Tagged Mental Health

Viewpoints: Short Shrift For Mental Health Coverage; Medicare’s Firewall From ‘Harmful’ Changes

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

Boston Globe: Changing Attitudes Is Harder Than Changing The Law 
Someone trying to access mental health care is twice as likely to be denied coverage by a private insurer than someone seeking surgical or other medical care, according to a survey of 84 insurance plans in 15 states by the National Alliance on Mental Illness. Matt Selig, executive director of Health Law Advocates, a Boston-based nonprofit group that represents low-income residents, said that last year alone his agency opened cases for 158 people who were denied coverage for mental health or substance use treatment, nearly half of them children. (Kevin Cullen, 3/27)

Arizona Republic: McCain Can Stop Cuts To Seniors’ Health Care
The future of Medicare and Medicaid may depend on John McCain. He is one of a handful of Senate Republicans who could serve as a firewall against harmful changes to this crucial program that Arizona seniors rely upon. … Looking down the road, the majority in Congress has also proposed to privatize Medicare and raise the eligibility age from 65 to 67. These actions could reduce health care coverage and increase out-of-pocket costs for Arizona’s 1,134,000 seniors and people with disabilities. (Max Richtman, 3/27)

Los Angeles Times: Note To Republicans: Drop The Crusade Against Planned Parenthood
Millions of Americans who rely on the Affordable Care Act for their insurance coverage dodged a bullet last week when Republican infighting killed a bill by the House GOP leadership to repeal and replace the healthcare law. So, thankfully, did Planned Parenthood. Embedded in the bill was a provision to bar federal funding temporarily for this well-regarded and crucial healthcare provider, which the GOP has tried, obsessively, to dismantle for years. (3/28)

St. Louis Post-Dispatch: Saluting Our Doctors: The Calm Within The Storm
For many, the role of physicians in hospice is especially important — as they attend to patients and families at this most vulnerable time, guiding and comforting them through the toughest decisions they will ever make. What kind of quality of life does the patient want? What side effects can be expected from chemo or certain medications? What’s the best way to deal with pain? It’s a role hospice doctors readily accept. (Dr. Hashim Raza, 3/28)

The New York Times: Training Your Brain So That You Don’t Need Reading Glasses
By middle age, the lenses in your eyes harden, becoming less flexible. Your eye muscles increasingly struggle to bend them to focus on this print. But a new form of training — brain retraining, really — may delay the inevitable age-related loss of close-range visual focus so that you won’t need reading glasses. Various studies say it works, though no treatment of any kind works for everybody. (Austin Frakt, 3/27)

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

Clinic Seeks To Turn Marijuana From ‘Gateway Drug’ To Gateway To Treatment

A small but growing number of pain doctors and addiction specialists are overseeing the use of marijuana as a substitute for more potent and dangerous drugs. In other public health news: the opioid epidemic, lead standards, childhood trauma, multiple sclerosis, Zika, HPV vaccines and concussions.

The New York Times: Addiction Specialists Ponder A Potential Aid: Pot
Nine days after Nikolas Michaud’s latest heroin relapse, the skinny 27-year-old sat on a roof deck at a new drug rehabilitation clinic here. He picked up a bong, filled it with a pinch of marijuana, lit the leaves and inhaled. All this took place in plain view of the clinic’s director. … The new clinic is experimenting with a concept made possible by the growing legalization of marijuana: that pot, rather than being a gateway into drugs, could be a gateway out. (Richtel, 3/27)

Stat: EPA Sidestepped Decision To Tighten Standards For Lead Levels
The 750,000-ton stack is a mix of lead, arsenic, and other toxic metals, blended with sand and abandoned by the businesses that once employed most of the town, about 100 miles southwest of Chicago, in the Illinois River Valley. When the wind blows, specks of toxic metals sail off the slag heap and land on the town’s modest houses and gardens, in school playgrounds, on church steps and, sometimes, in the water…It is the lead — a toxin that can damage children’s brains at even low levels of exposure — that worries most people here. (Kaplan, 3/28)

Milwaukee Journal Sentinel: An Intractable Problem
Public health experts in Milwaukee and around the nation now see a direct link between childhood trauma and an incapacitated workforce. Improving the latter is impossible without addressing the former. Children exposed to abuse, violence and neglect may not be able to concentrate in school, much less job training programs. (Schmid and Crowe, 3/27)

Columbus Dispatch: Multiple Sclerosis Drug Offers Hope Of Halting Disease
In multiple sclerosis, an abnormal immune-system response leads to an attack of nerve fibers and the fatty myelin that surrounds them in the central nervous system… Ocrelizumab works by depleting B cells, which are immune cells that participate in the attack on myelin, Racke said. The drug represents a transformation in MS care, said Dr. Aaron Boster, director of the MS center at OhioHealth, where he also serves as systems medical chief of neuroimmunology. (Viviano, 3/28)

Miami Herald: Zika Virus: Rick Scott Visits Miami Prepare Mosquito Season 
South Florida’s battle plan for Zika, expected to rebound with the rainy season, includes more boots on the ground to inspect and fumigate for mosquitoes, more lab resources to speed up test turnaround times and the promise of a more collegial collaboration between the federal and state governments. (Chang, 3/27)

Kaiser Health News: New Vaccine Recommendation Cuts Number Of HPV Shots Children Need
You’d think that a vaccine that protects people against more than a half-dozen types of cancer would have people lining up to get it. But the human papillomavirus (HPV) vaccine, which can prevent roughly 90 percent of all cervical cancers as well as other cancers and sexually transmitted infections caused by the virus, has faced an uphill climb since its introduction more than a decade ago. Now, with a new dosing schedule that requires fewer shots and a more effective vaccine, clinicians and public health advocates hope they may move the needle on preventing these virus-related cancers. (Andrews, 3/28)

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

State Highlights: Incidents Call Into Question Mass. Mental Health Care System; Texas ‘Granny Tax’ Sparks Nursing Homes Debate

Media outlets report on news from Massachusetts, Texas, Kansas, Connecticut, Washington, Tennessee, California and Wisconsin.

Boston Globe: In Massachusetts’ Failing Mental Health Care System, Even The Lucky Ones Aren’t So Lucky
James Boyd Jr.’s death is one of seven recent incidents involving Department of Mental Health clients that illuminate a growing concern inside the state agency: that the department is releasing a steady stream of people with serious mental illness to live in the community without proper supervision. While thousands with serious mental illness struggle to get any help, the roughly 21,000 Department of Mental Health clients are promised treatment at state-run facilities and state-funded programs in the community that are operated by private vendors… But the string of incidents raises questions about whether the department is doing enough to ensure the safety of its clients and the public. (Helman and Russell, 3/25)

San Antonio Press-Express: Nursing Homes Joust Over Fee Proposal: ‘Granny Tax’ Or Funding Lifeline? 
Nursing homes that are stretched thin as they care for Medicaid residents are asking lawmakers to approve a fee on their facilities that would allow Texas to get hundreds of millions of matching federal dollars to boost their low reimbursements. But the idea has generated a backlash from nursing homes that serve private-pay patients and object to paying the proposed assessment, which they call a “granny tax.” Their private-pay patients are outside of Medicaid, and the homes aren’t confident of promises that they’ll be otherwise repaid for their share of the fees that would trigger more Medicaid dollars. (Fikac, 3/25)

KCUR: Kansas Mental Health Centers Seek Exemption From Gun Law 
Unless the Legislature makes a change, community mental health centers across Kansas will have to allow patients and staff to bring their guns starting in July. A 2013 state law requires most publicly owned buildings to allow concealed weapons or to install metal detectors and post armed guards. The law included a four-year exemption for community mental health centers, universities, publicly owned medical facilities, nursing homes and low-income health clinics that ends July 1. (Wingerter, 3/24)

The CT Mirror: Anthem’s Cost Savings At Center Of Merger Suit Appeal Argument
Anthem and the Justice Department faced off in court Friday over the insurer’s proposed merger with Cigna, with the legal wrangling centered on whether any savings from the deal would justify shrinking the market for large employer insurance policies from four to three carriers. A federal district court in February sided with the Justice Department – and 11 states including Connecticut – in blocking the $54 billion merger. (Radelat, 3/24)

Seattle Times: Nurses Gain Traction In Legislature On Bills To Address ‘Dangerous’ Staffing 
For years, nurses have gone to Olympia, imploring lawmakers to understand that staffing problems were placing patient care at risk. There are constant staff shortages that force nurses to forgo meals and bathroom breaks in order to properly care for patients. There are the 12-hour nursing shifts that grow longer due to scheduling issues. There are nurse-to-patient ratios that seem to grow more dangerous. Nurses returned to Olympia this week to reiterate those messages to the Legislature yet again. But this time they have more optimism that lawmakers are listening. (Baker, 3/26)

Boston Globe: New State Rules For Long-Term Care Insurance Forgo Limits On Rate Hikes 
After five years of fits and starts, Massachusetts regulators are close to adopting rules that would increase oversight of long-term care insurance, a market that has been roiled by skyrocketing premiums for consumers and declining profits for insurance companies. But some consumers and advocates argue that the proposals would not do enough to protect policyholders from the escalating costs of long-term care insurance, which helps pay for nursing homes, home health services, and assisted living. (Fernandes, 3/26)

Nashville Tennessean: Can Nashville Find Cure For Price Blindness In Health Care?
“Price blindness,” or a lack of price transparency, affects healthcare consumers across the U.S. Pricing is so opaque that even many doctors and hospitals can’t estimate what a service might cost, leaving patients no options to compare or price-shop. This problem is unique to healthcare — can you imagine driving a car off the dealer’s lot and getting a bill in the mail later? Would you buy a television at Best Buy without a quick Amazon search? Most of us would not, but until recently, there just wasn’t a way for consumers to easily compare costs in healthcare. But Nashville companies like Healthcare Bluebook and MD Save are trying to change that, especially as consumers pick up more of the costs of their care. (Tolbert, 3/26)

Los Angeles Times: L.A. Officials Push For New Steps To Address Health Risks From Homebuilding Near Freeways
In a new push to address health risks from a surge in residential construction near freeways, Los Angeles officials have requested a study of development restrictions, design standards and other steps to protect residents from traffic pollution. Planning, transportation and other officials should prepare “strategies to address the hazard of freeway pollution affecting residents of new and existing structures,” according to a motion filed this week by councilmen Jose Huizar and Paul Koretz. These could include buffer zones and barriers, air filtration requirements and regulations on building design. (Barboza and Zahniser, 3/24)

Milwaukee Journal Sentinel: State Nearly Returned Suspended Psychologist To Wisconsin’s Youth Prison
State officials last year were on the verge of returning a suspended psychologist to his job at Wisconsin’s troubled juvenile prison, but backed off after a prosecutor said he could be charged with falsifying records, state records show. After learning of possible charges, the Department of Corrections kept psychologist Wilson Fowle on paid leave and began its own investigation. Six weeks later, Fowle retired and by the end of 2016 agreed to surrender his psychology license. (Marley, 3/24)

Boston Globe: Dozens Of Industries Could See A Boost From Legalized Marijuana 
A Swiss company that for years has provided Massachusetts with cigarette tax stamp services — helping the state thwart the black market — has its eyes set on what could be a much bigger public contract: tracking legal marijuana from seed to sale to keep it from being diverted to criminal enterprises… Such product tracing is one of dozens of industries that could see a big boom in business when recreational marijuana shops, growhouses, testing facilities, and infused-product manufacturers (think candy and brownies) open in Massachusetts, probably next year. (Miller, 3/27)

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

New ‘War On Drugs’ Needed To Battle Opioid Crisis, Sen. Manchin Argues

Stat interviews the West Virginia senator about his focus on a national epidemic that has hit his state particularly hard. In related news about the crisis: a New Jersey family files suit against a fentanyl manufacturer, doctor and pharmacy; Maryland lawmakers rush to pass an opioid bill; a New Hampshire physician assistant faces criminal charges over his Subsys prescriptions; and more.

