Tagged States

A Tale Of Two States: California, Texas And The Latest ACA Repeal Bid

The GOP’s latest attempt to repeal the Affordable Care Act wobbled on Friday as Sen. John McCain (R-Ariz.) said he could not support it. But the bill known as Graham-Cassidy isn’t dead yet. And whatever its fate, the long-held Republican goal it embodies — to fundamentally change how the government funds Medicaid — will survive.

Graham-Cassidy would dramatically redistribute federal funds to states. And, generally, states that expanded Medicaid — like California — stand to lose billions of dollars as that money is doled out to states that didn’t — like Texas.

“For a state like California or a Massachusetts or a New York — exactly the states that might be most motivated to at least try to preserve the ACA coverage gains — those are the states that would face the deepest cuts to their federal resources,” said Aviva Aron-Dine, a senior fellow with the Center on Budget and Policy Priorities.

The bill’s authors said their plan gives states more flexibility to build their own health systems. But health officials in California released a strongly worded analysis on Friday, predicting dire consequences if the measure were to pass.

Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,” top officials from the state Department of Health Care Services wrote, emphasizing their words in italics.

They cited the significant shift in costs from the federal government to the states, forcing California to pay nearly $4.4 billion more in 2020 to maintain current coverage levels. In 2027, when the federal block grants would end, the state’s additional burden would grow to $53.1 billion, according to the analysis.

All told, from 2020 through 2027, “the impact would total $138.8 billion in federal funding cuts,” the officials wrote.

“If this amendment is adopted and becomes law, California will be faced with tens of billions of dollars in new costs, [which] will require difficult decisions regarding the populations and benefits we choose to cover and how much we pay providers and plans for the services they provide,” the health officials said.

California’s overall uninsured rate dropped by more than half since the ACA’s coverage expansion.

Meanwhile, Texas looks like one of the bill’s big winners. It gets a windfall of more than $35 billion to help replace Obamacare exchanges and other programs, more than any other state. State officials get to decide how they want to spend that money.

But experts in the state said that could present its own set of problems.

“Regardless of the size of the block grant, there’s just no assurance that it would translate into good coverage or coverage that’s [as] affordable as what we have today,” said Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities in Austin.

Texas has replaced California as the state with the highest number of uninsured people. Pogue said the state doesn’t have the infrastructure in place to expand coverage to more people. It didn’t expand Medicaid, and the state didn’t set up its own Obamacare exchange.

To sell ACA policies, Texas uses healthcare.gov, which will cease to exist if Graham-Cassidy passes.

“There’s no planning and no thought put into how would we create affordable coverage for low-income Texans,” Pogue said. “Texas would be starting from scratch.”

For comparison, it took Massachusetts four years to set up its pre-Obamacare insurance market.

Pogue said the political will needed to expand health insurance to more Texans has been lacking among state lawmakers for years. In order to get the block grant, states would need to create something workable by 2020.

Another issue is how the grants would be calculated. The federal government would pay a fixed amount up to a cap for each Medicaid enrollee.

“We have very low per capita costs already, and we [would] get locked into that forever,” said Stacy Wilson, president of the Children’s Hospital Association of Texas. “We are very concerned.”

The Texas Public Policy Foundation, a conservative group, also said it was not happy about the bill. Its concern is that it doesn’t go far enough to repeal Obamacare.

“In the end, this rushed legislation will not lead to the creation of a functioning free market,” said Drew White, a senior policy analyst with the group.

This story is part of a partnership with NPR, local member stations and Kaiser Health News.

Categories: Repeal And Replace Watch, States, The Health Law


Policy Implications: The GOP Bill’s Math Problems; The Importance Of Funding CHIP

Editorial pages include policy analysis of the Graham-Cassidy health care bill and examine some of the key policies now in play.

The Washington Post: Tens Of Millions Of Americans Could Lose Obamacare Tax Credits Because Thousands Of Alaskans Won’t
American politics is always a math problem. If you have a group of x people, you need (x/2) + 1 votes to win the most votes. That holds true for most elections pitting two candidates against each other, and it holds true for passing legislation. In the case of Cassidy-Graham, the clumsily named bill that is the latest and last iteration of Republican efforts to gut the Affordable Care Act, also known as Obamacare, the x is 100 — the number of votes in the Senate. Thanks to two quirks of the process, the legislation would pass with just (x/2) votes, with the +1 being added by VPOTUS-ex-machina Mike Pence. (Philip Bump, 9/21)

Los Angeles Times: Believe It Or Not, Graham-Cassidy Socializes The Cost Of Health Insurance
There are plenty of things wrong with the Graham-Cassidy-Heller-Johnson proposal to overhaul Obamacare (and Medicaid, while it’s at it), from its cockamamie approach to helping people not insured by their employers to its blithe indifference to the rising cost of medical care. But give sponsoring Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Dean Heller (R-Nev.) and Ron Johnson (R-Wis.) credit for doing something remarkable: They got even the most conservative of their Republican colleagues to agree to socialize more of the cost of health insurance. (Jon Healey, 9/21)

The Washington Post: Republicans’ Brave New Strategy For Fixing The U.S. Health-Care System
Republicans have unveiled their brave new strategy for fixing the U.S. health-care system: Make someone else deal with it. Of all the god-awful Obamacare-repeal-and-replace plans that Republicans have proposed, Cassidy-Graham might be the god-awfulest. It’s definitely the most cowardly. Republicans spent nine months fighting over how to repeal Obamacare without shafting the poor and enraging voters, and they failed. So instead they’re passing the buck. (Catherine Rampell, 9/21)

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

Political Perspectives: Pleas For Truth Talk Regarding Graham-Cassidy; Does Panic On Left Suggest Progress On Right?

Opinion writers express outrage at the contents of the Senate GOP’s latest attempt to repeal and replace Obamacare and explore the political motivations for pursuing the measure’s passage.

The New York Times: Senator Cassidy, Please Stop Lying About Health Care
Here’s a giveway about how bad the new Senate health care bill is: Bill Cassidy, one of its authors, keeps trying to sell it by telling untruths. “The relatively new phenomenon of just ‘up is down’ lying about your bill’s impacts is jarring,” says Loren Adler of the USC-Brookings-Schaeffer Initiative on Health Policy. Most egregiously, Cassidy is claiming that the bill would not ultimately deprive sick people of health insurance. That’s false, as NPR calmly explained when Cassidy said otherwise. (David Leonhardt, 9/21)

The Wall Street Journal: The Panic Over Graham-Cassidy
Senate Republicans must be making progress on their latest attempt to reform health care, because the opposition is again reaching jet-aircraft decibel levels of outrage. The debate could use a few facts—not least on the claims that the GOP is engaging in an unfair process. Republicans are scrambling to pass Lindsey Graham and Bill Cassidy’s health-care bill before Sept. 30, when the clock expires on the budget procedure that allows the Senate to pass legislation with 51 votes. The bill would devolve ObamaCare funding to the states, which could seek waivers from the feds to experiment within certain regulatory boundaries, and it also repeals the individual and employer mandates and medical-device tax. (9/21)

The New York Times: Cruelty, Incompetence And Lies
Graham-Cassidy, the health bill the Senate may vote on next week, is stunningly cruel. It’s also incompetently drafted: The bill’s sponsors clearly had no idea what they were doing when they put it together. Furthermore, their efforts to sell the bill involve obvious, blatant lies.Nonetheless, the bill could pass. And that says a lot about today’s Republican Party, none of it good. (Paul Krugman, 9/22)

