Tagged The Health Law

Podcast: KHN’s ‘What The Health?’ You Have Questions, We Have Answers

This week, KHN’s “What the Health?” panelists answered questions submitted by listeners.

Among the topics covered were what might happen to parts of the Affordable Care Act if a lawsuit now working its way through the courts succeeds in declaring the health law unconstitutional, and how Medicare and Medicaid deal with surprise medical bills from out-of-network providers.

This week’s panelists are Julie Rovner of Kaiser Health News, Jennifer Haberkorn of the Los Angeles Times, Joanne Kenen of Politico and Kimberly Leonard of the Washington Examiner.

The panel addressed questions including the following:

  • What would happen to the Medicare Part D “doughnut hole” if the entire ACA is struck down, and would newer bills, such as the Bipartisan Budget Act, which helped close the coverage gap for brand-name drugs one year early, prevent this feature of the ACA from being eliminated?
  • Will the Health Insurance Portability and Accountability Act (HIPAA) of 1996 remain if the ACA is completely overturned?
  • Since surprise medical bills aren’t allowed in Medicare and Medicaid, what happens when an anesthesiologist or contract emergency room doctor who doesn’t accept Medicare or Medicaid treats an enrolled patient? Do they take a lower rate? Does the hospital make up the difference? Why can’t this be applied to all out-of-network arrangements?
  • Statistics show that approximately 5% to 10% of the population accounts for about 50% of total health care spending. Who makes up this population? Are there any reasonable proposals to address the health of this population and perhaps reduce spending while improving outcomes?

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

Julie Rovner: Kaiser Health News’ “Lethal Plans: When Seniors Turn To Suicide In Long-Term Care,” by Melissa Bailey and JoNel Aleccia

Jennifer Haberkorn: The New York Times’ “Insurers Want to Know How Many Steps You Took Today,” by Sarah Jeong

Joanne Kenen: Vox.com’s “Walmart’s $25 Insulin Can’t Fix the Diabetes Drug Price Crisis,” by Julia Belluz

Kimberly Leonard: The [Columbia, S.C.] State’s “SC Inmate’s Baby Died in Toilet: Lawsuits Allege Rampant Medical Neglect in Prisons,” by Emily Bohatch

And, The Atlanta Journal-Constitution’s “For Some in Ga. Prisons and Jails, Diabetes Has Meant a Death Sentence,” by Danny Robbins

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher, Google Play or Spotify.

Podcast: KHN’s ‘What The Health?’ You Have Questions, We Have Answers

This week, KHN’s “What the Health?” panelists answered questions submitted by listeners.

Among the topics covered were what might happen to parts of the Affordable Care Act if a lawsuit now working its way through the courts succeeds in declaring the health law unconstitutional, and how Medicare and Medicaid deal with surprise medical bills from out-of-network providers.

This week’s panelists are Julie Rovner of Kaiser Health News, Jennifer Haberkorn of the Los Angeles Times, Joanne Kenen of Politico and Kimberly Leonard of the Washington Examiner.

The panel addressed questions including the following:

  • What would happen to the Medicare Part D “doughnut hole” if the entire ACA is struck down, and would newer bills, such as the Bipartisan Budget Act, which helped close the coverage gap for brand-name drugs one year early, prevent this feature of the ACA from being eliminated?
  • Will the Health Insurance Portability and Accountability Act (HIPAA) of 1996 remain if the ACA is completely overturned?
  • Since surprise medical bills aren’t allowed in Medicare and Medicaid, what happens when an anesthesiologist or contract emergency room doctor who doesn’t accept Medicare or Medicaid treats an enrolled patient? Do they take a lower rate? Does the hospital make up the difference? Why can’t this be applied to all out-of-network arrangements?
  • Statistics show that approximately 5% to 10% of the population accounts for about 50% of total health care spending. Who makes up this population? Are there any reasonable proposals to address the health of this population and perhaps reduce spending while improving outcomes?

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

Julie Rovner: Kaiser Health News’ “Lethal Plans: When Seniors Turn To Suicide In Long-Term Care,” by Melissa Bailey and JoNel Aleccia

Jennifer Haberkorn: The New York Times’ “Insurers Want to Know How Many Steps You Took Today,” by Sarah Jeong

Joanne Kenen: Vox.com’s “Walmart’s $25 Insulin Can’t Fix the Diabetes Drug Price Crisis,” by Julia Belluz

Kimberly Leonard: The [Columbia, S.C.] State’s “SC Inmate’s Baby Died in Toilet: Lawsuits Allege Rampant Medical Neglect in Prisons,” by Emily Bohatch

And, The Atlanta Journal-Constitution’s “For Some in Ga. Prisons and Jails, Diabetes Has Meant a Death Sentence,” by Danny Robbins

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher, Google Play or Spotify.

