Tagged Medicaid

How The Medicaid Battle Is Far From Over: Despite Some Red States Embracing Limited Expansion, Others Dig In Their Heels

Recent moves by red state Republicans to block voter-approved Medicaid expansion, as well as threats from some Republican governors to slash funding highlight the fact that both sides are still fighting the Medicaid expansion battle. Medicaid news comes out of Georgia and Texas, as well.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Did you guys get as big a kick out of the #healthpolicyvalentines hashtag as I did? (I feel I’m talking to the right crowd here.) They’re quite delightful, including this timely one from KHN’s own Rachel Bluth: “Not even a PBM could get in the middle of our love.”

On to the news from the week.

Thursday was a somber day for many as the country marked the anniversary of the Parkland, Fla., mass shooting at Marjory Stoneman Douglas High School that left 17 dead.

On the eve of the anniversary, the House Judiciary Committee approved two bills that would expand federal background checks for gun purchases. Although the legislation faces certain demise in the Senate, it is the first congressional action in favor of tightening gun laws in years. In the votes you see echoes of a recent trend: Lawmakers are no longer treating gun control as “the third rail in politics.” The difference is stark if you look at just over 10 years ago when then-candidate Barack Obama was sending out mailers assuring voters he supported the Second Amendment.

Politico: House Democrats Make First Major Move to Tighten Gun Laws

The Associated Press: Parkland Anniversary Highlights Democratic Shift on Guns

There were too many heartbreaking anniversary stories to highlight just one, but a project worth checking out is one from The Trace, a nonprofit news organization that reports on gun violence. In the year since Parkland, nearly 1,200 more children have lost their lives to guns. The Trace brought together more than 200 teen reporters from across the country to remember those killed not as statistics, but as human beings with rich histories.

14 Children Died in The Parkland Shooting. Nearly 1,200 Have Died From Guns Since.

A handy reference: The good people at The Tampa Bay Times and the AP put together a useful list of all the gun laws that have been enacted in the country since the shooting.

Tampa Bay Times and Associated Press: Here Is Every New Gun Law in the U.S. Since the Parkland Shooting


There are some lawmakers on the Hill who are almost giddy to hold hearings on “Medicare-for-all” — and they’re not Democrats. Republicans have been struggling to find a winning stance on health care, ever since Dems’ midterm victories, which were attributed in part to their stance on the issue.

For the previously floundering GOP lawmakers, MFA is practically a gift-wrapped present that fell right into their laps. They’re confident they can frame the idea as reckless, radical and expensive, and pick off moderate voters who want to keep their insurance the way it is. Democratic leadership blasted the GOP’s calls for hearings as “disingenuous,” but MFA supporters were raring to duke it out — verbally, of course. “They think it’s going to be a ‘gotcha’ moment,” said Rep. Pramila Jayapal (D-Wash.) in Politico’s coverage. “But they have been wrong on this and continue to be wrong on it.”

Politico: Republicans Can’t Wait to Debate ‘Medicare For All’

Meanwhile, Democrats introduced legislation this week that would allow people over 50 to buy in to Medicare. The measure is much more politically palatable than MFA, and its sponsors are selling it is a realistic and incremental step in the direction toward universal coverage.

Politico: Push for Medicare Buy-In Picks Up With ’50 and Over’ Bill


Here’s something you don’t hear every day: Republicans and Democrats maybe (just maybe!) have found some common ground on the health law. As part of a package of bills to shore up the Affordable Care Act, Democrats are proposing slapping some consumer warnings on short-term plans. The hint of bipartisanship in the air, though, was limited to the advisories — Republicans were not fans of the rest of the changes proposed.

Modern Healthcare: Short-Term Health Insurance Plans May Get Consumer Warnings


Advocates deem Utah’s move to limit voter-approved Medicaid expansion as a “dark day for Democracy.” The governor and lawmakers who rushed through the restrictions to the expansion, however, say the work requirements and caps are necessary to make it sustainable for the state.

The Associated Press: Utah Reduces Voter-Backed Medicaid Expansion in Rare Move


As 2020 comes into focus, the abortion debate is definitely on the front burner for President Donald Trump, who has seized on recent controversies over so-called late-term abortions. This week, Trump and White House officials met with advocates, including Susan B. Anthony List President Marjorie Dannenfelser. While the discussions weren’t open to journalists, Dannenfelser confirmed that Trump was keenly interested in the issue. “The national conversation about late-term abortion … has the power to start to peel away Democrats, especially in battle grounds,” Dannenfelser said in The Hill’s coverage.

The Hill: Trump Offers Preview of Abortion Message Ahead of 2020


There was some movement in the agencies this week that should be on your radar:

— The Food and Drug Administration has announced it’s cracking down on the $40 billion supplement industry, especially targeting diseases that really should require medical care. Right now, that landscape is pretty much the Wild Wild West, where anything goes. And consumers don’t realize that.

The New York Times: F.D.A. Warns Supplement Makers to Stop Touting Cures for Diseases Like Alzheimer’s

— The Environmental Protection Agency has released its plan to address long-lasting toxins in drinking water. Activists were not impressed, saying the “action plan” was quite short on action.

Reuters: U.S. Unveils Plan to Control Some Toxins in Drinking Water, Sets No Limits

— The Centers for Medicare & Medicaid Services released two major proposed regulations that are meant to help ease patients’ access to their health care records. Right now, many health care providers and hospitals offer patient portals, but they often lack material such as doctor notes, imaging scans and genetic-testing data. Sometimes they’ll even charge for the data. The rules would address restrictions such as those.

The Wall Street Journal: New Rules Could Ease Patients’ Access to Their Own Health Records


In a sign of the growing awareness about the United States’ maternal mortality problem, the task force that sets the standards insurers are required to follow is expanding its guidance when it comes to depression during and after pregnancy. The U.S. Preventive Services Task Force already recommends that doctors screen pregnant women and new mothers, but the old guidelines focused on patients who were experiencing symptoms. The new advice is more proactive about addressing women who may be at risk.

The Wall Street Journal: New Mothers at Risk of Depression to Get Counseling Services, Covered By Insurance, Under New Guidelines


It’s a well-established fact that doctors have an unconscious bias when it comes to race and pain — one that leaves many minority patients undertreated and undermedicated. What’s interesting is to see how that disparity has shaped the opioid epidemic in the country — the ones that wreaked havoc on white communities.

