Tagged The Health Law

Senate Panel Makes Surprisingly Fast Work Of ‘Surprise Medical Bills’ Package

It may seem as if the Senate, or at least certain key senators, have decided on a way forward to fix the nation’s “surprise medical bill” problem. But make no mistake: The door is still open to try another solution.

Members of the Health, Education, Labor and Pensions (HELP) Committee approved a sweeping measure Wednesday that tackles a range of big-ticket health care concerns. The 196-page bill touches nearly every aspect of the health care industry, from lowering the price of prescription drugs and creating a national database of health care costs, to increasing vaccine rates and preventing youth tobacco use.

One thing the bill specifically does not deal with: the insurance market and the Affordable Care Act, which could be why the massive package was voted out of the committee in just over two hours with little debate. The Lower Health Care Costs Act of 2019, sponsored by HELP Committee Chairman Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), the top Democrat on the panel, sailed through with a bipartisan 20-3 vote.

“You don’t have to preach the whole Bible in one sermon,” said Alexander as he described his panel’s action. “We picked out one important thing: reducing health care costs.”

Still, just because the first hurdle has been cleared doesn’t mean there’s room for speculation about what could happen between now and when it reaches the Senate floor. Alexander said he’s hoping the bill will be voted on before the Senate leaves Aug. 2 for a monthlong recess.

The smooth hearing capped a busy few weeks, as senators debated the mechanism that would be used to stop surprise medical bills — the unexpected and often costly charges patients face when they get care from a doctor or hospital not in their insurance network.

An earlier draft of the bill outlined three options to solve disputes between payers and providers. There was an in-network guarantee, where all of the health care providers at a hospital — whether the anesthesiologist or lab — must accept in-network insurance rates.

Another option, often referred to as baseball-style arbitration, would have the health plan and the doctor — if they couldn’t reach an agreement on reimbursement — present to an independent arbitrator their best offers for how much a patient’s out-of-network care should cost. The arbitrator would choose between the two.

But another approach — benchmarking — ultimately made it into the formal draft. Here’s how it works: When patients are seen by doctors who aren’t in their network, the insurer would pay the providers the “median in-network rate,” meaning the rate would be similar to what the plan pays other doctors in the area for the same procedure.

At the markup hearing Wednesday, Alexander said he initially preferred one of the other approaches, the in-network guarantee, but changed his mind when the Congressional Budget Office said benchmarking would save more money.

A group of senators on the panel led by Sens. Bill Cassidy (R-La.), Maggie Hassan (D-N.H.) and Lisa Murkowski (R-Alaska) voted for the chairman’s choice, even though they had advocated for arbitration. Cassidy made clear he continues to have reservations.

“This is entirely for the insurance companies,” he said of benchmarking. “I’m surprised that my colleagues on the other side of the aisle running for president are OK with this.”

Neither of the two Democratic senators on the committee running for president, Sens. Elizabeth Warren (Mass.) and Bernie Sanders (Vermont), were present but both voted no by proxy.

But it is also not an entirely settled issue.

Cassidy and Alexander indicated that the door was still open to including independent arbitration before the package gets to the floor.

“We’re going to keep working on that the next three or four weeks. There are clearly opportunities to improve the bill and move in the direction Sen. Cassidy wants to go,” Alexander told reporters after the hearing.

At the markup hearing Wednesday, the committee took a step toward Cassidy’s preferred vision for fixing surprise bills. It passed an amendment from Cassidy that would require insurance companies to post accurate lists of who is in-network, so patients have a better chance of avoiding surprise bills.

“This bill is not as good as it should be,” Cassidy said. “And I thank the chairman because he has offered to work between now and floor consideration on the surprise bills.”

The only other amendment approved by the panel, offered by Sen. Tammy Baldwin (D-Wis.), would require drug companies to report price increases.

And despite Alexander saying early on that he didn’t want to talk about the individual insurance market or the ACA, some Democrats couldn’t let the opportunity pass without mentioning Republican efforts to undermine it.

“Repairing the train can only get you so far if you are pulling up the track at the same time — and that’s unfortunately exactly what this administration is doing,” Murray said in her opening statement. “The biggest threat to families’ health care continues to be sabotage from President Trump.”

