Tagged Insurance

Viewpoints: Executive Orders, Obamacare Replacements And Cold, Hard Facts; Medicare’s Challenges In Health Law Debate

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

The Wall Street Journal: The ObamaCare Holdouts
Republicans are getting battered at town halls on ObamaCare, with constituents — or least protestors — yelling about the benefits they’ll lose if the entitlement is repealed. But maybe the better measure of public sentiment is the choices that the people who are subject to ObamaCare have made in practice. (2/23)

The New England Journal Of Medicine: Trump’s Executive Order On Health Care — Can It Undermine The ACA If Congress Fails To Act?
Within hours after taking the oath of office, President Donald Trump executed his first official act: an executive order redeeming his campaign pledge to, on “day one,” begin repeal of the Affordable Care Act (ACA). The New York Times characterized his action as itself “scaling back Obamacare,” and the Washington Post said the order “could effectively gut [the ACA’s] individual mandate” to obtain health insurance coverage. But consumer advocate Ron Pollack dismissed Trump’s action as “much ado about very little.” To put these divergent assessments into perspective, it’s important to examine the actual executive order, recognize the departures from the Obama administration that it contemplates, and assess the scope and significance of changes the administration can lawfully make by executive order or other administrative actions. (Timothy Stoltzfus Jost and Simon Lazarus, 2/22)

Vox: John Boehner Told Republicans Some Inconvenient Truths On Obamacare
Didn’t Boehner hold repeal vote after repeal vote? Didn’t he win back the House in 2010, and hold it thereafter, promising to repeal Obamacare? Didn’t he participate in the government shutdown over Obamacare in 2013? He did. But to interpret Boehner generously, Obamacare is in a very different place now than it was in 2010, 2012, or even 2013. It’s delivering benefits to about 30 million people. Dozens of states have built budgets around Medicaid dollars flowing in from the federal government. Health systems nationwide have reorganized themselves around its provisions. (Ezra Klein, 2/23)

RealClear Health: Repeal & Replace: Missing The Medicare Forest For The Obamacare Trees
The Trump Administration has promised to deliver to the American people a healthcare plan that is, in President Trump’s own words, “much less expensive and far better” than Obamacare. But While Obamacare is expected to spend over $900 billion from 2018 to 2027, focusing solely on the Obama administration’s signature achievement ignores bigger fiscal challenges; Namely, the Medicare program. (Yevgeniy Feyman, 2/24)

Tribune News Service/Lincoln (Neb.) Journal-Star: A Simple Solution On Health Care
But the largest contributing factor to the voter anger directed at Republican senators and representatives didn’t require sly scheming — because it is very real, and even frightening to many voters. They are frightened about what they are NOT hearing from Trump and most Republicans in Congress about what will happen when they succeed in repealing President Obama’s Affordable Care Act. Republicans haven’t shown voters how they will replace it or sufficiently addressed what its elimination might mean to middle class folks who voted for Trump as an act of blind trust. (Martin Schram, 2/24)

Topeka Capital Journal: Medicaid Expansion Lives In Kansas
Considering how much disagreement there is on the economic and practical dimensions of Medicaid expansion – as well as the massive impact it has on the people of Kansas – didn’t it deserve a full debate in the Legislature? To Ward, Rep. Susan Concannon (a Beloit Republican who introduced the Medicaid amendment to HB 2044) and the legislators who voted in favor of expansion: Thank you for representing the interests of your fellow Kansans. While we’re not saying legislators should vote for a bill simply because it’s popular, they do have a responsibility to take their constituents’ concerns seriously and give critical issues their full attention. The lawmakers who tried to kill the Medicaid expansion bill in committee did the opposite. (2/23)

The New England Journal Of Medicine: Protecting The Tired, The Poor, The Huddled Masses
During Donald Trump’s presidential campaign and transition period, I worried that the climate of xenophobia and the widespread misunderstanding of the immigrants and refugees already in our country would dissuade others from seeking asylum here. … as a person who believes that health is a human right and that ensuring basic human rights promotes health, I remain terrified for the world’s well-being. The suspension of the U.S. Refugee Admissions Program for 120 days was poorly planned and discriminatory, and it has only intensified the fear and anxiety of people who are fleeing terror, bombings, domestic abuse, and other types of persecution because of their religion, sexual orientation, or ethnic background. … Moreover, many U.S. clinicians have noted that their patients who are already here are refraining from seeking the medical care they need or using other vital public services for fear of being incarcerated and deported. (Katherine Peeler, 2/22)

The Washington Post: Sean Spicer Seemed To Tie Marijuana Use To Opioids. The Evidence Isn’t On His Side.
The epidemic of opioid addiction in the United States has been well documented. A staggering 33,000 people died in 2015 from overdosing on prescription painkillers, heroin or similar drugs, on par with the number killed by firearms and in car accidents. The epidemic is growing, but its general causes are not in dispute. Nearly all research on the issue shows that excessive and improper prescriptions are what’s causing more people to become addicted. But White House press secretary Sean Spicer on Thursday appeared to link the surge in opioid abuse to another factor: recreational marijuana use. (Derek Hawkins, 2/24)

Milwaukee Journal Sentinel: Try Something New To Deal With Drug Crisis
In 2016, Milwaukee County saw a record high in deaths from drug overdoses, when at least 340 people died. Many of the drugs involved in this crisis such as oxytocin, vicodin and oxycodone are at first prescribed legally to treat physical pain. When users become addicted and lose avenues to these prescribed drugs, they often turn to illegal drugs. Bravo to Gov. Scott Walker, who has called for a special session of the Legislature to address this crisis. (Jerry Schultz, 2/23)

Stat: The Power — And The Fear — Of Knowing Your Cancer Genome
When it comes to cancer, all knowledge is power — even when that knowledge is scary. Knowing as much as you can about cancer lets you and your health care team act decisively in devising your treatment strategy. Even more important, it lets you act specifically in selecting treatments or clinical trials that might be best in treating your disease. … For me, learning everything about my disease has been essential to discovering how to attack and treat my cancer and, I believe, why I went into a surprising but welcome long-lasting remission. (Kathy Giusti, 2/23)

The New England Journal Of Medicine: The Perils Of Trumping Science In Global Health — The Mexico City Policy And Beyond
During his first week in office, President Donald Trump reinstated an executive order banning U.S. aid to any international organization that supports abortion-related activities, including counseling or referrals. The so-called Mexico City Policy — colloquially referred to as the “global gag rule” on women’s reproductive health — is allegedly intended to reduce the number of abortions around the world, in accordance with an antiabortion agenda. Scientific evidence suggests, however, that the policy achieves the opposite: it significantly increases abortion rates. The policy defunds — and in so doing, incapacitates — organizations that would otherwise provide education and contraceptive services to reduce the frequency of unintended pregnancies and the need for abortions. (Nathan C. Lo and Michele Barry, 2/22)

Seattle Times: Ethics And Trust Paramount In Physician, Patient Relationship
dramatic and complex changes in the health-care environment have placed a strain on medical professionalism and on physicians’ ability to exercise independent clinical judgment. We must ensure that doctors’ professionalism and independent judgment remain protected, even in our quest to have a healthy bottom line. (Jennifer Lawrence Hanscom, 2/22)

The New England Journal Of Medicine: Recreational Cannabis — Minimizing The Health Risks From Legalization
The cannabis-policy landscape is undergoing dramatic change. Although many jurisdictions have removed criminal penalties for possessing small amounts of cannabis and more than half of U.S. states allow physicians to recommend it to patients, legalizing the supply and possession of cannabis for nonmedical purposes is a very different public policy. Since the November 2016 election, 20% of the U.S. population lives in states that have passed ballot initiatives to allow companies to sell cannabis for any reason and adults 21 or older to purchase it. Although other states may move toward legalization, uncertainty abounds because of the federal prohibition on cannabis. The Obama administration tolerated these state laws; it’s unclear what the Trump administration will do. (Beau Kilmer, 2/22)

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

Research Roundup: Beverage Tax In Mexico; Health Care Access Survey; State Marketplaces

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

Health Affairs: In Mexico, Evidence Of Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax
Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages on January 1, 2014, and a previous study found a 6 percent reduction in purchases of taxed beverages in 2014. In this study we estimated changes in beverage purchases for 2014 and 2015. We used store purchase data for 6,645 households from January 2012 to December 2015. … Purchases of taxed beverages decreased 5.5 percent in 2014 and 9.7 percent in 2015, yielding an average reduction of 7.6 percent over the study period. Households at the lowest socioeconomic level had the largest decreases in purchases of taxed beverages in both years. … Findings from Mexico may encourage other countries to use fiscal policies to reduce consumption of unhealthy beverages. (Cochero et al., 2/22)

Morbidity and Mortality Weekly Report/CDC: Surveillance for Health Care Access and Health Services Use, Adults Aged 18–64 Years — Behavioral Risk Factor Surveillance System, United States, 2014
This report summarizes 2014 BRFSS [Behavioral Risk Factor Surveillance System] data from all 50 states and the District of Columbia on health care access and use of selected [clinical preventive services]. … The findings … indicate substantial variations in health insurance coverage; other health care access measures; and use of CPS …. In 2014, health insurance coverage, having a usual source of care, having a routine checkup, and not experiencing unmet health care need because of cost were higher among adults living below the poverty level (i.e., household income <100% of FPL) in states that expanded Medicaid than in states that did not. Similarly, estimates of breast and cervical cancer screening and influenza vaccination were higher among adults living below the poverty level in states that expanded Medicaid than in states that did not. (Okoro et al., 2/23)

Pediatrics: Pediatric Resident Burnout And Attitudes Toward Patients
Burnout occurs in up to 75% of resident physicians. Our study objectives were to: (1) determine the prevalence of burnout, and (2) examine the association between burnout and self-reported patient care attitudes and behaviors among pediatric residents. … A total of 39% of respondents … endorsed burnout. Residents with burnout had significantly greater odds … of reporting suboptimal patient care attitudes and behaviors, including: discharging patients to make the service more manageable … not fully discussing treatment options or answering questions …, making treatment or medication errors …, ignoring the social or personal impact of an illness …, and feeling guilty about how a patient was treated. (Baer et al., 2/23)

The Kaiser Family Foundation: Pre-ACA Market Practices Provide Lessons For ACA Replacement Approaches
One of the biggest changes that the ACA made to the non-group insurance market was to eliminate consideration by insurers of a person’s health or health history in enrollment and rating decisions. … Proposals for replacing the ACA such as Rep. Tom Price’s Empowering Patients First Act and Speaker Paul Ryan’s “A Better Way” policy paper would repeal these insurance market rules, moving back towards pre-ACA standards where insurers generally had more leeway to use individual health in enrollment and rating for non-group coverage. … [This discussion] focuses on some of the issues faced by people with health issues in the pre-ACA non-group insurance market. These pre-ACA insurance practices highlight some of the challenges in providing access and stable coverage for people and some of the issues that any ACA replacement plan will need to address. (Claxton, Levitt and Pollitz, 2/16)

Brookings: How Has Obamacare Impacted State Health Care Marketplaces?
[O]ur five states had four years of experience in the open enrollment periods from 2014 through 2017. The states array themselves in a continuum of apparent success in enhancing and maintaining competition among insurers. California and Michigan appear to have had success in nurturing insurer competition, in at least the urban areas of their states. Florida, North Carolina, and Texas were less successful. This divergence is recent, however. As recently as the 2015 and 2016 open enrollment periods, all of the states had what appeared to be promising, if not always robust, insurance competition. Large changes occurred in the run-up to the 2017 open enrollment period. (Morrisey et al., 2/9)

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

CNN: Chronic Knee Pain Eased With The Help Of Skype
Exercise, an online pain-coping skills program and Skype sessions with a physiotherapist helped relieve patients’ chronic knee pain, according to a study published Monday in the journal Annals of Internal Medicine. … The new study was designed to investigate “the efficacy of a combined internet delivered treatment package including education, Skype-delivered exercise physiotherapy and an Internet-based interactive pain-coping skills training program,” said Kim Bennell, lead author of the study and a research physiotherapist and professor at the University of Melbourne. (Scutti, 2/20)

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

Extension On Non-ACA Compliant Plans Could Undermine Efforts To Stabilize Markets

The CMS issued the ruling Thursday to allow grandmothered plans to operate until Dec. 31, 2018. Meanwhile AHIP President Marilyn Tavenner and American Hospital Association President Rick Pollack talk about fixing the marketplace for individuals.

Modern Healthcare: Will CMS’ Decision To Extend Non-ACA Compliant Plans Help Or Hurt The Market? 
The Trump administration will allow insurers and consumers to extend for an additional year individual and small-group health plans that do not comply with the Affordable Care Act’s coverage rules. The insurance industry lobbied for the grandmothering extension. But some experts say it will hurt efforts to stabilize the individual market and moderate rate hikes by letting healthier people stay in plans outside the ACA-regulated insurance pool…It’s estimated that fewer than one million people currently remain in grandmothered individual-market plans in the three dozen or so states that still allow them. The rest of the states, including California and New York, already halted the sale of non-ACA compliant plans to strengthen their ACA-regulated markets. (Meyer, 2/23)

Modern Healthcare: Tavenner, Pollack Ask That ACA Replacement Plan Tackle Individual Markets First, Medicaid Later
If the Trump Administration and Congress repeal the Affordable Care Act, they ought to first fix the marketplace for individuals and put off the contentious debate of Medicaid reform for many months, two leading health association presidents said Thursday. Speaking at a Nashville Health Care Council luncheon, American Hospital Association President Rick Pollack and Marilyn Tavenner, president of the America’s Health Insurance Plans, agreed that the individual insurance market was unstable before the ACA and it remains so. Of the millions of newly insured on the exchanges, 70% are receiving subsidies to be able to afford coverage, Tavenner said. (Barkholz, 2/23)

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

Uncertainty Over Health Law Repeal Throws Taxpayers For A Loop This Season

As Americans are filing their taxes, many are confused about what they have to divulge about their health insurance status.

