Tagged States

Perspectives On The Trump Budget: Examining The Charged Language Used To Respond To It; And What Does That Budget Say About Trump And His Voters?

Opinion writers take on a variety of fiscal issues advanced by President Donald Trump’s budget proposal, including how it treats Medicaid and Social Security’s disability program.

The New York Times: It’s All About Trump’s Contempt
For journalists covering domestic policy, this past week poses some hard choices. Should we focus on the Trump budget’s fraudulence — not only does it invoke $2 trillion in phony savings, it counts them twice — or on its cruelty? Or should we talk instead about the Congressional Budget Office assessment of Trumpcare, which would be devastating for older, poorer and sicker Americans? There is, however, a unifying theme to all these developments. And that theme is contempt — Donald Trump’s contempt for the voters who put him in office. (Paul Krugman, 5/26)

Boston Globe: Baby Boomers Beware: GOP’s Medicaid Cuts Could Hurt You Later
But there’s a giant hole in Medicare coverage, a hole that many aging American seniors eventually fall into: Nursing home care isn’t generally covered, and neither is full-time assistance at home. But if you live to 65, there’s a 40 percent chance you’ll enter a nursing home in the future. And it’ll cost you $80,000 to $90,000 a year on average. So where does that money come from if Medicare won’t pay? The answer is Medicaid, the other government insurance program, the one more often associated with the poor than the elderly. About 60 percent of nursing home residents rely on Medicaid. Which means that if the Republican plan to slash $834 billion from Medicaid goes forward, it could have a devastating impact on seniors with critical health needs. (Evan Horowitz, 5/25)

Chicago Tribune: Social Security’s Disabling Disability Program
Whhen the White House unveiled its 2018 budget on Tuesday, plenty of Democrats were quick to characterize it as stingy and cruel. Among the exhibits for the prosecution was the plan for Social Security Disability Insurance, whose projected outlays the administration would cut by 5 percent by 2027. White House budget director Mick Mulvaney started the argument in March. “It’s the fastest growing program,” he asserted. “It grew tremendously under President Obama. It’s a very wasteful program, and we want to try and fix that.” He was promptly accused of factual sloppiness and heartlessness, and some of the criticism was justified. But Mulvaney is onto a real problem that demands attention. (5/25)

The Kansas City Star: Truth From Mick Mulvaney
Cutting health care for the poor is a dream come true for many congressional Republicans. And that’s not an exaggeration, but a direct quote: “So Medicaid, sending it back to the states, capping its growth rate, we’ve been dreaming of this” since college, House Speaker Paul Ryan said in March. So, what are food stamp recipients who do work but don’t earn enough to feed their families to do? Get “the right mind-set,” says HUD head Ben Carson, since poverty is largely “a state of mind.” (Melinda Henneberger, 5/25)

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

Different Takes: The Politics Of Repeal, Replace And Reform

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

‘Health Care’ = Fighting Words In Montana

There was likely good reason why Greg Gianforte, successful Republican candidate for Congress from Montana, lost his cool on the eve of the election — scuffling with a reporter, breaking the man’s glasses and ending up with a misdemeanor assault charge:

He, like many Republicans these days, walks a perilous line when talking health care.

Ben Jacobs, a reporter for The Guardian, approached the candidate armed with an audio recorder and persistent, pesky questions about a Congressional Budget Office (CBO) report, which found that the GOP’s American Health Care Act would leave 23 million more Americans uninsured over 10 years and would effectively price out from coverage millions with preexisting conditions.

Though the AHCA passed muster in the House of Representatives, disapproval of the Republican plan has been high among voters — by ratios of more than 2-to-1 among men and more than 3-to-1 among women, according to a Quinnipiac University poll. Over 50 percent of Republicans opposed cutting federal funding for Medicaid, a component of the bill.

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Torn between conflicting impulses, the GOP candidate for Montana’s only seat in the House of Representatives had already stepped into the health care muck twice — on opposite sides of the issue. He told reporters he would not have voted for the Obamacare repeal bill passed by the House earlier this month, but a tape surfaced of him saying he was “thankful” for that same bill during a fundraising call with D.C. lobbyists. No wonder he wasn’t eager to respond to Jacobs’ question.

On the other side of the political divide, Democratic challenger Rob Quist tried to seize the moment, making opposition to the AHCA a campaign issue. On the final weekend before Thursday’s vote, Quist made a major buy of political ads that pinned the erosion of preexisting condition protections on his opponent. He confided his own preexisting condition — related to “a botched gall bladder surgery” — and noted that about half of all Montanans have a preexisting condition. Approximately 52 million Americans have a health history that could make them uninsurable in the future, if laws don’t guard against the practice.

According to the CBO report, “people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.”

Quist’s health narrative also dissolved one of Gianforte’s most potent attacks on him: financial problems that led to bankruptcy. Medical bills caused that bankruptcy, Quist said, and indeed, as a folk singer for most of his life, Quist was someone who had to buy health insurance on the unstable and discriminatory individual market. At 69, he can now rely on Medicare.

Gianforte, at 56, is in the age range of those who can be charged five times more than younger people for insurance under the House-passed bill. But, like President Donald Trump, Gianforte is a wealthy businessman, who likely has not had to focus deeply on the high costs of health coverage.

The altercation may not have affected the election. The seat has been occupied by a Republican for more than two decades, and nearly two-thirds of the expected turnout had already cast a ballot by mail. Montana also has same-day voter registration. Reporters from Montana Public Radio heard from brand-new voters Thursday — some who were appalled and compelled by Gianforte’s behavior and others who thought Jacobs was in the wrong.

