Tagged Public Health

A Busy Week For Health: Budget Cuts, CBO Scores And Mitch McConnell’s Cryptic Signal

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It was a hectic week for people who follow news about health politics. Kaiser Health News’ veteran reporters Mary Agnes Carey and Julie Rovner sat down to discuss some of the major developments.

MARY AGNES CAREY: Hello, and thanks for joining us. I’m Mary Agnes Carey, partnerships editor and a senior correspondent for Kaiser Health News. Julie Rovner, KHN’s chief Washington correspondent, is here with me to talk about a very busy week in health care: Medicaid cuts in President [Donald] Trump’s budget plan and a new Congressional Budget Office analysis of the House passed ACA overhaul. We’ll also look at what Senate Republicans have in mind for their ACA replacement bill. Julie, let’s get started.

JULIE ROVNER: OK.

MARY AGNES CAREY: First the budget. President Trump released his fiscal 2018 budget plan this week. Federal spending on Medicaid and the Children’s Health Insurance Program would be cut. Can you take us through those changes.

JULIE ROVNER: Yes these Medicaid changes would be on top of what’s in the House-passed health care bill, which would be about $800 billion. What the administration says is that they’re going to let the amount that Medicaid goes up every year go up by less. So that would result in even more cuts. There’s a roughly 20 percent cut to the Children’s Health Insurance Program.

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This budget also includes big cuts to the public health infrastructure. It cuts the Centers for Disease Control and Prevention by about 17 percent. It would cut the National Institutes of Health by nearly 18 percent. It would completely eliminate the Agency for Healthcare Research and Quality and fold that into the NIH. So there’s been a lot of uproar from the medical and scientific community, although we should point out that this budget is unlikely to happen. Presidents’ budgets are mostly wish lists — that goes back decades. Congress basically decides who gets how much money.

MARY AGNES CAREY: Because they control the purse, right.

JULIE ROVNER: Absolutely.

MARY AGNES CAREY: All right. Let’s move on to the ACA. The Congressional Budget Office, or the CBO as we like to call it, released a new score or analysis for the House Republicans’ plan to replace the Affordable Care Act. What were the top takeaways for you?

JULIE ROVNER: Well, a lot of attention was paid to, you know, that sort of top line — that it would result in 23 million more people not having insurance after 10 years and then overall it would save about $119 billion from the deficit.

But what most of us were really looking at is what would happen as a result of that last-minute compromise that actually got the bill passed in the House. That was this amendment that would let states waive some of the requirements in the bill, like having a set of benefits and not charging people with preexisting conditions more. And interestingly, the CBO said that either under the Affordable Care Act or under the original House bill the market for individual insurance would probably be stable. But in those states that decided to take those waivers, it might well become unstable.

And the CBO didn’t say which states that would be, but they estimated that about one-sixth of Americans lived in states where that might happen. In those cases, people with preexisting conditions might be completely priced out of being able to get policies and even people who could get insurance might have to pay many, many thousands of dollars more because some benefits that they might need, like maternity care or mental health care, would no longer be covered. So it was not a ringing endorsement of that last-minute compromise.

MARY AGNES CAREY: And there’s also a big differential between if you’re younger or older, right?

JULIE ROVNER: That’s absolutely right. This is in sort of the original House bill. They would change the way tax credits are provided for people to help pay their premiums. Right now, they’re basically based on your income and how much insurance costs, so it doesn’t matter in different parts of the country if you’re sure insurance costs more. You only have to pay a set percent of your income.

The Republicans would change that, and they would link the tax credits more to age so older people would get more. Younger people would get less, but people would get less help overall. So for older people, premiums would spike dramatically. Sometimes you know more than $10,000 or $12,000. Some younger people, healthy younger people, would see a decrease, but it would not be nearly as large as the increase for older people.

MARY AGNES CAREY: So what does this CBO score mean for Senate Republicans as they try to draft their ACA replacement.

JULIE ROVNER: Well it certainly doesn’t help. The Senate had to wait for the Congressional Budget Office to deliver this score. That’s one of the requirements of the budget process that they’re using. But Senate Majority Leader Mitch McConnell did a couple of interviews this week where he basically said that they’re working hard on health care, but he doesn’t see a path to 50 votes, which is what they need to get this bill passed. That’s assuming Vice President [Mike] Pence could break a tie.

What we’re starting to see are conservatives saying they need to have these waivers — the ones that the CBO just said might destabilize the insurance market. Then you’ve got more moderates saying no we want fewer or no waivers. It’s hard to see where they’re going to come together. We’re told that staff is going to try to draft something next week while Congress is out for the Memorial Day break. But there’s no real anticipated timeline for this yet.

MARY AGNES CAREY: So Julie, why do you think Mitch McConnell would send such a public signal that he’s having a problem getting to 50 votes?

JULIE ROVNER: I really don’t know. I thought it was kind of curious. One of the things that it might be is that he wants to, you know, light a fire under his caucus, who are having all this disagreement, saying you know this whole thing could, you know, just dissolve if you don’t actually start coming to the table and compromising. Why else do you think he might do it?

MARY AGNES CAREY: Well you talk about how the calendar is working against him if he wants to get to tax reform. We’re at Memorial Day, and typically tax reform takes a lot of work, a heavy lift, maybe he just wants to move onto that.

JULIE ROVNER: So basically abandon the whole health reform idea?

MARY AGNES CAREY: I mean it sounds a little nutty. And obviously it’s a campaign promise they’ve all made. But also, as we’ve seen, there are problems in the marketplace. You do see insurers leaving over uncertainty. Perhaps they want to let that play out. I’m not sure.

JULIE ROVNER: Neither am I.

MARY AGNES CAREY: All right, well there you go. Thank you, Julie Rovner of Kaiser Health News.

Categories: Health Industry, Insurance, Medicaid, Public Health, Repeal And Replace Watch, The Health Law, Uninsured

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Viewpoints: Taking Stock Of Genetic Privacy; What About Those Medical Misfits?

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

The New England Journal Of Medicine: Undermining Genetic Privacy? Employee Wellness Programs And The Law
Genetic information is becoming ubiquitous in research and medicine. The cost of genetic analysis continues to fall, and its medical and personal value continues to grow. Anticipating this age of genetic medicine, policymakers passed laws and regulations years ago to protect Americans’ privacy and prevent misuse of their health-related information. But a bill moving through the House of Representatives, called the Preserving Employee Wellness Programs Act (H.R. 1313), would preempt key protections. Because the bill, which was sent to the full House by the Education and the Workforce Committee in March, would substantially change legal protections related to the collection and treatment of personal health and genetic information by workplace wellness programs, it should be on the radar screens of physicians, researchers, and the public. (Kathy L. Hudson and Karen Pollitz, 5/24)

The New York Times: Where Will The Medical Misfits Go?
People with health insurance tend to think of safety-net hospitals the way airline travelers think of the bus: as a cheaper service they would use only if they had to. But without these essential hospitals — which specialize in the care of our country’s most medically and financially vulnerable, particularly the uninsured — our entire health care system would be in danger. (Nuila, 5/26)

RealClearScience: Alternative Medicine Is Not The Answer To The Opioid Epidemic
America’s opioid epidemic is not manufactured hype; it’s real. Prescription painkillers are now more widely used than tobacco. Opioids were to blame for 31,000 overdose deaths in 2015, a 300 percent increase from 1999. Of the top ten drugs involved in overdose deaths, half are prescription opioids. (Ross Pomeroy, 5/25)

The New England Journal Of Medicine: Accelerated Approval And Expensive Drugs — A Challenging Combination
For serious or life-threatening disease, the Food and Drug Administration (FDA) can approve drugs on the basis of surrogate end points that are “reasonably likely to predict clinical benefit,” through its accelerated approval review track. This pathway, which dates back to the early 1990s, was designed as a response to the demand for faster drug development in the context of the HIV/AIDS crisis. Since then, the accelerated-approval program has expanded to include oncology products and drugs for other diseases, now accounting for about 10% of new drug approvals. (Walid F. Gellad and Aaron S. Kesselheim, 5/25)

San Jose Mercury News: Mentally Ill Kids Shouldn’t Languish In Juvenile Halls
California’s mentally ill children need clearer laws when going through the juvenile court system… While competency laws exist for juveniles suffering from mental illness, there are no clear, prescriptive guidelines for juveniles on the delivery and duration of services like those that exist in the adult system. Because of this gap in the law, these very vulnerable children languish in juvenile halls, unable to receive the mental health treatment they desperately need. (Mark Stone and Laura Garnette, 5/25)

Cleveland Plain Dealer: Continued Federal Investment In Science Is Critical For Lake Erie And The Region
Scientific research is a critical national investment, providing strong economic and societal benefits that improve our quality of life. In Northeast Ohio, investments in scientific research and environmental protection have helped spur the growth of our local biotechnology and fuel cell industries, enhance our world-leading hospitals and universities, and revitalize the Cuyahoga River and Lake Erie. Yet the White House’s budget proposal seeks to walk away from these investments, threatening our nation’s ability to ensure a more prosperous future, healthy people, and a healthy environment. (Anne Jefferson, 5/26)

Health Affairs Blog: The Burgeoning “Yelpification” Of Health Care: Foundations Help Consumers Hold A Scale And A Mirror To The Health Care System
From flashy tech start-ups in Silicon Valley to modernized insurers in New York, everyone wants to “disrupt” health care. In practice, this is immensely more challenging than it sounds. Electronic health records (EHRs), more than a decade ago, were expected to revolutionize how health information is stored and shared. Yet, even today, 36 percent of office-based EHRs don’t permit secure messaging between patients and physicians, and 37 percent do not even allow patients to view their records. (Paul Howard, Yevgeniy Feyman and Amy Shefrin, 5/25)

RealClear Health: Health Heart 101
For millennia the heart was thought to be the seat of emotions — the source of love, of course, but also kindness and courage. To lose heart is to lose the fight, and perhaps even one’s life. In a literal sense, a weak heart means death. Unfortunately, sudden cardiac arrest is the leading natural cause of death in the United States. (Kamal Patel, 5/25)

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

Different Takes: The Politics Of Repeal, Replace And Reform

Editorial pages across the country include thoughts about the political risks in play as Congress and states confront efforts to dismantle Obamacare.

Bloomberg: Exposing The Obvious About The GOP Health-Care Bill
The gory details of the Congressional Budget Office’s report on the House legislation to “repeal and replace” Obamacare are, in many ways, superfluous. The bill’s flaws, substantive and otherwise, have long been evident. Less clearly understood, though equally disturbing, is the larger political context. (5/25)

Roll Call: A GOP Guide To Running For Cover On Health Care
Most of the news coverage highlighted the CBO’s estimate that 23 million fewer Americans would have health coverage in 2026 under the bill. But in 2026, most current House Republicans will be lobbyists and strategic consultants — and some future Congress would get the blame. In political terms, the scariest CBO number was that 14 million fewer Americans would be without health insurance next year. And many of these suddenly uninsured people just might remember whom to blame when they cast their 2018 ballots. (Walter Shapiro, 5/26)

Los Angeles Times: Die Hard: Republican Healthcare Bill Has No Problem Throwing You Off A Building
Glendale resident David Cannizzaro has had asthma since he was 7. Prior to Obamacare, his healthcare strategy was to see the doctor as little as possible so his insurer wouldn’t notice his preexisting condition and decide to raise his rates or drop his coverage. Now that Republican lawmakers are advancing a bill that would repeal the Affordable Care Act and potentially allow insurers to jack up premiums for people with preexisting conditions, Cannizzaro, 49, said he’s once again living in fear. “It’s very, very scary,” he told me. (David Lazarus, 5/26)

The Washington Post: Senate Republicans Who Are Gunning For Obamacare Are Caught In A Trap
Republican senators who are being asked today about the brutal Congressional Budget Office score of the health-care plan that passed the House have a ready answer: That doesn’t have anything to do with us. Numerous senators released statements saying that the CBO score just shows that the American Health Care Act (AHCA) is a radioactive fungus, which is why they’re starting over on their own bill. (Paul Waldman, 5/25)