Stat: Sen. Manchin: Time For A New ‘War On Drugs’ To Tackle Opioids
Senator Joe Manchin stepped onto the Senate floor last week to read a letter sent to him by Leigh Ann Wilson, a home caregiver whose 21-year-old daughter, Taylor, died from an opioid overdose last fall. “Please work quickly to prevent thousands of other Taylors from the same fate,” Manchin read. That was just the latest of many such letters that Manchin, a Democrat, has read on the Senate floor over the past year. He represents West Virginia, which has the highest rate of drug overdose deaths in the nation. And he seeks to amplify the voices of those most affected. (Blau, 3/27)

Stat: Lawsuit Blames Improper Marketing Of Potent Opioid For Woman’s Death
The family of a New Jersey woman who died after using a prescription version of the potent opioid fentanyl filed a wrongful death lawsuit Thursday against the drug’s maker, her doctor, and a specialty pharmacy that provided the drug. The lawsuit, filed in a New Jersey state court, alleges 32-year-old Sarah Fuller was the victim of a nationwide push by Insys Therapeutics to entice doctors to prescribe its Subsys fentanyl spray for patients for which the drug was not suitable. (Armstrong, 3/24)

Columbus Dispatch: More Ohio Newborns Suffer From Mother’s Addiction
The number of Ohio babies who come into the world sick and craving drugs continues to soar. New state reports show that the rate of neonatal abstinence syndrome — the medical term for withdrawal symptoms suffered by newborns — jumped to 159 per 10,000 live births in 2015. That’s more than eight times the rate a decade earlier, in 2005, when there were just 19 such hospitalizations for every 10,000 live births. (Price, 3/27)

The Hill: ‘Deaths Of Despair’ On The Rise Among Blue-Collar Whites 
A decades-long trend of economic stagnation and social immobility may be to blame for a shocking increase in death rates among middle-aged white Americans, a new study finds, as the number of deaths caused by drugs, alcohol abuse and suicide reaches levels not seen in generations. For nearly a century, advances in medical technology and healthy living have sent mortality rates of all Americans plummeting. But in recent years, a stark divide has emerged along educational and racial lines: as death rates plunge for minorities and well-educated whites, the number of whites without a college education dying in middle age is skyrocketing. (Wilson, 3/25)

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: Mass. Gov. Proposes Revised Tax On Employee Health Plans; Family Files Wrongful Death Suit Against Opioid Maker

Media outlets report on news from Massachusetts, Illinois, Connecticut, Ohio, Pennsylvania, New Jersey, Mississippi, Tennessee, Iowa, Wisconsin, California, Texas and Minnesota.

Boston Globe: Baker Administration Floats Alternative To Health Plan Levy 
After a backlash from the business community, Governor Charlie Baker is floating a new plan for employers to help cover the state’s soaring health care costs. But the proposal, an alternative to the one the administration included in its January budget proposal, still lacks broad support among businesses. (Dayal McCluskey, 3/24)

Stat: Lawsuit Blames Improper Marketing Of Potent Opioid For Woman’s Death
The family of a New Jersey woman who died after using a prescription version of the potent opioid fentanyl filed a wrongful death lawsuit Thursday against the drug’s maker, her doctor, and a specialty pharmacy that provided the drug. The lawsuit, filed in a New Jersey state court, alleges 32-year-old Sarah Fuller was the victim of a nationwide push by Insys Therapeutics to entice doctors to prescribe its Subsys fentanyl spray for patients for which the drug was not suitable. (Armstrong, 3/24)

St. Louis Post Dispatch: Illinois Supreme Court Delivers Partial Win For Hospitals On Property Taxes 
Illinois’ not-for-profit hospitals can continue to skip paying property taxes, for now, after an Illinois Supreme Court decision Thursday that follows years of battles between hospitals and municipalities over those dollars. The state Supreme Court on Thursday vacated the ruling of a lower court, which had found that an Illinois law exempting not-for-profit hospitals from paying property taxes was unconstitutional. The justices said the lower court didn’t have jurisdiction. (Schencker, 3/24)

The CT Mirror: State Worker Union Launches TV Ad To Fight Layoffs
Two days after Gov. Dannel P. Malloy threatened to lay off 4,200 unionized state workers unless concessions are granted, Connecticut’s largest healthcare workers union launched a television ad urging viewers to keep its members on the job. The 30-second spot, funded by 1199 New England SEIU, also comes five months after the union went to court to block nearly 500 layoffs tied to an administration plan to privatize 40 group homes for the disabled. (Phaneuf, 3/23)

Columbus Dispatch: Ohio Slips In National Mental Health Care Assessment
Ohio continues to slip in terms of mental health prevalence and access to care in a national ranking by Mental Health of America. The Buckeye State’s overall ranking, 26th among the 50 states, was a slot lower than last year and a drop of three positions since 2011, according to the report released today. The national organization looked at 15 indicators, including the number of adults and juveniles with mental illness, the incidence of adults with drug or alcohol problems, prevalence of suicide, and people with unmet needs for treatment. (Johnson, 2/23)

Columbus Dispatch: Elderly Often Victimized By Addicted Relatives, Friends
Addiction to prescription painkillers among seniors also is growing, with older adults increasingly seeking emergency treatment or coming to the attention of authorities. With the rise in heroin use, more grandparents are also raising their grandchildren because their parents are dead, in jail, chasing their next high or in rehab. It can be particularly challenging for those with limited financial resources or health problems. (Pyle, 3/24)

The Philadelphia Inquirer: New Digital Health Fund In Philadelphia Makes Its First Deal
A $6 million digital health investment fund launched in December by Ben Franklin Technology Partners of Southeastern Pennsylvania, Independence Health Group, and Safeguard Scientifics has made its first investment, of $150,000 in seed financing. The recipient was VitalTrax, a Philadelphia company started last year to help facilitate clinical trials for patients and researchers through a smartphone app and cloud-based data services. VitalTrax is expected to use the money to continue developing its system. (Brubaker, 3/23)

Stat: Mississippi’s Middle Class Carries The Burden Of High Medical Debt
Americans are no strangers to medical debt, and the burden is most severe in Mississippi, where nearly 40 percent of adults under age 65 owe hospitals or doctors, according to the Urban Institute. But the men and women carrying that debt are not always poor – they’re increasingly middle class. And their inability, or refusal, to pay their bills is straining hospital budgets and threatening the availability of care. (Blau, 3/24)

WBUR: Can Cardboard Boxes Save Infants’ Lives?
Since January, about 3,800 New Jersey parents have opted to lay their infants to sleep in simple cardboard boxes. It’s a public health initiative to reduce cases of sudden infant death syndrome, which killed 3,700 babies in the United States in 2015. (Young, 3/23)

Nashville Tennessean: Hendersonville Doctor Arrested On Prescription-Related Charges
A Hendersonville doctor has been arrested for issuing prescriptions for narcotics in exchange for money and sexual acts, police said. Special agents with the Tennessee Bureau of Investigation, the 18th Judicial District Drug Task Force and the Gallatin Police Department began investigating Dr. Lawrence Joseph Valdez after complaints he was issuing prescriptions for sexual favors. The investigation found he had made these exchanges to multiple individuals. (Todd, 3/23)

Des Moines Register: These Families With Children Injured By Doctor Mistakes Say They Don’t Want Caps On Malpractice Payouts
Families of Iowans who were severely injured by medical errors traveled to the Statehouse on Thursday to denounce bills that would limit awards in malpractice lawsuits. The families said if the bills were in effect, they probably couldn’t have found lawyers to take their cases, even though medical providers’ mistakes or neglect caused permanent disabilities or death of patients. (Leys, 3/23)

Milwaukee Journal Sentinel: An Epidemic Of Childhood Trauma Haunts Milwaukee 
In Milwaukee, the nation’s third most impoverished big city, trauma researchers contend the seeds of distress were planted years ago when the current generation of adults were children. They say new seeds are being planted right now. That revelation is beginning to shift how Milwaukee and other cities respond to social and economic decline. It also is prompting researchers to explore why some who are exposed to childhood trauma emerge undefeated — and whether their resilience can be coaxed out of others and even scaled to entire neighborhoods. (Schmid, 3/23)

The Philadelphia Inquirer: Why Christie Has More Than Tripled N.J.’s Funding Of Doctor Training
Gov. Christie wants more doctors in New Jersey, and he’s budgeted money to train them. But increasing the number of medical professionals — and getting them to stay in New Jersey — isn’t as easy as graduating more students. The calculation also includes the number of postgraduate residencies offered in New Jersey and the number of doctors who stay afterward. The state already has increased the number of graduates, with Cooper Medical School of Rowan University opening in 2012 and Seton Hall University’s medical school slated to open next year. Older schools also have added seats. (Lai, 3/24)

Sacramento Bee: Sacramento County Sheriff Adds Mental Health Beds To Jail 
As the Sacramento County Main Jail handles more inmates with psychiatric problems, the Sheriff’s Department is developing a new section staffed by UC Davis medical professionals, social workers and deputies that can provide intensive mental services without 24-hour care. The county currently keeps inmates who are suicidal or deemed a threat to others in an 18-bed “acute care” unit, which functions like a residential treatment facility. (Garrison, 3/23)

Houston Chronicle: Confusion Over Medical Facilities Could Cost A Bundle 
Walking into one type of neighborhood medical clinic instead of another can be a $2,000 mistake. Or at the very least, a big surprise. That is the finding of a new Rice University study that examines the proliferation of free-standing emergency rooms in Texas in recent years, which to the uninformed patient can look a lot like their lower-cost storefront cousin, the urgent-care clinic. (Deam, 3/23)

The Star Tribune: State: Waite Park Nurse Did Nothing For Patient’s Seizures Before He Died 
A Minnesota Health Department investigation lasting six months ruled that the nurse’s neglect was to blame for the anguish that 58-year-old Kenneth L. Allers endured last August for at least 11 hours at the Sterling Park Health Center in Waite Park. The licensed practical nurse, who is not identified in the state’s findings released this week, was suspended during the investigation and later fired. (Walsh, 3/23)

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

Late Move To Dump ‘Essential’ Benefits Could Strand Chronically Ill

A last-minute attempt by conservative Republicans to dump standards for health benefits in plans sold to individuals would probably lower the average consumer’s upfront insurance costs, such as premiums and deductibles, said experts on both sides of the debate to repeal and replace the Affordable Care Act.