It’s hard to say how much health care influenced Gianforte’s 6 percentage point win over Quist. The use of public lands had been the central issue in the election, and both candidates had avoided the topic of health care for much of the race, which replaces the seat vacated by Interior Secretary Ryan Zinke.

But Gianforte’s election eve scuffle may signal how tense and explosive health care will be politically for the 2018 election cycle.

Eric Whitney of Montana Public Radio contributed to this report.

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

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

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

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

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

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

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

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

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

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

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

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

Ominous Conclusions From The CBO Analysis Of The GOP Health Plan: ‘Fatal Flaws,’ ‘A Train Wreck’

Opinion writers use the Congressional Budget Office’s recent analysis of the updated American Health Care Act to pan the House Republican’s repeal-and-replace measure.

The Washington Post: The CBO Report Proves The GOP Health-Care Bill Is No Rescue Plan
Republicans sold the American Health Care Act (AHCA), the Obamacare repeal-and-replace plan that the House passed last month, with a number of untruths, chief among them that Obamacare is collapsing and the GOP effort is nothing short of a rescue plan. The Congressional Budget Office, Congress’s official scorekeeper, found Wednesday that the Republicans’ bill is no such thing. Not only would it result in 23 million more people lacking health insurance in a decade, but it would destabilize some states’ individual health-care insurance markets for all but relatively healthy people. (5/24)

The New York Times: C.B.O. Report Reveals Trumpcare’s Fatal Flaws
The Congressional Budget Office’s analysis of the House health care bill is a devastating indictment.The new report shows that millions of Americans would lose health insurance and the quality of insurance for millions more would deteriorate. The savings from that carnage — to borrow a favorite word of President Trump’s — would pay for tax cuts for the wealthy. (David Leonhardt, 5/24)

The New York Times: Republicans, Get Ready For The Trumpcare Headlines
In promising to repeal and replace the Affordable Care Act, many Republicans cited headlines from last year such as “Obamacare Premiums to Soar 22 Percent” and “As Obamacare Choices Dwindle, Feds Face Consumer, Political Backlash.” Yet based on a new analysis by the nonpartisan Congressional Budget Office, headlines would be even worse under the health care bill to repeal Obamacare, which was passed by the House this month. (Jeanne Lambrew, 5/24)

Los Angeles Times: CBO On GOP Obamacare Repeal: Still A Train Wreck
The Congressional Budget Office has spoken: The Obamacare repeal bill passed by the House GOP earlier this month could destroy the individual insurance markets in states where one-sixth of the population resides. It would cost 23 million people their insurance coverage within 10 years. And in many states it would be terrible for any but the most healthy Americans. That’s the CBO’s score of the latest version of the House bill, which only passed after it was amended to allow individual states to eviscerate consumer protections written into the Affordable Care Act. The CBO’s bottom line is that the bill is still a train wreck that will cost millions of Americans their coverage and sharply raise costs for millions more. (Michael Hiltzik, 5/24)

The New York Times: C.B.O. Has Clear Message About Losers In House Health Bill
The Senate now has a clearer sense of who would win and lose under the health bill the House sent them. It also got a startlingly direct message from government analysts about how destabilizing one of the House ideas could be. The Congressional Budget Office published its assessment of the House health bill on Wednesday, and warned that a last-minute amendment made to win conservative votes would result in deeply dysfunctional markets for about a sixth of the population. In those places, insurance would fail to cover important medical services, and people with pre-existing illnesses could be shut out of coverage, the budget office said. (Margot Sanger-Katz, 5/24)

The Washington Post: The CBO Confirms: The Republican Health-Care Bill Is Rotten Legislation
When the Congressional Budget Office finally released its scoring of the American Health Care Act, it seemed anti-climactic, if not irrelevant. The Senate is not bothering to take up the AHCA at all. The CBO score, to the delight of Democrats, does remind us how counterproductive is the GOP House bill, which every member will have to defend in 2018. (Jennifer Rubin, 5/24)

Huffington Post: 23 Million Fewer People Would Have Coverage Under Obamacare Repeal Bill, CBO Confirms
[T]he reasons why health insurance would be less expensive for some aren’t much to cheer about, the budget report makes clear. Prices would come down for healthy people because those who are sick or have illness in their medical histories would have less access to coverage ― and the policies available on the market would tend to be a lot less comprehensive. In other words, the price for lower premiums would be some combination of higher out-of-pocket costs, fewer covered services, and coverage that would be harder to get for the people who need it most. (Jonathan Cohn and Jeffrey Young, 5/24)

RealClear Health: CBO And America’s AHCA Headache
The much-anticipated Congressional Budget Office (CBO) score of the American Health Care Act (AHCA), the GOP’s effort to dismantle the Affordable Care Act (ACA) released yesterday, indicates that the bill would cause 23 million people to become uninsured while reducing the federal deficit by $119 billion. In that sense, there is little change from their assessment of the original version of AHCA. (Billy Wynne, 5/25)

USA Today: Republican Health Care Bill Indicted, Again
Now we know why House Republicans were so quick to ram through an Obamacare repeal-and-replace bill last month, not waiting for an estimate of its impact or holding any public hearings. On Wednesday the non-partisan Congressional Budget Office got around to “scoring” the bill, and the results are not pretty. By next year, 14 million fewer people would have health insurance. Within a decade, 23 million fewer people would be covered. (5/24)