The Washington Post: This Republican Health-Care Bill Is The Most Monstrous Yet
Motivated by the cynical aims of fulfilling a bumper-sticker campaign promise and lavishing tax cuts on the wealthy, Republicans are threatening to pass a health-care bill they know will make millions of Americans sicker and poorer. Do they think we don’t see what they’re doing? Does Sen. Charles E. Grassley (R-Iowa) think we didn’t hear what he said Wednesday? “You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” he told reporters. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.” (Eugene Robinson, 9/21)

The Wall Street Journal: The Graham-Cassidy Show Is Like ‘Jaws’—And You’re The Swimmer
If you’ve been following the congressional health-care “debate”—an overly kind word, to be sure—you may now be getting an eerie feeling. It’s sort of like “Jaws.” You thought it was safe to go back into the health-care waters. The poor and the powerless seemed to be out of harm’s way. Sens. Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.) were reporting progress on a bipartisan compromise. Then the Graham-Cassidy bill came out of nowhere, like a great white shark, accompanied by a bit of ominous music. (Alan S. Blinder, 9/21)

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

State Highlights: In Calif., Gubernatorial Candidates Try To Prove Health Care Street Cred; Death Toll Rises In Fla. Nursing Home Tradgedy

Media outlets report on news from California, Florida, Texas, Illinois and Pennsylvania.

Los Angeles Times: The Push For Single-Payer Health Care Just Went National. What Does That Mean For The California Effort?
When Vermont Sen. Bernie Sanders visited Beverly Hills last May, he made a full-throated appeal for California to “lead the country” and pass a pending state proposal to establish single-payer health care. On Friday, he’ll return here for a San Francisco speech trumpeting his own higher-stakes plan — a bill to drastically overhaul the nation’s health-care system by covering everyone through Medicare. (Mason, 9/22)

Los Angeles Times: Two Top Candidates For California Governor Have Been Touting Their Healthcare Wins. Here’S What They Really Did
Gavin Newsom and Antonio Villaraigosa are depicting themselves as Democratic healthcare visionaries as they campaign to become California’s next governor. To prove his healthcare mettle, Newsom points to Healthy San Francisco, a first-of-its-kind universal system adopted while he reigned as the city’s mayor in 2006. Newsom’s work on the program helped him land an endorsement from the influential California Nurses Association, and a boast or two will surely punctuate his speech at their convention on Friday as hyper-partisan politics intensify over efforts to repeal the Affordable Care Act and implement a national single-payer plan. (Willon, 9/22)

Reuters: Death Toll From Overheated Florida Nursing Home Rises To 10
A 10th elderly patient at a Miami-area nursing home has died after she was exposed to sweltering heat in the aftermath of Hurricane Irma, police said on Thursday. The resident of the Rehabilitation Center at Hollywood Hills died on Wednesday, police in Hollywood, Florida, said in a statement, without giving details. (Simpson, 9/21)

Los Angeles Times: Multiple Cases Of West Nile Virus In Glendale Prompt Education Campaign
With eight cases of West Nile virus reported in Glendale so far this year, health officials took part in a door-to-door education campaign Wednesday, informing residents of what they can do to protect themselves from infection. Conducted by the Greater Los Angeles County Vector Control District, the effort informed residents in Glendale, Los Feliz and Atwater Village about the preventive measures they can take to reduce the risk of being bitten by mosquitoes. Levy Sun, a spokesman for vector control, said wearing insect repellent and dumping out any stagnant water near homes are measures people should take regularly. (Nguyen, 9/21)

Houston Chronicle: Residents Near Houston Superfund Site Await Answers After Hurricane Harvey
Bonner and others in Channelview, Baytown and Highlands neighborhoods along this industrial stretch of the river south of the Lake Houston dam worry about the toxicity of murky water, white dust and the foul-smelling sludge covering their properties. The question for dozens of people, who a week after the storm still guard wrecked riverfront properties from marauders seeking scrap, is whether their neighborhoods are now too contaminated to recover. (Olson, 9/22)

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

Hospital Cracks Down On Inconsistencies With Prescribing Opioids As It Tries To Battle Crisis

Anne Arundel Health System joins hospitals across the region and the state of Maryland in attempting to eradicate a problem medical institutions now realize they helped create. Meanwhile, the Senate HELP Committee will plan on a hearing to address the epidemic next month.

The Hill: Senate Health Committee Schedules Hearing On Opioid Crisis
The Senate Health Committee will hold a hearing on the opioid crisis next month. The committee will focus on the federal response to the crisis and conduct oversight of the Comprehensive Addiction and Recovery Act, a law passed in 2016 that supports efforts to address the issue. (Hellmann, 9/21)

And in other news —

The Associated Press: Opioid Epidemic Laws Lead Panel To Revisit Recovery Schools
A fire led to the eventual end of Phoenix — a groundbreaking Maryland public school program for children with addiction that closed in 2012 — but the state could see institutions like it rise again from the ashes. Recent spikes in the Maryland heroin and opioid epidemic have triggered calls for substantial changes in education systems statewide, and a state work group is weighing the return of recovery schools after a Sept. 7 meeting. (Slater, 9/21)

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

VA Steps Up Efforts To Screen And Treat Veterans For Hepatitis C

With a higher rate of infection reported among vets than the general population, the Department of Veterans Affairs started taking proactive measures three years ago to cure patients. Meanwhile, Agent Orange exposure and a wrongful death case are also in veterans health news headlines today.

KQED: In The Battle Against Hepatitis C, The VA Takes The Lead
The VA has implemented an aggressive effort to screen and treat all veterans under their care for the virus. Hepatitis C experts and advocates have praised the VA for its proactive approach, and say it should be a model for other government health programs, and even private insurers. (Klivans, 9/2!)

Kansas City Star: VA Medical Center In Kansas City Focus Of Wrongful Death Suit Alleging Allergic Reaction
An 84-year-old patient developed pustular lesions on his face and died after a Veterans Affairs hospital in Kansas City treated him with a drug he was allergic to, according to a lawsuit filed Wednesday. The suit filed in federal court by Kansas City lawyer Leland Dempsey alleges that staff at the VA Medical Center on Linwood Boulevard caused Mark Beemer’s death last year by giving him Ceftriaxone, and the death could easily have been prevented. (Marso, 9/21)

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

Uncertainty Over Health Care’s Future Hobbles Entrepreneurs

Stinson Dean is used to taking risks. The entrepreneur from Independence, Mo., says coping with the ups and downs of the market is an inevitable part of his business.

But when he started his company about a year and a half ago, he laid down a firm rule.

“One of the things I wasn’t willing to risk was the health of my family,” Dean said.

Dean is the proud father of three young children — two girls and a boy. Playing with them in the front yard before dinner, he and his wife, Stephanie, talk about the possibility of another.

Like many Americans, Dean has nervously watched this year’s national health care debate. He credits the Affordable Care Act for making it possible to start his business, which involves buying Canadian lumber and selling it to U.S. lumberyards. Now, uncertainty about the ACA’s future affects his business’s potential for growth.

In May 2016, Stephanie was pregnant with their daughter Julie, and Dean was working as a commodities risk consultant.

A few months before a baby’s due date is typically not the time for a big career move, but it happened to mesh with a once-in-a-lifetime opportunity in the lumber market to buy low and sell high.

