Tagged Public Health

March Madness Vasectomies Encourage Guys To Take One For The Team

Doctors say it all started eight years ago, when a urology clinic in Oregon ran an ad promoting the benefits of scheduling a vasectomy in March.

“You go in for a little snip, snip and come out with doctor’s orders to sit back and watch nonstop basketball,” the voice-over promised. “If you miss out on this, you’ll end up recovering during a weekend marathon of ‘Desperate Housewives’!”

Copycat ads followed. Now a sports radio show in Washington, D.C., has an annual Vasectomy Madness contest, where the prize is a free vasectomy.

Here’s how it works: Three guys come on the air to make their cases for getting snipped. The announcers ruthlessly roast them, and then listeners vote on their favorite.

“All right, let’s bring in our next contestant,” a host said. “I believe it’s Abe from Warrenton, Va. So tell us your story. Why are you here?”

Abe has three kids, ages 9, 6 and 3.

“Another one — surprise! Due in July,” Abe said. “I was shopping after the third for a vasectomy and, like a dope, dragged my feet.”

There’s Mike, also expecting his fourth child — also a surprise.

“My wife and I have had enough,” he pleaded. “We need help to stop the flow.”

And then there’s Charles.

“Four kids. Three different women,” Charles said, inspiring a roar of jeers from the hosts.

Procrastination can be so common with the “Big V” that it takes a panel of sports jocks offering a free procedure for some guys to finally let a doctor take a scalpel to their nether regions.

That may be one reason vasectomy rates are low: About 5 percent of women rely on their partner’s vasectomy for contraception, unchanged from a decade ago. The Centers for Disease Control and Prevention’s National Survey of Family Growth compares that to 20 percent of women who have had a sterilization procedure, even though women’s surgery is more invasive and more expensive.

“Men are culturally the providers. It’s hard for them to seek care,” said Dr. Paul Turek, a California urologist. “They don’t know how to be a patient.”

Turek has clinics in San Francisco and Beverly Hills. He sees an uptick in vasectomy visits during March Madness, and he’s also noticed more guys coming in together.

“One group came in from a tech company in a limousine,” he said.

Last year, five college buddies scheduled a group vasectomy in March. They live all over the U.S. now, and one of them had an idea to reunite in San Francisco and undergo the outpatient procedure together.

“I gave ’em a deal,” Turek said. “I closed the doors. We had sports TV on. They were having fun.”

As each guy returned to the waiting room, he was greeted with fist bumps and high-fives. Then the men hobbled back to their hotel to bet on the games and yell at the television together.

Turek made an interesting observation during that bro basketball weekend: The friends seemed to recover faster than his typical patients.

“They had no complaints,” he said. “They were back at work sooner. They took fewer pain pills. It was the best anesthesia, having their buddies with them.”

Turek gives all his vasectomy patients a certificate of honor for “uncommon bravery and meritorious performance.”

There is another theory about why vasectomies aren’t more popular: the cost. The Affordable Care Act requires insurers to cover contraceptives without charging out-of-pocket costs. But vasectomies weren’t included in the rule. The procedure costs about $500, but some doctors charge up to $1,000.

That’s why Charles subjected himself to the free vasectomy contest at the D.C. radio station. His insurance covers a portion of the procedure, “but I’d still have to pay my deductible, which is, like, a thousand bucks.”

Vasectomy was overlooked in Obamacare because, under the law, birth control was considered a women’s health service.

“Right now the policy says to a couple: Your insurance will cover birth control without any out-of-pocket costs on your end, as long as it’s the woman who’s using it,” says Adam Sonfield, senior policy manager at the Guttmacher Institute.

Last year, 12,000 people signed a petition asking regulators to cover vasectomy without cost sharing. Doctors’ groups even drafted language to this effect to add to the regulations.

But when the Trump administration took over, it told the groups to stop trying, according to Aaron Hamlin, executive director of the Male Contraception Initiative.

“The birth control benefit has been under pretty much continual political attack since the ACA was enacted,” said Sonfield.

So for now that leaves guys like Charles, Mike and Abe vying for a free March Madness vasectomy. The winner in the end?

Abe — one of the guys expecting his fourth child.

His prize came with a catch, though. He will have to let one of the sportscasters come to his appointment, to broadcast a “play-by-play.”

This story is part of a partnership that includes KQED, NPR and Kaiser Health News.

Categories: Cost and Quality, Health Industry, Public Health, The Health Law


Lead Poisoning’s Lifelong Toll Includes Lowering Social Mobility, Researchers Find

Cynthia Brownfield was lucky. When her daughter, then 2 years old, tested for high levels of lead in her blood, she could do something.

Brownfield, a pediatrician in St. Joseph, Miss., got her home inspected and found lead in the windows. She got them replaced and had her pipes fixed, too. Her daughter, now 12, was probably affected, says Brownfield. But quick action minimized the exposure. Her daughter is now a healthy, fully-functioning preteen.

“We were in the financial position where we could hire a plumber and change the windows,” she said. But others — even her own patients — may not be so fortunate. This reality may have implications even more far-reaching than generally accepted.

Findings published Tuesday in JAMA break new ground by suggesting the effects of childhood lead exposure continue to play out until adulthood, not only harming an individual’s lifelong cognitive development, but also potentially limiting socioeconomic advancement. Specifically, Duke University researchers tracked a generation of kids based on data collected through a nearly 30-year, New Zealand-based investigation known as the Dunedin Multidisciplinary Health and Development Study.

They studied the development of more than 1,000 New Zealanders born between April 1972 and March 1973. Because at that time gasoline still contained lead, exposure was common, creating a sizeable sample that included people across class and gender. More than half in that data set had been tested for lead-exposure at age 11, and the study tracked brain development and socio-economic status over the years — making for “a natural time” to use them to study lead’s health effects, said Aaron Reuben, a PhD candidate in neuropsychology at Duke University, and the study’s first author.

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By the time study participants reached age 38, a pattern emerged: Children who were exposed to lead early in life had worse cognitive abilities, based on how their exposure level. The difference was statistically significant. They were also more likely to be worse off, socioeconomically, than those who had not been exposed to lead. The study found that no matter what the child’s IQ, the mother’s IQ, or the family’s social status, lead poisoning resulted in downward social mobility. That was largely thanks to cognitive decline, according to the research.

“Regardless of where you start out in life, exposure to lead in childhood exerts a downward pull to your trajectory,” Reuben said.

Though this research was set in New Zealand, it offers insight into a problem experts said is fairly ubiquitous in the United States and across the globe. The CDC estimates that as many as half a million children between ages 1 and 5 had blood lead levels high enough to cause concern: 5 micrograms per deciliter and up. At least 4 million households across the country have children experiencing significant lead exposure.

Last year’s water crisis in Flint, Mich., brought lead exposure front and center as a public health concern. Meanwhile, a Reuters investigation published this winter found elevated lead levels in almost 3,000 communities around the country. The Centers of Disease Control and Prevention recently changed its guidelines to suggest that any childhood exposure to the chemical is harmful, and is pushing to get rid of lead poisoning in kids by 2020.

In the U.S., children at risk are typically poorer and racial minorities — in part because they more often live in older houses with lead paint. This is a stark difference from the research population, which tended to be white. However, because the study spanned a period of time in which lead was still used in gasoline, the lead exposure measured in the study spanned a wider class spectrum.

That adds greater consequence to these findings, many said.

“Kids who are poor, or who have some of these other social determinants of health that are negative — they end up with a double whammy. Whatever health consequences they have from being poor, those are added to the additional consequences of being exposed to lead,” said Jerome Paulson, an emeritus professor and pediatrician at George Washington University. Paulson has researched lead’s effects on children, although he wasn’t involved with this study.