Los Angeles Times: Why Opioids Hit White Areas Harder: Doctors There Prescribe More Readily, Study Finds

While all eyes are on the massive consolidated opioid lawsuit in Ohio that’s being compared to the Big Tobacco reckoning of the ’90s, this little case in Oklahoma might steal its thunder.

Stateline: Pay Attention to This Little-Noticed Opioid Lawsuit in Oklahoma


In the miscellaneous file for the week:

• A powerful investigation from The Wall Street Journal and Frontline uncovers the history behind an Indian Health Service doctor who was accused of molesting Native Americans yet allowed to continue practicing for decades. Where did it go wrong?

The Wall Street Journal: HHS to Review Indian Health Service After Revelations on Pedophile Doctor

• Rural hospitals are collapsing everywhere, leaving vulnerable residents stranded in health deserts. It can be devastating for towns to watch their hospitals die. Ducktown, Tenn., offers a snapshot of what’s playing out in states all across the country.

Nashville Tennessean: Tennessee Rural Hospitals Are Dying. Welcome to Life in Ducktown

• Employer-sponsored health care is often held up as the gold standard. But is it really that great?

CNN: Employer Health Plans Cover Less Than You Think, Study Finds

• I vividly remember the global fear surrounding the bird flu back in the aughts. People were panicking and countries were stockpiling medical supplies, as everyone braced for an epidemic reminiscent of the catastrophic 1918 Spanish flu. But then nothing happened. So … where’d it go?

Stat: What Happened to Bird Flu? How a Threat to Human Health Faded From View


Early numbers show that the flu vaccine is doing a pretty good job this year, so remember it’s not too late to get your shot! And have a great weekend!

Podcast: KHN’s ‘What The Health?’ “Medicare-For-All” For Dummies

Republicans are still in charge of the White House and the Senate, but the “Medicare-for-all” debate is in full swing. Democrats of every stripe are pledging support for a number of variations on the theme of expanding health coverage to all Americans.

This week, KHN’s “What the Health?” podcast takes a deep dive into the often-confusing Medicare-for-all debate, including its history, prospects and terminology.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Paige Winfield Cunningham of The Washington Post and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • Medicare-for-all is a new rallying cry for progressives, but the current Medicare program has big limitations. It does not cover most long-term care expenses, and includes no coverage of hearing, dental, vision or foot care. Medicare also includes no stop-loss or catastrophic care limit that protects beneficiaries from massive bills.
  • Though recent comments by Sen. Kamala Harris on eliminating private insurance with a move to Medicare-for-all stirred controversy, private insurance is indeed involved in many aspects of the government program. Private companies provide the Medicare Advantage plans used by more than a third of beneficiaries, the Medicare drug plans and much of the bill processing for the entire program.
  • Many consumers — and politicians — are confused by the terms being thrown around in the current debate about Medicare-for-all. The plan offered by Sen. Bernie Sanders (I-Vt.) and some of his supporters would be a “single-payer” system, in which the government would be in charge of paying for all health care — although doctors, hospitals and other health care providers would remain private. Others often use the term Medicare-for-all to mean a much less drastic change to the U.S. health care system, such as a “public option” that would offer specific groups of people — perhaps those over age 50 or consumers purchasing coverage on the insurance marketplaces — the opportunity to buy into Medicare coverage.
  • Sanders’ vision of Medicare-for-all is based on Canada’s system. But even there, hospitals and doctors are private businesses, drugs are not covered everywhere, and benefits vary among the provinces.
  • The health care industry is nearly united in opposing the talk of moving to a Medicare-for-all program because of concerns about disruption to the system and less pay. Currently, Medicare reimbursements are about 40 percent lower than private insurance.

If you want to know more about the next big health policy debate, here are some articles to get you started:

Vox’s “Private Health Insurance Exists in Europe and Canada. Here’s How It Works,” by Sarah Kliff

The Washington Post’s “How Democrats Could Lose on Health Care in 2020,” by Ronald A. Klain

The American Prospect’s “The Pleasant Illusions of the Medicare-for-All Debate,” by Paul Starr

The Week’s “Why Do Democrats Think Expanding ObamaCare Would Be Easier Than Passing Medicare-for-All?” by Jeff Spross

Vox’s “How to Build a Medicare-for-All Plan, Explained By Somebody Who’s Thought About It for 20 Years,” by Dylan Scott

The New York Times’ “The Best Health Care System in the World: Which One Would You Pick?” By Aaron E. Carroll and Austin Frakt

The Nation’s “Medicare-for-All Isn’t the Solution for Universal Health Care,” by Joshua Holland

The New York Times’ “’Don’t Get Too Excited’ About Medicare for All,” by Elisabeth Rosenthal and Shefali Luthra

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too.

Julie Rovner: Yahoo News’ “What Trump Got Wrong About ‘Right to Try,’” by Kadia Tubman

Joanne Kenen: STAT News’ “The Modern Tragedy of Fake Cancer Cures,” by Matthew Herper

Rebecca Adams: The Texas Tribune’s “Thousands of Texans Were Shocked By Surprise Medical Bills. Their Requests for Help Overwhelmed the State,” by Jay Root and Shannon Najmabadi

Paige Winfield Cunningham: STAT News’ “The ‘Big Pharma’ Candidate? As He Runs for President, Cory Booker Looks to Shake His Reputation for Drug Industry Coziness,” by Lev Facher

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Podcast: KHN’s ‘What The Health?’ “Medicare-For-All” For Dummies

Republicans are still in charge of the White House and the Senate, but the “Medicare-for-all” debate is in full swing. Democrats of every stripe are pledging support for a number of variations on the theme of expanding health coverage to all Americans.