The Washington Post: Don’t Blame The CBO For Problems In The House Health-Care Bill
The new Congressional Budget Office score of the American Health Care Act is devastating. In 2026, 23 million fewer Americans would be insured with it than without it. The response of the secretary of health and human services and other defenders of the Republican bill? Attack the Congressional Budget Office. I had the honor of running the CBO a decade ago and will be the first to admit it’s not perfect. But it’s also far better than the alternatives, and most of the critiques are off base. (Peter Orszag, 5/25)

Los Angeles Times: If You Plan On Having A Baby Under Trumpcare, You Better Start Saving Now
Seventeenth century playwright William Congreve famously wrote that hell has no fury like a woman scorned. House Republicans may feel some of that heat once their constituents find out the healthcare bill they passed could make maternity coverage vastly more expensive and harder to obtain. It’s widely known that the House GOP’s proposed American Health Care Act would bar federal funding for Planned Parenthood, which provides many reproductive and maternal health services to lower-income women across the country. Less well understood is that an amendment to the AHCA would also allow states to lift the mandate that insurers include maternity coverage in all the policies they sell to people in the individual and small-group markets (i.e., everyone not covered by a large company health plan). (Jon Healey, 5/25)

Tribune News Service: Obamacare Replacement Would Give Women Better Options, Lower Costs
Women make the majority of decisions about care and insurance for our families, and we generally consume more healthcare than men. As a result, women have a lot at stake when it comes to the laws that govern American healthcare and insurance. In 2010, the Affordable Care Act — Obamacare — made it illegal for insurers to charge women more than men and mandated that insurance plans cover women’s preventive care, including birth control, with no copay. Therefore, some now suggest repealing the Affordable Care Act would be detrimental for women’s health. But the opposite is true: Repeal will afford women greater choice and lower costs when it comes to insurance plans, doctors and care. (Hadley Heath Manning, 5/25)

Detroit Free Press: Who Will Play Fred Upton In Senate Sequel To House Health Care Farce?
Fred Upton is a 16-term congressman who may or may not be interested in becoming Michigan’s next U.S. senator. But there are almost certainly some Republican U.S. senators interested in becoming the next Fred Upton. A grandson of Whirlpool Corp. co-founder Frederick Upton, Rep. Upton is among the wealthiest members of Congress. Until 2016, he served as chair of the House Committee on Energy and Commerce. (Brian Dickerson, 5/25)

Sacramento Bee: California Democrats Did Far More Than Flip Off Trump 
California Democrats now number more than 8 million for the first time, hold every constitutional office, and command a supermajority in the Legislature because we reflect the values of the citizens of our state.But we are not resting on our laurels, far from it. While President Donald Trump and Republicans in Congress are talking about slashing health care for 23 million Americans, California Democrats re-emphasized their belief that health care is a right, not a privilege, as we pursue Medicare for all with Senate Bill 562. (Eric Bauman, 5/25)

Des Moines Register: Privatized Medicaid Was Supposed To Save Money?
Iowa is now 14 months into its experiment with privatized Medicaid management. … Privatization is a slow-motion train wreck, with providers across the state closing up shop or taking out loans to make payroll because the checks from Medicaid are slow to arrive and patient services are being paid at a lower rate. At the same time, the managed care organizations that Iowa hired to administer Medicaid say they are losing millions, and need an enormous increase in funding in order to make ends meet. This was not only predictable, it was predicted. (5/25)

St. Louis Post-Dispatch: Western Missouri Becomes A Canary In Obamacare Coal Mine
In what could be a disturbing portent, Blue Cross Blue Shield of Kansas City on Wednesday announced it was pulling out of the Obamacare health exchanges in 2018. The decision will leave 67,000 people in 25 Missouri counties and two Kansas counties with no option for private insurance, subsidized or not, under the Affordable Care Act. Blue Cross Blue Shield announced it had lost nearly $100 million on Obamacare policies since 2014; only last year did it take in more premium money than it paid out, and overhead costs pushed the Blues into the red. (5/25)

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

Research Roundup: Early Hospital Discharges; Missed Vaccinations; Growth In Spending

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

JAMA Surgery: Costs And Consequences Of Early Hospital Discharge After Major Inpatient Surgery In Older Adults
Do fast-track discharge protocols and shorter postoperative length of stay after major inpatient surgery reduce overall surgical episode payments, or are there unintended increased costs because of postdischarge care? … In a cross-sectional cohort study of 639 943 risk and postoperative complication–matched Medicare beneficiaries undergoing colectomy, coronary artery bypass grafting, or total hip replacement, hospitals with shortest routine postoperative length of stay achieved lowest overall surgical episode payments and did not offset shorter hospital stays with greater postdischarge care spending. (Regenbogen et al., 5/17)

Annals of Internal Medicine: Missed Opportunities for Measles, Mumps, Rubella Vaccination Among Departing U.S. Adult Travelers Receiving Pretravel Health Consultations
40 810 adult travelers were included [in an observational study in U.S. pretravel clinics]; providers considered 6612 (16%) to be eligible for MMR vaccine at the time of pretravel consultation. Of the MMR-eligible, 3477 (53%) were not vaccinated at the visit; of these, 1689 (48%) were not vaccinated because of traveler refusal, 966 (28%) because of provider decision, and 822 (24%) because of health systems barriers. Most MMR-eligible travelers who were not vaccinated were evaluated in the South (2262 travelers [65%]) or at nonacademic centers (1777 travelers [51%]). Nonvaccination due to traveler refusal was most frequent in the South (1432 travelers [63%]) and in nonacademic centers (1178 travelers [66%]). (Hyle et al., 5/16)

Urban Institute/Robert Wood Johnson Foundation: The Evidence On Recent Health Care Spending Growth And The Impact Of The Affordable Care Act
Conventional wisdom holds that health care cost growth is high and the Affordable Care Act (ACA) has done little to address the problem. However, overall increases in national health expenditures (NHE) since the law passed have been lower than anticipated, premiums and premium growth in the ACA’s health insurance marketplaces are high in some states but quite low in others, and growth in Medicare and Medicaid spending per enrollee has been very modest. NHE are still high, now at 18.3 percent of gross domestic product …. In this brief, we attempt to address several misconceptions about recent spending increases; these misconceptions are centered in three areas: the recent and projected growth in NHE the levels and recent growth of ACA marketplace premiums the recent and projected spending growth in the Medicaid program. (Holahan et al., 5/25)

Urban Institute: Medicaid/CHIP Participation Rates Rose Among Both Children And Parents In 2015
Using the 2013-2015 American Community Survey, this brief finds improvements for both parents and children in uninsurance, Medicaid/CHIP participation, and the number who are eligible for Medicaid/CHIP but not enrolled. Uninsurance fell nationally and in nearly every state, and the number of eligible but uninsured children fell to 2.1 million – declining by over half since 2008. Children’s participation reached 93.1 percent in 2015 (exceeding 90 percent in 36 states), while participation among parents rose to 80.2 percent, with larger gains between 2013 and 2015 in expansion states than nonexpansion states. Participation grew among every subgroup of children and parents examined. (Kenney et al., 5/17)

The Kaiser Family Foundation: Financing Family Planning Services For Low-Income Women: The Role Of Public Programs
Medicaid, the Title X Family Planning Program, and Section 330 of the Public Health Service Act (PHSA) are the leading sources of federal funding for the over 10,000 safety-net clinics across the country that provide reproductive health services to low-income women, men, and teens. The Trump administration and the Republican leadership of the 115th Congress have proposed to block federal Medicaid funds from going to Planned Parenthood …. Changes to these programs and funding to the clinics that provide family planning services could limit the availability of contraceptive services, STI screenings and treatment, and preventive cancer screenings, along with other primary care services to low-income women. … One in three low-income women reported that they obtained birth control from a family planning clinic such as Planned Parenthood or another health center or public health clinic. (Ranji et al., 5/11)

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

State Highlights: Calif. Legislature Steps Into Tense Fight Over Tobacco Tax; Mass. Agency Finds Avoidable ER Visits Are Driving Up Costs

Media outlets report on news from California, Massachusetts, Connecticut, Ohio, Kansas, Minnesota, Louisiana, Texas, Georgia, Maryland, Arizona, Florida.

Los Angeles Times: California Senate, Assembly Advance Their Own Plans On How To Spend Tobacco Tax Revenue
Perhaps the biggest budget skirmish that remains unsolved this year is how California should spend revenue from the tobacco tax voters approved last fall. Gov. Jerry Brown wants to put that money to expand overall spending on Medi-Cal, which provides subsidized healthcare for the poor. But the some of initiative’s backers, namely doctor and dental groups, have cried foul, arguing that money is meant to go to increasing payments for providers. (Mason, 5/25)

WBUR: Tip No. 1 For Taking Charge Of Mass. Health Care Costs: Avoid The ER 
Forty-two percent of emergency room visits in Massachusetts in 2015 were for problems that could have been treated by a primary care doctor, according to the state’s Health Policy Commission. This state agency, which is charged with driving down costs, says a 5 percent cut in avoidable emergency room trips would save $12 million a year; 10 percent fewer such visits would save $24 million. (Bebinger, 5/25)

The CT Mirror: Advocates: Disabled Children Stranded In CT Hospital ERs 
Insufficient services, a complex funding system and deep state budget cuts have increasingly stranded developmentally disabled children in hospital emergency departments over the past year, often for weeks at a time, two state advocates told legislators Thursday. Sarah Eagan, Connecticut’s child advocate, and Ted Doolittle, the state’s healthcare advocate, said the problem is centered almost exclusively on children with “complex diagnoses,” meaning they face a combination of developmental and intellectual disabilities and mental health conditions. (Phaneuf, 5/25)

Cleveland Plain Dealer: Lawmakers Hear Opposition To Lead Amendment From Doctors, Parents, Elected Officials And Healthy Home Advocates
Doctors, parents, city leaders and healthy home advocates took turns Wednesday telling the Ohio Senate Finance subcommittee on Health and Medicaid why they oppose an amendment to the state budget that would strip municipalities of authority to create local efforts to address childhood lead poisoning… Rep. Derek Merrin, a Republican who represents parts of Lucas and Fulton counties, proposed the amendment last month and has argued that a fractured system of rules that change from city-to-city is not only unfair to landlords but doesn’t give all children in Ohio equal protection from lead exposure. (Dissell and Zeltner, 5/25)

Los Angeles Times: No One Knows How Many Untested Rape Kits There Are In California. This Bill Aims To Fix That
ens of thousands of rape kits are sitting on shelves in police and sheriff’s department evidence rooms nationwide. And no one has tested them to see what crimes they could help solve. A bill by Assemblyman David Chiu (D-San Francisco) would help determine how many of those unanalyzed exam kits exist in California, part of a national backlog that federal officials have grappled with for nearly two decades. (Ulloa, 5/26)

KCUR: Kansas Crisis Centers Say New Law Creates Mental Health Funding Need 
A new law will allow Kansas crisis centers to treat involuntary mental health patients for up to 72 hours, but it isn’t clear if lawmakers will fund it. Gov. Sam Brownback on Wednesday signed House Bill 2053, which allows crisis centers to treat people deemed a danger to themselves or others because of a mental health or substance use disorder. The bill had passed the House unanimously and passed the Senate 27-12 after some amendments. Lawmakers didn’t allocate funding for additional crisis center beds before they left for the Memorial Day weekend, although they have yet to finalize a budget. (Wingerter, 5/25)

California Healthline: For California Hospitals That Don’t Pass Quake Test, Money’s Mostly At Fault
With a state deadline looming, some California hospitals still need to retrofit or rebuild so that their structures can withstand an earthquake — and money remains a challenge. Some hospital officials are turning to voters to raise money, while others are pursuing more innovative financing schemes.About 7 percent of the state’s hospital buildings — 220 — are still designated as having the highest risk of collapse following an earthquake, according to the Office of Statewide Health Planning and Development. That’s a slight drop from 251 buildings a year ago. (Ibarra, 5/26)

The Star Tribune: HCMC Seeks To Ease Patient Bottlenecks With New Mental Health Crisis Center
To ease chronic bottlenecks in countywide mental health services, Hennepin County Medical Center (HCMC) is nearing completion of a new 16-bed home that will help people with mental illnesses transition back into the community after acute hospital stays. The Victorian-style home, located at 3633 Chicago Av. in south Minneapolis, will provide short-term housing and treatment for adults who are stable enough to be discharged from a hospital psychiatric unit but who may need more therapy and social support before returning to their regular homes and jobs. (Serres, 5/25)