Encouraged by the availability of affordable insurance through the ACA, the family took the plunge. Dean left his job and started his company. The move paid off, as new construction boosted Dean’s business far beyond what he imagined.

He’s now ready to expand and bring on three or four new people, but there’s a problem.

“There’s a huge unknown with the ACA and what that’s going to look like,” Dean said.

President Trump and many members of Congress campaigned with promises to repeal and replace the Affordable Care Act, and they’ve spent much of this year attempting to do so.

That’s meant hardship for Dean. He’s having trouble persuading people with steady jobs and great benefits to take a chance and work for him.

Repeal-and-replace efforts are again alive in the Senate, and the president has threatened to withhold certain payments to insurers. That strain, on top of already unstable insurance markets, has led Dean to worry about whether decent insurance coverage will be available in the long run for him, his family and potential new employees

“What that’s doing for me is preventing me [from luring] folks who are in a similar situation to where I was — a nice corporate job, making good money, with great benefits, with kids — convincing them to leave that to come work for me with no benefits,” he said. “They’re going to have to go on the individual marketplace, on healthcare.gov, just like I did, and pick a plan.”

Exactly how the ACA has affected entrepreneurs and job growth remains unclear, said Dean Baker, co-director of the left-leaning Center for Economic and Policy Research, based in Washington, D.C. But there’s been a sharp increase in entrepreneurial activity since 2013, when the insurance marketplaces started.

Baker says the ACA has helped entrepreneurs by leveling the playing field in the competition for hiring talent. Before the health law, entrepreneurs had been at a disadvantage compared with larger businesses, who were more likely to be able to afford to offer insurance.

“Once [an entrepreneur’s] workers are able to get insurance through the exchange, much of that disadvantage goes away,” Baker said.

Baker said uncertainty is poison for any business, but all the questions about the ACA’s future have made 2017 especially toxic for entrepreneurs.

“For a lot of small businesses, they are sitting there with some trepidation, saying, ‘OK, how does this work out? Where are we a year from now? Where are we two years from now?’ And presumably, at least some of them are going to be putting their plans on hold,” Baker said.

That’s the case for Stinson Dean. He sees big opportunities opening in his field again, but he may not be able to take advantage of them, even if the ACA survives this year.

“What about 2019, 2020?” Dean said. “These are the questions I’m being asked by these folks I’m trying to recruit, and I don’t have an answer for them.”

This story is part of a reporting partnership with NPR, KCUR and Kaiser Health News.

Categories: Repeal And Replace Watch, States, The Health Law

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State Perspectives: Outlooks Are Not Rosy Regarding The On-The-Ground Impact Of The Current GOP Repeal Plan

Newspapers offer their members of Congress a bleak picture of what would happen in their states if the Graham-Cassidy proposal were to become law.

The Kansas City Star: No, Sen. Pat Roberts, This Awful Health Care Bill Isn’t The Only Obamacare Alternative
The Category 5 Hurricane known as Graham-Cassidy is a man-made disaster that may yet be avoided. But if you’re asking why even the craziest storm chaser wouldn’t steer clear of the direct hit that this latest health care bill would amount to, well, talk to our own Sen. Jerry Moran, who remains undecided. Or better yet, listen to his fellow Kansas Republican, Sen. Pat Roberts, whose explanation of this final attempt to blow up the Affordable Care Act is daft but highly instructional. (9/20)

The Des Moines Register: Senate’s Latest Health Bill Offers No Lifeline For Iowa
Gov. Kim Reynolds jumped aboard the latest Republican effort to repeal most of Obamacare as if it were the last lifeboat off the Titanic. “You know, this can work and I believe right now, this is the only vehicle we have to address Obamacare, that’s failing,” she said Tuesday. She was talking about legislation co-sponsored by Republican U.S. Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. The bill would put states in charge of designing their own health-care systems, with federal money from existing Obamacare taxes. Expansion of the federal program for low-income Americans, Medicaid, would end in 2020 and states would get block grants instead. (Kathie Obradovich, 9/20)

Lexington Herald Leader: Latest GOP Bill Greatest Threat To Ky. Health Care Coverage
The latest attempt to repeal the Affordable Care Act is known as Cassidy-Graham, and it very well may be the greatest threat to Kentucky’s health care. The state’s success in getting people coverage, and even health-care gains achieved decades ago, are at risk of being undone with this legislation. The bill, sponsored by Sens. Bill Cassidy and Lindsey Graham, is perhaps the final attempt at tearing up the ACA and doing permanent damage to Medicaid. It’s being rushed through before policymakers and the public can understand its implications. That’s because after Sept. 30, the Senate can no longer pass a partisan repeal bill with only 51 votes, due to chamber rules. (9/19)

Kansas City Star: Cassidy-Graham Health Care Bill Would Hurt Kansans
Now, in a last ditch effort to repeal the ACA by September 30, the end of the federal fiscal year, Congress is back with another destructive bill. Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina have introduced legislation that, like its failed predecessors, will result in coverage losses, higher costs, and elimination of consumer protections. (Sandy Praeger, 9/20)

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

Parsing The Policies: Is This Just Another ‘Lousy’ Bill Or Does It Advance A ‘Great Idea’?

Editorial pages offer a variety of ideas about the Graham-Cassidy bill now pending in the Senate, with some saying it’s “poison” and others praising its intent to give states flexibility.

Los Angeles Times: Graham-Cassidy: Another Day, Another Lousy GOP Healthcare Bill
The latest proposal — by Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Dean Heller (R-Nev.) and Ron Johnson (R-Wis.) — suffers from the same fundamental problems as all of its predecessors. Aiming to lower insurance costs for the healthy, it would allow states to herd people with preexisting conditions or potentially expensive risks — say, women who might want maternity coverage — into insurance gulags with egregiously high premiums. (9/21)

USA Today: Last-Ditch Obamacare Repeal Would Be Poison
Given up as a lost cause this summer, the Republican effort to repeal and replace Obamacare is back, this time in the form of a last-ditch effort led by GOP Sens. Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson. Like previous efforts, this measure would strip tens of millions of people of their health coverage. It would gut Medicaid, the program responsible for funding nearly half of baby deliveries and most of nursing home care. It would allow insurers in some states to deny coverage based on a previous medical condition. And it would allow insurers to skip coverage of essential services, including maternity care. (9/20)

USA Today: Let States Tailor Health Care Plans
Under Obamacare, insurance premiums in the individual market have more than doubled nationally, and without billions of additional taxpayer dollars, many of those markets are at risk of collapse. Obamacare was never designed to be patient-friendly. In fact, one of the key tenets of Obamacare is taking power away from patients and local officials. Obamacare gives this decision-making power to the federal government, allowing bureaucrats to call the shots. (Sen. Ron Johnson, 9/20)

The New York Times: Graham-Cassidy Has One Great Idea
In the timid sense, the proposal would keep much more of Obamacare’s taxes and spending in place than previous Republican plans this year. Yet Graham-Cassidy makes more sweeping changes by turning money currently used on insurance subsidies and the Medicaid expansion into block grants to states. This change would give states more flexibility to design their own health care systems. (Philip Klein, 9/20)

The Washington Post: Cassidy-Graham Is Attractive In Theory. But It Has A Giant Flaw.
A group of Republican senators, led by Bill Cassidy (La.) and Lindsay O. Graham (S.C.), have revived GOP efforts to repeal and replace Obamacare. Their bill has a number of attractive attributes: It would repeal Obamacare’s individual mandate, for example, and make important reforms to Medicaid. But Cassidy-Graham also has an important, albeit fixable, flaw — what we might call “asymmetric federalism.” (Avik Roy, 9/20)

Los Angeles Times: The Disastrous Impact Of The GOP’s Obamacare Repeal Plan, In Three Devastating Charts
The healthcare consulting firm Avalere on Wednesday released the latest in a series of independent analyses of Senate Republicans’ new effort to repeal the Affordable Care Act. The findings are beyond ugly. They show devastating cuts in healthcare funding for adults, children and the disabled — in effect, almost every population category in the U.S. other than seniors enrolled in Medicare. (Michael Hiltzik, 9/20)

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Political Reverberations: How Graham-Cassidy Impacts The Health Care Debate

Editorial pages feature opinions praising this “last-chance” legislation or calling it “nonsense” and “cynical.” They also detail how, regardless of the outcome of the vote planned for next week, the GOP will own it.