Hickenlooper Expanded Medicaid, Created State-Run Marketplace To Insure Nearly All Coloradans

Former two-term Colorado Gov. John Hickenlooper is a rare breed in the 2020 presidential race — he’s running as a moderate.

On health care, he supports universal coverage and boasts about Colorado’s record-low uninsured rate. But unlike many of his competitors for the Democratic nomination, he opposes “Medicare-for-all,” the single-payer federal system that would guarantee health care coverage to every American.

Hickenlooper has been making the rounds on cable talk shows and is trying to distinguish himself as a compromiser. In an interview on MSNBC’s “Meet the Press,” Hickenlooper said, “We got to almost universal coverage in health care in Colorado. We expanded Medicaid. We created one of the most innovative exchanges in the country.” His campaign website claims that “nearly 95 percent” of Coloradans currently have health care coverage.

We wondered how Colorado’s uninsured rate changed during Hickenlooper’s time in the governor’s mansion and how it compares with the rest of the country.

How Did Hickenlooper Do It?

The Affordable Care Act, or ACA, authorizes states to expand Medicaid to include health care coverage for all adults earning up to 138% of the federal poverty level. Colorado is one of 37 states that have opted to do so.

In 2013, then-governor Hickenlooper announced his proposal to expand Medicaid at no cost to the state general fund. Under the ACA, the federal government would pay for the program until 2016, after which states had to pay a portion. Hickenlooper planned to cover future expenses with cost-cutting efforts and existing revenues, including a hospital provider fee rolled out in 2009.

After Hickenlooper launched the Medicaid expansion, Colorado’s uninsured rate dropped from 14.3% in 2013 to 6.5% in 2017, according to the Colorado Health Institute.

However, about 350,000 Coloradans still don’t have health insurance — one-quarter of whom are undocumented, making them ineligible for public insurance. Also, the price of coverage continues to rise in Colorado, where people pay some of the highest premiums in the United States.

Hickenlooper saw Medicaid expansion as a step toward his goal of making Colorado the “healthiest state in America.” But he hasn’t always supported policies that could give more people health care coverage. In 2016, he opposed a ballot measure that would have created a single-payer state health care system called ColoradoCare. Then, he said he’d be open to a Trump administration-backed policy to implement a work requirement for Medicaid recipients.

How Does Colorado Compare?

Hickenlooper’s Medicaid expansion more than halved Colorado’s uninsured rate. But if a 6.5% uninsured rate counts as “almost universal coverage,” then how many other states can tout that accomplishment?

According to the Kaiser Family Foundation, Colorado’s uninsured rate positions it squarely in the upper half of the pack, with a national average uninsured rate of 9%. (It’s important to note that the Kaiser Family Foundation measured Colorado’s uninsured rate differently, pegging it at 8%. The Colorado Health Institute said its rate is slightly lower because it includes more data on children. Kaiser Health News is an editorially independent program of the foundation.)

The foundation lists 20 states with even lower uninsured rates than Colorado, including Massachusetts at 3% and Iowa at 4%.

In an email to PolitiFact, Michele Lueck, the president of the Colorado Health Institute, called Hickenlooper’s claim that “nearly 95 percent” of Coloradans currently have health care coverage a “friendly rounding error.”

Enrollment Numbers In Decline Nationwide, But Not In Colorado

About 300,000 fewer Americans bought insurance through healthcare.gov during the enrollment period in 2018 than in the previous year. Meanwhile, Colorado’s enrollment numbers were up.

The Affordable Care Act allowed states to create their own marketplaces to sell insurance plans to people who aren’t covered by their employer, Medicaid or Medicare — which includes about 8% of the total market in Colorado. Twelve states, including Colorado, run their own marketplaces.

Some credit lower enrollment across the country to the Trump administration’s policies to stymie the Affordable Care Act. It cut funding for healthcare.gov’s budget for marketing and eliminated the penalty for not having insurance.

But in Colorado, nearly 6% more people purchased a plan on Connect for Health Colorado, the state-run marketplace that operates independently of the federal government. While healthcare.gov released fewer ads and shut down weekly for maintenance, Connect for Health Colorado continued to reach out to eligible customers.