“If you want to talk about ‘breaking out of poverty,’ kids who have lead exposure are probably going to have more difficulties,” he added.

That said, these conclusions aren’t perfect. For instance, the research doesn’t account any variation in how the children who were tested may have been previously exposed to lead, or how their continued lead exposure through adulthood may have differed. Those who worked in jobs like construction, for instance, may have had greater lead exposure than those in white-collar jobs, Paulson noted. But on the whole, he said, it makes a strong case for the long-term impact of childhood lead exposure.

Pennsylvania, Maryland and Massachusetts, which all have cities with concentrated areas of older housing, have identified lead poisoning as a major child health hazard. The CDC has also embraced “primary prevention” — testing homes for lead and removing it before people move in and risk exposure. But securing resources for lead testing, screening and abatement poses its own set of challenges.

The JAMA study illustrates, in part, one such difficulty. Lead poisoning happens over years, not overnight. So illustrating the impact, even if it’s ultimately significant, is hard to do.

“Prevention doesn’t have a lot of pizzazz. If you prevent something from happening, it’s a wonderful thing, but it’s hard to measure and take credit for,” said David Bellinger, a neurology professor at Harvard Medical School and a professor in the environmental health department of the university’s public health school, who wrote a commentary that ran alongside the JAMA paper.

And funding for such programs is often unreliable, said Donna Cooper, the executive director of Public Citizens for Children and Youth, a Pennsylvania-based nonprofit that advocates on behalf of young people. For instance, the White House’s initial budget plans would boost some lead abatement funds but slash other grants used for similar purposes. And for many states, she said, even what’s long been available isn’t enough to meet the scope of the concern.

“We have very clear CDC guidance on what should be done, and no money to back it up,” Cooper said. “It ebbs and flows with the headlines.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

White House Shies Away From Planned Parenthood Defunding Talk

Press secretary Sean Spicer says the Trump administration won’t commit to including the hot-button issue in the upcoming spending bill. In other women’s health news, some states are still moving to protect access to contraception and Democrats try to reconcile their platform with a need to include anti-abortion voters.

The Hill: WH Won’t Commit To Defunding Planned Parenthood In Spending Bill
The White House refused to commit Monday to defunding Planned Parenthood in an upcoming must-pass spending bill, a sign it’s looking to avoid a government shutdown over the hot-button issue. President Trump viewed the now-dead Republican healthcare bill as “an opportunity to defund” Planned Parenthood, according to press secretary Sean Spicer, who wouldn’t say whether the president would demand defunding in future legislation. (Fabian, 3/27)

Roll Call: Abortion Opponents Look For A Home In Democratic Party
For supporters of abortion rights, the Democratic Party has become the only real option. But as the party struggles to make inroads in red states, where its economic message may resonate more than its social values, some Democrats think there needs to be more flexibility on that issue. … But there’s no easy answer for the Democratic Party. The platform’s narrow focus on abortion rights is borne of a commitment to protect the rights of women to control their own bodies — a self-determination issue from which few Democratic lawmakers in Congress want to back away. (Pathé, 3/28)

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New Vaccine Recommendation Cuts Number Of HPV Shots Children Need

You’d think that a vaccine that protects people against more than a half-dozen types of cancer would have people lining up to get it. But the human papillomavirus (HPV) vaccine, which can prevent roughly 90 percent of all cervical cancers as well as other cancers and sexually transmitted infections caused by the virus, has faced an uphill climb since its introduction more than a decade ago.

Now, with a new dosing schedule that requires fewer shots and a more effective vaccine, clinicians and public health advocates hope they may move the needle on preventing these virus-related cancers.

In December, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommended reducing the number of shots in the HPV vaccine from three to two for girls and boys between the ages of 9 and 14. The recommendation was based on clinical trial data that showed two doses was just as effective as a three-dose regimen for this age group. (Children older than 14 still require three shots.)

Michelle AndrewsInsuring Your Health

The study was conducted using Gardasil 9, a version of the vaccine approved by the Food and Drug Administration in late 2014. It protects against nine types of HPV: seven that are responsible for 90 percent of cervical cancers and two that account for 90 percent of genital warts.

In addition, the new version of Gardasil improved protection against HPV-related cancers in the vagina, vulva, penis, anus, rectum and oropharynx — the tongue and tonsil area at the back of the throat.

An earlier version protected against four types of HPV.

From the start, clinicians have run into some parental and political roadblocks because the vaccine, which is recommended for preteens, protects against genital human papillomavirus — a virus transmitted through sexual contact. Many physicians are also reluctant about discussing the need for the vaccine, and for many parents, the vaccine’s cancer-prevention benefits were overshadowed by concerns about discussing sexual matters with such young kids. Yet for maximum protection, the immunizations should be given before girls and boys become sexually active.

The focus should not have been on sexually transmitted infections, some say. “You only get one chance to make a first impression,” said Dr. H. Cody Meissner, a professor of pediatrics at Tufts University School of Medicine and a member of the American Academy of Pediatrics’ committee on infectious diseases. “This vaccine should have been introduced as a vaccine that will prevent cancer, not sexually transmitted infections.”

The HPV virus is incredibly common. At any given time, nearly 80 million Americans are infected, and most people can expect to contract HPV at some point in their lives. Most never know they’ve been infected and have no symptoms. Some develop genital warts, but the infection generally goes away on its own and many people never have health problems.

However, others may develop problems years later. There are approximately 39,000 HPV-related cancers every year, nearly two-thirds of them in women. In addition to cervical cancer, more than 90 percent of anal cancers and 70 percent of vaginal and vulvar cancers are thought to be caused by the HPV virus. Recent studies show that about 70 percent of cancers in the oropharynx may also be linked to HPV.

A 2015 study published in the Journal of the National Cancer Institute estimated that earlier versions of the HPV vaccine could reduce the number of HPV-related cancers by nearly 25,000 annually, and the new version of the vaccine could further reduce the number of such cancers by about 4,000.

The vaccine is estimated to prevent 5,000 cancer deaths annually, said Dr. Paul Offit, professor of pediatrics and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

But compliance is an ongoing problem. “They’re not getting the one vaccine that protects against diseases from which they’re most likely to suffer and die,” Offit said, noting that deaths from pertussis and meningococcal disease, for which adolescents are also vaccinated at that age, are minuscule compared with HPV-related cancers.

In 2015, 87 percent of 13-year-olds were up-to-date with the Tdap vaccine that protects against tetanus, diphtheria and pertussis, and 80 percent had received the meningococcal vaccine, according to the Centers for Disease Control and Prevention. But just 30 percent of girls and 25 percent of boys at that age had received all three doses of the HPV vaccine. In contrast to other vaccines, however, the HPV vaccine is required only in a few states for secondary school.

Public health advocates say they think the shift to a two-dose regimen could make a big difference in the number of adolescents who get all the necessary doses of the HPV vaccine. For one thing, the fewer shots the better, in general, they say.

In addition, because the second HPV shot is supposed to be given anywhere from six months to a year after the first one, “parents can fit it into a routine regimen when people go in for their 12-year-old’s regularly scheduled visit,” said Dr. Joseph Bocchini Jr., chairman of pediatrics at Louisiana State University Health in Shreveport who is president-elect at the National Foundation for Infectious Diseases.