The Wall Street Journal: Republicans Get One Last Chance On ObamaCare Reform
For seven years Republicans promised to repeal ObamaCare, and now they have one last chance to deliver. A bill recently introduced by Sens. Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson would eliminate some of ObamaCare’s most unpopular provisions and enact reforms that would lower costs, expand choices, promote federal fiscal responsibility, and give power back to states and consumers. … The Graham-Cassidy bill’s biggest strength is the idea that states are uniquely equipped to design and implement health care programs that suit their residents. The bill would consolidate much of the federal funding given to states under ObamaCare’s coverage provisions—including money for its Medicaid expansion and subsidies to help people buy private insurance—into a single block grant, which states could use for a wide variety of health reforms. (Lanhee J. Chen, 9/20)

JAMA Forum: Republicans Will Own Whatever Happens To The ACA And Health Care Reform
As has become clear, “Repeal and Replace” of the Affordable Car Act (ACA), a mantra that provided such a unifying theme for Republicans when Democrats controlled the White House, has been much harder than Republicans expected when they achieved “full control” of the government. Republicans were barely able to pass a health care bill in the House despite their substantial majority over Democrats (240-194) and the Senate fell short of passing the so-called “skinny” repeal bill, HR 1628, which repealed only a limited portion of the ACA. (Gail Wilensky, 9/19)

The Washington Post: Lots Of Vulnerable House Republicans Come From States That Will Lose Under Cassidy-Graham
If the Senate passes Cassidy-Graham, its latest attempt to repeal Obamacare, the legislation will then go to the House for a vote. If that happens, Speaker Paul D. Ryan (R-Wis.) has vowed to engineer its quick passage in the lower chamber, too …. certain states are going to be hit with major losses if this bill becomes law. And it turns out that those states that would lose out happen to be heavy with incumbent House Republicans whose seats are vulnerable in 2018. Will those vulnerable House Republicans vote for a bill that drains their states of huge sums of money that could have been used to cover their own constituents? (Sarah Posner and Greg Sargent, 9/20)

The Wall Street Journal: The Republicans Who May Save ObamaCare
Like Lazarus, the Republican effort to repeal ObamaCare has risen from the dead. Pundits dutifully filled out the toe tag in July, after a repeal-and-replace bill failed to pass the Senate. Now comes new legislation championed by Sens. Lindsey Graham and Bill Cassidy, which just might get the 50 GOP votes needed for Vice President Mike Pence to break the tie and pass the bill. … Senate passage would clear the way to ending the individual and employer mandates, repealing the medical-device tax, and phasing out the ObamaCare exchanges and their highly prescriptive regulations. … The danger is that there are at least four Republican senators at risk of voting “no.” (Karl Rove, 9/20)

Bloomberg: Republicans Peddle Nonsense To Sell Health-Care Plan
Graham and Cassidy have sold this hastily assembled measure as a bipartisan compromise that, rather than cutting coverage, merely gives the states the funds and flexibility to determine their own health-care policies. None of that holds up. The bill is purely partisan—it’s being rushed through for the simple reason that it lacks any Democratic support. Graham, in press conferences, has hailed the plan as a middle-ground compromise between Obamacare and the coverage-slashing Republican proposals that collapsed in July. That’s nonsense. (Albert R. Hunt, 9/20)

Boston Globe: Yet Another Cynical GOP Ploy On Health Care
The latest Republican vehicle for repealing and replacing Obamacare is Graham-Cassidy, a bill that would dramatically cut federal health care spending and block-grant remaining monies to the states while not requiring those states to spend the money on expanding care. (Micheal Cohen, 9/20)

Bloomberg: How The Health-Care Debate Would Change If Graham-Cassidy Passes
What a difference a week makes. Last week, many commentators (including me) saw the Graham-Cassidy bill as a bit of Hail Mary legislating, a last desperate stand against Obamacare. This week, it started to look as if it might actually have some chance of passage. The legislative math remains daunting; the parliamentary obstacles high. But the status of Republican health-care efforts has moved from “flatline” to “still breathing, barely.” (Megan McArdle, 9/20)

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

State Highlights: Texas Bill To Curb ‘Surprise Medical Bills’ Now In Effect; Blue Cross Will Continue To Run N.C.’s State Health Plan

Media outlets report on news from Texas, North Carolina, Maine, Florida, California, Nevada, Colorado, Michigan, Missouri, New Hampshire, Louisiana and Minnesota.

The Associated Press: Lawsuit Challenges Law That Only Doctors Perform Abortions
The American Civil Liberties Union and Planned Parenthood filed a federal lawsuit Wednesday that challenges a Maine restriction common across most of the U.S. that abortions be performed solely by physicians. The two groups were joined by four nurses and abortion provider Maine Family Planning in challenging the law that prevents advanced practice registered nurses, such as nurse practitioners and nurse midwives, from performing the procedure. (9/20)

Las Vegas Review-Journal: Southern Nevada Medicare Dilemma: Pay More Or Switch Doctors
The recent decision by Southwest Medical Associates to stop covering traditional Medicare patients in Southern Nevada makes 66-year-old Anne Zarate sick to her stomach. That queasy feeling is not just because, as the Las Vegas woman puts it, she’s being “thrown out with 7,000 others in a city where access to medical care is weak at best.” She also sees Southwest’s action as an example of the inability of government to deliver quality health care in the United States. (Harasim, 9/18)

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Thoughts On Graham-Cassidy: ‘Bad Idea’; ‘Shoddiest’ Repeal Idea Yet; ‘Ideological Crusade’

Opinion writers offer dim views of the current measure being advanced by Senate Republicans to undo the Affordable Care Act.