This week, KHN’s “What the Health?” podcast takes a deep dive into the often-confusing Medicare-for-all debate, including its history, prospects and terminology.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Paige Winfield Cunningham of The Washington Post and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • Medicare-for-all is a new rallying cry for progressives, but the current Medicare program has big limitations. It does not cover most long-term care expenses, and includes no coverage of hearing, dental, vision or foot care. Medicare also includes no stop-loss or catastrophic care limit that protects beneficiaries from massive bills.
  • Though recent comments by Sen. Kamala Harris on eliminating private insurance with a move to Medicare-for-all stirred controversy, private insurance is indeed involved in many aspects of the government program. Private companies provide the Medicare Advantage plans used by more than a third of beneficiaries, the Medicare drug plans and much of the bill processing for the entire program.
  • Many consumers — and politicians — are confused by the terms being thrown around in the current debate about Medicare-for-all. The plan offered by Sen. Bernie Sanders (I-Vt.) and some of his supporters would be a “single-payer” system, in which the government would be in charge of paying for all health care — although doctors, hospitals and other health care providers would remain private. Others often use the term Medicare-for-all to mean a much less drastic change to the U.S. health care system, such as a “public option” that would offer specific groups of people — perhaps those over age 50 or consumers purchasing coverage on the insurance marketplaces — the opportunity to buy into Medicare coverage.
  • Sanders’ vision of Medicare-for-all is based on Canada’s system. But even there, hospitals and doctors are private businesses, drugs are not covered everywhere, and benefits vary among the provinces.
  • The health care industry is nearly united in opposing the talk of moving to a Medicare-for-all program because of concerns about disruption to the system and less pay. Currently, Medicare reimbursements are about 40 percent lower than private insurance.

If you want to know more about the next big health policy debate, here are some articles to get you started:

Vox’s “Private Health Insurance Exists in Europe and Canada. Here’s How It Works,” by Sarah Kliff

The Washington Post’s “How Democrats Could Lose on Health Care in 2020,” by Ronald A. Klain

The American Prospect’s “The Pleasant Illusions of the Medicare-for-All Debate,” by Paul Starr

The Week’s “Why Do Democrats Think Expanding ObamaCare Would Be Easier Than Passing Medicare-for-All?” by Jeff Spross

Vox’s “How to Build a Medicare-for-All Plan, Explained By Somebody Who’s Thought About It for 20 Years,” by Dylan Scott

The New York Times’ “The Best Health Care System in the World: Which One Would You Pick?” By Aaron E. Carroll and Austin Frakt

The Nation’s “Medicare-for-All Isn’t the Solution for Universal Health Care,” by Joshua Holland

The New York Times’ “’Don’t Get Too Excited’ About Medicare for All,” by Elisabeth Rosenthal and Shefali Luthra

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too.

Julie Rovner: Yahoo News’ “What Trump Got Wrong About ‘Right to Try,’” by Kadia Tubman

Joanne Kenen: STAT News’ “The Modern Tragedy of Fake Cancer Cures,” by Matthew Herper

Rebecca Adams: The Texas Tribune’s “Thousands of Texans Were Shocked By Surprise Medical Bills. Their Requests for Help Overwhelmed the State,” by Jay Root and Shannon Najmabadi

Paige Winfield Cunningham: STAT News’ “The ‘Big Pharma’ Candidate? As He Runs for President, Cory Booker Looks to Shake His Reputation for Drug Industry Coziness,” by Lev Facher

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Utah’s Novel Plan For Medicaid Expansion Opens Door To Spending Caps Sought By GOP

Utah this week became the 35th state to approve expanding Medicaid under the Affordable Care Act, but advocates for the poor worry its unusual financing could set a dangerous precedent and lead to millions of people losing coverage across the country.

That’s because the plan includes unprecedented annual limits on federal and state spending.

Those restrictions would be a radical change for Medicaid. Since it began in 1966, the state-federal health program for low-income residents has been an open-ended entitlement for anyone who meets eligibility criteria. State and federal spending must keep pace with enrollment.

Joan Alker, executive director of the Georgetown University Center for Children and Families, is concerned that the state and federal Medicaid funding caps can limit how many people are enrolled and what services they receive. She said no state has before tried to cap its own funding.

“This is a way for the state to look like it’s doing expansion when they are really doing very little,” she said.

If Utah’s plan is approved, Alker added, other states that have already expanded Medicaid and some that are considering it will likely seek to strike a similar deal.

Limiting spending on Medicaid has been a longtime goal of fiscal conservatives, but opposition to the idea helped blow up  Republican efforts to repeal and replace the ACA in 2017.

Also fueling criticism: The law signed by Utah Gov. Gary Herbert on Monday expands Medicaid only to people earning up to 100 percent of the federal poverty level instead of the 138 percent mark set by the ACA and approved by Utah voters in a referendum supporting expansion in November. Both the Obama and Trump administrations have refused in the past to accept that condition.

The proposal also includes a work requirement for adults who gain coverage through the expansion.

Utah’s proposal needs federal approval, and state officials said they hope to have that in time to expand Medicaid to 90,000 adults on April 1.

The state expects to adopt annual spending caps after negotiations with the Trump administration.

Congressional Republicans and President Donald Trump tried to cap federal Medicaid payments as part of their health law repeal efforts in 2017. But that move met stiff opposition from Democrats, hospital and patient advocates and some Republican lawmakers. They warned it would lead to cuts in benefits and enrollment.

Utah’s proposal to limit federal spending was necessary to get the Trump administration to approve its application to only partially expand Medicaid, the state’s top Medicaid official said.

“We were looking for a way to make our waiver more attractive to the federal government,” said Nathan Checketts, Utah’s Medicaid director.

He said the Trump administration last year was skeptical of the state’s proposal to expand Medicaid to adults with incomes below 100 percent of the federal poverty level — about $12,500 annual income for an individual — instead of 138 percent of the poverty level, about $17,000 in annual income. That’s because it would mean higher federal spending, since people earning between 100 percent and 138 percent of poverty would be eligible for federal subsidies to help pay for premiums for insurance they buy on the ACA exchange.

By capping funding at a negotiated per capita rate, the federal government could better control its spending, Checketts said.

Under Trump, the federal Centers for Medicare & Medicaid Services has not approved requests by Arkansas and Massachusetts to get the higher federal match rate for partial expansion.

CMS, Checkett added, has been open to a deal since after Election Day. “They’ve become more receptive to our request than they were last year, but there are no guarantees,” he said.

Under the proposed deal, the federal government would pay 90 percent of the costs for anyone coming into Medicaid through expansion — the rate set by the ACA. In traditional Medicaid, the state receives a 70 percent federal match.

The federal spending cap would vary based on how many people are enrolled under expansion. If the costs for covering the expansion population exceeded the federal spending cap, the state could limit how many people it enrolled, Checketts said.

The law also includes a state funding cap so Utah officials can limit enrollment if spending were to exceed the budget, Checketts said. The federal government would also have to approve a state spending cap.

“The state has to balance its budget every year, and this allows the state to align its budget and a certain amount of money to put toward this population and not any more,” he said.