New Orleans Times-Picayune: She Saved $3,786 By Shopping Her MRI; Here’s How You Can Save, Too 
It was only after her doctor recommended she get an abdominal MRI that a New Orleans woman learned just how costly it can be to have a medical procedure without first shopping around. The woman, who asked to remain anonymous in order to discuss her health, said her doctor suggested the MRI to help her understand a hereditary condition that might affect her years from now. A month later, the day before the test, she got a call from Tulane Medical Center asking how she planned to pay for it, she said. (Lipinski and Zurik, 5/25)

Texas Tribune: Behind Closed Doors, Texas Lawmakers Strip Funding For Sex Trafficking Victims
In recent private negotiations between the Texas House and Senate about which public programs to fund and how to fund them, state lawmakers opted to kill a $3 million initiative to rehabilitate victims of sex trafficking. That ended hopes from child welfare advocates that 2017 would be the first year in recent memory in which state lawmakers might set aside funds specifically intended to help victims who were sold for sex. (Waltersn, 5/25)

Cleveland Plain Dealer: AxessPointe Offers Healthcare Clinic For North Hill Refugees, Immigrants 
To serve the refugee community in Akron’s North Hill, AxessPointe Community Health Centers will provide a weekly healthcare clinic at the Exchange House. The Exchange House, created by the Better Block Foundation, serves as a community center for the large refugee population, predominantly Bhutanese, which travels mostly on foot and has a large number of children and senior citizens. (Conn, 5/25)

Georgia Health News: Not Just A School Clinic, But A Clinic That’s At A School
Five days a week, a team of nurses and a rotating cadre of pediatricians, nutritionists and dentists at the Gilbert Community Clinic see not just schoolchildren but Walker County residents of all ages… Although the idea of a general medical clinic on the grounds of a public school sounds novel, it’s not a new idea in Georgia. (Park, 5/25)

Georgia Health News: Meals On Wheels: Volunteers Deliver Food As They Fret About Funding
Last year, Meals on Wheels programs brought nearly 4 million meals to 28,000 seniors living in Georgia. But federal support for this program could shrink under President Trump’s proposed budget. If the federal portion of funding for the program is cut, the effects will reverberate in tiny towns like Chickamauga, where Betty Richardson delivers lunches every week. (Male, 5/25)

The Baltimore Sun: Emerging Hopkins Center Harmonizing Music And Medicine 
[Alex] Pantelyat, 34, a Johns Hopkins University neurologist (and, not so incidentally, an accomplished violinist) is a co-founder and co-director of the Center for Music & Medicine, an emerging collaboration between the Johns Hopkins medical community and the Peabody Institute. The mission, he said, is to combine the expertise of faculty members in both camps toward a pair of ends: integrating music and rhythm into medical care and improving the health of musicians worldwide. More than 80 Johns Hopkins faculty members across dozens of disciplines have affiliated themselves with the center, the first of its kind in the eastern United States. (Pitts, 5/26)

Arizona Republic: What To Know As Arizona’s Mandatory Paid Sick-Leave Law Takes Effect
Arizona’s new law mandating paid sick leave starts July 1, and employers had better be prepared for it. Businesses and non-profit groups could face penalties for failing to keep adequate records or post sufficient notice, and they could incur damages for failing to provide paid sick time. Employers who retaliate against workers exercising their rights could face fines of at least $150 per day, say attorneys at Gallagher & Kennedy, a Phoenix law firm that held a workshop to alert employers of the requirements. (Wiles, 5/25)

Miami Herald: Valley Children’s Hospital Has Volunteer Baby Cuddling Program 
Lynne Meccariello, unit support supervisor of the neonatal intensive care unit and a liaison for the hospital’s volunteer services department, describes the cuddling program as providing “developmental care and comfort to babies when their parents can’t be there.” Meccariello says holding a sick baby reduces pain and provides warmth, and the cuddler encourages “self-soothing” – children’s ability to comfort themselves when they aren’t being held. (George, 5/25)

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

Many Adults Don’t Know That Secondhand E-Cigarette Vapor Poses Health Risk To Kids

In a survey, nearly one-third say they don’t know if such aerosol causes harm to children. In other public health news, groups worried about superbugs press In-N-Out Burger to make good on its pledge to phase out beef raised with antibiotics. And researchers investigate the impact of Facebook on mental health.

NPR: Many Adults Don’t Think Exposure To Vaping Is Bad For Kids
Despite the toxic ingredients commonly found in e-cigarettes and other vaping products, many adults don’t think secondhand e-cigarette aerosol poses a risk to children, according to a report published Thursday by the Centers for Disease Control and Prevention. About one-third of adults surveyed didn’t know if secondhand aerosol caused harm to children, and 40 percent of the adults said this kind of exposure caused “little” or “some” harm to children. (Columbus, 5/25)

Reuters: Activists Call On In-N-Out Burger To Join The Superbug Fight
Nearly three dozen consumer, environmental and public health groups on Thursday pressed privately held In-N-Out Burger to make good on its vow to set time lines for phasing out the use of beef raised with antibiotics vital to human health. Some 70 percent of antibiotics needed to fight infections in humans are sold for use in meat and dairy production. Medical researchers say overuse of the drugs may diminish their effectiveness in fighting disease in humans by contributing to the rise of dangerous, antibiotic-resistant bacteria often referred to as “superbugs.” (Baertlein, 5/25)

The Wall Street Journal: Does Facebook Make Us Unhappy And Unhealthy?
If you’re one of the almost two billion active users of Facebook , the site’s blend of gossip, news, animal videos and bragging opportunities can be irresistible. But is it good for you? A rigorous study recently published in the American Journal of Epidemiology suggests that it isn’t. Researchers found that the more people use Facebook, the less healthy they are and the less satisfied with their lives. To put it baldly: The more times you click “like,” the worse you feel. (Pinker, 5/25)

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

Mapping Zika’s Family Tree With Genome Sequencing Shows The Origins Of An Epidemic

Using the technique could help researchers predict how the next pandemic will move across the globe.

Los Angeles Times: What The DNA Of The Zika Virus Tells Scientists About Its Rapid Spread
A family tree can reveal a lot, especially if it belongs to a microscopic troublemaker with a knack for genetic shape-shifting. DNA sleuthing can outline the route an emerging pathogen might take once it makes landfall in the Americas and encounters a wholly unprotected population. It’s a modern take on old-fashioned public health surveillance strategies that focused on the exhaustive collection and analysis of samples from the field. Now they’ve been bolstered by rapid genome sequencing — and the result can be a picture of an epidemic rendered in exquisite detail, and in near-real time. (Healy, 5/25)

In other news on Zika —

The Wall Street Journal: New York City Issues Zika Travel Warning
In advance of the summer travel season, New York City health officials on Thursday stepped up warnings to would-be parents about the threat of contracting Zika, a mosquito-borne virus that has been linked to serious birth defects in babies and, in some cases, in utero deaths. (West, 5/25)

The New York Times: A Quarter Of U.S. Babies With Zika-Related Birth Defects Were Born In New York
A quarter of all infants in the United States born with defects related to the Zika virus were born to women in New York City, city health officials announced on Thursday, a stark reminder of the dangers posed by the virus. Looking ahead to summer and the threat of the resurgent virus spreading through the Caribbean, the New York City Department of Health said that 402 pregnant women had been infected with the virus and that 32 infants had been infected with the virus and 16 of them had Zika-related birth defects since last spring. (Santora, 5/25)

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House Panel Broadens Investigation Of NIH Safety And Compliance Issues

House Energy and Commerce Committee requests more documents in its probe of contaminated research samples reported at the NIH Clinical Center in Bethesda, Maryland. In other administration news, former Rep. Renee Ellmers (R-N.C.) starts her new job as director for the Department of Health and Human Service’s regional office in Atlanta

Roll Call: NIH Probe By House Panel Expands
The National Institutes of Health is in hot water again with the House Energy and Commerce Committee over a scandal that occurred nearly two years ago at one of the agency’s main research institutions. On Thursday, the panel broadened its probe into safety and compliance issues at the NIH Clinical Center, a research hospital located on the agency’s campus in Bethesda, Maryland. In a letter sent to Director Francis Collins and obtained by Roll Call, the committee requested a larger swath of documents not yet provided by the agency. (Williams, 5/25)

Roll Call: Ellmers Gets HHS Job
Former North Carolina Rep. Renee Ellmers has landed a job in the Trump administration as director for the Department of Health and Human Service’s regional office in Atlanta. Ellmers started her job Wednesday, the News & Observer in Raleigh reported. Ellmers was the first Republican member of Congress endorsed by Trump, but lost her primary race last year to fellow Republican Rep. George Holding after redistricting. (Garcia, 5/25)

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Influx Of Elderly Patients Forces ER To Practice Comfort Care

A man sobbed in a New York emergency room. His elderly wife, who suffered from advanced dementia, had just had a breathing tube stuck down her throat. He knew she never would have wanted that. Now he had to decide whether to reverse the life-sustaining treatment that medics had begun.

Dr. Kei Ouchi, then a resident at Long Island Jewish Medical Center, had no idea what to say. The husband, who had cared for his wife for the past 10 years, knew her condition had declined so much that she wouldn’t want a heroic rescue. But when Ouchi offered to take out the tube, the man cried more: “She’s breathing. How can we stop that?”

Ouchi had pursued emergency medicine to rescue victims of gunshot wounds and car crashes. He was unprepared, he said, for what he encountered: a stream of older patients with serious illnesses like dementia, cancer and heart disease — patients for whom the lifesaving techniques he was trained to perform often only prolonged the suffering.

As the nation’s elderly population swells, more older Americans are visiting the emergency room, which can be an overcrowded, disorienting and even traumatic place. Adults 65 and older made 20.8 million emergency room visits in 2013, up from 16.2 million in 2000, according to the most recent hospital survey by the Centers for Disease Control and Prevention. The survey found 1 in 6 visits to the ER were made by an older patient, a proportion that’s expected to rise as baby boomers age.

Half of adults in this age group visit the ER in their last month of life, according to a study in the journal Health Affairs. Of those, half die in the hospital, the study found, even though most people say they’d prefer to die at home.

The influx is prompting more clinicians to rethink what happens in the fast-paced emergency room, where the default is to do everything possible to extend life. Hospitals across the country, including in Ohio, Texas, Virginia and New Jersey, are bringing palliative care, which focuses on improving quality of life for patients with advanced illness, into the emergency department.

Interest is growing among doctors: One hundred forty-nine emergency physicians have become certified in palliative care since that option became available just over a decade ago, and others are working closely with palliative care teams. But efforts to transform the ER face significant challenges, including a lack of time, staffing and expertise, not to mention a culture clash.

Researchers who interviewed emergency room staff at two Boston hospitals, for instance, found resistance to palliative care.

ER doctors questioned how they could handle delicate end-of-life conversations for patients they barely knew. Others argued the ER, with its “cold simple rooms” and drunken patients screaming, is not an appropriate place to provide palliative care, which tends to physical, psychological and spiritual needs.

Ouchi saw some of these challenges up close during his residency in New York, when he visited the homes of older patients who were frequent visitors to the emergency room.

He saw how difficult it is for these patients to make it to the doctor. Often, “they can barely see. They can barely get out of the house,” he said. To make it to a doctor’s appointment, he said, they’d often have to call for a ride service, which could take several hours to arrive.

“So what do they do?” Ouchi said. “They call 911.”

When these patients arrive at the emergency room, doctors treat their acute symptoms but not their underlying needs, Ouchi said. In more severe cases, when the patient can’t talk and doesn’t have an advanced directive or a medical decision-maker available, doctors default to the most aggressive care possible to keep them alive — CPR, intravenous fluids, breathing tubes.

“Our default in the ER is pedal to the metal,” said Dr. Corita Grudzen, an emergency physician at NYU Langone Medical Center who studies palliative care in the ER. But when doctors learn after the fact that the patient would not have wanted that, the emergency rescue puts the family in the difficult position of deciding whether to remove life support.

(Heidi de Marco/KHN)

When older adults are very ill — if they need an IV drip to maintain blood pressure, a ventilator to breathe or medication to restart the heart — they are most likely to end up in an intensive care unit, Grudzen said. Rates of transfer from the ER to the ICU have been rising, she noted.