Our Ruling

Hickenlooper said, “We got to almost universal coverage in health care in Colorado.” Though Colorado is much closer to universal health care coverage than before the Affordable Care Act, hundreds of thousands of Coloradans remain uninsured and other states have even lower uninsured rates. Nevertheless, the state has an uninsured rate of 6.5%, which is close to universal coverage, as Hickenlooper said. The state achieved this by expanding Medicaid and running its own health care marketplace.

We rate the claim Mostly True.

Watch: ACA’s Future And ‘Medicare-For-All’ Front And Center As Candidates Line Up For 2020

Julie Rovner, KHN’s chief Washington correspondent, joined C-SPAN host Bill Scanlan Tuesday morning on “Washington Journal” to discuss how health care is playing out in the current political debate. They talked about the Republican-sponsored lawsuit to overturn the Affordable Care Act and the backing by many Democratic candidates of a “Medicare-for-all” health plan, and took questions from viewers about a wide variety of health issues. The video is available on the C-SPAN website.

Rovner also was on NPR’s “Weekend Edition Saturday” with host Scott Simon to talk about Sen. Bernie Sander’s “Medicare-for-all” proposal. That is available on the NPR website.

Watch: ACA’s Future And ‘Medicare-For-All’ Front And Center As Candidates Line Up For 2020

Julie Rovner, KHN’s chief Washington correspondent, joined C-SPAN host Bill Scanlan Tuesday morning on “Washington Journal” to discuss how health care is playing out in the current political debate. They talked about the Republican-sponsored lawsuit to overturn the Affordable Care Act and the backing by many Democratic candidates of a “Medicare-for-all” health plan, and took questions from viewers about a wide variety of health issues. The video is available on the C-SPAN website.

Rovner also was on NPR’s “Weekend Edition Saturday” with host Scott Simon to talk about Sen. Bernie Sander’s “Medicare-for-all” proposal. That is available on the NPR website.

Workplace Wellness Programs Barely Move The Needle, Study Finds

Workplace wellness programs have become an $8 billion industry in the U.S. But a study published Tuesday in JAMA found they don’t cut costs for employers, reduce absenteeism or improve workers’ health.

Most large employers offer some type of wellness program — with growth fueled by incentives in the federal Affordable Care Act.

A host of studies over the years have provided conflicting results about how well they work, with some showing savings and health improvements while others say the efforts fall short.

Many studies, however, faced a number of limitations, such as failing to have a comparison group, or figuring out whether people who sign up for such wellness programs are somehow healthier or more motivated than those who do not.

Now researchers from the University of Chicago and Harvard may have overcome these obstacles with one of the first large-scale studies that is peer-reviewed and employs a more sophisticated trial design.

They randomly assigned 20 BJ’s Wholesale Club outlets to offer a wellness program to all employees, then compared results with 140 stores that did not.

The big-box retailer employed nearly 33,000 workers across all 160 clubs during the test.

After 18 months, it turned out that yes, workers participating in the wellness programs self-reported healthier behavior, such as exercising more or managing their weight better than those not enrolled.

But the efforts did not result in differences in health measures, such as improved blood sugar or glucose levels; how much employers spent on health care; or how often employees missed work, their job performance or how long they stuck around in their jobs.

“The optimistic interpretation is there is no way we can get improvements in health or more efficient spending if we don’t’ first have changes in health behavior,” said one study author, Katherine Baicker, dean of the Harris School of Public Policy at the University of Chicago. (Dr. Zirui Song, an assistant professor of health policy and medicine at Harvard Medical School, was its co-author.)

“But if employers are offering these programs in hopes that health spending and absenteeism will go down, this study should give them pause,” Baicker said.

The study comes amid widespread interest in wellness programs.

The Kaiser Family Foundation’s annual survey of employers found that 53% of small firms and 82% of large firms offer a program in at least one of these areas: smoking cessation, weight management and behavioral or lifestyle change. (Kaiser Health News is an editorially independent program of the foundation.)

Some programs are simple, offering gift cards or other small incentives to fill out a health risk assessment, take a lunch-and-learn class or join a gym or walking group. Others are far more invasive, asking employees to report on a variety of health-related questions and roll up their sleeves for blood tests.

A few employers tie financial incentives to workers actually lowering risk factors, such as high blood pressure or cholesterol — or making concerted efforts to participate in programs that might help them do so over time.