If CMS does not grant the waiver for a partial expansion, the bill requires the state to establish a full expansion in 2020.

Jessie Mandle, senior health policy analyst for Voices for Utah Children, an advocacy group, said the plan is tough to swallow for advocates who have been fighting for expansion for more than six years.

“This will create more barriers and restraints to care,” she said. “This was not the way voters chose to expand.”

Utah’s plan to seek a per capita spending cap comes even though the state’s per capita Medicaid spending is among the lowest, according to a report last year by the Utah Foundation, a nonpartisan research group.

The average cost for each Medicaid enrollee in Utah was $5,326 in 2014, the most recent year for which that figure is available, the report found. That number was the 10th lowest in the United States.

Nationwide, Utah also had the lowest percentage of its population enrolled in Medicaid as of 2016, the report said.

Can California Beat The Federal Government In Lowering Drug Prices?

California Gov. Gavin Newsom says he’s done waiting for the federal government to curtail the rising cost of prescription drugs.

Newsom has his own plan to ease that financial burden — one he hopes other states can join or replicate.

The Democratic governor said he intends to use California’s might as the world’s fifth-largest economy to demand lower prices directly from drug companies for millions of Medicaid enrollees, state government workers and, eventually, Californians in the private sector.

“I recognize deeply the anxiety so many of you feel around the issues related to the cost of prescription drugs,” Newsom said in a Facebook Live video when announcing his initiative. “And I hope California’s efforts here can lead the way to other states to consider the same.”

Newsom said later he’s already “talking to other state governors about how they can participate.”

Whether he can deliver on his ambitious pledge to take on big pharmaceutical companies is far from certain. The plan he introduced his first day in office is based on broad ideas, with few details and start dates that may be years away.

States have taken smaller steps to rein in drug prices and achieved limited savings. But the issue has stymied lawmakers at the federal level, including President Donald Trump, who called for lowering the cost of prescription drugs in his State of the Union address last week.

Lawmakers face an array of challenges that make reform hard, such as secretive drug pricing and the political influence of the pharmaceutical industry, one of the most powerful lobbies in the country, said Rachel Sachs, an associate professor at Washington University in St. Louis who specializes in health law.

“Drug pricing is one of the most complicated areas within a complicated health care system,” Sachs said.

In California, the amount the state government spends on prescription drugs has risen 20 percent per year since 2012, according to Newsom’s executive order.

To stem that rise, he wants the state Department of Health Care Services — which oversees Medi-Cal, the country’s largest Medicaid program, for low-income residents — to negotiate prescription drug prices for all of its roughly 13 million enrollees by 2021.

Currently, the vast majority of Medi-Cal enrollees get their prescription drugs through managed-care plans that contract with the state to provide Medi-Cal coverage — a fragmented system that doesn’t yield the best price for consumers, the Newsom administration argues.

With the state in charge of negotiations, Medi-Cal could save $150 million a year, the administration said, and Medi-Cal enrollees could go to virtually any pharmacy, as opposed to the limited options authorized by their health plans.

Although the concept of bulk purchasing might sound good, health experts say, the state faces barriers.

Federal law requires Medicaid programs to cover most drugs approved by the Food and Drug Administration. That leaves states without one of the biggest bargaining chips available to the private sector: the ability to tell drugmakers they won’t buy their products.

But California can get creative, said Jennifer Kent, the health department’s director. For example, the state can create a preferred drug list that gives drugmakers an incentive to reduce their prices. If a medication is on the list, doctors don’t need to obtain preauthorization from Medi-Cal to prescribe it, making it more accessible and thus more likely to be used by patients, Kent said.

In addition, the sheer size of California’s Medi-Cal program can help drive down prices, Kent said.

“I think of us as the third-largest public purchaser in the nation” behind Medicare and the Department of Veterans Affairs, Kent said. “We cover a very significant number of people.”

But representatives for California health plans and pharmacy benefit managers, the middlemen who negotiate with drugmakers on behalf of health plans and government entities, say their organizations already work to find the best prices for consumers. They haven’t publicly opposed Newsom’s plan but have expressed skepticism.

The Pharmaceutical Care Management Association, which represents pharmacy benefit managers, said in a written statement that its companies are set to save the California Medi-Cal program $8.59 billion in projected costs from 2016 to 2025.

Drugmakers have launched a national campaign that blames insurers for failing to pass along more than $150 billion a year in rebates and discounts to consumers.

In addition to negotiating for Medi-Cal enrollees, Newsom wants to get a better deal for state workers. He has directed his administration to study how agencies could band together in a separate drug-purchasing pool to buy prescription drugs as one entity.

Currently, more than 20 state agencies negotiate drug prices separately.

Newsom said he envisions private purchasers — including small businesses, health plans and self-insured Californians — eventually joining these state agencies at the bargaining table in a bid to “marshal public and private parties” for lower drug prices.

A report last year by the National Academy of Sciences found that spending on biopharmaceuticals accounts for nearly 17 percent of America’s annual health care bill, and that many people have difficulty paying for the drugs they need.

Among the report’s recommendations to lower costs: The federal government should consolidate its purchasing power and directly negotiate prices for all federal health care programs, including Medicare and Department of Veterans Affairs coverage. However, legislation to do that within Medicare has stalled repeatedly over the years and remains controversial.

Trump’s proposal last year to link Medicare spending for certain drugs to what other industrialized countries pay has gone nowhere. Last month, the Trump administration proposed a new prescription drug discount plan that would steer the rebates drug companies now give to insurers directly to consumers.

In the absence of federal action, states have sought to curb drug prices on their own. Among those efforts: a Connecticut law requiring drug companies to justify price increases, a California law requiring them to report price hikes, and a New York cap on drug spending in the state’s Medicaid program.

Twenty-eight states and the District of Columbia belong to multistate purchasing pools, mostly for their Medicaid programs. But data about how much money these pools have saved is scarce, said Edwin Park, a research professor at Georgetown University’s Center for Children and Families.

“I think there are real opportunities and real interest in the states about leveraging their buying power,” said Trish Riley, the executive director of the National Academy for State Health Policy. “The states can’t wait for federal action.”