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

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Viewpoints: When Insurers Reject ‘Unproven Therapies’; Can Trump Help Americans Who Are Dying ‘Deaths Of Despair’

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

Arizona Republic: Sarah Wants Her Life Back (UnitedHealthcare Refuses To Give It To Her)
Isn’t it nice that the insurance company is looking out for Sarah, preventing her from having to endure “unproven therapies,” regardless of what her doctor has witnessed with other patients over and over and, well, over again? I’m quite sure UnitedHealthcare’s denial is for Sarah’s own good. Quite sure it has nothing to do with the cost of IVIG: about $32,000 a month. Or the fact that she’d need it for up to a year. (Laurie Roberts, 3/26)

The Washington Post: Americans Are Dying ‘Deaths Of Despair.’ Will Trump Help? 
It is a political cliche that President Trump owes his electoral victory to the extraordinary support he received from white voters without a college degree, two-thirds of whom voted for the Republican. Much less settled is the question of why these largely low-income voters, once reliable Democrats, cast their lot with a brash billionaire from New York. (3/25)

The Washington Post: More Lies On Planned Parenthood
Not “even a scintilla of evidence.” That was the judgment of a federal judge last month in Texas about allegations of wrongdoing by Planned Parenthood. He was not alone in finding that the health-care organization did not illegally profit from fetal-tissue donation: Three Republican-led congressional investigations, 13 states and a Texas grand jury all could find no substance to claims about the alleged sale of “baby body parts,” which gained currency through videos released by anti-abortion activists. (3/26)

The Wall Street Journal: High-Tech Help For The Freelance Physician
From Amazon to eBay and Uber to Airbnb, digital technology has revolutionized everyday life. But when you get sick, you might as well take a time machine back a few decades. You phone your doctor’s office to make an appointment. You sit in a waiting room stocked with old magazines. The physician writes down notes about your symptoms and stores them in paper files. When you’re done, a receptionist hands you a little card with the date and time of your next visit. (Allysia Finley, 3/24)

Louisville Courier-Journal: ‘Tired Of Burying My Friends’
I am a full-time student with a part-time job. I went to decent schools and stayed away from the neighborhoods my parents warned me about. I am not an anomaly, and neither is gun violence. I apologize if I seem insensitive towards the individual’s right to own a gun, but it is time we take a critical look at our society’s priorities. What good is a world full of guns if we must fill our days with this pain? How many of our children are we willing to lose to maintain our sense of entitlement? (Tara Ann Steiden, 3/23)

The New York Times: To Win Again, Democrats Must Stop Being The Abortion Party
But once-solid Catholic support for Democrats has steadily eroded. This was due at least in part to the shift by many American Catholic bishops from emphasizing social issues (peace, the economy) to engaging in the culture wars (abortion, gay marriage). Along the way, many Catholics came to view the Democrats as unconditionally supporting abortion. Last year’s election was a watershed in this evolution. Hillary Clinton lost the overall Catholic vote by seven points — after President Obama had won it in the previous two elections. She lost the white Catholic vote by 23 points. In heavily Catholic states like Pennsylvania, Wisconsin and Michigan, she lost by a hair — the last by less than 1 percent. A handful more of Catholic votes per parish in those states would have won her the election. (Thomas Groome, 3/27)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Doctor’s Social Media Promos For His Company’s Cancer ‘Breakthrough’ May Violate Federal Rules

Following questions from Stat about promotion of a non-Food and Drug Administraiton approved treatment, NantKwest softened the language. Meanwhile, The New York Times writes on how more surgeries are being conducted while patients are awake. And other news outlets report on tuberculosis, the flu vaccine, Zika, another virus that can cause birth defects called Cytomegalovirus and more public health stories.

Stat: CEO’s Promotion Of ‘Breakthrough’ Cancer Therapy Raises Questions
The emotional video tells of a patient with blood cancer who tries an experimental therapy involving “natural killer” cells. “NEW BREAKTHROUGH HELPS PATIENTS KILL CANCER” the banner headline declares as the patient, wiping away tears, covers her face with her hands and murmurs, “It’s really good news.” Billionaire Dr. Patrick Soon-Shiong retweeted the video several times in recent days, amid a flurry of social media posts in which he vowed to “solve” cancer. But where the ordinary viewer might see an inspirational story, drug industry experts saw a likely violation of federal regulations. (Robbins, 3/27)

The New York Times: Going Under The Knife, With Eyes And Ears Wide Open
“Do you want to see your tendons?” Dr. Asif Ilyas, a hand and wrist surgeon, was about to close his patient’s wound. But first he offered her the opportunity to behold the source of her radiating pain: a band of tendons that looked like pale pink ribbon candy. With a slender surgical instrument, he pushed outward to demonstrate their newly liberated flexibility. (Hoffman, 3/25)

Stat: How One County Battled A Deadly Strain Of Tuberculosis
The drug-resistant TB had quietly spread for the better part of a decade among [Atlanta’s] homeless population. Then in 2014, the stubborn strain turned fatal, killing at least three men and infecting dozens. The deadly “Atlanta strain” also cropped up in more than a dozen states nationwide. Alarmed, the Centers for Disease Control and Prevention intervened with emergency aid. A multimillion-dollar effort to screen and treat vulnerable residents has worked: Officials announced this week that TB cases in Fulton County, which includes most of Atlanta and and some of its surrounding suburbs, have dropped by nearly a third. They say the approach here can offer valuable lessons to other communities battling public outbreaks. (Blau, 3/24)

NPR: New Parents Get Baby Boxes To Encourage Safe Sleep
For Jernica Quiñones, the reality of sudden infant death syndrome, or SIDS, hit close to home this year when a friend woke up on New Year’s Day and discovered the lifeless body of her baby girl. That’s why Quiñones’ 4-month-old son, Bless’n, has spent a lot of his life so far sleeping in a cardboard box. (Pao, 3/26)

The Baltimore Sun: Study: African-Americans Don’t Trust Flu Vaccine; Whites Don’t Think Flu Is That Bad 
The researchers found African-Americans worried about the safety of the shot more than the health risks of the flu. The findings are important as the medical community tries to improve vaccination rates. Fewer than half of Americans get the flu vaccine, according to the Centers for Disease Control and Prevention. Just 41 percent of African-Americans get vaccinated, compared with 47 percent of whites. The study, published in the journal Risk Analysis, included 800 white and 800 African-American participants. Researchers from the University of Georgia and the University of Pittsburgh also participated in the research. (McDaniels, 3/25)

NPR: Common Virus Can Cause Devastating Birth Defects
When Kathleen Muldoon had her second child everything was going smoothly. The delivery was short, the baby’s APGAR score was good and he was a healthy weight. “Everyone said he was amazing,” says Muldoon. But when a doctor noticed that Gideon was jaundiced, everything changed. (Neighmond, 3/27)

NPR: Breast-Fed Kids May Be Less Hyper, But Not Necessarily Smarter, Study Finds
Breast-feeding has many known health benefits, but there’s still debate about how it may influence kids’ behavior and intelligence. Now, a new study published in Pediatrics finds that children who are breast-fed for at least six months as babies have less hyperactive behavior by age 3 compared with kids who weren’t breast-fed. (Aubrey, 3/27)

Kaiser Health News: Want To Live Past 100? Centenarians Share Secrets Of Knee Bends And Nips Of Scotch
Gertrude Siegel is 101 and hears it all the time. “Everyone says ‘I want to be just like you.’ I tell them to get in line,” she said. John and Charlotte Henderson, 104 and 102, often field questions from wannabes eager to learn their secrets. “Living in moderation,” he said. “We never overdo anything. Eat well. Sleep well. Don’t overdrink. Don’t overeat. And exercise regularly.” (Jayson, 3/27)

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New Utah Law Requires Doctors To Tell Women That Abortion Induced By Pill Can Be Stopped, Despite No Evidence Proving Claim

In news from other states’ debates on the abortion issue, an Oklahoma lawmaker defends his antiabortion legislation that does not include an exception for cases of rape or incest, saying such pregnancies are instances when “God can bring beauty from ashes.” And in Montana, state senators advance a measure seeking to protect “pain-capable” fetuses.