“It’s a terrible place to be if you’re older,” Grudzen said, as older patients are more likely to develop hospital-acquired infections and delirium. Meanwhile, it’s not clear whether these aggressive interventions really extend their lives, she said.

Some have sought to address these problems by creating separate, quieter emergency rooms for older patients. Others say bringing palliative care consultations into regular emergency rooms could reduce hospitalization, drive down costs and even extend life by reducing suffering.

There’s no hard evidence that approach will live up to its promise. The only major randomized controlled trial, which Grudzen led at Mount Sinai Hospital in New York City, found that palliative care consultations in the emergency room improved quality of life for cancer patients. It did not find statistically significant evidence that the consultations improved rates of survival, depression, ICU admission or discharge to hospice.

But frontline doctors say they’re seeing how palliative care in the ER can avert suffering. For instance, Ouchi recalled one patient, a man in his late 60s, who showed up at the emergency room — for the fifth time in six months — seeking relief from fever and back pain. In previous visits, doctors had quelled his symptoms, but they hadn’t addressed the underlying problem: The man was dying of cancer, which was causing persistent pain in his bones.

This time, a nurse and social worker called in a palliative care team, who talked to the patient about his goals.

“All he wanted was to be comfortable at home,” Ouchi said. The man enrolled in hospice, a form of palliative care for terminally ill patients. The hospice sent staff to his home to manage his symptoms and spiritual needs. He died about six months later, at home. His daughter returned to the hospital to thank the staff.

Now Ouchi and others are trying to come up with systematic ways to identify which patients could benefit from palliative care.

One such screening tool, dubbed P-CaRES, developed at Brown University, is a simple list of questions clinicians can answer about each patient in the ER. It asks if the patient has life-limiting conditions such as advanced dementia or sepsis. It asks the patient’s frequency of ER visits, the level of caregiver stress, and whether the doctor would be surprised if the patient died within 12 months.

Doctors are using the tool to screen patients at the University of California-San Francisco Medical Center at Parnassus and to connect them to palliative care doctors, said Dr. Kalie Dove-Maguire, a clinical instructor there. The questions pop up automatically on the hospital electronic medical record for every ER patient who is about to be admitted to the hospital.

Dove-Maguire said UCSF hasn’t published results, but the tool has helped individual patients, including a middle-aged man with widespread cancer who showed up at the ER with low blood pressure. The man “would have been admitted to the ICU with lines and tubes and invasive procedures,” she said, but staff talked to his family, learned his wishes and sent him home on hospice instead.

“Having that conversation in the ER, which is the entry point to the hospital, is vital,” Dove-Maguire said.

But time is scarce in ERs, where revenue depends on how many patients come through. Doctors’ performance is measured in minutes, Grudzen noted, and the longer they stop to make calls to refer one patient to hospice, the more patients line up waiting for a bed.

Finding someone to have conversations about a patient’s goals of care can be difficult, too. Ouchi enlisted ER doctors to use the screening tool for 207 older ER patients at Brigham and Women’s Hospital in Boston, where he now works as an emergency physician. They found a third of the patients would have benefited from a palliative care consultation. But there aren’t nearly enough palliative care doctors to provide that level of care, Ouchi said.

“The workforce for specialty palliative care is tiny, and the need is growing,” said Grudzen. Palliative care is a relatively new specialty, and there’s a national shortfall of as many as 18,000 palliative care doctors, according to one estimate.

“You can screen up the wazoo,” Grudzen said, but if there aren’t any palliative care doctors available to talk to a patient, “what are you going to do?”

“We’ve got to teach cardiologists, intensivists, emergency physicians how to do palliative care,” she said. “We really have to teach ourselves the skills.”

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

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Viewpoints: Sessions’ War On Drugs; Contemplating Rural Hospitals; Packing Heat At Kansas’ Psychiatric Institutions, State Facilities

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

Detroit Free Press: Sessions’ Policies Stand To Destroy Minority Communities
U.S. Attorney General Jeff Sessions has announced he’s reigniting the “war on drugs,” ordering prosecutors to seek the toughest possible charges and sentences, even for minor drug crimes. What he’s really doing is declaring war on people of color, because his harsh policies will eviscerate struggling black and brown families across America. He is resurrecting a war that has destroyed generations of minority families without eradicating the commerce of illegal drugs or Americans’ appetite for them. (Benjamin Crump, 5/25)

JAMA Forum: Rethinking Rural Hospitals
Since 2010, 78 of the more than 2150 rural nonspecialty US hospitals have closed. While the closure rate has recently declined, the proportion of financially struggling rural hospitals has increased. When a rural hospital closes, the economic losses can devastate an already stressed community through loss of health care workers, emergency services, and primary care capacity, as well as higher unemployment and lower per-capita income, a drop in housing values, poorer health, and increasing health disparities. An urgent look at how to prevent these closures is merited, but it may also be time to rethink what a rural hospital should be. (Diana Mason, 5/24)

The Kansas City Star: Concealed Weapons Likely Are Coming To A Kansas Institution Near You
Hey, Kansans: Brace yourselves. Your state is about to change in a consequential way. Barring the unexpected, concealed weapons soon will be allowed in state hospitals, psychiatric institutions and on the state’s public university campuses. That’s happening in just 38 days unless pro-common-sense lawmakers pull a rabbit out of their hats and muscle through a new law. But that looks increasingly unlikely as the Legislature struggles with big issues in its ongoing wrap-up session. (5/24)

JAMA Forum: Payment Power To The Patients
There is broad consensus that the quality of care that is delivered in the United States is uneven and too often inadequate. For more than a decade, the approach to remedying deficiencies in health care quality has been through measurement, incentives, and accountability. But now consensus is emerging that efforts have not worked particularly well, and that doing more of the same is unlikely to lead to progress. It may be time to try a radically simple idea: let patients decide what comprises high-quality health care. (Ashish K. Jha, 5/22)

The New York Times: Get Married, Get Healthy? Maybe Not.
In a nation as divided and contentious as our own, it is rare to find a belief we all share. But trust in the transformative power of marriage is close to universal — and it has endured for decades. This isn’t just a matter of faith, we’ve been assured. It’s science. Research is said to have established what our fairy tales promised: Marry and you will live happily ever after. And you will be healthier, too. A new study challenges the claim that people who marry get healthier. (Bella DePaulo, 5/25)

JAMA: Finding Joy In Practice: Cocreation In Palliative Care
Four years ago, after nearly 20 years in practice, I walked out of the familiar world of infectious disease and into the world of palliative care. In the world I left, I cared for hundreds of patients, educated countless learners, led dozens of infection prevention efforts. But that world felt increasingly superficial, fragmented, isolated, a hard place to find joy and meaning in my work. (Kathryn B. Kirkland, 5/23,30)

The Columbus Dispatch: Treatment At Hospital Follows ‘Catholic Tradition’
A hospital policy with wide-ranging consequences for patients of Mercy Medical Center in Des Moines, Iowa, was made public recently through a Facebook post on a page for mothers. It came from a woman who was denied a tubal ligation after having a cesarean section because Mercy is a Catholic hospital. In verifying that prohibition, I discovered other religious-based restrictions at Mercy and 547 other Catholic hospitals across the U.S., which make up 14.5 percent of all acute care hospitals in the country. It raises a question of whether these institutions are fulfilling their legal and professional obligations to their patients and the taxpayers who subsidize them with billions of dollars. (Rekha Basu, 5/25)

St. Louis Post-Dispatch: The Immediate Need For Action On Life
The Missouri Legislature has for many years demonstrated a commitment to protecting the health and safety of women and the dignity of the unborn, passing various laws to further these ends. A number of recent developments, though, have dealt serious blows to these laws and merit immediate attention in a special session of the Legislature. On Monday, the maternity home Our Lady’s Inn, Archdiocesan Elementary Schools of the Archdioceses of St. Louis, and St. Louis businessman Frank O’Brien filed a federal lawsuit against the “abortion sanctuary city” ordinance passed by the city of St. Louis in February. As the plaintiffs note, the bill, which purports to be an anti-discrimination ordinance for those making “reproductive health decisions,” is so broad that it would “force nonprofit organizations like Our Lady’s Inn, whose mission is to promote and facilitate abortion alternatives, to hire abortion advocates, despite their opposition to the ministry’s reason for existence.” (State Sen. Bob Onder, 5/25)

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Perspectives On The Trump Budget: Questionable Math; Who Feels The Most Pain?

Editorial pages across the country include analysis and review of President Donald Trump’s fiscal blueprint, including some tough talk about its political and policy implications.

The New York Times: Trump’s Budget: The Math Is Phony But The Cruelty Isn’t
Phony math is a time-honored tradition in the Washington world of budget making, but the first full fiscal plan from the Trump administration breaks new ground. The bottom line: A budget that the White House says will be in balance by 2027 would, in reality, remain deeply in red ink throughout the coming decade and ultimately add trillions of dollars to the national debt. … This budget’s blatant disregard for intellectual integrity is matched by the extraordinary extent to which it seeks to slash social welfare programs, including another $616 billion out of Medicaid on top of $800 billion that would be sliced as part of the Republicans’ health care plan. That’s a 28 percent reduction to the existing Medicaid budget plan. (Steven Rattner, 5/24)

Chicago Tribune: Trump’s Budget: A Slow Boat To Disaster
The plan has been assailed by Democrats and various activist groups for coddling the rich, punishing the poor and shortchanging important functions. Trump proposes to cut outlays for Medicaid, food stamps, Head Start and Social Security disability. Ditto for Environmental Protection Agency enforcement and State Department security. He would close the National Endowment for the Arts, the National Endowment for the Humanities and the Corporation for Public Broadcasting. (Steve Chapman, 5/24)

Forbes: Trump’s Budget For Seniors: Bad, But It Could Have Been Worse
The best that can be said about President Trump’s 2018 budget and older adults: It could have been worse. In a fiscal plan focused on historic domestic spending cuts, programs for older adults were hit by substantial reductions, though not slashed as deeply as other domestic programs. Medicare was largely untouched. So was Social Security for seniors, although Trump would tighten eligibility and reduce some benefits in the Social Security disability program. (Howard Gleckman, 5/23)

The Des Moines Register: Donald Trump 2018 Budget Could Turn Off His Voters And Sink His Approval Rating
The best way to think about the fiscal 2018 budget released by the White House is as a Trump political campaign rally on paper. The budget was clearly developed to make a statement to President Trump’s base of voters in the hope that they will see it as him keeping his campaign promises. According to Office of Management and Budget Director Mick Mulvaney, the budget will be in surplus in 10 years, construction will start on the wall between the U.S. and Mexico, there will be more money for enforcing immigration laws, and there will be much more for the Pentagon. Meanwhile, wasteful government spending will be cut and taxes will be reduced. (Stan Collender, 5/24)

Louisville Courier-Journal: Tell Congress The Budget Must Provide For The Poor
“A preferential option for the poor” is a fundamental concept in Catholic social teaching. Though the phrase itself is only 50 years old, it derives from Jesus’ Gospel message to pay special attention to poverty. … The concept is shared by many religions and has become part of the ethos of the United States. Whether through Social Security, Medicaid, food stamps or foreign aid, our nation has recognized that our worth is judged by how we treat the most vulnerable among us. … The U.S. Congress is now considering a budget proposal by the current administration. So many helped in this country and abroad would be devastated by this budget. (Archbishop Joseph E. Kurtz, 5/24)

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Longer Looks: Shuttering Abortion Clinics, Obamacare In The Senate And A Lead-Poisoned Generation

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

Vox: The Obscure Senate Rule That Could Sink Obamacare Repeal, Explained
The fate of the Republican drive to repeal and replace Obamacare — and of the 24 million more Americans who could be uninsured if they succeed — now lies with obscure, complex Senate rules. One rule in particular will determine what Republicans can include in the bill, how much of Obamacare they can repeal, and perhaps whether the bill can pass at all. And the last-minute additions that got conservatives on board with the House version of the American Health Care Act might run into trouble, according to experts and recent legislative precedents. (Dylan Scott, 5/22)