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Advocates Hope Emerging Evidence About Economic Benefits Of Medicaid Expansion Will Nudge Kansas, Missouri Into Action

The states have long-balked at the price tag associated with expansion, but economists are saying other red states are reaping the benefits of injecting the economy with millions in federal dollars. Beginning next year, however, the federal government’s contribution will phase down to 90 percent from the current 93 percent of expansion costs, which will make it a harder sell. Medicaid news comes out of Utah and North Carolina.

CMS Has Granted Red States Ever-Increasing Flexibility With Medicaid. Will That Hold True When Blue States Come Knocking?

Following the elections that flipped seven governorships, this could be a pivotal year for CMS Administrator Seema Verma. “Does flexibility go to everyone or is it just for cheaper, less regulated insurance?” said Chris Sloan, a director at Avalere, a health-care consulting firm. “That has yet to be decided.” Meanwhile, Democrats want the administration to crack down on state that aren’t fully complying with Medicaid abortion rules.

Fast-Moving Bill To Curtail Voter-Approved Medicaid Expansion Secures Key Approval In Utah Legislature

Lawmakers who have been worrying about the long-term costs of expanding Medicaid have been quickly working to roll back some of the changes that Utah voters approved through a ballot initiative in November’s elections. Other Medicaid news focuses on waivers, delays in payment and mental health services.

Utah Voters Approved Medicaid Expansion, But State Lawmakers Are Balking

Utah residents may have thought they were done fighting about Medicaid expansion last November. But when Utah lawmakers opened a new legislative session in late January, they began pushing through a bill to roll back the scope and impact of an expansion that voters approved in a ballot measure.

“We voted for this on Nov. 6. We were very clear about what we wanted,” said Andrew Roberts, a spokesman for Utah Decides, the group that organized the Medicaid expansion referendum, known as Proposition 3.

The voter-approved measure would extend coverage to 150,000 uninsured people in the state.

“We are frustrated, and I think Utahns are frustrated,” Roberts said.

That frustration led his group to hire a billboard truck to drive in circles around the Capitol building and through the snowy streets of Salt Lake City and its suburbs. Signs on the sides of the truck flash phrases in LED lights, including “Support democracy. Support Utah’s vote.” A looping video advertisement urges residents to call lawmakers “who don’t respect the will of the people.”

After six years of talking about Medicaid expansion, voters approved the ballot measure on Nov. 6, with 53 percent in favor. But the issue erupted again when the legislative session started Jan. 28.

Similar legislative efforts to curtail expansion are also happening in Idaho, where voters passed a Medicaid expansion initiative in November. Sixty-one percent of voters were in favor. Idaho lawmakers are considering ways to scale that program back.

In politically and fiscally conservative Utah, legislators argue the 0.15 percent non-food sales tax that voters approved won’t be enough to pay for Medicaid expansion. So they’ll pass an expansion, but only a very limited one.

Voters “wanted Medicaid expansion, and that’s what we’re doing,” said Republican state Sen. Allen Christensen. But, he added, the voters “didn’t fill in the proper blanks. We are filling in those blanks for them. They are not obligated to balance the budget. We are.”

Christensen is leading the rollback effort in Utah. His alternative proposal, SB 96, would cap the number of individuals who would qualify for Medicaid, add work requirements and lower the annual income limit. Proposition 3 supporters had wanted the coverage available for people who made up to 138 percent of the federal poverty level, or nearly $17,000 a year. But Christensen’s bill would offer Medicaid coverage only to people who made less than 100 percent of the federal poverty level, or about $12,000 for an individual.

Making those changes would require the state of Utah to get approval for two federal waivers from the federal Centers for Medicare & Medicaid Services. Proposition 3 supporters point out that similar requests from other states have been denied.

“From the perspective of voters, I think voters have a right to be furious right now,” said Matt Slonaker, executive director of the Utah Health Policy Project, another group that has supported Medicaid expansion.

Slonaker said changing the scope of Proposition 3 would mean fewer people getting health coverage, and the state would receive less money from the federal government. He also fears it could make voters feel disillusioned.

“Why would voters ever want to pursue ballot initiatives and direct democracy if the legislature’s just going to repeal it anyway?” Slonaker asked.

While some Utah lawmakers, such as Christensen, describe being “philosophically opposed” to Medicaid expansion, much of the political debate in Utah is about how much expansion will cost, and whether the new sales tax will pay for it. Supporters point to the fiscal experience of other states.

“You should think of Medicaid expansion as no different than if you said, ‘Oh, hey, somebody’s going to go open up a factory,’” said Bryce Ward, an economist at the University of Montana, in Missoula. “And that factory is going to bring, in the case of Montana, $600 million of outside money into the state that we’re going to pay to workers here.”

Ward recently published a report on the economic impacts of Medicaid expansion in Montana during the first two years of that program. He said it brought in about $600 million dollars in new funds to the state per year. That money supported about 6,000 jobs, he added, or about $350 million in additional income for residents.

Ward said states like his also can take advantage of savings, because Medicaid expansion makes providing health care to certain groups, like prisoners, more affordable. While states do have to pay 10 percent of the cost of expanded Medicaid (the federal government covers 90 percent — a more generous “match” than traditional Medicaid), the combination of savings and economic growth meant that, in the case of Montana, the program basically pays for itself, Ward said.

“The benefits that people in Utah have is that people like me in other states have done the work trying to figure this out,” he said. “Or at least get some ballpark estimates of it.”

So far, Utah lawmakers remain unconvinced by studies like Ward’s. The bill to restrict Medicaid expansion is moving fast, and could reach the governor’s desk as soon as next week.

This story is part of a partnership that includes KUERNPR and Kaiser Health News.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Also known as the day President Donald Trump is getting his second annual physical. Last year, Dr. Ronny L. Jackson attributed the president’s “excellent health” to good genes and God. Will this year be different with a new physician?

The headliner from this week was obviously the State of the Union address, so let’s get right to it.

Trump’s pledge to end the HIV epidemic was greeted with cautious optimism — laced with a heavy dose of skepticism. The administration’s plan involves targeting HIV hot spots and increasing access to medications that treat and prevent the disease. However, the lack of specific details in Trump’s address have HIV advocates nervous. “To date, this administration’s actions speak louder than words and have moved us in the wrong direction,” said AIDS United.

The Associated Press: Trump Launching Campaign to End HIV Epidemic in US by 2030

Kaiser Health News: Trump Pledges To End HIV Transmission By 2030. Doable, But Daunting.