Politico: Obamacare’s Limbo Befuddles Taxpayers
Republicans’ stalled campaign to repeal the Affordable Care Act is sowing confusion among those now trying to do their taxes. Many taxpayers believe Republicans have already repealed the law, tax preparers say, and they’re surprised and upset to learn they are still subject to Obamacare’s penalty for failing to have health insurance — a charge that climbed this year to more than $2,000 per family. (Faler, 2/23)

California Healthline: To Pay Or Not To Pay – That Is The Question
K.A. Curtis gave up her career in the nonprofit world in 2008 to care for her ailing parents in Fresno, which also meant giving up her income. She wasn’t able to afford health insurance as a result, and for each tax year since 2014, Curtis has applied for — and received — an exemption from the Affordable Care Act’s coverage requirement and the related tax penalty, she says. This year, given President Donald Trump’s promise to repeal the ACA, along with his executive order urging federal officials to weaken parts of the law, Curtis began to wonder whether she’d even have to apply for an exemption for her 2016 taxes. (Bazar, 2/24)

Meanwhile, the threat of repeal hangs heavy over those who rely on the health law —

The Washington Post: Cancer Patients, Survivors Fear GOP Efforts To Dismantle The Affordable Care Act
Ashley Walton was 25 when a mole on her back turned out to be melanoma. She had it removed, but three years later she discovered a lump in her abdomen. She was then unemployed and uninsured, and so she put off going to a doctor. She tried to buy health insurance. Every company rejected her. By the time Walton finally sought medical help, the melanoma had spread to her brain, lungs and elsewhere. And she eventually became eligible for California’s Medicaid program, which had been expanded under the Affordable Care Act. Two major surgeries, radiation and immunotherapy did not cure the cancer — but did beat it back. (McGinley, 2/23)

Kaiser Health News: Threat Of Obamacare Repeal Leaves Community Health Centers In Limbo
Treating people for free or for very little money has been the role of community health centers across the U.S. for decades. In 2015, 1 in 12 Americans sought care at one of these clinics; nearly 6 in 10 were women, and hundreds of thousands were veterans. The community clinics — now roughly 1,300-strong — have also expanded in recent years to serve people who gained insurance under the Affordable Care Act. (2/24)

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

Viewpoints: Taking Stock Of The GOP Repeal-Replace-Repair Effort; Anti-Vaxxers See A Friend In President Trump

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

The Washington Post: Republicans Suddenly Realize Burning Down The Health-Care System Might Not Be A Great Idea
The Republican effort to repeal the Affordable Care Act is not going well, in large part because it turns out that making sweeping changes to a system that encompasses one-sixth of the American economy turns out to be rather more complicated than they imagined. Their backtracking has an interesting character to it, in particular how they’ve been gobsmacked by the transition from shaking their fists at the system to being responsible for it. (Paul Waldman, 2/22)

JAMA Forum: Replacing ACA Would Harm Economically Vulnerable Persons And The Health Care Safety Net
The US Congress recently took its first steps toward repealing the Affordable Care Act (ACA). The Congressional Budget Office projected that repeal would increase the number of uninsured by 18 million people initially, and by 27 million after funding for Medicaid expansion and subsidies are eliminated. Repealing the ACA also threatens the safety net critical to health care access for economically vulnerable individuals and families. (Roy Grant, 2/20)

The Washington Post: Under Trump, Obamacare’s Medicaid Enrollments May Actually Go Up
Much of the media coverage and public political battle has focused on regulations and subsidies that impact middle America and those with coverage. The program targeted at the poor — Medicaid —has received less attention but demands more. For now, it looks as if the Republican Congress will end up leaving the structure of Obamacare’s expanded Medicaid program intact and that Tom Price — President Trump’s secretary of health and human services — will use his administrative powers to grant states greater discretion in running their Medicaid programs. (Timothy Callaghan and Lawrence R. Jacobs, 2/22)

Modern Healthcare: Fierce Medicaid Critic Joins Trump’s ACA Repeal Team
A fierce critic of Medicaid expansion has joined the White House team working on repealing and replacing the Affordable Care Act. White House staffers are expected to play a key role in helping craft the upcoming budget reconciliation bill to repeal and replace the ACA. One of those key aides is Brian Blase, who recently left the conservative Mercatus Center at George Mason University to serve as health policy adviser to Gary Cohn, director of President Donald Trump’s National Economic Council and former president of Goldman Sachs. (Harris Meyer, 2/22)

The New York Times: The Anti-Vaccine Movement Gains A Friend In The White House
Vaccine opponents, often the subject of ridicule, have found fresh energy in the election of a president who has repeated discredited claims linking childhood immunizations to autism and who has apparently decided to pursue them. With President Trump’s support, this fringe movement could win official recognition, threatening lives and making it urgent that health officials, educators and others respond with a science-based defense of vaccines. Vaccines have saved lives by protecting children and adults from diseases like measles, polio, smallpox, cervical cancer and whooping cough. And there is no evidence whatsoever that vaccines or a preservative used in flu shots cause autism. (2/23)

JAMA Forum: Vaccines And The Trump Administration
Writing recently in the New York Times, infectious disease physician Peter Hotez warned: “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.” (Joshua M. Sharfstein, 2/22)

Stat: Scientists Can’t Cower In The Face Of Trump Policies That Threaten Research
Fear of speaking and debating openly on controversial issues and inquiry is antithetical to science. So it has been chilling for me to listen to the fear expressed by medical students, resident physicians, faculty members, and administrators engendered by Trump’s actions. I’ve heard medical students say they are worried about speaking out because they might be branded as “activists” by residency programs. Faculty members worry about how their opposition to the Trump agenda may be perceived by philanthropists who fund their work. Administrators fear overstepping the line in response to Trump and struggle to balance supporting their staff’s concerns about how new policies affect their colleagues and families while avoiding perceived political conflict. (Duncan Maru, 2/22)

JAMA: Revamping the U.S. Federal Common Rule: Modernizing Human Participant Research Regulations
On January 19, 2017, the Office for Human Research Protections (OHRP), Department of Health and Human Services, and 15 federal agencies published a final rule to modernize the Federal Policy for the Protection of Human Subjects (known as the “Common Rule”).1 Initially introduced more than a quarter century ago, the Common Rule predated modern scientific methods and findings, notably human genome research. (James G. Hodge and Lawrence O. Gostin, 2/22)

The Washington Post: A Health-Care Change That Could Prove Catastrophic
While a handful of high-profile policy questions have preoccupied Americans since the election, one potentially catastrophic health-care change has quietly been taking shape without much media attention. The Accreditation Council for Graduate Medical Education — the professional body charged with overseeing the nation’s physician training programs is poised to eliminate the 16-hour limit on work shifts for first-year resident physicians (referred to as interns) that it implemented in 2011. It proposes allowing interns to return to working extreme shifts of 28 hours — twice each week. (Christopher P. Landrigan and Charles A. Czeisler, 2/22)

Bloomberg: That Free Health Tracker Could Cost You
Using big data to improve health might seem like a great idea. The way private insurance works, though, it could end up making sick people — or even those perceived as likely to become sick — a lot poorer. Suppose a company offers you an insurance discount and a free FitBit if you agree to share your data and submit to a yearly physical. You’re assured that the data will be used only in aggregate, never tied back to specific identities. If that makes you feel safe, it shouldn’t. (Cathy O’Neil, 2/23)

The Washington Post: If Abortion Rights Fall, LGBT Rights Are Next
We represent the organizations that won leading Supreme Court cases in recent years on sexual and reproductive rights: Obergefell v. Hodges in 2015, which secured legal protections for the marriage of same-sex couples, and Whole Woman’s Health v. Hellerstedt in 2016, which struck down Texas’s attempt to use sham health regulations to shut down 75 percent of the state’s abortion clinics. President Trump has taken sharp aim at the rights affirmed in those cases. During the campaign, he attacked the Obergefell opinion and repeatedly and unambiguously promised to put justices on the Supreme Court who would overturn Roe v. Wade. According to the president, it’s the government, not each individual, that should hold the power to decide who can get married and whether women can terminate a pregnancy. (Nancy Northup and Rachel B. Tiven, 2/22)

The Des Moines Register: Lawmakers, You Still Owe Us For Illegal Health Plans
Iowa Code allows state lawmakers to enroll in health insurance plans offered to executive branch employees “excluded from collective bargaining.” Those workers pay 20 percent of the total cost of their monthly premium. A few weeks ago, The Des Moines Register reported that legislators are instead enrolled in health plans negotiated by unions on behalf of union-covered state employees. Many lawmakers are paying as little as $20 in monthly premiums when they should be paying hundreds of dollars. (2/22)

Louisville Courier-Journal: Dangers Lurking In E-Cigs
During my nursing career, I have come across numerous heroes, but my first was Surgeon General Everett Koop. More than 50 years ago, he published the first report on Smoking and Health. … Today, my new hero is another Surgeon Gen. Vivek Murthy, who released the first report on E-cigarette Use Among Youth and Young Adults in December 2016. We now have data and ammunition to halt the debate that e-cigarettes are harmless. The report lays out in clear, indisputable terms that e-cigarette use increases the risk of nicotine addiction, harm to brain development and future use of other tobacco products for young users. (Janie Heath, 2/22)

The Washington Post: Helmets Save Lives So Why Don’t All States Require Them?
A new report from the World Health Organization suggests we’ve made some progress in reducing traffic fatalities through seat belt laws, improved highway and vehicle design, and campaigns to reduce drunk or drug-impaired driving. But motorcycles are bucking the trend, even in the world’s wealthiest and most developed countries, including the United States. (Fredrick Kunkle, 2/22)

Stat: Global Health Is An Investment We Can’t Afford To Pass Up
More than at any time in history, good health for all is a real possibility. The technology, scientific advancement, and remarkable understanding of disease now available to the medical and nursing community show the progress we have made. As a career physician, I have seen modern medicine rescue people from the brink of death with the power of machines, medicines, and smart minds. The successes aren’t just in developed countries — they’re global. For example, the number of people newly infected with HIV around the world has stopped growing. There are now 18.2 million people undergoing treatment for HIV, up from 15.8 million in the last year alone. Equally encouraging, new infections in children are down 50 percent since 2010. (Vanessa Kerry, 2/22)

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

State Highlights: In N.Y., Cuomo Feels Push Back On Proposed Public Health Program Cuts; Texas Lawmakers Revisit Bid To Crack Down On Bad Nursing Homes

Outlets report on news from New York, Texas, Arizona, Florida, California, Pennsylvania, Massachusetts, Louisiana, Connecticut, New Hampshire, Iowa and Ohio.

Houston Chronicle: Lawmakers Renew Effort To Crack Down On Bad Nursing Homes
Two years after falling short in a high-profile bid to crack down on bad nursing homes, some Texas state lawmakers are trying again. State Sen. Charles Schwertner kicked off the effort by introducing a trio of bills to make it harder for nursing homes and other long-term care facilities and home and community services agencies to avoid discipline and lawsuits when they are found to have done wrong. (Rosenthal, 2/22)

Arizona Republic: Arizona Senate OKs Bill That Would Let Providers Opt Out Of ‘Right To Die’ Efforts​
Despite growing concerns that Arizona legislation to protect the religious freedoms of health-care workers could undermine patients’ end-of-life decisions, the Senate approved the bill Wednesday. Senate Bill 1439, which is sponsored by Sen. Nancy Barto, R-Phoenix, and pushed by the conservative Center for Arizona Policy, would protect from discrimination a health-care provider that refuses to participate in any service or provide any item that results in the death of an individual. (Beard Rau, 2/22)

Health News Florida: PTSD Coverage For First Responders Could Expand Under New Bill 
Democratic State Senator Victor Torres filed a bill Tuesday to allow first responders to get worker’s compensation coverage for post-traumatic stress disorder. The bill makes PTSD and mental conditions more easily eligible, and it removes the requirement that first responders also be hurt physically. Jessica Realin’s husband was diagnosed with PTSD after cleaning up the Pulse Night Club tragedy. (Aboraya, 2/22)

KQED: After Introduction Of New Bill, Nurses Rally For Universal Health Care 
Chanting “Medicare for all is our fight, health care is a human right,” nurses and healthcare activists rallied in Sacramento Wednesday to support a new bill that would create universal health coverage for Californians. State Senators Ricardo Lara (D-Bell Gardens) and Toni G. Atkins (D-San Diego) introduced Senate Bill 562 last week. The bill would cover all residents of the state, even those who are undocumented. (Klivans, 2/22)

The Philadelphia Inquirer/Philly.com: Nurses At Delaware County Memorial Call Two-Day Strike
Nurses at Delaware County Memorial Hospital will go on strike for two days next month to protest stalled labor contract bargaining and unfair labor practices, the Pennsylvania Association of Staff Nurses and Allied Professionals said Wednesday. The union, known as PASNAP, won the right a year ago to represent 370 registered nurses and technical employee at the Drexel Hill facility, which was purchased in July 2016 by Prospect Medical Holdings Inc. as part of the hedge-fund backed firm’s acquisition of Crozer-Keystone Health System. (Brubaker, 2/22)

Boston Globe: Doctor Says He Brought Needed Care To Bermuda 
When he returned to his native Bermuda in the early 1990s to open a medical clinic, Dr. Ewart Brown felt as if he had stepped back in time. On the small island, care that was readily available to patients he treated in one of LosAngeles’s poorest neighborhoods was out of reach. That stark portrait eventually led Brown to a partnership with Lahey Hospital and Medical Center — one that is now the subject of a civil racketeering lawsuit that has uncovered a little-noticed relationship between the Burlington-based hospital and the small British territory. (Murphy and Dayal McCluskey, 2/23)

New Orleans Times-Picayune: These High-Tech Mannequins Help LSU Medical Students Learn How To Save Your Life
…Faculty and staff at LSU’s Health Sciences Center (HSC) considered the flight simulators used by airplane pilots. The LSU team realized that a similar training system could be used in medical education, in order to more efficiently and ethically judge students’ competency. As a result, in 2001, LSUHSC began using high-tech medical mannequins to simulate human patients. LSU faculty and staff helped develop life-size mannequins that breathe and blink, have heartbeats and blood pressure, talk and even have names. The mannequins are programmed to simulate various medical conditions and injuries, allowing medical students to engage with mock patients in a low-risk, controlled environment. (Harrison, 2/22)

The CT Mirror: School-Level Immunization Data Could Be Released Under Proposal 
Wondering how many children at your kid’s school aren’t vaccinated? If you live in Connecticut, there’s no way to find out.But that could change under a legislative proposal favored by the state Department of Public Health, which is currently prohibited from releasing data on immunization rates by school. The state health department already gets data from schools on the number of vaccine-exempt students, the number who have been fully immunized and those who have received some but not all vaccines. (Levin Becker, 2/22)

Tampa Bay Times: In Harm’s Way: Gun Injuries And Deaths Among Florida Kids Have Spiked. One Child Is Shot Every 17 Hours.
Gun injuries are a growing problem for Florida’s children, rising along with the increasing availability of firearms across the state, the Tampa Bay Times has found. To determine how many kids are shot each year — accidentally, intentionally or during the commission of a crime — the Times looked at millions of hospital discharge records for patients across Florida, as well as data collected by the state’s 24 medical examiners. The analysis found that, between 2010 and 2015, nearly 3,200 kids age 17 and under were killed or injured by firearms. Put another way, a child in Florida was shot, on average, every 17 hours. (McGrory and Humburg, 2/23)

New Hampshire Union Leader: Iranian Doctor At Dartmouth-Hitchcock Reunites With His Wife 
A resident doctor at Dartmouth-Hitchcock Medical Center said he was “shocked, relieved, happy” when he was able to hug his Iranian wife Wednesday for the first time in nine months. Dr. Omid Moghimi said President Trump’s ban on residents of seven countries to travel to the United States meant his wife, Dorsa Razi, couldn’t get her final immigration interview in late January or a required visa needed to come to the United States. But a federal court blocked the travel ban, giving her a reprieve to gain the necessary approvals. Moghimi said he had worried he might not see his wife “for several more months if not for a year. (Cousineau, 2/23)

Columbus Dispatch: Fifth Child Dies As Flu Spreads Across Ohio
Despite the relatively mild 2016-2017 winter so far, Ohio is close to matching the number of children — six — who died during the 2014-15 flu season. One child died last flu season and none in 2013-2014. Adult flu deaths are not reported in Ohio, and health officials could not release whether the children who died had received a flu vaccine. (Viviano, 2/22)