The Values Of Health Care

Julie Rovner, the chief Washington correspondent for Kaiser Health News, joins Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and Alan Weil of Health Affairs at the Aspen IdeasHealth festival to discuss the politics surrounding the national debate on health care. The panel explores the failed effort to repeal and replace the Affordable Care Act, the strong support for coverage guarantees for people with preexisting conditions and for the expansion of Medicaid, and efforts among progressives to move to a “Medicare for All” system. The discussion is available here.

Fuzzy Math Fuels Sanders’ Claim That Cost Barriers To Health Care Kill 30,000 A Year

“Medicare for All” — or single-payer health care — is a flagship issue for Democratic presidential candidate and Vermont Sen. Bernie Sanders. So when a conservative group launched an ad campaign claiming such a policy would drive up wait times for medical care, the 2020 candidate responded aggressively.

His point: Some people may wait a bit for care under a new system. But under the current one, many people do not have access to affordable care and the results are sometimes dire.

Still, Sanders’ precision gave us pause.

Namely, he tweeted, “30,000 Americans a year die waiting for health care because of the cost.”

Where did that 30,000 figure come from? How could Sanders — or for that matter, anyone — know how many people died “waiting for health care” specifically “because of the cost”?

We reached out to the Sanders campaign but never heard back.

But multiple experts suggested that the 30,000 figure, while not conjured out of thin air, relies on math that is shaky at best. There isn’t enough evidence, either way, to entirely validate or repudiate this claim.

The Math

Sanders’ 30,000 statistic appears to come from a figure used by Physicians for a National Health Program, a doctor-driven nonprofit group that has advocated for years for single-payer health care.

But how did it compute that number? We asked Dr. David Himmelstein, a physician and part-time lecturer at Harvard Medical School, and one of PNHP’s founders.

He said the group looked at the Oregon Health Insurance Experiment, a landmark study in which some state residents had been assigned Medicaid coverage by lottery, and others remained uninsured. One year into that study, researchers found the death rate differed by 0.13 percentage points between those who received insurance and those who did not.

But, per the researchers’ analysis, that difference was not statistically significant. (That’s important and something we’ll come back to.)

Himmelstein said the margin of 0.13 percentage points suggests that for every 769 people to lack health coverage, one will die. Looking at the current American uninsured population — about 27 million lack coverage —should put you close to 30,000.

The Problem

Generally, experts said, it’s likely that cost barriers prevent thousands of Americans from accessing lifesaving medical care.

But “the particular math here seems a bit questionable” in arriving at 30,000, said Dr. Benjamin Sommers, a physician and health economist at the Harvard T.H. Chan School of Public Health.

The problem lies in extrapolating so much from the Oregon Health Insurance Experiment. While it yielded important findings, the death rate differential in particular is not statistically significant, so it cannot be applied so broadly, he said. The study wasn’t big enough to generate sufficient evidence spelling out the link between insurance coverage and mortality.

Other research makes clear that such a link exists. Sommers’ own work, for instance, looked at the impact of Massachusetts’ 2006 health reform law — the model for the Affordable Care Act, which brought the state to near-universal coverage.

That expansion was associated with a significant drop in mortality. For every 830 adults to gain coverage, one death was prevented.

But differences nationally in both population and health care generally still mean it’s difficult to apply this statistic to the rest of the country — and, namely, to the remaining 27 million uninsured.

So is 30,000 right or wrong?

We don’t know.

“My guess is that one, [Sanders] is right that thousands of people die because they remain uninsured, despite the ACA; but two, the 30,000 number may be too high,” said Stan Dorn, a senior fellow at Families USA, a left-leaning health policy advocacy group.

Going Beyond Insurance

There’s one other issue: More often than not, people are uninsured because they can’t afford to buy coverage. In turn, that often means they can’t afford health care and suffer dire consequences.

But it isn’t a one-to-one substitution.

For instance, there are healthy people who lack insurance but may not need much medical care in that particular year, or may simply choose not to buy it.

And, on the other hand, some people have coverage that isn’t robust enough to make lifesaving treatments affordable.

So, if you want to measure how many Americans do die “waiting for health care because of the cost,” you’d have to look beyond just the question of having insurance.