When it comes to high drug prices, Trump had very simple instructions for Congress: “Do more.” The response, as you can imagine, was mixed. Some Democrats saw it as an invitation to work on an issue that could be one of the few bipartisan successes emerging from the current Congress. Others don’t have any interest in getting on board with the president’s policies — which include capping U.S. drug payments based on prices paid abroad.

Stat: Democrats Can’t Decide How to React to Trump’s Call for ‘More’ on Drug Pricing

Meanwhile, in his address, Trump used a pretty wonky (as in, in the weeds) metric to praise his administration’s efforts on bringing down drug prices. The consumer price index, at best, doesn’t tell the full story of costs, and experts say that, given how complicated the system has become (i.e. with rebates), it has outlived its usefulness.

Stat: Trump Claims Drug Prices Have Fallen. But He’s Cherry-Picking That Data

Recent controversies over abortions provided Trump the perfect opportunity, as he starts to gear up for 2020, to give a little love to a highly valued segment of his base. Virginia’s governor had made comments last week that led to accusations that he supported infanticide; and New York just passed a bill that protects against efforts to roll back Roe v. Wade. Trump used those incidents as a springboard to call on Congress to ban “late-term abortions.” And the language he used in the speech — “All children — born and unborn — are made in the holy image of God” — is being seen as a play for evangelical voters.

The Associated Press: With Anti-Abortion Push, Trump Woos Evangelicals Again

Doctors weighed in on the debate with this reality check: Clinically, there is no such thing as a “late-term abortion.” See what else they say the president got wrong.

The New York Times: What Is Late-Term Abortion? Trump Got It Wrong

Childhood cancer also got a shout-out in the SOTU. Although it has an 80 percent cure rate, scientists say that number is skewed by the tremendous progress that’s been made against childhood leukemia. Other pediatric cancers have a long way to go. (And so they are welcoming the $500 million with open arms and a distinct list of ideas.)

Stat: Scientists Have Ideas to Spend Trump’s Money for Childhood Cancer


Former Rep. John Dingell died on Thursday at age 92. Lawmakers and politicians praised the country’s longest-serving congressman, calling him a “beloved pillar of the Congress” who is leaving behind “a towering legacy.” One common thread in the heartfelt messages was the impact he had on America’s health care. “He had a long tradition of introducing legislation on the first day of each new Congress to guarantee health care for every single American,” former President Barack Obama wrote. “Because of him, we’ve come closer to that vision than ever before. And when we finally achieve it — and we will — we’ll all owe him our gratitude.”

The Washington Post: Colleagues, friends remember John Dingell, an ‘American legend’ and ‘beloved pillar of Congress’


Fresh off their midterm victories, Democrats are wasting no time setting up hearings to secure protections for people with preexisting conditions. Any legislation would be mostly symbolic because it would face an all-but-certain death in the Republican-controlled Senate, but it solidifies talking points that have been successful for Democrats recently.

The New York Times: Democrats Unite to Begin Push to Protect Pre-Existing Condition Coverage


If you’re confused about Trump’s rebate proposal join the (very crowded) club. But here’s the bottom line: Most patients will pay a little more since their premiums will go up (because insurers would no longer be able to apply rebate money from the drugs to lower premiums). However, people who take outrageously expensive medication will get relief. Experts say the trade-off is worth it.

The New York Times: How Trump’s Latest Plan to Cut Drug Prices Will Affect You

How does a drug that, until December, was free to patients now have a $375,000 price tag? Paint Sen. Bernie Sanders (I-Vt.) … curious … to say the least.

Stat: Sanders Calls Price of a Rare Disease Drug ‘Immoral Exploitation’


Court watchers were eagerly awaiting the Supreme Court’s decision on a Louisiana admitting-privileges law — the first real gauge of how the new dynamics of the court will play out with abortion decisions. The Louisiana restrictions are quite similar to ones knocked down in a 2016 ruling, but the court is also more conservative than it was at that time. For now, Chief Justice John Roberts disappointed his conservative colleagues by joining with the liberal justices in issuing a stay on the law. The decision likely means the court will take up the issue in its next term, which starts in October.

The New York Times: Supreme Court Blocks Louisiana Abortion Law


Medicaid expansion advocates were ecstatic last year when ballot initiatives proved a successful way to circumnavigate red-state legislatures that had been blocking changes to the program. This week, a bucket of cold water has doused that enthusiasm as lawmakers in both Utah and Idaho scramble to counter the expansion as much as possible. While the proposals — like adding work requirements — gain popularity in red states across the country, the fact it’s happening at all after voters OK’d the expansion highlights the reality that ballot initiatives can do only so much.

The New York Times: In Utah and Idaho, G.O.P. Looks to Curb Medicaid Expansions That Voters Approved


In a startling, horrifying trend, veterans have been killing themselves in VA parking lots in what experts see as a protest against a system that failed them. The latest was a Marine colonel who, dressed in his uniform blues and medals, sat on top of his military and VA records and shot himself with a rifle outside the Bay Pines Department of Veterans Affairs. “It’s very important for the VA to recognize that the place of a suicide can have great meaning. There is a real moral imperative and invitation here to take a close inspection of the quality of services at the facility level,” said Dr. Eric Caine, director of the Injury Control Research Center for Suicide Prevention at the University of Rochester.

The Washington Post: Parking Lot Suicides at Veterans Hospitals Prompt Calls for Better Staff Training, Prevention Efforts

Meanwhile, USA Today released a comprehensive analysis on the quality of VA hospitals versus civilian ones. Some of the scores came back positive (death rates, on the whole, were lower at VA facilities); others that look at preventable infection rates and bedsores hinted at neglect. USAT offers a very cool look-up tool if you want to see how your clinic fared.

USA Today: Death Rates, ER Waits: Where Every VA Hospital Lags, Leads Other Care


An HHS official is arguing that pulling separated migrant children from their sponsor homes to reunite them with their families would do more harm than good psychologically at this point. Jonathan White, an official leading HHS’ reunification efforts, said in a court filing that it would make more sense for the government to focus on children who were still in custody. The ACLU called the position a “shocking concession that it can’t easily find thousands of children it ripped from parents, and doesn’t even think it’s worth the time to locate each of them.”

The Associated Press: US Sees Limitations on Reuniting Migrant Families


In the miscellaneous file for the week:

• There’s a long history of mistrust between the African-American community and medical professionals, and Virginia Gov. Ralph Northam’s photo involving black face pressed sharply against that never-healed wound. (At the time, Northam was graduating from medical school on his way to becoming a pediatrician.)