The Affordable Care Act allowed employers to offer financial incentives worth up to 30% of the cost of health insurance, leading some employers to offer what could be hundreds or even thousands of dollars off workers’ deductibles or premiums to get them to participate. That led to court challenges about whether those programs are truly voluntary.

In the study reported in JAMA, the incentives were modest. Participants got small-dollar gift cards for taking wellness courses on topics such as nutrition, exercise, disease management and stress control. Total potential incentives averaged $250. About 35% of eligible employees at the 20 participating sites completed at least one module.

Results from those workers — including attendance and tenure data, their self-reported health assessment and results from lab blood tests — were specifically compared with similar reports from 20 primary comparison sites where workers were not offered the wellness gift cards and classes. Overall employment and health spending data from all worksites were included in the study.

Wellness program vendors said details matter when considering whether efforts will be successful.

Jim Pshock, founder and CEO of Bravo Wellness, said the incentives offered to BJ’s workers might not have been large enough to spur the kinds of big changes needed to affect health outcomes.

Amounts of “of less than $400 generally incentivize things people were going to do anyway. It’s simply too small to get them to do things they weren’t already excited about,” he said.

An accompanying editorial in JAMA noted that “traditional, broad-based programs like the one analyzed by Song and Baicker may lack the necessary intensity, duration, and focus on particular employee segments to generate significant effects over a short time horizon.”

In other words, don’t give up entirely on wellness efforts, but consider “more targeted approaches” that focus on specific workers with higher risks or on “health behaviors [that] may yield larger health and economic benefits,” the editorial suggested.

It could be, the study acknowledges, that 18 months isn’t enough time to track such savings. So, Baicker and Song also plan to publish three-year results once they are finalized.

Still, similar findings were recently reported in another randomized control trial conducted at the University of Illinois, where individuals were randomly selected to be offered wellness programs.

In one interesting point, that study found that wellness-program participants were likely already healthier and more motivated, “thus a primary benefit of these programs to employers may be their potential to attract and retain healthy workers with low medical spending.”

Everyone involved in studying or conducting wellness agrees on one thing: Changing behavior — and getting people motivated to participate at all — can be difficult.

Steven Aldana, CEO of WellSteps, a wellness program vendor, said that for the efforts to be successful they must cut across many areas, from the food served in company cafeterias to including spouses or significant others to help people quit smoking, eat better or exercise more.

“Behavior is more complicated than simply taking a few wellness modules,” said Aldana. “It’s a lifestyle matrix or pattern you have to adopt.”

Workplace Wellness Programs Barely Move The Needle, Study Finds

Workplace wellness programs — efforts to get workers to lose weight, eat better, stress less and sleep more — are an $8 billion industry in the U.S.

Most large employers offer some type of wellness program — with growth fueled by incentives in the federal Affordable Care Act.

But no one has been sure they work.

A host of studies over the years has provided conflicting results, with some showing savings and health improvements while others say the efforts fall short.

Many studies, however, faced a number of limitations, such as failing to have a comparison group, or figuring out whether people who sign up for such wellness programs are somehow healthier or more motivated than those who do not.

Researchers from the University of Chicago and Harvard may have overcome some of these obstacles with one of the first large-scale studies that employs more sophisticated research techniques. It was published Tuesday in JAMA.

They randomly assigned 20 BJ’s Wholesale Club outlets to offer a wellness program to all employees, then compared results with 140 stores that did not.

The big-box retailer employed nearly 33,000 workers across all 160 clubs during the test.

After 18 months, it turned out that yes, workers participating in the wellness programs self-reported healthier behavior, such as exercising more or managing their weight better than those not enrolled.

But the efforts did not result in differences in health measures, such as improved blood sugar or glucose levels; how much employers spent on health care; or how often employees missed work, their job performance or how long they stuck around in their jobs.

“The optimistic interpretation is there is no way we can get improvements in health or more efficient spending if we don’t’ first have changes in health behavior,” said one study author, Katherine Baicker, dean of the Harris School of Public Policy at the University of Chicago. (Dr. Zirui Song, an assistant professor of health policy and medicine at Harvard Medical School, was its co-author.)

“But if employers are offering these programs in hopes that health spending and absenteeism will go down, this study should give them pause,” Baicker said.

The study comes amid widespread interest in wellness programs.

The Kaiser Family Foundation’s annual survey of employers found that 53% of small firms and 82% of large firms offer a program in at least one of these areas: smoking cessation, weight management and behavioral or lifestyle change. (Kaiser Health News is an editorially independent program of the foundation.)