Our rating

On its face, Sanders’ claim speaks to an important, undisputed policy concern — thousands of Americans die because they cannot afford their health care.

But his “30,000 people” talking point relies on weak math, and it lacks meaningful support either way. It could be true. But it also could easily not be.

“The senator’s comment looks like a reasonable attempt to use prior research,” Sommers said. But “he’s overstating the precision and confidence we can have in that number.”

Sanders’ argument speaks to something more broadly true but neglects important details of the Oregon Health Insurance Experiment’s limitations. We rate it Half True.

KHN’s ‘What The Health’: Politics Heading Into 2020: Live From Aspen!


Can’t see the audio player? Click here to listen on SoundCloud.


The cost of health care looms as a major issue going into the 2020 campaign. But even as Democratic presidential candidates debate ways to bring down prices and expand insurance to more Americans, Democrats and Republicans in Congress are trying to pass legislation to address the price of prescription drugs and put an end to “surprise” out-of-network medical bills.

Chris Jennings and Lanhee Chen know about both. Jennings, president of Jennings Policy Strategies, has been a health adviser to Presidents Bill Clinton and Barack Obama. Lanhee Chen is a research fellow at the Hoover Institution and a director in the public policy program at Stanford University. He has advised Republican presidential candidates Mitt Romney, Marco Rubio and others.

This week’s panelists for KHN’s “What the Health?” — recorded at the Aspen Ideas: Health festival — are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico and Margot Sanger-Katz of The New York Times.

Among the takeaways from this week’s podcast:

  • The term “health care costs” means different things to different people. For most of the public, it refers to the amount they must pay out-of-pocket for premiums, deductibles and services. For policymakers, it often means the total amount the U.S. spends on the health care system. That often creates a disconnect.
  • Even small changes to the way drugs are priced and ending surprise medical bills might end up satisfying many members of the public, although those adjustments might have a minimal effect on overall health spending.
  • Republicans are as divided as Democrats on health care. That is the main reason Republicans did not repeal the Affordable Care Act in 2017 and why there has been no major Republican replacement proposal since then.
  • Many of the Democrats running for president, meanwhile, continue to advocate for a “Medicare for All” program run by the government, although many are hedging their bets by supporting other, less sweeping proposals to expand coverage, as well.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

Non-English Speakers Face Health Setback If Trump Loosens Language Rules

A federal regulation demands that certain health care organizations provide patients who have limited English skills a written notice of free translation services.

But the Trump administration wants to ease those regulations and also no longer require that directions be given to patients on how they can report discrimination they experience.

The changes could save $3.16 billion over five years for the health care industry, according to the administration.

These changes are part of a broader proposed regulation that would roll back protections banning discrimination based on gender identity. The public comment period closes Aug. 13.

The proposal would not change the government’s requirements that insurers and medical facilities provide foreign language translators and interpreters for non-English speakers.

The government acknowledged in the proposal that the change would lead to fewer people with limited English skills accessing health care and fewer reports of discrimination. But it also questioned the need for these notices, pointing out that in some areas health organizations spend money to accommodate a small contingent of language speakers. For example, notices in Wyoming must account for the 40 Gujarati speakers — a language of India — in the state.

In all, the government said, the impact of doing away with these requirements would be “negligible.”

Others disagree.

“I haven’t seen any reason to believe that this will only have a negligible impact,” said Mara Youdelman, managing attorney for the Washington, D.C., office of the National Health Law Program, a civil rights advocacy group. She said it “will likely result in people just not knowing their rights but not accessing care to which they’re eligible.”

Regulations under Section 1557 of the Affordable Care Act require insurers, hospitals and others to include a “tagline” of free translation services for the 15 languages that are most prevalent in a state. Additionally, it requires a nondiscrimination clause and directions on how to file a complaint with the Department of Health and Human Services Office for Civil Rights.

This information must be posted on websites, in physical spaces and in “significant communications” to the patient. But the ambiguity of that phrase prompted health care organizations to post the required information on numerous pieces of material — such as a separate page about language options sent with each Explanation of Benefits statement from an insurer. Together, these efforts cost organizations billions of dollars.