The Philadelphia Inquirer: Chronic Pain Considered For Medical Marijuana Use In New Jersey
Chronic pain may be added to the list of ailments that qualify for medical marijuana treatment in New Jersey, according to the chairman of a Health Department advisory panel that took emotional testimony from patients Wednesday in a crowded meeting room at the War Memorial. The panel will decide in the coming months whether to recommend that the health commissioner expand the list, which now has about a dozen ailments, including terminal cancer, multiple sclerosis, and epilepsy. (Hefler, 2/22)

Iowa Public Radio: Medical Marijuana Bill Advances; Similar Bill Failed Last Year 
Patients and their advocates made a return trip to the Iowa Capitol Wednesday, arguing once again for the legalization of medical marijuana in Iowa. A new bill is under consideration in the House to regulate the growing, manufacturing, and distribution  of cannabis oil. This is a working vehicle. -Rep. Jared KleinEarlier legislation is about to expire. It allows epilepsy patients to travel out of state to acquire the drug, which has created numerous obstacles. (Russell, 2/22)

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Viewpoints: Health Policy Moves Back To Town Halls; GOP Wrestles With Medicaid Debate

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

Chicago Tribune: To The GOP On Obamacare: This Spud’s For You
Health care policy as a political hot potato has become a popular metaphor. Writers at Vox, CNBC, the American Constitution Society and elsewhere have compared Obamacare to a fresh-from-the-oven tuber that’s too painful to hold and must be tossed back across the aisle as quickly as possible. Noting growing concerns about inherent flaws in the complex structure of Obamacare — formally known as the Patient Protection and Affordable Care Act — libertarian Bloomberg View columnist Megan McArdle argued in a Feb. 15 essay that Congress is no longer “arguing about whether (and how) the exchanges can be saved, but playing hot potato as both parties vie to avoid being stuck with the blame for the ensuing disaster.” Nice try. (Eric Zorn, 2/21)

Roll Call: Town Hall Winners And Losers So Far
We’re halfway through the Presidents Day recess, the first during President Donald Trump’s first term in office. … it’s no surprise that town halls would become a focal point for the anger swirling on the left. Some members have plainly refused to meet with groups they think will be hostile to them. Others have flung open the sashes and let the emotions fly. Others have worked assiduously to restrain something that is inherently not theirs to control — the reaction of voters to their government’s actions in Washington. With half of the recess still left to play out, here are the winners and losers so far. (Patricia Murphy, 2/22)

The Wall Street Journal: Repeal And Replace Panic
In the 2009 ObamaCare debate, White House aide David Plouffe told nervous Democrats “no bed-wetting,” meaning keep calm and all will be well. House Democrats went on lose 63 seats in 2010, but the double irony is that Mr. Plouffe’s advice now applies to those reporters and liberals who seem to be invested in the failure of the GOP’s version of health-care reform. Every day brings a new story about Republicans in disarray, the “mirage” of the GOP’s reform and the impossibility of change. … The reality is that Congress is on schedule, progress is underway, and the many potential problems are avoidable. (2/21)

Forbes: Cassidy-Collins Patient Freedom Act Looks Better As Other Reform Efforts Falter
In a different political climate, the “Patient Freedom Act” introduced last month by Republican Senators Bill Cassidy and Susan Collins would be getting close scrutiny and perhaps some significant support. It is — and I apologize for language that appears to have become profane in these polarized times — a compromise. The bill recognizes that an outright repeal and replacement of Obamacare is going to be politically challenging for at least the next two years. It likewise recognizes that the persistence of Obamacare nationwide is likely to be challenging and expensive. (Seth Chandler, 2/21)

Bloomberg: A GOP Tax Idea Would Upend Health Insurance 
Last week brought thwarted mergers, threats by insurers to leave the Affordable Care Act’s individual exchanges, and the release of a (very) rough sketch of a possible GOP repeal-and-replace plan for the ACA. What’s missing in that skeletal outline is how to pay for new initiatives, such as an expanded tax credit to help people buy insurance, while also repealing the new taxes established by the ACA. Some in the GOP are floating one possible solution: capping the federal tax breaks workers and companies get for employer-provided health insurance. (Max Nisen, 2/21)

WBUR: Caring For Immigrant Patients When The Rules Can Shift Any Time
Knowing patients’ immigration status and the reasons they came to this country can affect the services they are eligible for, the relative costs of medications, the fears that may keep them from returning for needed services, and even the diagnosis of unexplained symptoms. Immigration policy, Marlin told us, “is no longer a spectator sport” for us or for our patients. But it is not simple to practice medicine under these new and uncertain circumstances. (Elisabeth Poorman, 2/21)

Bloomberg: ‘Right To Try’ Laws Don’t Help The Dying 
A national “right to try” law, supported by Vice President Mike Pence and scores of Republicans in the the House and Senate, is meant to circumvent the FDA’s regulatory authority by giving patients who are terminally ill the right to use drugs that the agency hasn’t yet approved. The idea sounds reasonable; in the past few years, bipartisan majorities in two-thirds of state legislatures have passed essentially the same law. In reality, however, these laws give patients no new rights at all. They do nothing to compel drug makers to provide experimental medicines to the dying, or insurers to pay for them. They merely eliminate a patient’s right to sue for any injuries that might arise — that is, if any patient ever gets an untested drug in this way. (2/21)

Boston Globe: Did Dana-Farber Pay Too High A Price For Its Mar-A-Lago Fund-Raiser?
When asked why he robbed banks, the legendary bank robber Willie Sutton said, “Because that’s where the money is.” That’s also why the Dana-Farber Cancer Institute holds fund-raisers at Mar-a-Lago, the posh Palm Beach resort that serves as President Trump’s Florida home. It’s where the money is. The most recent gala, held over the past weekend, raised $2.2 million. All for a good cause. But at what cost? (Joan Vennochi, 2/21)

St. Louis Post-Dispatch: Turn Off The Drug Spigot In The St. Louis Region
Heroin and opioid overdoses have increased to the point where they claim more lives regionally than homicides. State and local lawmakers need to focus greater efforts on combating a growing epidemic. Gov. Eric Greitens’ pledge to help create a statewide prescription drug database is a good start, but a more comprehensive law enforcement effort would go even further to push down the number of drug-related deaths. (2/21)

Pittsburgh Post-Gazette: Overprescribed: Curbing The Easy Fix Of Psychiatric Meds For Seniors
With many communities still struggling to manage the opioid epidemic, the last thing the nation needs is a new drug-related problem — the overprescribing of psychiatric and other medications to senior citizens. A new report in the journal JAMA Internal Medicine raises a red flag about the trend, saying it appears to be particularly common in rural areas where patients with symptoms of mental illnesses might have less access to talk therapy and other nondrug treatments. But even in these communities, there are alternatives to medications that can and should be explored. (2/20)

Stat: Patient Reviews Published Online Can Help Improve Health Care
It’s no secret that the US health care system needs to improve. Consumers — in this case patients and employers — have more collective power to influence change than they realize by choosing how, where, and from whom they get health care. Uber, Nordstrom, and many other companies seek their customers’ opinions and respond to them. Health care needs to follow suit to become the patient-centered service industry that it should be. The University of Utah, where I work, began collecting patient feedback early on and was the first health system in the US to publicly post patients’ reviews of their providers. It has paid off in many ways. (Vivian S. Lee, 2/21)

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State Highlights: N.H. Health Budget Would Give Nurses A Raise; Texas Lawmaker Moves To Outlaw Guns At State Mental Hospitals

Outlets report on news from New Hampshire, Texas, Florida, Oregon, California, Missouri and Minnesota.

New Hampshire Union Leader: DHHS Budget Calls For $10M In Raises For Nurses 
A 15 percent raise for nurses working in the Department of Health and Human Services will cost the state $10 million over the next two years, but is necessary to attract and retain health care professionals in an increasingly competitive market, according to Health and Human Services Commissioner Jeffrey Meyers. The head of the state’s biggest agency presented a $1.4 billion two-year spending plan for fiscal years 2018-2019 to House budget-writers on Tuesday. He said increased pay for nurses and other providers is a top priority. (Solomon, 2/21)

Austin Statesman: Legislator Seeks To Keep Guns Out Of State Psychiatric Hospitals
One year after state psychiatric hospitals began letting people carry guns on campus, a Republican legislator is pushing a bill that reverses course. House Bill 14, filed by Rep. Andrew Murr, R-Junction, outlaws firearms at Texas’ 10 state-run mental health hospitals, which care for people with depression, schizophrenia, bipolar disorder and other illnesses. (Ball, 2/21)

Health News Florida: Flu Widespread In Florida, With Extra Bug 
Influenza season is at its peak nationwide, and Florida is no exception. That’s obvious on the map at the Centers for Disease Control website. Warren McDougle, epidemiology manager for the Hillsborough County Health Department, says the flu shot apparently did a good job of covering the predominant strain, A (H3). But unfortunately, there’s another mean virus going around, according to anecdotal reports. (Gentry, 2/21)

Register-Guard: Oregon Plan Would Provide Insurance To Unauthorized Kids 
Now, both women are advocating for a new state law — dubbed “Cover All Kids” by supporters — that would extend government-funded health insurance in Oregon to many unauthorized immigrants under the age of 19. The proposal would give government-funded health insurance to an estimated 17,600 unauthorized immigrants, at a cost of $55 million in the biennium that starts July 1. Critics blast the concept and the price tag, especially given state government’s cash crisis.But supporters say it’s a humane and sensible idea. (Hubbard, 2/21)

The Wall Street Journal: Bidder Says Los Angeles-Area Hospital Didn’t Need To Close
A health-care firm that offered to buy Gardens Regional Hospital and Medical Center Inc., a Los Angeles-area hospital that cared for low-income residents before shutting down, told a bankruptcy judge that its purchase efforts were unfairly ignored. In court papers, Le Summit Healthcare LLC officials told Bankruptcy Judge Ernest Robles that they are still willing to operate the nonprofit hospital while they obtain the new licensing and permits to restart its operations. They say Gardens Regional Hospital’s lawyers closed the 137-bed hospital unnecessarily. (Stech, 2/21)

St. Louis Public Radio: Homer G. Phillips Hospital: ‘They Were Not Going To Be Treated As Second-Class Citizens’ 
In the first half of the 20th century, segregation touched virtually every part of American life. Black residents of St. Louis weren’t just barred from schools, lunch counters and drinking fountains reserved for whites. Even hospitals could refuse to admit black patients. But the hospitals that were built to serve African-American patients hold a special place in medical history. The facilities employed and trained thousands of black doctors and nurses. In St. Louis, Homer G. Phillips Hospital quickly became a trusted household name. Today marks the 80th anniversary of its dedication ceremony on Feb. 22, 1937. (Bouscaren, 2/22)

The Star Tribune: Minnesota Medical Professionals Work To Close Health Gaps For LGBT Patients 
[Deb] Thorp, medical director of the Park Nicollet Gender Services Clinic in Minneapolis, is taking part in a rare national conference next week to address health disparities among lesbian, gay, bisexual and transgender people. She and other researchers say the LGBT community is more vulnerable to some diseases, and has poorer access to, and a lower quality of, health care compared with the general population — in part because of fear. (Shah, 2/21)

The Star Tribune: Minnesota Parents Lobby For Kids At ‘Dyslexia Day’ At State Capitol 
On Tuesday, the advocacy group’s annual rally spread across the Capitol rotunda, where several hundred parents and children called attention to a hidden disability that affects as many as one in 10 children. Dyslexia wasn’t even recognized as a specific learning disability by the Minnesota Department of Education until 2015. Children who spoke at Tuesday’s rally said they wished schools understood more. (Hopfensperger, 2/21)

St. Louis Public Radio: Chemical Companies To Pay $15 Million To Clean Up Sauget Superfund Site 
Four chemical companies could have to pay $14.8 million to clean up a federal Superfund site in Sauget. The settlement, which needs court approval, would address groundwater contamination, cap some of the waste and install a well monitoring system. Industrial waste has been dumped in six sites within the Sauget Area 1 Superfund from the 1930s until the 1980s. The Environmental Protection Agency has been investigating the site since the early 1980s. (Chen, 2/21)

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The Health Law’s Two Americas: Those Who Qualified For Help And Those Who Didn’t

For those who were able to get federal subsidies, the health law was a blessing. The ones who didn’t were left feeling angry and short-changed.

The Associated Press: Health Law Created Winners And Losers When Buying Insurance
Michael Schwarz is a self-employed business owner who buys his own health insurance. Subsidized coverage through “Obamacare” offers protection from life’s unpredictable changes and freedom to pursue his vocation, he says. Brett Dorsch is also self-employed and buys his own health insurance. But he gets no financial break from the Affordable Care Act. “To me, it’s just been a big lie,” Dorsch says, forcing him to pay more for less coverage. (Alonso-Zaldivar, 2/22)

Kaiser Health News: GOP Fix To Insurance Markets Could Spike Premiums For Older Customers
Dale Marsh has not been enamored with his health insurance since the Affordable Care Act took effect. Premiums for Marsh, 53, and his wife, Tammy, rose, their deductibles grew, and they gave up access to their regular doctors to keep costs down. This year, facing monthly premiums of $1,131 — a 47 percent increase from four years before — they decided to go without coverage. “It’s useless insurance,” said Marsh, who owns a software company with Tammy, 52, in Graford, Texas. “We’re praying for the best, that neither one of us need insurance, that we don’t have to go the hospital.” Yet, a new premium spike may be in store for those in their 50s and 60s. (Rau and Appleby, 2/22)

In other news, worries about repeal persist —

The Associated Press: ‘It Saved My Life’: Talk Of Obamacare Repeal Worries Addicts
While the Affordable Care Act has brought health coverage to millions of Americans, the effects have been profound, even lifesaving, for some of those caught up in the nation’s opioid-addiction crisis. In Kentucky, which has been ravaged worse than almost any other state by fentanyl, heroin and other drugs, Tyler Witten went into rehab at Medicaid’s expense after the state expanded the program under a provision of the act. Until then, he had been addicted to painkillers for more than a decade. “It saved my life,” he said. (Beam and Johnson, 2/22)

The Philadelphia Inquirer: Advocates: Repealing Obamacare Would Cost N.J. Jobs And Lives
The generally left-leaning groups detailed county-by-county effects in an effort to get residents to put pressure on representatives at town hall meetings during this week’s congressional recess. Some lawmakers who have not scheduled meetings are discovering that gatherings have been planned in their absence. With more than $4 billion a year in direct federal funding at stake, the ripple effect of rescinding the law would kill 86,000 jobs, according to an analysis by New Jersey Policy Perspective. About 800,000 residents would lose health insurance without the ACA’s Medicaid expansion and subsidies for coverage purchased on the federal exchange. Plus, 212,000 seniors who fall into Medicare’s “doughnut hole” would each lose an average $1,241 in prescription assistance. (Sapatkin, 2/21)

Asbury Park Press: Group: Obamacare Repeal Costs Jersey Shore Over $500M
The Jersey Shore would lose more than $500 million a year in federal funding and 11,000 jobs if Obamacare is repealed without a replacement, according to a study released by consumer advocates on Tuesday. While replacement proposals on the table would soften the blow, they would leave New Jersey and consumers with less financial help for health care and possibly insurance policies that don’t cover as much, they said. (Diamond, 2/21)

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Tax Proposals In GOP Repeal Plan Could Be Hard To Swallow For Conservatives

In addition to a credit to help people buy insurance, Republicans have suggested opening up some employer-sponsored health insurance plans to taxation. Both ideas are drawing opposition from the right wing of the party. Meanwhile, the fight over Medicaid looms large in the Senate.