Some programs are simple, offering gift cards or other small incentives to fill out a health risk assessment, take a lunch-and-learn class or join a gym or walking group. Others are far more invasive, asking employees to report on a variety of health-related questions and roll up their sleeves for blood tests.

A few employers tie financial incentives to workers actually lowering risk factors, such as high blood pressure or cholesterol — or making concerted efforts to participate in programs that might help them do so over time.

The Affordable Care Act allowed employers to offer financial incentives worth up to 30% of the cost of health insurance, leading some employers to offer what could be hundreds or even thousands of dollars off workers’ deductibles or premiums to get them to participate. That led to court challenges about whether those programs are truly voluntary.

In the study reported in JAMA, the incentives were modest. Participants got small-dollar gift cards for taking wellness courses on topics such as nutrition, exercise, disease management and stress control. Total potential incentives averaged $250. About 35% of eligible employees at the 20 participating sites completed at least one module.

Results from those workers — including attendance and tenure data, their self-reported health assessment and results from lab blood tests — were specifically compared with similar reports from 20 primary comparison sites where workers were not offered the wellness gift cards and classes. Overall employment and health spending data from all worksites were included in the study.

Wellness program vendors said details matter when considering whether efforts will be successful.

Jim Pshock, founder and CEO of Bravo Wellness, said the incentives offered to BJ’s workers might not have been large enough to spur the kinds of big changes needed to affect health outcomes.

Amounts of “of less than $400 generally incentivize things people were going to do anyway. It’s simply too small to get them to do things they weren’t already excited about,” he said.

An accompanying editorial in JAMA noted that “traditional, broad-based programs like the one analyzed by Song and Baicker may lack the necessary intensity, duration, and focus on particular employee segments to generate significant effects over a short time horizon.”

In other words, don’t give up entirely on wellness efforts, but consider “more targeted approaches” that focus on specific workers with higher risks or on “health behaviors [that] may yield larger health and economic benefits,” the editorial suggested.

It could be, the study acknowledges, that 18 months isn’t enough time to track such savings. So, Baicker and Song also plan to publish three-year results once they are finalized.

Still, similar findings were recently reported in another randomized control trial conducted at the University of Illinois, where individuals were randomly selected to be offered wellness programs.

In one interesting point, that study found that wellness-program participants were likely already healthier and more motivated, “thus a primary benefit of these programs to employers may be their potential to attract and retain healthy workers with low medical spending.”

Everyone involved in studying or conducting wellness agrees on one thing: Changing behavior — and getting people motivated to participate at all — can be difficult.

Steven Aldana, CEO of WellSteps, a wellness program vendor, said that for the efforts to be successful they must cut across many areas, from the food served in company cafeterias to including spouses or significant others to help people quit smoking, eat better or exercise more.

“Behavior is more complicated than simply taking a few wellness modules,” said Aldana. “It’s a lifestyle matrix or pattern you have to adopt.”

Changes To CMS Readmission Penalties Appear Effective In Addressing Unique Challenges Of Rural, Teaching Hospitals

The changes were made to address complaints from hospitals—safety-net hospitals in particular—that they are unfairly penalized in the readmissions program because of their complex patient case mix. For rural hospitals, their average penalties are estimated to decline from $55,268 to $53,633; while average penalties for teaching hospitals will drop from $287,268 to $283,461. Other news from CMS looks at accountable care organizations and primary care accounts.

Changes To CMS Readmission Penalties Appear Effective In Addressing Unique Challenges Of Rural, Teaching Hospitals

The changes were made to address complaints from hospitals—safety-net hospitals in particular—that they are unfairly penalized in the readmissions program because of their complex patient case mix. For rural hospitals, their average penalties are estimated to decline from $55,268 to $53,633; while average penalties for teaching hospitals will drop from $287,268 to $283,461. Other news from CMS looks at accountable care organizations and primary care accounts.

Town Hall Audience Erupts In Cheers When Asked About Support For Sanders’ ‘Medicare For All’ Plan

The slice of public opinion at the town hall for 2020 hopeful Sen. Bernie Sanders (I-Vt.) reflects broader polling that shows support for a system that guarantees universal coverage. However, when details about paying for the plan are revealed, that support has, in the past, dropped.

N.C. Lawmakers Working Toward Covering More Low-Income People, But Shy Away From Politically Charged ‘Medicaid Expansion’ Term

The NC Health Care for Working Families Act would help low-income people get coverage through the state’s Medicaid program, but it wouldn’t technically be “expanding” Medicaid. It’s estimated that about 543,000 people would end up gaining coverage through the proposal. Medicaid news comes out of North Dakota, Illinois and Ohio, as well.