“No one realized exactly what that definition of ‘significant communication’ — how much would be wrapped up in that,” said Katie Keith, a Georgetown University professor who specializes in the ACA.

An estimated 25.9 million people in the United States in 2017 had limited English proficiency, the Census Bureau reported. Patients facing language barriers have a higher risk of health care complications, such as surgical infections and falls, because they may misunderstand a doctor’s orders, make mistakes preparing for procedures or improperly use medications.

In this latest proposal, however, the federal government questions whether the written notices are needed. The majority of enrollees speak English — census data from 2017 showed that 91.5% of people over age 5 spoke only English at home or spoke the language “very well.” In certain states, the proposal claims, every enrollee receives a notice for translation services in a language that only a few dozen people speak in the area.

Other state and federal laws protect the rights of patients with limited language services, the proposed rule says. It also cites evidence of some enrollees not liking the extra forms and being less inclined to open their mail because of them.

“These complaints make us concerned that the Section 1557 Regulation has resulted in ‘cognitive overload,’” the document stated, “such that individuals experience a diminished ability to process information” because of the additional paperwork.

Anecdotal reports cited by the government also point out that the notices did not significantly increase the number of patients using language services and reporting complaints. However, the proposed rule also estimates at least 90% of hospitals and physicians were not complying with the requirements.

Youdelman admitted she does not have concrete data showing that these taglines translate to increased access to services. However, she added, removing them wholesale without a promise to prevent discrimination in a different way is also counterproductive.

“Eliminating taglines is not the correct solution,” Youdelman said. “There is a way to inform folks while being cost-conscious.”

Health insurers and pharmacy benefit managers’ reactions to the proposed change have been tepid. The Pharmaceutical Care Management Association — the trade organization for pharmacy benefit managers — said in an email it “believes all consumers should be informed regarding translation services.” America’s Health Insurance Plans, the trade association for health insurers, said in an email that insurers would make sure consumers get the support they need to understand information — “including providing phone interpreters and written translations for customers who need them.”

Keith said that if the proposal is finalized more patients would not understand information involving their health. Some of these details on insurance and billing documents are already difficult for native English speakers to decipher and could be a challenge for less fluent people.

“Anytime you’re not notifying people of their rights,” Youdelman said, “you disempower them.”

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! The jury is still out whether we’re all growing horns out of the back of our heads because of how much we use smartphones, but apparently humans on the whole are somewhat decent people when it comes to finding wallets with cash in them. Now buckle up, because our cups have runneth over this week in terms of truly excellent health stories.

We’ll start, though, with what to look out for next week: President Donald Trump is expected to issue an executive order that would compel hospitals, insurers and others in the health industry to reveal closely guarded information about the true cost of procedures, according to The Wall Street Journal. This is the order that certain players in the health field have been dreading. It’s unclear how aggressive the administration will be with the rule, considering the rumblings of discontent already rippling through D.C. But a whopping 88% of people in a recent survey said they support such a policy — so the president is not exactly going out on a limb with voters.

The Wall Street Journal: Trump to Issue Executive Order on Health-Care Price Transparency


Speaking of voters, this executive order comes closely on heels of the official kickoff for Trump’s reelection campaign, which took place on Tuesday in Florida. The president has been searching for ways to win back ground against Democrats on the topic of health care — and promised to issue a plan within the next month or two that would counter the buzzy “Medicare for All.”

Many Republicans, though, kind of wish Trump would channel “Frozen” and let it go. With polls showing voters favor Democrats’ stance on health care, Republicans want the president to focus on issues where they think they have an edge, such as immigration.

The New York Times: Trump Wants to Neutralize Democrats on Health Care. Republicans Say Let It Go.

The New York Times: Trump, At Rally in Florida, Kicks Off His 2020 Re-Election Bid

Adding to the prevailing narrative that health care is a winning issue for the Dems, House Speaker Nancy Pelosi is using the topic to divert attention away from the more volatile talk of impeachment. “When we won the election in November, it was health care, health care, health care,” Pelosi said earlier in the week. She also promised that Democrats would fight relentlessly against Trump’s attempts to chip away at the health law.

In short, you can pretty much guarantee health care is going to play a central role in the 2020 races.