USA Today: Republican Health Care Bill Fails The Jimmy Kimmel Test. Again.
Every so often a “national moment” takes us out of our day-to-day and helps shape our national thinking. The Exxon Valdez oil spill helped forge our national opinion about environmental responsibility. Terry Schiavo’s life-support case made the public contemplate a dignified death. Someday, when we look back on the current health care debate, we may see how a national moment helped us articulate a new consensus when late night TV host Jimmy Kimmel told the poignant story of the birth of his son Billy. (Andy Slavitt, 5/24)

Los Angeles Times: Trumpcare Will Make It Even Harder For Millions Of California’s Kids To Graduate And Get Jobs
he latest report from the Congressional Budget Office once again exposes the sharp and bitter truth about the House Republican efforts to “repeal and replace” President Obama’s Affordable Care Act. The American Health Care Act — now in the hands of the Senate — represents a glaring transfer of wealth, security and opportunity from low-income to high-income individuals. Should the AHCA or anything close to it become law, the students we serve in the California State University system and California Community Colleges system will be among the hardest hit. (Zelman Epstein, 5/24)

Modern Healthcare: An Extremist Attack On Public Health
Anyone who knows anything about healthcare didn’t need a Congressional Budget Office scorecard to understand the disastrous consequences of the American Health Care Act. That legislation, now before the Senate, passed the House in early May in a straight party-line vote without hearings or a CBO score. Now we know the score. 23 million would lose their health insurance over the next decade, including 14 million by the end of next year. (Merrill Goozner, 5/24)

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Different Visions: Are Republicans Trying ‘To Starve’ Obamacare To Death; Analyzing The State Of ACA Insurance Markets And Premiums

Opinion writers offer a variety of thoughts on health policy issues, including whether the health law is “collapsing under its own weight,” some ominous predictions about the individual insurance markets, the importance of the public option and a range of other ideas.

The New York Times: How The G.O.P. Sabotaged Obamacare
Obamacare is not “collapsing under its own weight,” as Republicans are so fond of saying. It was sabotaged from the day it was enacted. And now the Republican Party should be held accountable not only for any potential replacement of the law, but also for having tried to starve it to death. The Congressional Budget Office on Wednesday released its accounting of the House Republicans’ replacement bill for the Affordable Care Act, and the numbers are not pretty: It is projected to leave 23 million more Americans uninsured over 10 years, through deep cuts to insurance subsidies and Medicaid. The report underscores how the bill would cut taxes for the rich to take health care away from the less well-off. (Abbe R. Gluck, 5/25)

The Wall Street Journal: How To Read An ObamaCare Prediction
The political world waited with rapt attention Wednesday for the oracles at the Congressional Budget Office to release their cost-and-coverage predictions for the revised House health reform bill, which arrived late in the afternoon. But while Washington stood by, two reports emerged from the real world that are far more consequential. (5/24)

Los Angeles Times: Trump’s Team Issues A Stunningly Dishonest Study Of Obamacare Rate Increases
The Department of Health and Human Services seemed mightily pleased with a statistic it issued Tuesday. The agency’s figures showed that premiums on the Affordable Care Act exchanges “doubled” from 2013 through this year. This might not sound like good news for the people buying their coverage on those exchanges, but to HHS it was vindication. “This report is a sobering reminder of why reforming our healthcare system remains a top priority of the Trump administration,” agency spokesperson Alleigh Marré said. (Michael Hiltzik, 5/24)

Kansas City Star: Should A Limited Public Option Be Part Of Health Care Reform? 
Weren’t we focused on health care reform just a few weeks ago? Yes we were. And as it turns out, while we’re all looking at other things, lawmakers in Washington are still working on a rewrite of the Affordable Care Act. There were two important developments over the last two weeks we should think about. (Dave Helling, 5/24)

Stat: Native Americans’ Health Threatened By Denial Of Medicaid Expansion
America has broken several centuries worth of promises to its indigenous people. And we’re poised to do it again. … The Affordable Care Act provided a way to improve the health of thousands of Native Americans through Medicaid expansion. It provided a much-needed injection of funding to the long-neglected Indian Health Service and tribal health facilities by raising the income level needed for eligibility. With the poverty rate at 28 percent among Native Americans, this group disproportionately benefited from Medicaid expansion. (Kevin Duan and Aaron Price, 5/25)

Milwaukee Journal Sentinel: Health Care Reform The Wisconsin Way
Wisconsin has been a leader in covering its residents with high-quality health care and providing community supports so people with disabilities and frail elders can stay in their homes and communities and out of costly facilities. The American Health Care Act poses a particularly dangerous threat to our state’s residents, in part because we have done so much right. (Barbara Beckert, 5/24)

Lexington Herald Leader: Calling Dr. Paul: Seriously, You Don’t Think The U.S. Can Afford Health Care?
The United States spends more per person on health care than any other country, but our health outcomes are far from the best. Simply put, the challenge facing Congress is how to get more value for all that money. Yes, the details are complex, but we’re a big, complex country with a big, complex economy. Our elected leaders should engage that complexity and produce practical reforms and solutions that inspire confidence in the future. That is a reasonable expectation. (5/24)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In related news —

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

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Some States, Facing Tight Budgets, Working To Recertify Medicaid Enrollees’ Eligibility

Missouri, Wyoming and Mississippi have enacted laws to scrutinize whether Medicaid or food stamp recipients are eligible, and several other states are considering such measures. News outlets also report on Medicaid news from Oregon, Iowa, Indiana and Kansas.