The Washington Post: Another Execrable Health-Care Bill Proves Bad Ideas Never Die
Over the next week and a half, Republican senators may try one last time to repeal and replace Obamacare. The latest bill, from Sens. Bill Cassidy (La.), Lindsey O. Graham (S.C.), Dean Heller (Nev.) and Ron Johnson (Wis.), is about as execrable as the others that GOP lawmakers previously failed to approve. The process by which Republicans would pass it would be as sloppy and partisan as the one to which senators such as John McCain (R-Ariz.) objected earlier in the summer. The outcome would be no less destructive. The big difference now is the clock; the procedural window for passing a health-care bill along straight party lines will disappear at the end of the month, spurring Republicans to try one last time. That is a sad excuse to rush through — without even an attempt at bipartisanship and without a complete Congressional Budget Office assessment — a half-baked bill that would harm millions. (9/19)

Bloomberg: The Latest Obamacare Repeal Is The Shoddiest Yet
The new version, sponsored by Senators Lindsey Graham of South Carolina and Bill Cassidy from Louisiana, would do a number of things to a health care system that millions rely upon. A main selling point is giving states additional ability to act on their own — which means that virtually all of the popular protections of the Affordable Care Act, including on pre-existing protections, would be at risk — and also slashing health care funding. What exactly would it do? It’s not much clearer than that now and won’t get much clearer until next month. The Congressional Budget Office has announced they “will not be able to provide point estimates of the effects on the deficit, health insurance coverage, or premiums for at least several weeks.” (Jonathan Bernstein, 9/19)

USA Today: Obamacare Repeal Is An Ideological Crusade Past Its Sell-By Date. Give It Up, GOP
Just when Democrats thought it was safe to either stop paying attention or go full Don Quixote on Medicare For All, Obamacare repeal is back. When an entire political party has campaigned and won for seven years on getting rid of a law that was about as popular as President Trump (as in not very), it’s hard to move on. We get that. And who would have thought the country would change its collective mind, just when Republicans won control of the whole government? (Jill Lawrence, 9/19)

Bloomberg: Graham-Cassidy Is Already Hurting Health Care 
This last-gasp bill — called Graham-Cassidy after the senators leading it — would be extremely disruptive to hospitals and government-focused insurers. The proposal ends individual and employer insurance mandates, gives states a big chunk of money and then largely leaves them to run their own health-care markets. It would likely lead to large cuts to Medicaid, destabilize the individual insurance market, and significantly reduce insurance coverage. (Max Nisen, 9/19)

The Washington Post: The Graham-Cassidy Health-Care Bill Puts Millions Of Americans At Risk
The Senate is on the verge of launching a dangerous experiment. Having failed for months to repeal and replace the Affordable Care Act, Republicans hope to dump onto the states the problem of providing low- and moderate-income Americans with access to health care. So long as they are determined to push forward without meaningful Democratic input, they have until Sept. 30 to act under Senate rules. The Graham-Cassidy bill — their last chance to meet this deadline — would simply hand the states block grants and abandon to them millions of Americans whom the ACA now helps. (Timothy Jost, 9/19)

Los Angeles Times: Repeal And Replace Is Back, And Scarier Than Ever
Like the villain in a slasher movie, Senate Republicans keep coming for the health insurance of tens of millions of Americans. After Sen. John McCain’s dramatic “no” vote seemed to finish off this year’s attempts to repeal the Affordable Care Act, a proposal by two senators with mostly unearned reputations for moderation — Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) — represents the latest threat to the many people who gained access to healthcare under President Obama. The scariest part is that it might just pass. (Scott Lemieux, 9/19)

St. Louis Post-Dispatch: Last-Ditch Graham-Cassidy Health Care Bill Is The Worst One Yet
Under cover of a fog of news, Senate Republicans have been trying to round up enough votes for yet another bid to repeal and replace the Affordable Care Act. The bill they have in mind is in many ways worse than any of the three bills that failed this summer. After a dramatic thumbs-down “no” vote by Sen. John McCain, R-Ariz., killed the GOP’s third ACA replacement bill, Senate Majority Leader Mitch McConnell, R-Ky., said it was time to move on. Congress went into recess until after Labor Day, and the nation’s attention turned to hurricanes, immigration, budget matters and rapprochement between President Donald Trump and Democrats. (9/19)

The New York Times: John McCain Faces A New Test Of His Principles
It looks as if John McCain’s Senate colleagues are going to test him once again. And the health insurance of millions of Americans depends on the outcome. This summer, when his party was trying to force a health bill with unprecedented haste — no hearings, no support from medical experts — McCain stood up for the idea of the Senate. By now, you’ve probably heard a line or two from his July 25 speech, shortly after learning he had aggressive brain cancer. But the full speech is worth reading. It’s McCain at his best, a defense of the imperfect but noble pursuit of democratic politics. (David Leonhardt, 9/19)

Roll Call: The Fatal Flaw For Republicans In Graham-Cassidy
The Republicans’ latest drive to repeal Obamacare is reminiscent of a poetry fragment from Tennyson’s “The Charge of the Light Brigade”: “Theirs not to make reply, theirs not to reason why.” Whatever happens with the bill likely slated to reach the Senate floor next week, it is hard to escape the feeling that this wild charge will end badly for the Republicans. (Walter Shapiro, 9/20)

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State Highlights: States, Localities Face High Costs For Retiree Health Benefits; Hepatitis A Outbreak Declared In Los Angeles

Media outlets report on news from Illinois, California, the District of Columbia, Delaware, Maryland, Connecticut, Arizona, Ohio, Kansas, Florida, Minnesota, Colorado and Texas.

The Wall Street Journal: States Need $645 Billion To Pay For These Promises, And That’s Not Counting What They Owe In Pensions
When Aurora, Ill., closed its books in December, about $150 million disappeared from the city’s bottom line. The Chicago suburb of 200,000 people hadn’t become poorer. Instead, for the first time it recorded on its balance sheet the full cost of health care promised to public employees once they retire. States and cities around the country will soon book similar losses because of new, widely followed accounting guidelines that apply to most governments starting in fiscal 2018. (Gillers, 9/20)

Los Angeles Times: Health Officials Declare Hepatitis A Outbreak In L.A. County
Los Angeles County health officials declared a hepatitis A outbreak Tuesday, days after a public health emergency was announced in San Diego County, where at least 16 people have died of the highly contagious virus. Case numbers are still small in L.A. County, with only 10 people infected as part of the outbreak, said Dr. Barbara Ferrer, director of the L.A. County Department of Public Health. By comparison, almost 450 people have contracted the virus in San Diego. (Karlamangla, 9/19)

The Washington Post: Poor, Sick And Still Traveling Long Distances For Health Care In D.C.
The District’s poorest residents are still forced to travel far outside their neighborhoods for their health care, according to a report released Tuesday by Mayor Muriel E. Bowser. Less than 25 percent of Medicaid patients living east of the Anacostia River see a primary-care doctor in their Zip code. Despite efforts to expand services in Wards 7 and 8, many still call 911 emergency services for their basic health needs. And residents needing specialty care must commute downtown where most of the medical specialists are clustered. (Itkowitz, 9/19)

The Associated Press: New Delaware Law Will Expand Cancer Treatment Options
Cancer patients in Delaware will soon have more treatment option under legislation being signed by Gov. John Carney. A bill to be signed Wednesday requires health insurers to cover any medically appropriate drug that has been approved by the Food and Drug Administration for the treatment of stage 4 metastatic cancer and other cancers without requiring proof that the patient failed to respond to a different drug or drugs. (9/20)

The Baltimore Sun: Baltimore Health Department Seeks To Double Buprenorphine Treatment 
Baltimore health officials want to double the number of people in the city who can get access to the addiction treatment drug buprenorphine, help they say heroin addicts desperately need. Officials estimate that 25,000 people in the city are addicted to heroin or other opioids. Numbers on how many people are currently getting buprenorphine in Baltimore were not available, but officials said that even doubling the number of patients with access would not close the gap entirely. (Duncan, 9/19)

The Wall Street Journal: Doctor’s Defamation Suit Highlights Online Patient Reviews
A defamation lawsuit filed by an Ohio plastic surgeon that is slated to go to trial early next year could have far-reaching consequences for disputes between doctors and their patients over online reviews about the quality of medical care, according to legal experts. Dr. Bahman Guyuron, former chairman of the department of plastic surgery at Case Western Reserve University School of Medicine, sued Marisa User in 2015 over anonymous reviews she had posted on the cosmetic-surgery website RealSelf and other sites where patients swap information about doctors. (Palazzolo, 9/19)