But, they add, it will likely also induce insurers to offer much skimpier plans, potentially excluding the gravely ill, and putting consumers at greater financial risk if they need care.

For example, a woman who had elected not to have maternity coverage could face financial ruin from an unintended pregnancy. A healthy young man who didn’t buy drug coverage could be bankrupted if diagnosed with cancer requiring expensive prescription medicine. Someone needing emergency treatment at a non-network hospital might not be covered.

What might be desirable for business would leave patients vulnerable.

“What you don’t want if you’re an insurer is only sick people buying whatever product you have,” said Christopher Koller, president of the Milbank Memorial Fund and a former Rhode Island insurance commissioner. “So the way to get healthy people is to offer cheaper products designed for the healthy people.”

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The proposed change could give carriers wide room to do that by eliminating or shrinking “essential health benefits” including hospitalization, prescription drugs, mental health treatment and lab services from plan requirements — especially if state regulators don’t step in to fill the void, analysts said.

The Affordable Care Act requires companies selling coverage to individuals and families through online marketplaces to offer 10 essential benefits, which also include maternity, wellness and preventive services — plus emergency room treatment at all hospitals. Small-group plans offered by many small employers also must carry such benefits.

Conservative House Republicans want to exclude the rule from any replacement, arguing it drives up cost and stifles consumer choice.

On Thursday, President Donald Trump agreed after meeting with members of the conservative Freedom Caucus to leave it out of the measure under consideration, said White House Press Secretary Sean Spicer. “Part of the reason that premiums have spiked out of control is because under Obamacare, there were these mandated services that had to be included,” Spicer told reporters.

Pushed by Trump, House Republican leaders agreed late Thursday to a Friday vote on the bill but were still trying to line up support. “Tomorrow we will show the American people that we will repeal and replace this broken law because it’s collapsing and it’s failing families,” said House Speaker Paul Ryan (R-Wis.). “And tomorrow we’re proceeding.” When asked if he had the votes, Ryan didn’t answer and walked briskly away from the press corps.

But axing essential benefits could bring back the pre-ACA days when insurers avoided expensive patients by excluding services they needed, said Gary Claxton, a vice president and insurance expert at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

“They’re not going to offer benefits that attract people with chronic illness if they can help it,”said Claxton, whose collection of old insurance policies shows what the market looked like before.

One Aetna plan didn’t cover most mental health or addiction services — important to moderate Republicans as well as Democrats concerned about fighting the opioid crisis. Another Aetna plan didn’t cover any mental health treatment. A HealthNet plan didn’t cover outpatient rehabilitative services.

Before the ACA most individual plans didn’t include maternity coverage, either.

The House replacement bill could make individual coverage for the chronically ill even more scarce than a few years ago because it retains an ACA rule that forces plans to accept members with preexisting illness, analysts said.

Before President Barack Obama’s health overhaul, insurers could reject sick applicants or charge them higher premiums.

Lacking that ability under a Republican law but newly able to shrink benefits, insurers might be more tempted than ever to avoid covering expensive conditions. That way the sickest consumers wouldn’t even bother to apply.

“You could see even worse holes in the insurance package” than before the ACA, said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University. “If we’re going into a world where a carrier is going to have to accept all comers and they can’t charge them based on their health status, the benefit design becomes a much bigger deal” in how insurers keep the sick out of their plans, she said.

Michael Cannon, an analyst at the libertarian Cato Institute and a longtime Obamacare opponent, also believes dumping essential benefits while forcing insurers to accept all applicants at one “community” price would weaken coverage for chronically ill people.

“Getting rid of the essential health benefits in a community-rated market would cause coverage for the sick to get even worse than it is under current law,” he said. Republicans “are shooting themselves in the foot if they the offer this proposal.”

Cannon favors full repeal of the ACA, allowing insurers to charge higher premiums for more expensive patients and helping consumers pay for plans with tax-favored health savings accounts.

In an absence of federal requirements for benefits, existing state standards would become more important. Some states might move to upgrade required benefits in line with the ACA rules but others probably won’t, according to analysts.

“You’re going to have a lot of insurers in states trying to understand what existing laws they have in place,” Koller said. “It’s going to be really critical to see how quickly the states react. There are going to be some states that will not.”

Mary Agnes Carey and Phil Galewitz contributed to this story.

Categories: Cost and Quality, Insurance, Mental Health, Public Health, Repeal And Replace Watch, The Health Law

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Longer Looks: Explaining The GOP Health Bill, Utah’s Teen Suicide Spike And Election Anxiety

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

FiveThirtyEight: How The GOP Bill Could Change Health Care, In 8 Charts
After years of trying to repeal and replace the Affordable Care Act, aka Obamacare, Republicans finally got their chance with the election of President Trump. The House GOP made haste coming up with a bill, releasing the American Health Care Act on March 6. It’s a partial repeal of Obamacare — it includes substantial changes to the law, but when it comes to health insurance coverage and how people get it, the GOP bill largely works within the framework set up by the Affordable Care Act. (Anna Maria Barry-Jester and Charlie Smart, 3/20)

Vox: “If It Wasn’t For Insurance, I Wouldn’t Be Here”: How Obamacare’s End Would Worsen The Opioid Crisis
[Jessica] Goense is one of the hundreds of thousands of Americans who rely on the Affordable Care Act (“Obamacare”) and particularly Medicaid, which Obamacare expanded, for addiction care. By expanding not just access to health insurance but also enforcing requirements that insurers cover mental health and addiction services, Obamacare and the rules tied around it have dramatically expanded access to addiction coverage. By one estimate, the law gave potentially life-saving coverage to 2.8 million Americans with drug use disorders. (German Lopez, 3/21)

The New York Times: Coming Out In Droves For Free Health Care
A nonprofit sets up temporary clinics that provide free medical services to people in rural areas of the United States. For the hundreds that showed up in Cookeville, Tenn., this was a chance to get a checkup, dental treatment or eye care. Video. (Chris Carmichael, Niko Koppel and Kaitlyn Mullin, 3/22)

The Atlantic: The Silent Victims Of The GOP Health-Care Proposal
This is a 21st-century success story, one that health-care policy experts attribute to the Affordable Care Act, Medicaid, and the Children’s Health Insurance Program. Since 2008, the number of uninsured kids in the country has been cut in half. Since 2014, when the ACA was implemented, uninsurance among children dropped 20 percent. The bad news is that the significant gains in coverage for kids in recent years appear poised for a reversal. (Adrienne Lafrance, 3/20)

The Economist: Donald Trump Has Not Faced A Challenge Like Fixing American Health Care Before
On the campaign trail, [now-President Donald] Trump pledged to abolish what he called the “disaster” that is the ACA, and to “come up with a new plan that’s going to be better health care for more people at a lesser cost.” He promised to scrap things that the public dislikes about Obamacare, starting with its government mandate to buy health insurance or pay a penalty, while keeping things that are popular, such as protections for people with pre-existing conditions. (3/16)

Vox: “I See My Son In Every One Of Them”: With A Spike In Suicides, Parents Of Utah’s Queer Youth Fear The Worst
In recent years, suicide has become the leading cause of death in Utah among adolescents between the ages of 10 and 17, whereas national rates of youth suicide are considerably lower. According to the Centers for Disease Control and Prevention, suicide is the third leading cause of death among teenagers across the US each year. Hard data on the youth suicide rate is difficult to come by for 2016 because the year has only recently drawn to a close. (Nico Lang, 3/20)

FiveThirtyEight: Did The Election Stress Americans Out? If It Did, We Didn’t See Our Doctors About It
A wealth of anecdotes, and some research, supports the idea that the turbulence and hostility of the current political environment, along with many Americans’ fear that they will be adversely affected by changes in policy, could be bad for our mental health. After the election, for example, the National Suicide Prevention Lifeline reported a surge in calls for help. Recent research has also found that Google searches for “presidential election” are associated with searches for anxiety and depression. And a new report from the American Psychological Association found that 57 percent of Americans say the current political climate is a “very” or “somewhat” significant source of stress and that 59 percent of Republicans and 76 percent of Democrats are stressed about the future of the country. (Anupam Jena, Josh Gray, Stewart Richardson and Dhruv Khullar, 3/16)

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

State Highlights: Pharma Launches Campaign Against N.Y. Plan To Curb Drug Prices; Fla., Ga. Residents Struggle With Medical Bills

Media outlets report on news from New York, Florida, Illinois, Michigan, Minnesota and Louisiana.