Economists Weigh In On True Cost Of ‘Medicare For All.’ Bottom Line: It Would Be Expensive.

Sen. Bernie Sanders (I-Vt.), a 2020 hopeful at the front of a crowded pack, is set to unveil an updated version of his “Medicare for All” legislation, a plan that has gained momentum with progressive Democrats. It’s difficult to put an actual price tag on one of the largest proposed domestic policy changes in a generation, but economists try provide an estimate. In the end, patients would probably pay less, and the government would pay a whole lot more.

House Committee Chairmen Demand Answers About Administration’s ‘Sudden And Significant’ Reversal In Health Law Case

“The [Justice] Department owes Congress and the public an explanation as to why it refuses to enforce the law,” chairmen of five House committees wrote. Meanwhile, Attorney General William Barr defended the decision at a hearing on Tuesday. “Do you think it’s likely that we are going to prevail?” he asked, in response to questions about the reversal. “If you think it’s such an outrageous position, then you have nothing to worry about. Let the courts do their job.”

The Ripple Effects From Medicaid Expansion: Study Finds It’s Linked To Fewer Heart-Related Deaths

“The overall results of this study are that after expansion of Medicaid in 2014, the areas in the country that did expand had a significantly lower mortality rate compared to if they had followed the same trajectory as the areas in the country that didn’t expand,” said Dr. Sameed Khatana, a fellow in cardiovascular disease at the Hospital of the University of Pennsylvania. Other Medicaid news comes out of Illinois, Kansas and Tennessee.

The Ripple Effects From Medicaid Expansion: Study Finds It’s Linked To Fewer Heart-Related Deaths

“The overall results of this study are that after expansion of Medicaid in 2014, the areas in the country that did expand had a significantly lower mortality rate compared to if they had followed the same trajectory as the areas in the country that didn’t expand,” said Dr. Sameed Khatana, a fellow in cardiovascular disease at the Hospital of the University of Pennsylvania. Other Medicaid news comes out of Illinois, Kansas and Tennessee.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! The question for the day is: If there were a drug that would turbocharge your brain, would you take it? I’ve seen enough sci-fi movies to make me, uh, less than enthused about the idea, but as my second cup of coffee of the day has yet to kick in, I find it interesting to ponder.

Anyway, on to this roller coaster of a news week!

Republicans on the Hill have been quietly pretending they might wake up and this renewed focus on the health law will all have been a fever dream. But Democrats are doing their best to make sure everyone knows exactly where everyone stands on President Donald Trump’s recent legal attacks. On Wednesday, the House Dems officially voted to condemn the president’s decision to tell the courts to nullify the entire health law instead of just parts of it. In practice, this means nothing, but it puts Republicans on record of once again voting against popular health law provisions.

Trump, meanwhile, softly backpedaled on his promises that Republicans were coming up with a “spectacular” replacement plan before 2020. This came after a talk with Senate Majority Leader Mitch McConnell — who essentially channeled his inner Ariana Grande and said thank u, next to the issue that has left the party with political bruises the past two years.

But Trump is remaining steadfast in his message that Republicans need to reclaim health care as a winning topic for 2020. “We can’t run away” from health care, he said. “We’ll lose.”

The bumpy week, for some, was a reminder of the surprises that could be in store for the upcoming election season.

The Wall Street Journal: Democrats, Trump Try to Keep Spotlight on Health Care

The Associated Press: Pivoting on Pledges, Trump Explores Art of the Climb-Down

Bloomberg: Trump Says GOP `Blew It’ on Health Care and Must Run on New Plan

Politico: Killing Obamacare Kills Trump’s Health Agenda, Too


Going on name only, the Violence Against Women Act sounds like one of the least controversial bills out there, but a closer look at its history reveals fault lines. The House this week passed its version of the legislation (which is geared toward protecting women from violence and domestic abuse and has to be renewed every few years), but don’t expect smooth sailing the rest of the way. This time the underlying drama stems from a new provision that expanded law enforcement’s ability to strip domestic abusers of their guns.