FiveThirtyEight: The Obamacare Marketplaces Aren’t In A Death Spiral
Are the insurance marketplaces created by the Affordable Care Act really on the verge of collapse, as President Trump and GOP leaders have repeatedly claimed? Three months ago, this story would have started like this: It depends on where you look and who you ask. Today, it goes something like this: They are in a fragile state pretty much everywhere. (Anna Maria Barry-Jester, 5/19)

WIRED: Medicine Is Going Digital. The FDA Is Racing To Catch Up
When Bakul Patel started as a policy advisor in the US Food and Drug Administration in 2008, he could pretty much pinpoint when a product was going to land in front of the reviewers in his division. Back when medical devices were heavy on the hardware—your pacemakers and your IUDs—it would take manufacturers years to get them ready for regulatory approval. FDA reviewers could keep up pretty well. (Megan Molteni, 5/22)

The New Yorker: A Bipartisan Way To Improve Medical Care
The health-care crisis in the United States is in many ways a pricing crisis. Nearly all medical care is paid on a fee-for-service basis, which means that medical providers make more money if they perform more procedures. This is perverse. We don’t want an excess of health-care services, especially unnecessary ones; we want health. But hardly anybody gets paid when we are healthy. (Adam Davidson, 5/22)

The Atlantic: The Lead-Poisoned Generation In New Orleans
There is no safe level of lead in the human body. Even at low levels, chronic exposure can damage the brain and the central nervous system, and can cause symptoms from hearing loss to IQ deterioration to lack of impulse control. Over time, lead gets absorbed into the bones, making them brittle and stunted, and causes teeth to crack and rot. Exposure in young children with developing minds and growing bones is most destructive, and in times of serious stress and trauma—common in places like the New Orleans projects in the 1990s—those effects are magnified. (Vann R. Newkirk II, 5/21)

Vox: 45 Million Americans Rely On Food Stamps. Trump Wants To Gut The Program.
In the 1960s and 1970s, food stamps were rolled out in different counties at different times — and researchers have used this variation as a natural experiment to examine the health impacts of SNAP. From improving birth weight to reducing obesity, food stamps were associated with a number of positive health effects. (Julia Belluz, 5/23)

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State Highlights: Vt. Gov. Vetoes Pot Bill; Pa. Gov. Taps Teresa Miller To Head Proposed Health And Human Services Department

Media outlets report on news from Vermont, Pennsylvania, New York, Minnesota, Massachusetts, Texas, California, Virginia and Arizona.

WBUR: Vermont’s Governor Vetoes Recreational Pot Bill
Vermont Governor Phil Scott, a Republican, said on Wednesday he was vetoing a bill to legalize marijuana, and sending it back to the legislature for changes… Though he said he views the issue “through a libertarian lens,” Scott vetoed the bill due to concerns about detecting and penalizing impaired drivers, protecting children, and the role and makeup of a Marijuana Regulatory Commission. (Wamsley, 5/24)

The Philadelphia Inquirer: Nominee For New Pa. Health And Human Services Dept. Digging In
Teresa Miller, nominated Tuesday by Gov. Wolf to be the inaugural secretary of the proposed Pennsylvania Department of Health and Human Services, said she is a big believer in her boss’s “government that works” mantra.“…Advocates worry that initiatives, such as heightened oversight of nursing homes by the Department of Health, could fizzle because of the proposed consolidation of the departments of health, human services, aging, and drug and alcohol programs. (Brubaker, 4/24)

ProPublica: In A Lonely Corner Of Coney Island, A Fight Over Care For The Vulnerable 
Today, Oceanview has taken on a distinctive role in the latest act of the legal saga surrounding the adult homes. Lawyers for the adult home industry have sued the state on behalf of a single former resident at Oceanview, a man who had taken advantage of the judge’s plan and moved into alternative housing, but who the lawyers say now wants to return. The man missed his friends and the conveniences of the Coney Island neighborhood, the lawyers argue. (Sapien, 5/24)

The Star Tribune: Annandale Nursing Home Is Faulted In Patient’s Death 
An Annandale nursing home resident developed internal bleeding and died after being denied crucial blood-thinning medication for 15 days, according to a state investigation that blamed the death on the facility’s procedural shortcomings. The state Health Department’s investigation into the stroke patient’s Nov. 28 death concluded that the nonprofit Annandale Care Center “had no system, policies or procedures in place” to ensure that certain medications and some other services were being provided as prescribed. (Walsh, 5/24)

Boston Globe: Surgeon Who Raised Concerns About Double-Booked Surgeries Faced Retaliation, Judge Rules 
A prominent Boston neurosurgeon was illegally forced out of his previous job at a New York hospital for strongly objecting to a policy that allowed another surgeon to perform complex spine surgeries on two patients simultaneously, a judge ruled. Double-booking, as the practice is sometimes called, triggered a fierce dispute among doctors at Massachusetts General Hospital in recent years, leading to the 2015 dismissal of an orthopedic surgeon who opposed it. But Dr. James Holsapple may be the first doctor to win a lawsuit alleging he faced retaliation for challenging the practice. (Saltzman, 5/24)

The Star Tribune: 26 Patients Die After Upgrading Abbott Blood Pump At Home 
At least 26 patients in advanced heart failure have died after replacing the controller for an Abbott Laboratories blood pump while out of the hospital. Abbott has issued an alert for 28,882 HeartMate II controllers that includes new software and alarm guides, after reports of 70 incidents in which the life-preserving device malfunctioned after a patient changed out the controller at home. Those incidents included 26 deaths and 19 injuries. (Carlson, 5/24)

Austin American-Statesman: Texas Senate Approves Priority House Bills To Address Foster Care Woes
The Texas Senate unanimously passed a priority House bill Wednesday that would make several changes to the foster care system, including keeping children at risk of entering foster care with their parents. House Bill 7, filed by Rep. Gene Wu, D-Houston, would, among several other provisions, bar a court from taking children away from parents on the grounds that they home-schooled their children, were economically disadvantaged, had reasonably disciplined their children or had been charged with a nonviolent misdemeanor. (Chang, 5/24)

San Jose Mercury News: Second Botulism Death Unrelated To ‘Extremely Rare’ Nacho Cheese Botulism 
The country’s foremost researchers on botulism in dairy products are calling the recent outbreak at a gas station in Walnut Grove a “perfect storm” of circumstances that left one dead and nine sickened… Although extremely rare, Northern California has seen two deaths from foodborne botulism in the last few months. Within the last month, Napa County has had one death from botulism related to canned goods, according to county health officials. (Davis, 5/24)

San Francisco Chronicle: Nearly 1 In 4 San Franciscans Struggle With Hunger 
According to the SF-Marin Food Bank, 23 percent of San Francisco residents struggle with hunger. The number is a striking amount, and much higher than the city’s homeless population, which the city said was 6,886 in 2015 (though others estimate it to be much higher), making it less than 1 percent of the population. (Duggan, 5/24)

Richmond Times-Dispatch: McAuliffe Signs Bill On Jail Deaths Related To Jamycheal Mitchell On Same Day Portsmouth Prosecutor Requests Special Grand Jury Into His Death At Hampton Roads Regional Jail 
In the name of Jamycheal Mitchell on Wednesday, the state’s highest elected official signed a bill in Richmond strengthening oversight of Virginia’s 60 local and regional jails, and a prosecutor in Portsmouth requested a special grand jury convene to investigate how the mentally ill 24-year-old wasted away behind bars… Still, no information has been provided publicly that explains what led to Mitchell’s death. His family has said he was physically healthy but had been diagnosed with schizophrenia and bipolar disorder. (Kleiner, 5/24)

Richmond Times-Dispatch: ‘This Is A Public Health Epidemic:’ Experts Speak To State Commission On Preventing Childhood Trauma In Virginia
Childhood traumatic experiences have strong links to dozens of adult health conditions, such as HIV, heart disease and cancer. In states that track such data, childhood trauma is considered a cause in between 11 and 89 percent of those health conditions. On average, whenever a toxin impacts more than 10 percent of health conditions, awareness grows and lawmakers, advocates and public health officials become interested in how to stop it to save lives, said Allison Sampson-Jackson. (O’Connor, 5/24)

Arizona Republic: Would Legalizing Marijuana Bring Money To Arizona Schools?
A fact sheet presented by the anti-marijuana group Arizonans for Responsible Drug Policy, which helped defeat Prop. 205 last November, mentions projected social costs outweigh the revenue provided by legalization… Merilee Fowler, vice chair of ARDP, said via email that “there are many unintended consequences of legalization that produce costs for the state.” (Jarvis, 5/24)

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Marijuana Extract Found To Reduce Seizures In Kids With Epilepsy

The study adds another layer to the debate over the health benefits of the plant.

The Washington Post: Marijuana Extract Sharply Cuts Seizures In Severe Form Of Epilepsy
An oil derived from the marijuana plant sharply reduces violent seizures in young people suffering from a rare, severe form of epilepsy, according to a study published Wednesday that gives more hope to parents who have been clamoring for access to the medication. Cannabidiol cut the median number of monthly convulsive seizures from 12.4 to 5.9 in 52 children with Dravet syndrome who took the medication over a 14-week test period, according to research published in the New England Journal of Medicine. Fifty-six children using a placebo saw the number of seizures drop only from a median of 14.9 to 14.1 per month. (Bernstein, 5/24)

The Associated Press: Marijuana Extract Helps Some Kids With Epilepsy, Study Says
“This is the first solid, rigorously obtained scientific data” that a marijuana compound is safe and effective for this problem, said one study leader, Dr. Orrin Devinsky of NYU Langone Medical Center. He said research into promising medical uses has been hampered by requiring scientists to get special licenses, plus legal constraints and false notions of how risky marijuana is. “Opiates kill over 30,000 Americans a year, alcohol kills over 80,000 a year. And marijuana, as best we know, probably kills less than 50 people a year,” Devinsky said. (Marchione, 5/24)

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Patients Seeking Aid In Dying Driven More By Psychological Suffering Than Physical Pain, Study Finds

“It’s what I call existential distress. Their quality of life is not what they want.” says researcher Madeline Li, an associate professor at University of Toronto. Today’s other public health news stories cover so-called “conversion therapy,” Zika, tuberculosis, fitness trackers, knee arthritis and “high-intensity” drinking.

The Washington Post: It’s Not Pain But ‘Existential Distress’ That Leads People To Assisted Suicide, Study Suggests
A few decades ago, doctor-assisted suicide was considered a fringe idea despite surveys showing many physicians support the idea under certain circumstances. The face of euthanasia at that time was Jack Kevorkian, a Michigan pathologist nicknamed “Dr. Death.” By his own admission, he helped 130 people end their lives. He was convicted of homicide and served eight years in prison. While doctor-assisted suicide remains a polarizing issue, some countries and states have begun to accept it. Belgium, the Netherlands, Luxembourg and Switzerland have legalized voluntary euthanasia. In 2016, Canada legalized “medically assisted death.” Australia, France, South Africa and the United Kingdom are considering similar measures. (Cha, 5/24)

The New York Times: Nevada And Connecticut Are Latest To Ban Discredited ‘Conversion Therapy’
At least nine states now ban “conversion therapy” for minors, a discredited method meant to change a person’s sexual orientation or gender identity, after Nevada and Connecticut this month joined others in prohibiting the practice. Gov. Brian Sandoval of Nevada last week signed Senate Bill 201, making it illegal for any licensed medical or mental health care professional to provide sexual orientation or gender conversion therapy to anyone under 18 years of age, a statement from his office said. (Hauser, 5/24)

NPR: The Zika Virus Made Its Way To Miami Earlier Than Thought
Last year’s Zika outbreak in Miami likely started in the spring of 2016, with the virus introduced multiple times before it was detected, researchers say. And most of those cases originated in the Caribbean. The study, published Wednesday in Nature, examined more than 250 cases of local Zika transmission in three Miami neighborhoods. Researchers analyzed 39 Zika virus genomes isolated from 32 people who had been infected and seven Aedes aegypti mosquitoes, the species that carries Zika. (Allen, 5/24)

WBUR: Tuberculosis And Rural Healthcare In America 
In most places tuberculosis is a disease from the past. But in the small county of Perry, Alabama it’s a near outbreak… It was so bad, the county finally paid residents to get tested. It all comes down to racial divides. (Yellin, 5/24)

NPR: Some Fitness Trackers Give Inaccurate Measurements Of Calories Burned
Sleek, high-tech wristbands are extremely popular these days, promising to measure heart rate, steps taken during the day, sleep, calories burned and even stress. And, increasingly, patients are heading to the doctor armed with reams of data gathered from their devices. “They’re essentially asking us to digest the data and offer advice about how to avoid cardiovascular disease,” says cardiologist Euan Ashley, associate professor of medicine at the Stanford University Medical Center and Stanford Hospital and Clinics in northern California. (Neighmond, 5/24)

Houston Chronicle: New Study Shows Increase In ‘High-Intensity’ Drinking, Defined As Consuming 10 Or More Drinks
With a three-day weekend upon us, several Texans will be stocking up on beer and wine for weekend cook-outs. That also means more drunk drivers on the road. One new study suggests that young drivers could be more dangerous on roadways today than ever before, since they’re engaging in “high-intensity” drinking, which is defined as consuming 10 or more drinks in a row…The May 2017 report indicates that “one in nine young adults (11 percent) were classified as high-intensity drinkers from 2005 to 2015” with “similar prevalence” among high school-aged students. (Guillen, 5/24)

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In Snapshot Of How Bad Opioid Crisis Has Become, Counselors Overseeing Halfway House Die Of Overdoses

“The staff members in charge of supervising recovering addicts succumbed to their own addiction and died of opioid overdoses. Opioids are a monster that is slowly consuming our population,” Pennsylvania’s Chester County District Attorney Tom Hogan said.