The Washington Post: Oklahoma Lawmaker Defends Pregnancy From Rape And Incest As ‘Beauty From Ashes’
In defending his controversial antiabortion legislation, Oklahoma state Rep. George Faught said that even in pregnancies that result from rape or incest, “God can bring beauty from ashes.” Faught made the statement during a debate on the Oklahoma House floor earlier this week. Faught’s bill, which overwhelmingly passed the House on Tuesday, would outlaw abortions sought by women based solely on a diagnosis of Down syndrome or other genetic abnormalities. A fellow lawmaker criticized the Republican from Muskogee for not including an exception for pregnancies that resulted from rape and incest. (Phillips, 3/25)

The Associated Press: Montana Bill Seeks Abortion Ban On ‘Pain-Capable’ Fetuses
The Montana Senate on Friday advanced a proposal seeking to extend protections to so-called “pain-capable” fetuses. If approved, Montana would join more than a dozen states adopting laws protecting pain-capable fetuses. The measure is one of a pair of anti-abortion bills that continued moving through the Montana Legislature. Earlier in the week, a House committee further advanced a bill that would effectively ban all abortions after 24 weeks of pregnancy by requiring doctors to save a fetus. (Calvan, 3/24)

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Viewpoints: Support For Paid Leave; Immigrants Afraid Of Seeking Care

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

Arizona Republic: The Wrong Bill About Dying Went To Ducey’s Desk
Gov. Doug Ducey can stand up for individual rights and dignity. Or he can sign Senate Bill 1439 and buck a trend toward letting people control their lives and deaths. The bill is ostensibly about religious freedom. It is supported by the powerful Center for Arizona Policy, which supports conservative social policies and is headed by Ducey supporter Cathi Herrod. SB 1439 is supposed to protect health-care professionals and hospitals from discrimination if they refuse to help people die. (Linda Valdez, 3/22)

Louisville (Ky.) Courier-Journal: Savannah’s Funeral – ‘Tired Of Burying My Friends’
We should not feel comfortable raising children in a world where they learn how to order flowers for their friend’s funeral before they learn how to buy a house or start a retirement fund. I am a full-time student with a part-time job. I went to decent schools and stayed away from the neighborhoods my parents warned me about. I am not an anomaly, and neither is gun violence. I apologize if I seem insensitive towards the individual’s right to own a gun, but it is time we take a critical look at our society’s priorities. What good is a world full of guns if we must fill our days with this pain? How many of our children are we willing to lose to maintain our sense of entitlement? (Tara Ann Steiden, 3/23)

The New England Journal of Medicine: Chilling Effect? Post-Election Health Care Use By Undocumented And Mixed-Status Families
Navigating the health care system is particularly difficult for people with limited English proficiency and health literacy or without health insurance or a Social Security number. Many undocumented immigrants and their families therefore go without needed care, to their detriment and sometimes that of others, as in the case of a woman with syphilis who is pregnant with a future U.S. citizen. (Kathleen R. Page and Sarah Polk, 3/23)

The New England Journal of Medicine: Patient Inducements — High Graft Or High Value?
In May 2016, Uber announced a partnership with the Southeastern Pennsylvania Transportation Authority (SEPTA) to provide discounted ride-sharing services to “bridge the first and last mile gap” and encourage people to ride the regional rail system. It was a potential win for all — increased ridership for Uber and SEPTA, decreased traffic and pollution. The partnership was lauded for testing an innovative way to advance social goals. Contrast this partnership with one that might be arranged in health care. For instance, a partnership between a health system and a ride-sharing service to provide free rides for patients with transportation barriers might help elderly patients with disabilities or those with limited transportation options get needed care. However, it might be illegal. (Krisda H. Chaiyachati, David A. Asch and David T. Grande, 3/23)

The New England Journal of Medicine: Adopting Innovations In Care Delivery — The Case Of Shared Medical Appointments
Transformative innovations in care delivery often fail to spread. Consider shared medical appointments, in which patients receive one-on-one physician consultations in the presence of others with similar conditions. Shared appointments are used for routine care of chronic conditions, patient education, and even physical exams. Providers find that they can improve outcomes and patient satisfaction while dramatically reducing waiting times and costs. (Kamalini Ramdas and Ara Darzi, 3/23)

JAMA: The Rise Of Crowdfunding For Medical Care
The rise of medical crowdfunding carries the promise of more efficiently matching potential donors with unmet needs in ways that may increase overall giving, mirroring emerging technologies in other industries such as ride-hailing and retail services that aim to more efficiently match supply and demand. Despite its protean promises, however, medical crowdfunding raises a constellation of ethical and legal hurdles for patients, clinicians, institutions, and society. Understanding these issues will be of increasing importance as medical crowdfunding continues to grow in popularity. (Michael J. Young and Ethan Scheinberg, 3/23)

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Essential Health Benefits Reviewed: ‘Galling’ Return To Bad Old Days; Lowering Premiums

Some opinion writers urge caution before jettisoning insurance guarantees, but premium costs appear to be at the heart of the argument to get rid of the health law’s essential health benefits.

Los Angeles Times: Remember When You Couldn’t Get Insurance With A Preexisting Condition? Those Days Are Probably Coming Back
Raise your hand if you want to go back to the days when you couldn’t get health insurance because you’d been sick or injured. That’s one of the galling possibilities raised by the evolving version of the American Health Care Act, the House GOP leadership’s plan to repeal and replace Obamacare. The blame lies with the changes that President Trump and House leaders reportedly pledged to make in the bill to win the support of members of a group of far-right House members, the Freedom Caucus. (Jon Healy, 3/23)

Forbes: Bring GOP Right-Wingers And Pragmatists Together On Obamacare — By Making Premiums Affordable
Thursday, March 23 was a wild day in Republicans’ quest to repeal and replace Obamacare, with vote cancellations, last-minute amendments, CBO analyses, and Presidential ultimatums. But the most surprising development of all was this: a way has emerged to get both hard-line and pragmatic conservatives to support the American Health Care Act. … The GOP’s right wing came to a surprisingly pragmatic realization. While refundable tax credits were not their favored approach to health reform, there were too many Republicans who believed otherwise; stubbornness on this point would jeopardize the success of any bill to replace Obamacare. So, congressional hard-liners reoriented their efforts toward repealing most, if not all, of Obamacare’s insurance regulations. (Avik Roy, 3/24)

The New York Times: Late G.O.P. Proposal Could Mean Plans That Cover Aromatherapy But Not Chemotherapy
Why should that 60-year-old man have to pay for maternity benefits he will never use? If 60-year-old men don’t need to pay for benefits they won’t use, the price of insurance will come down, and more people will be able to afford that coverage, the thinking goes. … But there are two main problems with stripping away minimum benefit rules. One is that the meaning of “health insurance” can start to become a little murky. The second is that, in a world in which no one has to offer maternity coverage, no insurance company wants to be the only one that offers it. (Margot Sanger-Katz, 3/23)

Huffington Post: Spicer Denies That Ending Maternity Care Guarantee Would Mean Women Pay More For Health Care He’s Wrong.
White House press secretary Sean Spicer on Thursday defended the idea of taking away guaranteed maternity coverage in health insurance, denying that it would mean women must pay relatively more for their health care. He’s wrong about that. Ending the guarantee could mean slightly lower premiums for individual men and much older women, but it would just as surely drive up premiums for women of child-bearing age and their families ― unless it left them paying the full cost of prenatal care and delivery, typically many thousands of dollars, out of their own pockets. (Jonathan Cohn, 3/23)