The Wall Street Journal: Drug Industry Launches TV Ads Lambasting Cuomo’s Pricing Plan
On the heels of a presidential election in which the pharmaceutical industry was a popular target, Gov. Andrew Cuomo proposed new state controls over drug prices. Now the industry is punching back. On Wednesday, the industry’s largest trade group began running television ads in New York lambasting the proposal, a campaign that cost $100,000, people involved said. (Vilensky, 3/22)

Miami Herald: Floridians Report Trouble With Medical Bills In 2016, Survey Says 
Residents of Florida and Texas were more likely to report having difficulty paying their medical bills in 2016 than those who lived in California or New York, according to a survey published Wednesday by the nonprofit Commonwealth Fund, a health policy think tank and advocate for coverage. Though all four states made gains in the numbers of residents with health insurance since the launch of the Affordable Care Act’s coverage expansions in 2014, the survey found that Florida and Texas residents were more likely to report having a medical bill problem in the prior year or having carried long-term medical debt. (Chang, 3/22)

Chicago Sun Times: Health Study Finds Huge Disparities Based On Race, Neighborhood 
A three-year health study of nine city neighborhoods found large disparities among racial and ethnic groups in areas including physical and mental health, food insecurity and encounters with the criminal-justice system. Funded by a $1 million Chicago Community Trust grant, the study, titled “Community Health Counts,” is believed the largest community-driven, face-to-face health survey ever conducted in Chicago. (Ihejirika, 3/23)

Modern Healthcare: Mental Health Agencies Say They’ve Saved State Billions Under Medicaid 
A new report by advocates for Michigan’s public Medicaid behavioral health system estimates it has saved the state $5.3 billion over the past 18 years and would save an additional $7.4 billion through 2024 using their patient-centered and integrated care model. They also contend rate increases for behavioral health systems were lower than Medicaid HMOs and state Medicaid programs during that period. A trade group for the HMOs contends that the comparison is unfair because the figures used for HMOs are national in scope rather than focused on Michigan. (Greene, 3/22)

The Star Tribune: Mental Clinic Owned By Marcus Bachmann Sanctioned For Violating State Rules
A Christian counseling center owned by the husband of former congresswoman Michele Bachmann violated a series of state rules governing patient treatment and client records, according to a state correction order released Tuesday. Bachmann & Associates Inc., which does business as Counseling Care at clinics in Lake Elmo and Burnsville, was cited for failing to keep information about its clients’ developmental condition, as well as failing to keep records demonstrating that clients were informed of treatment alternatives and possible outcomes, among other violations, the Minnesota Department of Human Services found. (Serres, 3/22)

New Orleans Times-Picayune: How Long Should Louisiana Keep Old, Ill Criminals In Prison? 
Gov. John Bel Edwards is expected to make a push to lower Louisiana’s highest-in-the-world incarceration rate, in part by opening options for parole for non-violent offenders who serve shorter prison sentences. But the governor also has said he is interested in reducing the number of Louisiana inmates with longer sentences as well. Many of Louisiana’s older, long-term prisoners might no longer pose a threat to society, judging from national studies of recidivism. And for prisoners with serious illnesses, the costs of treatment can be daunting. Taxpayers are responsible for prison medical care, but some of that money could be used elsewhere, such as for higher education and mental health care for children, if ill prisoners were released. (Donoghue, 3/22)

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Former Obama Drug Czar Named To Lead Addiction Research Center In Boston

Michael Botticelli, who speaks openly about his history of alcohol and drug abuse, said his leadership of the new Grayken Center for Addiction Medicine will be rooted in his philosophy that addiction is a public health issue best remedied by treatment.

Boston Globe: Boston Medical Center Picks Ex-Obama Drug Czar To Run Opioid Center 
The nation’s former drug czar is bringing his expertise back to Massachusetts. Michael Botticelli, a recovering addict who rose to become director of the White House Office of National Drug Control Policy, will head Boston Medical Center’s new Grayken Center for Addiction Medicine, which aims to become a national leader in fighting opioid abuse. (Pfeiffer, 3/22)

WBUR: Former White House Drug Czar To Lead Addiction Medicine Center In Boston
The center was formally established earlier this month with a $25 million private gift from the Grayken family to be used to improve addiction treatment, prevention and training in addiction medicine. In an interview, Botticelli said he’s eager to come back to Massachusetts. He worked for the state Department of Public Health for decades until 2012. He later was named director of the Office of National Drug Control Policy under the Obama administration. (Becker, 3/22)

In other news on the crisis —

The Philadelphia Inquirer: Mayor’s Opioid Task Force Sees Huge Obstacles To Safe-Injection Sites In Philly
The idea of opening special facilities where heroin users could inject drugs safely in Philadelphia was panned Wednesday by numerous members of Mayor Kenney’s opioid task force. The 20-member group met for the final time to review and refine the 20 recommendations it will submit to help combat opioid abuse and addiction in the city, which had 910 fatal drug overdoses last year. But the bulk of the two-hour meeting was spent on the controversial concept of reducing that death toll by creating injection sites that are medically supervised. (McCullough, 3/22)

The Associated Press: Some Of The Youngest Opioid Victims Are Curious Toddlers
Curious toddlers find the drugs in a mother’s purse or accidentally dropped on the floor. Sometimes a parent fails to secure the child-resistant cap on a bottle of painkillers. No matter how it happens, if a 35-pound toddler grabs just one opioid pill, chews it and releases the full concentration of a time-released adult drug into their small bodies, death can come swiftly. (Ehlke, 3/23)

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As ‘Deaths Of Despair’ Among White Adults Spike, Researchers Identify Root Causes

Husband-and-wife economists find links between the jobs market and the mortality-rate jump among middle-aged, less-educated white Americans from drugs, alcohol-related diseases and suicide.

NPR: The Forces Driving Middle-Aged White People’s ‘Deaths Of Despair’
In 2015, when researchers Ann Case and Angus Deaton discovered that death rates had been rising dramatically since 1999 among middle-aged white Americans, they weren’t sure why people were dying younger, reversing decades of longer life expectancy. Now the husband-and-wife economists say they have a better understanding of what’s causing these “deaths of despair” by suicide, drugs and alcohol. (Boddy, 3/23)

The Wall Street Journal: Death Rates Rise For Wide Swath Of White Adults, Study Finds
Mortality has been rising since the turn of this century for an even broader swath of white adults, starting at age 25, the researchers found, driven by troubles in a hard-hit working class. Death rates for white non-Hispanics with a high-school education or less now exceed those of blacks overall, the pair said—and they’re 30% higher for whites age 50 to 54 than for blacks overall of that age. (McKay, 3/23)

The Associated Press: Less-Educated Middle-Age US Whites Dying Younger Than Others
“This is a story of the collapse of the white working class,” [Angus] Deaton said in an interview. “The labor market has very much turned against them.” Those dynamics helped fuel the rise of President Donald Trump, who won widespread support among whites with only a high school degree. Yet Deaton said his policies are unlikely to reverse these trends, particularly the health care legislation now before the House that Trump is championing. That bill would lead to higher premiums for older Americans, the Congressional Budget Office has found. (Rugaber, 3/23)

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Lawyers For OxyContin Maker Ask Judge To Dismiss Suit Filed By City Over Opioid Epidemic

Purdue Pharma argues that the lawsuit by Everett, Washington, has “multiple, independent legal failings.” In other stories on the nation’s drug crisis: the nominee for New Hampshire attorney general has defended a major opioid manufacturer; an Ohio toxicologist develops a test for carfentanil; kids call 911 when they wake up to find their overdosed parents; and the debate over needle exchanges goes on as hepatitis C spreads.

Los Angeles Times: OxyContin Drugmaker Seeks To Dismiss City’s Lawsuit
In a motion filed in federal court in Seattle, attorneys for Purdue Pharma wrote that the suit by Everett, Wash., suffered from “multiple, independent legal failings” — including statute of limitations problems and a failure to demonstrate a close connection between the company’s conduct and the criminal acts of drug dealers and addicts. (Ryan, 3/21)

Columbus Dispatch: Carfentanil Test Developed By Franklin County Toxicologist Helps In Drug Overdose Fight
No matter how hard he looked, a frustrated Dan Baker couldn’t find the answer. Knowing it could help save lives, though, he refused to give up. His tenacity was rewarded when Baker, chief toxicologist in the Franklin County coroner’s office, developed a new test to detect even minute quantities of carfentanil, a little-known, man-made opioid used to tranquilize elephants, polar bears, moose and other large animals. Baker’s test helped officials across Ohio and the country determine that the “heroin” that was causing a frightening increase in overdoses and deaths last summer was much more. (Perry, 3/22)

The Washington Post: ‘They’re Not Waking Up’: Four Children Call 911 After Their Parents’ Suspected Drug Overdose
The four children woke up and were about to start getting ready for school when they found their parents, Brian and Courtney Halye, unresponsive and cold in their bedroom. The children, ages 9 to 13, dialed 911. “My mom’s on the floor and my stepdad’s basically pale and they’re not waking up,” Courtney Halye’s daughter told an emergency dispatcher through tears. (Bever, 3/21)

Cincinnati Enquirer: Why Isn’t This Solution To The Spread Of Hep C Being Used Here?
Only one exchange site exists in Northern Kentucky, two years after a state law was changed to allow such programs, and it’s outside the population centers of Boone, Campbell and Kenton counties. In Southwest Ohio, the only needle exchange program is limping along with spotty funding and little government support. Needle exchange is lagging locally although the national Centers for Disease Control and Prevention supports such exchanges to prevent the spread of infectious diseases, including hepatitis B and C and HIV. (DeMio, 3/21)

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Hospital Bills Due To Gun Injuries Cost $6.6 Billion Over Last 8 Years

And that tally does not include expensive emergency room treatment. Today’s stories cover other public health news related to cancer and breast implants, Lewy body dementia, Alzheimer’s, Parkinson’s, smoking, “synthetic biology,” teen marijuana use, heart disease and more.