The Hill: Two Tax Issues Dividing Republicans On ObamaCare
Republican lawmakers are objecting to two key elements of their party’s plan to replace ObamaCare, creating obstacles in the road to repeal. Conservatives worry a tax credit to assist people with the cost of insurance, which would help people maintain or get coverage, will be too costly and that recipients might abuse the government help…Objections also are being raised against a proposal to open up some employer-sponsored health insurance plans to taxation. Some Republicans worry that proposal is essentially a new version of ObamaCare’s much-reviled “Cadillac tax.” (Sullivan, 2/21)

The Hill: ­ObamaCare Fix Hinges On Medicaid Clash In Senate 
The most divisive issue for Senate Republicans when it comes to repealing and replacing ­ObamaCare is what to do with Medicaid. The Affordable Care Act gave states the option of accepting federal funds to expand Medicaid, the healthcare program for the poor and disabled. Millions of people gained health insurance after 31 states — including many with Republican governors — decided to accept the deal. Repealing ­­ObamaCare would end the Medicaid expansion, cutting federal funds to all of those states. (Bolton, 2/22)

Iowa Public Radio: Loebsack: GOP Plan To Replace ACA “Wholly Inadequate” 
Iowa’s only Democrat in the U.S. House of Representatives says he still doesn’t know the details of what Republicans will propose as a replacement for the Affordable Care Act. Dave Loebsack is on the House Energy and Commerce Committee, which will vote on a replacement before sending it to the full House. (Kieffer, Perkins and Leland, 2/21)

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A Not-So-Fun Recess: Hostile Crowds Confront GOP Lawmakers Over Repeal Plans

“With all due respect, sir, you’re the man that talked about the death panels. We’re going to create one great big death panel in this country,” the vice chairman of the Iowa Democratic Party’s Rural Caucus said at Sen. Chuck Grassley’s town hall meeting. Across the country, lawmakers are facing agitated and concerned voters during their weeklong recess.

The New York Times: At Town Halls, Doses Of Fury And A Bottle Of Tums
Representative Marsha Blackburn may have expected to draw a friendly crowd by scheduling a town hall-style meeting in a Tennessee community that had voted overwhelmingly for President Trump, but she instead faced a hurricane-strength blast of disapproval on Tuesday. Ms. Blackburn, an eight-term Republican, was sharply questioned about a wide range of issues that have unsettled Mr. Trump’s first month in office, including health care, the environment, education and the president’s links to Russia. (Gabriel, Kaplan, Alvarez and Huetteman, 2/21)

The Associated Press: GOP Members Of Congress Meet With Protests At Town Halls
A month into Trump’s presidency, protests continue over his immigration policies, Cabinet selections and the GOP’s push to repeal the Affordable Care Act, without all the specifics on how to replace it. At the town halls, protesters are probing their lawmakers to see if they will veer from some of Trump’s more controversial decisions, and if they will promise coverage for those currently served by the Affordable Care Act. Trump took to Twitter on Tuesday to address the town halls. “The so-called angry crowds in home districts of some Republicans are actually, in numerous cases, planned out by liberal activists. Sad!” he tweeted. (Matisse, 2/21)

The Associated Press: US Senate Leader: Winners Make Policy, Losers Go Home
Nearly 1,000 people jeered Senate Majority Leader Mitch McConnell as he drove to a speech Tuesday where he told local business leaders that “winners make policy and the losers go home.” … Several people stood and booed as McConnell finished his remarks, including answering a few questions about the Affordable Care Act and regulations on the financial industry imposed by the legislation known as Dodd-Frank. McConnell was largely unfazed by those he called “the people outside,” saying he was “proud” of them for expressing their views. (Beam, 2/21)

Politico: This Time, Grassley Hears Pro-Obamacare Voices
What a difference eight years makes. More than 100 Iowans on Tuesday packed into a small farm town community center by 7:45 a.m. to urge Sen. Chuck Grassley not to repeal Obamacare, and to air their opposition to President Donald Trump’s agenda, his Cabinet nominees and his Supreme Court pick. (Haberkorn, 2/21)

Politico: GOP Lessons From The Latest Round Of Brutal Town Halls
An overflow crowd here was eager to take on Rep. Dave Brat, the conservative Republican who just weeks earlier needled liberal protesters in his district and groused about all the women “in my grill” over GOP plans to repeal and replace Obamacare. But with a plain-spoken approach — and a format that didn’t revolve around live-fire questions from the combative crowd — Brat offered his colleagues a potential blueprint for defusing tense constituent town halls that have bedeviled his Republican colleagues as they’ve been swarmed by protesters. (Cheney, 2/21)

CNN: Brat Faces Raucous Crowd At Town Hall
Rep. Dave Brat faced a raucous crowd Tuesday night at a town hall here in the outer edge of his district, where a majority of the room interrupted him with angry shouts and jeers. The Virginia Republican took at least 34 questions for over an hour and at times appeared to enjoy the back-and-forth. “I don’t mind boisterousness. I’m having fun,” Brat said toward the end, swinging his arm in the air as people continued to shout at him. “I like having debate, spirited conversation — if you can have a conversation.” (Killough, 2/21)

WAVY (Hampton Roads, Va.): Boisterous Crowd Voices Concerns At Rep. Taylor’s First Town Hall In Va. Beach
Representative Scott Taylor (R-VA) held a packed town hall meeting at Kempsville High School in Virginia Beach Monday night. 10 On Your Side’s Joe Fisher reports the crowd was at capacity with about 750 people inside. Hundreds more were turned away at the door because they couldn’t fit in the school’s auditorium. … Taylor also said he supports the repeal of the Affordable Care Act and the implementation of a new policy that doesn’t discriminate against people with pre-existing conditions. “The vast majority of people are getting crushed by Obamacare,” he said. “What’s responsible I believe, is dissecting, having a discussion, and finding the best thing.” (Satchell, 2/21)

KTVH (Helena, Mont.): Hundreds Gather In Helena To Ask Daines To Hold Town Hall
U.S. Sen. Steve Daines was scheduled to speak before the Montana House Tuesday, but several hours before the address, his office announced it had been rescheduled to Wednesday. Despite that change, hundreds of protesters still gathered on the State Capitol steps in Helena in hopes of getting the senator’s attention. … Celeste Thompson, a home care worker, said she has health care because of the federal Affordable Care Act. She asked for more information on how Republicans in Congress plan to replace the ACA if it is repealed. “Our lives and so many others depend on access to health care,” Thompson said. “If the Affordable Care Act is repealed, that access will be stripped away from us.” (Ambarian, 2/21)

Montana Public Radio: Protesters Give Sen Daines An Earful At The State Capitol
Just before U.S. Senator Steve Daines was scheduled to give a speech in front of Montana lawmakers Tuesday afternoon, a crowd of protesters gathered on the Capitol steps. The event was organized by a Facebook group called “Bring The Town Hall to Steve Daines”. … About an hour and a half before Senator Daines was scheduled to arrive at the Capitol Tuesday to address Montana’s House of Representatives, he postponed his speech, pushing it to Wednesday. Staff with Senator Daines’ office say he pushed his speech back a day to work with his schedule, saying Daines had several other reasons to be in Helena on Wednesday. (Cates-Carney, 2/21)

Arkansas Online: Cotton Hears Medicare Concerns
A group of Arkansas senior citizens told U.S. Sen. Tom Cotton on Tuesday that they like their Medicare Advantage plans, but a few expressed concerns about higher spending caps and rising medication costs. Cotton, a Republican from Dardanelle, told the group that he supports the federally-funded program and will defend it on Capitol Hill. Nonetheless, the overall health care system needs changes, he said, promising to work to improve it. (Lockwood, 2/22)

CQ Roll Call: Health Coverage Questions Persist For Republicans
As Republican lawmakers face questions from constituents and colleagues about their plans to repeal and replace the 2010 health care law, they’re finding few answers, including what kind of legislation could pass the Senate. Republicans do not need Democratic support to undo parts of the law, since they will move the legislation through the budget reconciliation process that requires a simple majority in the Senate. But with only 52 Republican senators, the GOP plan will need support from the party’s conservatives and moderates, and it’s not clear what could get everyone on board. (Bowman, 2/22)

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Different Takes On Inside-The-Beltway Health Policy Developments

Opinion writers offer a variety of views on how the plans being advanced by the Trump administration and GOP Congress will shape a range of health concerns — from the effort to repeal, replace or repair the health law effort to federal health programs and Planned Parenthood’s future.

The Washington Post: Obamacare’s Enduring Victory
What’s the holdup, House Republicans? During the Obama administration, you passed literally dozens of bills to repeal all or part of the Affordable Care Act — knowing that none had any chance of being signed into law. Now that Donald Trump is in the White House, why can’t you seem to pull the trigger? (Eugene Robinson, 2/20)

The New York Times: Ryancare: You Can Pay More For Less!
President Trump promised to replace the Affordable Care Act with something that is better, is cheaper and covers more people. Scratch that. Republican leaders in the House and Mr. Trump’s secretary of health and human services released a plan last week that would provide insurance that is far inferior, shift more medical costs onto families and cover far fewer people. (2/19)

Los Angeles Times: ‘Death Spirals,’ Deceit And Pampering The Rich: The Republicans Face High Noon On Repealing Obamacare
Congressional Republicans who have visited their home districts over the last few weeks have gotten a faceful of constituent rage about their plans to eviscerate the Affordable Care Act, which brings health coverage to more than 20 million Americans. If past is prologue, those heading home now for the Presidents Day recess are likely to feel a lot more heat. That may be why House Republicans this week rushed out a “policy brief” on “Obamacare Repeal and Replace.” Unfortunately for the poor souls who will be meeting with constituents, the brief answers none of the key questions about the GOP’s plans for the ACA. (Michael Hiltzik, 2/17)

The Washington Post: Republicans Are Selling Health-Care Reform That People Don’t Want 
House Speaker Paul Ryan (R-Wis.) says Obamacare is failing. Club for Growth president David McIntosh warns that voters “gave Republicans the charge to repeal and replace Obamacare,” so the “delays and discussions about repairing Obamacare need to stop.” The problem is that voters fear disruption, don’t want to lose what they have and won’t find what Republicans are selling very attractive. (Jennifer Rubin, 2/20)

The Washington Post: Ryan’s Health-Care Plan Will Be Hard To Defend
House Speaker Paul Ryan (R-Wis.) outlined a health-care plan to his members yesterday. Surprisingly, it did not include much detail, either because the speaker has not gotten that far or because he’s afraid of the reaction when the numbers are revealed. (Jennifer Rubin, 2/17)

Modern Healthcare: Give Seema Verma A Chance
Seema Verma, the Indiana consultant who injected personal responsibility requirements and health savings accounts into that state’s Medicaid program, deserves a shot at working with other states that want to redesign their programs. She repeatedly testified last week that her main goal for the program, if confirmed as CMS administrator, will be to achieve better outcomes for the vulnerable populations served by the program. “This shouldn’t be about kicking people off,” she said. (Merrill Goozner, 2/18)

Fox News: Seema Verma For Medicaid/Medicare Czar Is The Final Piece In The Health Care Puzzle
Seema Verma is a bold pick by President Trump to head the Centers for Medicare and Medicaid Services. She should be approved without further delay. During a hearing by the Senate Finance Committee this week she appeared confident and informed, refusing to take positions on raising Medicare’s eligibility age, price negotiation with drug companies, or caps on Medicaid allotments to the states. She stated that these decisions are up to Congress, showing an understanding of her role’s limits. (Marc Siegel, 2/20)

The Washington Post: Staffing, Budget Shortages Put Indian Health Service At ‘High Risk’
There’s a sliver of good news for a stricken federal agency during the first alarming month of President Trump’s administration: relief from Trump’s hiring freeze for the Indian Health Service (IHS). “This exemption is a step in the right direction,” seven Democratic senators said in a statement Friday. “Indian Health Services facilities face staff vacancy rates of 20 percent or higher, and a hiring freeze would make these challenges even more severe, further impacting access to health care and even patient health.” (Joe Davidson, 2/20)

Stat: Vaccine Programs Threatened By Exemptions, ACA Repeal
Our highly successful vaccination programs will be in danger if they are not factored into the current discussion of the repeal of the Affordable Care Act (ACA). There’s a clear connection between having health insurance and getting vaccinated, so reducing the number of people with health insurance, which could likely happen if the ACA is repealed, will translate into fewer children and adults who get their recommended vaccines. (John Auerbach, 2/17)

Los Angeles Times: An Attack On Abortion Rights And A Handout To The Rich: The Republicans’ New Plan For Repealing Obamacare
Congressional Republicans who have visited their home districts over the last few weeks have gotten a faceful of constituent rage about their plans to eviscerate the Affordable Care Act, which brings health coverage to more than 20 million Americans. If past is prologue, those heading home now for the Presidents Day recess are likely to feel a lot more heat. (Michael Hiltzik, 2/17)

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State Highlights: Ind. House Panel To Revisit Controversial ‘Abortion Reversal’ Bill; Mich. Whooping Cough Cases On The Rise

Outlets report on news from Indiana, Michigan, Connecticut, Illinois, Ohio, Kentucky, Florida, Texas and California.