The New York Times: Yes, Senator, You Wouldn’t Want To Lose Your Mammograms — Or Women Voters
Republicans seem to have an evil genius for tone-deafness when it comes to women. On Thursday, a photograph that was widely circulated on Twitter showed a room packed with white men cutting a deal to eliminate maternity care and mammograms from the package of essential benefits that insurers are required to provide in the Republican bill to replace the Affordable Care Act. There were some women out of camera range, including Kellyanne Conway, the White House counselor. Earlier in the day, Senator Pat Roberts, Republican of Kansas, made an ill-judged quip that he quickly had to apologize for: “I wouldn’t want to lose my mammograms,” he said to a reporter from Talking Points Memo. (Susan Chira, 3/23)

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Research Roundup: Ads And Testosterone Use; Home Monitoring With Apps; Per Capita Caps

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

JAMA: Association Between Direct-To-Consumer Advertising And Testosterone Testing And Initiation In The United States, 2009-2013
Question: Is there an association between televised direct-to-consumer testosterone advertising and testosterone testing and initiation in the United States? Findings: In this ecological study of 75 US designated market areas, each exposure to a testosterone advertisement was associated with monthly relative increases in rates of new testosterone testing of 0.6%, new initiation of 0.7%, and initiation without a recent baseline test of 0.8%. (Layton et al., 3/21)

JAMA Surgery: Effect Of Home Monitoring Via Mobile App On The Number Of In-Person Visits Following Ambulatory Surgery
Question: For patients undergoing ambulatory surgery, can follow-up care via a mobile app avert in-person visits compared with conventional, in-person follow-up care during the first 30 days after the operation? Findings: In this randomized clinical trial of 65 patients, those who used the mobile app attended fewer in-person visits for follow-up care during the first 30 days after the operation than patients in the in-person follow-up care group. This difference was statistically significant. (Armstrong et al., 3/22)

JAMA Surgery: Costs And Consequences Of Early Hospital Discharge After Major Inpatient Surgery In Older Adults
Question: 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? Findings: 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., 3/22)

JAMA Internal Medicine: Patient Mortality During Unannounced Accreditation Surveys At US Hospitals
Question: What is the effect of heightened vigilance during unannounced hospital accreditation surveys on the quality and safety of inpatient care? Findings: In an observational analysis of 1984 unannounced hospital surveys by The Joint Commission, patients admitted during the week of a survey had significantly lower 30-day mortality than did patients admitted in the 3 weeks before or after the survey. This change was particularly pronounced among major teaching hospitals; no change in secondary safety outcomes was observed. (Barnett, Olenski and Jena, 3/20)

The Kaiser Family Foundation: Health Insurance Premiums Under The ACA Vs. AHCA: County-Level Data
These maps compare county-level estimates of premiums and tax credits under the Affordable Care Act (ACA) in 2020 with what they’d receive under the American Health Care Act as unveiled March 6 by Republican leaders in Congress. The maps were updated on March 21, 2017 to show estimates of how much a person buying their own insurance would have to pay under both the ACA and the House replacement bill. The maps include premium tax credit estimates by county for current ACA marketplace enrollees at age 27, 40, or 60 with an annual income of $20,000, $30,000, $40,000, $50,000, $75,000, or $100,000. (3/22)

Urban Institute: The Impact Of Per Capita Caps On Federal And State Medicaid Spending
In this paper, we analyze the effect of two per capita cap approaches: that in the AHCA and that in Speaker of the House Paul Ryan’s “Better Way” health care plan, released in June 2016. We estimate the effect of each of these per capita caps on federal and state spending from 2019 to 2028. We estimate that between 2019 and 2028, the Better Way proposal would reduce federal Medicaid spending by $841 billion, or 18.1 percent. The AHCA would reduce federal spending by $457 billion, or 9.8 percent. Assuming the bulk of states that expanded coverage under the ACA dropped eligibility for their expansion populations, we estimate that 8 million enrollees would lose Medicaid coverage, and federal savings would increase to $735 billion between 2019 and 2028. (Holahan, Buettgens and Wang Pan, 3/20)

The Kaiser Family Foundation: What Could A Medicaid Per Capita Cap Mean For Low-Income People On Medicare?
Policymakers are giving serious consideration to proposals, such as the American Health Care Act (AHCA), that would fundamentally change the structure and financing of Medicaid – the federal-state program that provides health coverage for 70 million low-income Americans, including one in five people on Medicare. Federal financing for Medicaid would be converted to a per capita cap model (such as under the AHCA) or block grant, both of which aim to limit and make more predictable federal spending on Medicaid and provide states more flexibility in their management of Medicaid spending. Such a change could affect low-income people on Medicare because Medicaid help cover Medicare’s premiums and cost-sharing, and pays for services not covered by Medicare, such as nursing home care. (Jacobson, Neuman and Musumeci, 3/20)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What might be desirable for business would leave patients vulnerable.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mary Agnes Carey and Phil Galewitz contributed to this story.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Opponents Of KanCare Expansion Challenge Supporters’ Claim It Will Pay For Itself

Outlets report on news out of state legislatures in Kansas, Minnesota, Texas, Arkansas and Florida.

KCUR: Cost Of KanCare Expansion Debated Ahead Of Key Vote
A dispute about the cost and potential benefits of expanding Medicaid eligibility is heating up ahead of a Kansas Senate committee vote on a bill. In testimony Monday to the Senate Public Health and Welfare Committee, supporters of expanding eligibility for KanCare, the state’s privatized Medicaid program, said expansion would more than pay for itself. Former Kansas Senate President Dave Kerr, a Hutchinson Republican, said in its first full year, expansion would add about $81 million to the cost of KanCare. But he said it would generate more than $154 million in revenue and savings, enough to cover the costs of expansion with about $73 million to spare. (Mclean, 3/22)

The Star Tribune: Dayton Issues Warning On ‘Reinsurance’ Plans 
Gov. Mark Dayton on Wednesday warned Republican lawmakers he won’t agree to give insurance companies hundreds of millions of dollars to stabilize Minnesota’s individual health insurance market without more information about how the companies would use the money. The House and Senate passed bills last week to spend, respectively, $384 million or $600 million over the next two years on a new “reinsurance” program to protect insurers against unusually high claims. (Golden, 3/22)

Austin American-Statesman: Texas Senate Gives Initial OK To Ban On Abortion Insurance
The Texas Senate, voting 19-10, gave initial approval Wednesday to a bill that would ban insurance coverage for abortions in the state. Senate Bill 20 by Sen. Larry Taylor, R-Friendswood, would prohibit abortion coverage in private plans, under the Affordable Care Act and in state-issued insurance plans, except for medical emergencies. Those interested in abortion coverage would have to purchase supplemental coverage if offered by their insurer. (Lindell, 3/22)

Texas Tribune: Texas Senate Passes Restrictions On Abortion Insurance 
The Texas Senate on Wednesday gave initial approval to a measure that would require women to pay a separate premium if they want their health plan to cover an elective abortion. Under Senate Bill 20, health plans would still be allowed to cover abortions that are deemed medically necessary. The measure does not make exceptions for cases of rape or incest. (Evans, 3/22)

The Associated Press: ‘Sex-Selection’ Abortion Ban Gets Final OK In Arkansas House
A proposal to impose fines and prison time on doctors who perform abortions that are based solely on whether the mother wants to have a boy or girl received final passage from the Arkansas House. The measure was passed Wednesday on a 57-9 vote. The bill’s sponsor, Republican Rep. Charlie Collins previously told lawmakers that having this ban as law is the right thing to do. (Mukunyadzi, 3/22)

Tampa Bay Times: Future Of Medical Pot In Florida Still Cloudy After Senate Discussion 
Lawmakers have put forward competing proposals to implement Amendment 2, which passed with 71 percent of the vote in November and lets patients with debilitating medical conditions such as cancer, HIV/AIDS, epilepsy and post-traumatic stress disorder use cannabis. On Wednesday, the Senate’s Health Policy panel discussed five approaches to implement the voters’ will. Their deliberations, led by Sen. Dana Young, R-Tampa, revealed the first look at what kind of cannabis bill might pass the Senate — as well as early fault lines. (Auslen, 3/22)

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

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

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

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

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

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‘Right-To-Try’ Advocates Help Pass Laws In 33 States As Movement Gains National Foothold

Legislation to allow terminally ill patients access to experimental treatments not approved by the FDA also have momentum in the other 17 states. Today’s other public health stories report developments on a potential sepsis treatment, a devicemaker’s redesigned medical scope, a link between breast implants and a deadly cancer and the latest on the bird flu outbreak.