The Washington Post: Residents Of Halfway House Found Two Men Dead From Overdoses — Their Drug Counselors
The man’s losing battle with heroin was laid out right there on the nightstand of the halfway house. There were three morning devotionals, including “God Calling,” geared toward keeping a person’s thoughts pointed heavenward. Then there was the nicotine: two packs of cigarettes, a vaporizer and a case of snus to quell cravings. And near the edge: empty packets of heroin, a spoon and a syringe half full of the last hit the man would ever inject. (Wootson, 5/24)

Meanwhile, in Tennessee —

Nashville Tennessean: State Data Confirms Overdose Deaths Are Primarily White Opioid Users
A new report from the Tennessee Department of Health on drug overdose deaths sheds new light on the opioid epidemic plaguing the state, darkening the lines of an emerging portrait of the typical abuser killed by the powerful painkillers. The drug overdose fatalities are overwhelmingly white, mostly male and increasingly less likely to have prescriptions for the drugs that kill them. And, across Tennessee, those killed are more likely to overdose on opioids — including heroin and fentanyl — than on any other kind of drug. (Fletcher, Nelson and Wadhwani, 5/24)

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Johnson & Johnson To Pay $33M In Investigation Over Manufacturing Practices

“Johnson & Johnson’s disregard for proper manufacturing practices of children’s medications was unacceptable,” says Illinois Attorney General Lisa Madigan in a statement.

Stat: J&J To Pay $33 Million For Lapses That Led To ‘Phantom Recalls’
Johnson & Johnson agreed to pay $33 million to 42 states to settle allegations that its over-the-counter subsidiary falsely claimed have to followed federal manufacturing practices that led to the recall of millions of bottles of Tylenol, Motrin, Benadryl, and Sudafed. The settlement comes eight years after an embarrassing scandal for the health care giant, which endured congressional investigations, shareholder lawsuits, and a disturbing loss of market share in a key business over its handling of the manufacturing lapses. (Silverman, 5/24)

In other pharmaceutical news —

Stat: Drug Pricing Battle Hits Ohio With Dueling Ads Over Ballot Measure
The next battleground over prescription drug prices is now playing out in Ohio, where consumer groups and the pharmaceutical industry this week launched dueling ad campaigns over a controversial November ballot measure that is being promoted to lower costs. At issue is the Ohio Drug Price Relief Act, which would require state agencies to pay no more for medicines than the US Department of Veterans Affairs. The agency currently gets a 24 percent federally mandated discount off average manufacturer prices and the measure, if passed, would presumably benefit more than 3.4 million residents. (Silverman, 5/24)

Stat: No One Says ‘Cure,’ But Pipeline For ALS Treatments Looks Promising
Considering it took more than two decades for a second ALS drug to make it to the US market, you might think that few companies are willing to take the risk of developing such treatments. But in fact, it hasn’t been for lack of trying. After the Food and Drug Administration approved MT Pharma America’s Radicava this month, experts said there have always been a number of possible therapies being explored and tested in ALS — commonly known as Lou Gehrig’s disease — but without much success. Now, though, researchers say advances in the field over the past few years mean the treatments that are currently in clinical trials seem to hold greater potential than in the past. (Joseph, 5/25)

The New York Times: Rare Gene Mutations Inspire New Heart Drugs
What if you carried a genetic mutation that left you nearly impervious to heart disease? What if scientists could bottle that miracle and use it to treat everyone else? In a series of studies, the most recent published on Wednesday, scientists have described two rare genetic mutations that reduce levels of triglycerides, a type of blood fat, far below normal. People carrying these genes seem invulnerable to heart disease, even if they have other risk factors. (Kolata, 5/24)

The Cannabist: Report: Medical Marijuana Could Poach $4 Billion From Pharmaceutical Sales Annually
If the United States legalized medical marijuana for conditions such as chronic pain, anxiety and seizures, cannabis could siphon more than $4 billion annually from the nation’s pharmaceutical industry, a new study hypothesizes. The report expected to be released Wednesday by New Frontier Data, a provider of data and analytics to cannabis businesses, is intended to show how cannabis could disrupt pharmaceutical sales in nine key treatment areas. (Wallace, 5/24)

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Viewpoints: The Rule Of Law And Subsidies; Anticipating CBO’s Score On The GOP Health Plan

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

Bloomberg: Rule Of Law Actually Applies To Democrats, Too
Yes. Congress can mandate subsidies without also mandating a funding source. Medicaid is another example. This is crazy, but there it is. For once the Constitution is admirably clear on how the executive branch should handle this quandary: “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law; and a regular Statement and Account of the Receipts and Expenditures of all public Money shall be published from time to time.” The law appropriated no money for these cost-sharing reduction payments. But the Obama administration went ahead and paid them anyway. (Megan McArdle, 5/23)

The New York Times: How To Read The C.B.O. Score Of The Health Bill Like An Expert
Today, the Congressional Budget Office will issue important numbers about the House-passed version of the American Health Care Act, the Republican bill to repeal and replace portions of the Affordable Care Act. Although the budget office had analyzed an early version of the bill, the House on May 4 took the unusual step of voting before the budget office could gauge how several last-minute amendments might affect the deficit or the number of uninsured. (Margot Sanger-Katz, 5/24)

RealClear Health: Why Nutrition Standards And Policies Should Continue
The U.S. Department of Agriculture said recently it will delay the implementation of school lunch rules aimed at lowering the amount of sodium and raising the whole grain content of meals served to kids. At the same time, the Food and Drug Administration announced it will delay for one year the implementation of Obama administration rules to require calorie labels on menus and prepared food displays. (Deborah A.Cohen, 5/24)

WBUR: America’s Food Access Problem Starts On The Farm 
Given that we’re tangled in knots over how to pay for health care, it’s remarkable that food and farm policy isn’t more in the public’s mind. Heads of hunger programs and food banks have begun to grasp the obvious; as one told WBUR, “food is medicine, food is health,” with good health impossible in the absence of nutritious eating. (Rich Barlow, 5/23)

San Jose Mercury News: Single-Payer Detracting From Big Medi-Cal Fight
Sen. Ricardo Lara’s single-payer legislation was a non-starter in California from day one, even before it was given an eye-popping $400 billion price tag. … It’s merely an exercise in politics, which is all well and good except that it detracts from a far more important California health care issue: Can the state fight off President Trump’s inhumane effort to slash the nation’s Medicaid budget by more than $880 billion through 2026? (5/23)

Stat: Risk Scores For Preventing Heart Disease, Stroke Must Take The Long View
Back in 1998, researchers with the legendary Framingham Heart Study created the first heart risk calculator. Using answers to questions about age, cholesterol and blood pressure levels, tobacco use, and the presence of diabetes, it estimated an individual’s risk of having a heart attack or stroke over the next 10 years. Since then, this calculator has been revised and many others have been developed, including ones that extend the time horizon out to an individual’s lifetime. Yet much to our surprise, the use of these single-point-in-time risk calculators does little to reduce the risk of heart attack or stroke compared with not using such calculators. ( Kunal N. Karmali and Mark Huffman, 5/23)

On the Ground: Our Teeth Are Making Us Sick
The left side of Jacquelyn Garcia’s face throbbed fiercely. She had tried taking Tylenol and Excedrin for the pain, but threw them up. On a Monday morning straight after working the night shift as a custodian, she rushed to the N.Y.U. emergency dental clinic. Here a student delivered the verdict: decay so deep it had reached the nerve. The tooth needed to be pulled. (Zoe Greenberg, 5/23)

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Perspectives On Doing The Math: Trying To Add Up ‘Trumponomics;’ The Trump Budget’s ‘Best New Idea’

Opinion writers take a hard look at how health and safety net programs fare in the Trump administration’s proposed budget plan.

Los Angeles Times: Surprise, Surprise: Trump’s Budget Punishes The Sick And The Poor While Rewarding The Wealthy
One factor holding back economic growth is that too many working-age Americans have fallen out of the labor force. The administration’s proposed budget for the fiscal year that begins Oct. 1 tries to tackle that problem, as well it should. But rather than grapple with some of the challenges underlying the disappearance of millions of Americans from the workforce — in particular, the technological changes and globalization that have caused so many blue-collar and middle-class jobs to evaporate, and the gap between the education and training Americans have received and the skills demanded by today’s employers — the Trump budget seeks to force people back into the workforce by making it harder to obtain or keep food stamps, Medicaid and Social Security disability benefits, while reducing federal support for welfare and children’s health. (5/23)

The Washington Post: Trumponomics: The Philosophy That It Doesn’t Suck Enough To Be Poor
For months, pundits and political advisers have tried to figure out what “Trumponomics” really stands for. Even President Trump himself struggled to characterize it, saying, “It really has to do with self-respect as a nation.” Now that we have the president’s budget in hand, we have a more definitive answer: Trumponomics — like Ryanonomics — is based on the principle that living in poverty doesn’t suck quite enough. That is, more people would be motivated to become rich if only being poor weren’t so much fun. (Catherine Rampell, 5/23)

The New York Times: Trump’s Budget Doesn’t Make Sense
Yes, Republicans have a blind spot when it comes to acknowledging that revenues must be a part of the fix. But to their credit, many Republicans — including, notably, Paul Ryan, the speaker of the House — have made the case for why we have to reform our largest entitlement programs, including Social Security and Medicare (though there has recently been a disquieting silence on the topic). And many Republicans are taking the responsible position that tax reform should at least be revenue neutral. Democrats, many of whom too often act as demagogues on entitlement reform, are clear that taxes must increase (though they also must stop pretending it is just millionaires who will be affected). They also have been admirable in their commitment to the pay-as-you-go principle in recent major legislation, which at least keeps us from digging the hole deeper. (Maya MacGuineas, 5/23)

The New York Times: Why Work Requirement Became A Theme Of The Trump Budget
The new White House budget proposal is built on a deep-rooted conservative belief: The government should help those who are willing to work, and cull from benefit rolls those who aren’t. That emphasis on work underlies deep cuts and proposed changes to food stamps, cash assistance and health benefits for the poor in a budget that boosts spending for the military and border security. Expect the poor to work in exchange for aid, the White House argues, and antipoverty programs will work better while costing the government less. (Emily Badger, 5/24)

USA Today: Trump Budget’s Best New Idea
Since the passage of the Family and Medical Leave Act in 1993, American parents working for companies with at least 50 employees have had a right to 12 weeks of unpaid leave after the birth or adoption of a child. But many don’t take advantage of that option for the simple reason that they can’t afford to go that long without a paycheck. The Trump administration, at the urging of first daughter Ivanka Trump, has included in its budget released Tuesday a plan for paid medical leave of up to six weeks. (5/23)

USA Today: Trump’s Parental Plan Will Hurt
President Trump’s budget includes a proposal for six weeks of mandated paid family leave for new parents. Despite its superficial appeal, this idea is likely to harm families more than it helps. The initial Trump proposal, floated in September, would have limited mandated leave to mothers, thereby likely engaging in unconstitutional sex discrimination. Key aspects of the new plan are still unclear. But it avoids legal problems by covering fathers, too. Yet it has serious flaws, nonetheless. (Ilya Somin, 5/23)

Bloomberg: Trump’s DOA Budget Has Two Silver Linings
It also breaks Trump’s campaign commitments to spare Social Security and Medicaid from budget cuts. Budget Director Mick Mulvaney explained this problem away (with Trump in Israel) by asserting in a Monday night briefing that proposals in the plan to cut Social Security disability benefits don’t count because they’re not retirement payments. (Albert R. Hunt, 5/23)

The Kansas City Star: Trump Budget Replicates Disastrous Kansas Approach. This Won’t End Well.
But tax cuts were only one half of the [Gov. Sam] Brownback experiment. Aided by conservatives in the Legislature, Kansas eviscerated the state’s social safety net: privatizing Medicaid, imposing new restrictions on welfare benefits, insisting on a tough food stamp work requirement. Humiliating the poor seemed to be a particular focus. For a time, the state told welfare recipients they could withdraw only $25 at a time from an automated teller machine, a decision that prompted anger and derision across the nation before it was repealed. (5/23)

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State Highlights: Contract Dispute In Ariz. Leaves Many Out Of Network At Dignity Health Hospitals; Texas Lawmakers OK Maternal Health Bills

Media outlets report on news from Arizona, Texas, California, Minnesota, Georgia, Colorado and Florida.