Detroit Free Press: Whooping Cough Cases Keep Climbing In Michigan
Pertussis, or whooping cough, is on the rise in Michigan. The number of cases this year has surpassed 100  and continues to climb, according to preliminary data from the Michigan Department of Health and Human Services and the Oakland County Health Department. In 2016, there were about 448 cases of whooping cough in the state. In Oakland County last month, there were 31 confirmed and probable cases of the vaccine-preventable disease, compared with four cases in January 2016. (2/17)

The CT Mirror: Insurance Coverage Mandates Would Face More Analysis Under Malloy Proposal 
Patients who testify in support of proposed benefit mandates often share stories about struggles they faced getting needed care or medications. And critics warn legislators that adding mandates increases the cost of insurance premiums. In some cases, they also take issue with the merits of the particular service being considered for mandatory coverage. (Levin Becker, 2/20)

Chicago Tribune: School Workers In State Must Know How To Handle Asthma Crises, New Law Says
Under the new legislation signed by Gov. Bruce Rauner in August, all school personnel who work with students must be trained to handle asthma emergencies. School districts must adopt an emergency response protocol for asthma — similar to those used in the case of anaphylaxis or fire. And every child with asthma must have a written “asthma action plan” on file at the school to allow the most efficient and helpful treatment when needed. “Asthma has been a chronic problem for a long time; it did not just rear its ugly head,” said Maureen Damitz, spokeswoman for the Illinois Asthma Consortium which lobbied to get the law passed. “But I think people are more aware that we need to change something.” (Healy, 2/20)

The Associated Press: Doctor-Lawmaker Tries To Restrict Smoking In Tobacco Country
When Dr. Ralph Alvarado was elected to the Kentucky state Senate in 2014, he found his new colleagues had something in common with most of his patients: They knew smoking was bad, they just couldn’t quit. For more than two years, Alvarado has led the effort to restrict smoking in a state with the highest smoking rate in the country. (2/19)

Orlando Sentinel: New Emergency Medical Campaign Aims To Save Lives
Community leaders on Monday announced the launch of a new campaign that they hope will teach bystanders how to intervene during the first crucial minutes to prevent injured people from bleeding to death. Orange County Mayor Teresa Jacobs and Orlando Mayor Buddy Dyer joined other medical leaders at Orlando Regional Medical Center to promote the national initiative. A person can bleed to death from a serious injury within five to 10 minutes, said Joseph Ibrahim, the trauma medical director. (Russon, 2/20)

WFAA: Doctor Convicted Of Botched Surgery Gets Life Sentence
Life in prison. Those were the words that Christopher Duntsch never wanted to hear. And the words that his patients and their families desperately wanted to hear. The one-time neurosurgeon was sentenced by the 12-member jury to spend the remainder of his life behind bars Monday afternoon. (Eiserer, 2/21)

St. Louis Post Dispatch: Mercy And St. Anthony’s Enter Affiliation Agreement
Mercy and St. Anthony’s Medical Center have entered into an affiliation agreement, hospital officials said Monday. While details of the agreement are still being hashed out, Mercy has agreed to a “substantial capital commitment” at St. Anthony’s, Winthrop Reed, vice chair of St. Anthony’s board, told the Post-Dispatch. For St. Anthony’s, the agreement means one of the last remaining independent hospitals in the St. Louis area will become part of a much-larger health care system. For Chesterfield-based Mercy, with 43 hospitals in four states, the move grows its market share in St. Louis, where it already has four hospitals. (Liss, 2/21)

Arizona Republic: Bleeding, Talking Mannequins Prep Health-Care Workers For Patient Crisis
Volunteers and anatomically correct mannequins that bleed, breathe and talk helped health-care professionals strengthen their lifesaving skills recently in Phoenix. Seventy-five health professionals participated in the intensive two-day training that simulated patients in crisis at the University of Arizona College of Medicine-Phoenix Center for Simulation and Innovation. (Borgelt, 2/20)

Cleveland Plain Dealer: Report: Northeast Ohio Ranks Fourth In Midwest Biomedical Investments
Last year was a big one for the biomedical industry in the Midwest. In the first half of 2016, healthcare startups in the Midwest brought in a record-breaking $1.04 billion. By the end of the year, Midwest healthcare startups brought in $1.7 billion. And Cleveland is near the top of the Midwest, according to a report from BioEnterprise, a Northeast Ohio biomedical business accelerator. Cleveland brought in $198 million dollars in biomedical investments last year, just behind Minneapolis, Chicago and St. Louis. (Bamforth, 2/20)

Cincinnati Enquirer: Disabled Ludlow Teen’s Death From Bedsores, Neglect ‘Makes No Sense’
There was just no holding him back, Terrie Collins-Laytart said last week just days after Joey [Bishop]’s mother and grandparents were charged with manslaughter in his death. The neglect, charges allege, was so severe it led to bed sores that pumped toxins through Joey’s body eventually killing him. The case has seasoned investigators shaking their heads and wondering – like Collins-Laytart – how the 18-year-old became a prisoner in the Ludlow home he shared with his mother and grandparents, why no one seemed to know he lived there and what could have been done to protect him. (Graves and Vogel, 2/20)

Miami Herald: UM’s New LGBTQ Clinic Focuses On Transgender Patients 
UM opened its LGBTQ center in January to serve the needs of the growing population. The new clinic brings together specialists in urology, endocrinology and psychiatry, as well as a team of surgeons to accompany the patient into the operating room. [Christopher] Salgado and other doctors can even perform multiple surgeries on a patient simultaneously, so after a marathon session the patient can emerge with everything done at once. (Harris, 2/20)

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As Health Law Debate Shifts From Theoretical To Tangible, Opponents No Longer Have Loudest Voices

Now that the spotlight is off of the president who created the law, the focus is on the care it provides. The shouts for repeal have quieted as those clamoring for answers about their coverage flood the space. Meanwhile, despite his vocal criticism of the Affordable Care Act, Mike Pence, while governor of Indiana, turned to it when his state was in a crisis.

Politico: How Mike Pence Used Obamacare To Halt Indiana’s HIV Outbreak
When then-Gov. Mike Pence faced the worst public health crisis to hit Indiana in decades, he turned to Obamacare — a program he vilified and voted against. In 2015, as a rash of HIV infections spread through rural southern Indiana, state health officials parachuted into Scott County and enrolled scores of people into Obamacare’s expanded Medicaid program so they could get medical care and substance abuse treatment. Many were addicted to opioids and had contracted HIV by sharing dirty needles. (Ehley, 2/20)

The Washington Post: Obamacare Launched A New Wave Of Start-Ups. Now They’re Bracing For What’s Next.
Four years ago, Noah Lang saw an opportunity in Obamacare. With an eye toward the millions of people set to purchase health insurance on their own for the first time, the 29-year-old Silicon Valley entrepreneur founded a start-up, Stride Health, that helps them compare and choose between plans — and do it all from a smartphone. Steadily and without fanfare, the Affordable Care Act has created a boom in Silicon Valley. (Dwoskin, 2/20)

The Wall Street Journal: The Affordable Care Act: The View From A Hospital CEO
Health care in the U.S. appears to be heading toward dramatic changes for the second time in less than a decade. As president and chief executive of New York-Presbyterian, Steven Corwin will have to maneuver a system with 10 hospitals and $7 billion in annual revenue through what may be years of regulatory uncertainty and upheaval for U.S. hospitals. (Evans, 2/20)

And in news from the states —

Nashville Tennessean: Amid Health Care ‘Chaos,’ Tennesseans Push Lawmakers For Assurances
With Tennessee’s healthcare.gov market for 2018 at a breaking point, some are ramping up calls on federal lawmakers to take action to make sure people aren’t without health insurance options next year. Since Humana’s decision last week to leave the federally run exchange, the Tri-Cities area is the only region of the state that will have two insurers from which residents can choose in 2018. The Greater Knoxville area will have none. Yet, without progress on repeal-and-replace or repair of the Affordable Care Act in Washington, D.C., the exchange’s existence in the state beyond 2017 will depend on business decisions by insurers BlueCross BlueShield of Tennessee and Cigna. (Fletcher, 2/20)

Texas Tribune: UT/TT Poll: Texans Want A Health Care Program That’s Not Called Obamacare 
Texans want to dump the previous president’s signature health care program, but only a small minority want to move on without replacing it, according to the latest University of Texas/Texas Tribune Poll. If the Affordable Care Act, better known as Obamacare, were to be repealed and replaced, 68 percent of Texans said lawmakers should wait until they have a replacement plan worked out before they repeal the current law. A smaller group — 23 percent — would repeal Obamacare immediately and figure out the details of a replacement plan later. (Ramsey, 2/21)

The Philadelphia Inquirer: I Have Obamacare Insurance. What Do I Do Now?
If you are already enrolled in a plan through the ACA, there are ways to maximize your coverage before any changes happen.  Remember those labs, specialist referrals or imaging that your physician recommended, but maybe you’ve postponed?  Now is the time to follow through with them.  Also, talk to your physician about switching from brand-name medications to generics when possible to cut down on future co-pays.  There are many generics that work as well as brand names, and which certain pharmacies offer through discounted prescription plans. (Chan, 2/19)

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Trump Promises Health Plan Will Be Coming ‘In A Couple Of Weeks’

“Just so you understand, our plan will be much better healthcare at a much lower cost,” the president said. “OK? Nothing to complain about.” Meanwhile, Tuesday is the deadline for the Trump administration to decide the actions it will take on controversial insurer bailouts.

The Hill: Trump: ObamaCare Replacement Coming In ‘A Couple Of Weeks’ 
President Trump said on Saturday that a plan to replace the Affordable Care Act will come “in a couple of weeks.” “We are going to be submitting in a couple of weeks a great healthcare plan that’s going to take the place of the disaster known as ObamaCare,” he said at a campaign rally in Melbourne, Fla. “It will be repealed and replaced.” “Just so you understand, our plan will be much better healthcare at a much lower cost,” he added. “OK? Nothing to complain about.” (Greenwood, 2/18)

CQ Roll Call: Appropriators Watch Trump’s Next Move On Obamacare Lawsuit
The Trump administration faces a key legal deadline Tuesday in the push to repeal and replace the 2010 health care law — and it could prompt Republican lawmakers to appropriate funds for a part of the statute they once sued to stop. The Justice Department will tell a federal appeals court what it sees as the future of a lawsuit over appropriations for subsidy payments to health insurance providers under the law  (PL 111-148, PL 111-152), estimated at $175 billion over 10 years. House Republicans filed the lawsuit in 2014 to stop the payments, as a response to a series of President Barack Obama’s unilateral executive actions that they said were unconstitutional. (Ruger and Mejdrich, 2/21)

The Hill: Trump Officials Weigh Fate Of Birth-Control Mandate 
The era of free birth control for women could be coming to an end. The requirement that insurance companies cover contraception at no cost is believed to be on the chopping block now that Tom Price has taken over the Department of Health and Human Services (HHS). Price opposed the mandate as a member of Congress and could take aim at the regulation — and other rules related to ObamaCare — as Republicans in Congress move to repeal and replace the Affordable Care Act. (Hellmann, 2/21)

And in other news on President Donald Trump —

Stat: Trump Attends Controversial Dana-Farber Fundraiser At Mar-A-Lago
President Trump attended Saturday night’s fundraising ball for the Dana-Farber Cancer Institute, which was held at Mar-a-Lago — his Florida home and so-called winter White House. While the Harvard-affiliated Boston hospital has held the posh annual event at the private club since 2011, and in 2008, this year’s gala drew criticism from Dana-Farber’s staff and Harvard medical students, who saw Trump’s actions, especially his executive order on immigration, as in direct conflict with the hospital’s mission. Dana-Farber declined to cancel, saying it was too late to change plans, but said it would avoid “controversial venues” in the future. (Swetlitz, 2/19)

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Don’t Expect Any ‘Bipartisan Kumbaya Moments’ When It Comes To Repeal, McConnell Says

Senate Majority Leader Mitch McConnell says he does not expect any cooperation from Democrats as Congress works toward dismantling and replacing the health law. Meanwhile, The Associated Press breaks down what’s in the Republicans’ plans, and the intra-party divide on the right continues to grow.

The Associated Press: McConnell Intends To Replace ‘Obamacare’ Without Democrats
Republicans will repeal and replace the health care law and overhaul the tax code without Democratic help or votes, Senate Majority Leader Mitch McConnell said Friday. “It’s clear that in the early months it’s going to be a Republicans-only exercise,” the Kentucky senator said at a news conference before lawmakers left for a weeklong President’s Day recess. “We don’t expect any Democratic cooperation on the replacement of Obamacare, we don’t expect any Democratic cooperation on tax reform.” (Werner, 2/17)

The Associated Press: GOP Health Plan: Lower Costs, Better Care, Or Road To Ruin?
Top House Republicans say their outline for replacing President Barack Obama’s health care law is a pathway to greater flexibility and lower costs for consumers. Democrats see a road to ruin for millions who’d face lost coverage and higher medical expenses, particularly the poor. The plan “ensures more choices, lower costs and greater control over your health care,” according to talking points GOP leaders handed lawmakers heading home to face constituents during this week’s recess. (Fram, 2/20)

Modern Healthcare: GOP Anxiety Rises As Conservatives And Moderates Split On ACA Repeal 
Divisions sharpened last week between hard-right and more pragmatic Republicans over both policy and strategy for repealing and replacing the Affordable Care Act. Those differences—along with the apparently slow progress in drafting actual legislation that could be scored by the Congressional Budget Office on cost and coverage impact—underscore the tough struggle Republicans face in dismantling Obamacare and establishing an alternative system. (Meyer, 2/18)

Bloomberg: Conservatives Object To Obamacare Replacement’s Tax Credits
Some conservative House Republicans are objecting to a major part of the Obamacare replacement outline presented to them by party leaders, underscoring the party’s continuing inability to agree on an alternative health plan. The proposal would allow Americans who lack insurance to buy coverage with refundable tax credits they can receive before the end of a tax year. House Ways and Means Chairman Kevin Brady said he and other leaders presented the idea during Thursday’s private conference of the House GOP. (Kapur and House, 2/17)

CQ Roll Call: Key Senator Sees Promise In House GOP Health Care Proposal
A key Republican senator on Friday said the House GOP’s health care proposal was written with input from the Senate, and the House would ultimately pass a bill the upper chamber can accept.  Meanwhile, Democrats are spurring their allies to rally in support of President Barack Obama’s 2010 health care law, which Republicans want to replace. House Republicans on Thursday began their recess with a committee document to help them respond to constituents’ questions about plans to repeal and replace the 2010 law. It outlines proposals for age-based tax credits, an expansion of health savings accounts and transitioning out the Medicaid expansion. (Siddons, 2/17)

CQ HealthBeat: GOP Leaps On Congressional Review Act To Kill Obama Rules
A law that’s been successfully used only once until now is the conduit for a whole lot of action on Capitol Hill. Republicans in Congress are expected to send a stream of bills — most of which require a single sentence — to President Donald Trump’s desk, using a process to repeal agency rules known as the Congressional Review Act (PL 104-121). The act was tucked into 1996 legislation tied to former House Speaker Newt Gingrich’s famous “Contract With America.” So far, Trump has signed two of the rule repeals into law. (Mejdrich, 2/21)

Meanwhile, insurers weigh in on Republicans’ replace plans and more —

The Wall Street Journal: Insurers Voice Concern Over House GOP’s Outline For Health Law Repeal
The new House Republican plan, whose backers include House Speaker Paul Ryan (R., Wis.), is far from a complete bill, and the limited summary highlighted many GOP divisions over the health overhaul’s future. President Donald Trump has promised to deliver an initial ACA replacement plan next month. Still, insures saw the House document as a key signal and parsed it closely. Many were concerned that they found no answers to some of their most important questions—and some of what they did find was alarming. For instance, insurers said, the outline promised to immediately end enforcement of the ACA’s coverage mandate but appeared to offer no replacement mechanism that would prod healthy consumers to purchase plans. (Wilde Mathews, 2/17)

Kaiser Health News: Health Law’s 10 Essential Benefits: A Look At What’s At Risk In GOP Overhaul
As Republicans look at ways to replace or repair the health law, many suggest shrinking the list of services insurers are required to offer in individual and small group plans would reduce costs and increase flexibility. That option came to the forefront last week when Seema Verma, who is slated to run the Centers for Medicare & Medicaid Services in the Trump administration, noted at her confirmation hearing that coverage for maternity services should be optional in those health plans. Maternity coverage is a popular target and one often mentioned by health law critics, but other items also could be watered down or eliminated. (Andrews, 2/21)

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Viewpoints: GOP Health Plan Runs Contrary To Robin Hood’s Rules By Redirecting Funding From Poor To Rich; The Town Hall Duck And Run