Los Angeles Times: Gun Injuries Cost Americans $730 Million A Year In Hospital Bills
Americans paid more than $6.6 billion over eight years to care for victims of gun violence, according to a new tally of hospital bills. And U.S. taxpayers picked up at least 41% of that tab. That’s just the tip of the iceberg, say the authors of a study published this week in the American Journal of Public Health. Their sum does not include the initial — and very costly — bill for gunshot victims’ care in emergency rooms. Nor does it include hospital readmissions to treat complications or provide follow-up care. The cost of rehabilitation, or of ongoing disability, is not included either. (Healy, 3/22)

The New York Times: 9 Deaths Are Linked To Rare Cancer From Breast Implants
A rare cancer first linked to breast implants in 2011 has now been associated with nine deaths, the Food and Drug Administration said Tuesday. As of Feb. 1, the agency had received a total of 359 reports of the cancer associated with the implants. The deaths were not caused by breast cancer, the agency said, but by a rare malignancy in the immune system, anaplastic large-cell lymphoma. (Grady, 3/21)

Denver Post: Englewood Doctor Studying Drugs Aimed At Fighting Lewy Body Dementia
[Dr. Rajeev] Kumar explained that Lewy body dementia is caused by the accumulation of the protein, alpha-synuclein, in the brain. The abnormally processed protein clumps together and impacts patients’ cognitive functions including the ability to plan and process information, ability to pay attention and ability to get rapid eye movement, or REM, sleep. Patients are known to physically act out their dreams, sometimes violently. The disorder is also linked to Parkinsonism — stiffness, tremors, slowness that come with the disease’s better-known related disorder, Parkinson’s disease. Behavior and mood problems including depression and anxiety and even hallucinations and delusions may develop. (Rubino, 3/21)

The Washington Post: FDA OKs New Drug As Add-On Treatment For Parkinson’s
U.S. regulators have approved the first new drug in a decade for Parkinson’s disease, a chronic neurological disorder that causes tremors and movement difficulties. The Food and Drug Administration said Tuesday that it has approved Xadago for use when a patient’s regular medicines aren’t working well. The pill was tested in two six-month studies that included about 1,200 patients taking a standard treatment, levodopa. (Johnson, 3/21)

WBUR: Harvard Scientists Call For Better Rules To Guide Research On ‘Embryoids’ 
How far should scientists be allowed to go in creating things that resemble primitive human brains, hearts, and even human embryos? That’s the question being asked by a group of Harvard scientists who are doing exactly that in their labs. They’re using stem cells, genetics and other new biological engineering techniques to create tissues, primitive organs and other living structures that mimic parts of the human body. Their concern is that they and others doing this type of “synthetic biology” research might be treading into disturbing territory. (Stein, 3/21)

The Washington Post: A Big Thing Marijuana Opponents Warned You About Is Definitely Not Happening
A state-run survey of 37,000 middle and high school students in Washington state finds that marijuana legalization there has had no effect on youngsters’ propensity to use the drug. The Washington State Healthy Youth Survey found that the 2016 rate of marijuana use was basically unchanged since 2012, when the state voted to legalize marijuana for recreational use. In the survey, researchers used the measure of “monthly use,” asking students across all grade levels whether they’d used the drug within the past month. (Ingraham, 3/21)

Orange County Register: What Lifestyle Prevents Heart Disease? California Cardiologist Looks To The Amazon For Answers
A Southern California cardiologist’s study of indigenous South Americans found that an extremely healthy lifestyle appears to prevent coronary artery disease, a leading cause of death in the U.S. Dr. Gregory Thomas, medical director of the Heart and Vascular Institute at Long Beach Memorial, helped lead the research project that was published Friday, March 17, in the British journal The Lancet. Researchers took CT scans of the hearts of 705 Tsimane adults who live in the Bolivian Amazon. (Perkes, 3/21)

Seattle Times: Rare, Often Fatal, Respiratory Disease Carried By Mice — Hantavirus — Confirmed In King County
Hantavirus Pulmonary Syndrome (HPS) is the severe respiratory disease in humans caused by infection with hantavirus. Anyone who comes into contact with rodents that carry hantavirus is at risk, according to the CDC. Rodent infestation in and around the home remains the primary risk for hantavirus exposure. There are no reported cases of hantavirus in the U.S. in which the disease was transmitted from one person to another, according to the CDC. (Young, 3/21)

Stat: For Insect Detectives, The Trickiest Cases Involve The Bugs That Aren’t There
Officially, as a scientist in the state Experiment Station’s insect inquiry office, Gale Ridge’s job is to help the public with many-legged creatures that actually exist. She has an “open-door policy”: Anyone can walk in, ring the service bell, and benefit from her expertise…But her most difficult cases haven’t involved spiders or bedbugs or chiggers or mites. Instead, the hardest bugs she has to deal with are the ones that aren’t really there. She labels these cases DP, short for delusional parasitosis. Some entomologists prefer Ekbom syndrome, because it carries less stigma. In the Diagnostic and Statistical Manual of Mental Disorders, which most psychiatrists use, the condition is listed as one kind of delusional disorder, defined as an unshakeable belief that you are being attacked by bugs or parasites even when there is no evidence of infestation. (Boodman, 3/22)

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Health Policy Perspectives: The Risks People Who Enrolled In Obamacare Now Face; What Can Trump, The GOP Deliver?

Opinion writers around the country examine what is at stake for individuals, the health insurance market and the entire health system as the debate over the GOP’s American Health Care Act continues.

The New York Times: How Trump Can Fix Health Care
President Trump has mostly stayed on the sidelines of the messy policy debates regarding health care reform. But amid the war on Capitol Hill among Republican factions, he could seize the opportunity to provide leadership consistent with his campaign message to disrupt existing health policy. Instead of trying to satisfy the free-market wing of his party, Mr. Trump could push for a solution that delivers on his populist promises by proposing universal catastrophic coverage, ending the specter of medical bankruptcy for many Americans. (Benjamin Domenech, 3/21)

The Washington Post: Trumpcare Never Can Deliver
If you watch the Sunday shows you’ll quickly see the GOP’s circular reasoning: To drive down insurance premium costs you have to remove the insurance mandates, but that’s not in the bill. It comes later, they say, but their fellow Republicans candidly acknowledge that later means “never.” (Jennifer Rubin, 3/20)

The Wall Street Journal: Saving Private Health Insurance
The biggest gamble in the House health-care bill is whether it includes enough reform to arrest the current death spiral in the individual insurance market. No one knows for sure, but critics are overlooking important provisions that will help people who are now exposed to ObamaCare’s rapidly rising premiums. (3/20)

RealClear Health: The Little Death Spiral That Couldn’t
Following an exceedingly unfavorable report from the Congressional Budget Office, prospects of the House Obamacare repeal-and-replace bill becoming law in its original form have become bleak. In its wake comes talk of significant changes to the bill, and even the renewal of an old strategy: letting the Affordable Care Act implode on its own accord, then picking up the pieces anew. There’s only one problem. The predicted “death spiral” hasn’t happened yet, and there’s a reason it won’t. (Stan Veuger and Benedic Ippolito, 3/21)

The Washington Post: Republicans’ Arguments Against Obamacare Are In A Death Spiral
“Obamacare is not going to last,” House Speaker Paul D. Ryan (R-Wis.) said Sunday when challenged to explain how he could support a replacement plan that independent experts project would result in millions of people losing health coverage. “There’s no way Obamacare could stick another two or three years, let alone 10 years.” This is the last rhetorical refuge for defenders of a shoddy GOP replacement plan: Practically any system would be better than the “collapsing” status quo. (3/20)

Richmond Times-Dispatch: Maybe You Should Check Out That Other CBO Report, Too 
Last week the Congressional Budget Office made front-page headlines when it reported that the House proposal to replace Obamacare would throw millions of people off the insurance rolls. Apparently the future of the country’s health-care entitlement system is of profound importance. … But the 10-year forecast is just as important, and adds crucial context to the debate over health care. For instance, it shows that the national debt is set to explode, growing from $20 trillion to $30 trillion by 2027. (3/20)

Stat: AHCA Could Increase Insurance Costs For Pregnancy And Addiction
For individual marketplace insurance, the AHCA removes the requirement to cover specified percentages of the expected medical costs. This means that while plans are required to include the full set of benefits, they are free to raise the cost sharing for particular benefits — like mental health services or maternity and newborn care — to potentially prohibitive levels. (Richard G. Frank and Sherry A. Glied, 3/20)

The Wall Street Journal: My Old Kentucky Health Care
It’s not often that a Donald Trump rally is the bottom story in the state he’s visiting. But when the state is Kentucky and it’s March Madness and the University of Kentucky Wildcats have just advanced to the NCAA’s Sweet 16 in college basketball, it’s understandable that local attentions are focused on hoops not politics. (William McGurn, 3/20)

The Wichita Eagle: Without Health Insurance Mandate, All Will Pay For It
Political opportunism and irrational ideology continue to dominate reason in our latest phase of the struggle over health care. Assuming there is an American future, the people living in it will look back in wonderment that in 2017 a few hundred adult, fairly well-informed, decently educated men and women had such difficulty solving a fundamental problem of governance and math. Why, they will ask, did so many people of that era not understand that every one of them had a financial – let alone moral and humanitarian – stake in everyone else’s physical well-being? (Davis Merritt, 3/21)

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Opioid Use Complicates Doctors’ Decisions About Who Should Get Heart Surgery

In other news on the nation’s drug crisis, two studies give cautious hope that opioid use among teens and poisonings of young children may be declining. And a Maryland sheriff’s office publicly counts the county’s fatal overdoses. The number just hit 100.

The Baltimore Sun: Heroin Has Killed More Than 100 Since Sheriff’s Office Started Count In 2015
With four fatal heroin overdoses this weekend, Harford County has reached the tragic milestone of 100 opioid-related deaths since the sheriff’s office started keeping track at the start of 2015. And Sheriff Jeffrey Gahler said the worst is yet to come. The deaths this weekend – three Saturday and one Sunday – bring the total of opioid-related deaths this year to 20. With 56 in 2016 and 27 in 2015, that’s 103 heroin deaths, according to statistics from the Harford County Sheriff’s Office. (Butler, 3/21)

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Congress May Delete Requirement That Businesses Track Worker Injuries

Also in public health news, the traditionally high U.S. infant death rate is making a promising decline and a new study highlights a connection between global warming and diabetes rates. Media outlets also report on a range of other developments, including ketamine being used to treat severely depressed patients and insurers weighing a simple treatment for artery disease.

