug makers began openly blaming pharmacy benefit managers for rising prices, these crucial middlemen in the arcane and complicated health care system are starting to fight back. On Monday, the trade group representing pharmacy benefits managers, which negotiate prices on behalf of health plans and create lists of drug that receive preferred coverage, circulated a memo to its members outlining a six-point plan designed to push back against mounting criticism of their business. (Silverman, 2/9)

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

Zenefits Lays Off Nearly Half Of Its Remaining Workers

The troubled company has not cut 70 percent of its staff since its height in September 2015.

Reuters: Zenefits Cuts Nearly Half Its Workforce As Startup’s Struggles Continue
Zenefits is laying off nearly half its staff as the software startup grapples with the fallout of insurance violations that resulted in hefty penalties from state regulators. The company, which offers free human-resources software to manage benefits and payroll while making its money as an insurance broker, said on Thursday that 430 employees would lose their jobs. That leaves 4-year-old Zenefits with about 500 employees, roughly a third of what it had a year ago. (Somerville, 2/9)

The Wall Street Journal: Zenefits Cuts Nearly Half Of Staff
In a memo to staff, the company’s new chief executive, Jay Fulcher, wrote that “in 2015, the company grew too quickly, hiring employees to support revenue projections that far surpass where we are today. Today’s action aligns our costs more closely to our business realities.” (Winkler, 2/9)

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

Facing Long Odds, Anthem Plans To Appeal Cigna Merger Decision

Meanwhile, the $1.85 billion breakup fee is likely to cause further tension between the two companies.

The Wall Street Journal: Anthem To Appeal Decision Against Cigna Deal
Anthem Inc. on Thursday appealed a federal judge’s decision to block its acquisition of Cigna Corp., but the future of the deal was unclear amid discord between the two partners. On Wednesday, U.S. District Judge Amy Berman Jackson said the proposed $48 billion deal between the two health insurers violated federal antitrust law because it would create an unacceptable reduction in the number of companies able to serve large multistate employers that offer insurance to their workers. (Wilde Mathews, 2/9)

The CT Mirror: Anthem Will Appeal Judge’s Decision To Block Merger With Cigna
“The company promptly intends to file a notice of appeal and request an expedited hearing of its appeal to reverse the Court’s decision so that Anthem may move forward with the merger, which was approved by over 99 percent of the votes cast by the shareholders of both companies,” Anthem said in a statement. (Radelat, 2/9)

The New York Times: Next Fight For Anthem And Cigna: The Breakup Fee
Anthem and Cigna may have one fight left. Their $54 billion deal was nixed on Wednesday by a federal judge, who agreed with the Justice Department’s concerns about competition. In addition to fighting the government, the two health insurers had been squabbling with each other over the merger. That suggests that the payment of the breakup fee could be contentious, too. (Cyran, 2/9)

Reuters: Cigna, Humana Could Still Combine Despite Anti-Trust Rulings-Analysts
Although judges shot down Anthem Inc’s $54 billion acquisition of Cigna Corp and Aetna Inc’s $35 billion takeover of Humana Inc on anti-trust grounds, the rulings left scope for a possible combination of Cigna and Humana, industry insiders said. Cigna would have both the motives and finances to pursue an acquisition of Humana, these experts suggested. Because of its much smaller Medicare Advantage business, Cigna may have a better shot at winning a regulatory green light, they added. (O’Donnell, 2/9)

Politico Pro: Insurers Face Tough Legal Path To Green-Lighting Blocked Mergers 
The Big Five are still the Big Five. After two years of merger talks, blockbuster deals and legal fights, the same five companies still dominate the national health insurance market. And despite being thwarted by courts, their push to consolidate in friendly or hostile deals remains strong, as the companies seek to exert leverage in negotiations with hospitals and doctors. (Demko, 2/9)

Marketplace: What Happens Now That The Anthem-Cigna Merger Is Blocked?
The proposed $48 billion merger between insurance giants Anthem and Cigna looks like it’s dead, as does the $37 billion deal between Aetna and Humana, though Aetna said it will appeal. In both cases, federal judges ruled the mergers would hurt consumers, eliminating competition and driving up prices. So what now for four of the nation’s five largest health insurers? These companies have billions on hand, and they’ve got to do something with it. (Gorenstein, 2/9)

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

Dozens Of New Cancer Drugs Do Little To Improve Survival, Frustrating Patients

Marlene McCarthy’s breast cancer has grown relentlessly over the past seven years, spreading painfully through her bones and making it impossible to walk without a cane.

Although the 73-year-old knows there’s no cure for her disease, she wants researchers to do better. It’s been years, she said, since she has found a drug that has actually helped. McCarthy said she’s frustrated that the Food and Drug Administration is approving cancer drugs without proof that they cure patients or help them live longer.

“That simply isn’t good enough,” said McCarthy, of Coventry, R.I. “I understand [why] that could be satisfactory for some people. It isn’t to me.”

Pushed by patient advocates who want earlier access to medications, the­ Food and Drug Administration has approved a flurry of oncology drugs in recent years, giving some people with cancer a renewed sense of hope and an array of expensive new options. A few of these drugs have been clear home runs, allowing patients with limited life expectancies to live for years.

Many more drugs, however, have offered patients only marginal benefits, with no evidence that they improve survival or quality of life, said Dr. Vinay Prasad, assistant professor of medicine at the Oregon Health and Sciences University, who has written extensively about the FDA’s approval process for cancer drugs.

Overall cancer survival has barely changed over the past decade. The 72 cancer therapies approved from 2002 to 2014 gave patients only 2.1 more months of life than older drugs, according to a study in JAMA Otolaryngology–Head & Neck Surgery.

And those are the successes.

Two-thirds of cancer drugs approved in the past two years have no evidence showing that they extend survival at all, Prasad said.

The result: For every cancer patient who wins the lottery, there are many others who get little to no benefit from the latest drugs.

“We are very concerned about the push to get more drugs approved, instead of effective drugs approved,” said Fran Visco, president of the National Breast Cancer Coalition, who said the last game-changing breast cancer drug, Herceptin, was approved nearly 20 years ago.

In a November study published in JAMA Internal Medicine, researcher Diana Zuckerman looked at 18 approved cancer drugs that didn’t help patients live longer. Only one had clear data showing that it improved patients’ lives, such as by relieving pain or fatigue.

Two drugs harmed quality of life. For example, thyroid cancer patients taking the most expensive drug, cabozantinib, scored worse on a scale measuring five symptoms: diarrhea, fatigue, sleep disturbance, distress, and difficult remembering, Zuckerman said.

“Our patients need drugs that provide the greatest possible benefit, particularly when you put that in the context of cost,” said Dr. Richard Schilsky, senior vice president and chief medical officer at the American Society of Clinical Oncology, which represents cancer specialists. “You begin to question what is the real value of a therapy when the benefit is small, the toxicity may be similar to a previous drug and the cost is much higher.”

Cancer drugs approved last year cost an average of $171,000 a year, according to the Center for Health Policy and Outcomes at New York’s Memorial Sloan Kettering Cancer Center. Although the high prices can lead patients to think they’re getting the Mercedes of cancer drugs, research shows that a medication’s price has no relationship to how well it works.

“We cannot have a system where drugs that may not even work are being sold for these amazingly crazy amounts of money,” said Zuckerman, president of the National Center for Health Research, a nonprofit in Washington that aims to explain research to consumers.

Recognizing the slow pace of progress, the American Society of Clinical Oncology has set goals for new cancer drugs of extending life or controlling tumors for at least 2.5 months. The bar was set relatively low because “it’s not very often that we come across a transformative treatment,” said Dr. Sham Mailankody, an assistant attending physician and myeloma specialist at Memorial Sloan Kettering.

Yet in a study published in September in JAMA Oncology, Mailankody found that only one in five cancer drugs approved from 2014 to 2016 met those standards.

Even those slim gains, achieved during carefully controlled clinical trials, can evaporate in the real world, where patients are often older and sicker than those who participate in research studies, said Hanna Sanoff, an associate professor and section chief of the University of North Carolina School of Medicine Gastrointestinal Medical Oncology Program.

Cancer is primarily a disease of aging; 59 percent of patients are over 65 and 30 percent are older than 75. Yet only 33 percent of participants in cancer trials are over age 65 and just 10 percent are over 75, according to a 2012 study in the Journal of Clinical Oncology.

In a study published in September in The Oncologist, Sanoff found that a drug that improved survival in liver cancer by three months offered no survival advantage among Medicare patients outside the clinical trial.

McCarthy, who reviews breast cancer research proposals for the Department of Defense, said she was twice turned down for clinical trials because of her age. When researching experimental therapies, “I’d get excited by something that seemed promising, only to be told I was too old to join the trial, because the cutoff age was 70,” she said.

Marlene McCarthy, 73, from Coventry, R.I., works on a computer as her husband Joe McCarthy, looks on. Marlene McCarthy, a mother of four, was first diagnosed with breast cancer at 44. Seven years ago, the disease returned in her bones, a condition that is not curable. (Katye Brier/for KHN)

McCarthy works on a computer as her husband, Joe, looks on. McCarthy, a mother of four, was first diagnosed with breast cancer at 44. Seven years ago, the disease returned in her bones, a condition that is not curable. (Katye Brier for KHN)

Lowering The Bar

FDA officials said there are good reasons why many promising cancer drugs lack evidence of improved survival.