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

The Washington Post: Trump’s Toxicity Has Republicans Running Away From Their Constituents
As recent town-hall meetings of GOP Reps. Tom McClintock of Elk Grove, Jason Chaffetz of Utah, Gus Bilirakis of Florida, Diane Black of Tennessee and others turn into well-publicized tongue-lashings, their colleagues are ducking and running. … The scene is reminiscent of the tea party summer of 2009, but the energy is on the other side this time. Now, as then, the victims say the perpetrators are outsiders – Chaffetz said those who protested him included “paid” people from out of state, an echo of Nancy Pelosi’s claim of “astroturfing” – but now, as then, the anger is real. (Dana Milbank, 2/15)

Los Angeles Times: Trump Tries To Save Obamacare Exchanges While Undermining Them
With the drive to “repeal and replace” Obamacare losing steam, the Trump administration quietly moved to shore up a key feature of the healthcare law this week: the state exchanges where people shop for non-group coverage. And to its credit, Trump’s Department of Health and Human Services zeroed in on some of the factors that have led a handful of major insurers to leave the exchanges. (Jon Healey, 2/16)

Bloomberg: A Sign That Obamacare Exchanges Are Failing
Yet more bad news for Obamacare this week: Molina Healthcare lost $110 million on the exchanges last year, and the CEO told investors, “There are simply too many unknowns with the marketplace program to commit to our participation beyond 2017.” At first glance, it’s hard to see why this piece of news is worth worrying about. UnitedHealth recently projected several times those losses, and it’s a bigger player on the exchanges. Why spend so much time looking at one modest-size insurer? Because Molina is one of the companies that has been repeatedly pointed to, by virtually every health-care-policy wonk in the business, as one of the “bright spots” on the exchanges. (Megan McArdle, 2/16)

The New England Journal Of Medicine: Adjusting Risk Adjustment — Accounting For Variation In Diagnostic Intensity
In the U.S. health care system, payments and performance measures are often adjusted to account for differences in patients’ baseline health and demographic characteristics. The idea behind such risk adjustments is to create a level playing field, so that providers aren’t penalized for serving sicker or harder-to-treat patients and insurers aren’t penalized for covering them. For example, the private insurance companies that participate in Medicare Advantage and the Affordable Care Act (ACA) exchanges receive risk-adjusted payments from the U.S. government, with the rationale that insurers should be reimbursed more for enrollees with higher expected costs. (Amy Finkelstein, Matthew Gentzkow, Peter Hull and Heidi Williams, 2/16)

RealClear Health: A Small HSA Fix Could Produce Big Results
As Congress and the Trump administration begin laying the foundation for their replacement plan for the Affordable Care Act (ACA), their starting point should be ensuring all Americans have a ready path for enrollment in health insurance that, at a minimum, provides protection against major medical expenses. They should also promote broadened enrollment in Health Savings Accounts (HSAs) as an important means for paying for care before insurance coverage kicks in. (James C. Capretta, 2/17)

Louisville Courier-Journal: Demand For Medicaid Waivers Exceeds Funds
The “most vulnerable of our society” is a phrase that gets thrown around a lot. Politicians employ it in speeches and press releases to describe constituents who cannot take care of themselves. People with intellectual and developmental disabilities fall under this banner of protection. (Amanda Beam, 2/16)

Sacramento Bee: California Provides Model To Replace The Affordable Care Act
The new administration and Congress are under intense pressure to craft a market-based alternative to the Affordable Care Act. It won’t be easy. To achieve the financial stability required to make the market work, reformers should heed some important lessons from California. Health plans and risk-taking medical groups essentially made a “deal” with Congress to participate in the ACA. They agreed to cover applicants with pre-existing conditions without charging higher premiums in return for: an expanded individual market driven by a federal mandate that everyone buy insurance; premium and cost-sharing subsidies financed by insurers and the government; and three federal risk-mitigation programs to help stabilize the new marketplaces. (Leonard D. Schaeffer and Dana Goldman, 2/14)

Orange County Register: California Job Losses From Obamacare Repeal? Fear Not!
Obamacare was a cash cow for providers, which now argue it was a program for jobs and economic growth. They now say that repealing Obamacare will kill California jobs. That grabs any politician’s attention, but it is not true. According to a study by the UC Berkeley Labor Center, which is promoted by the California Hospital Association, “The majority (135,000) of these lost jobs would be in the health care industry, including at hospitals, doctor offices, labs, outpatient and ambulatory care centers, nursing homes, dentist offices, other health care settings and insurers. (John R. Graham, 2/16)

Cleveland Plain Dealer: Boost Funding To An Ohio Foster Care System Increasingly Burdened By The Opioid Crisis
Ohio Gov. John Kasich has been in the thick of the battle against deadly opioids, signing a bill this year to tighten restrictions on prescription opioids, speaking at conferences about heroin and even sending an Ohio Highway Patrol superintendent in April to Trumbull County after beleaguered officials there begged for help in quelling a rising tide of opioid overdoses and deaths. (2/17)

The Des Moines Register: A Second Chance To Pass Aid-In-Dying Bills
In a Gallup Poll conducted May 4-8, 2016, respondents were asked: “When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his or her family request it?” Sixty-nine percent of respondents answered yes. (John S. Westefeld, 2/16)

Lexington Herald Leader: Whooping Cough Making A Comeback
In the past few weeks, there have been several confirmed cases of whooping cough, also known as pertussis, in Fayette County schools and other surrounding counties. Many parents are concerned about exposure and have questions about preventing pertussis infection or recognizing symptoms. (Jessica Murray, 2/16)

The New England Journal Of Medicine: Addressing The Fentanyl Threat To Public Health
Fentanyl, a powerful synthetic opioid, poses an increasing public health threat. Low production costs encourage suppliers to “cut” heroin with the drug, particularly white powder heroin sold in the eastern United States. Fentanyl also appears as a prevalent active ingredient in counterfeit OxyContin (oxycodone) tablets. The result is that fentanyl plays a major role in rising mortality due to heroin or opioid overdose. It poses a serious overdose risk because it can rapidly suppress respiration and cause death more quickly than do other opioids. (Richard G. Frank and Harold A. Pollack, 2/16)

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

Research Roundup: Medicaid Block Grants; Job Loss And The ACA; Growing HIV Coverage

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

Urban Institute: What TANF Can Teach Us About Block Granting Social Services
White House officials and congressional leaders have talked about seizing the opportunity to pass sweeping changes to federal antipoverty programs. One potential change is to give block grants of federal funds to states and allow states greater flexibility …. House Speaker Paul Ryan has long contended that expanding the block grant model to other facets of the safety net — such as Medicaid and food stamps — would afford states the flexibility to drive innovation in combating poverty. But examining the results of welfare reform after two decades presents a more cautionary tale …. Simply put, all states ended up with far fewer funds and a diminished ability to meet their residents’ needs. (Hahn and Coffey, 2/7)

The Kaiser Family Foundation: Current Flexibility In Medicaid: An Overview Of Federal Standards And State Options
This brief provides an overview of current federal standards and state options in Medicaid to help inform upcoming debates about increasing state flexibility in the program as part of efforts to restructure Medicaid financing. Today, states operate their Medicaid programs within federal standards and a wide range of state options in exchange for federal matching funds that are provided with no limit. Each state Medicaid program is unique, reflecting states’ use of existing flexibility and waiver authority to design their programs to meet their specific needs and priorities. As proposals to restructure Medicaid financing develop, it will be important to examine what additional flexibilities they would provide to states and what standards, accountability and enrollee protections would remain for states to access federal funds. (Artiga et al., 1/31)

Urban Institute/Robert Wood Johnson Foundation: Recent Evidence On The ACA And Employment: Has The ACA Been A Job Killer? 2016 Update
We find no evidence to support claims that the ACA has been a job killer. Through 2016, the ACA had little to no adverse effect on employment and usual hours worked per week. For both measures, levels in 2014, 2015, and 2016 are statistically identical to our projections based on patterns existing before 2014, the year the major provisions of the ACA went into effect. Our conclusion applies to the full sample of nonelderly persons and to subgroups of nonelderly persons based on gender and educational attainment. Levels of part-time work (29 or fewer hours per week) have fallen since 2014, but remain at somewhat higher levels than would be expected given recent declines in the unemployment rate and overall economic improvement. (Garrett, Kaestner and Gangopadhyaya, 2/16)

The Kaiser Family Foundation: Insurance Coverage Changes For People With HIV Under The ACA
This brief provides the first national estimates of changes in insurance coverage among people with HIV since the implementation of the ACA. It is based on analysis of data from the Centers for Disease Control and Prevention (CDC). We find that coverage increased significantly for people with HIV due to the ACA’s Medicaid expansion; indeed, increased Medicaid coverage in expansion states drove a nationwide increase in coverage for people with HIV. In addition, the share relying on the Ryan White HIV/AIDS Program also increased. (Kates and Dawson, 2/14)

Brookings/USC Schaeffer Center for Health Policy & Economics: Re-Balancing Medical And Social Spending To Promote Health: Increasing State Flexibility To Improve Health Through Housing
The health impacts of interventions that improve economic conditions such as household income are still the subject of considerable debate. Some economists find little support to show that public transfer payments improve health outcomes, while others argue that federal assistance frees family income to spend on better access to health care, and thereby improves population health. Some researchers have identified evidence that stressful work environments and educational disparities are social mechanisms with a deleterious impact on health, but the evidence that increased public spending targeting these mechanisms will improve health outcomes is nascent. In contrast, the research showing that expenditures that improve access to safe, affordable housing improve population health is relatively strong. (Butler, Matthew and Cabello, 2/15)

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

MedPage Today: Study: Beware The Snippy, Snarky Surgeon?
The more complaints lodged at surgeons, the more likely it was for their patients to suffer complications after going under the knife, a study found, helping explain why operators with the least favorable reviews get sued the most. Surgeons who had a history of unsolicited patient reviews — often regarding rudeness and intimidation directed at patients and other healthcare professionals alike — were tied to greater risks of: Complications for patients …. Surgical complications …. Patient readmissions. (Lou, 2/15)

Reuters: Salt Reduction Policies Cost-Effective Even Without Healthcare Savings
Government policies designed to reduce how much salt people eat may be cost-effective even without considering the potential healthcare savings, a recent study suggests. That’s because efforts to curb salt use through policies like public education and industry agreements would not cost that much relative to their potential to reduce mortality and disability, researchers estimate. (Rapaport, 2/10)

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. Senate Panel Amends But OKs Surprise Medical Bill Measure; Conn. Non-Profit Hospitals Fight Bid To Make Them Pay Local Property Taxas

Outlets report on news from Georgia, Connecticut, Minnesota, Kansas, Texas, Massachusetts, Florida, Washington, Arizona, Wisconsin, Ohio and Louisiana.

Georgia Health News: After Tweak In Payment Formula, Senate Committee OKs Remedy For ‘Surprise’ Billing
A Georgia Senate panel Thursday passed legislation to halt ‘’surprise’’ medical billing – but not without a last-minute amendment that changed the contentious payment formula. The Health and Human Services Committee approved Senate Bill 8, which will address those situations in which patients get unexpected bills from providers who are not in their network, even though the hospital is a network facility. (Miller, 2/16)

The CT Mirror: CT Hospitals Launch TV Ad To Protest New Tax Proposal
Connecticut’s hospital industry launched a new television ad Thursday to protest Gov. Dannel P. Malloy’s proposal to end nonprofit hospitals’ exemption from local property taxation. The Connecticut Hospital Association announced the commercial will air starting today on network and cable television stations, and also can be seen at http://nomorehospitaltax.org. The commercial opens by listing a variety of occupations and one common thread among the people in all of them: they all pay a price when taxes rise on Connecticut hospitals. (Phaneuf, 2/16)

The CT Mirror: Budget Cuts Cost CT Medical Examiner’s Office Full Accreditation 
The Connecticut Office of the Chief Medical Examiner (OCME) has lost its full accreditation and was downgraded to provisional status because of staffing and facility shortcomings driven largely by budget cuts. The National Association of Medical Examiners (NAME), which ordered the downgrade, will reassess Connecticut’s status in September, the state office announced this week. (Phaneuf, 2/16)

The Star Tribune: Report On Minnesota Hospital Errors Sees Problems With Lost Tissue Samples 
The misplacing of irreplaceable biological specimens has proved to be a vexing problem for Minnesota hospitals, which reported 31 instances in the 12 months that ended last Oct. 6. The state’s 13th annual report on hospital “adverse events,” released Thursday, included 336 reportable mistakes, including operations on the wrong body parts and disabling medication errors. But few were as common as lost tissue samples, which also can have serious consequences. (Olson, 2/17)

KCUR: House Committee OKs Involuntary Hold Plan For Kansans In Mental Health Crisis 
A bill that would allow treatment centers to detain Kansans in mental health crisis for up to three days moved forward Thursday after months of work to develop a compromise. A similar bill proposed last year raised concerns that it would deprive Kansans with mental illnesses of their due process rights. A committee of law enforcement officers, treatment providers, mental health advocates and others met six times between legislative sessions to come up with a compromise bill that still fulfilled the original goal of providing short-term mental health care. (Wingerter, 2/17)

Stat: Texas Board Recommends Sanctions Against Stanislaw Burzynski
Along-running battle between the Texas Medical Board and controversial Houston doctor Stanislaw Burzynski could be coming to a head. The board said this week that it had proposed $380,000 in fines and a stiff set of sanctions for Burzynski’s failure to adhere to proper medical procedures in treating cancer patients. The decision is preliminary, and will be submitted and formally reviewed on March 3. (Tedeshci, 2/16)

Boston Globe: For This Hospital Chaplain, Work Is A Matter Of Life And Death 
As [Alyssa] Adreani, 41, likes to point out, [she] isn’t hanging out in the Newton hospital’s chapel and doesn’t wear a collar or a cross. She makes the rounds of the neonatal intensive care unit, oncology, ICU, orthopedics, and medical/surgical units, following her personal Golden Rule of chaplaincy: “Wear comfortable shoes.” The Globe spoke with Adreani about how hospital chaplains are considered part of the treatment team, sometimes even improving health outcomes. (Atoji Keene, 2/16)

Seattle Times: State Regulators Investigating Swedish’s Cherry Hill Hospital, Top Surgeon 
State health regulators have launched an investigation into the practices of Swedish Health Services’ Cherry Hill hospital, days after a Seattle Times report uncovered wide-ranging concerns about patient care at the facility. David Johnson, a spokesman with the state Department of Health, said Thursday a case-management team authorized the new investigation after reviewing The Seattle Times’ findings. Johnson added that the state Medical Commission, which handles issues involving specific doctors, was in the process of investigating complaints filed against Dr. Johnny Delashaw. (Baker, 2/16)

Arizona Republic: New Flu-Tracking App Uses Maricopa County As Beta Site
A California-based health diagnostics company has chosen Maricopa County as the pilot testing site for Communidy, a free web app that allows users to see the age and county of people who currently have the flu. The app, which displays real-time data from doctors’ offices, hospitals, clinics and labs, may encourage people to get vaccinated early, said Machrina Leach, nurse program manager at the Maricopa County Department of Public Health. (Bosch and Jha, 2/16)