Sacramento Bee: Health Care For Illegal Immigrants Proposed By California Senator
State Sen. Ricardo Lara doesn’t only want to reconstruct the way health care is delivered and paid for in California. As the debate around publicly funded universal health care heats up in the Capitol, Lara is also seeking to expand the state’s low-income health program to undocumented adults up to age 26. (Hart and Miller, 5/23)

Georgia Health News: State AG Backs Wider View Of Records In Hospital Court Fight 
The state’s attorney general has urged the Georgia Supreme Court to reverse a lower court opinion that barred access to Northside Hospital’s financial records. Chris Carr, in office since late last year, said in a Monday court filing that the Georgia Open Records Act is broader in its applications than what Northside Hospital has argued. (Miller, 5/23)

Atlanta Journal Constitution: GA Attorney General Weighs In On Northside Hospital Open Records Case 
Georgia law requires open government even when a private party is carrying out the public’s work, Attorney General Christopher Carr argued in a brief filed Monday in the Northside Hospital open records case before the Georgia Supreme Court… The Georgia Supreme Court asked the Attorney General’s office to file an opinion in the hotly-contested case that started when attorney E. Kendrick Smith requested documents from Northside under the state’s sunshine law. (Teegardin, 5/23)

Texas Tribune: Grieving Mom “Humbled” And “Relieved” After Senate Passes Autopsy Bill 
As the Texas Senate passed a bill on Tuesday that would ensure parents can view their deceased child’s body before an autopsy is conducted, a grieving mother shed tears from the gallery… Currently, parents need permission from a justice of the peace or medical examiner to see their deceased child if his or her death occurs outside a hospital or health care institution. (Mansoor, 5/23)

Austin American Statesman: Texas Senate Approves Bill Aimed At Identifying Postpartum Depression
The Texas Senate on Tuesday approved a bill aimed at increasing identification of postpartum depression among mothers participating in federally backed health care programs for low-income families. Under House Bill 2466 by Rep. Sarah Davis, R-West University Place, mothers who bring their kids in for checkups can get screened for postpartum depression by their children’s pediatricians. (Collins Walsh, 5/23)

Denver Post: New Leadville Hospital Dealt Major Setback After Feds Withhold Loan 
Lake County’s only hospital, St. Vincent in Leadville, has put plans to build a new facility on hold after financial projections came up shorter than expected, indicating the small hospital has recovered from the financial brink but still needs to improve its balance sheet before a much-needed building upgrade. In 2014, the hospital announced it would be shutting down because of critical building repairs and declining revenues, but service cuts and a partnership struck several months later with Centura Health — which also runs St. Anthony Summit Medical Center in Frisco — kept the 138-year-old hospital open. (5/23)

Sacramento Bee: Abortion Reversal Therapy Grows More Popular Despite Doubts
Several California clinics advertise the therapy, claiming to be able to undo the effects of the first dose containing mifepristone, which blocks progesterone production and causes the uterine lining to shed. The second set of pills contains misoprostol, which makes the uterus contract and initiates bleeding and cramping. More than 350 providers nationwide perform abortion reversal therapy, according to proponents of the treatment. (Caiola, 5/23)

Kansas City Star: Kansas Records: Several Hotline Calls Still Didn’t Save Adrian Jones 
The head of Kansas’ child welfare agency said earlier this month that social workers’ last contact with the family of Adrian Jones was in February 2012. But records obtained by The Kansas City Star on Tuesday show that social workers with the Kansas Department for Children and Families investigated a hotline call 10 months later, in December 2012. (Baurer and Woodall, 5/23)

Kansas City Star: Missouri Hospital And Clinic Settle Medicare Fraud Suit 
A Missouri hospital, clinic and infusion center have agreed to pay $34 million to settle a federal lawsuit that alleged they defrauded Medicare. The suit alleged that Mercy Hospital Springfield and its affiliate, Mercy Clinic Springfield Communities, had an improper financial agreement that provided kickbacks to oncologists based on the value of their chemotherapy referrals to the infusion center. (Marso, 5/23)

KQED: Valero Outage Prompts Benicia To Consider Industrial Safety Ordinance 
City officials would have greater oversight over the Valero refinery under a proposal set to be unveiled at the Benicia City Council meeting on Tuesday—a potential reform prompted by the major outage at the facility earlier this month. Mayor Elizabeth Patterson is proposing the city develop regulations similar to those in Contra Costa County, home to several refineries. That county’s industrial safety ordinance, considered to be one of the strongest in the country, requires oil refining facilities to undergo safety audits and have risk management plans. (Goldberg, 5/23)

Miami Herald: John Morgan ‘Prepared To Invest $100M’ In Medical Marijuana 
John Morgan spent nearly $7 million pushing two statewide ballot initiatives to expand medical marijuana throughout the state of Florida. But that’s a drop in the bucket compared to what the wealthy Orlando attorney and possible gubernatorial candidate says he’s prepared to invest in the industry now that it’s about to explode. (Smiley, 5/23)

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WHO’s Next Director-General Will Be First To Come From Africa

Former Ethiopian health minister Tedros Adhanom Ghebreyesus has been elected to head the World Health Organization, the United Nations agency responsible for coordinating international responses to infectious disease epidemics like Ebola and Zika.

The New York Times: W.H.O. Elects Ethiopia’s Tedros As First Director General From Africa
Tedros Adhanom Ghebreyesus of Ethiopia was voted director general of the World Health Organization on Tuesday, the first African ever to head the agency. The election was the first conducted by the W.H.O. under more open and democratic rules. After nearly two years of public campaigning, originally by six candidates, the voting took place in a closed-door session in which the health ministers of 186 countries cast their ballots in secret. (McNeil and Cumming-Bruce, 5/23)

The Washington Post: WHO Picks Tedros Adhanom Ghebreyesu Of Ethiopia To Lead The Global Health Agency
During the third and final round of balloting in Geneva, members of the World Health Assembly voted 133 to 50 to pick Tedros, as he is known, to be the next director-general, according to unofficial tallies. Cheers broke out, observers said, as he beat out David Nabarro, a 67-year-old physician and longtime United Nations official from Britain, and Sania Nishtar, a 54-year-old cardiologist from Pakistan. It was the first time member states took part in a secret ballot that gave each member state an equal vote. In the past, leaders were chosen by an executive board and voting took place behind closed doors. Nishtar was eliminated during the first round of voting. (Sun, 5/23)

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Teaching Hospitals Have Lower Death Rates For Older Patients Than Less Costly Community Hospitals

Researchers found that the 30-day mortality rate at major teaching facilities was 8.3 percent, compared with 9.5 percent at non-teaching ones. Today’s other public health stories cover child fatalities from car crashes, near-death experiences, botulism in California, and the heart benefits of chocolate.

Stat: Pricey Teaching Hospitals Have Lowest Death Rates For Older Patients
At a time when insurers are steering patients away from expensive academic medical centers, a new study counters the idea that the quality of care is consistent across hospitals, concluding that major teaching hospitals have lower mortality rates for older patients than community hospitals. Using millions of Medicare records, researchers found that the 30-day mortality rate — the percentage of patients who died within 30 days of hospitalization and one common way to gauge quality — was 8.3 percent at major teaching hospitals, compared with 9.2 percent at minor teaching hospitals and 9.5 percent at non-teaching hospitals. The figures accounted for differences in patient populations and hospital characteristics. (Joseph, 5/23)

NPR: One Fifth Of Children In Fatal Car Crashes Were Improperly Restrained
A new study found that 20 percent of children who were in a fatal car crashes were not buckled in properly, or were not wearing a seat belt at all, and that child fatality rates in deadly car crashes vary widely by state. The results add evidence to the argument that state regulations and public information tactics can affect motor vehicle safety for kids. The Centers for Disease Control and Prevention has noted that, for example, seat belt use across all age groups is higher in states with more stringent seat belt enforcement laws. (Hersher, 5/23)

Cronkite News: ‘Everybody Wants That Miracle’: Survivors Of Near-Drownings Face Tough Road To Recovery
The state’s constant warm climate keeps pools open year-round, the most common environment for drownings involving toddlers; in fact, toddlers in the Grand Canyon state are far more likely to drown compared with rates of childhood drownings from around the nation  —  and authorities say they’re nearly all preventable. For those who survive, recovery could last a lifetime. (Souse, 5/23)

The New York Times: Why Chocolate May Be Good For The Heart
Eating chocolate has been tied to a reduced risk of heart disease. Now scientists have uncovered one possible reason. Using data from a large Danish health study, researchers have found an association between chocolate consumption and a lowered risk for atrial fibrillation, the irregular heartbeat that can lead to stroke, heart failure and other serious problems. The study is in Heart. (Bakalar, 5/23)

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Who Should Be Punished When A Child Dies From An Accidental Gunshot? The Answer Varies State To State

A series by USA Today and The Associated Press offers a look at gun safety and children in different states.