Because some cancers grow slowly, it can take many years for a study to show whether a new drug helps people live longer, said Dr. Richard Pazdur, director of the FDA’s Oncology Center of Excellence. While individual drugs may only modestly improve survival, “when used sequentially or in combination, they can transform a disease,” Pazdur said.

The design of some cancer trials also can make it hard to tell if drugs help patients live longer. That’s because many trials now allow patients in the control group the opportunity to “cross over” to get the drug being studied, if preliminary data suggests it could help them, Pazdur said. While such crossover benefits people in the study, who are facing a life-threatening disease, it can lead to inconclusive findings.

Lastly, Pazdur said that overall survival rates also don’t reflect that fact that some drugs, such as targeted therapies for lung cancer, allow a subset of patients to do extremely well, surviving for years instead of months.

The number of patients with advanced melanoma who survive five years after diagnosis has increased from 5 percent before the advent of immune therapies to 30 percent to 40 percent today, said Dr. Steven O’Day, director of immuno-oncology and clinical research at the John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, Calif. Immune therapies work by stimulating a patient’s natural immune system to combat cancer cells.

“There is a lot of excitement about these [immunotherapy] drugs, and for good reason,” Schilsky said. “There’s no diminishing the progress that’s been made.”

The FDA wants to give patients the chance to benefit as soon as possible, rather than waiting for definitive proof of improved survival, Pazdur said. In some cases, the FDA requires pharmaceutical companies to perform long-term studies after drugs are approved, to measure whether drugs live up to their early promise.

But many of these studies never provide an answer, Zuckerman said. Once a drug is approved and is available to anyone, patients have no incentive to participate in a clinical trial. So studies can end with no clear conclusion.

In a 2015 study, Prasad looked at 36 drugs approved without proven survival advantages. More than four years later, only five had evidence of improved survival.

Otis Brawley, chief medical officer at the American Cancer Society, said he’s concerned that the FDA is lowering its standards.

“We’re getting less rigorous scientifically because we want to get these drugs out to people faster,” Brawley said.

Unless the FDA requires companies to provide survival data before approving a drug, “we may never have answers,” Zuckerman said. “We will have all of these expensive drugs on the market and we will never have the information we need about how well they work or even how safe they are.”

President Donald Trump has vowed to cut regulations at the FDA and recently told pharmaceutical industry leaders that he wants to further speed up the drug approval process.

Helpful Or Harmful?

Cancer patients, who are making decisions at a time of intense stress, don’t always understand the full risks and benefits of therapy, Brawley said. Studies suggest that both patients and doctors tend to overestimate drugs’ benefits, but underestimate their risks and side effects.

A study of 2,944 people in JAMA Internal Medicine found that 39 percent mistakenly believed the FDA only approves “extremely effective” drugs, while 25 percent mistakenly believed the agency only approves treatments without serious side effects.

Even doctors think “we are better than I actually think we are,” Brawley said. “The thought that these drugs could be harmful is foreign to them.”

Patients “see the survival benefit, and of course these are scared, desperate people trying to get themselves any chance they can get,” said Dr. Ellyn Lee, who guides patients about cancer treatments as director of Seattle’s Swedish Palliative Care Services. “However, the survival benefit is not often realized, or it’s three months of misery due to side effects and bankruptcy at the end. Is that really fair?”

One of the biggest recent changes at the FDA is that more drugs are being approved based on “progression-free survival” — medical jargon for the amount of time that patients live while their tumors are under control.

Because small changes in tumor size aren’t always clearly visible on scans, doctors consider tumors to be under control as long as they don’t grow more than 20 percent, Brawley said.

Doctors always hope that a drug that delays tumor growth will help patients live longer. But in a study published in 2015, Prasad found that most statistical analyses have found the link between progression-free survival and overall survival to be very weak.

Measures such as progression-free survival “are just a guess as to whether or not the drug actually works,” Brawley said. “The problem with approving a drug based on a progression-free survival is that you don’t know if the drug is actually doing anything positive for the patient.”

Brawley said he’s concerned that patients could be harmed by oncology drugs whose long-term side effects are unknown.

The drug Avastin, which was approved for breast cancer in 2008, without evidence that it improved survival, lost its approval three years later, after studies showed it did not help people live longer. The FDA concluded that life-threatening side effects, which included heart attacks, bleeding and high blood pressure, outweighed the drug’s benefits.

“There are all these drugs that we used for a long, long time, but we ended up taking them off the market because we finally realized they were harmful,” Brawley said. “We are setting ourselves up for that again.”

“Breast cancer doesn’t seem to have a road map to cure. It’s just a damn sneaky disease,” said Marlene McCarthy, 73, from Coventry, R.I. She lives with advanced breast cancer that has spread to her bones, a painful condition that makes it difficult to walk. She uses a cane to walk. (Katye Brier/for KHN)

“Breast cancer doesn’t seem to have a road map to cure,” said Marlene McCarthy. “It’s just a damn sneaky disease.” (Katye Brier for KHN)

McCarthy has been disappointed in the new cancer therapies she’s tried. The last drug that kept her tumors from growing was letrozole, which was approved in 1997. It kept McCarthy’s tumors under control for three years.

In 2015, after her tumors began growing again, McCarthy began a new breast cancer drug, called Ibrance. The FDA approved Ibrance because it improved progression-free survival by 10 months when combined with a standard hormonal therapy. Four months after McCarthy began the drug, however, scans found new bone tumors.

A spokeswoman for Pfizer, Sally Beatty, noted that Ibrance’s proven benefits have improved since then. In a study published in November, women taking the Ibrance combination lived 24.8 months with limited tumor growth, compared to 14.5 months for women who took the hormonal therapy alone.

McCarthy opted not to try another breast cancer drug, Afinitor, after doctors warned her that it posed too many risks. The FDA approved Afinitor in 2012 because it limited tumor growth for four months longer than placebo.

“That’s nothing to be excited about,” said McCarthy, who has four children and four grandchildren. “I want to live more than four months.”

But keeping tumors in check can be a huge help to patients, said Pazdur, who notes that there are many ways for drugs to help patients, even without extending life. Shrinking a bone tumor, for example, can relieve pain. Shrinking a lung tumor can make it easier for someone to breathe.

“Most patients are pleased if they go to the doctor and the doctor says, ‘Your scan says everything is stable. There are no new lesions,’” Schilsky said. “I’ve given that result to patients many times over the years and they are all happy about it. Are they as happy as they would be if the tumor were gone? Of course not. But being free from progression and otherwise feeling OK is not such a bad outcome.”

As someone with incurable cancer, McCarthy remains frustrated with the pace of progress. Scientists, she said, aren’t asking the right questions.

McCarthy said she wants researchers to focus on prevention of cancer, and to learn why breast cancers like her can remain dormant for years before suddenly reactivating. Her cancer, which was first diagnosed when she was 44, disappeared for two decades before reappearing in her bones.

“The status quo isn’t good enough,” said McCarthy. “I want us to have a breast cancer vaccine to prevent my granddaughter from getting cancer. I’ll be working for that with my dying breath.”

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation and coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Cost and Quality, Health Industry, Syndicate

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Longer Looks: The IUD Rush; The World’s Best Health Care System; Immigrant Doctors

Each week, KHN’s Shefali Luthra finds interesting reads from around the Web.

The Washington Post: The IUD Rush: Why Women Are Seeking Out Birth Control That Can Outlast A Presidency 
The day after President Trump’s inauguration, millions of women of all ages marched in the streets of major cities. In the past few months, there’s been another, quieter march that’s far more personal, yet still political. If you’re not a woman of childbearing age or a health-care provider, you might not have noticed it. Since the election, women have been seeing their gynecologists and visiting Planned Parenthood offices specifically to ask about birth control. (Lisa Bonos, 2/7)

The Atlantic: How The GOP Might Repair Obamacare Before Repealing It
Lamar Alexander’s preferred metaphor for the current state of the Affordable Care Act is that of a collapsing bridge. Rising premiums and fewer coverage options in many states have destabilized the law’s insurance exchanges, the veteran Republican senator argues, and Congress must step in to rescue consumers trapped in a system of dwindling and increasingly expensive health-care plans. (Russell Berman, 2/7)

Vox: A College Student Got Liquid Stitches And A Bandage At The ER. Then He Got A $2,783 Bill. 
Last summer, Matt Anderson cut his finger on a knife while doing dishes. He’s a college student, and his roommate, a biology major, suggested that he go to the emergency room. He had recently used the same knife to cut raw meat and thought Anderson’s finger might get infected. Anderson estimates he got to the emergency room around 11 pm. A nurse saw him shortly after midnight and cleaned his wound. A doctor came by a little later to apply liquid stitches to his finger. Anderson went home around 1 am. (Sarah Kliff, 2/6)

The Atlantic: Trump’s Immigration Ban Ignores Value Of Immigrant M.D.’s
Immigrants from seven majority-Muslim countries have a reprieve—for now at least. A federal judge in Washington blocked President Trump’s travel ban Friday night.That means that among other visa-holders, the 260 medical-school graduates from the affected countries who had applied for medical residency slots in the United States are temporarily able to travel to the U.S. and interview for positions. (Olga Khazan, 2/6)

BBC News: Why Don’t More African Americans Become Organ Donors? 
When her daughter, Thalya, was diagnosed with chronic kidney disease, Chantal Onelien’s initial reaction was shock. But, as Adam Harris reports, it was only the beginning of a long and difficult fight. Thalya, then only 13 years old, would need to begin dialysis immediately, and she would also need a new kidney. (2/6)

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: Malloy’s Budget For Conn. Includes Deep Cuts In Health, Social Services; Wis. Legislators Skeptical Of Walker’s Health Plan For Public Employees

Outlets report on news from Connecticut, Wisconsin, Arizona, Ohio, Massachusetts, New Hampshire, Michigan, Pennsylvania, Maryland, Florida, Texas and California.