KCUR: Southeast Kansas County Among Eight U.S. Communities Awarded Culture Of Health Prize 
Residents of Allen County in Kansas are getting some national recognition for their health-improvement efforts. The county is one of eight 2017 winners of the Culture of Health Prize awarded by the Robert Wood Johnson Foundation, the nation’s largest public health philanthropy.  Richard Besser, the foundation’s president and CEO, traveled to Iola, the county seat, to make the announcement in person Tuesday. (Mclean, 9/19)

Health News Florida: Preventing Mosquito Infestations After Irma
With restoration continuing this week after Hurricane Irma, Florida Department of Health officials are warning residents about standing water left by the storm as a thriving environment for mosquitoes. Containers like garden pots, birdbaths, tires and cans, when filled with standing water, can host mosquitoes laying up to 200 eggs. (Riggins, 9/19)

The Star Tribune: St. Paul Considers Restricting Sale Of Menthol Tobacco
The City Council is considering adding menthol, mint and wintergreen-flavored tobacco to the list of products that can only be sold at tobacco shops. The council will hold a public hearing Wednesday night on the proposed change, which is similar to one the Minneapolis City Council approved last month. (Van Berkel, 9/19)

Columbus Dispatch: Legionnaires’ Cases Involving Ohio State Under Investigation
Columbus Public Health is investigating two separate Legionnaires’ disease cases with ties to Ohio State: one a student at the Drackett Tower dormitory and a Columbus resident who is employed at the university’s Newark campus. A statement released by Ohio State University said Columbus Public Health informed them late Tuesday afternoon that they believe there is no connection between the two cases. (Woods, 9/20)

Denver Post: These Services For Developmentally Disabled Residents Have Grown Because Douglas And Araphoe Voters Approved A Tax In 2001 
In the last 15 years, nonprofits and programs serving people with developmental disabilities have multiplied across Douglas and Arapahoe counties. Much of that growth can be traced to 2001, when voters in both counties approved a tax to fund those operations. …Wellspring Community opened in 2009 with a mission to provide work, education and enrichment opportunities to adults with special needs. Today, the growing organization has an art studio in downtown Castle Rock, a fully operational bakery in the Emporium and cooperative work/education programs at four locations around town. (Mitchell, 9/19)

Texas Tribune: For Some Transgender Texans, Bathroom Bill Fight Spurs Bids For Office
Four people in two years are hardly a speck in a state of nearly 28 million, but that number means Texas currently has more transgender candidates than any other state, according to Logan Casey, a Harvard researcher who studies LGBTQ representation in politics. And it’s a disproportionately large group — Texas carries just under 9 percent of the country’s population, but about 14 percent of its current transgender candidates. (Platoff, 9/20)

Chicago Tribune: Centegra Health To Eliminate, Outsource Hundreds Of Jobs
Financially troubled Centegra Health System plans to eliminate 131 jobs and outsource another 230 positions, the northwest suburban hospital system announced Tuesday. The layoffs and outsourcing come amid a time of financial stress for many hospitals nationwide and follow a year of steep losses for Centegra, which has hospitals in McHenry, Woodstock and Huntley. (Schencker, 9/19)

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Health Warnings On Soda Ads Suppresses Free Speech, Judges Rules

A San Francisco ordinance would have required a warning on sodas and sugary beverages, but Ninth U.S. Circuit Court of Appeals Judge Sandra Ikuta writes in the ruling that the label is “not purely factual” and “unduly burdens and chills protected commercial speech.”

The Associated Press: Appeals Court Blocks San Francisco Warning Law For Soda Ads
A federal appeals court on Tuesday blocked a San Francisco law requiring a health warning on soda ads, saying the measure was misleading and would suppress free speech. A unanimous, three-judge panel of the 9th U.S. Circuit Court of Appeals stopped the 2015 ordinance from going into effect until a lawsuit filed by the American Beverage Association and other groups is resolved. (Thanawala, 9/19)

The Wall Street Journal: Appeals Court Blocks San Francisco Law Requiring Soda Health Warnings
The three-judge panel of the Ninth U.S. Circuit Court of Appeals found the ordinance stifles commercial speech and unfairly targets soda over other potentially unhealthy food and drinks. The panel blocked the rule from going into effect. The San Francisco ordinance, passed in 2015, requires advertisements for certain sugar-sweetened drinks to include a disclaimer that says “WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay. This is a message from the City and County of San Francisco.” (Randazzo, 9/19)

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Following 9 Deaths At Florida Nursing Home, Task Force Formed To Push For Reforms

“We now have a chance to fix what went wrong and ensure something like this never happens again,” said one state lawmaker.

Miami Herald: Haunted By Nursing Home Deaths, Task Force Joins Rush To Make Reforms
In a crowded North Miami Beach City Hall chamber, elected officials, first responders and healthcare workers gathered to establish a task force to better regulate senior facilities, in the wake of eight deaths in Hollywood. The task force, started Tuesday, aims to combine efforts to enact national, state and local policies to ensure the safety of those in assisted living facilities in the wake of a disaster. (Ostroff, 9/19)

The Washington Post: Hurricane Aftermath: Death Toll Rises To 9 In South Florida Nursing Home That Overheated
A ninth patient from a South Florida nursing home that overheated during power outages following Hurricane Irma died on Tuesday, according to police. The death of Carlos Canal, the ninth patient, occurred nearly a week after the nursing home in Hollywood, Fla., became the focus of a criminal investigation when the air conditioning failed and eight other patients ultimately died. (Berman, 9/19)

Kaiser Health News: Nursing Home Disaster Plans Often Faulted As ‘Paper Tigers’
It does not take a hurricane to put nursing home residents at risk when disaster strikes. Around the country, facilities have been caught unprepared for far more mundane emergencies than the hurricanes that recently struck Florida and Houston, according to an examination of federal inspection records. Those homes rarely face severe reprimands, records show, even when inspectors identify repeated lapses. (Rau, 9/19)

Miami Herald: Gov. Scott Places Blame For 9 Deaths Directly On Hollywood Nursing Home
Four days after the owners of a Hollywood nursing home released a detailed time line casting blame for the deaths of eight elders on Florida health administrators and a local utility, Gov. Rick Scott’s administration issued a time line of its own — declaring that the Rehabilitation Center at Hollywood Hills “failed to do their basic duty to protect life.” (Marbin Miller and Klas, 9/19)

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N.M. Officials To Brief Lawmakers Today On Plans To Curb Medicaid Spending

Proposals to cut state spending have included requiring enrollees to pay monthly premiums and copayments. In other Medicaid news, a look at Louisiana’s program, a managed care contract controversy in Mississippi and record backlogs in Oregon.