The Associated Press: Blackface Photo Reopens Long History of Bigotry in Medicine

• Anecdotal evidence was thick on the ground that women were seeking emergency contraception in the wake of Trump’s election victory. Now there are numbers to back it up.

The Hill: Demand for Certain Forms of Contraception Increased After Trump’s Election: Study

• Could an infamous party drug really help quiet suicidal ideation in the midst of an ever-worsening crisis? This fascinating history on the use of ketamine is well-worth the read.

Bloomberg: Ketamine Could Soon Be Used to Treat Suicidal Ideation

• “It’s like throwing a match into a can of gasoline,” experts say of the measles outbreak in the Pacific Northwest. Are they just the norm now? And why were there so many kids who weren’t vaccinated?

The New York Times: ‘A Match Into a Can of Gasoline’: Measles Outbreak Now an Emergency in Washington State

CNN: Measles Rarely Kills in the US — But When It Does, Here’s How 


I was delighted this morning over the fact that scientists had a major breakthrough in creating a way to take insulin in pill form because of … turtles! Last week hedgehogs, this week turtles. I swear the Breeze isn’t turning into an animal news newsletter (or is it?). Have a great weekend!

Shrinking Medicaid Rolls In Missouri And Tennessee Raise Flag On Vetting Process

Tangunikia Ward, a single mom of two who has been unemployed for the past couple of years, was shocked when her St. Louis family was kicked off Missouri’s Medicaid program without warning last fall.

She found out only when taking her son, Mario, 10, to a doctor to be treated for ringworm.

When Ward, 29, tried to contact the state to get reinstated, she said it took several weeks just to have her calls returned. Then she waited again for the state to mail her a long form to fill out attesting to her income and family size, showing that she was still eligible for the state-federal health insurance program for the poor.

Mario, who is in third grade, missed much of school in December because Ward could not afford a doctor visit without Medicaid. His school would not let him return without a doctor’s note saying he was no longer infected.

In January, with the help of lawyers from Legal Services of Eastern Missouri, she was able to get back on Medicaid, take her son to a doctor and return him to school. “It was a real struggle as it seemed like everyone was giving me the runaround,” Ward said. “I am upset because my son was out of school, and that pushed him behind.”

Ward and her children are among tens of thousands of Medicaid enrollees who were dropped by Missouri and Tennessee last year as both states stepped up efforts to verify members’ eligibility.

Last year, Medicaid enrollment there declined far faster than in other states, and most of those losing coverage are children, according to state data.

State health officials say several factors, including the improved economy, are behind last year’s drop of 7 percent in Missouri and 9 percent in Tennessee.

But advocates for the poor think the states’ efforts to weed out residents who are improperly enrolled, or the difficulty of re-enrolling, has led to people being forced off the rolls. For example, Tennessee sent packets to enrollees that could be as long as 47 pages to verify their re-enrollment. In Missouri, people faced hours-long waits on the state’s phone lines to get help in enrolling.

Medicaid enrollment nationally was down about 1.5 percent from January to October last year, the latest enrollment data available from the federal government’s Centers for Medicare & Medicaid Services (CMS).

Herb Kuhn, president and chief executive of the Missouri Hospital Association, said the state’s efforts to verify Medicaid eligibility could be tied to an increase in the number of people without coverage that hospitals are seeing.

“When we see over 50,000 children come off the Medicaid rolls, it raises some questions about whether the state is doing its verifications appropriately,” he said. “Those who are truly entitled to the service should get to keep it.”

In 2018, Missouri Medicaid began automating its verification system for the state-federal insurance program for the poor. People who were identified as ineligible, for income or other reasons, were sent a letter asking them to provide updated documentation. Those who did not respond or could not prove their eligibility were dropped.

The state does not know how many letters it sent or how many people responded, said Rebecca Woelfel, spokeswoman for the Missouri Department of Social Services, which oversees Medicaid. She said Missouri Medicaid enrollees were given 10 days to respond.

Woelfel cited the new eligibility system, the improved economy and Congress rescinding the federal tax penalty for people who lack insurance as factors behind the decline in enrollment.

Missouri’s unemployment rate dropped from 3.7 percent in January 2018 to 3.1 percent in December as the number of unemployed people fell by about 17,000.

Missouri Medicaid had almost 906,000 people enrolled as of December, down from more than 977,000 in January 2018, according to state data. About two-thirds of those enrolled are children or pregnant women.

Timothy McBride, a health economist at Washington University in St. Louis who heads a Missouri Medicaid advisory board, said the state’s eligibility system has made it too difficult for people to stay enrolled. Since low-income people move or may be homeless, their mailing addresses may be inaccurate. Plus, many don’t read their mail or may not understand what was required to stay enrolled, he added.

“I worry some people are still eligible but just did not respond, and the next time they need health care they will show up with their Medicaid card and find out they are not covered,” McBride said.

Tennessee’s Medicaid enrollment fell from 1.48 million in January 2018 to 1.35 million in December, according to state data. Tennessee Medicaid spokeswoman Kelly Gunderson credits a healthy job market. The state’s unemployment rate was relatively stable last year at under 4 percent.

“Tennessee is experiencing a state economy that continues to increase at what appears to be near-historic rates, which is positively impacting Tennesseans’ lives and, in some cases, decreasing their need to access health insurance through the state’s Medicaid” program and the Children’s Health Insurance Program (CHIP), she said.

She added that the state has a “robust appeals process” for anyone who was found ineligible by the state’s reverification system.

The Tennessee Justice Center, an advocacy group, has worked with hundreds of families in the past year trying to restore their Medicaid coverage. The verification process will make “Medicaid rolls smaller and saves money, and that’s a poor way for the state to measure success,” said Michele Johnson, executive director of the nonprofit group. “But it’s penny-wise and pound-foolish” because it leads to people showing up at emergency rooms without coverage — and hospitals have to pass on those costs to everyone else.

After rapid growth since 2014, when the Affordable Care Act expanded health insurance coverage to millions of Americans, Medicaid enrollment nationally started to fall, declining from 74 million in January 2018 to about 73 million in October, according to the latest enrollment data released by CMS.

Missouri and Tennessee are among 17 states that have not expanded Medicaid under the ACA. But many of those non-expansion states nevertheless saw enrollment grow, because as people tried to sign up for insurance on the ACA exchanges, those meeting state criteria were routed to Medicaid.