The CT Mirror: Malloy Budget Hinges On Big Labor Savings, New Revenues 
Gov. Dannel P. Malloy unveiled a $40.6 billion two-year budget Wednesday that seeks $1.5 billion in labor concessions, imposes $400 million of annual pension costs on municipalities and reorganizes the financial relationship between the state, communities and hospitals. The governor also would increase taxes by close to $200 million, scaling back income tax credits for the middle class and working poor and boosting the cigarette levy by 45 cents per pack. (Phaneuf, 2/8)

The CT Mirror: How Health Care And Medicaid Fare In Malloy’s Budget 
About 9,500 parents would lose Medicaid, fewer seniors would receive home care, mental health and substance abuse treatment providers would receive millions of dollars less from the state, and school-based health centers would see a 10 percent funding cut under the budget plan Gov. Dannel P. Malloy proposed Wednesday. The plan aims to close a budget deficit projected at nearly $1.7 billion, and many of the individual cuts drew concern from providers and advocates for health and social service programs. Still, some said the plan left them more optimistic than had previous proposals by Malloy. (Levin Becker, 2/8)

Milwaukee Journal Sentinel: Republicans Resist Walker’s Insurance Plan
Gov. Scott Walker is banking on saving $60 million in taxpayer funds over two years by changing the way public employees get health insurance, but legislators are deeply skeptical of the proposal. In the state budget he unveiled Wednesday, the governor detailed plans to shift the state to a self-insurance system to cover employee health care costs. But his fellow Republicans who control the Legislature questioned whether the state could generate the savings Walker is counting on and said the change could hurt the insurance market for individuals and small businesses. Republican legislators have resisted the proposal in the past. (Marley and Stein, 2/8)

The Wall Street Journal: Report Cites Deficiencies At Theranos Lab
Theranos Inc.’s lab in Arizona failed to ensure some patients who got potentially inaccurate diabetes test results were notified, according to a federal inspection report obtained through a public-records request. The embattled Silicon Valley company also performed patient blood-coagulation tests on a machine its staff configured improperly, according to the report and the company’s response to regulators. (Weaver, 2/8)

Milwaukee Journal Sentinel: Two More Cases Confirmed In Mumps Outbreak At Marquette University
Two more Marquette University students who live in a residence hall have been diagnosed with mumps, bringing to three the total number of cases confirmed on campus since winter break…. The newly diagnosed students are recovering at home, and the Milwaukee Health Department is following up with those known to have come into close contact with them, Smith said in the email. Mumps is a viral infection spread through coughing, sneezing, talking or occasionally through utensils and cups. It also can be spread by touching unwashed, contaminated surfaces. (Herzog, 2/8)

Arizona Republic: Gov. Doug Ducey Wants 86K Arizona Newborns A Year Tested For This Disease
Hospitals on the reservation include SCID in their newborn screenings. But outside of the Navajo Reservation, Arizona does not screen newborns for the disease, a practice Gov. Doug Ducey wants to change this year in the hopes of giving children like Ava, now 3, a chance at lifesaving treatment. Left undetected, SCID can lead to repeated infections and even death. The screening costs about $6, and Arizona is one of three states across the U.S. that do not screen for SCID. (Wingett Sanchez, 2/8)

Cleveland Plain Dealer: Toledo City Council Bans ‘Conversion Therapy’ 
City Council voted unanimously Tuesday to ban “conversion therapy,” the controversial psychological treatment that attempts to change a person’s sexual orientation or gender identity. The legislation, approved by a 12-0 vote, makes conversion therapy a fourth-degree misdemeanor with an attached fine for each offense, according to the Associated Press. (Pinckard, 2/9)

Boston Globe: OSHA Cites Brookline Psychiatric Hospital 
Workplace safety inspectors have cited Arbour-HRI, a Brookline psychiatric hospital, after discovering that front-line employees suffered broken bones and concussions during interactions with violently ill patients. The Occupational Safety and Health Administration said the hospital “has not developed and implemented adequate measures to protect employees’’ from aggressive patients. Nurses and mental health workers were punched, hit, scratched, bitten, and hit with objects including a soda bottle and wooden dresser drawer, the federal agency said. (Kowalczyk, 2/9)

NH Times Union: Hampton Nursing Facility Denies Role In Death Of Elderly Woman
A Hampton nursing facility denies that it played any role in the death of an elderly woman whose family claims died as a result of a bad hair perm.The lawyer for Oceanside Center and Oceanside Healthcare and Rehabilitation Center disputes some of the allegations made in a wrongful death suit filed late last year following the death of 89-year-old Betty Pettigrew in 2015. (Schreiber, 2/8)

Detroit Free Press: Detroit Hospitals See Hope For Heart Attacks With New Pump
Five health systems in southeastern Michigan have joined forces to save heart attack victims, using a new tiny heart pump. Since July, doctors from Henry Ford Health System, Beaumont, DMC Heart Hospital, St. Joseph Mercy Health System and St. John Providence Ascension have used Impella pumps, inserted in cardiac patients dealing with cardogenic shock, which has led to an 80% survival rate. When in cardogenic shock, patients’ heart function plummets, which leads to low blood pressure and not enough blood flowing to vital organs. (Meyer, 2/8)

The Philadelphia Inquirer/Philly.com: Money Fight Starts In North Philly Health System Bankruptcy
There is not much money to fight over in the bankruptcy of North Philadelphia Health System, which owed $24.8 million to its 30 largest unsecured creditors, according to its Dec. 30 filing. That explains the intense interest in the $692,000 that NPHS received from a New Jersey trust last Thursday. Before a hearing on the matter Wednesday in Center City, NPHS and three creditor groups reached a preliminary deal, which they detailed in U.S. Bankruptcy Judge Magdeline D. Coleman’s courtroom. (Brubaker, 2/8)

The Baltimore Sun: Center For Health Security At Hopkins Awarded $16 Million Grant
The Center for Health Security at the Johns Hopkins Bloomberg School of Public Health will study biosecurity and pandemics with the help of a $16 million grant announced Wednesday. The three-year grant from the Open Philanthropy Project will help the center study responses to serious biological risks and how technology could change those risks, improve biosafety practices, and increase awareness of biosecurity and pandemic challenges, according to the center. (Wells, 2/8)

Tampa Bay Times: Hernando Residents Tapped To Participate In National Health, Nutrition Survey 
The National Health and Nutrition Examination Survey, ongoing in Hernando County through March 8, will result in some answers to such questions and, likely, in revised national standards and recommendations regarding diet and physical and mental health. In the survey’s 55th year nationwide, this appears to be the first time Hernando County residents have been sampled, officials said. (Gray, 2/9)

Austin American Statesman: Critics Accuse UT Medical School Of Misspending Local Tax Dollars
The University of Texas Dell Medical School has spent millions of dollars on administrative and educational expenses using local tax dollars that are supposed to go only for indigent care, two activists and a former state senator charged Wednesday in remarks before UT’s governing board. The allegations echo previous complaints but were delivered with a stronger assertion of misspending and more detail. They were leveled by former state Sen. Gonzalo Barrientos of Austin and two local lawyers, Fred Lewis and Bob Ozer. (Haurwitz, 2/8)

Los Angeles Times: Southern California Gas To Pay $8.5 Million To Settle Lawsuit Over Aliso Canyon Leak
Southern California Gas Co. will pay $8.5 million to settle a lawsuit filed by air quality regulators over the Aliso Canyon gas leak and will fund a study of community health effects. The settlement with the South Coast Air Quality Management District, announced Wednesday, resolves a dispute over the months-long leak of methane from the gas company’s Aliso Canyon storage facility above the Porter Ranch neighborhood of Los Angeles. (Barboza, 2/8)

Orlando Sentinel: Orlando-Area Doctors, Patients, Growers Have Their Say On Medical Marijuana Rules
Dozens of people with ailments including cancer, chronic pain and multiple sclerosis implored the Florida Department of Health on Wednesday night to loosen the regulations for medical marijuana and allow them to get treatment faster. Voters in November approved a constitutional amendment that allows doctors to recommend full-strength marijuana for a wide variety of ailments including glaucoma, HIV, AIDS, ALS, Parkinson’s disease, Crohn’s disease and PTSD. Now the department’s Office of Compassionate Use is scrambling to figure out how to regulate the drug within the required six months of the effective date of the amendment, which was Jan. 3. (Jacobson, 2/8)

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

Democrats Seek Answers Over Spike In Pricing For Overdose Antidote

“Such a steep rise in the cost of this drug threatens to price-out families and communities that depend on naloxone to save lives,” the senators wrote to the drugmaker.