Stateline: What Happens When States Go Hunting For Welfare Fraud
Now, faced with growing Medicaid enrollment and tight budgets, Republican lawmakers in several … states are taking … steps to ensure that people receiving welfare benefits are eligible for them. Under their proposals, which are modeled on legislation drafted by a national conservative group, recipients would face tougher and more frequent eligibility checks. And the checks could be conducted by private contractors who are motivated to justify their hiring by knocking as many people as possible off the rolls. (Fifield, 5/23)

The Oregonian: Health Authority Estimates 32,000 Medicaid Recipients Could Be Ineligible 
Oregon Health Authority officials told a legislative committee Tuesday that the agency might have provided Medicaid benefits to some 32,000 people who no longer qualified for them. If historical trends hold true, as the state processes a backlog of 115,000 Medicaid renewals, 28 percent of them could be deemed ineligible because they make too much money. But Lynne Saxton, director of the health authority, flatly rejected the idea that the lingering questions about the state’s Medicaid rolls poses a financial risk for the state. The questions come just as state lawmakers consider a new tax on health care providers. At the federal level, the Trump administration continues to push for the repeal of the Affordable Care Act and the sweeping Medicaid changes that came with it. (Manning, 5/23)

Des Moines Register: Privatized Medicaid Appears To Be Saving Iowa Money. But Is It Real?
Iowa will spend $600 less on each Medicaid recipient this year compared with before private companies were hired to manage the program, according to a projection from the nonpartisan Legislative Services Agency. … The data does not account for millions of dollars in losses the private companies hired to manage the program have accrued in the current fiscal year, losses Iowa has agreed to at least partially repay in 2018. Those losses won’t show up in the current year’s budget. (Clayworth, 5/23)

Modern Healthcare: Indiana Medicaid Director Moser Steps Down
Joe Moser, a key architect of Indiana’s alternative Medicaid expansion program has stepped down from his role as the state’s Medicaid director. Moser was appointed by then-Gov. Mike Pence in 2013 and oversaw the care of more than 1.5 million Medicaid and Children’s Health Insurance Program enrollees. Moser told Modern Healthcare he has no plans to work with the Trump administration, but would be open to that possibility. He decided to leave Indiana’s Medicaid agency in order to pursue new opportunities. (Dickson, 5/23)

Kansas City Star: Federal Officials Accept Plan To Fix Kansas Medicaid Program 
Federal officials have accepted a corrective action plan for Kansas’ privatized Medicaid program, an important hurdle in ensuring the program can continue to operate next year. The federal Centers for Medicare & Medicaid Services had rejected the state’s request to extend its KanCare program through 2018 in January after finding that the program was “substantively out of compliance” with federal regulations. (Lowry, 5/23)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Price Tag For Universal Health Care In California Would Run $400B

A state Senate panel considering the measure says that money for existing public programs could cover half the cost of a single-payer system to cover all 39 million Californians. But the rest might have to come from new taxes — a serious political obstacle.

The Associated Press: $400 Billion Price Tag For California Single-Payer Bill
A California bill that would eliminate health insurance companies and provide government-funded health coverage for everyone in the state would cost $400 billion and require significant tax increases, legislative analysts said Monday. Much of the cost would be offset by existing state, federal and private spending on health coverage, the analysis found, but total health care costs would increase by an estimated $50 billion to $100 billion a year. That’s a massive sum in a state where the entire general fund budget is $125 billion. (5/22)

California Healthline: Tab For Single-Payer Proposal In California Could Run $400B
A proposed single-payer health system in California would cost about $400 billion annually, with up to half of that money coming from a new payroll tax on workers and employers, according to a state analysis. The report by the state Senate Appropriations Committee, issued Monday, put a price tag for the first time on legislation that would make the state responsible for providing health coverage to all 39 million Californians. The state-run system would supplant existing employer health insurance in California, as well as coverage through public programs such as Medicaid and Medicare. (Terhune, 5/23)

Sacramento Bee: Universal Health Care Cost In California $400 Billion A Year
The price tag is in: It would cost $400 billion to remake California’s health insurance marketplace and create a publicly funded universal heath care system, according to a state financial analysis released Monday. California would have to find an additional $200 billion per year, including in new tax revenues, to create a so-called “single-payer” system, the analysis by the Senate Appropriations Committee found. (Hart, 5/22)

KQED: Single-Payer Plan’s Price Tag In California: $400 Billion Per Year 
It would cost the state of California an estimated $400 billion per year to cover all of its 39 million residents, according to a staff analysis by the state’s Senate Appropriation Committee. That’s more than twice the state’s total annual budget of $180 billion. But the main legislative advocate for single-payer, Senator Ricardo Lara (D-Bell Gardens), explained the state could get access to half of that amount, $200 billion, by shifting over what it already spends on Medicare, Medi-Cal and other state-run health services. (Feibel, 5/22)

POLITICO Pro: California Lawmakers Get First Look At Single-Payer Cost: $400 Billion 
California’s universal health care bill could cost the state about $400 billion a year. Half of that could be covered by existing federal, state and local funding streams, but additional taxes would be required to make up the balance, according to a state committee fiscal analysis released Monday. While the bill’s financing has yet be worked out, the Senate appropriations committee’s report provides the first insight into what an audacious overhaul of the state’s health system could cost. It concluded that $200 billion would be needed in new taxes. (Colliver, 5/22)