McBride, the health economist, said the steep drop is especially disconcerting because most of those affected are children. Because children are eligible for Medicaid or CHIP with family incomes as high as 300 percent of the federal poverty level, or $77,250 for a family of four, he said, it’s unlikely a parent’s change in job would be enough for a child to lose eligibility.

Missouri’s 70,000-person drop in enrollment, he noted, marks the biggest single-year reduction since 2006, when the state instituted tighter eligibility levels for certain groups.

Legal Services of Eastern Missouri, which advocates for low-income residents, estimates that nearly 57,000 of those dropped from the Medicaid rolls were children, a decline that is nine times the national average.

Joe Pierle, chief executive officer of the Missouri Primary Care Association, a trade group representing community health centers, said he doesn’t think the state is doing anything “underhanded or nefarious.” Nevertheless, he’s not sure Medicaid officials did enough to reach out to people before dropping them.

“I suspect some people are falling through the cracks,” he said.

Former Rep. John Dingell Dies; Longest-Serving Congressman Was A Force In Health Policy

Former Rep. John Dingell, the Michigan Democrat who holds the record as the longest-serving member of the U.S. House, died Thursday night in Michigan. He was 92.

And while his name was not familiar to many, his impact on the nation, and on health care in particular, was immense.

For more than 16 years Dingell led the powerful House Energy and Commerce Committee, which is responsible for overseeing the Medicare and Medicaid programs, the U.S. Public Health Service, the Food and Drug Administration and the National Institutes of Health.

As a young legislator, he presided over the House during the vote to approve Medicare in 1965. As a tribute to his father, who served before him and who introduced the first congressional legislation to establish national health insurance during the New Deal, Dingell introduced his own national health insurance bill at the start of every Congress.

And when the House passed what would become the Affordable Care Act in 2009, leaders named the legislation after him. Dingell sat by the side of President Barack Obama when he signed the bill into law in 2010.

Dingell was “a beloved pillar of the Congress and one of the greatest legislators in American history,” said a statement from House Speaker Nancy Pelosi. “Yet, among the vast array of historic legislative achievements, few hold greater meaning than his tireless commitment to the health of the American people.”

He was not always nice. He had a quick temper and a ferocious demeanor when he was displeased, which was often. Witnesses who testified before him could feel his wrath, as could Republican opponents and even other committee Democrats. And he was fiercely protective of his committee’s territory.

In 1993, during the effort by President Bill Clinton to pass major health reform, as the heads of the three main committees that oversee health issues argued over which would lead the effort, Dingell famously proclaimed of his panel, “We have health.”

Dingell and his health subcommittee chairman, California Democrat Henry Waxman, fought endlessly over energy and environmental issues. The Los Angeles-based Waxman was one of the House’s most active environmentalists. Dingell represented the powerful auto industry in southeastern Michigan and opposed many efforts to require safety equipment and fuel and emission standards.

In 2008, Waxman ousted Dingell from the chairmanship of the full committee.

But the two were of the same mind on most health issues, and together during the 1980s and early 1990s they expanded the Medicaid program, reshaped Medicare and modernized the FDA, NIH and the Centers for Disease Control and Prevention.

“It was always a relief for me to know that when he and I met with the Senate in conference, we were talking from the same page, believed in the same things, and we were going to fight together,” Waxman said in 2009.

Dingell was succeeded in his seat by his wife, Rep. Debbie Dingell, herself a former auto industry lobbyist.

Podcast: KHN’s ‘What The Health?’ A ‘Healthy’ State Of The Union

Health policy played a surprisingly robust role in President Donald Trump’s 2019 State of the Union address.

The president laid out an ambitious set of health goals in his speech Tuesday to Congress and the nation, including reining in drug prices, ending the transmission of HIV in the U.S. during the next decade and dedicating more resources to fighting childhood cancer.

Meanwhile, in Utah and Idaho, two of the states where voters last fall approved expansion of the Medicaid health program, Republican legislatures are trying to scale back those plans.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Anna Edney of Bloomberg News, Margot Sanger-Katz of The New York Times and Alice Ollstein of Politico.

Among the takeaways from this week’s podcast:

  • The Trump administration is proposing to change the drug rebates in Medicare so that consumers purchasing the medicines get more of the savings and the middlemen negotiating the deals get less. But that effort could lead to increased insurance premiums — a consequence that could have significant political repercussions.
  • Trump’s pledge to end HIV transmissions in 10 years was a bit of a surprise since the disease had not been much of a priority in earlier moves by the administration.
  • The efforts to restrict Medicaid expansion approved by voters in Utah and Idaho show the limitations of referendums and could impact a move to get a Medicaid expansion question on the Florida ballot.
  • An intriguing study this week showed that medications to treat cardiac problems saved Medicare money. The results were surprising because generally public health officials suggest that prevention is important to improve health but doesn’t necessarily save money.

Also this week, Rovner interviews KHN senior correspondent Phil Galewitz, who investigated and wrote the latest “Bill of the Month” feature for Kaiser Health News and NPR. It’s about a man with a minor problem — fainting after a flu shot — and a major bill. You can read the story here.

If you have a medical bill you would like NPR and KHN to investigate, you can submit it here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: NPR’s “Texans Can Appeal Surprise Medical Bills, But the Process Can Be Draining,” by Ashley Lopez

Margot Sanger-Katz: The Los Angeles Times’ “In Rush to Revamp Medicaid, Trump Officials Bend Rules That Protect Patients,” by Noam N. Levey

Anna Edney: Bloomberg News’ “Ketamine Could Be the Key to Reversing America’s Rising Suicide Rate,” by Cynthia Koons and Robert Langreth

Alice Ollstein: The Washington Post’s “’It Will Take Off Like a Wildfire’: The Unique Dangers of the Washington State Measles Outbreak,” by Lena H. Sun and Maureen O’Hagan

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Energized By Success In Other Conservative States, Advocates Work To Get Medicaid Expansion On Florida’s 2020 Ballot

But Florida activists face additional obstacles to get the measure in front of voters. While in Idaho, Maine, Nebraska and Utah, advocates only needed a simple majority for approval, Florida ballot measures must get at least 60 percent support. However, supporters have been cleared by the Florida Division of Elections to begin collecting signatures. Medicaid news comes out of North Carolina, as well.