Bloomberg: Impeach Trump? Pelosi’s Dems Prefer Health Care Focus for 2020

Meanwhile, The New York Times interviewed many of the Democratic candidates about their stances on different issues, including health care. While they all agree something needs to be done about the country’s system, what that looks like becomes a dividing line in a crowded field.

The New York Times: 2020 Democrats on Health Care


A federal appeals court handed the Trump administration a win this week when a panel of three Republican-appointed judges ruled that new rules prohibiting federal family-planning grants to health clinics offering on-site abortions or referrals for the procedure can go into effect. The changes — which are largely thought to be targeting Planned Parenthood and are called a “gag rule” by opponents — have provoked fierce backlash among abortion rights groups that say the implementation of such restrictions will be devastating to women who rely on the clinics for health care. Although the decision isn’t the final say on the matter, the judges predicted the administration will prevail in this case.

The Washington Post: Trump Administration’s Abortion ‘Gag Rule’ Can Take Effect, Court Rules

Meanwhile, a look at two abortion clinics 20 minutes apart highlights the great divide evident around the country as state-level laws stand in stark contrast to one another.

The Wall Street Journal: Two Abortion Clinics, 20 Minutes and a Legal Universe Apart


Politico lifts the curtain on the ever-deepening quarrel between White House aides and HHS Secretary Alex Azar. “Alex is outnumbered and keeps losing,” an individual familiar with the simmering tensions told reporters. With Trump’s focus on health issues as he launches his campaign, the discord threatens to derail progress on key administration agenda items like high drug prices.

Politico: ‘They’re All Fighting Him’: Trump Aides Spar With Health Secretary


Major stakeholders have been anxiously watching congressional action on surprise medical bills — an issue most lawmakers agree needs to be addressed but for which there are several approaches. Industry players each have a preferred strategy (such as independent arbitration), but powerful HELP Committee leaders Sens. Alexander Lamar and Patty Murray hadn’t yet settled on theirs. That changed this week when they announced they back a “benchmark” plan, meaning insurers would pay a provider a rate similar to what the plan pays other doctors in the area for the same procedure. Alexander had “intrinsically” supported a different plan previously but changed his mind after the Congressional Budget Office ruled that this one would garner the most federal savings.

Hospitals were not pleased with the direction this is taking, calling the tactic “unworkable.”

Politico: HELP Committee Leaders Back Benchmark for ‘Surprise’ Billing


One of my favorite stories of the week looks at how those much-hated robocalls, which are mostly just a huge nuisance for most of us, become a life-and-death situation for hospitals. While the rest of us can either block or ignore the calls, hospitals don’t have that option. And when the calls come in waves of thousands, they can jam up emergency lines.

The Washington Post: Robocalls Are Overwhelming Hospitals and Patients, Threatening a New Kind of Health Crisis

I know a lot of people are creeped out by the privacy issues of having digital ears listening in on your every move, but there could be a flipside. Researchers want to train Alexa et al. to listen for gasping that could signal someone is experiencing cardiac arrest.

Stat: ‘Alexa, Are You Listening?’ A Research Tool Warns of Cardiac Arrest


Arkansas’ implementation of a Medicaid work requirement was closely watched by other conservative states eager to follow its lead. Advocates were appalled by the tens of thousands of people dropped from coverage, while state leaders and the Trump administration insisted that an improving economy was the reason behind the declining enrollment.

But a new study adds another layer to the debate: The work mandate has done nothing to affect the number of people who are unemployed in the state. So, after all of that, fewer people have insurance and fewer people have jobs.

Modern Healthcare: More Arkansans Uninsured, Unemployed Post-Medicaid Work Requirement


In news that surprised zero people, but should be noted anyway: Drugmakers made official their opposition to the new rules requiring them to include prices in TV ads. They say the requirements violate their freedom of speech rights and will be confusing to patients, since the prices aren’t what most people end up paying for the drugs.

Reuters: U.S. Drugmakers File Lawsuit Against Requiring Drug Prices in TV Ads


In the miscellaneous file this week:

• It often seems as if the anti-vaccination movement is this grassroots thing that has bubbled up through social media. But the tried-and-true “follow the money” method paints a more interesting picture, starting with a wealthy Manhattan couple who pumped millions into the cause over the past several years.