NPR: Congress May Undo A Key Worker Safety Rule
Safety advocates are worried that lawmakers are getting ready to make it harder to penalize companies that don’t keep track of workers’ injuries. Since 1971, the Occupational Safety and Health Administration has required many employers to keep careful records of any worker injuries or illnesses. (Greenfieldboyce, 3/20)

Stat: Infant Deaths, Stubbornly High In The US, Continue A Promising Decline
In the US, a rising number of babies are living to see their first birthday, according to a study released Tuesday by the Centers for Disease Control and Prevention. The data show that infant mortality has declined by 15 percent over the last decade, with the biggest gains concentrated in the south and east of the country. That’s good news given that the US has persistently had a higher rate of infant deaths than other wealthy nations. (Swetlitz, 3/21)

NPR: Ketamine For Severe Depression Gains Popularity Among Doctors
Gerard Sanacora, a professor of psychiatry at Yale University, has treated hundreds of severely depressed patients with low doses of ketamine, an anesthetic and popular club drug that isn’t approved for depression. This sort of “off-label” prescribing is legal. But Sanacora says other doctors sometimes ask him, “How can you be offering this to patients based on the limited amount of information that’s out there and not knowing the potential long-term risk?” Sanacora has a simple answer. (Hamilton, 3/20)

Stat: Insurers Weigh A Simpler Treatment For Artery Disease: Supervised Workouts
When Char Zinda’s doctors discovered that she had had a couple of small, undiagnosed heart attacks, their instructions were to start walking. She was game. She tried going to the local university’s indoor walking track near her house. But she couldn’t even walk two-tenths of a mile. “The bottoms of my feet just felt like somebody had taken a sharp pencil and was poking it in,” said the 64-year-old, who lives in Morris, Minn. The pain was so bad it made her cry. (Boodman, 3/20)

Stateline: With A Daily Dial, Police Reach Out To Seniors
Living alone can be tough for seniors. Some don’t have family nearby to check on them, and they worry that if they fall or suffer a medical emergency and can’t get to the phone to seek help, no one will know. That’s why hundreds of police agencies in small towns, suburbs and rural areas across the country are checking in on seniors who live alone by offering them a free automated phone call every day. (Bergal, 3/21)

The New York Times: Popular Prostate Cancer Therapy Is Short, Intense And Unproven
After learning he had early stage prostate cancer, Paul Kolnik knew he wanted that cancer destroyed immediately and with as little disruption as possible to his busy life as the New York City Ballet’s photographer. So Mr. Kolnik, 65, chose a type of radiation treatment that is raising some eyebrows in the prostate cancer field. It is more intense than standard radiation and takes much less time — five sessions over two weeks instead of 40 sessions over about two months or 28 sessions over five to six weeks. (Kolata, 3/20)

The Washington Post: This Woman’s Labored Breathing Alarmed Her Friends. Doctors Were Startled To Find The Cause.
“What’s wrong with you?” Dianne Hull remembered her friend Vicky Weinstein asking, alarm evident in her voice. The two women had just finished lunch in December 2012, and Hull breathed heavily as she walked across the kitchen of her friend’s home. Hull’s audible breathing — and increasing breathlessness — had been shoved aside in her constellation of pressing concerns. For months, Hull had been focused on a medical crisis affecting her young son. But now Weinstein — a nurse — was delivering a forceful reminder: It was past time for Hull, then 38, to pay attention to her own health. (Boodman, 3/20)

Stat: Craig Venter Wants $1,400 To Sequence A Genome. Is It Worth It?
The genomics pioneer who sequenced the human genome carved out a new niche just over a year ago, selling exhaustive $25,000 medical workups to apparently healthy people. Now Craig Venter’s trying to take one small piece of that business to a much wider audience — and to prove it’s worthwhile. (Robbins, 3/21)

Sacramento Bee: How To Wean Yourself From Your Gadget Addiction 
Many people find the constant dings, rings, buzzes and beeps that come from their computers and cell phones impossible to ignore. Experts say its a sign of our dependency on technology, which validates and entertains us while also cutting into our productivity and altering our attention span for the worse. (Caiola, 3/20)

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Viewpoints: For Opioids, The Drug War Misses The Target; In Defense Of Meals On Wheels

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

Chicago Tribune: Opioid Epidemic: Another Drug War Failure
Illicit drug use is an old phenomenon, and Jeff Sessions has an old solution: Take off the gloves. “We have too much of a tolerance for drug use,” the attorney general complained to an audience of law enforcement officials Wednesday, promising more aggressive policing. … in his prepared remarks, Sessions insisted that cannabis is “only slightly less awful” than heroin. Oh, please. The nation is in the midst of an epidemic of overdose deaths involving heroin and other opioids. In 2015, 32,000 Americans died of such overdoses. Compare that with the number of people who died from ingesting an excess of marijuana: zero. (Steve Chapman, 3/17)

RealClear Health: Gottlieb Promises To Accelerate Drug Approvals; Surrogate Endpoints Can Help
President Trump’s FDA appointee Scott Gottlieb wants to speed up the drug approval process to give patients quicker access to life-saving drugs. Luckily for him, President Obama gave him the tools he’ll need to do so. In the waning days of his presidency, President Obama signed into law the bipartisan 21st Century Cures Act. The legislation permits the FDA to approve more drugs based on “surrogate endpoints.” This move will speed up the drug approval process and improve millions of Americans’ chances of beating cancer. (Sandip Shah and Vidya Ramesh, 3/20)

Morning Consult: Why Drug Importation Is Flawed Policy
With the issue of prescription drug importation being debated on Capitol Hill again, mark me in the skeptical camp. As a matter of safety and practical policymaking, drug importation simply doesn’t work. It is not by happenstance that our country has the world’s safest drug supply. Counterfeit medicines are proliferating around the world and the people who do this are brilliant at making these products look just like the real deal. (Mike Leavitt, 3/20)

The New York Times: The Cost Can Be Debated, But Meals On Wheels Gets Results
Meals on Wheels has been delivering food to older people in the United States since the 1950s. Last year it served 2.4 million people. This week, after President Trump released his budget proposal, a furor erupted over the program’s future and effectiveness. Let’s look at the evidence. (Aaron E. Carroll, 3/17)

Miami Herald: Trump’s Budget Makes The Unkindest Cuts Of All
Sadder still, is that so many of these cuts will do damage to so many of the people he persuaded to vote for him: the low-income, the unemployed, the chronically sick and under-housed. Though the president’s increases for training programs for disabled Americans deserve praise, his cutbacks in job training programs for seniors, perhaps unable to retire, but thrust into the job market; disadvantaged youth — and they don’t all live in inner cities, but in rural areas, too; and the out-of-work are headscratchers. Who’s going to fill all those jobs he’s promised to restore? And independent studies show Meals on Wheels, also on the chopping block, is extremely effective at providing isolated seniors nutrition and socialization. (3/18)

The New York Times: Why Cystic Fibrosis Patients In Canada Outlive Those In The U.S.
Cystic fibrosis is an inherited disorder that affects the lungs, pancreas, intestines and other organs. A genetic mutation leads to secretory glands that don’t work well; lungs can get clogged with thick mucus; the pancreas can become plugged up; and the gut can fail to absorb enough nutrients. Cystic fibrosis has no cure. Over the last few decades, though, we have developed medications, diets and treatments for depredations of the disease. Care has improved so much that people with cystic fibrosis are living on average into their 40s in the United States. In Canada, however, they are living into their 50s. (Aaron E. Carroll, 3/20)

The Kansas City Star: Prospect Of Guns In State Mental Hospitals Means It’s Time For Lawmakers To Act
Common sense dictates that Kansas doesn’t want guns in its mental hospitals. But the state is headed precisely in that direction unless lawmakers can rally in the days ahead and agree on exemptions to a gun law passed in 2013. That law gave mental hospitals, other hospitals and the state’s college campuses four years to prepare for the day when firearms would be allowed in their buildings. (3/18)

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State Highlights: Va.’s Immunization Rates Plateau; Ga. Senate OKs Family Sick Leave Bill

Outlets report on news from Virginia, Georgia, Pennsylvania, Missouri and Connecticut.

WABE: Georgia Senate Passes Family Sick Leave Legislation
The Georgia Senate passed SB 201 that would require employers to let workers use their sick days to take care of a child, parent, or any dependent listed on tax returns. State Rep. Brian Strickland (R-McDonough) is sponsoring the bill in the House. (Bandlamudi, 3/17)

Kansas City Star: Ill Missouri Woman Turns Destitute While Fighting For Social Security Disability | The Kansas City Star
[Barbara] Sales’ situation goes to the heart of problems that have plagued the Social Security Administration for years: Underfunded and overwhelmed, it operates with a workforce that has remained all but flat for more than 20 years in the face of a rising population and an explosion of disability applications… Some good news came this month when union officials representing federal workers were told that despite a federal hiring freeze, the Social Security Administration would be allowed to hire 100 extra workers to authorize benefits. (Adler, 3/19)

The CT Mirror: Unspeakable Horrors Gave Theanvy Kuoch Incredible Strength And Compassion 
The organization [Khmer Health Advocates] provides health care and counseling, and runs a treatment program for torture survivors. It has used a variety of innovative techniques to provide care, including a videoconferencing program that allowed people across the state to communicate with – and receive care from – those in the West Hartford office without having to travel. Another program paired the organization’s community health worker with a pharmacist who helped patients manage their medications. (Levin Becker, 3/19)

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Once Every 45 Minutes Poison Control Fields A Call About A Child Being Exposed To Opioids

Pediatric exposure to opioids increased by 86 percent from 2000 to 2009 but decreased overall for all ages under 20 from 2009 until 2015. Most of the exposures — 60 percent — were among children age 5 or younger.

The Washington Post: Poison Control Centers Receive 32 Calls A Day About Children Exposed To Opioids
The phone rings once approximately every 45 minutes — that is how often poison control centers in the United States receive calls about children being exposed to prescription opioids, according to a study published Monday. Over a span of 16 years, from January 2000 until December 2015, about 188,000 calls were placed to poison control centers regarding pediatric and teenage exposure to opioids, the study published in the journal Pediatrics found. Sixty percent of the children exposed to opioids were younger than 5, while teenagers accounted for 30 percent. (Naqvi, 3/20)

Columbus Dispatch: Kids Getting Hands On Adults’ Pain Pills, Study Finds
The numbers, Casavant said, show that the opioid epidemic “that has been ravaging our adults and our teens has worked its way down to young people as well.” Most of the exposures — 60 percent — were among children age 5 or younger. The second-highest percentage — 30 percent — was among those 13 to 19 years old. Findings show that most of the exposures among the youngest children were unintentional and probably occurred when the youngsters found pills that were inappropriately stored, whether in sight or within reach in a purse. (Viviano, 3/20)

In other news on the crisis —

The Associated Press: No Opioids, Please: Clearing The Way To Refuse Prescriptions
The ease of relapsing into opioid addiction has led a growing number of states to help residents make it clear to medical professionals they do not want to be prescribed the powerful painkillers. Connecticut and Alaska are two of the latest considering legislation this year that would create a “non-opioid directive” patients can put in their medical files, formally notifying health care professionals they do not want to be prescribed or administered opioid medications. (Haigh, 3/19)

The Washington Post: First Opioid Prescriptions Influence The Likelihood Of Chronic Drug Use
The first prescription that patients get for opioid painkillers has a large influence on their risk of long-term use, according to a new report published Friday. Prescribing fewer opioids to be taken over a period shorter than three days in the initial prescription decreases the likelihood of chronic use, researchers wrote in the Morbidity and Mortality Weekly Report, published by the Centers for Disease Control and Prevention. (Naqvi, 3/17)

The Washington Post: As Opioid Crisis Intensifies, One Md. School System Looks At A ‘Recovery’ School
Kevin Burnes thinks his school saved his life. He arrived there at 14 years old, just out of rehab, and says it was exactly what he needed: a place where kids with drug and alcohol problems could stay on a path of recovery as they worked toward high school graduation. “I have no question that it changed the course of everything I was doing,” said Burnes, now a music teacher and musician. (St. George, 3/19)

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Viewpoints: Pharma Execs Embrace Trump’s Pick To Head FDA As One Of Their Own; What About ‘Good Eugenics’?