USA Today/The Associated Press: States Rejecting Bills Intended To Keep Guns Away From Kids
In state after state, proposals that would create or toughen laws intended to keep kids from getting ahold of unsecured guns have stalled — caught up in a debate over whether they are effective prevention measures or just government overreach. Child access prevention laws allow prosecutors to bring charges against adults who fail to safely store their loaded guns, especially when they are obtained by minors and used to harm. (Foley and Penzenstadler, 5/24)

In related news —

KCUR: Kansas Committee Advances Bill To Keep Gun Ban At Some Health Facilities 
The Kansas Senate Ways and Means Committee on Tuesday advanced a bill that would allow public health care facilities to continue to ban concealed guns. A state law taking effect July 1 will allow people to carry concealed guns into any public building that is not secured by armed guards and metal detectors. The bill that advanced Tuesday would allow guns to be banned at state-run psychiatric hospitals, publicly owned medical facilities and the University of Kansas Health System. (Koranda, 5/23)

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Viewpoints: ‘Taxpayer-First Budget’ Inflicting Pain; Slow Rollout Of Menu Calorie Counts

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

The New York Times: A Budget That Promises Little But Pain
If President Trump’s 2018 budget, to be unveiled on Tuesday, was worthy of praise, you can bet Mr. Trump would be in Washington to bask in it. But his overseas trip keeps him at a distance physically, if not politically. As detailed in a preview on Monday by Mick Mulvaney, the White House budget director, the budget is a naked appeal to far-right Republicans aiming for a partisan rallying cry, even as a legislative victory most likely remains out of reach. Of 13 major initiatives in the budget, nine are drastic spending cuts, mostly aimed at low-income Americans. The biggest of those, by far, is an $866 billion reduction over 10 years in health care spending, mostly from Medicaid. (5/23)

The Washington Post: Another Bad Budget From Trump Targets The Poor
President Trump released a proposal for fiscal year 2018 discretionary spending — the “skinny budget” — two months ago, and the $1.1 trillion plan garnered deservedly poor reviews. In a nutshell, Mr. Trump would have gutted the Environmental Protection Agency, the National Institutes of Health and similarly crucial domestic agencies to fund a big boost in defense spending and border security. On Tuesday the White House releases its ideas for the remaining $3 trillion or so in federal spending, including large-scale entitlements such as Medicaid, and the early indications are that the priorities embodied in this sequel will be no more humane or rational. (5/22)

Miami Herald: The Federal Budget Released Today Puts Taxpayers First
This Tuesday, the president will release his Fiscal Year 2018 budget request. The title on the cover reads “A New Foundation for American Greatness.” But it’s what’s inside that’s more important. What people will see there is something that has been missing from Washington for a long time: “A Taxpayer First Budget.” … For years, we’ve focused on how we can help Americans receive taxpayer-funded assistance. Under President Trump’s leadership, we’re now looking at how we can respect both those who require assistance and the taxpayers who fund that support. For the first time in a long time, we’re putting taxpayers first. (Budget director Mick Mulvaney, 5/22)

The Washington Post: Trump’s First Budget: Why Attention Must Be Paid To It
So, with two partial exceptions, the President’s budget cannot be viewed as anything other than the standard issue, highly partisan, thoroughly uncompromising budgets we’ve seen from Republicans since the rise of Paul D. Ryan. The purpose of these budgets, which even Ryan himself has characterized as more “visionary” than realistic, is to shrink government outside of defense and give the savings to their wealthy donors in the form of regressive tax cuts. Their ultimate targets are Social Security, Medicare, and Medicaid, and with this budget, we can see that strategy evolving. (Jared Bernstein, 5/22)

Los Angeles Times: Trump’s Budget Plan Continues His Deceitful Attack On The Disabled — And Violates A Campaign Pledge
We pointed out back in March that Trump budget direct Mick Mulvaney displayed an alarming ignorance about Social Security disability benefits during an appearance on the CBS program “Face the Nation.” Now it turns out that there was method to his muttering. In effect, Mulvaney was telegraphing that the Trump White House was planning to cut disability benefits sharply. Axios reported Sunday that the Trump budget due out Tuesday will include $1.7 trillion in cuts to major social insurance and assistance programs, including food stamps, the Children’s Health Insurance Program, and Social Security disability. (Michael Hiltzik, 5/22)

Forbes: This Week’s Rollout Of Trump 2018 Budget Could Be His Biggest Failure Yet
On top of everything else, the Trump 2018 budget and OMB Director Mulvaney’s first testimony about it, which is currently scheduled for Wednesday before the House Budget Committee, is virtually certain to get much less attention because the Congressional Budget Office is now expected to release its estimates of the impact of the House-passed American Health Care Act that same day … and those numbers are very likely to be devastating. … CBO’s new AHCA numbers took on dramatically increased importance last week when the Republican leadership let it be known that the House might have to vote on the bill a second time because, as reported, it might not satisfy all of the Senate’s Byrd rule requirements. (Stan Collender, 5/21)

Philly.com: Slash Medicaid And You Jeopardize Care For Everyone
Just before launching his presidential campaign, Donald Trump promised that if elected, he would not cut funding for Medicaid. Chalk that up to yet another campaign promise reneged on. Trump’s budget proposal calls for more than $800 billion in cuts. … But even more is at stake than the lives of poor and disabled Americans, something the architects of these plans don’t seem to care much about. The cuts would jeopardize the entire health care system. (Robert I. Field, 5/23)

The Washington Post: Trump’s Budget Is So Cruel A Russian Propaganda Outfit Set The White House Straight
Trump, who once vowed “no cuts” to Medicaid, would now cut Medicaid by more than $800 billion, denying support to 10 million people. He lops a total of $1.7 trillion off that and similar programs, including food stamps, school lunches and Habitat for Humanity. Mulvaney, defending the budget Monday, made a frank admission: “This is, I think, the first time in a long time an administration has written a budget through the eyes of people who actually are paying the taxes. Too often in Washington I think we often think only on the recipient side.” (Dana Milbank, 5/22)

USA Today: Calorie Labeling Isn’t Rocket Science
Watching your weight while grabbing a bite at your favorite chain restaurant, supermarket food bar or convenience store was supposed to get easier under a 2010 federal law requiring that certain businesses post calorie counts. This isn’t rocket science. But after seven years, the final posting rules are still on hold, and this month the Trump administration delayed compliance again. If the newest date — May 7, 2018 — holds, it will have taken nearly as long to post calorie counts as it did to put a man on the moon after President Kennedy announced this ambitious goal in 1961. (5/22)

USA Today: Pizza Makers Weigh In On Calories
America’s pizza delivery companies want a reasonable 21st century solution to the nutrition labeling challenge: We simply want approval to put the information where our customers look for it. At Domino’s, we’ve been posting nutritional information on our website for nearly 14 years because it’s the easiest way to provide the information to our customers where they will most likely see it. Unfortunately, the menu labeling rule as written does not make accommodations for brands whose majority of orders come from people who order online. The rule seems better suited to sit-down chains and fast-food joints. (Tim McIntyre, 5/22)

Forbes: North Carolina Poised To Reform Welfare Programs To Protect Truly Needy
A provision in the [North Carolina] Senate’s budget proposal, spearheaded by Sen. Ralph Hise, would rein in frequently-exploited loopholes in the state’s food stamps and Medicaid systems, bringing overdue protection to valuable resources for families who need them most and protecting the system from abuse. North Carolina’s current broad-based eligibility expansion in food stamps has been ripe for reform since 2010 when former Gov. Bev Perdue took advantage of a loophole that expanded welfare eligibility beyond the federal limits. (Josh Archambault, 5/22)

The New York Times: Hey Parents, Surprise, Fruit Juice Is Not Fruit
Many American children consume more than half of their fruit as juice, and the American Academy of Pediatrics has issued new guidelines clarifying its stance on that substitution: For most kids, it’s a bad thing. The new guidelines aren’t just intended to persuade pediatricians to talk to parents about the disadvantages of the ubiquitous juice box. They also take aim at the federal government’s Dietary Guidelines for Americans, which are the basis for the nutritional guidelines in the Department of Agriculture’s School Lunch Program — guidelines that allow for the replacement of half of the recommended daily servings of fruits with 100 percent fruit juice. (KJ Dell’Antonia, 5/22)

Louisville Courier-Journal: Fighting The Opioid Epidemic
As many as two million Americans are struggling with prescription drug addiction across the nation. Tragically, heroin and opioid overdoses claim an average of 91 lives every day. This startling trend continues to get worse, especially here in Kentucky. … I made securing crucial new resources to help combat heroin and prescription opioid abuse a top priority in the government funding bill that was recently signed into law. These new resources, which dedicates substantial funding through the appropriations process to address this crisis, will allow us to take another step towards ending it. (Senate Majority Leader Mitch McConnell (R-Ky.), 5/23)

Stat: Training Medical Students How To Teach Helps Them Embrace Ambiguity
In volunteering to help teach the course, neither of us anticipated that questions asked by first-year medical students would heighten our curiosity and passion for medicine. But they did. We looked for answers and followed up with the students who asked them. In the process, we also reflected on how to be better self-directed learners and more effective teachers. (Jasmine Rana and Taylor Freret, 5/22)

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

State Highlights: Aid-In-Dying Case To Be Heard In N.Y.; Mass. Hospital Revises Plan To Close Psychiatric Beds After Criticism

Media outlets report on news from New York, Massachusetts, Virginia, Texas, Connecticut, Florida, California, Colorado and Missouri.

The Wall Street Journal: New York Appeals Court To Hear Case On Doctor Aid In Dying
Eric Seiff says his mother begged his father to end her life throughout the two years she suffered from breast cancer before dying in 1955. Mr. Seiff told himself at the time he would never prolong his death. Mr. Seiff, an 84-year-old lawyer, is among those plaintiffs arguing that doctors should have the right to prescribe a fatal dosage of medication, in most cases barbiturates, to mentally competent terminally ill people. Their case against the state is scheduled to be heard May 30 in the New York Court of Appeals in Albany, the state’s highest court. (Kanno-Youngs, 5/22)

Boston Globe: UMass Memorial Seeks To Quell Criticism Of Psychiatric Bed Cuts 
UMass Memorial Medical Center, responding to sharp criticism from mental health advocates and the state, has revised its plan to close 13 psychiatric beds in Worcester and transfer patients to other Central Massachusetts hospitals. Worcester’s largest hospital submitted the updated plan late last week in response to officials at the state Department of Public Health, who said they were deeply concerned that the hospital’s original proposal would curtail patients’ access to services. (Dayal McCluskey, 5/22)

Richmond Times-Dispatch: New Mental Health Care Program Launched In Virginia
The Virginia Health Care Foundation has announced a new $1.5 million behavioral health program that is designed to increase access to mental health care for uninsured Virginians and those with little to no access to medical care… The foundation is a public-private partnership that helps uninsured Virginians and those who live in areas without robust medical, dental and mental health services. (Kleiner, 5/22)

The CT Mirror: Healthcare Union Ad Protests Ongoing State Layoffs 
The state’s largest healthcare workers’ union launched a new online ad Monday to protest the latest layoffs ordered by Gov. Dannel P. Malloy. The governor, who warned unions recently that he might have to order as many as 4,200 layoffs if concessions are not granted, has issued 113 pink slips in recent weeks. (Phaneuf, 5/22)

Health News Florida: Mosquito Control Ramps Up As South Florida Prepares For Zika 
Last summer’s wave of local transmission of the Zika virus hasn’t yet bled into 2017 , but officials from Key West to West Palm Beach are gearing up for another round of mosquito control by creating new staff positions, adding more equipment and increasing outreach efforts. In 2016, Florida saw more than 250 cases of locally transmitted Zika, the mosquito-borne virus spread by the Aedes aegypti mosquito that can cause fevers, rashes and joint pain. (Stein, 5/22)

Sacramento Bee: Nacho Cheese From Gas Station Blamed For Botulism Death 
One person has died of botulism after eating nacho cheese sauce from a Walnut Grove gas station, California health officials confirmed Monday. The man was one of 10 people who fell ill with the rare form of food poisoning in recent weeks after eating food purchased at Valley Oak Food and Fuel. (Caiola and Chang, 5/22)

Denver Post: Centura Health’s Longtime CEO To Step Down, Assume Special Advisor Role 
Centura Health’s chief executive will step down Sept. 1 after leading the Centennial-based healthcare network for nine years. Gary Campbell, the longest tenured CEO in Centura’s history, will be succeeded by chief operating officer Peter Banko, officials announced Monday. “Centura Health has been truly blessed with Gary’s visionary leadership,” Centura Health board chairwoman Patricia Webb said in a statement. “His faithful commitment to our ministry and efforts to transform the delivery of health care have allowed us to optimize health value across our region and meet the needs of consumers.” (Rusch, 5/23)

Texas Tribune: Bill On Certification Pits Doctors Against Hospitals 
A bill moving through the Legislature in the last week of the session is pitting doctors against hospitals over how much testing doctors should have to undergo to maintain their certification… Senate Bill 1148 would ban the Texas Medical Board from using the MOC as a requirement for physicians to obtain or renew their medical license. (Mansoor, 5/23)

San Francisco Chronicle: Evictions From Residential Care Home Disrupt Lives
The owner and operator of the Fulton Rest Home, an independent living facility for men with disabilities in Berkeley, told residents last month they had 60 days to clear out… A private operator of a residential care facility can close the business and evict the tenants with only a 30-day notice, according to Disability Rights California, an advocacy group that runs a website listing tenant rights for people in care homes. (Taylor Jr., 5/22)

Sacramento Bee: Norovirus Stomach Illness Spreads In Yolo County Schools 
That vomit- and diarrhea-inducing illness spreading through schools has reached more than 2,800 people in Yolo County as of Monday and could linger on campuses through the end of the academic year, health officials say… Kristin Weivoda, emergency medical services administrator for the county, said the spread of norovirus will be difficult to overcome before school is out because of the ease of transmission among children. (Kalb, 5/22)

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