San Jose Mercury News: Healthy California Act Annual Price Tag: $400 Billion
The annual price tag for California’s proposed universal, single-payer health care system would come to a staggering $400 billion and possibly trigger substantial tax increases, according to a state review released Monday. That eye-popping number means the cost of Senate Bill 562, known as The Healthy California Act, would be three times higher than the state’s proposed $124 billion general fund budget for next year. (Seipel, 5/22)

San Francisco Chronicle: Single-Payer Health Care Would Cost More Than California Budget
Creating a single-payer health care system in California would cost $400 billion a year — including $200 billion in new tax revenue, according to an analysis of legislation released Monday by the Senate Appropriations Committee. The projected cost far surpasses the annual state budget of $180 billion, and skeptics of the bill say the price tag is “a nonstarter.” (Ho, 5/22)

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

St. Louis Sued Over Law Prohibiting Work Discrimination Against Women Who Have Had An Abortion, Used Birth Control

Some St. Louis Catholics are challenging the city’s so-called abortion sanctuary ordinance that is aimed at protecting women from discrimination by an employer or landlord based on whether they’ve had an abortion, used contraceptives or are pregnant.

The Associated Press: Catholics Challenge St. Louis’ ‘Abortion Sanctuary’ Law
A group of St. Louis Catholics filed a lawsuit against the city Monday over a local ordinance that prohibits discrimination based on “reproductive health decisions,” saying the law could force employers or landlords to go against their religious beliefs. The law, enacted in February, bars employers from hiring or firing people based on whether they have had an abortion, get pregnant outside of marriage, or use contraceptives or artificial insemination. Landlords also can’t refuse to rent to someone based on those criteria. (Salter, 5/22)

St. Louis Public Radio: St. Louis’ ‘Abortion Sanctuary’ Opponents Take Their Fight To Federal Court
The Archdiocese of St. Louis and the city are in a legal showdown over new provisions in St. Louis’ anti-discrimination law regarding women’s reproductive decisions. The archdiocese’s schools and a private company, O’Brien Industrial Holdings, on Monday in federal court filed a lawsuit challenging a St. Louis ordinance that they say adds abortion rights supporters to a protected class, while discriminating those who are against abortions. (Pratt, 5/22)

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

New Hampshire Governor Supports Moving State To High-Risk Pool Model

Meanwhile, the state’s conservatives speak out against reported rate increases for next year. “The latest premium increases under Obamacare will break many families’ budgets,” says New Hampshire Republican State Committee Chairman Jeanie Forrester.

New Hampshire Union Leader: Sununu Proposes Return Of High-Risk Pool
Gov. Chris Sununu and the state’s top insurance official on Monday backed a revision in state law that would allow officials to waive some of the provisions of Obamacare — including provisions addressing pre-existing conditions. In a joint statement, Sununu and New Hampshire Insurance Commissioner Roger Sevigny endorsed an amendment to House Bill 469, which they said would authorize Sevigny to seek federal waivers if they would keep insurance affordable and available in the state. On Sunday, the New Hampshire Sunday News reported about a document that details a potential premium increase of 44 percent next year on the Obamacare Exchange. (Hayward, 5/23)

New Hampshire Union Leader: NH Conservative Groups Critical Of Possible Obamacare Rate Increases 
Granite State conservative groups weighed in Monday on a report in the New Hampshire Sunday News that health insurance policies through the Affordable Care Act could see high rate increases in the coming year. “The latest premium increases under Obamacare will break many families’ budgets. The law is obviously failing working people and is doing far more harm than good. Republicans in Congress are actively working to reform our nation’s healthcare system with a plan that lowers premiums while ensuring folks have access to quality coverage,” said New Hampshire Republican State Committee Chairman Jeanie Forrester. (5/22)

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$2M Ad Blitz In Support Of GOP Health Plan Targets Vulnerable Republicans’ Districts

The group launching the campaign, the American Action Network, is aligned with House Speaker Paul Ryan (R-Wis.).

The Hill: Ryan-Allied Group Launches $2M Ad Campaign Ahead Of Healthcare CBO Score 
An outside GOP group aligned with Speaker Paul Ryan (R-Wis.) unveiled a $2 million TV ad blitz on Tuesday defending the legislation to replace ObamaCare ahead of the highly anticipated Congressional Budget Office analysis of its effects. American Action Network’s ad will run in 21 House districts and nationally on MSNBC’s “Morning Joe” to tout the GOP’s bill, known as the American Health Care Act. (Marcos, 5/23)

Los Angeles Times: Conservative Group Runs Ads Thanking California GOP For Health Care Vote
A conservative advocacy group will run television ads thanking six California Republicans for voting for the GOP bill to roll back the Affordable Care Act. All 14 Republicans in California’s congressional delegation voted for the bill, called the Affordable Health Care Act, when it passed the House without Democratic support last month. Democrats have pledged to make it a campaign issue. (Wire, 5/22)

And in other election-related news —

Kaiser Health News: Health Debate Heats Up In Montana For This Week’s Special Election
Montana’s one and only seat in the House of Representatives is up for grabs, and in the final weekend before Thursday’s special election, the underdog Democrat was hammering the Republican health care bill in TV ads. The ads open with Democrat Rob Quist asking, “Did you know half of all Montanans have a preexisting condition?” He then attacks Republican challenger Greg Gianforte for supporting the House-passed American Health Care Act, which would allow states to drop preexisting conditions protections. (Whitney, 5/23)

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Tab For Single-Payer Proposal In California Could Run $400 Billion

A proposed single-payer health system in California would cost about $400 billion annually, with up to half of that money coming from a new payroll tax on workers and employers, according to a state analysis.