The New York Times: A Brief History of the 25-Year Debate Over the Violence Against Women Act


Fill-in-the-blank copycat bills powered by special interests and businesses have infiltrated the legislative process to a shocking extent. USA Today, The Arizona Republic  and the Center for Public Integrity has an amazing two-year investigation that examined nearly 1 million bills in all 50 states and Congress to root out legislation that was nearly identical to others. These measures touched on almost every subject imaginable, from sugary drinks to “right-to-try” legislation to abortion to gun control. The investigation found that these bills are often drafted with deceptive titles, include misleading information on the extent of expert or public support, and push agendas that override the will of voters. Be sure to check out this story — it has examples of the bills, data and charts, and all kinds of fun goodies to delve into.

USA Today: Abortion, Gun Control: How Special Interest Groups Push Legislation


A veritable flurry of movement on drug pricing bills is coming up in the next week or so, with legislation and hearings that will focus on PBMs, the price of insulin, transparency, public accountability for pharma and more. With that as context …

Express Scripts this week announced that it is capping the price of insulin at $25 per month. Under the new plan, employers who cover their workers through Cigna and Express Scripts can opt into the program, and the extra costs will be picked up by the three drugmakers that sell insulin — Eli Lilly, Novo Nordisk and Sanofi. Advocates deemed the decision nothing but a PR move, saying it does little to address the actual problems of high list prices for people who aren’t lucky enough to be on one of the plans.

The New York Times: Express Scripts Offers Diabetes Patients a $25 Cap for Monthly Insulin

Stat: House Committee to Weigh Bills Aimed at Shedding Light on High Drug Prices


“One medical emergency, that’s all it would take to wipe me out financially,” is something I’ve heard friends worry about time and again, so a grim new report about the reality of paying for health care in America came as no surprise. Over the past year, Americans have borrowed $88 billion (billion! with a b!) to pay for health care. A survey went on to report that nearly half of Americans are haunted by fears of medical-related bankruptcy, and 1 in 4 people have skipped needed care because of the cost. Not only that, about 70% of respondents across the political spectrum said they had no confidence in their elected officials to bring prices down.

The New York Times: Americans Borrowed $88 Billion to Pay for Health Care Last Year, Survey Finds


This technically happened last Friday, but not in time for the Breeze: The Trump administration approved a work-requirements waiver for Utah — just days after similar restrictions were struck down for both Kentucky and Arkansas. The Utah story is even more nuanced, though, because voters in that state approved full expansion of the program. Lawmakers have been scrambling to put rules into place ever since the ballot measure passed.

The New York Times: Trump Administration Approves Medicaid Work Requirements in Utah

Meanwhile, both HHS Secretary Alex Azar and CMS Administrator Seema Verma have been quietly trying to sell states on applying for block grant waivers, with Verma, in particular, pushing Alaska to become the first in the nation to apply. A legal challenge would almost certainly follow any such decision.

The Hill: Trump Administration Urging Alaska to Be First to Apply for Medicaid Block Grant


In the same vein as this happened late last week but you should know about it: The Trump administration announced the recipients of $250 million in Title X federal family planning grants, including a chain of anti-abortion clinics designed to siphon off patients from Planned Parenthood. The group had been turned down last year because it doesn’t provide birth control other than natural family planning and abstinence. Meanwhile, Planned Parenthood and its affiliates saw a steep drop in what it had been previously receiving — going from about $50 million-$60 million to $16 million.

Politico: Millions in Family Planning Grants Given to Groups and States Fighting Trump’s Policy Changes


In the miscellaneous file this week:

• A look at how a former congressman has become a one-man gate-keeping operation when it comes to lobbying the VA.

Politico: Millions in Family Planning Grants Given to Groups and States Fighting Trump’s Policy Changes

• A wild investigation into how high-speed chases, while frowned upon in other agencies, are a strategy often used by the Border Patrol, despite the fact that they can often end in gruesome injuries and death.

Los Angeles Times/ProPublica: Border Patrol Agents Are Granted Wide Latitude When Trying to Catch Drivers Seeking to Enter U.S. Illegally

• Torture, rape, murder and other violence in the Alabama prison system is “severe and systematic,” a new Department of Justice report finds. Fair warning, the details are pretty disturbing, but it’s worth a read.

The New York Times: Alabama’s Gruesome Prisons: Report Finds Rape and Murder at All Hours

• Can getting drugs to treat libido issues or thinning hair be as easy as ordering off a restaurant menu? That’s what these new types of websites offer: a way for patients to self-diagnose their problems and then get a sign-off from a doctor whom they don’t even meet with. The sites often don’t include warnings about side effects of the medications, and it’s entirely unclear whether their doctor-screening process follows any kind of standards.