The Washington Post: Meet the New York Couple Donating Millions to the Anti-Vax Movement

• Immigrant children in U.S. custody give bleak accounts to lawyers of their experiences — including reports of toddlers without diapers being cared for by 10-year-old girls. The lawyers involved say that during their interviews the “little kids are so tired they have been falling asleep on chairs and at the conference table.”

The Associated Press: Migrant Children Describe Neglect at Texas Border Facility

• The youth suicide rate appears to have reached the highest since the government began collecting such statistics in 1960 — driven, in part, by a sharp increase among older teenage boys.

Los Angeles Times: Suicide Rates for U.S. Teens and Young Adults Are the Highest on Record

• Firefighters who die of cancer outnumber firefighters who die responding to an emergency “at least ten, 20, 30 to one.” Yet the very cities they risk their lives protecting are turning their backs on them once they become sick. “My city’s workers’ comp carrier initially flat-out said, ‘We don’t cover cancer,’” one firefighter recalled.

CBS News: Firefighters Battle Occupational Cancer: Many Sickened First Responders Are Being Denied Workers’ Comp Benefits


That was a fairly grim file to end The Friday Breeze with, so make sure to check out Stat’s list of 23 of the best health and science books to read this summer to give yourself a little boost to finish off your week. And have a great weekend!

IBM Agrees To $14.8M Settlement Over Botched Rollout Of Maryland’s Health Law Exchanges In 2013

The state’s online marketplace crashed the first day, in a very public black mark against then-Gov. Martin O’Malley. There were similar embarrassments around the country, as many state-run exchange websites failed to work properly. But Maryland’s site was among the worst.

Although Trump Administration Has Fallen Short Of Scrapping Health Law, The Changes It Has Made Reshaped Marketplace

The cumulative effect of the Trump administration’s rules could erode a core principle of the health law: ensuring that people can rely on their health insurance if they get sick, and to spread the costs of illness widely. The most recent change gives employers more flexibility to steer tax-exempt dollars to employees for health care.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Have drug prices gotten so bad that patients are now turning to robbing banks to afford them? It sounds like something out of a movie script, but it’s what a Utah man told police when he was accused of just that. While it’s unverified whether he, in fact, had any prescriptions, it doesn’t seem like much of a stretch for anyone paying attention to the state of drug prices in this country.

On to what you may have missed this week (including one of the wilder health stories I can recall reading in a while).

Lawmakers were busy, busy bees this week with hearings on health care issues.

The moment that drew perhaps the biggest spotlight was almost cinematic: A furious Jon Stewart took members to task in an almost nine-minute display of pointed, nonpartisan outrage over their feet-dragging on health care funding for 9/11 first responders and victims. Why is this “so damn hard?” the comedian asked. Firefighters, police and other first responders “did their jobs with courage, grace, tenacity and humility,” Stewart said. “Eighteen years later, do yours.” A bill allocating money to the fund for 70 years passed the House panel following the hearing.

The Associated Press: Jon Stewart Lashes Out at Congress Over 9/11 Victims Fund

The New York Times: How Jon Stewart Became a Fierce Advocate for 9/11 Responders

Reuters: House Panel Approves Permanent Sept. 11 Victims’ Compensation

But it wasn’t just made-for-TV drama on Capitol Hill this week. There was a flurry of activity related to health care. Here are some of the highlights, including a hearing on universal health coverage, which was heavy on fiery political rhetoric and light on substance:

The Hill: House Democrats Vote to Overturn Trump Ban on Fetal Tissue Research

CNN: Medicare for All Hearing Turns Into a Defense of Obamacare

Modern Healthcare: Arbitration for Surprise Medical Bills Splits House Panel

The Hill: Pelosi to Change Drug-Pricing Plan After Progressive Complaints

The Hill: Democrats Scuttle Attempt to Strike Hyde Amendment From Spending Bill

The Hill: House Panel Launches Investigation Into Juul


Even if “Medicare for All” were to overcome the daunting political hurdles lying in its path, it’s likely it would face so many legal challenges it could be bled out before it’s ever implemented. “There could be a death by a thousand-lawsuits approach,” Georgetown law professor Katie Keith told Politico. Other experts note, though, that there’s a difference between forcing someone to buy a product and banning something, which makes Medicare for All less vulnerable legally than the health law.