Stat: Lawmakers Demand Info On Opioid Overdose Antidote After Price Hike
Once again, lawmakers are pressuring a company that sells a version of naloxone, a decades-old drug that is widely used to reverse the effect of opioid and heroin overdoses, to explain its pricing. A group of 31 US senators — all Democrats — sent a letter on Wednesday to Kaleo seeking pricing data about its Evzio treatment, along with production costs, donation programs, and reimbursement from federal health care programs. The letter was sent after the company recently began selling a stronger version of the antidote at an even higher price than an older version that contains less medicine. (Silverman, 2/8)

In other news on the opioid crisis —

The Baltimore Sun: Maryland Seeks To Curb Prescriptions For Addictive Painkillers 
Health officials say they’re clamping down on excessive prescriptions for opioids in the state’s Medicaid program — part of a larger effort to curb runaway addiction that often begins with painkillers. Under a policy that goes into effect in July, doctors in the program that serves one in five Marylanders will need prior authorization to write some prescriptions for the drugs. (Cohn, 2/8)

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Federal Appeals Court Grants Reprieve To Sanofi And Regeneron In Cholesterol-Drug Battle

In other pharmaceutical industry news, Gilead Sciences’ revenue problem, a status check of FDA user fees and Vice President Mike Pence’s position on right-to-try laws.

Stat: Sanofi And Regeneron Win A Reprieve In Cholesterol Drug Battle
In a dramatic development, Sanofi and Regeneron Pharmaceuticals can continue selling their cholesterol medicine while they fight an injunction that might force their drug off the market permanently, according to a federal appeals court ruling. The court suspended a permanent injunction that was issued last month by a lower court, and would have prevented the companies from marketing Praluent, a new type of cholesterol treatment. The injunction was issued in response to a jury verdict last year that found the drug infringed on patents held by Amgen, which sells a rival medicine called Repatha. (Silverman, 2/8)

The Wall Street Journal: Gilead’s Boom Fades And Bust Will Linger
Gilead Sciences, perhaps the company most responsible for powering the last biotech bull market, has a revenue problem on its hands. Its struggles highlight how quickly the moment of opportunity can pass for research-focused drug companies. Gilead announced Tuesday it expects between $7.5 billion and $9 billion in sales for its hepatitis C franchise this year, well below analyst expectations. Hitting the high end of that forecast would mark a 40% annual sales decline. As a result, total company revenues could be down more than 20% in 2017 from a year ago. (Grant, 2/8)

CQ Roll Call: FDA User Fees On Track Despite Health Law ‘Chaos’
Lawmakers are feeling pressure to turn to Food and Drug Administration legislation that Republicans and Democrats alike hope can be cleared quickly and with limited controversy, despite partisan debate over changes to the broader health system. Every five years Congress must renew the FDA’s ability to collect fees from some of the industries it regulates. The current authorization expires at the end of September. The fees total about $2 billion of the FDA’s $5 billion annual budget. (Siddons, 2/9)

Bloomberg: Dying Patients Have Pence’s Backing On ‘Right To Try’ Policy
Vice President Mike Pence may have just picked another fight with pharmaceutical companies — one that doesn’t involve drug prices. Pence is pushing for a nationwide law that would give terminally ill patients expanded access to experimental drugs that haven’t been approved yet but have made it through the first of three approval phases. The vice president had championed the so-called right-to-try issue while governor of Indiana and later on the campaign trail. (Edney, 2/8)

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Medicaid Managed Care Firm To Cut Reimbursements To Iowa Providers

Dozens of agencies that provide services to Medicaid enrollees with disabilities will be affected by the cuts announced by AmeriHealth Caritas, which is the largest of the three firms hired by the state to handle the Medicaid program. Managed care programs in Tennessee and California are also in the news.

Des Moines Register: Medicaid Shift: Agencies That Help Disabled Iowans Face Major Cuts
Dozens of agencies that assist thousands of Iowans with disabilities learned this week that they face significant cuts in how much they’re paid by a private company managing the state’s Medicaid program. Industry leaders said they fear some service agencies will go under because of the looming cuts from AmeriHealth Caritas. “It’s not a matter of whether we can be patient — we can’t pay our bills. You can’t pay staff with a wish,” said Linda Dunshee, executive director of Link Associates, which serves central Iowans with intellectual disabilities. (Leys, 2/8)

Nashville Tennessean: Health:Further To Aid TennCare’s Aim To Improve Member Communication
TennCare is enlisting Nashville’s health tech scene to find companies with technologies to improve communication with members. Health:Further, as part of the TennCare Innovation Program, will be using its in-house resources to find companies — whether a startup or mature firm — that can aid the managed care organizations that administer the state’s Medicaid program. The program is the first of its kind, said Marcus Whitney, CEO of Health:Further, a Nashville initiative that links startups, the established health care industry and policymakers to the disparate factors and sectors that impact health. (Fletcher, 2/8)

California Healthline: Industry Giants Anthem, Centene Among The Lowest-Rated Medicaid Plans In California
Anthem Inc. and Centene Corp., top players in the growing Medicaid managed care market nationally, run some of the lowest-quality health plans serving California’s poor population, according to state data. The two insurers combined run five of the six lowest-rated plans in the state’s Medicaid program, known as Medi-Cal. And until they improve the quality of patient care in some areas of the state, officials have placed both companies under stricter oversight. Together, the plans cover about 3 million people, or roughly 20 percent of the Medi-Cal population. (Terhune, 2/9)

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With An Eye On Doctor Shortages, AMA Asks Congress To Enact Law Protecting Immigrants

The BRIDGE Act would allow undocumented immigrants who meet DACA requirements to apply for protection from deportation and for work authorization for three years.

Modern Healthcare: AMA Letter To Congress Urges Protection For Some Immigrants 
In a letter sent Tuesday to members of Congress, the American Medical Association voiced support for the BRIDGE Act, a bipartisan bill aimed at providing protection to immigrants with Deferred Action for Childhood Arrivals status. It cast such protection as helping to shore up the physician workforce, which faces a looming shortage over the coming decades. The legislation, if enacted, would allow undocumented immigrants who meet DACA requirements to apply for protection from deportation and for work authorization for three years. Immigrants already protected under DACA would be able to apply for the same protections after their status expires. (Whitman, 2/8)

In other news —

WBUR: How An Advocate With Mass. Ties Is Helping The Family Of An Iraqi Toddler Awaiting Surgery Get Back To The U.S. 
Two-year-old Dilbireen Muhsin’s face was badly burned when a heater in the Iraqi refugee camp where he was living with his family caught fire last year. He is now awaiting a second surgery at Shriners Hospital for Children in Boston. But the operation is on hold because his parents can’t get back to the U.S. to be with him. Their visas were revoked after Dilbireen’s father returned to Iraq, to be there when his wife gave birth to another child. (Mullins and Joliocoeur, 2/8)

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Judge Nixes Anthem-Cigna Merger Over Anti-Competition Concerns

The ruling echoes an earlier case that rejected the proposed Aetna-Humana megamerger.

The Associated Press: Anthem-Cigna Health Insurance Merger Rejected By Judge
Predicting diminished competition and likely higher costs, a federal judge rejected Anthem Inc.’s bid to buy rival health insurer Cigna Corp. U.S. District Judge Amy Berman Jackson on Wednesday said the merger would significantly reduce competition in the already concentrated insurance market, particularly for large national employers. Cigna and Anthem are two of just four insurers selling to companies with 5,000 employees spread across multiple states, and they compete aggressively for business, the judge wrote. (Cooper, 2/9)

The New York Times: Judge, Citing Harm To Customers, Blocks $48 Billion Anthem-Cigna Merger
The ruling, by Judge Amy Berman Jackson of the Federal District Court for the District of Columbia, came two weeks after another federal judge blocked a proposed $37 billion merger between Aetna and Humana on antitrust grounds. Judge Jackson wrote in her order that she found the Justice Department’s arguments against the deal persuasive, and that putting Anthem and Cigna together would harm customers. (de la Merced and Picker, 2/8)

The Wall Street Journal: Federal Judge Blocks Anthem’s Planned Acquisition Of Cigna
“The evidence has also shown that the merger is likely to result in higher prices, and that it will have other anticompetitive effects: it will eliminate the two firms’ vigorous competition against each other for national accounts, reduce the number of national carriers available to respond to solicitations in the future, and diminish the prospects for innovation in the market,” Judge Jackson wrote. (Kendall and Wilde Mathews, 2/9)

Bloomberg: U.S. Health Insurance Mergers Killed As Companies Plot Moves
The question now becomes what the companies will do with the large piles of cash they allocated for the acquisitions, and whether they’ll try anew at fresh takeovers under a Trump administration, whose antitrust officials could be more amenable to large consolidations. They could also opt for something more conservative in the face of widespread uncertainty about the future of the U.S. health system. (Tracer, McLaughlin and Harris, 2/8)

Modern Healthcare: Judge Blocks Anthem-Cigna Merger 
The judge also said Cigna, which has long shown lukewarm commitment to the merger, is “actively warning against it.” During the trial, Cigna officials presented “compelling testimony” that undermined the projections of future savings that would result from the merger. The two also have deep disagreements in strategy. Anthem attempted to cast these differences as a “side issue,” according to the order. (Livingston, 2/8)

Politico: Judge Rejects Anthem’s $54 Billion Takeover Of Cigna
Anthem can appeal the ruling, but it faces a tight timeline. At the end of April, either of the merging companies can pull the plug on the deal, and Cigna is expected to do so immediately. That would trigger a $1.85 billion breakup fee that Anthem would owe to Cigna. This is the second blockbuster merger to be thwarted. Last month, Aetna’s $37 billion takeover of Humana was also blocked. (Demko, 2/8)

The Hill: Judge Blocks Anthem-Cigna Insurer Merger
Senate Majority Leader Mitch McConnell (R-Ky.) last year called the Aetna-Humana merger “the inevitable result of Obamacare’s push toward consolidation as doctors, hospitals, and insurers merge in response to an ever-growing government.” (Sullivan, 2/8)

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Georgia Legislative Panel Hears Concerns About Surprise Medical Billing

Physician, hospital and insurer groups each expressed concerns Tuesday about Georgia Senate legislation that aims to prevent “surprise billing’’ of patients, but perhaps the most compelling testimony came from a legislator’s wife.