The New York Times: Drug Sites Upend Doctor-Patient Relations: ‘It’s Restaurant-Menu Medicine’

• The “lede” on this story was a cold reality check about the intersection of public health fears and prejudice when it comes to vulnerable populations. Rockland County, N.Y., where one of the country’s largest measles outbreaks is rippling through the Jewish Orthodox community, is serving as a model of how those tensions can boil over in times of crisis.

The New York Times: An Outbreak Spreads Fear: Of Measles, of Ultra-Orthodox Jews, of Anti-Semitism

• “Healthy Holly” may sound like an innocuous children’s book, but the controversy surrounding it — and its author, Baltimore Mayor Catherine Pugh — will likely bring down several careers.

The Baltimore Sun: As a Maryland Senator, Pugh Pushed Bills to Benefit Hospitals While Getting Book Payments From Medical System


And make sure to check out this fun history on how the concept of personal space is hard-wired into our brains. Have a great weekend!

Podcast: KHN’s ‘What The Health’ The GOP’s Health Reform Whiplash

President Donald Trump last week insisted that Republicans would move this year to “repeal and replace” the Affordable Care Act. Or possibly not. Senate Majority Leader Mitch McConnell made it clear the GOP Senate did not plan to spend time on the effort as long as the House is controlled by Democrats. So, the president changed his tune. At least for the moment.

Meanwhile, states with legislatures and governors that oppose abortion are racing to pass abortion bans and get them to the Supreme Court, where, they hope, the new majority there will overturn or scale back the current right to abortion.

This week’s panelists are Julie Rovner of Kaiser Health News, Rebecca Adams of CQ Roll Call, Anna Edney of Bloomberg News and Alice Miranda Ollstein of Politico.

Also, Rovner interviews KHN’s Paula Andalo, who wrote the latest “Bill of the Month” feature about a very expensive knee brace.

If you have an exorbitant or inexplicable medical bill you’d like to submit for our series, you can do that here.

Among the takeaways from this week’s podcast:

  • Although Trump’s political base may support his actions to undermine the entire federal health law, Republican lawmakers are flummoxed. They are hesitant to take up the cause because Democrats used the issue so effectively against Republicans in last fall’s election. They also know that many Republicans like key provisions of the health law, such as its closing of the doughnut hole in the Medicare drug benefit, letting adult children stay on parents’ plans up to the age of 26 and protecting people with preexisting conditions.
  • The unveiling this week of a new Democratic health initiative — Medicare X — signals an increasing push by party moderates to move away from progressives’ call to dramatically reshape American health care with a “Medicare-for-all” system. Medicare X is a much smaller initiative that would allow some people to buy in to the Medicare system, but it would be rolled out gradually over a number of years.
  • In other ACA news, a federal judge struck down the administration’s regulations allowing small businesses to join association health plans, saying it was an end run to avoid the health law. Thousands of people could be affected by the decision, and Labor Secretary Alex Acosta said he will decide by the end of the May whether to appeal.
  • Anti-abortion activists in many states are pushing new laws to test whether the retirement last summer of Justice Anthony Kennedy has left the Supreme Court more willing to turn back the Roe v. Wade decision. Among the types of cases going forward are state laws that would ban abortions once a fetal heartbeat could be determined, which often happens about six weeks into a pregnancy or before many women even know they are pregnant.
  • Despite a stiff rejection last week by a federal judge who overturned the Trump administration’s permission for work requirements in the Medicaid expansion approved in Arkansas and Kentucky, federal officials said that Utah could go forward with a plan to start work requirements as part of a partial expansion. Supporters of the ACA insist that expansion should be for anyone earning up to 138% of the federal poverty level. But the issue is tough for Democrats, some of whom say a partial expansion is better than none.

Ask Us Anything!

Do you have a health policy question you’d like the panelists to answer? You can send it to whatthehealth@kff.org. Please include where you’re from and how to pronounce your name.

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

Julie Rovner: Vox.com’s “The Doctor’s Strike That Nearly Killed Canada’s Medicare-for-All Plan, Explained,” by Sarah Kliff

Rebecca Adams: CQ Roll Call’s “Legal Challenges Are Threatening Trump Administration Changes to the ACA,” by Sandhya Raman

Anna Edney: The Baltimore Sun’s “Baltimore Mayor Pugh to Take Leave of Absence in Midst of ‘Healthy Holly’ Book Controversy” by Ian Duncan and Yvonne Wenger

Alice Miranda Ollstein: The New York Times’ “Rituals of Honor in Hospital Hallways,” by Dr. Tim Lahey

To hear all our podcasts, click here.

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