Milwaukee Journal Sentinel: United Community Center Opens Third Residential Treatment Facility
This month, the United Community Center, commonly known as UCC, opened its third residential treatment facility for people working to overcome alcoholism and drug addictions. The $1.1 million residence, named Latinas Unidas II, will enable 16 more women to participate in UCC’s residential treatment program at any given time. The new residence, UCC’s second for women, also will treat women who are pregnant or who have infant children, and the program will include prenatal and post-partum care, child care coordination and parenting classes. (Boulton, 2/16)

Cleveland Plain Dealer: Summa Health Gift Establishes Traumatic Stress Chair 
Longtime philanthropists Jim and Vanita Oelschlager have donated more than $4 million to Summa Heath over the last three decades. This week, couple’s foundation provided another donation to Summa Health to establish a Chair in Traumatic Stress. Dr. Patrick Palmieri, director of the Traumatic Stress Center, will serve as the first Oelschlager Chair. As director of the Summa Health Traumatic Stress Center, Palmieri is responsible for the center’s clinical, training and research activities for patients experiencing post-traumatic stress disorder, anxiety and depression. (Becka, 2/16)

Health News Florida: Students Discover Lead In Tap Water May Be Common In Older Homes 
Last semester, the students in Laura Manke’s community cares class embarked on a project, collecting samples of tap water from their homes.  And testing provided by University of South Florida researchers revealed that all of the 46 samples contained lead.Fortunately, the amount of lead in the water in their homes fell below levels that would trigger action under Environmental Protection Agency standards. But experts, including the EPA, say any amount of lead is not good for the body, especially in children under six. Damage can be permanent. (Ochoa, 2/16)

Pioneer Press: Forest Lake Nurse Avoids Jail Time For Stealing Patient’s Medication
A Forest Lake nurse who pretended to check on a patient so he could steal the man’s medication evaded jail time for the offense. Gregory Thomas Welcher, 30, was sentenced in Ramsey County District Court Thursday to five years probation on one count of felony-level theft. He also was ordered to spend one day in jail, but was given credit for the day he already logged at the Ramsey County Correctional Facility. Welcher pleaded guilty to the charge this past December. (Horner, 2/16)

Shreveport Times: Workshop Lets Caregivers Take Care Of Themselves
Social workers seeking a moment of rest from careers steeped in others’ suffering participated in a free “Compassion Fatigue” workshop on Thursday. The workshop, presented by the Noel Memorial United Methodist Church’s arts program, aimed at offering those who take care of others a chance to center and to take care of themselves. (Talamo, 2/16)

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

Treatment Gaps Persist Between Low- And High-Income Workers, Even With Insurance

Low-wage workers with job-based health insurance were significantly more likely than their higher-income colleagues to wind up in the emergency department or be admitted to the hospital, in particular for conditions that with good primary care shouldn’t result in hospitalization, a new study found.

At the same time, low-wage workers were much less likely to get preventive care such as mammograms and colonoscopies, even though many of those services are available without cost-sharing under the 2010 health law.

There’s no single reason for the differences in health care use by workers at different wage levels, said Dr. Bruce Sherman, an assistant clinical professor at Case Western Reserve University in Cleveland and the study’s lead author, which was published in the February issue of Health Affairs.

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Finances often play a role. Half of workers with employer-sponsored insurance are enrolled in plans with a deductible of at least $1,000 for single coverage. As deductibles and other out-of-pocket costs continue to rise, low-wage workers may opt to pay the rent and put food on the table rather than keep up-to-date with regular doctor visits and lab work to manage their diabetes, for example.

Likewise, convenient access to care can be problematic for workers at the lower end of the pay scale.

“Individuals are penalized if they leave work to seek care,” Sherman said. “So they go after hours and their access to care is limited to urgent care centers or emergency departments.”

The study examined the 2014 health care claims, wage and other data of nearly 43,000 workers at four self-funded companies that offered coverage through a private health insurance exchange. Workers were stratified into four categories based on annual maximum wages of $30,000, $44,000, $70,000 and more than $70,000.

Workers in the lowest wage category were three times more likely to visit the emergency department than top earners, and more than four times more likely to have avoidable hospital admissions for conditions such as bacterial pneumonia or urinary tract infections. But they used preventive services only half as often, the study found.

There are no easy solutions. Varying premiums or deductibles based on workers’ wages could take some of the bite out of low-wage workers’ out-of-pocket costs, but very few employers have adopted that strategy, Sherman said. Offering plans that pay for certain services, such as care related to chronic conditions, before the deductible is met could boost the use of care. But preventive services are available without cost-sharing in most plans and many low-wage workers aren’t getting recommended services.

“Health literacy concerns are important,” said Sherman, but it may not be the only barrier. “Some focus groups I’ve participated in, employees have said, ‘I understand the services are free, but if an abnormality is found that requires further services, I’ll have to [pay for it]. So because I feel fine, I’m not going to go.’”

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

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Viewpoints: Will The IRS Do In Obamacare Or Is The Sweeping Health Law Here To Stay Despite Attack?

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

The Washington Post: Reality Dawns: Obamacare Might Be Here To Stay
The burgeoning crisis over President Trump’s and former national security adviser Michael Flynn’s connections to Russia makes the already difficult task of repealing and replacing the Affordable Care Act even more confounding for Republicans, who won the White House and both houses of Congress based on unrealistic expectations about an as-yet-unidentified replacement plan. (Jennifer Rubin, 2/15)

Bloomberg: A Rough 24 Hours For Obamacare
The last 24 hours have been one long string of bad news for Obamacare. Tuesday, the insurer Humana announced that it would be pulling out of the exchanges for next year. Then we found out that the IRS had responded to Trump’s executive order on Obamacare by quietly rolling back a new rule planned for this year, which would have required filers to indicate whether they had maintained coverage in 2016 or to pay a penalty. And on Wednesday, word came that Mark Bertolini, the CEO of Aetna, had told a Wall Street Journal conference that Obamacare was in a death spiral. This stands in pretty stark contrast to claims by Andy Slavitt, who ran the Center for Medicare and Medicaid Services under President Barack Obama, that things were shaping up splendidly for 2018, so long as Republicans didn’t screw anything up. (Megan McArdle, 2/15)

Los Angeles Times: Trump’s IRS Stages A Stealth Attack On Obamacare
The Internal Revenue Service has become the first agency to follow President Trump’s directive to start undermining the Affordable Care Act. In a quiet rule change, but an important one, the IRS has told tax preparers and software firms that it won’t automatically reject tax returns that fail to state whether the tax filer had health insurance during the year. That effectively loosens enforcement of the ACA’s individual mandate. It appears to be a direct response to Trump’s Jan. 20 executive order requiring federal agencies “minimize … the economic and regulatory burdens of the Act.” (Michael Hiltzik, 2/15)

The New York Times: Now You Can Do Your Taxes Without Filling Out The Insurance Question
If you want to keep your health insurance status a secret from the I.R.S., the Trump administration just made it a little easier. The policy change, confirmed by the I.R.S. on Wednesday after elements were reported by the libertarian magazine Reason, does not do away with the Affordable Care Act’s requirement that all Americans who can afford it obtain health insurance or pay a fine. But it might make it a little harder for the I.R.S. to figure out who is breaking the rules. (Margot Sanger-Katz, 2/15)

Forbes: 4 Ways GOP Medicare Reform Plan Will Hurt You
Now that Tom Price has been confirmed as Secretary of Health and Human Services, it’s time to examine what he has in store for Medicare. He backs “premium support,” which is the GOP’s backdoor plan to privatize the system. Although GOP leaders such as House Speaker Paul Ryan have said that privatization is the only way to save Medicare — it’s not — there are some dangerous drawbacks for retirees. (John Wasik, 2/15)

RealClear Health: High Risk Pools Solve The Problem Of Preexisting Conditions
One reason health insurance premiums exploded under the Affordable Care Act is the law’s requirement that health insurers accept anyone who applied for individual coverage, known as guaranteed issue. The provision destroys an insurance market because it allows people to wait until a medical incident has occurred to get coverage. (Merrill Matthews and Mark Litow, 2/16)

JAMA: Medical Liability Reform In A New Political Environment
The election of President Donald Trump and a Republican-controlled US Congress may once again thrust medical liability reform into the health care debate. One likely policy solution to be advocated for is to place a cap on noneconomic damages that plaintiffs can recover through lawsuits. This policy proposal is part of the GOP’s A Better Way health care platform and has been part of previous Republican proposals to limit medical malpractice torts despite concerns that federal medical liability reform, by preempting state laws, may potentially weaken successful state regulation in some cases. (Anand Parekh and G. William Hoagland, 2/15)

Bloomberg: The Big Abortion Question For Gorsuch
If the U.S. Supreme Court were to reverse Roe v. Wade, individual states could still permit abortion. But, in theory, the Supreme Court could go further, and rule that laws permitting abortion violate the equal protection rights of unborn fetuses. That may seem far-fetched — but in his book on assisted suicide and euthanasia, Judge Neil Gorsuch lays out an argument that could easily be used to this end. (Noah Feldman, 2/16)

JAMA: Should The Definition Of Health Include A Measure Of Tolerance?
In 1948 the World Health Organization officially defined health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The definition has remained unchanged for more than 60 years. When it was adopted, tools to measure health did not exist. Indeed, it was decades before a comprehensive set of tools to measure physical, mental, and social well-being were developed. (Robert H. Brook, 2/14)

The New York Times: Congress Says, Let The Mentally Ill Buy Guns
For all their dysfunction, the Republican Senate and House have managed to act with lightning speed in striking down a sensible Obama administration rule designed to stop people with severe mental problems from buying guns. President Trump, who championed the National Rifle Association agenda as a candidate, is expected to sign the regressive measure. This, despite the Republican mantra that tighter control of mentally troubled individuals — not stronger gun control — is the better way to deal with the mass shootings and gun carnage that regularly afflict the nation. (2/15)

The Wichita Eagle: Statewide Health Plan Could Cost Wichita Teachers
One promising idea in a state efficiency study was having school districts join a statewide health insurance plan. But as a new audit found, such a move is complicated and would not save as much money as previously suggested. What’s more, a big share of the potential savings would be cost shifts to schoolteachers, especially in Wichita. In fact, 40 percent of the projected savings would come from shifting costs to teachers and other district employees. And of the $25 million in net cost shifts statewide, nearly $24 million would come from Wichita school district employees. (2/16)

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State Highlights: Surprise Medical Bill Measure Progresses In Ariz. Legislature; Conn. Claims One Of The Lowest Rates Of Uninsurance Naitonally

Outlets report on news from Arizona, Connecticut, California, Missouri, Minnesota, Ohio, Georgia and Washington, D.C.

Arizona Republic: Arizona Lawmakers Propose Relief For Consumers From Unexpected Medical Bills
Health-care consumers who have been stung by surprise medical bills might soon find some relief from an unexpected source: the Arizona Legislature. The problem occurs when a consumer seeks care after checking to be sure a doctor, clinic or hospital is part of their insurance company’s network — only to be billed later by out-of-network providers such as anesthesiologists or surgical assistants who were part of the chain of care. That can sometimes result in a whopping medical tab, with the consumer caught between an insurance company that doesn’t want to pay more and a medical provider who refuses to accept less. (Alltucker, 2/15)

The CT Mirror: CT Uninsured Rate Among Lowest In The Country, Report Says
Connecticut had one of the lowest rates of uninsured residents in the country last year, according to estimates from a federal survey released this week. The estimates from the National Health Interview Survey, released by the National Center for Health Statistics, pegged Connecticut’s uninsured rate at 3.5 percent – but the authors warned that that figure should be used with caution because the potential for error “does not meet standards of reliability or precision.” (Levin Becker, 2/16)

KQED: California Prisons Fight To Reduce Dangerous ‘Valley Fever’ Infections Among Inmates
When the wind kicks up in the town of Coalinga, dust devils whirl over almond orchards and pumpjacks. You can even see the narrow brown funnels from the grounds of Pleasant Valley State Prison, on the outskirts of town.But at the prison itself, there’s hardly any dust. That’s evidence of years of work by the California Department of Corrections and Rehabilitation to reduce and control the San Joaquin Valley’s ubiquitous wind-borne dust. The dust carries the spores of the debilitating fungal disease known as coccidioidomycosis, or “valley fever.” (Klein, 2/15)

St. Louis Public Radio: Refugee Restrictions Disrupt Work Of St. Louis Disease Researchers 
President Donald Trump’s executive order last month reduced the cap of refugees allowed into the United States from 110,000 to 50,000. That means that fewer refugees will be resettled into areas like St. Louis. But the cap also is curtailing disease research across the country. To understand diseases that are widespread in poor, war-torn countries, scientists study refugees from those nations that are infected with those diseases. (Chen, 2/15)

The Star Tribune: Resident Dies After Eden Prairie Caregiver Forgot To Plug In Heart Pump
A distracted aide at an Eden Prairie assisted-living center failed to plug in a resident’s heart pump at bedtime, and the man didn’t live through the night, according to a state investigation released Wednesday. The state Health Department found the facility, Aging Joyfully, at fault in the July 10 death because it had no procedure to ensure the pump would keep operating when switched every night from batteries to electricity from an outlet. (Walsh, 2/15)

San Jose Mercury News: Sunnyvale School Grocery Program Provides Weekend Meals To Students 
For many parents, San Miguel Elementary School is not just a place to fill their children’s minds but their stomachs as well. Since 2015 the school has participated in the Weekend School Food Program organized by Sunnyvale Community Services in partnership with the Sunnyvale School District. The program allows parents and other residents to pick up 32 pounds of donated food twice a month on Fridays. (Kezra, 2/15)

The Washington Post: ‘Urgent Care On Wheels’: Fire Departments Rescuing Patients From Costly ER Trips
In the 15 minutes after firefighters and a nurse knocked at Thelma Lee’s Maryland townhouse, they checked her blood pressure, told her what foods would keep her blood sugar from skyrocketing and set up an appointment — and a ride — to visit her primary-care physician. They also changed the battery in her chirping fire alarm and put a scale in her bathroom so she could monitor her weight. Then they rolled out in an SUV to their next house call. (Bui and Williams, 2/15)

San Jose Mercury News: Palo Alto Marsh To Get Mosquito Control Treatment
Palo Alto’s flood basin and nearby areas will be sprayed Thursday, Feb. 23 with a pesticide in an effort to reduce the growth of salt marsh mosquitoes, which are known for being “very vicious biters.” Russ Parman, assistant manager of the Santa Clara County Vector Control District, said the day-biting salt marsh mosquitoes are not known to transmit diseases such as West Nile or Zika. Officials are concerned, however, that treatment delays caused by winter storms will result in a “big cohort of mosquitoes,” Parman said. (Lee, 2/15)

Cleveland Plain Dealer: 4th Ohio Child Dies Of Flu-Related Illness: What You Need To Know 
A 7-year-old Columbiana County boy who died on Saturday of flu-related illness marked the fourth such death in the state so far this flu season, coming only two days after the death of a Rocky River 6 year old. Eva Harris of Rocky River died February 9th after being admitted to the Cleveland Clinic with a high fever two days earlier. The Columbiana County child was the second from that county to die of flu-related illness since the January 25th death of a 6-year-old Salem boy. (Zeltner, 2/15)

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

For California’s Smallest Businesses, Obamacare Opened The Door

If Republicans in Congress scrap the Affordable Care Act, Carmina Bautista-Ortiz might have to go back to Mexico for health care. But she’d rather spend the time running the printing shop she and her husband own in Jurupa Valley, a city about 50 miles east of Los Angeles.