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

Los Angeles Times: Farewell To Drug Regulation? Trump Nominates A ‘Bona-Fide Pharma Shill’ To Head The FDA
Lots of people in the healthcare field heaved a sigh of relief last week when President Trump nominated Scott Gottlieb, a physician, venture investor and former official of the Food and Drug Administration, to be the FDA’s next commissioner. Some healthcare experts were relieved that, whatever Gottlieb’s particular qualities, at least he wasn’t someone from the camp of “we-have-to-destroy-the-agency-to-save-it” species of Trump appointee like, say, Environmental Protection Agency boss Scott Pruitt. (Michael Hiltzik, 3/16)

Los Angeles Times: Is There Such A Thing As Good Eugenics?
We entered a new phase as a species when Chinese scientists altered a human embryo to remove a potentially fatal blood disorder — not only from the baby, but all of its descendants. Researchers call this process “germline modification.” The media likes the phrase “designer babies.” But we should call it what it is, “eugenics.” And we, the human race, need to decide whether or not we want to use it. (Adam Cohen, 3/17)

Boston Globe: Trump NIH Cuts Threaten Mass. 
Lawmakers need a stark reminder that advances in medicine and cures for human disease often come only after decades of painstaking scientific research — much of it funded by government grants. That’s why the $5.8 billion cut proposed for the National Institutes of Health on Thursday is as short-sighted as it is devastating for the nation’s researchers, doctors, and patients. (3/16)

The New England Journal Of Medicine: Out Of Sight, Out Of Mind — Behavioral And Developmental Care For Rural Children
The Centers for Disease Control and Prevention (CDC) has just offered further evidence that American children — and rural children in particular — are in trouble. Previously, the CDC had noted that poor U.S. children 2 to 8 years of age have higher rates of parent-reported mental, behavioral, and developmental disorders (MBDDs) than their wealthier counterparts. Now, in the latest of a series of reports, the agency documents the finding that rural children from small communities are more likely to have MBDDs than those living in cities and suburbs. (Kelly J. Kelleher and William Gardner, 3/16)

WBUR: Doctor: Boston Evictions Tantamount To A Public Health Crisis 
Evictions can lead to many health problems. According to a nationally representative study published by Harvard and Rice University researchers, evicted mothers are more likely to have depression and report worse health for themselves and their children. Disruptive life events like eviction and homelessness at a young age may have lifelong health impacts for developing children. (Lara Jirmanus, 3/16)

The Des Moines Register: Profit-Seeking Medicaid Insurers Vs. Iowans
Iowa has been victimized by Gov. Terry Branstad’s Medicaid privatization for nearly a year. Handing over a $4 billion government health insurance program to profit-seeking companies did not make sense in theory, and in practice, it has been a nightmare for health providers and low-income Iowans. Enough is enough. It is time to return to the state-managed Medicaid system that had low administrative expenses, timely reimbursement for providers and consistency in coverage for patients. (3/16)

San Jose Mercury News: Too Many Health Plan Choices Mean Worse Care
I appreciate that the healthcare system within which I work accepts most insurance plans, but when my patients change jobs, move, become eligible for Medicare, or their insurance plan switches networks, they are forced to get new doctors and establish care within a new system. Many critics of universal healthcare argue that it limits patient choice. However, in my experience there are overlooked negative consequences of having too many health insurance options. (Tenessa Mackenzie, 3/16)

The New England Journal Of Medicine: Clarifying Stem-Cell Therapy’s Benefits And Risks
The current excitement over the potential for stem-cell therapy to improve patient outcomes or even cure diseases is understandable. We at the Food and Drug Administration (FDA) share this excitement. However, to ensure that this emerging field fulfills its promise to patients, we must first understand its risks and benefits and develop therapeutic approaches based on sound science. Without a commitment to the principles of adequate evidence generation that have led to so much medical progress, we may never see stem-cell therapy reach its full potential. (Peter W. Marks, Celia M. Witten and Robert M. Califf, 3/16)

Arizona Republic: Trust These Folks To Apply Anesthesia To Patients
There is – Senate Bill 1336.This simple, commonsense measure benefits Arizona patients and health-care professionals. We write as surgeons who recognize the critical service provided by our nursing colleagues, Certified Registered Nurse Anesthetists (CRNAs). In many facilities, especially in rural or underserved communities, it is a CRNA – not an anesthesiologist – who is in charge of making sure the patient is asleep and comfortable for their procedure. (Eric Nelson, Robert Schuster and Steven Washburn, 3/16)

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A General Found A Way To Reduce Veteran Suicide — But The Army Isn’t Adopting It

Major General Dana Pittard implemented a strategy at Fort Bliss in Texas so that it had the lowest suicide rate of any major Army installation in the world. But despite it being acknowledged as a model of success, the Army as a whole hasn’t implemented it.

Politico: The General Who Went To War On Suicide
On the evening of July 19, 2010, Major General Dana Pittard, the new commander of Fort Bliss in El Paso, Texas, got a call from the base’s 24-hour duty officer. A SWAT team had been sent to the house of a young sergeant named Robert Nichols. Nichols was inside with a gun, threatening to kill himself. Pittard arrived at the soldier’s home just in time to see the soldier step out of the house, put the gun to his chest and fire. Neighbors and police crowded the street, but Pittard was the only officer from the Army base at the scene. He went home, where his boxes were still packed from his move 10 days before, feeling disturbed and helpless. (Hattem, 3/17)

NH Times Union: Statewide Effort Aims To Improve Mental Health Services For Veterans 
Leaders in the mental health and veteran fields say that New Hampshire is the first in the nation to implement a statewide effort to identify mental health patients with a military background and fashion outreach and treatment programs for them. At least one staff member at each of the state’s community mental health centers is a designated liaison for military issues. Hundreds of mental health workers have been trained on military culture. (Hayward, 3/16)

In other veterans health care news —

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Residents Of Richer Nations Have Higher Anxiety Rates Than Poorer Countries, Survey Shows

That anxiety can interfere more with daily activities and responsibilities, researchers find. In other public health news, a group of doctors warns that Americans are sicker due to climate change. And experts looks to practices in Oregon as end-of-life examples.

Stat: Rich Countries Are More Anxious Than Poorer Countries
Richer countries have higher rates of anxiety in their population than poorer countries and — in a finding that surprised even the researchers — that anxiety also interfered more with daily activities and responsibilities. Specifically, there was a higher proportion of people in higher-income countries with generalized anxiety disorder, or GAD — defined as excessive and uncontrollable worry that affects a person’s life — and with severe GAD. The researchers, who are members of the WHO World Mental Health Survey Consortium, published their findings in JAMA Psychiatry on Wednesday. (Sheridan, 3/15)

Cleveland Plain Dealer: Climate Change Is Making Americans Sick, Nation’s Medical Societies Warn 
Eleven national medical societies representing more than half of the nation’s doctors came together today to warn about the ongoing health impacts of climate change and to advocate for a quicker transition to cleaner, renewable energy sources to help protect patients. Most Americans don’t realize that climate change is making us sick, these doctors fear, because there has been little public discussion about the connection between the two. Yet extreme weather events, increasing temperatures and air pollution are already affecting us, they say. (Zeltner, 3/15)

Kaiser Health News: Where You Live May Determine How You Die. Oregon Leads The Way.
Americans who want to ensure they have a say in how they die should examine the lessons of Oregon, a new analysis suggests. Seriously ill people in that state are more likely to have their end-of-life wishes honored — including fewer intensive-care hospitalizations and more home hospice enrollments — than those living in neighboring Washington state or the rest of the country. (Aleccia, 3/15)

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‘This Pain Has Gone Too Far’: Family’s Search For A Drug Treatment Bed Is Hauntingly Common Story In U.S.

Stat profiles the 41-day struggle of a West Virginia mother and father to get professional help for their 21-year-old daughter before it was too late. In other news on the nation’s drug crisis, FDA panels reconsider Opana, a pain doctor in Massachusetts faces fraud charges and a former drug policy director weighs in on the potential impact of Republicans’ replacement health plan.

Stat: A 41-Day Fight To Get Treatment Ends In A Daughter’s Overdose
Leigh Ann and John Wilson play back those 42 days in a constant loop. They remember the clinics with lengthy waiting lists; the treatment centers that wouldn’t take Medicaid; the doctors who discouraged Taylor from inpatient treatment, saying she could do without it. They wonder, more than anything, why it’s so hard to get addiction treatment in the state with the nation’s highest drug death rate — 818 deaths last year, most of them from opioids. (Blau, 3/16)

Stat: FDA Panel Rebukes Powerful Opioid Reformulated To Curb Abuse
As the national opioid crisis rages, painkiller manufacturers have raked in profits and earned plaudits by reformulating their opioids in an attempt to deter abuse. But on Tuesday, a federal advisory panel delivered an extraordinary rebuke to one such product on the market, suggesting that Endo Pharmaceuticals’ efforts to make Opana ER harder to crush ended up making things worse by enabling addicts to inject it. … Opana has been blamed by some for spurring a high-profile HIV outbreak in rural Indiana in 2015, and it was also tied to reports of a rare but serious blood disease characterized by clots that can lead to organ damage. (Robbins, 3/14)

Boston Globe: Pain Doctor Who Prescribed Large Amounts Of Oxycodone Pleads Guilty To Fraud 
A former doctor who at one point prescribed more oxycodone than most Massachusetts hospitals pleaded guilty in federal court Wednesday to fraud charges and is facing more than a decade in prison. Patients allegedly waited in line for hours to see Fathalla Mashali, 62, who saw patients for only minutes at a time in an office at his pain clinics, rather than in an exam room. (Valencia, 3/16)

WBUR: Former Drug Czar Says GOP Health Bill Would Cut Access To Addiction Treatment 
Michael Botticelli served as President Obama’s director of National Drug Control Policy, and pushed Congress to pass a funding measure last year making more money available for the treatment of opioid addiction. Now he’s concerned that the proposed Republican health plan will reduce access to health services for people with addiction. (Hersher, 3/15)

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Where You Live May Determine How You Die. Oregon Leads The Way.

Americans who want to ensure they have a say in how they die should examine the lessons of Oregon, a new analysis suggests.

Seriously ill people in that state are more likely to have their end-of-life wishes honored — including fewer intensive-care hospitalizations and more home hospice enrollments — than those living in neighboring Washington state or the rest of the country.