The Senate Health and Human Services Committee heard testimony on a proposal to halt these medical bills, which can come from ER doctors, anesthesiologists, radiologists, pathologists and others who are not in a patient’s insurance network — even though the hospital where they work is.

Vicki Willard, wife of Rep. Wendell Willard, a Sandy Springs Republican, testified that in August, she went to Emory Saint Joseph’s Hospital after experiencing numbness in her cheek and arm.

She knew St. Joseph’s was in her insurance network. “I’m an educated advocate for my health care,’’ she told the panel.

But four weeks after her treatment there, Willard said, she received an unexpected $700 bill from a cardiologist.

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She then called her insurer. The first cardiologist who had seen her, she found out, was a network doctor. But a second cardiologist — the one who sent her the bill — wasn’t in her network, even though that doctor was in the same medical group as the other doctor.

“I have absolutely no control over that,’’ Willard said. “That’s extremely frustrating.”

Sen. Renee Unterman (R-Buford), a nurse who chairs the panel and sponsor of Senate Bill 8, said health insurers and medical providers can’t agree on a solution to the “complicated issue.’’

“It’s like putting cats and dogs in a room,’’ she said. “The one that suffers the most is the consumer.”

Beth Stephens of Georgia Watch, a consumer watchdog organization, said issues with medical bills were the No. 1 reason why consumers called her organization in 2016.

The two current proposals on surprise billing — Unterman’s in the Senate and one in the House — call for greater transparency about which doctors are in an insurer’s network and an estimated cost of the procedure.

The Unterman proposal would also create a database of reasonable charges for a procedure. If a bill is disputed, the insurer and doctor would have to work out a resolution.

“I have tried my best to be fair,’’ said Unterman. “To listen to both sides.”

Representatives from the insurance industry said that one database of rates that Unterman’s bill would use, Fair Health, should not be used as a benchmark for reimbursements because it’s too high.

Physician organizations have said they support Fair Health, and blamed “narrow’’ insurance networks for many instances of high non-network charges.

Hospital groups, meanwhile, said the transparency required to educate patients about network providers should be shared among hospitals, physicians and insurers.

Other states, including Florida, recently passed legislation to address the problem.

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

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Viewpoints: Anti-Vaxxers Vexed By Calif.’s Bill Of Rights For Kids; Defund Planned Parenthood? Consider The Texas Experience

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

Los Angeles Times: A Lofty — And Troubling — Proposed Bill Of Rights For California Kids
Sen. Richard Pan (D-Sacramento) hasn’t submitted the official text yet of his proposed California Children’s Bill of Rights, but already the protests have begun. Largely, they come from anti-vaccine parents who vehemently opposed Pan’s SB 277, the law passed in 2015 that requires almost all children who attend school to get their routine childhood vaccinations. (2/7)

The New York Times: How The Anti-Vaxxers Are Winning
It’s looking as if 2017 could become the year when the anti-vaccination movement gains ascendancy in the United States and we begin to see a reversal of several decades in steady public health gains. The first blow will be measles outbreaks in America. (Peter J. Hotez, 2/8)

The Washington Post: Defunding Planned Parenthood Was A Disaster In Texas. Congress Shouldn’t Do It Nationally.
The Trump administration and the Republican-controlled Congress are pushing to prevent Planned Parenthood from receiving federal funds to pay for contraception and cervical and breast cancer screenings. Funding for the federal Title X program, which provides infrastructure support to a network of nearly 4,000 clinics across the country, could also be in jeopardy. Five years ago, we learned in Texas what can happen when efforts to defund Planned Parenthood are carried out: The network of health-care providers falls apart and women lose access to essential preventive services. (Joseph E. Potter and Kari White, 2/7)

Austin American Statesman: Local, State Leaders Must Find Indigent Health Care Solutions
If societies were measured by the health care they provide their most vulnerable members, then Texas wouldn’t have a leg to stand on. That point was brought home on Sunday by American-Statesman’s Mary Ann Roser’s report that hundreds of low-income patients in Travis County have to wait more than a year to see a specialist. While many people with private insurance also face long waits for a specialist, the poor are hit hardest because fewer doctors are willing to accept lower payments associated with government-sponsored coverage, such as Medicaid. A shortage of physicians exacerbates the problem. (2/7)

WBUR: Disabled Children Stand To Lose In Political Upheaval 
A perfect storm of political challenges hovers darkly over disabled people, especially children. It shouldn’t come as a surprise that a president who would mock a journalist with a disability should now be responsible for the trifecta of disability rights upheaval. Congress just confirmed Betsy DeVos as education secretary, even though she made it clear that she knows little about special education. The Supreme Court is getting ready to decide how low we can place the special education bar and remain within the law. And Supreme Court nominee Neil Gorsuch has a record for taking an unfavorable view on disability issues. (Susan Senator, 2/8)

Cincinnati Enquirer: Ky. Bill Would Remove Barriers To Quitting Smoking
In Kentucky, you don’t have to look far to see the negative impacts of smoking. With more than a quarter of Kentuckians regularly lighting up, we consistently lead the nation in smoking rates. As an ear, nose and throat specialist, I have treated many patients suffering the physical consequences of smoking. … many insurers in Kentucky do not offer comprehensive, barrier-free smoking cessation coverage. This makes it extremely difficult for smokers to stay motivated to quit. Senate Bill 89 would ensure that physicians, not insurers, determine patient care. It would remove complicated barriers like prior authorization and step therapy that often inhibit patients from quickly and affordably getting the treatments they need. (Shawn Jones, 2/7)

Lexington Herald Leader: Say Yes To Smoke Free, No To Smokers As A Protected Class
It’s no surprise that the American Lung Association gave Kentucky straight “F’s” in its recent report card. Our state is the worst in the nation for smokers and cancer deaths. It has been that way for a long time. Because we are the worst, businesses moving into our state are surprised to find we allow employees to be subjected to the harmful effects of secondhand smoke. The majority of states now have smoke free laws in place. (Brent Cooper, 2/6)

Stat: The Day I Zipped My Lips And Let My Patients Talk
How long, I’ve sometimes wondered, would my patients actually talk if I didn’t say anything at all? According to a group of Swiss researchers, when doctors did not interrupt, the average duration of their patients’ monologues was 92 seconds. Not exactly the deluge of historic proportions that most physicians fear. … The day after reading that study I tried it out in my clinic. For each patient I saw, I quietly clicked on a stopwatch after saying, “How can I help you today?” My first patient took 37 seconds, the second 32. But these were basically healthy individuals. The third had more issues: unresolved back pain, plus his glucose, cholesterol, and weight were all creeping up. He took two minutes. (Danielle Ofri, 2/7)

Boston Globe: Trump Spills The Beans On Who Grows Americans’ Food 
Media pundits, academics, and commentators alike are scrambling to provide insights into the likely effects of President Trump’s policies. One of his most controversial policy goals concerns the mass deportation of millions of undocumented immigrants currently living and working in the United States. Experts have been grappling with how this policy will affect our food system and — most importantly — how much we will have to pay to put food on the table. (Sydney Giacalone and Julian Agyeman, 2/7)

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Perspectives: Reality Of Global Drug Pricing Is Much More Complex Than Trump Realizes

Read recent commentaries about drug-cost issues.