For at least 10 years, before the Affordable Care Act made it possible for them to get insurance, Bautista-Ortiz and her husband Roger had been uninsurable — she because of a heart condition known as tachycardia, he because of high cholesterol.

Bautista-Ortiz crossed the border to get tests and specialty care for her rapid heartbeat. Her husband was slapped with a $20,000 hospital bill, which Carmina spent two years negotiating down until the hospital dismissed the debt.

Three years ago, the couple was finally able to buy subsidized health coverage through the state’s Obamacare exchange, Covered California, and Bautista-Ortiz said they now spend less time worrying about how to get care.

“Our health is … basically the most important thing that we have,” said Bautista-Ortiz. “If you’re not feeling well, you’re not going to do your job the right way.”

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Under Republican-led plans to repeal the Affordable Care Act, hundreds of thousands of self-employed people in California are at risk of losing their ability to buy affordable insurance. Some business owners welcome the rollback of the law, but the smallest of California businesses — entrepreneurs and contract workers who buy insurance on their own through Covered California — have the most to lose under a repeal.

That worries small business advocates who favor the Affordable Care Act. They say putting health care coverage out of reach of the self-employed could threaten Americans’ entrepreneurial spirit and burden people who create jobs and take on financial risk.

“When you’re providing a benefit that allows folks to take that risk with a little more of a safety net … that allows more entrepreneurs to take the plunge,” said Mark Herbert, California Director for Small Business Majority, an advocacy organization that opposes repeal.

Nationally, California has one of the highest rates of small business owners who get their coverage through a health insurance exchange — 16 percent — according to a U.S. Department of the Treasury analysis of 2014 data. And Covered California officials say nearly a quarter of enrollees — 377,000 people — declared themselves “self-employed” as of December. Enrollees receive an average of $440 a month in tax credits to help offset insurance premium costs, a spokesperson for the exchange said.

Herbert said rolling back subsidized health care and the no-exclusion policy for preexisting conditions could lead entrepreneurs to abandon their endeavors for more secure jobs, or prevent them from setting up shop in the first place.

“Uncertainty is very scary,” Herbert said. “There are enough variables and challenges that small business owners face,” said Herbert.

Other self-employed people say the looming repeal of Obamacare may not make them change careers, but it would change their relationship to health care.

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Charlie Murphy, a sewer pipe inspector in San Rafael, Calif., signed up for health insurance through Covered California last year. He recently lost 20 pounds after a doctor’s check-up. (Courtesy of Charlie Murphy)

Charlie Murphy, a sewer pipe inspector in Marin County, says if the hefty government subsidies that help him pay his monthly premium disappeared, he’d drop his coverage, or get a skeletal policy instead.

“My focus would be more [on] something catastrophic, than [a plan that supports] health maintenance,” said Murphy, 54, who pays a fraction of a monthly premium of roughly $500. The rest is subsidized with federal money.

When Murphy signed up for health care last year, he decided it was time for a check-up, the first in seven years. He barely interacted with doctors during the previous fifteen years, which he spent uninsured.

He was surprised to hear that his blood sugar and blood pressure were higher than they should be.

“I thought I was in better health than I was,” Murphy said.

The doctor’s visit — and a break up with a girlfriend — inspired Murphy to lose 20 pounds this past year. He cut down on smoking and drinking alcohol, and learned he can “survive without cookies and pie.”

He got some mental health treatment for anxiety, too, which improved his “outlook,” he said.

Although Obamacare may have made a notable impact on his health, he said he wouldn’t pay more for insurance or abandon his career to keep the same health care access he has now.

“I like working for myself, it’s nice … Driving around with the dog,” said Murphy, who performs site visits on homes for sale, inspecting sewage systems.

Just as each individual experiences the health care system differently, small business owners’ perspectives on Obamacare also vary widely and are influenced by ideological views and how much care costs.

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Sunder Ramani, owner of Westwind Media in Burbank, Calif., pays the health care premiums for roughly a dozen employees who opt into his employer-sponsored plans. He says premiums he have been steadily increasing in recent years. (Courtesy of Sunder Ramani)

Sunder Ramani, who owns Westwind Media, a post-production company in Burbank, Calif., offers small group coverage to roughly a dozen employees, even though he’s not legally required to. He pays 100 percent of their premiums.

“I’ve been paying higher and higher premiums, but for what appears to be packages that are less and less attractive,” said Ramani. He is a member of the California Leadership Council of the National Federation of Independent Business, a conservative small business association which opposes the Affordable Care Act and sued to overturn the law when it was first passed.

Ramani said if his business revenue hadn’t grown over the past several years, he might have shifted more of the health cost burden onto his employees. While Obamacare may not be solely responsible for health cost increases, Ramani said, the law didn’t bring them down as much as it could have.

In California, premiums in the small group market have been going up, but recent premium hikes have been smaller than in previous years, according to data from one of California’s two insurance regulators, the California Department of Managed Health Care. Premiums grew by almost 10 percent for small employer plans in 2011, whereas this year, they rose less than 6 percent, according to the data.

Businesses with 50 or more workers have greater legal responsibilities under the Affordable Care Act. The health reform law requires them to offer employees affordable coverage or pay a penalty.

That employer mandate has created an administrative “headache” for small business owners, say the insurance agents who help them comply with new required paperwork.

What’s more, the new requirement on employers hasn’t increased the rate of people with job-based coverage, because most employers of that size already offered employee health care before Obamacare, according to researchers at the Urban Institute.

But to the individuals who run the smallest of California’s enterprises, the law gave them benefits that didn’t exist before — the guaranteed availability of insurance, and the financial support to pay for it.

The promised repeal of the federal health law, as well as other policy changes under President Donald Trump, is complicating Carmina Bautista-Ortiz’s decisions to hire more employees or offer health care to the two she currently has.

Right now, those two employees, hired late last year, are responsible for their own health care. One is covered through her husband, and Carmina suggested to the other that he find a policy on the open market.

Bautista-Ortiz plans to look into a group health policy and help her employees pay for coverage. But right now, she says, those decisions are on hold.

She’s not sure how a repeal of Obamacare would affect her business yet, but she knows it will affect her personally.

“We’re ready for the worst, and hoping for the best,” she said.

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

Categories: California, California Healthline, Covered California, Insurance, Repeal And Replace Watch, Syndicate, The Health Law, Uninsured

New Rules Try To Shore Up Individual Health Insurance Market In 2018

While Congress continues to struggle with how to “repeal and replace” the Affordable Care Act, the Trump administration today unveiled its first regulation aimed at keeping insurers participating in the individual market in 2018.

“These are initial steps in advance of a broader effort to reverse the harmful effects of Obamacare, promote positive solutions to improve access to quality, affordable care and ensure we have a health system that best serves the needs of all Americans,” Tom Price, secretary of the Department of Health and Human Services said in a Twitter message.

But the new rule, which had been widely expected, was actually begun by the outgoing Obama administration. In part, it is an effort to address complaints by insurers that consumers were “gaming” the system to purchase coverage only when they were sick and then dropping it when they were healthy.

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To combat that, the regulation makes it harder for patients to sign up outside of annual open enrollment periods and would allow insurers to collect past-due premiums before starting coverage for a new year. It would also shorten the annual enrollment period by half, from three months to 45 days, ending right between Thanksgiving and Christmas. And it would give insurers more flexibility in the types of plans they offer and return regulation of the size and adequacy of health care provider networks to the states.

But it remains unclear whether the action will be too little, too late to ensure insurance is available next year. That would be necessary to keep congressional Republicans’ promises that people “do not get the rug pulled out from under them” during the transition to a new program, as House Speaker Paul Ryan (R-Wis.) says frequently.

On Tuesday, Humana announced it would stop selling policies in the health exchanges at the end of this year, and on Wednesday Mark Bertolini, the CEO of Aetna, suggested his firm might follow suit, repeating GOP charges that the individual market exchanges are in a “death spiral” where only sick people buy coverage.

While Humana was not a major player in the state exchange market — it only sold policies in 11 states for 2017 — its exit could leave at least 16 counties in Tennessee, including Knoxville, with no insurance company offering policies on the health exchange, according to data from the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

That alarmed Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health, Education, Labor and Pensions Committee, who has been one of the leading voices in Congress advocating a slower repeal and replace strategy.

“Yesterday’s news from Humana should light a fire under every member of Congress to work together to rescue Americans trapped in the failing Obamacare exchanges before they have no insurance options next year,” Alexander said in a statement.

Last year Aetna’s Bertolini also cited losses in the market as the reason for the company’s scaling back participation in the exchanges, although in an unrelated case, a judge’s ruling later said the decision had at least as much to do with pushing federal officials to allow Aetna to merge with Humana. On Monday that merger was officially called off after being blocked by a judge.

The new rules were greeted with cautious optimism by insurance industry trade groups.

“While we are reviewing the details, we support solutions that address key challenges in the individual market, promote affordability for consumers, and give states and the private sector additional flexibility to meet the needs of consumers,” Marilyn Tavenner, president and CEO of America’s Health Insurance Plans, said in a statement.

The Alliance of Community Health Plans, which represents nonprofit insurers, called the regulation “a promising first step.” But in a statement, president and CEO Ceci Connolly warned that the rule “does not resolve all of the uncertainty for plans and patients alike. Without adequate funding it will be extremely difficult to provide high-quality, affordable coverage and care to millions of Americans.”

Groups representing patients, however, were less happy with the changes. They argue that the rules could result in higher out-of-pocket costs.

Ron Pollack, executive director of the consumer group Families USA, said the new administration “is deliberately trying to sabotage the Affordable Care Act, especially by making it much more difficult for people to enroll in coverage.”

Sick people are likely to jump through any hoops required to get coverage, but healthy people are less inclined to sign up when it is more difficult. So by making it harder for healthy people to enroll, said Pollack, “they are creating their own death spiral that would deter young adults from gaining coverage, thereby driving up costs for everyone.”

And the American Cancer Society said that the new rules could hurt cancer patients in particular — for example, when they need to purchase new coverage after becoming too sick to work or moving to be closer to health providers. The proposed changes “would require documentation that is often challenging to quickly obtain,” and could “delay a patient’s treatment and jeopardize a person’s chance of survival,” said a statement from Chris Hansen, president of the society’s Cancer Action Network.

Unless the new administration changes the date, insurers must decide by May 3 if and where they will sell insurance for next year on the state exchanges.

Meanwhile, the Republican-led Congress remains in a deadlock between conservatives in the House, who want to repeal the health law as soon as possible, and moderates in the Senate like Alexander, who want to wait until there is agreement on what will replace it.

“We should just do what we said we would do,” Rep. Raul Labrador (R-Idaho) told reporters on Tuesday.

Conservatives say, at a minimum, Congress should pass the partial repeal bill it passed in 2015 that President Barack Obama vetoed. That measure would eliminate the expansion of the Medicaid program, financial help for people to purchase insurance, the penalties for not having coverage, and all the taxes that pay for the program, among other things.

“Why would it be difficult to get [the Senate] to vote for something they already voted for?” asked Rep. Mark Meadows (R-N.C.).

But congressional budget scorekeepers in January said that bill, which has no replacement provisions, could result in a doubling of premiums and 32 million more people without insurance.

And Republicans in the Senate, as well as President Donald Trump, continue to say that repeal and replace should take place simultaneously.

“I thought we were embarked on an effort to replace it,” said Sen. John McCain (R-Ariz.).

Categories: Insurance, Repeal And Replace Watch, Syndicate, The Health Law

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Viewpoints: A Planned Mega Merger Breaks Up; Donating Organs And Health Data

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

Los Angeles Times: How Aetna Frittered Away $1.8 Billion On A Merger Destined To Fail
Breakups are always emotional, more so when they’re expensive. Let’s calculate the financial carnage of Aetna’s breakup with Humana, a $34-billion merger deal that was shut down by a federal judge three weeks ago and ended by the two big insurance companies on Tuesday. We figure that Aetna wasted roughly $1.8 billion, pre-tax, in pursuit of a merger that many experts said was so anti-competitive that it probably wouldn’t fly. (Michael Hiltzik, 2/14)

Stat: Why You Should Donate Your Health Data, And Your Organs, When You Die
Data might not seem important in the way that organs are. People need organs just to stay alive, or to avoid being on dialysis for several hours a day. But medical data are also very valuable – even if they are not going to save someone’s life immediately. Why? Because medical research cannot take place without medical data, and the sad fact is that most people’s medical data are inaccessible for research once they are dead. (David Martin Shaw, Basel. J. Valérie Gross and Thomas C. Erren, 2/14)

Stat: A Dying Patient Teaches A Young Doctor About The Limits Of Medicine
One purpose of medical school is to inspire action in the face of daunting illnesses, and to meld that action with compassion and humanity. The medical knowledge accumulated from textbooks and experience is intended to embolden a physician as he or she ventures into the realm of disease. All of this is designed to help physicians provide their patients with refuge and reassurance when faced with a malady like cancer. Yet standing there in front of Janice and her family, everything I knew about her cancer stopped me from offering them any possibility for further curative treatment. That stood in stark contrast to what I thought was my principal task as a physician: making things better again. (Jalal Baig, 2/14)

The New York Times: Disabled, Shunned And Silenced In Trump’s America
I’m a woman. I’m physically disabled. And I’ve never been more scared than I am right now. I sat there staring at my computer screen as the words “page not found” popped up on the White House website. My eyes did a double take and then my heart sank. I felt like I’d just been punched in the gut as I realized that the Disabilities section had been removed from the site in the wake of President Trump’s inauguration. (Melissa Blake, 2/15)

Stat: Humans Are Living Longer Than Ever. But We Aren’t Necessarily Aging Well.
Worldwide, 901 million people are over the age of 60 today. That number is projected to reach 1.4 billion by 2030 and nearly 2.1 billion by 2050. But the success story of longer lives is a worthless prize if the quality of those lives is compromised because of poor health and a loss of autonomy. To ensure that people of all ages, but particularly older people, can do what they value, national health care systems must be able to respond to those with age-related chronic conditions such as type II diabetes to ensure timely access to education, screening, and appropriate treatment. (Jane Barratt, 2/14)

KevinMD: How Much Are Patients To Blame For ER Overuse?
The U.S. rings the bell on health care spending, and some point fingers at patients themselves. But why do patients choose the paths they choose? Just about every shift, I and my coworkers shake our heads, and wonder what may be driving our patients’ decisions. Parents who haven’t yet tried a drop of acetaminophen bring kids in at 2 a.m. with fevers. Patients show up with nose bleeds that have already stopped bleeding out in the car. Sprained ankles roll in by ambulance. (Sam Slishman, 2/14)

Pittsburgh Post-Gazette: The Right To Try: A National Law For Experimental Drugs Is Wise
The Trump administration has signaled support for a federal law to help terminally ill patients get access to drugs that might be their best hope but aren’t fully approved by the Food and Drug Administration. It’s a good cause. The FDA currently allows “compassionate use” of experimental drugs in certain cases, and its statistics show that almost every time it is asked to let someone take a drug under that program, it agrees; in fiscal 2015, the applications numbered more than 1,200. (2/15)

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