In 2013, nearly two-thirds of Oregonians who died did so at home, compared with fewer than 40 percent of people elsewhere in the U.S., according to the report published Wednesday in the New England Journal of Medicine. Previous research had shown that more than 85 percent of Americans say they’d prefer to die at home.

“Obviously, if you’ve spent decades trying to improve your end-of-life care, it’s pretty rewarding to see that something changes,” said Dr. Susan Tolle, director of the Center for Ethics in Health Care at the Oregon Health & Science University in Portland, who co-led the study.

The review analyzed Medicare fee-for-service claims data from 2000, 2005 and 2013, and it compared end-of-life care in Oregon and Washington — a nearby state with similar demographics and attitudes toward end-of-life care — with the rest of the U.S., excluding those two states.

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It found that in 2013, ICU use in the last 30 days of life was about 18 percent in Oregon, compared with 23 percent in Washington and 28.5 percent in the rest of the U.S. Nearly three-quarters of patients in Oregon hospitalized in the last month of life were discharged to home, compared with slightly fewer than two-thirds in Washington state and a little more than half — 54.2 percent — in the rest of the U.S.

More than 40 percent of patients in Oregon were enrolled in home hospice in 2013, compared with about 30 percent in Washington and fewer than 20 percent in the rest of the U.S, the analysis found.

Oregon, which enacted the nation’s first death-with-dignity law and led the way on implementing portable medical orders for treatment at the end of life, may be reaping the results of those and other efforts, said Tolle’s co-author, Dr. Joan Teno, a professor of medicine, gerontology and geriatrics at the University of Washington in Seattle.

“When you look at the patterns, it’s very different than the rest of the United States,” she said. “It’s even different than a borderline state.”

Pat Duty, 64, who ran a Portland floor-covering business with her husband, Jimmy, for years, said Oregon’s palliative care culture helped guide treatment decisions after his 2013 diagnosis of lung cancer and dementia. Jimmy Duty wanted limited medical interventions; he had a do-not-resuscitate order, plus a request to avoid the ICU.

“He was very clear that quality of life was his first choice,” Pat Duty recalled. “We knew we needed to discuss these things while he could make decisions for himself. We wanted to give him the dignity and grace he deserved for his final couple of years.” He died in October 2015 at age 74.

Pat Duty of Portland, Ore., cared for her husband, Jimmy, after a diagnosis of lung cancer and complications that led to his death at age 74 in 2015. The couple discussed end-of-life treatment options and palliative care, part of Oregon’s integrated system that sets it apart from other states. (Photo courtesy of Pat Duty)

Creating such a culture is much harder than it looks, Tolle and Teno argued. Oregon has successfully integrated awareness of end-of-life care at all levels, from state government and emergency care to individual decisions made by patients and their doctors.

“If patients’ goals are not linked to actionable care plans that are supported by local health care systems and state regulations, many patients who wish to remain at home will die intubated for all the reasons the current system fails them,” they wrote.

Across the U.S., there’s been a push to promote ways to indicate end-of-life treatment preferences, including advance directives, which provide guidance for future care, and Physician Orders for Life-Sustaining Treatment, or POLST, portable medical orders authorizing current care. Twenty-two states now have POLST programs and others are working on or considering them, said Tolle, who co-led the creation of POLST in the early 1990s.

But the researchers warned that, while POLST efforts are important, simply filling out the forms is not enough.

“We were highlighting that there’s no simple answer,” Tolle said. “You can’t just do one thing and think that you will change the culture of end-of-life care. It is a whole lot of work.”

Dr. Scott Halpern, a medical ethics and health policy expert at the Perelman School of Medicine at the University of Pennsylvania, has been a chief critic of POLST efforts, contending that there’s little evidence that the medical orders improve quality of life near death.

The new analysis by Tolle and Teno doesn’t fill the gap, he said. But he agreed with the authors’ contention that a focus on single interventions ignores the complexity of end-of-life decisions.

“Good end-of-life care involves physicians eliciting patients’ values, hopes and fears and making treatment decisions that align,” Halpern said.

The new analysis, which was funded by a grant from the Robert Wood Johnson Foundation, underscores that families and patients outside of Oregon must be vigilant to ensure they receive the care they want, Tolle said.

“The level of care you receive near the end of life depends more on the state you live in and the systems they have in place than your actual wishes,” she said.

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.

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State Highlights: Calif. Failing To Screen Social Services Workers Properly, Audit Finds; Ala. Investigating Possible Bird Flu Cases

Outlets report on news from California, Ohio, Kansas, Alabama, Georgia, Texas and Minnesota.

Sacramento Bee: Audit Slams Background Checks At California Care Facilities
The California Department of Social Services’ Community Care Licensing Division, which oversees and regulates nearly 75,000 facilities statewide, is charged with ensuring the safety of a wide range of people, including those with disabilities and illnesses, elderly adults and children. It reviews background checks from the state Department of Justice on applicants for jobs at the facilities and decides whether those with criminal convictions can be hired. But auditors found that the state Department of Justice stopped routinely providing social services with sentencing information in 2016 because state law didn’t explicitly require it. (Opsahl, 3/14)

Bloomberg: Bird Flu Cases Probed In One Of The Largest U.S. Chicken States
Alabama, one of the leading U.S producers of chicken meat, is investigating suspected cases of bird flu in three northern poultry flocks and has introduced some restrictions on the transportation of birds. A commercial chicken-breeding farm in Lauderdale County and a backyard flock in Madison County are among the facilities under investigation, the Alabama Department of Agriculture & Industries said in a statement Tuesday. The state is also probing a flea market in Jackson County and has issued an order limiting the movement of some poultry. (Dursin, 3/14)

Cleveland Plain-Dealer: Akron Children’s Hospital Program Helps Kids With Asthma Breathe Easier, Avoid Hospital Visits
Community health assessments conducted in 2013 and 2016 have shown that asthma is a significant health need for children in Medina, Portage, Stark, Summit, Wayne, Mahoning, Trumbull, Columbiana and Richland counties. But thanks to an evidence-based asthma management program implemented by Akron Children’s Hospital two years ago, the hospital has seen a has seen a significant decrease in the number of asthma-related ER visits and hospitalizations. The program, Easy Breathing, is helping to standardize the diagnosis and treatment of asthma in Akron Children’s primary care offices throughout the region. (Becka, 3/14)

KCUR: Getting Innovators To Come To Work — At A Children’s Hospital
Health care providers who work with kids are natural innovators, says Krista Nelson, Children’s Mercy Hospital’s director of innovation development. Nelson, an expert in innovation — not medicine, was hired by the hospital to run its new Center for Pediatric Innovation. “In the children’s hospital or pediatric environment, we really deal with every size of child from a premature baby all the up to the captain of the football team at one of our big high schools,” says Nelson. (Ellison, 3/15)

Columbus Dispatch: Virtual Reality Aids Medical Trauma Training
The virtual-reality experience is new for residents training in trauma care at the Downtown hospital… The virtual-reality scenarios — there are three — were filmed in July by a team from Ohio University that hung or mounted three softball-size camera and microphone units in the emergency department to capture 360-degree experiences, said Eric Williams, co-creator of the new Immersive Media Initiative at the Athens school. Patients consented to be in the videos. (Viviano, 3/15)

Georgia Health News: Can Mobile Apps Help Fill Sex Education Gaps?
The sex education course at Clarke Central in Athens is taught over two weeks during the first semester of ninth grade. Teachers will continue to talk about sex ed and health topics in the following years of high school, but STIs, birth control methods and HIV/AIDS probably won’t be mentioned again. However sporadic it may be, the F.L.A.S.H. curriculum taught in the Clarke County School District may be better than what’s taught in many other school systems around the state. (Knight, 3/14)

Texas Tribune: Texas Senate Tentatively Approves “Bathroom Bill”
The Texas Senate on Tuesday tentatively signed off on the “bathroom bill” on a 21-10 vote with one Democrat — state Sen. Eddie Lucio Jr. of Brownsville — voting in favor of the bill. Senate Bill 6, a legislative priority of Lt. Gov. Dan Patrick, would require transgender people to use bathrooms in public schools, government buildings and other publicly-owned facilities that match their “biological sex” and not gender identity. And it would preempt local anti-discrimination laws meant to allow transgender residents to use public bathrooms that match their gender identity. (Ura, 3/14)

The Star Tribune: Complaint Puts New Age Healers On Minnesota Regulators’ Radar
Unconventional healing practices, from energy readers to faith healers, typically operate below the state’s radar screen unless a complaint is made… t’s a tricky issue. The Health Department’s mandate isn’t to evaluate whether a treatment is effective or fraudulent. It’s to determine whether the department has jurisdiction over a provider, and if so, to decide whether the provider is following state rules, such as providing a Client Bill of Rights and factual advertising. (Hopfensperger, 3/15)

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Experts Fear That GOP Health Plan Could Harm Addiction Services Now Covered By Medicaid

In other news on the substance abuse crisis, two federal advisory panels take steps that could lead to a ban on Opana, a reformulated opioid billed as crush resistant, making it harder to snort. But instead people are injecting the drug, leading to fatal overdoses and the spread of HIV. And, The New York Times reports that teen drug use is down.

Stat: How Medicaid Pays For Addiction Treatment, State By State
More than 30,000 Americans are dying from heroin and painkiller overdoses every year. Hundreds of thousands of people covered by Obamacare’s expansion of Medicaid — more than a million, by at least one estimate — have mental health and substance abuse issues. The GOP plan could impact the program in two ways. First, it would eliminate in 2020 the requirement that states, which administer Medicaid and jointly fund it with the federal government, offer robust coverage of mental health and substance abuse services for people who enrolled in Medicaid under the Obamacare expansion. (Scott, 3/14)

USA Today: Federal Advisory Panels Agree Opana’s Risks Outweigh Benefits
In a move that could lead to a national ban, two federal advisory panels voted Tuesday that the risks outweigh the benefits of a widely-abused opioid that was reformulated to deter addicts from snorting it. The new extended-release version of Endo Pharmaceuticals’ Opana may even be more dangerous than the version it replaced, according to critics including the advocacy group Public Citizen. Two Food and Drug Administration advisory panels seemed to agree, voting 18 to 8 that it presents more risks than benefits to society. (Wise and O’Donnell, 3/14)

The New York Times: Are Teenagers Replacing Drugs With Smartphones?
Amid an opioid epidemic, the rise of deadly synthetic drugs and the widening legalization of marijuana, a curious bright spot has emerged in the youth drug culture: American teenagers are growing less likely to try or regularly use drugs, including alcohol. (Richtel, 3/13)

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