The Associated Press: New Mexico Presses Forward With Medicaid Premiums, Copays
New Mexico is pressing forward with plans to limit increases in state spending on Medicaid health care for low-income and disabled residents by adding monthly premiums and copays from patients, as Senate Republicans in Washington contemplate fundamental changes to Medicaid. State officials will brief lawmakers Wednesday on an array of proposed changes to the state’s Medicaid health care program designed to keep costs down while improving the delivery of health care for New Mexico’s poorest residents. (9/20)

New Orleans Times-Picayune: Medicaid In Louisiana: Who Gets It? How Does It Work?
Medicaid has been at the center of much of the health care and budget debate this year in Washington and Baton Rouge. Here is a primer on the program. … About 74 million people — 1 in 5 five Americans — are enrolled in Medicaid. Louisiana is more dependent, with 1.6 million — about 1 in 3 residents — using the program. (O’Donoghue, 9/19)

Jackson (Miss.) Clarion-Ledger: $2B Medicaid Contract Moving Forward After Contract Review Board Refuses To Vote
Public Service Contract Review Board members took a passive role on the Medicaid managed care debate Tuesday, refusing to take up the matter after their staff recommended they approve the $2 billion contract. The non-vote means the MississippiCAN contract, the subject of much controversy since the Mississippi Division of Medicaid signed it in June, is effective and will move forward, according to the board and Medicaid’s attorney. (Wolfe, 9/19)

East Oregonian: Eliminating Medicaid Backlog Will Cost Oregon At Least $4.3 Million
An intensive effort to shore up Oregon’s Medicaid enrollment records is expected to cost the state at least $4.3 million. Participants in the Oregon Health Plan, Oregon’s Medicaid program, must have their eligibility for the plan verified annually in a process called redetermination. Oregon had fallen behind on those annual redeterminations, and by late May had an estimated backlog of about 115,000 people whose eligibility for the Oregon Health Plan was in question. (Withycombe, 9/19)

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Viewpoints: Nursing Home ‘Horror’; Time To Talk About Mental Illness, Not Blame The Victim

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

The Washington Post: The Inexplicable Horror Of The Deaths Of Eight Elderly People In Florida
“Unfathomable.” “Inexcusable.” Those were the words used respectively by Florida Gov. Rick Scott (R) and Sen. Bill Nelson (D-Fla.) to describe the deaths of eight elderly people found in a sweltering nursing home in the aftermath of Hurricane Irma last week. Those descriptions, while accurate, nonetheless fail to capture the full, inexplicable horror of the deaths. That people who were so vulnerable and needed special care were instead treated as an afterthought is insupportable. (9/17)

The Charlotte Observer: We Need To Talk About Mental Health
As we reflect on lessons learned one year after Keith Lamont Scott’s death and the subsequent community uprising, it’s time to start asking how we can provide more help to treat mental illness – which may be an underlying factor in crime, violence and misunderstanding. Research has shown that up to one half of people killed by law enforcement officers suffered from a disability, typically those with a mental illness or, in the case of Keith Lamont Scott, a traumatic brain injury. Yet stories in the public narrative often ignore the disability component or blame the victim. (John Cleghorn, Ophelia Garmon-Brown and Brandon Risher, 9/15)

San Jose Mercury News: Homelessness, Health Care Crises Overlap At VMC
Housing provides immediate stability and independence, and this stabilizing force can lead to vastly improved health outcomes. Traditionally, housing programs for the homeless – particularly those run by the government – have required that patients “get clean” before they can earn housing. But that view has been changing. (Nuriel Moghavem, 9/15)

Los Angeles Times: Refusing To Build Public Toilets Doesn’t Make Homeless People Go Away. It Creates A Public Health Crisis
Faced with an appalling shortage of public toilets in the Skid Row area, Los Angeles city officials promised in July to put up 10 more toilets by mid-September. Time’s up, but the toilets are not — at least not yet. City officials say they will unveil within a month a mobile “hygiene center” in the midst of Skid Row on a city-owned parking lot, offering toilets, hand-washing stations, showers, and half a dozen stacked washers and dryers for laundry. There will be security personnel as well as formerly homeless people working at the site, along with outreach workers who can steer people to housing and services. So, if downtown homeless people can hold it for a month, they’ll get 10 toilets and more. (9/16)

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Different Takes: What To Do With CHIP; Deal With Threats To Obamacare Before Single Payer

News outlets examine a variety of pressing health policy issues, ranging from the reauthorization of the Children’s Health Insurance Program to what’s next for the Affordable Care Act.

Forbes: Children’s Health Insurance Program Demands Quick, Bipartisan Passage
CHIP was a shared vision of Republicans and Democrats alike. It seems like ancient history now, but, in 1997, I joined with members from both sides of the aisle to debate health care policy forcefully but productively. Led by Senators Ted Kennedy (D-MA) and Orrin Hatch (R-UT), we crafted the CHIP language. Bipartisan action, so crucial to the health of the country and the economy, was never more important than when it came to insuring America’s children. Now, two decades later, that progress is in jeopardy. CHIP is set to expire on September 30. (Bill Frist, 9/14)

National Review: Continue To Fund Children’s Health Care, But Coordinate The Programs Better
CHIP, which helps states provide health-care coverage to low-income kids, is better structured than Medicaid to ensure that funds are targeted to those who need assistance most. Now, after the Affordable Care Act has created an entitlement to subsidized coverage through the exchange, CHIP-eligible families are often torn between two programs that fit together poorly. If a few minor flaws in its design are fixed, however, CHIP can fill a gap and enhance the rest of America’s health-care safety net. (Chris Pope, 9/18)

The Washington Post: Before Tackling Single-Payer, Save Obamacare
Before supporters of universal health coverage get all wrapped up debating a single-payer system, they need to focus on a dire threat to the Affordable Care Act likely to come up for a vote in the Senate before the end of the month. The latest repeal bill is an offering from Republican Sens. Lindsey O. Graham (S.C.) and Bill Cassidy (La.) that would tear apart the existing system and replace it with block grants to the states. Block grants — flows of money for broad purposes with few strings attached — are a patented way to evade hard policy choices. All the tough decisions are kicked down to state capitals, usually with too little money to achieve the ends the block grant is supposed to realize. (E.J. Dionne, 9/17)

The New York Times: Complacency Could Kill Health Care
I haven’t yet read Hillary Clinton’s “What Happened,” but it seems pretty clear to me what did, in fact, happen in 2016. These days, America starts from a baseline of extreme tribalism: 47 or 48 percent of the electorate will vote for any Republican, no matter how terrible, and against any Democrat, no matter how good. This means, in turn, that small things — journalists acting like mean kids in high school, ganging up on candidates they consider uncool, events that suggest fresh scandal even when there’s nothing there — can tip the balance in favor of even the worst candidate imaginable. (Paul Krugman, 9/18)

Baltimore Sun: Medicaid Cuts Shift Burdens To States
Thanks to massive grassroots mobilization efforts, our state narrowly averted disaster when Congress failed to pass any version of Affordable Care Act (ACA) repeal that would have restructured Medicaid and left thousands of my constituents without health care coverage. Stopping health care repeal was a huge victory, but the fight is not over yet. Even deeper cuts to Medicaid have been proposed in the 2018 budget resolution, which would slash health care by $1.5 trillion over the next 10 years to pay for billions in tax breaks to the rich and corporations over that same period. (Rep. C.A. “Dutch” Ruppersberger, 9/17)

The New York Times: The Best Health Care System In The World: Which One Would You Pick?
“Medicare for all,” or “single-payer,” is becoming a rallying cry for Democrats. This is often accompanied by calls to match the health care coverage of “the rest of the world.” But this overlooks a crucial fact: The “rest of the world” is not all alike. The commonality is universal coverage, but wealthy nations have taken varying approaches to it, some relying heavily on the government (as with single-payer); some relying more on private insurers; others in between. (Aaron E. Carroll and Austin Frakt, 9/18)