Politico: ‘Death by a Thousand Lawsuits’: The Legal Battles That Could Dog ‘Medicare for All’

Over in Chicago at the American Medical Association’s annual meeting, a medical student-led push to get the organization to reverse its decades-long opposition to single-payer health care failed. But, there’s more to it than that! A fabulous thread on Twitter from Bob Doherty of the American College of Physicians explains how the fact that the vote percentages were so close is remarkable in and of itself. The outcome would have been “unimaginable” in years past, he says.

The Hill: Major Doctors Group Votes to Oppose Single-Payer Health Care

And read Doherty’s thread here.


When premiums shot up over the past several years, more and more people turned to health care sharing ministries — which essentially connect people of similar faiths and set up a cost-sharing arrangement among the members. Because these models are not technically insurance, they’re allowed to skirt health law regulations and aren’t regulated by state commissioners. All of that was seen as a point in their favor from supporters at the time they joined them. But now it means that when bills aren’t paid on time, or at all, consumers have little recourse and officials’ hands are tied in holding the organizations responsible for their promises.

The Wall Street Journal: As Sharing Health-Care Costs Takes Off, States Warn: It Isn’t Insurance

Meanwhile, the Trump administration continues to chip away at the health law with its latest rule on health reimbursement arrangements, which will allow small firms to use tax-free accounts to help workers pay for insurance.

The Hill: Trump Officials Issue New Rule Aimed at Expanding Health Choices for Small Businesses


If you took anything away from last week’s drama over former Vice President Joe Biden’s stance on the Hyde Amendment it was probably that it seems the parties are dead set on their positions on abortion. But a look at how the public feels about the issue reveals blurred lines and nuance that doesn’t always fit into pat sound bites and political declarations. Many Americans struggle with the moral complexities surrounding abortion and their opinions can change from one question to the next, depending on the wording.

The New York Times: Politicians Draw Clear Lines on Abortion. Their Parties Are Not So Unified.

A new poll does show, however, that despite the ever-increasing threat to Roe v. Wade a strong majority of Americans don’t want to see it overturned.

NPR: Abortion Poll: Majority Wants to Keep Abortion Legal, but With Restrictions


Actress Jessica Biel ignited a firestorm of criticism after speaking out about a controversial California bill that would give a state official the final say on medical exemptions from vaccines. Once the blaze was lit, Biel tried to clarify that her issue was not with the vaccines themselves, but rather with the legislation introducing bureaucrats into the process. California’s governor has even hinted at similar concerns. The blowback, though, highlights how inherently inflammatory the topic has become as measles cases continue to climb across the country.

The New York Times: Here Is What Jessica Biel Opposes in California’s Vaccine Bill

In New York — the state at the heart of the record-busting measles outbreak — lawmakers passed a bill banning religious exemptions to vaccines. The governor signed it minutes later.

The Associated Press: New York Set to Cut Religious Exemption to Vaccine Mandates


I have kept you on tenterhooks long enough! One of the wilder health stories I’ve read in a long time comes from gruesomely fascinating Arizona Republic reporting. It’s a look into the thriving for-profit world of whole-body donations following death. Critics deem the practice as no better than “back alley grave robbing.” “There’s a price list for everything from a head to a shoulder, like they are a side of beef. They make money, absolutely, because there’s no cost in getting the bodies,” lawyer Michael Burg told The Arizona Republic. Supporters, however, see it as an affordable way to dispose of the remains of loved ones (which can actually be very expensive for low-income families).

Either way, it garnered my favorite quote of the week, asked by one potential donor: “Will I have a head in heaven?”

The Arizona Republic: Arizona Is a Hotbed for the Cadaver Industry, and Potential Donors Have Plenty of Options

The Arizona Republic: Despite 2-Year-Old State Law, Arizona’s Body Donation Industry Still Unregulated


In a move that left Flint, Mich., residents stunned and frustrated, prosecutors dropped all criminal charges against officials over the city’s water contamination crisis. Although prosecutors said the old investigation was bungled and there will be new charges, the announcement came like a fist to the jaw to people who already have had their faith in the government shattered.