Stat: Dear Mr. President: Your Big Idea On Drug Pricing Is Half-Baked
Let’s be blunt: Your idea is half-baked. Why? Because it is much more complicated than you think. Unlike the United States, most other countries provide some form of insurance coverage for their populations and take responsibility for negotiating drug prices. Government agencies around the world have been pushing back against drug makers over the rising cost of medicines, a development that has proven not only popular with voters, but increasingly necessary given strained budgets. Some Americans, however, grumble that they are, in effect, subsidizing other countries. That may be true, but the US has failed to take any significant steps to lower prices. (Ed Silverman, 2/6)

Bloomberg: Trump Had One Good Idea. Then He Ditched It.
It wasn’t all that long ago — though it seems that way, admittedly, with the never-ending flood of Trumpian news — that I was prepared to acknowledge that President Donald Trump actually has a few good ideas. Or at least one. It was Tuesday morning. The new president was about to go into a meeting with chief executives from Johnson & Johnson, Merck and a handful of other major pharma companies. During his campaign, he often said that if he were elected, the federal government would start negotiating with the drug companies over the prices Medicare and Medicaid had to pay for drugs — something it’s now prevented from doing by statute. This is an issue that resonated with most Americans, the majority of whom want the government to do something about high drug prices. (Joe Nocera, 2/2)

The Washington Post: Trump Loses Backbone On Drug Prices. Is There A Pill For That?
Amid all the kerfuffle in the last week over immigration, the Supreme Court, Iran and Arnold Schwarzenegger’s TV ratings, too little attention was paid to an extraordinary meeting at the White House at which President Trump reneged on a campaign promise and sold out millions of “forgotten” Americans to giant drug companies. (Steven Pearlstein, 2/4)

St. Louis Post Dispatch: Trump Must Follow Tough Talk On Drug Pricing With Action
Another runaway drug-pricing problem is putting an easy-to-use version of naloxone, a life-saving drug that can reverse an opioid overdose, out of reach for most drug addicts, their families and first responders. The cost of an auto-inject version of the drug, specifically approved for people without medical training to use in life-threatening situations, has increased more than 500 percent to $4,500 since 2014. The wholesale price of insulin, a life-saving drug for some 1.25 million Americans who suffer from Type 1 diabetes, increased from $45 for a highly concentrated monthly form in 2001, to $1,447 last year. This is life and death for patients whose pancreases can’t make insulin. (2/5)

The Hill: Hate High Drug Prices? Blame Greedy Companies And Our Politicians
One might first think that Acthar was an ancient civilization in Mesopotamia or a prison facility in upstate New York. In fact, it is the most expensive drug for the U.S. government. In 2015, Medicare paid $504 million for H.P. Acthar Gel, an average of $162,300 per patient. So then it must at least be the hottest new drug for cancer or dementia, right? Not so, unfortunately. (Dr. Hagop M. Kantarjian and Michael A. Carrier, 2/1)

Houston Chronicle: Complicated, Expensive Drug Market Needs Simplification 
Production costs are rarely the key factor in determining a price, because when your life depends on a drug, you will pay almost anything to get it.Just ask the 8,000 people in the U.S. and Europe who suffer from paroxysmal nocturnal hemoglobinuria, a disease that destroys red blood cells at night, causing life-threatening clots, anemia and organ failure. Alexion Pharmaceutical’s drug Soliris is the only treatment available, and it can cost $440,000 a year, making it the most expensive drug sold in. (Chris Tomlinson, 2/7)

Bloomberg: Repatha Will Test The New Drug Pricing Reality
The epic battle between drug makers and the insurers and pharmacy benefit managers that pay for their medicines just opened a fascinating new front. Amgen Inc.’s earnings report Thursday afternoon was largely overshadowed by its announcement that its cholesterol-lowering drug Repatha succeeded in a clinical trial designed to prove it helps prevent heart attacks and other cardiovascular events. (Max Nisen, 2/3)

Conservative Review: Killing TPP Saved Poor Countries From High Drug Prices. How About Saving Ourselves?
Donald Trump is well known to be no fan of the Trans Pacific Partnership. In fact, one of his first acts as president was to issue a notice that the U.S. is withdrawing from the agreement, citing concerns that the deal is unfair to American workers. While Trump was focused primarily on the trade aspects of the deal, there are other provisions of the agreement relating to pharmaceuticals and intellectual property that should be just as worrying. Now, as President Trump expresses a wish to make prescription medicine more affordable, he would do well to apply the same skepticism he had for trade to the sweetheart deals Big Pharma has traditionally received from government. (Logan Albright, 2/5)

Bloomberg: Teva’s Dividend Should Follow Its CEO Out
When a CEO abruptly steps down after three years in charge, it’s a safe bet the new guy isn’t inheriting a corporate bouquet of roses. That’s certainly the case at generics giant Teva Pharmaceutical Industries Ltd. Erez Vigodman’s surprise exit Monday afternoon leaves interim CEO and ex-Chairman Yitzhak Peterburg with a struggling generics business, the likely loss of billions in sales from its best-selling product Copaxone after a court invalidated several patents, and a debt load that exceeds the company’s market cap. (Max Nisen, 2/7)

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Drugmakers Eager To Shift Focus From Price To Value

News outlets report on stories related to pharmaceutical drug pricing.

Stat: Trump’s Pharma Crusade Could Bring Changes Industry Wants
Congressman Greg Walden, a key House Republican for pharmaceutical policy, suggested this week that President Trump wants to encourage drug makers to enter value-based contracts with private health plans and the government insurance programs. Maybe that’s what the president has meant all along in his vague promises to change bidding and negotiations. (Scott, 2/3)

NPR: Trump Wants Medicare To Negotiate Drug Prices Directly With Drugmakers
Drug companies could be forgiven if they’re confused about whether President Donald Trump thinks the government should get involved in negotiating the price of prescription drugs for Medicare patients. … So on Tuesday, White House spokesman Sean Spicer cleared up the confusion, for now at least. When asked during his daily news briefing whether the president is in favor of having Medicare negotiate lower prices for prescription medicine, Spicer said, “He’s for it, yes. Absolutely.” (Kodjak, 2/7)

Bloomberg: Trump Sinks Pharma Stocks On Medicare Drug Price Negotiation
President Donald Trump supports Medicare drug price negotiations, his spokesman said Tuesday, remarks that sent pharmaceutical stocks swinging again as investors tried to assess whether drugmakers will be forced into bidding wars for government business. “He’s for it, yes,” White House spokesman Sean Spicer said at a press briefing in response to a question asking to clarify Trump’s position on the matter. Trump has given conflicting signals in the past weeks on whether he would let the government intervene directly in drug prices to reduce health-care costs. (Daurat and Olorunnipa, 2/7)

WBUR: Pfizer CEO On Trump, Drug Prices And The FDA 
President Trump made a campaign promise to lower the price of prescription drugs. After meeting with several big pharmaceutical companies last week, the president emerged with different plans to do that, from reducing taxes to cutting back regulations. Here & Now’s Jeremy Hobson speaks with Ian Read, the CEO of Pfizer, one of the biggest pharmaceutical companies in the world, about drug prices, the Food and Drug Administration and how Pfizer is adjusting to the new administration. (Hobson, 2/7)

The CT Mirror: Trump Attempt To Rein In Drug Prices May Have Limited Success 
President Donald Trump wants to stop the sharp hikes in prescription drug prices, but appears limited in what he can and will do. On the last day in January, Trump called the price hikes for medicine “astronomical” and met behind closed doors with chief executives from some of the nation’s biggest drug companies. (Radelat, 2/8)

Stat: In Germany, Pharma Groups Greet Trump’s Remarks With Scorn
American drug makers have been wary of criticizing President Trump for fear of provoking a nasty tweet. Here in Germany, however, the top trade groups for pharmaceutical industries have come out swinging — taking on the American president for both the tone and the substance of his remarks.Trump’s accusation that the drug industry is “getting away with murder” with sky-high prices has drawn particular scorn. (Feldwisch-Drentrup, 2/6)

CNBC: Drug Prices Rose 11 Percent Last Year, Providing Fuel For Both Sides Of Price Debate
Drug prices, on their face, rose by about 11 percent last year, according to Express Scripts, the largest U.S. pharmacy benefits manager. But costs for employers increased just 2.5 percent across all prescription drugs, Express Scripts said in its new Drug Trend Report, released Monday. The St. Louis-based PBM, which negotiates drug prices on behalf of insurers and employers, hailed the difference in figures as evidence that it saves the system money. (Tirrell, 2/6)

CBS News: Express Scripts CEO On PBMs And Rising Costs Of Drugs
Pharmacy benefit managers, or PBMs, negotiate drug prices directly with drug companies. They work on behalf of insurance and employer groups that pay for drugs. The companies act as middlemen and collect rebates and other fees. PBMs say they are the ones trying to lower drug prices. Tim Wentworth, CEO of Express Scripts — the largest PBM — joins “CBS This Morning” to discuss rising drug prices and what role they play in the debate. (2/7)

The Fiscal Times: Drug Prices Are Soaring: Here’s Why You May Not Get The Meds You Need 
The base price of the most commonly used brand-name drugs rose on average by nearly 11 percent in 2016, providing added grist to the debate over the need for government intervention to slow the rate of growth of pharmaceutical prices and eliminate blatant price gouging. A new study released on Monday by Express Scripts, a major pharmacy benefit management services based in St. Louis, found that the average price of brand name drugs has steadily risen by more than 200 percent since 2008, far outpacing the 11 percent overall cost-of-living increase during the same period. (Pianin, 2/6)

Stat: Another Channel For Pharma Lobbying: Political Groups With No Limits
Last year PhRMA announced plans to save its political spending for lobbying against federal efforts to fight rising drug prices. But the pharmaceutical industry group found giving to political groups known as 527s a good way to channel money to political party operations in the states. Federal election reports filed for the end of 2016 show that PhRMA gave more than $1.77 million to Republican groups, including GOPAC, which supports both federal and state candidates. PhRMA donated slightly over $1 million to Democratic groups. (Kaplan, 2/1)