The report by the state Senate Appropriations Committee, issued Monday, put a price tag for the first time on legislation that would make the state responsible for providing health coverage to all 39 million Californians. The state-run system would supplant existing employer health insurance in California, as well as coverage through public programs such as Medicaid and Medicare.

One of the chief obstacles to the legislation, Senate Bill 562, is the prospect of higher taxes. It also has exposed deep divisions among Democrats over whether now is the time to pursue single-payer — just as the Affordable Care Act comes under attack from Republicans in Washington. At a hearing Monday, one Democratic legislator questioned whether the state can effectively manage a universal health care system.

The legislative analysis estimates a total annual cost of $400 billion to enact the Healthy California program for all residents, regardless of their immigration status.

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To put that in perspective, about $367 billion was spent on health care last year statewide, including public and private spending by employers and consumers, according to the UCLA Center for Health Policy Research.

Legislative analysts said federal, state and local taxpayer funding of about $200 billion a year for existing programs could be available to offset the overall tab of $400 billion for universal coverage. But additional tax revenue would be needed to foot the other half of the cost, according to the report, which raised the possibility of a 15 percent payroll tax on earned income.

Of course, the shift to a single-payer system should reduce current spending on health insurance by employers and workers, so those savings could offset some of the new taxes, the analysts said. The report estimated that employers and employees in California spend $100 billion to $150 billion a year now on health insurance and medical care.

“Total new spending required under the bill would be between $50 billion and $100 billion per year,” the report said.

The Senate analysis noted that all of its projections were “subject to enormous uncertainty” because the bill would mark “unprecedented change in a large health care market.”

A single-payer system likely “would be more efficient in delivering health care,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. (California Healthline is produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.)

But the proposal expands coverage to all and eliminates premiums, copayments and deductibles for enrollees, and that would cost more money, Levitt said. “You can bet that opponents will highlight the 15 percent tax, even though there are also big premium savings for employers and individuals,” he added.

State Sen. Ricardo Lara (D-Bell Gardens), a chief sponsor of the legislation, said the present system is unsustainable because health spending continues to grow faster than the overall economy, making coverage unaffordable for too many people.

Lara touted the potential savings from creating a public plan with greater bargaining power and cutting out the administrative overhead and profits of private health insurers acting as middlemen.

Overall, many of the details behind California’s single-payer proposal remain in flux. Under questioning from fellow lawmakers, Lara said the 15 percent payroll tax is “hypothetical” and “we don’t have a financing mechanism yet for this bill.”

Lara said he has sought a review from researchers at the University of Massachusetts-Amherst into potential funding sources for the measure.

Lara also said there’s no guarantee the Trump administration would grant the federal waivers necessary for California to shift Medicare and Medicaid funding into a single pot for universal health care.

With so many unknowns, the Senate Appropriations Committee didn’t vote on the measure Monday. Backers of the legislation are hopeful for a vote in the full Senate next month and then lawmakers can continue to work on the financial aspects during the summer.

At Monday’s hearing, many consumers pointed to Medicare as a model for how single-payer works now and urged lawmakers to make California the proving ground for how it can succeed at the state level.

Business groups and health insurers spoke out in opposition, saying it would lead to massive disruption and escalating costs. Even if it passes the legislature, California Gov. Jerry Brown hasn’t endorsed the idea and new taxes may require a statewide ballot measure, which are always hard-fought campaigns.

The California Chamber of Commerce said the costs would likely be far higher than what was projected and the taxes imposed on employers would trigger major job losses.

State Sen. Jim Nielsen (R-Tehama), a member of the Appropriations panel, expressed similar concerns. “The impact on employers will be astounding,” Nielsen said. “How can you say this will be fiscally prudent for the state? The state has never gotten anything right in health care.”

State Sen. Steven Bradford (D-Gardena) also preached caution, questioning whether state agencies are up to the task. “I don’t want California to move toward a program that is not sustainable and one that we can’t manage,” Bradford said.

Other states have taken a close look at single-payer and balked. Colorado voters rejected a ballot measure last year that would have used payroll taxes to fund a near-universal coverage system.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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State Highlights: Texas Vaccination Bill Concerns Doctors; Major Reforms Sought In Iowa After Deaths Of Teens In Foster Care

Media outlets report on news from Virginia, Texas, California, Iowa, Kansas, Minnesota, Georgia, Florida, Ohio and Wisconsin.