The Washington Post: A Century Ago, Women Fought For Access To Contraception. The Trump Administration Threatens To Undo Their Work.
Trump administration officials vow that they are going to take care of the health of moms and babies. But their pledge to cut funding to Planned Parenthood promises to do the opposite. The proposed cuts have focused not just on the procedure of legal abortion (which is, of course, another column), but also on eliminating access to contraceptives. These proposals ignore a fundamental truth: Access to birth control is central to women’s health. In fact, it always has been. (Lauren MacIvor Thompson, 9/15)

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State Highlights: Texas Ranked As State With Most Uninsured People; Surge Of Domestic Violence Cases Stuns Sacramento

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

Houston Chronicle: Texas, And Many Of Its Cities, Have The Most Uninsured People In The U.S. 
Of the 10 highest uninsured cities in the U.S. in 2016, eight of them were in Texas.Those Texas cities include Dallas, Laredo, and Baytown, according to the analysis conducted by WalletHub of health insurance data. WalletHub measured and ranked 547 different cities around the country. Of the 64 largest cities analyzed (these were cities with more than 300,000 people), Dallas (22.2 percent) came in dead last with Houston  right above it. (Alfonoso, 9/15)

Los Angeles Times: UCLA Pharmacy Closed After State Finds It Sent Out Drugs With Expired, Potentially Dangerous Ingredients
A state pharmacy inspector made a surprising discovery last year while conducting a routine records review at a Westside facility that compounded drugs for patients at UCLA medical centers. More than 1,000 IV bags of sterile medications for heart patients and others with serious health issues had been made with expired and potentially dangerous ingredients, according to state Board of Pharmacy records. (Christensen, 9/15)

The CT Mirror: Last Night, The Budget Politics — Today, The Details
Legislators arrived at the State Capitol on Friday with the opportunity for the first time to see the details of a $41.4 billion, two-year budget proposal that the administration of Gov. Dannel P. Malloy and Democratic legislative leaders hoped would end Connecticut’s summer-long budget impasse. (Phaneuf, Pazniokas and Rade Thomas, 9/15)

Richmond Times-Dispatch: VDH Encourages Everyone, Especially Health Care Workers, To Receive Flu Shots
Last week, the Virginia Department of Health held an event at the Richmond City Health District with health care leaders, as well as Richmond Mayor Levar Stoney, in which Stoney and Virginia’s health commissioner, Dr. Marissa Levine, received their flu shots. … In Virginia, the rate of people receiving their flu shots remained relatively stagnant between 2010 and 2014, VDH data show, with just under 50 percent receiving vaccines. (O’Connor, 9/17)

Columbus Dispatch: Study Says The Developmentally Disabled Receive Poorer Health Care
An author of a study that shows Ohioans with developmental disabilities struggle to get adequate medical care says medical schools should focus more on the issue. The study revealed that people with disabilities fared worse than others when it comes to their health status, the quality of their health care, access to care, unmet health-care needs and number of hospitalizations and emergency department visits. (Viviano, 9/16)

The Desert Sun: Thermal’s Flying Doctors, Providing Free Health Care, Sees Fewer Patients. Fear Of Deportation May Play Role
Before the sun rose Saturday, people in need of medical care began lining up outside Desert Mirage High School in Thermal for an opportunity to see physicians, dentists, optometrists and hearing specialists – all for free. From 8 a.m. to about 3 p.m., volunteers with Flying Doctors health fair, organized by Luz Moreno with Clinicas de Salud del Pubelo Inc. in Coachella, brings doctors from all over into the east end of the valley to provide much-needed medical care. The one-day clinic offers everything from basic medical checkups to cancer screenings and everything in between. Volunteers also assist with insurance enrollment for those who qualify. (Barkas, 9/16)

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Hospitals Involved In Safety Problems Rarely Face Serious Repercussions, Investigation Finds

USA Today has been following the probe into MedStar Washington Hospital Center for its sewage leaks. Outlets report on more hospital news from Kansas, Connecticut and Wisconsin as well.

USA Today: Hospital Safety Investigations Seldom Result In Major Penalties
Hospitals that fail to report or address safety problems, including those that increase the risk of infections, rarely face meaningful repercussions by state or federal officials, health care experts say. USA TODAY reported last week that MedStar Washington Hospital Center is under investigation by the D.C. health department for recent sewage leaks, although the problem has been going on for up to two years. The go-to hospital for members of Congress and the White House also suffers from poor quality ratings, particularly on foreign bodies left inside patients and certain infections. (O’Donnell, 9/17)

KCUR: How One Missouri Town Saved Its Hospital From Financial Collapse 
$1.25 million.That’s the size of the bill that could have shuttered the only public hospital in rural Pemiscot County, Missouri in August 2013. $750,000 for payroll.  $500,000 for a bond payment. $1.25 million total. One August day in 2013, the hospital’s CEO Kerry Noble had to face facts: The money just wasn’t there. It took an emergency bailout from a local bank to keep their doors open. For now. (Sable-Smith, 9/18)

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LA Tries To Get Ahead Of Highly Contagious Hep A Outbreak That’s Sweeping San Diego

Since November, 421 people in San Diego County have been infected with the virus, including the 16 who died. So far Los Angeles has been spared, but they don’t want to be caught off-guard.

Los Angeles Times: San Diego Is Struggling With A Huge Hepatitis A Outbreak. Is It Coming To L.A.?
Health officials in San Diego have scrambled for months to contain an outbreak of hepatitis A — vaccinating more than 19,000 people, putting up posters at bus stations and distributing hand sanitizer and cleansing wipes. Despite those efforts, 16 people have died of the highly contagious virus in San Diego County and hundreds have become ill in what officials say is the nation’s second-largest outbreak of hepatitis A in decades.Earlier this month, San Diego officials declared a public health emergency. (Karlamangla, 9/16)

Los Angeles Times: San Diego Opens Downtown Restrooms Amid Hepatitis A Crisis
New portable public restrooms were opened in downtown San Diego over the weekend in an effort to help combat the growing hepatitis outbreak that has killed 16 people and infected more than 400 since last fall, officials said. The dearth of 24-hour public restrooms downtown has long been cited as a shortcoming in the city — an inconvenience for visitors and a more dire problem for the growing homeless population. (Smolens, 9/16)

San Diego Union-Tribune: Diners Warned Of Possible Hepatitis Exposure At San Diego Beach Restaurant
A person at a Pacific Beach restaurant may have exposed an unknown number of customers to hepatitis A on seven different days, according to the San Diego County Health and Human Services Agency. Anyone who may have eaten or had a drink at the World Famous restaurant at 711 Pacific Beach Drive in San Diego at specific times on dates in late August and early September “may have been exposed to a person with the hepatitis A virus,” according to a statement released Friday morning by the county. (Sisson, 9/15)

The San Diego Union-Tribune: Restaurants, Diners Taking Precautions After Latest Hepatitis A Scare 
A day after news that San Diego’s deadly hepatitis A outbreak may have infiltrated the food service industry, more than 200 people lined up for vaccinations, restaurants reinforced their health safety measures and the city opened a new set of portable public restrooms downtown in an effort to gain some control over the disease’s spread. “All eyes are on San Diego,” Steve Zolezzi, president of the Food & Beverage Association of San Diego, said of the outbreak, one of the nation’s largest in decades which prompted county officials to declare a local public health emergency earlier this month. (Nikolewski, 9/16)

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