Bloomberg: Big Pharma’s Offer To Trump: Discounts When Drugs Don’t Work
President Donald Trump says drug prices are astronomical and something needs to be done. Pharmaceutical giants have an answer that doesn’t involve lowering list prices: refunding some of the money to insurers if a drug doesn’t work as expected. The concept of pay-for-performance isn’t new in the industry. But the number of such agreements between drugmakers and insurers has grown in the past year as Big Pharma seeks to defuse criticism over the soaring prices of some brand drugs, which can cost $10,000 a month or more for cancer treatments. (Hopkins, Langreth and Paton, 2/6)

Bloomberg BNA: No Dearth Of Legislation On Tackling High Drug Costs
Lawmakers are pushing various ideas to combat high prescription drug prices. Some lawmakers have already introduced legislation or said they plan to introduce legislation on this issue. Solutions include allowing Medicare to negotiate with pharmaceutical manufacturers to lower prices, increasing access to generic drugs and importing less expensive drugs from other countries. (Mixter, 2/7)

Stat: Lilly Cuts 200 R&D Jobs, But Says An Alzheimer’s Failure Not Why
On the heels of a recent failure of an Alzheimer’s drug clinical trial, Eli Lilly is eliminating about 200 research and development jobs, a company spokeswoman confirmed, although she maintained the cuts are strictly an effort to fine-tune its workforce and are not related to the recent flop. (Silverman, 2/3)

Stat: Former Life-Sciences General Counsel Wins Whistleblower Case
In an intriguing case, a federal court jury awarded nearly $8 million to the former top lawyer at a small life sciences company, who claimed he was fired after reporting that bribes were paid in China. The verdict, which was handed down on Monday, capped an unusual episode that was being closely watched by lawyers and companies nationwide, not just the pharmaceutical industry, because of an unusual twist — the former general counsel was also the whistleblower. It also arrives as a growing number of drug makers have been fined for paying bribes in foreign countries. (Silverman, 2/7)

Boston Globe: Second Cambridge Biotech Worker Faces Insider Trading Charge 
Federal prosecutors have charged a former Merrimack Pharmaceuticals Inc. employee with conspiracy, part of a larger case alleging that another local biotech worker used confidential information about drug studies to buy stock. Songjiang Wang of Westford was arrested Tuesday on a charge of conspiracy, according to court records. His attorney did not respond to a message seeking comment Tuesday afternoon. (Woodward, 2/7)

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State Highlights: Ga. Lawmakers Wrestle With Surprise Medical Billing Solution; In N.H., Dartmouth-Hitchcock Cancer Center Gets OK In Dispute Over Fundraising Cash

Outlets report on news from Georgia, New Hampshire, New York, Florida, Virginia, Wisconsin, Ohio, New Jersey and California.

Atlanta Journal Constitution: Surprise Billing For Medical Care Gets Georgia State Senate Hearing
Surprise billing of medical patients – when people go to a hospital in their insurance network but get surprised by a bill from an out-of-network doctor anyway – is a big problem. Legislators are still wrestling with a solution. On Tuesday the state Senate’s Health and Human Services Committee met to discuss one proposal on surprise billing: Senate Bill 8, sponsored by the committee’s chairwoman, Renee Unterman, R-Buford. (Hart, 2/7)

Atlanta Journal-Constitution: What’s Happening Today At The Georgia Legislature?
The House and Senate will be back in session at 10 a.m. today. The House has several insurance bills on its calendar, including House Bill 74, which would help identify troubled insurance companies. The Senate has a couple of minor bills requested by the state Department of Agriculture, including SB 69, which would eliminate a requirement for organic companies to register annually with the state since federal law requires them to register annually with the USDA. (Galloway, 2/8)

Atlanta Journal Constitution: Medical Marijuana Bill Passes Georgia Senate Committee
Georgia’s limited medical marijuana law would be expanded to include autism, under legislation passed Tuesday in a state Senate committee. Senate Bill 16 is the first of several bills dealing with the law’s expansion to move this year, although medical marijuana advocates oppose the bill because it would also roll back the maximum THC level in the cannabis oil now allowed here. (Torres, 2/7)

New Hampshire Union Leader: Report: Cancer Center Can Use Fundraiser For Operating Costs
Dartmouth-Hitchcock’s Norris Cotton Cancer Center properly used $6.1 million raised for cancer research, a state regulator has ruled, in a dispute that led its former director to file a whistleblower lawsuit. Thomas Donovan, head of the state Justice Department’s Charitable Trusts Unit, said the fundraising dollars, including money from the center’s signature fundraiser, The Prouty, were directed to be used for the cancer center’s benefit. The review did not find language restricting the gift from being used for the center’s operations, according to Donovan. (Cousineaug, 2/7)

New Hampshire Union Leader: State Numbers Show A Slow Start To Winter Stomach Bug
The mild winter has meant less shoveling, fewer warm layers and something else — fewer outbreaks of the dreaded winter stomach bug. Beth Daly, chief of the state’s Bureau of Infectious Disease Control, said there’s been only 15 reported outbreaks of norovirus illness since December. The norovirus season usually runs from December until March and produces approximately 70 outbreaks, Daly said. While the numbers seem to be lower than usual, Daly said it’s too soon to predict if this season will be an easier one on Granite Staters’ bellies. (Grosky, 2/7)

The Associated Press: Company Accused Of Scamming 9/11, NFL Concussion Victims
A company that promised sick 9/11 responders and NFL players with concussion injuries that it could “cut through red tape” to get their payouts faster lured them into advances that meant hundreds of thousands of dollars in illegally high interest and fees, authorities said Tuesday. In a lawsuit filed Tuesday, New York’s attorney general and the Consumer Financial Protection Bureau allege that New Jersey-based RD Legal Funding and its founder Roni Dersovitz snared 9/11 responders who are struggling with cancer and respiratory illness as well as former NFL players with brain injuries into taking costly advances on their settlements. (Sweet, 2/7)

Miami Herald: Florida Marijuana Rules Too Restrictive, State Told In Fort Lauderdale 
New medical marijuana regulations proposed by state health officials would block patients from timely and affordable access to medication, restrict physicians in treating their patients, and potentially undercut the development and distribution of quality medicine, an overflow crowd told Florida Department of Health officials Tuesday morning in Fort Lauderdale. (Smiley, 2/7)

Richmond Times Dispatch: Culpeper Cardiologist Accused Of Striking Hospital Nursing Director 
A Culpeper cardiologist faces a misdemeanor assault and battery charge stemming from a reported confrontation with a female nursing director inside Novant Health UVa Health System Culpeper Medical Center last week. According to the official criminal complaint filed in Culpeper County General District Court, Dr. Zia Roshandel, 47, of Blue Ridge Cardiovascular Associates is accused of hitting Irene C. D’Gama in the shoulder following what she described as a heated argument inside her office Thursday. (Simmons, 2/7)

The Associated Press: Clinic Falsely Told Dozens They Had Alzheimer’s, Suits Say
Shawn Blazsek knew a string of concussions from high school football and boxing was catching up with him. He would go days without sleeping and was forgetting how to tie his shoes. Still, at age 33, he was stunned after being told he had Alzheimer’s disease. He started planning out who would take care of his four kids if something happened to his wife, and thought about how hard it would be for them when he could no longer recognize his family. So he stuffed fistfuls of sleeping pills into a bottle and wrote himself a note, vowing to swallow all of them when he wasn’t able to remember the names of his children. That day never came. (Seewer, 2/8)

The Associated Press: Dozens Plead Guilty, But Doctor Goes To Trial In $200M Fraud
Details of a long-running health care kickback scheme that allegedly featured prostitutes, cash-stuffed envelopes and private jet junkets began to unfold in federal court Tuesday as a 79-year-old physician went on trial. Dr. Bernard Greenspan isn’t alleged to have engaged in any of the seamier activities surrounding now-defunct Biodiagnostic Laboratory Services, but prosecutors painted him as eager to accept about $200,000 in bribes from the company over several years in exchange for sending his patients’ blood samples there. (Porter, 2/7)

San Jose Mercury News: Stanford Team Is Growing Healthy Skin For Diseased Patients
Small sheets of healthy skin are being grown from scratch at a Stanford University lab, proof that gene therapy can help heal a rare disease that causes great human suffering. The precious skin represents growing hope for patients who suffer from the incurable blistering disease epidermolysis bullosa — and acceleration of the once-beleaguered field of gene therapy, which strives to cure disease by inserting missing genes into sick cells. (Krieger, 2/7)

Miami Herald: Fugitive Who Fled To Cuba To Evade $130 Million Healthcare Fraud Case Arrested At MIA 
Soon after the feds broke up a family-run chain of clinics that tried to steal $130 million from Miami-Dade Public Schools and a string of major U.S. companies, a trio of Cuban immigrants fled to Mexico and eventually back home to the island. For almost two years, the chain’s boss, Reynaldo Castillo, and his right-hand man, Jose Gerardo Gonzalez, hid in Cuba. Castillo and Gonzalez were wanted for their leading roles in an indictment charging a total 16 defendants with healthcare fraud in March of 2015. (Weaver, 2/7)

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

Americans Say Their Number 1 Concern Is Health Care Costs

A Monmouth University poll finds that health care costs outrank terrorism or crime as a worry for families. Also, a Harvard health care researcher finds that high deductibles can have a very personal effect, and lawmakers in Georgia weigh efforts to stop surprise medical bills for consumers.