Texas Tribune: Senate Passes Religious Protections For Child Welfare Agencies 
Texas senators voted 21-10 on Sunday to give child welfare providers protection from legal retaliation if they assert their “sincerely held religious beliefs” while caring for abused and neglected children in foster or Child Protective Services custody. House Bill 3859 would allow faith-based organizations to place a child in a religion-based school; deny referrals for abortion-related contraceptives, drugs or devices; and refuse to contract with other organizations that don’t share their religious beliefs. (Evans, 5/21)

Des Moines Register: ‘Heartbroken’ Iowa Agency Asks Experts How To Prevent Child Deaths
Two of the girls died after becoming extremely malnourished. The third ran away, fearing for her life. Advocates for home-schooling parents will tell you that such cases are rare, and statistics back them up. Just one of the 20 Iowa children who died in preventable deaths last year was home-schooled: 16-year-old Natalie, Reader’s Watchdog found. But revelations about the suffering of the three teens — and other cases nationally — have prompted Iowa legislators and advocates for children to call for major state reforms. Some want to bolster screening of potential foster and adoptive parents, as well as home-schoolers, to provide a better safety net. (Rood, 5/20)

Sacramento Bee: CA Nursing Board Quits Education Audit 
A California licensing board curtailed a massive audit of nursing credentials that it launched late last year, choosing not to finish a project that threatened to overwhelm the small department. The Board of Vocational Nursing and Psychiatric Technicians reviewed just 15 percent of the education records it demanded from more than 52,000 nurses and mental health workers last November before it elected to end the audit. (Ashton, 5/19)

Richmond Times-Dispatch: Virginia Ranks Best In Country For Early Elective Delivery Rates 
As of the end of 2016, Virginia had the lowest rate of early elective deliveries in the country, according to federal government data. The state’s rate was 1.3 percent, compared with the nationwide rate of 2 percent. An early elective delivery is an induction or cesarean section delivery between 37 and 39 weeks that is not medically necessary. (O’Connor, 5/20)

KCUR: Kansas City Health Organizations Launch Collaborative Health Science District 
Some of Kansas City’s largest health organizations announced on Friday the launch of a collaboration centered on Hospital Hill. The “UMKC Health Sciences District” includes the University of Missouri-Kansas City School of Medicine, Truman Medical Centers, Children’s Mercy Hospital and the Kansas City, Missouri, Health Department, among other partners. At an event that included the signing of the collaborative agreement, institution and civic leaders highlighted the value of having so many health providers, educational institutions and local city health organization within a few blocks of each other working together. (Smith, 5/19)

WABE: New Program Teaches Ga. Educators Youth Suicide Warning Signs 
The Georgia Bureau of Investigation’s Child Fatality Review Program teamed up with state education and health officials to create a new training program for school personnel. The program focuses on teaching educators warning signs in students and figuring out way to get the issue of suicide out in the open at their schools. (Hawkins, 5/19)

Sacramento Bee: California Democrats Shout Down Tom Perez
State Democrats’ three-day convention had a raucous start Friday, as liberal activists booed and heckled Democratic National Committee Chair Tom Perez after marching from the state Capitol to promote a universal heath care program. The leader of the nurses’ union that opposed Perez’s recent election had just warned California Democrats that they would put up primary election challengers against lawmakers if they don’t support a bill to create public-funded, universal healthcare. (Cadelago and Hart, 5/19)

Cleveland Plain Dealer: The Gender Pay Gap Is Alive And Well In Cleveland Healthcare 
Cleveland has the 18th greatest gender wage gap in the country. Here, female physicians are paid 27 percent – or $92,320 – less than their male counterparts, according to a recent study by Doximity, a social network for physicians. Female physicians in Cleveland earn an average annual wage of $246,210, while men make $338,530. (Christ, 5/19)

Milwaukee Journal Sentinel: Milwaukee’s Infant Mortality Numbers Improve But The Racial Disparity Is Still Wide
The call to arms was first sounded in 2004, when the Wisconsin Medical Journal reported that Wisconsin’s black infant mortality rate had collapsed from the third best in the nation to the second worst. Most of those babies — 77% — died in Milwaukee…The new FIMR shows that by 2016, the African-American rate had dropped to 13.6 deaths per 1,000 live births, which places Milwaukee on par with Detroit, Dallas and Minneapolis. (Stephenson, 5/20)

Tampa Bay Times: Entrepreneurs Aren’t Waiting For Lawmakers To Plan The Future Of Medical Cannabis 
The revolution started last year in Florida, when voters passed Amendment 2, a constitutional amendment designed to expand medical marijuana legalization beyond the limited use allowed under the Compassionate Use Act. But before departing Tallahassee earlier this month, the Florida Legislature failed to pass rules regulating marijuana’s medical use. Negotiations over regulations that are needed to implement the amendment stalled because of disagreements on the number of dispensaries each marijuana grower would be allowed to open. (Solomon, 5/19)

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Merger Would Make Steward Health Care The Largest Private For-Profit Hospital Operator

Boston-based Steward Health Care System announces that it will acquire Franklin, Tenn.-based IASIS Healthcare for $2 billion.

Boston Globe: Steward Health Care Merges With Tenn. Hospital System 
Steward Health Care System, founded almost seven years ago to rescue a group of struggling Massachusetts hospitals, is making its biggest move yet to become a national player in the competitive for-profit hospital industry. Steward on Friday announced a nearly $2 billion deal with IASIS Healthcare of Franklin, Tenn., which would make it the largest private for-profit hospital operator in the country. (Dayal McCluskey, 5/19)

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Texas Lawmakers Pass Strict Abortion Bill, Shifting Priority From Protecting Mother To Protecting Fetus

The legislation bans a commonly used procedure for second-trimester abortions, similar to laws that courts have blocked in other states. And Missouri asks an appellate court to step in over a judge’s decision to block the state’s abortion restrictions.