Stat: ‘Right To Try’ Is Becoming The Law Of The Land, State By State
Over the past three years, “right-to-try” advocates in 33 states have helped enact legislation to eliminate legal obstacles blocking terminally ill patients from treatments that aren’t yet approved by the Food and Drug Administration. Those advocates are showing considerable momentum in the remaining 17 states, potentially upending the established order for experimental drugs. The movement has been fueled in no small part by the anti-regulatory sentiment that propelled Donald Trump’s rise to the presidency and by the explicit support of Vice President Mike Pence. (Tedeschi, 3/23)

NPR: Doctor Turns Up Possible Treatment For Deadly Sepsis
It’s hard not to get excited about news of a potentially effective treatment for sepsis, a condition that leads to multiple organ failure and kills more people in the hospital than any other disease. But there have been so many false promises about this condition over the years, it’s also wise to treat announcements — like one published online by the journal, Chest — with caution. The study, from Eastern Virginia Medical School in Norfolk, Va., reported some remarkable success in treating patients who were at high risk of sudden death. (Harris, 3/23)

Los Angeles Times: Olympus’ Redesigned Scope Linked To Infection Outbreak
Doctors have tied a superbug outbreak at a foreign health facility to a medical scope that Olympus modified last year in an attempt to reduce its risk of spreading bacteria between patients. Five patients treated with the modified device tested positive for the same potentially deadly bacteria, according to a report filed with the Food and Drug Administration. (Petersen, 3/22)

NPR: Breast Implants Linked To Rare Blood Cancer In Small Proportion Of Women
The Food and Drug Administration says at least nine women have died of a rare blood cancer after receiving breast implants, and that the agency is officially acknowledging an association between the implants and the disease. On Tuesday, the agency announced that as of Feb. 1, it had received 359 breast implant-associated reports of a rare type of non-Hodgkin’s lymphoma called anaplastic large cell lymphoma, or ALCL. (Hersher, 3/22)

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Video Help Is On Way For Family Caregivers Who Must Draw Blood Or Give Injections

Renata Louwers has a hard time getting her blood drawn. The needle, the pinprick of pain, the viscous liquid flowing out of her arm — they make her queasy.

So, Louwers had to steel herself when her husband, Ahmad Khoshroo, developed metastatic bladder cancer four years ago at age 72.

Within months, as a tumor pressed on his spine, Khoshroo was taking heavy-duty opioids and Louwers was administering his medications. When he developed blood clots following a stay in intensive care, she injected a blood thinner into his belly.

Figuring out what to do as her husband’s eventually fatal disease progressed was a nightmare. Louwers remembers getting hastily delivered, easily forgotten instructions from hospital nurses and, later, limited assistance from a home health agency. “It wasn’t much, and it was incredibly hard,” she said.

Now, groups around the country are mobilizing to help family caregivers like Louwers manage medications, give injections, clean catheters, tend to wounds and perform other tasks typically handled in medical facilities by nurses or nursing assistants.


In December, 15 organizations joined a new national consortium, the Home Alone Alliance, devoted to providing better training and instructional materials for family caregivers. Founding members include the AARP Public Policy Institute, the Family Caregiver Alliance, the United Hospital Fund and the Betty Irene Moore School of Nursing at the University of California, Davis.

This week, the alliance released a series of 10 short videos (five each in English and Spanish) designed to help caregivers deal with seniors who use canes or walkers and need help getting up or down stairs, into a wheelchair, or in and out of a tub or a shower.

Two of the videos deal with falls — the most common cause of injury among older adults.

This summer, nine videos on wound care and topics will be added and include dealing with newly sutured wounds, bed sores, cellulitis and diabetic foot care, among other topics, and, by the end of the year, another 20 videos should be available.

Potential topics include nutrition, the use of specialized equipment such as nebulizers, feeding tubes and oxygen tanks, and a revised series on medication management — a topic profiled in a pilot project for the alliance.

Organizations across the country will be free to put the videos on their websites. The goal is to disseminate them as widely as possible and “bridge the gap between what family caregivers are expected to do and what we actually teach them to do,” said Susan Reinhard, director of AARP’s Public Policy Institute.

That gap was highlighted in 2012, when AARP and the United Hospital Fund’s Families and Health Care Project published a groundbreaking report on medical and nursing tasks undertaken by caregivers. It found that 46 percent helped patients who required specialized care, but few got adequate training.

After the study’s publication, AARP started compiling educational materials from around the country that addressed caregivers’ increasingly complex responsibilities. There wasn’t much available.

With the United Hospital Fund, AARP convened focus groups and asked people what would be helpful. Don’t overwhelm us with information; break the material into chunks focusing on concrete tasks, they said. And tell us a story that we can relate to, involving people like us — not doctors and nurses, they requested.

Ongoing research into what works, from family caregivers’ perspective, will be an integral part of the Home Alone Alliance. And while videos will be a core component of the consortium’s offering, they won’t be the only one.

“It may be that within certain Asian communities, a video isn’t the best approach — we may want to partner with Asian resource centers and do ‘train the trainer’ sessions about caregiving,” said Heather Young, founding dean and a professor at the Betty Irene Moore School of Nursing at UC Davis.

In African-American communities, churches are a pillar of caregiving support and the focus may be on “helping congregations build their capacity,” Young said. “You can equip one person at a time all you want, but if there isn’t a broader context of support, a net around them, it’s very difficult to sustain the caregiving.”

Meanwhile, alliance members are developing plans for disseminating materials. The Family Caregiver Alliance will incorporate them in a new online platform for caregivers, FCA CareJourney — a source of support and resources that is still under development.

FCA began producing videos for family caregivers about four years ago; its Caregiver College series and SafeAtHome series have been watched by about 500,000 people to date. “We’re going to a more visual information exchange society,” said Kathleen Kelly, FCA’s executive director.

The U.S. Department of Veterans Affairs partnered with AARP in producing the alliance’s video series on mobility. It plans to post the videos on the VA’s caregiver website and encourage their use by patients discharged from rehabilitation and those served through its home-based primary care program, said Meg Kabat, national director of the VA’s Caregiver Support program.

Recognizing the value of videos, the VA’s Office of Rural Health has created a 20-module series on caring for someone with dementia and a five-part series on managing challenging behaviors associated with dementia. An extensive compilation of materials on various health conditions, Veterans Health Library, is also online, and another valuable resource for caregivers.