Detroit Free Press: All Flint Water Crisis Criminal Charges Dismissed by AG’s Office


In the miscellaneous file this week:

• If you ever think you’re having a bad day at work, read this story about how an employee’s small photocopier mishap triggered a series of events that undermined a pair of late-stage clinical trials and ultimately scrapped a development deal between pharma companies.

Stat: How a Mishap at a Photocopier Derailed Clinical Trials and a Development Deal

• I am fascinated by the anatomy of pandemics, and this is a great tick-tock of the start of the last one. They don’t play out as they would in Hollywood, but, to me, the reality is even more interesting (I can’t be the only one, right?!).

Stat: The Last Pandemic Was a ‘Quiet Killer.’ Ten Years After Swine Flu, No One Can Predict the Next One

• World health officials have been begging farmers to stop using antibiotics on healthy farm animals in an effort to combat the ever-looming threat of resistance (which, as you know, terrifies yours truly). The farmer,s though, also have drugmakers whispering in their ears — despite a public facade from pharma of wanting to help combat the problem.

The New York Times: Warning of ‘Pig Zero’: One Drugmaker’s Push to Sell More Antibiotics

• Are you a sufferer of “white coat hypertension”? You might think it’s just because you get stressed out when you visit the doctor (join the club!), but a study shows that those anxiety-induced numbers are linked to an increased risk of a cardiac event.

Stat: Those With ‘White Coat Hypertension’ More Likely to Die From Cardiac Events


That’s it from me! Have a great and restful weekend. (Truly, insomnia can kill!)

KHN’s ‘What The Health’: Who Will Pay To Fix Problem Of Surprise Medical Bills?


Can’t see the audio player? Click here to listen on SoundCloud.


Congress is finally getting down to real work on legislation to end “surprise” medical bills, which patients get if they inadvertently receive care from an out-of-network health providers or use one in an emergency. But doctors, hospitals, insurers and other health care payers can’t seem to agree on who should pay more so patients can pay less.

Meanwhile, the fight over women’s reproductive rights continues in both Washington, D.C., and the states. This week, governors in three states — Vermont, Illinois and Maine — signed bills to make abortions easier to obtain. At the same time, the Democratic-led U.S. House of Representatives took up a spending bill for the Department of Health and Human Services that still includes the “Hyde Amendment,” which bans most federal abortion funding — despite the fact that most House Democrats oppose the restriction. House Democratic leaders fear that the fight to eliminate the restriction would jeopardize the rest of the spending bill in the GOP-controlled Senate and at the White House.

This week’s panelists are Julie Rovner from Kaiser Health News, Stephanie Armour of The Wall Street Journal, Alice Miranda Ollstein of Politico and Kimberly Leonard of the Washington Examiner.

Among the takeaways from this week’s podcast:

  • Republicans on Capitol Hill and at the White House are just as eager as Democrats are to settle on legislation that would keep consumers from getting surprise medical bills. It would provide a nice counterpoint during the upcoming campaign to Democrats’ charges that the GOP has been undermining health care with its opposition to the Affordable Care Act.
  • A federal judge in Texas has struck down the ACA’s provision that health plans must cover contraception. That is at odds with another judge in Pennsylvania who earlier this year blocked the Trump administration’s plans to loosen the birth control mandate.
  • State insurance regulators are raising concerns about health care sharing ministries, which offer plans that provide coverage for some medical expenses. But consumers often don’t realize that the plans may not cover many health costs, including those from preexisting conditions.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: The Washington Post’s “In Alabama — Where Lawmakers Banned Abortion for Rape Victims — Rapists’ Parental Rights Are Protected,” by Emily Wax-Thibodeaux

Alice Miranda Ollstein: The New York Times’ “Planned Parenthood to Host Women’s Health Forum for 2020 Democrats,” by Lisa Lerer

Stephanie Armour: NPR’s “You May Be Stressing Out Your Dog,” by Rebecca Hersher

Kimberly Leonard: Politico’s “Lost in Translation: Epic Goes to Denmark,” by Arthur Allen

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