Texas Tribune: Texas House Approves New Abortion Restrictions
GOP House lawmakers took a sweeping approach to anti-abortion legislation on Friday, giving an initial OK to a measure that would ban the most common form of second-trimester procedure and change how health care providers dispose of fetal remains. Under the broad strokes of Senate Bill 8, any health care facility, including hospitals and abortion clinics, would have to bury or cremate any fetal remains whether from abortion, miscarriage or stillbirth, and they would be banned from donating aborted fetal tissue to medical researchers. (Evans, 5/19)

The Associated Press: Texas House Approves New Limits On Abortion
Texas’ Republican-controlled Legislature has advanced tough new limits on abortion, hitting back at a United States Supreme Court decision last summer that struck down most of the sweeping restrictions on the procedure that the state approved four years ago. (5/20)

Austin American-Statesman: Texas House Votes To Expand Abortion Regulations
After almost six hours of sometimes heated, sometimes tearful debate Friday, the Texas House approved legislation that would greatly expand abortion regulations in Texas. Senate Bill 8 would require abortion clinics and health centers to ensure that fetal tissue from abortions and miscarriages to be buried or cremated, with the ashes properly scattered — similar to a state agency rule that a federal judge voided earlier this year for limiting access to abortion without offering any health benefits. (Lindell, 5/19)

Meanwhile, in news about Planned Parenthood —

The Washington Post: Planned Parenthood To Close 10 Health Centers Across Midwest, Southwest
Planned Parenthood affiliates announced the closures of 10 health centers across the Midwest and Southwest this week, citing a variety of reasons including political attacks by antiabortion lawmakers. Planned Parenthood of the Heartland said it planned to close four clinics across Iowa because of the recent budget signed into law by Gov. Terry Branstad, who pledged to “defund” the women’s health organization. (Somashekhar, 5/19)

Denver Post: Planned Parenthood Will Close Clinics In Longmont And Parker, Blames Obamacare
Planned Parenthood says it will close clinics in Longmont, Parker and four others in the region, citing a tough financial landscape in the reproductive health care field due to effects of the Affordable Care Act. … “They would come in and get a pap smear and pay out of pocket,” [spokeswoman Whitney] Phillips said. “Under the ACA, a lot of patients were given the opportunity to be on Medicaid. Again, that’s wonderful, but it meant that rather than bill them directly, we had to bill Medicaid. And Medicaid reimburses at a very low rate.” (Antonacci, 5/19)

Atlanta Journal-Constitution: Georgia 6th: Ossoff Slams Handel’s ‘Nonsense’ Planned Parenthood Stance 
Democrat Jon Ossoff held a roundtable Friday with women’s health advocates and breast cancer survivors as his campaign stepped up the attack on Republican Karen Handel’s stint at a breast-cancer charity. A split on abortion is one of the starkest contrasts between the two candidates in the nationally-watched June 20 runoff to represent suburban Atlanta’s 6th District. (Bluestein, 5/19)

Roll Call: Sparring Over Women’s Health In Georgia’s 6th District
As the June 20 runoff election in Georgia’s 6th district approaches, Democrat Jon Ossoff and Republican Karen Handel are facing off with competing ads on women’s health and anti-abortion groups have joined in the fight. Ossoff’s broadcast cable ad, released Tuesday, features an ob-gyn doctor criticizing Handel for her move to “cut off funding for Planned Parenthood cancer screenings when she was an executive at Susan G. Komen.” Handel, then senior vice president of public policy at Susan G. Komen Foundation, spearheaded the organization’s decision to stop funding cancer screenings at Planned Parenthood. When the foundation overturned that decision, Handel resigned. (Raman, 5/19)

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Georgia Appears To Dodge A Bullet As Blue Cross Doesn’t Signal Plans To Pull Back Operations

In its initial filings with the state, the company says it will continue to sell individual policies in all 159 counties. In other news, a New Hampshire paper reports indications that premiums could go up significantly and California Healthline examines which companies are enticing customers on that exchange.

Atlanta Journal-Constitution: Blue Cross Blue Shield May Stay In Georgia Obamacare Market
Blue Cross Blue Shield of Georgia, the only remaining company to serve all 159 counties in the state, has filed its annual plans for next year’s insurance market exchange under the Affordable Care Act. In its initial filing, it filed plans for the entire state, said spokeswoman Debbie Diamond. The decision can still change. Negotiations between insurers and the state will continue for several months. (Hart, 5/19)

NH Union Leader: Obamacare Rate Could See Big Spike In NH Next Year 
Some Obamacare exchange premiums could increase an average of 44 percent next year in New Hampshire due in large part to Medicaid expansion and the opioid and mental health crises, according to a document obtained by the New Hampshire Union Leader. The document — stamped “Confidential” and marked “Draft Only” and “not for distribution” — hints that New Hampshire soon could be hit with health-care premium increases it has not experienced since Obamacare coverage started in January 2014. Provided by a government official, the document appears to be written by an insurance carrier to explain the expected double-digit increase. (Hayward, 5/20)

California Healthline: Blue Shield Has Highest Share Of Enrollees In Covered California
Blue Shield of California has the largest number of enrollees in the Covered California health insurance exchange, widening its lead over rivals Anthem Blue Cross and Kaiser Permanente, according to recently released data. The data, from Covered California, show that Blue Shield had 389,480 enrollees in the exchange as of December 2016, about 31 percent of the market. Anthem was next with 310,690 members, for a 25 percent share. Kaiser Permanente was third with 297,030 exchange enrollees, or 24 percent. Health Net and Molina Healthcare were fourth and fifth, respectively. (Terhune and Bazar, 5/22)

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