What’s missing from the current offerings is advice on dealing with older adults who are frail and have multiple conditions. Catherine Yanda’s 91-year-old mother, Mary, is in this situation: She has end-stage dementia, sarcopenia, heart disease, incontinence, frequent skin tears and difficulty swallowing — a set of problems that Yanda has had to figure out how to manage, largely on her own.

“I learn what to do as it happens,” said Yanda, who turns to FCA’s website for support and websites for nurses for information. “You go to whatever site helps you deal with the problem you’re trying to address. I’m lucky because I have the belief system that I can do it. But for some people, it’s just too much.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation and its coverage of aging and long-term care issues is supported by The SCAN Foundation.

Categories: Aging, Navigating Aging, Public Health

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GOP Health Plan Aims To Curb Medicaid, Expand State Options

For all its populist design, the House GOP’s latest proposal to overhaul federal Medicaid funding creates financial risks for states and could leave some enrollees worse off.

Dramatic changes in Medicaid are a big part of the House bill to partially repeal the Affordable Care Act that’s steaming toward a floor vote scheduled for Thursday.

Big revisions were made to the legislation this week to appeal to conservatives pushing to reduce federal Medicaid spending and shift more power to states. Advocates for the program fear those measures, if enacted, could lead to cuts in benefits and fewer enrollees in the state-federal health insurance program for low-income people.

“We could see a complete unwinding of the Medicaid program as we know it today,” said Donna Friedsam, a health policy expert at the University of Wisconsin.

One big change in the GOP’s current bill would immediately shut off federal money to allow any more states to expand Medicaid eligibility under the ACA, commonly known as Obamacare. During the past three years, 31 states plus the District of Columbia have taken advantage of the provision, adding about 11 million people to Medicaid, and Kansas is considering the option. States also would gain more latitude to determine Medicaid eligibility and benefits for their populations. And for the first time, states could require some enrollees to work as a condition for getting coverage.

The GOP’s original plan was to begin shifting Medicaid expansion funding away from states in 2020. In the revised bill, states could keep funds after 2020 but only as long as those adults who gained coverage in the expansion stay in the program. When they drop out or lose eligibility, their funding would vanish.

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Because of changes in jobs and incomes, many Medicaid enrollees on average lose eligibility within two years, according to Census data.

Regular Medicaid funding also gets an overhaul in the GOP bill.

Since Medicaid’s creation in 1965, everyone eligible has been guaranteed coverage. The federal government’s commitment to help states deal with costs is open-ended, meaning its costs rise as states spend more. The states’ obligation is to cover certain groups of people and to provide specific benefits. Children and pregnant women who meet a state’s income criteria must be protected, for example.

The GOP bill would end that federal commitment, limiting what the government gives states to fixed amounts per year. States could choose two options.

The first way, called a per-capita allotment, means that federal dollars would be allocated to states based on how many Medicaid enrollees they served in a prior year, with annual adjustments for inflation and enrollment increases.

The second way would be a block grant.

Under the revised GOP bill, the block grant option would be available for Medicaid spending only on children, non-elderly adults without disabilities and pregnant women — groups that account for most enrollees.

All states would cover their disabled and elderly populations under the per-capita system, which would get a higher annual inflation rate adjustment than the block grant system under the GOP bill.

The objective is to ensure that funding keeps pace with rising health care costs and the needs of a growing elderly population.

Children could fare badly in states that choose the block grant option, said Joan Alker, executive director of the Center for Children and Families at Georgetown University.

They would no longer be guaranteed access to a standard Medicaid benefit that Congress created in 1967 to ensure that children got access to preventive health care services, treatment and periodic screenings to catch developing health problems early, Alker said.

“That means the governor and/or the state legislature would decide what benefits a child would get, not the child’s pediatrician,” she said.

Of the two funding arrangements, Medicaid block grants also would be financially riskier for states during economic downturns, when unemployment rises and more people seek to enroll in the program. While per-capita caps rise as enrollment grows, block grants do not — and that could leave a state short of federal aid when demand is strongest.

Most states would likely choose a per-capita cap for that reason, said Bill Hammond, director of health policy at the conservative Empire Center for Public Policy in New York.

But some would take a block grant for the freedom they would gain to change benefits and eligibility standards. As a bonus, they would also get to keep any federal money they saved and use it for non-Medicaid spending, he said.

Jason Fichtner, a Medicaid expert at George Mason University in Fairfax, Va., said a block grant would be attractive only for states if they could get more money than under the per-capita option, at least in the short term.

The GOP proposal would allow states to opt out of block-granted funds after 10 years and return to a full per-capita allotment.

Regardless whether the government uses block grants or per-capita caps, the prospects for dramatic changes are already causing shudders among advocates for low-income people.

“Both are really bad options and neither is good for Kentucky and neither is better than what we have now,” said Emily Beauregard, executive director for Kentucky Voices for Health.

Kentucky has a pending request with the Centers for Medicare & Medicaid Services to drastically change its Medicaid program, including adding a requirement that some enrollees work as a condition for enrollment.

The Obama administration consistently rejected states’ requests for a work requirement on the grounds that they would thwart low-income people from getting health care. Studies have found that many Medicaid enrollees who aren’t disabled or elderly already hold jobs, though often in positions that don’t provide health insurance.

The changes in the GOP bill would give states the option starting in October 2017 to add a work requirement for non-disabled adults. Pregnant women and parents of disabled children or children under 6 would be exempt.

Republican leaders said the requirement is modeled on those applied to federal welfare recipients. Under the Kentucky waiver request, people could meet the job requirement by caring for a family member or volunteering.

The work requirement provision is almost certain to face a court challenge if adopted.

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


Viewpoints: Concern Over NIH Budget Cuts; Abortion And The Supreme Court Again Are Front And Center

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

The New York Times: Why Trump’s N.I.H. Cuts Should Worry Us
Last week I was in London to participate in a scientific symposium. During coffee breaks, many British colleagues asked me and other American visitors to explain the bewildering news that President Trump had announced his intention to cut the budget for the National Institutes of Health by 18.3 percent, about $5.8 billion. (Harold Varmus, 3/22)

The New York Times: Gorsuch, Abortion And The Concept Of Personhood
Judge Neil M. Gorsuch has written little about abortion, and we do not know whether he would vote to overturn Roe v. Wade, the 1973 Supreme Court decision that established abortion as a fundamental right. But he has expressed a position on two related subjects, assisted suicide and euthanasia. In his Oxford dissertation and a later book, he defended the inviolability of human life. He rejected the role of states in granting the terminally ill a right to die and offered a legal framework that could be applied to abortion. (Corey Brettschneider, 3/21)

The Kansas City Star: Hobby Lobby Case Affirms That The Law Protects Religious Beliefs, Even Unpopular Ones
Democratic senators questioning Supreme Court nominee Neil Gorsuch appear quite preoccupied with how often he has ruled for “the little guy.” That seems an odd way to measure the independence and acuity of a judge; presumably, little guys can be wrong now and again. But in his opinion in the controversial Hobby Lobby case, Gorsuch did rule for the little guy. And in doing so, he has given us some clues about the kind of justice he would be. (Melinda Henneberger, 3/21)

Chicago Tribune: Why Tomi Lahren Will Get ‘Right’ On Abortion
Lahren, the 24-year-old conservative internet provocateur, angered many of her followers Friday when she said this during an interview on ABC’s “The View”: “I’m pro-choice and here’s why. I’m a constitutional — you know, someone that loves the Constitution. I am someone that’s for limited government. And so I can’t sit here and be a hypocrite and say I’m for limited government but I think that the government should decide what women do with their bodies. I can sit here and say that, as a Republican, and I can say, you know what, I’m for limited government, so stay out of my guns, and you can stay out of my body as well.” This did not go over well with her bosses at The Blaze, a conservative media site founded by Glenn Beck. (Eric Zorn, 3/21)

Morning Consult: Fentanyl: The Next Wave of the Opioid Crisis
We’re in the midst of a rampant opioid epidemic that has surged in three successive waves. The first involved prescription opioids. The second saw increased usage of heroin as many of those addicted to prescription opioids sought a different source of pain relief, for various reasons. The third wave has been fentanyl. The drug that killed Prince has been linked to a soaring amount of overdoses and deaths across the country. (Rep. Tim Murphy (R-Pa.), 3/21)

WBUR: In Pausing Human Research On Zika, Medical Ethicists Acknowledge A Dark Past 
This was the proposal: Deliberately infect a small group of consenting adults with the Zika virus to learn about the disease and speed up the search for a vaccine… What might go wrong and what might go right with such an experiment? Perhaps no institution can handle those questions better than the National Institutes of Health. (Paul McLean, 3/21)

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Policy Thoughts: Much Is At Stake As The House Approaches A Vote On The GOP Health Bill

Editorial pages across the country are full of tough talk for the American Health Care Act and challenges for the Republican Party.