McClatchy: Americans More Worried About Health Care Cost Than Other Concerns 
American families aren’t as worried about terrorism or crime as they are about paying their health care bills, a new poll suggests. Health care costs have emerged as the No. 1 concern for American families, according to a new national Monmouth University poll. Health care costs outranked a variety of other concerns that registered in the single digits, including college tuition and taxes. (Clark, 2/7)

Asbury Park Press: Poll: Health Care Cost Tops Americans’ Biggest Concerns
National security and immigration have been taking up much of the spotlight lately with Donald Trump in the White House, but what has Americans worried the most is their health care, according to a new Monmouth University Poll. About 25 percent of respondents in a nationwide poll said the cost of health care was the biggest concern facing their family, a 10-point jump over a similar poll conducted in 2015. By contrast, national security and immigration — issues that jumped to the forefront during the chaotic first weeks of the Trump administration — ranked very low in the survey. (Davis, 2/7)

Kaiser Health News: With A High Deductible, Even A Doctor Can Short Change His Health
All the doctor’s tricks were failing him. He’d tried neck massage, pressure to the eyes, ice on the face. But an hour in, Ashish Jha still couldn’t slow his racing heart. His wife asked what he’d recommend if a patient called with the same problem. “I said, ‘Oh, that’s easy.’ Go to the emergency department.” As a physician, Jha knew this tachycardia could possibly lead to a heart attack. Yet he felt caught by a decision he’d made in enrolling his family in a so-called high-deductible insurance plan. (Gorenstein, 2/8)

Georgia Health News: Senate Panel Hears Surprising Testimony On Surprise Medical Bills 
The Senate Health and Human Services Committee heard testimony on a proposal to halt these medical bills, which can come from ER doctors, anesthesiologists, radiologists, pathologists and others who are not in a patient’s insurance network — even though the hospital where they work is. “It’s a very complicated issue,’’ said Sen. Renee Unterman (R-Buford), who chairs the panel and is a nurse by profession. She is the sponsor of Senate Bill 8. Health insurers and medical providers can’t agree on a solution, she said. (Miller, 2/7)

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

HHS Pick Price Made ‘Brazen’ Stock Trades While His Committee Was Under Scrutiny

Health and Human Services secretary nominee Tom Price showed little restraint in his personal stock trading during the three years that federal investigators were bearing down on a key House committee on which the Republican congressman served, a review of his financial disclosures shows.

Price made dozens of health industry stock trades during a three-year investigation by the Securities and Exchange Commission that focused on the Ways and Means Committee, according to financial disclosure records he filed with the House of Representatives. The investigation was considered the first test of a law passed to ban members of Congress and their staffs from trading stock based on insider information.

Price was never a target of the federal investigation, which scrutinized a top Ways and Means staffer, and no charges were brought. But ethics experts say Price’s personal trading, even during the thick of federal pressure on his committee, shows he was unconcerned about financial investments that could create an appearance of impropriety.

“He should have known better,” Richard Painter, former White House chief ethics attorney under President George W. Bush and a professor at the University of Minnesota Law School said of Price’s conduct during the SEC inquiry.

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As Price awaits a Senate vote on his confirmation, Senate Democrats and a number of watchdog groups have asked the SEC to investigate whether Price engaged in insider trading with some of his trades in health care companies. Price has said he abided by all ethics rules, although he acknowledged to the Senate Finance Committee that he did not consult the House Ethics Committee on trades that have now become controversial.

The SEC’s inquiry began in 2013, as it battled Ways and Means for documents to develop its case.

A few weeks ago, the day before President Donald Trump’s inauguration, the SEC quietly dropped its pursuit of committee documents without explanation, according to federal court records. No charges were brought against the staffer, Brian Sutter, who is now a health care lobbyist. Sutter’s lawyer declined to comment.

Craig Holman, government affairs lobbyist with Public Citizen, described Price’s volume of stock trades during the SEC inquiry as “brazen,” given the congressman’s access to nonpublic information affecting the companies’ fortunes.

“The public is seeing this and they really don’t like it,” said Holman whose watchdog group recently filed complaints about Price’s stock trading with both the SEC and the Office of Congressional Ethics.

Trump administration officials and Price have dismissed questions that news reports and lawmakers have raised about stock trades coinciding with official actions to help certain companies, saying Price’s brokers chose the stocks independently and all of his conduct was transparent.

After acknowledging that he asked his broker to buy stock in an Australian drug company, he told the Senate Finance Committee that he did not direct his broker to make other trades.

“To the best of my knowledge, I have not undertaken such actions,” he wrote in response to finance committee questions. “I have abided by and adhered to all ethics and conflict of interest rules applicable to me.”

An analysis of Price’s trades shows that he bought health stocks in 2007, the first year Congress financial disclosures are posted online. In 2011, the the first year Price sat on the health subcommittee, he traded no health-related stocks, according to his financial disclosures filed with Congress.

That same year, members were facing public criticism because of a book detailing how they could use inside information and a “60 Minutes” investigation focused on how members and staff could legally use inside information to gain from their own stock trades.

In 2012, President Barack Obama signed the Stop Trading on Congressional Knowledge Act to rein in insider trading by members and require more disclosure. Public watchdog groups suggested at the time that the law would curb the practice.

That year, after his one-year break in health care trades, Price resumed investing in health care companies.

Along with investments in technology, financial services and retail stocks, he also bought and sold stock in companies that could be impacted by actions of his subcommittee, which has a role in determining rates the government pays under the Medicare program.

Health care firms spend heavily to influence members of Congress, lobbying on health matters, funding political campaigns and seeking favor with Medicare officials who decide how much the program will pay for certain drugs and devices. The Food and Drug Administration holds similar power, approving or putting conditions on drug and device use.

Beyond his personal investments in health care companies, Price has also advocated their interests in letters to officials and proposed laws, government records show.

In 2012, disclosure records show Price sold stock in several drug firms, including more than $110,000 worth of Amgen stock. Amgen’s stock price had steadily climbed out of a recession-level slump, but Price’s sale came a few weeks before the company pleaded guilty to illegally marketing an anemia drug.

By 2013, the health subcommittee was at the center of a major conflict between Medicare, which sets Medicare Advantage rates, and the insurance industry. Medicare issued a notice early that year announcing its intention to reduce Medicare Advantage rates by 2.3 percent as part of a major cost-cutting initiative.

That prompted fierce lobbying by the health insurance industry. Members of Congress, including Price, wrote a letter to Marilyn Tavenner, then acting administrator for the Centers for Medicare & Medicaid Services, protesting the rate cut, saying the decrease would “disadvantage vulnerable beneficiaries with multiple chronic conditions.”

Ultimately, Medicare decided not to cut rates but instead, to increase them. Yet an hour before Medicare announced the change, a Height Securities analyst fired off a “flash” report to 200 clients that touched off a surge of trading.

The analyst’s report said a political deal was hatched on Capitol Hill to prevent the cuts as a condition for moving forward on Tavenner’s confirmation. Medicare officials increased rates by nearly 4 percent, a change that would positively impact the bottom lines of health insurance companies.

The SEC began looking for the leak’s source, and within weeks, FBI agents began interviewing staffers at the Ways and Means Committee, court records show.

They discovered communications between Sutter and a health care lobbyist. The HHS Inspector General also began a probe, and federal prosecutors briefly examined the matter activity as well.

As the case unfolded, Price bought more health care-related stocks, according to his financial disclosures. He has testified that his broker directed all of the trades, except for his investments in Innate Immunotherapeutics, an Australian company partly owned by Rep. Chris Collins (R-N.Y.), according to Collins’ disclosures. An HHS spokesman said Monday that Price held three broker-directed accounts.

Ethics experts have said that Price should have further distanced himself by placing his assets in a blind trust.

On April 30, 2013, Price bought $2,093 worth of stocks in Incyte, a company that develops cancer drugs; $2,076 in Onyx Pharmaceuticals, a drugmaker that would soon merge with a larger drug firm; and $2,097 in Parexel International, a consultancy that helps drugs and devices win FDA approval, according to the financial disclosure records.

The same day, Price shed shares of Express Scripts, a drug management firm, and Danaher, which makes products hospitals and doctor’s offices using for testing and diagnostics. In August of that year, he bought a $2,429 stake in Jazz Pharmaceuticals, which makes sleep and cancer drugs.

On May 6, 2014, the SEC served its first subpoena for the Ways and Means Committee documents. The committee launched a vigorous fight, appealing a federal district judge’s ruling that it should comply with the SEC subpoena.

Price continued his health stock trades, including $1,000 to $15,000 in drug firms Amgen, Eli Lilly and Co., Pfizer, Biogen and Bristol-Myers Squibb. He also bought stocks in Aetna, a major health insurer, and Athenahealth, which sells electronic medical record and medical billing software. In 2016, he also increased his investment in Innate Immunotherapeutics.

The purchase became controversial because both he and Collins bought stock in a private placement at a discounted price.

“You’re asking for trouble if you have access to nonpublic information about the health care industry and you’re buying and selling health care stocks,” Painter said.

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