USA Today: The Republican Reckoning On Health Care
Ronald Reagan wanted to shrink the government and Bill Clinton said the era of big government was over. But their talk was premature. There was still one great task for the world’s wealthiest, most powerful nation to accomplish, and that was to make sure all Americans could get health care. The Affordable Care Act has put us closer to that goal than we’ve ever been, yet President Trump and many in the Republican Party appear determined to reverse these gains. Why? It sure seems like it’s because they’re wedded to ideological purity, the fantasy of a skeletal government, and a cruel political tactic (rip out “Obamacare” root and branch) that has outlived its purpose. (Jill Lawrence, 3/21)

The Wall Street Journal: A Defining Health Vote
The House health-care bill is gaining momentum, and on Monday night the GOP posted amendments meant to add fence-sitters to the coalition. Don’t discount the stakes: The vote scheduled for Thursday is a linchpin moment for this Congress, and a test of whether the GOP can deliver on its commitment to voters. (3/21)

The Wall Street Journal: The GOP Is Out Of Excuses On Health Care
Although this week got off to a crackling start with high-profile hearings on Judge Neil Gorsuch’s Supreme Court nomination and potential Russian interference in the 2016 presidential election, the event with the largest consequences for the Trump administration and the Republican congressional majority occurs on Thursday. That’s when the full House takes up legislation to repeal and replace the Affordable Care Act. (William A. Galston, 3/21)

San Francisco Chronicle: Trump’s Orgy Of Unnecessary Cruelty 
Next comes the House Republican plan, which Trump enthusiastically supports, to repeal the Affordable Care Act and replace it with a system that will cause 14 million Americans to lose their health insurance next year, and 24 million by 2026, according to the Congressional Budget Office. How does Trump justify this human hardship? The plan barely makes a dent in the national debt. It cuts the federal budget deficit by only $337 billion over the next 10 years — a small fraction of the national debt. (Robert Reich, 3/21)

Atlanta Journal-Constitution: Trumpcare, A Bullhorn Touting Its Scorn For The Poor
The poor can be safely ignored largely because they allow themselves to be split along tribal lines of creed and color and kept at one another’s throats. Then they are nickled and dimed and robbed damn near blind by monied interests and their political henchmen. The new health care bill is a prime example. (Leonard Pitts, 3/22)

USA Today: GOP Should Slow Down And Rethink Health Bill
Exactly seven years ago Thursday, after decades of effort to make health care available to all Americans, the Affordable Care Act was signed into law. Now, in what House Speaker Paul Ryan calls “an act of mercy,” the House is planning an anniversary vote to repeal it and, in addition, to radically alter the Medicaid program that has been a staple of the national safety net since the 1960s. For members of Congress, this is one of the most consequential votes they might ever face. (Andy Slavitt, 3/22)

Los Angeles Times: House Republicans Are Hoping The Senate Can Save Them From Their Own Ruinous Healthcare Bill
The House GOP leadership has aligned itself so closely with President Trump on healthcare, it’s borrowing his signature sales tactic as it tries to ram through a bill this week to “repeal and replace” Obamacare: the bold but empty promise. Specifically, it’s promising House Republicans a solution to their concerns about drastically increasing insurance premiums for millions of older Americans, but leaving the Senate to figure out how to deliver it. (Jon Healey, 3/21)

The Washington Post: Who Gets Blamed If The House Doesn’t Pass The AHCA
No great political acumen or psychology degree is necessary to conclude that President Trump is highly susceptible to flattery. It’s little wonder then that House Speaker Paul D. Ryan (R-Wis.), desperate to pass GOP health-care reform or at least not be blamed if it fails, keeps talking about what a terrific “closer” Trump is. (Jennifer Rubin, 3/21)

The New York Times: What’s At Stake In A Health Bill That Slashes The Safety Net
What do we lose when social insurance unravels? It is startling to realize just how much the social safety net expanded during Barack Obama’s presidency. In 2016, means-tested entitlements like Medicaid and food stamps absorbed 3.8 percent of the nation’s gross domestic product, almost a full percentage point more than in 2008. (Eduardo Porter, 3/21)

The New York Times: Fewer Americans Would Be Insured With G.O.P. Plan Than With Simple Repeal
The Congressional Budget Office recently said that around 24 million fewer Americans would have health insurance in 2026 under the Republican repeal plan than if the current law stayed in place. That loss was bigger than most experts anticipated, and led to a round of predictable laments from congressional Democrats — and less predictable ones from Republican senators, including Bill Cassidy of Louisiana and John Thune of South Dakota, who told reporters that the bill needed to be “more helpful” to low-income people who wanted insurance. (Margot Sanger-Katz, 3/21)

Axios: Why Deductibles Would Rise Under The GOP Health Care Plan
Health care is complicated, as the president has discovered. But here is one thing that is not so complicated: if people have modest means and limited tax credits, and coverage is expensive, they will mostly buy health plans with lower premiums — and high deductibles. This is what is likely to happen under the GOP health care bill, the American Health Care Act. Only people who need more health care will stretch for more generous coverage. If that happens, those health plans will draw too many sick people, causing insurance companies to stop offering them for fear of losing money. That would leave mostly the low-premium, high-deductible plans. (Drew Altman, 3/22)

The New York Times: A Republican Health Care Bill In Search Of A Problem
Republican leaders in the House have been huddling over the last few days in a frantic search for enough votes to win passage of their proposed revision of Obamacare, in the process making an already flawed bill even worse. One measure of their desperation was a cynical last-minute provision that would shift Medicaid costs from New York’s rural and suburban counties to the state government, pleasing upstate Republicans who represent those counties but reducing coverage provided by the state. (3/21)

The Charlotte Observer: What You Need To Know About Medicaid This Week
Per capita caps on Medicaid beneficiaries? Block-granting Medicaid? Do these wonky and innocuous-sounding proposals really make any difference? They do. The American Health Care Act – the Republicans replacement for Obamacare – is scheduled for a vote this week in the U.S. House. You will hear much discussion about the individual insurance marketplace, tax credits, and promotion of health savings accounts. However, the changes in Medicaid are the most profound in the AHCA. (Jessica Schorr Saxe, 3/21)

Bloomberg: Better Health Care for Less Money? It’s Not Easy
“America spends more on health care than other rich nations, but has lower life expectancy.” If I had a nickel for every time I have been informed this by an email, seen it in a headline, heard it in conversation, or watched it scroll across my social media feed, I would be able to personally fund a single-payer health-care system. (Megan McArdle, 3/21)

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